Carlos Eduardo dos Santos Ferreira

Intervalos de referência no laboratório clínico

The definition of reference ranges is a challenging task to all clinical laboratories. It is particularly worth mentioning the definition of their own ranges, the validation of data on reagent directions and the use of information available in medical literature as possibilities for the establishment of these ranges. The creation of their own ranges is undoubtedly the most desirable choice in most tests, inasmuch as it reflects the condition of the population on whom they will be applied on a daily basis, yet it is the most laborious and onerous. The validation of ranges offered by the reagent directions and the use of data from medical literature seem to be the most commonly used options in our country. The choice of appropriate reference ranges is essential so that clinical laboratories offer reliable information and physicians interpret the results correctly and choose the best approach towards the assisted population.

Biotin interference in immunoassays mimicking subclinical Graves’ disease and hyperestrogenism: a case series

*Corresponding author: Marcelo C. Batista, MD, Clinical Laboratory, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Bloco E – 2° andar – Laboratório Clínico, São Paulo – SP CEP 05652-900, Brazil, Phone: +55 11 2151-5555, Fax: +55 11 2151-0408, Cell phone: 55 11 99140-0282, E-mail: marcelo.batista@einstein.br Carlos E.S. Ferreira: Clinical Laboratory, Hospital Israelita Albert Einstein, São Paulo, Brazil; and Department of Laboratory Medicine, Universidade Federal de São Paulo – UNIFESP, São Paulo, Brazil Adriana C.L. Faulhaber, Simão A. Lottenberg and Cristóvão L.P. Mangueira: Clinical Laboratory, Hospital Israelita Albert Einstein, São Paulo, Brazil Jairo T. Hidal: Department of Endocrinology, Hospital Israelita Albert Einstein, São Paulo, Brazil Letter to the Editor

Monocyte subtypes and the CCR2 chemokine receptor in cardiovascular disease

Monocytes circulate in the blood and migrate to inflammatory tissues, but their functions can be either detrimental or beneficial, depending on their phenotypes. In humans, classical monocytes are inflammatory cluster of differentiation (CD)14++CD16-CCR2++ cells originated from the bone marrow or spleen reservoirs and comprise ≥92% of monocytes. Intermediate monocytes (CD14++CD16+CCR2+) are involved in the production of anti-inflammatory cytokines [such as interleukin (IL)-10], reactive oxygen species (ROS), and proinflammatory mediators [such as tumor necrosis factor-α (TNF-α) and IL-1β). Nonclassical monocytes (CD14+CD16++CCR2-) are patrolling cells involved in tissue repair and debris removal from the vasculature. Many studies in both humans and animals have shown the importance of monocyte chemoattractant protein-1 (MCP-1) and its receptor [chemokine receptor of MCP-1 (CCR2)] in pathologies, such as atherosclerosis and myocardial infarction (MI). This review presents the importance of these monocyte subsets in cardiovascular diseases (CVDs), and sheds light on new strategies for the blocking of the MCP-1/CCR2 axis as a therapeutic goal for treating vascular disorders.

Clinical correlation between a point-of-care testing system and laboratory automation for lipid profile.

BACKGROUND We evaluated the clinical correlation between the CardioChek PA analyzer and a clinical laboratory reference method to use for screening program purposes. METHODS Fasting blood samples were collected on 516 patients (age 20-85 y). One venous sample was collected using a serum tube for the evaluation on a COBAS reference analyzer. A second venous sample was collected in a lithium heparin tube and was evaluated on the CardioChek PA analyzer (CCPA venous). A fingerstick sample (CCPA fingerstick) was evaluated only on the CardioChek PA analyzer. Linear regression analyses were performed for each measured analyte, total cholesterol, HDL-cholesterol and triglycerides. RESULTS The correlation between the CCPA fingerstick and CCPA venous was extremely high for HDL-C and triglycerides, and good for total cholesterol. Our results demonstrated a good clinical agreement for total cholesterol, HDL-C and triglycerides between 97.7% and 94.6% in the comparison of the CCPA to the reference analyzer. CONCLUSIONS We identified the pre-analytic phase as an important step to guarantee the quality of results and indicate that the CardioChek PA is a reliable lipid point-of-care testing system that can be used for the application of clinical screening anywhere.

The development of arthritis and antinuclear antibodies correlate with serum 25-hydroxyvitamin D levels in patients with leprosy

Leprosy, a chronic granulomatous infection, presents with cutaneous and neurological manifestations. Musculoskeletal involvement, though the third most common manifestation, is underdiagnosed.1 ,2 In its natural history, other immune manifestations besides articular manifestations may be present, such as the presence of autoantibodies.3 ,4 There is evidence that vitamin D influences the activity of immune-mediated diseases, particularly autoimmune diseases.5 ,6 Amazon is a state in the northern part of Brazil where the disease is endemic. It has a high level of sunshine, so a low prevalence of vitamin D insufficiency would be expected. In this study we looked at the serum vitamin D …

Positioning about the Flexibility of Fasting for Lipid Profiling

Arq Bras Cardiol. 2017; 108(3):195-197 Positioning about the Flexibility of Fasting for Lipid Profiling Marileia Scartezini,1 Carlos Eduardo dos Santos Ferreira,2 Maria Cristina Oliveira Izar,3 Marcello Bertoluci,4 Sergio Vencio,5 Gustavo Aguiar Campana,2 Nairo Massakazu Sumita,2 Luiz Fernando Barcelos,1 André A. Faludi,3 Raul D. Santos,3, Marcus Vinícius Bolívar Malachias,3 Jerolino Lopes Aquino,1 César Alex de Oliveira Galoro,2 Cleide Sabino,4 Maria Helane Costa Gurgel,4 Luiz Alberto Andreotti Turatti,5 Alexandre Hohl,4 Tania Leme da Rocha Martinez3 Sociedade Brasileira de Análises Clínicas (SBAC),1 Rio de Janeiro, RJ; Sociedade Brasileira de Patologia Clínica/Medicina Laboratorial (SBPC/ ML),2 Rio de Janeiro, RJ; Sociedade Brasileira de Cardiologia (SBC),3 Rio de Janeiro, RJ; Sociedade Brasileira de Endocrinologia e Metabologia (SBEM),4 Rio de Janeiro, RJ; Sociedade Brasileira de Diabetes (SBD),5 São Paulo, SP – Brazil

Comparação entre BNP e NT-proBNP quanto à concordância e quanto à influência das variáveis clínicas e laboratoriais

OBJETIVO: Correlacionar os niveis sericos do peptideo natriuretico tipo B e da fracao N-terminal do pro-peptideo natriuretico tipo B, alem de analisar a influencia de idade, obesidade, insuficiencia renal, fracao da ejecao do ventriculo esquerdo, disfuncao diastolica e anemia nos niveis sericos de ambos os marcadores. METODOS: Estudo observacional, no qual se comparou a concordância entre esses marcadores em amostras consecutivas de 138 pacientes. Para a correlacao, utilizou-se o teste de Pearson e foi considerado estatisticamente significante p<0,05. RESULTADOS: Observou-se associacao linear entre peptideo natriuretico tipo B e fracao N-terminal do pro-peptideo natriuretico tipo B (r=0,907; p<0,001). Ao se avaliarem as medidas categorizadas como normais e alteradas, encontrou-se boa concordância, com 90,6% de classificacoes concordantes (p<0,001), sendo que valores alterados da fracao N-terminal do pro-peptideo natriuretico tipo B e normais de peptideo natriuretico tipo B representaram 8,7% do total, e o contrario representou 1% do total. A avaliacao da influencia dos fatores clinicos e laboratoriais nos niveis dos peptideos natriureticos mostrou que eles se elevam de acordo com a idade, mas que diminuem conforme aumenta a fracao de ejecao. Pacientes com anemia (p<0,001) ou com insuficiencia renal (p=0,007) apresentaram valores maiores de ambos os marcadores. Nao houve associacao entre obesidade e peptideo natriuretico tipo B. CONCLUSAO: Houve concordância satisfatoria entre peptideo natriuretico tipo B e a fracao N-terminal do pro-peptideo natriuretico tipo B. Idade, niveis de creatinina e hemoglobina, assim como funcao ventricular, influenciam os niveis sericos de ambos os peptideos natriureticos.ABSTRACT Objective: To correlate the serum levels of B type natriuretic peptide and the N-terminal fraction of the pro-B type natriuretic peptide, as well as to analyze the influence of age, obesity, renal failure, left ventricle ejection fraction, diastolic dysfunction, and anemia on serum levels of both markers. Methods: An observational study in which the agreement was compared between these markers in consecutive samples of 138 patients. For the correlation, Pearsons test was used, and p<0.05 was considered statistically significant. Results: A linear association was observed between the B type natriuretic peptide and N-terminal fraction of the pro-B type natriuretic peptide (r = 0.907; p<0.001). When evaluating the categorized measurements as normal and altered, there was good agreement, with 90.6% of agreement classifications (p<0.001) in which altered values of the N-terminal fraction of the pro-B type natriuretic peptide and normal values of the B type natriuretic peptide represented 8.7% of the total; the opposite situation represented 1% of the total. Assessment of the influence of the clinical and laboratorial factors on the levels of natriuretic peptides showed that they rise according to age, but that they fall as the ejection fraction increases. Patients with anemia (p<0.001) or with renal failure (p=0.007) had higher values of both markers. There was no association between obesity and the B type natriuretic peptide. Conclusion: There was satisfactory agreement between the B type natriuretic peptide and the N-terminal fraction of the pro-B type natriuretic peptide. Age, creatinine levels, and hemoglobin, as well as ventricular function, influence the serum levels of both natriuretic peptides.

Challenges Facing the Use of Endothelial Progenitor Cells in Stem Cell Therapies

The paper summarizes the difficulties to study the rare population of endothelial progenitor cells in clinical trials, based on the experience of our group in many publications in this area.

Serum level of vitamin D3 in cutaneous melanoma

Objective To compare the level of vitamin D3 in cutaneous melanoma patients, with or without disease activity, with reference values and with patients from a general hospital. Methods The serum levels of vitamin D3 were measured in cutaneous melanoma patients, aged 20 to 88 years, both genders, from January 2010 to December 2013. The samples from the general group were processed at Hospital Israelita Albert Einstein (control group). Data analysis was performed using the Statistics software. Results A total of 100 patients were studied, 54 of them men, with mean age of 54.67 years, and 95 Caucasian. Out of these 100 patients, 17 had active disease. The average levels of vitamin D3 in the melanoma patients were lower than the level considered sufficient, but above the average of the control group. Both groups (with or without active disease) of patients showed a similar distribution of vitamin D3 deficiency. Conclusion Vitamin D3 levels in melanoma patients were higher than those of general patients and lower than the reference level. If the reference values are appropriate, a large part of the population had insufficient levels of vitamin D, including those with melanoma, or else, this standard needs to be reevaluated. No difference in vitamin D3 levels was found among melanoma patients with or without active disease. More comprehensive research is needed to assess the relation between vitamin D and melanoma.

Consensus – reference ranges of vitamin D [25(OH)D] from the Brazilian medical societies. Brazilian Society of Clinical Pathology/Laboratory Medicine (SBPC/ML) and Brazilian Society of Endocrinology and Metabolism (SBEM)

1. Hospital Israelita Albert Einstein, São Paulo, Brazil. 2. Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil. 3. Universidade Federal de Minas Gerais (UFMG), Minas Gerais, Brazil. 4. Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil. 5. Hospital Federal de Bonsucesso, Rio de Janeiro, Brazil. 6. Laboratório Hermes Pardini, Minas Gerais, Brazil. 7. Universidade Federal do Paraná (UFPR), Paraná, Brazil.