Cristóvão Luis Pitangueiras Mangueira

Yellow fever revaccination during infliximab therapy

Yellow fever vaccinations in patients receiving immunosuppressive therapy have been shown to be contraindicated due to the increased risk of viscerotropic disease in nonimmunocompetent patients (1). Biologic therapy such as anti–tumor necrosis factor (anti-TNF) has the capacity to block antibody development postvaccination, which is of concern to clinicians (2). Yellow fever vaccination is important in controlling this disease. Immunization of the native population and travelers is advisable in countries where this disease is endemic. Yellow fever vaccination uses a live attenuated virus (17-D strain) that induces low-grade viremia in 50% of the vaccinated people and elicits neutralizing antibody levels in 99% of all the vaccinated individuals (3,4). Recently an outbreak of yellow fever occurred in Brazil and, following a massive advertising campaign by the health authorities in the media, several patients receiving anti-TNF therapy were vaccinated without previously consulting their doctors. In Brazil, yellow fever vaccination is recommended every 10 years for those living in endemic areas. In view of this outbreak, there was a group of patients who had exceeded the 10-year revaccination period, and they demanded yellow fever vaccination in spite of receiving anti-TNF therapy. In this study we describe the clinical observations and laboratory findings of 17 rheumatoid arthritis patients receiving infliximab therapy while receiving the yellow fever vaccination and of paired controls.

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

Rubella vaccination and transitory false-positive test results for human immunodeficiency virus Type 1 in blood donors

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common red blood cell enzyme deficiency, affecting more than 400 million people worldwide. The prevalence of G6PD deficiency in Iran is reportedly 3.5% to 11%. Screening of our (mostly male) blood donors for G6PD deficiency is not performed routinely. The aim of this study was to evaluate the frequency of G6PD deficiency in blood donors. Blood samples were obtained from 706 randomly selected blood donors, who presented between June and September 2008. Enzyme activity was measured in triplicate by an automated analyzer (Chem Enzyme, Tehran, Iran). Deficiency was defined as an activity of less than 1.26 IU/g hemoglobin (Hb), 1 SD (2.8 IU/g Hb) below the mean (4.4 IU/g Hb). Based on this protocol, 16.3% of our donor population was classified as G6PD deficient. The prevalence of G6PD deficiency was higher in donors with a positive family history (34.8% vs. 15.7%, p value by Pearson chisquare, 0.02). As donors with a history of favism are deferred, the observed prevalence may be lower than that in the general population. Is screening for G6PD deficiency in blood donors necessary or beneficial in an area of relatively high prevalence? One study of 23 patients who received 24 units of G6PD-deficient blood (G6PD A–) failed to reveal any deleterious effects and did not recommend routine screening for African-American donors, although additional data were felt to be necessary before reaching a similar conclusion about Caucasians in the United States (despite G6PD deficiency being found in only 0.5% of males with Greek and Italian surnames). Nevertheless, the potentially severe consequences of a G6PD hemolytic crisis may argue in favor of routine G6PD screening of male blood donors in areas with high prevalence of G6PD deficiency.

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 …

III Consenso Brasileiro para Pesquisa de Autoanticorpos em Células HEp-2: perspectiva histórica, controle de qualidade e associações clínicas

OBJETIVO: O III Consenso Brasileiro para Pesquisa de Autoanticorpos em Celulas HEp-2 (FAN) objetivou discutir estrategias para controlar a qualidade do ensaio, promover a atualizacao das associacoes clinicas dos diversos padroes e avaliar as dificuldades de implantacao do II Consenso ocorrido no ano de 2002. METODOS: Nos dias 13 e 14 de abril de 2007 participaram do encontro em Goiânia pesquisadores e especialistas de diversos centros universitarios e laboratorios clinicos de diferentes regioes do Brasil, com o proposito de discutir e aprovar as recomendacoes que visam a melhores padronizacao, interpretacao e utilizacao do ensaio pelos clinicos. Foram convidados como ouvintes representantes comerciais de diferentes empresas produtoras de insumos para realizacao do teste de FAN. RESULTADOS E CONCLUSAO: Dada a heterogeneidade de microscopios e reagentes disponiveis no mercado, o III Consenso enfatizou a necessidade do controle de qualidade em ensaios de imunofluorescencia indireta. Foram tambem feitas algumas adequacoes na terminologia utilizada para classificar os diferentes padroes. Finalmente, foi realizada uma atualizacao das associacoes clinicas com finalidade de facilitar cada vez mais o melhor uso do ensaio pelos clinicos.

Amiloidose AL em um adulto jovem: remissão clínica e laboratorial com transplante autólogo de células tronco

Autologous stem cell transplant is one of the therapies employed in the treatment of primary amyloidosis or AL. The authors report on a 46-year-old patient with bilateral periorbital hematomas, macroglossia who presented, during the investigation, IgG-Kappa paraprotein in serum. The diagnosis of primary amyloidosis or AL was confirmed and the treatment proposed consisted of high-dose melphalan as conditioning regimen before autologous stem cell transplant, which determined complete remission of the disease, along with the disappearance of clinical signs and absence of the monoclonal component.

Impact of self-reported fasting duration on lipid profile variability, cardiovascular risk stratification and metabolic syndrome diagnosis

OBJECTIVE We sought to investigate the impact of self-reported fasting duration times on the lipid profile results and its impact on the cardiovascular risk stratification and metabolic syndrome diagnosis. SUBJECTS AND METHODS We analyzed data from all consecutive individuals evaluated in a comprehensive health examination at the Hospital Israelita Albert Einstein from January to December 2015. We divided these patients in three groups, according to the fasting duration recalled (< 8h, 8-12h and > 12h). We calculated the global cardiovascular risk and diagnosed metabolic syndrome according to the current criteria and estimated their change according to fasting duration. RESULTS A total of 12,196 (42.3 ± 9.2 years-old, 30.2% females) patients were evaluated. The distribution of cardiovascular risk was not different among groups defined by fasting duration in both men and women (p = 0.547 for women and p = 0.329 for men). Similarly, the prevalence of metabolic syndrome was not influenced by the fasting duration (p = 0.431 for women and p = 0.166 for men). CONCLUSION Self-reported fasting duration had no significant impact on the lipid profile results, including triglyceride levels. Consequently, no changes on the cardiovascular risk stratification using the Framingham risk score nor changes on the prevalence of metabolic syndrome were noted.

Comparison of different laboratory tests in the evaluation of hemorrhagic risk of patients using rivaroxaban in the critical care setting: Diagnostic accuracy study

BackgroundRivaroxaban is a direct oral anticoagulant designed to dispense with the necessity of laboratory monitoring. However, monitoring rivaroxaban levels is necessary in certain clinical conditions, especially in the critical care setting.MethodsThis is a diagnostic accuracy study evaluating sensitivity and specificity of prothrombin time (PT), activated partial thromboplastin time (aPTT), and Dilute Russell viper venom time (dRVVT), to evaluate the hemorrhagic risk in patients taking rivaroxaban. The study used a convenience sample of 40 clinically stable patients using rivaroxaban to treat deep vein thrombosis or atrial fibrillation admitted in a private hospital in Brazil, compared to a group of 60 healthy controls. The samples from patients were collected two hours after the use of the medication (peak) and two hours before the next dose (trough).ResultsThe correlation with the plasmatic concentration measured by anti-FXa assay was higher for PT and dRVVTS. The PT and aPTT tests presented higher specificity, while dRVVT was 100% sensible.ConclusionsThere was a strong correlation between the tests and the plasma concentration of the drug. Additionally, our results demonstrated the potential use of dRVVT as a screening test in the emergency room and the need of a second test to improve specificity.

Radiotherapy‐related acute myeloid leukaemia with KMT2A amplification

An 86-year-old male presented with three months of asthenia. He had a history of a vocal cord neoplasm eight years previously, which had been treated with radiotherapy. Physical examination showed only mucocutaneous pallor. Laboratory tests showed haemoglobin concentration 92 g/l, mean cell volume 101 fl, white blood cell count 1 78 9 10/l, neutrophils 0 96 9 10/l, lymphocytes 0 44 9 10/l and platelets 108 9 10/l. Myeloblasts were present. Bone marrow aspiration showed marked hypocellularity with hypogranular and Pelgeroid neutrophils and 27 7% blast cells, expressing CD34 and CD117. Bone marrow biopsy showed 10% cellularity with 20% CD34 cells. The karyotype demonstrated a hypodiploid clone with numerous structural abnormalities, including 5q deletion, monosomy 7, triplication of part of 11q, a marker chromosome and a ring chromosome (left). Fluorescence in situ hybridization was compatible with deletion of EGR1, monosomy 7, RUNX1T1 trisomy, TP53 deletion and KMT2A (MLL) amplification in 50% of cells (right, dual-colour break-apart KMT2A probe). The patient was diagnosed with therapy-related acute myeloid leukaemia and showed a haematological and cytogenetic remission after one cycle of decitabine. KMT2A (located at 11q23) encodes a histone methyltransferase that has a role in epigenetic regulation of transcription, important for embryonic and haematopoietic development. Abnormalities of KMT2A, particularly rearrangements, are frequently seen in acute leukaemias. Amplification is a rare event and often associated with advanced age, a complex karyotype and a shorter overall survival. There is an association of KMT2A rearrangement with previous exposure to alkylating agents but whether there is a relationship of amplification to previous radiotherapy is unknown.