Gleim Dias de Souza

Procalcitonin as a prognostic biomarker of severe sepsis and septic shock

OBJETIVO: Avaliar a tendencia da concentracao plasmatica e do clearance de procalcitonina (PCT-c) como biomarcadores de prognostico de pacientes com sepse grave e choque septico, comparado a um outro marcador precoce de prognostico representado pelo numero de criterios de SIRS no momento do diagnostico da sepse. METODOS: Estudo de coorte prospectivo observacional onde foram incluidos pacientes com sepse grave e choque septico. A concentracao serica de procalcitonina foi determinada no momento do diagnostico da sepse e apos 24 e 48 horas. Foram coletados dados demograficos, escore APACHE IV, escore SOFA na chegada, numero de criterios de SIRS no momento do diagnostico, sitio da infeccao e resultados microbiologicos. RESULTADOS: Vinte e oito pacientes foram incluidos, 19 clinicos e nove cirurgicos. Em 13 (46,4%) a fonte da sepse foi pulmonar, em sete abdominal (25,0%), em cinco urinaria (17,9%) e de partes moles em tres casos (10,7%). Quinze pacientes tinham sepse grave e 13 choque septico. A mortalidade global foi cinco pacientes (17,9%), tres deles com choque septico. Vinte e oito determinacoes de PCT foram realizadas no momento do diagnostico da sepse, 27 apos 24 horas e 26 apos 48 horas. A concentracao inicial nao se mostrou expressivamente diferente entre os grupos sobreviventes e nao sobreviventes, mas as diferencas entre os dois grupos apos 24 e 48 horas alcancaram significância estatistica expressiva. Nao se observou diferenca em relacao ao numero de criterios de SIRS. O clearance de procalcitonina de 24 horas mostrou-se expressivamente mais elevado no grupo de sobreviventes (-3,0 versus -300,0, p=0,028). Embora o clearance de procalcitonina de 48 horas tenha mostrado resultado mais elevado no grupo de sobreviventes comparado aos nao sobreviventes, a diferenca nao alcancou significância estatistica. CONCLUSAO: Concentracoes persistentemente elevadas de procalcitonina no plasma, assim como, reducao do PCT-c 24 horas, associaram-se a elevacao expressiva da mortalidade de pacientes com sepse grave e choque septico.

Vitamina D e cicatrização de pele: estudo prospectivo, duplo-cego, placebo controlado na cicatrização de úlceras de perna

OBJECTIVE To analyze the relation between vitamin D insufficiency and wound healing in patients with venous ulcers; to correlate vitamin D insufficiency with characteristics of the ulcer (size and pain) and to evaluate if reposition of vitamin D in these subjects expedites ulcer healing. METHODS We selected 26 patients with leg ulcers, and 26 control patients without ulcers, matched for gender, age, systemic arterial hypertension and tobacco use. The venous ulcer group was divided in two subgroups: one that received placebo (nine patients) and other receiving vitamin D, 50.000 IU per week over two months (13 patients). Blood was collected for 25 OH vitamin D dosage before and after the medication. In the ulcer group, we obtained data concerning demographics, leg ulcer size, as well as pain severity, measured by an analogical visual scale. Data was grouped in contingency and frequency tables, the tests of Fisher and chi-squared being used for nominal variables and Mann-Whitney for numerical variables. The adopted significance was of 5%. RESULTS We found vitamin D insufficiency in the great majority of the patients. The median level in the ulcer group was 17.05 ng/dl and 22.75 ng/dl in the group without ulcer (p=0,0182) No relation was found between the ulcer size without treatment and the level of vitamin D. After treatment, the average size of the ulcer changed from 25 cm² to 18 cm² in the patients that took vitamin D and from 27 cm² to 24,5 cm² in the placebo group (p=0,7051 and p=0,7877, respectively). Considering the variability of the size of the ulcer in the treatment group versus placebo group, the average size was equal to -0,75 cm² in the first group and +4cm² in the second (p=0,0676) CONCLUSION Patients with leg ulcers have more vitamin D deficiency. No difference in the ulcer characteristics was noted between those with and without vitamin D deficiency. There was a trend toward a better healing in those with vitamin D reposition.

Serum Immune Mediators Independently Associate with Atherosclerosis in the Left (But Not Right) Carotid Territory of Older Individuals

BACKGROUND AND AIM Disturbance in the carotid arteries strongly predicts cerebrovascular events and correlates with a systemic inflammatory milieu. We investigated the relationship of a profile of 10 circulating inflammatory mediators with measures of carotid intima-media thickness (cIMT) in elderly subjects, taking traditional risk factors into account. METHODS Clinical inspection for present and past chronic conditions and events, as well as biochemical and anthropometric measurements, was performed for patients in ambulatory setting. Scores of cIMT were obtained bilaterally in the distal common carotid artery wall. Serum concentrations of cytokines were assessed by bead-based, multiplexed flow cytometry immunoassays. RESULTS Correlation analysis between log-transformed cytokines levels implicated the mediators interleukin-1β (IL1β), IL6, IL8, IL10, and tumor necrosis factor-α (TNFα) (P ≤ .005) with scores of the left cIMT. Stepwise multivariate regression showed that TNFα, IL1β, and IL6 levels accounted for most of the variance in the cIMT scores. Comparison of cytokine levels across increasing tertiles of the left cIMT reproduced the positive association with TNFα and IL1β levels. CONCLUSION Five out of ten immune mediators independently correlated with cIMT of older subjects in a territory-sensitive manner. This possible contribution of immune mediators to an atherosclerotic process probably relates to the inflammaging process.

Expressão citofotométrica do fator de proliferação celular ki-67 no bócio colóide e no carcinoma papilífero da tireóide

OBJECTIVE To compare the cytophotometric quantitative expression of Ki-67 cellular proliferation factor in the colloid goiter with papillary carcinoma of the thyroid. METHODS The protein Ki-67 was studied with immunohistochemistry in 20 cases of papillary carcinoma of the thyroid and 12 cases of colloid goiter. The immunomarked cell nuclei were quantified through the software SAMBA 4000 and analyzed by software IMMUNO, considering variables index marker and optical density. The coefficient of the Spearman rank correlation and the non-parametric test of Mann-Whitney were estimated. RESULTS There is significant difference between the goiter colloid and the papillary carcinoma of the thyroid in Ki-67 measurements, being bigger in papillary carcinomas. No difference was found in optical density. The correlation coefficient between the index marker and the optic density was 0,78. In colloid goiter, there was positive and significant association between the index marker and the optic density. For the papillary carcinoma of the thyroid the correlation between index marker and optic density was 0,18 (p = 0,572). There was no association between the index marker and the optic density in the carcinoma papillary of the thyroid. CONCLUSION The cytophotometric expression of the Ki-67 showed higher cellular proliferation in the papillary carcinoma of the thyroid in comparison with in the colloid goiter.

Imagiology of Caroli’s Disease

Caroli’s Disease (CD) is a rare congenital malformation characterized by segmental saccular or fusiform dilatation of the intrahepatic ducts. Initially asymptomatic, it enerally manifests itself in adulthood coursing with recurrent cholangitis and its complications. The diagnosis is radiological and relies on the demonstration of continuity between the cystic lesions and the biliary tree. The aim of this study is to discuss the pathology and to highlight the available diagnostic tools and their findings, focusing on magnetic resonance’s gains compared to the other methods.

Correlação entre o doppler da veia hepática direita com a biópsia transcutânea guiada pela ultrassonografia em hepatopatias

OBJECTIVE To correlate chronic liver disease diagnosed by transcutaneous liver biopsy guided by ultrasound, with ultrasound findings with B-mode and Doppler of the right hepatic vein; 2) to compare the wave patterns between the study group and the control group; 3) to compare the right hepatic vein Doppler findings with histopathology findings as a possible marker of chronic liver disease. METHODS Were studied 38 patients with chronic liver disease diagnosed by biopsy and serology (study group) and 10 persons without serologic liver disease (control group), assessed only by ultrasound B-mode and Doppler. The criteria were based on histology classification of the Brazilian Society of Pathology for chronic hepatitis. Chi-square, Fishers exact and Student t tests were used. RESULTS The B-mode and Doppler ultrasound were useful in inferring the differentiation between individuals with chronic liver disease from normal. There were significant differences between the study group and the controls when comparing the histopathology findings, ultrasound B-mode and Doppler in relationship to the wave patterns of the right hepatic vein. CONCLUSION The correlation of liver biopsies with ultrasound B-mode and Doppler of hepatic vein was positive; 2) individuals with liver disease showed alterations in the flow of the right hepatic vein and normal subjects not, being the wave pattern in normal triphasic and in patients with chronic liver disease monophasic or biphasic; 3) Doppler of the right hepatic vein is useful marker for chronic liver disease.