Willy Sarti

Proposal of abolition of the skin sensitivity test before equine rabies immune globulin application

An epizootic outbreak of rabies occurred in 1995 in Ribeirão Preto, SP, with 58 cases of animal rabies (54 dogs, 3 cats and 1 bat) confirmed by the Pasteur Institute of São Paulo, and one human death. The need to provide care to a large number of people for the application of equine rabies immune globulin (ERIG) prevented the execution of the skin sensitivity test (SST) and often also the execution of desensitization, procedures routinely used up to that time at the Emergency Unit of the University Hospital of the Faculty of Medicine of Ribeirão Preto, University of São Paulo (EU-UHFMRP-USP), a reference hospital for the application of heterologous sera. In view of our positive experience of several years with the abolition of SST and of the use of premedication before the application of antivenom sera, we used a similar schedule for ERIG application. Of the 1489 victims of animal bites, 1054 (71%) received ERIG; no patient was submitted to SST and all received intravenously anti-histamines (anti-H1 + anti-H2) and corticosteroids before the procedure. The patients were kept under observation for 60 to 180 minutes and no adverse reaction was observed. On the basis of these results, since December 1995 ERIG application has been decentralized in Ribeirão Preto and has become the responsibility of the Emergency Unit of the University Hospital and the Central Basic Health Unit, where the same routine is used. Since then, 4216 patients have received ERIG (1818 at the Basic Health Unit and 2398 at the EU-UHFMRP), with no problems. The ideal would be the routine use of human rabies immune globulin (HRIG) in public health programs, but this is problematic, because of their high cost. However, while this does not occur, the use of SST is no longer justified at the time of application of ERIG, in view of the clinical evidence of low predictive value and low sensitivity of SST involving the application of heterologous sera. It is very important to point out that a negative SST result may lead the health team to a feeling of false safety that no adverse reaction will occur, but this is not true for the anaphylactoid reactions. The decision to use premedication, which is based on knowledge about anaphylaxis and on the pharmacology of the medication used, is left to the judgment of health professionals, who should always be prepared for eventual untoward events.

Lipid peroxidation and urinary excretion of vitamin E in rats submitted to an immunological inflammatory process.

Abstract Inflammation is a protective physiologic response, generally controlled by the organism at the injury site. Vitamin E is the most important antioxidant in the lipid phase present in nature and acts by interrupting the chain reaction produced by free radicals. The objective of this study was to evaluate the effect of inflammation on vitamin E levels and lipid peroxidation in rats. Forty Wistar rats (four groups of 10 rats each) were studied over a period of 15 days. Two substances inducing the inflammatory process were parenterally administered, anti-rat basement membrane serum (ABMG) and Freunds complete adjuvant (FAG). Lipid peroxidation levels in hepatic and renal tissue and in plasma and urine were analyzed and compared with the control (CG). Vitamin E was determined by HPLC and lipid peroxidation by quantification of thiobarbituric acid reactive substances (TBARS). ABMG produced more (p<0.05) TBARS in renal and hepatic tissues (0.7 ± 0.11 and 1.28 ± 0.27 nmol/g protein, respectively) compared to CG (0.65 ± 0.81 and 0.69 ± 0.13 nmol/g protein). Analysis of TBARS in urine did not show statistically significant differences between the experimental groups and the control. Vitamin E levels in the hepatic tissue of ABMG and FAG (40.7 ± 10.04 and 44.26 ± 20.24 µg/g tissue) were higher than in CG (22.37 ± 8.20 µg/g tissue) while in kidney tissue and plasma these values were lower (P<0.05). Renal excretion was increased (P<0.05) in the group that received anti-rat basement membrane serum (22.39 ± 0.11 mmol/mL) compared to CG (0.56 ± 0.056 mmol/mL). We conclude that the acute inflammatory process causes important alterations in the metabolism of vitamin E and lipid peroxidation leading to a significantly increased excretion of this vitamin in the urine.