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OBJECTIVE: Data about the survival rate of lupus patients on dialysis is controversial. The objective of this controlled prospective study was to report the survival of SLE patients undergoing dialysis and to analyse factors associated with mortality. METHODS: Twenty dialysis centres were visited between May 2003 and February 2004. Disease activity was evaluated using the SLEDAI without the renal-related parameters [non-renal (nr)SLEDAI] data collection was performed at entrance to the study. The control group consisted of haemodialysis patients without SLE matched for gender, age, dialysis modality, time on dialysis and dialysis-associated HCV infection. Patients were prospectively followed for 60 months. The Kaplan-Meier method was used to estimate survival. Associations of risk factors with mortality were tested using the Cox proportional hazards model. RESULTS: Each group was composed of 57 patients. In the multivariate analysis, only nrSLEDAI > 8 [hazard ratio (HR) 6.368; 95% CI 1.798, 22.548; P = 0.004], and urea reduction ratio (HR 0.953; 95% CI 0.917, 0.990; P = 0.014) were independently associated with mortality in lupus patients. The 5-year survival rate of the control group and the one from SLE patients with nrSLEDAI ≤ 8 (n = 51) were similar (83% and 73%, respectively) but significantly better than the one for SLE patients with nrSLEDAI > 8 (n = 6, 17%), P < 0.001. CONCLUSION: A high nrSLEDAI was strongly associated with 5-year mortality in lupus patients on dialysis.

Os alelos HLA-DRB1, que codificam uma sequencia de aminoacidos (QKRAA/QRRAA/RRRAA) nas posicoes 70 a 74 da terceira regiao hipervariavel da cadeia β1 do gene DRB1, denominada epitopo compartilhado (EC), estao associados a maior suscetibilidade e gravidade para artrite reumatoide (AR) em diversas populacoes. OBJETIVO: Determinar a frequencia dos alelos HLA-DRB1 em pacientes brasileiros com AR, e sua associacao a fator reumatoide (FR) e anticorpos antipeptideos citrulinados (ACPA). MATERIAL E METODOS: Foram incluidos 412 pacientes com AR e 215 controles. A tipificacao HLA-DRB1 foi realizada pela reacao em cadeia da polimerase (PCR) usando primers especificos e hibridizacao com oligonucleotideos de sequencia especifica (SSOP). A pesquisa de ACPA foi determinada pela tecnica de ELISA, e a do FR por nefelometria. Para analises estatisticas foram utilizados os testes do qui-quadrado e t de Student e a regressao logistica. RESULTADOS: Alelos HLA-DRB1*04:01, *04:04 e *04:05 associaram-se a AR (P < 0,05)); a despeito do amplo intervalo de confianca, vale a pena ressaltar a associacao observada entre o alelo DRB1*09:01 e a doenca (P < 0,05). Alelos HLA-DRB1 EC+ foram observados em 62,8% dos pacientes e em 31,1% do grupo-controle (OR 3,62; P < 0,001) e estiveram associados a ACPA (OR 2,03; P < 0,001). Alelos DRB1-DERAA mostraram efeito protetor para AR (OR 0,42; P < 0,001). CONCLUSAO: Em uma amostra de pacientes brasileiros com AR de etnia majoritariamente mestica, alelos HLA-DRB1 EC+ estiveram associados a suscetibilidade a doenca e a presenca de ACPA.

Objective To determine Retinol Binding Protein 4 (RBP4) levels in patients with Familial Partial Lipodystrophy (FPLD). Methods Ten patients with FPLD and a control group (9 patients) were selected to participate in the study. Results RBP4-log levels were lower in patients with FPLD in comparison to control group (1.52 ± 0.32 vs 1.84 ± 0.25, p = 0.029). A statistical trend was observed between Waist-to-Hip Ratio and RBP4-log (r = - 0.44, p = 0.054). Conclusion RBP4 levels are decreased in FPLD.

OBJECTIVE: The Third Brazilian Consensus for autoantibodies Screening in HEp-2 cells had as purpose the evaluation of difficulties in the accomplishment of the 2nd Consensus recommendations that took place in the year of 2002, the discussion of strategies for quality control of the assay and the promotion of an update of the clinical associations of the several immunofluorescent patterns. METHODS:Several ANA experts from university centers and private laboratories in different areas in Brazil joined the workshop in Goiânia on 2008 April 13 and 14 with the purpose of discussing and approving the recommendations for standardization, interpretation and use of the test by physicians. Commercial representatives of different ANA slide brands were also invited as listeners to the workshop. RESULTS AND CONCLUSIONS: The 3rd Consensus emphasized the need for quality control in indirect immunofluorescent since there is a considerable heterogeneity of available microscopes and reagents. It also promoted adaptations in the previously approved terminology used to classify the different patterns and finally updated the clinical associations of the several patterns with the purpose of providing guidance for interpretation of the assay by clinical pathologists and assistant physicians.

The HLA-DRB1 alleles encoding an amino acid sequence (QKRAA/QRRAA/RRRAA) at position 70 74 of the third hypervariable region of the β1 chain of the HLA-DRB1 gene, called shared epitope (SE), are associated with increased susceptibility to and severity of rheumatoid arthritis (RA) in different populations.To determine the frequency of HLA-DRB1 alleles in Brazilian patients with RA and their association with rheumatoid factor (RF) and anti-citrullinated peptide antibodies (ACPA).Four hundred and twelve patients with RA (ACR 1987) and 215 controls were included. HLA-DRB1 typing was performed by use of polymerase chain reaction (PCR) with specific primers and hybridization with sequence-specific oligonucleotide probe (SSOP). ACPA was measured by use of the ELISA technique and RF by nephelometry. The statistical analysis comprised the chi-square and Student t tests and logistic regression.HLA-DRB1*04:01, *04:04, *04:05 alleles were associated with RA (P0.05); despite the wide confidence interval, it is worth noting the association between the DRB1*09:01 allele and RA (P0.05). HLA-DRB1 SE+ alleles were observed in 62.8% of the patients and in 31.1% of controls (OR 3.62; P0.001) and were associated with ACPA (OR 2.03; P0.001). DRB1-DERAA alleles showed a protective effect against RA (OR 0.42; P0.001).In a sample of Brazilian patients with RA, most of whom of mixed heritage, HLA-DRB1 SE+ alleles were associated with susceptibility to disease and presence of ACPA.

OBJETIVO: O III Consenso Brasileiro para Pesquisa de Autoanticorpos em Células HEp-2 (FAN) objetivou discutir estratégias para controlar a qualidade do ensaio, promover a atualização das associações clínicas dos diversos padrões e avaliar as dificuldades de implantação do II Consenso ocorrido no ano de 2002. MÉTODOS: Nos dias 13 e 14 de abril de 2007 participaram do encontro em Goiânia pesquisadores e especialistas de diversos centros universitários e laboratórios clínicos de diferentes regiões do Brasil, com o propósito de discutir e aprovar as recomendações que visam a melhores padronização, interpretação e utilização do ensaio pelos clínicos. Foram convidados como ouvintes representantes comerciais de diferentes empresas produtoras de insumos para realização do teste de FAN. RESULTADOS E CONCLUSÃO: Dada a heterogeneidade de microscópios e reagentes disponíveis no mercado, o III Consenso enfatizou a necessidade do controle de qualidade em ensaios de imunofluorescência indireta. Foram também feitas algumas adequações na terminologia utilizada para classificar os diferentes padrões. Finalmente, foi realizada uma atualização das associações clínicas com finalidade de facilitar cada vez mais o melhor uso do ensaio pelos clínicos. OBJECTIVE: The Third Brazilian Consensus for Autoantibodies Screening in HEp-2 Cells (ANA) had as purpose the evaluation of difficulties in the accomplishment of the 2nd Consensus recommendations that took place in the year of 2002, the discussion of strategies for quality control of the assay and the discussion of an update of the clinical associations of the several immunofluorescent patterns. METHODS: Several ANA experts from university centers and private laboratories in different areas in Brazil joined the workshop in Goiânia on 2007 April 13 and 14 with the purpose of discussing and approving the recommendations for standardization, interpretation and use of the test by physicians. Commercial representatives of different ANA slide brands were also invited as listeners to the workshop. RESULTS AND CONCLUSION: The 3rd ANA Consensus emphasized the need for quality control in indirect immunofluorescent assays since there is a considerable heterogeneity of available microscopes and reagents. It also promoted adaptations in the previously approved terminology used to classify the different patterns and finally updated the clinical associations of the several patterns with the purpose of providing guidance for interpretation of the assay by clinical pathologists and assistant physicians. UCG Universidade Federal de São Paulo (UNIFESP) UNIFESP Programa de Pós-Graduação da disciplina de Reumatologia Fleury Medicina e Saúde setor de Imunologia UCG Departamento de Biomedicina Laboratório de Apoio Didático Centro Imuno-Reumatológico de São Paulo AFIP-Medicina Laboratorial Padrão Laboratório Clínico Universidade Federal de Uberlândia UFU Hospital das Clínicas serviço de reumatologia Pontifícia Universidade do Rio Grande do Sul Faculdade de Medicina Metanalysis Centro de Diagnósticos Médicos Universidade Federal do Pará Laboratório Amaral Costa Centro de Educação Técnica do Estado do Pará NewLife Comércio de Produtos Laboratoriais Universidade de São Paulo Faculdade de Medicina Hospital das Clínicas FMUSP Hospital das Clínicas Divisão de Laboratório Central Hospital Israelita Albert Einstein Departamento de Patologia Clínica Instituto Hermes Pardini Biometrix Diagnóstica FMUSP Laboratório Atalaia Sérgio Franco Medicina Diagnóstica setor de Imunoensaios UCG Faculdade de Medicina Hospital das Clínicas Universidade do Sul de Santa Catarina Universidade do Vale do Itajaí Laboratório Médico Santa Luzia Hospital e Maternidade e Jardim América Laboratórios Saúde Hemagen Diagnósticos Universidade Federal da Bahia Fundação Bahiana para Desenvolvimento das Ciências Hospital Santa Izabel serviço de reumatologia Universidade Federal de Mato Grosso FMUCG Alka Universidade do Estado do Rio de Janeiro Hospital Pró-cardíaco Centro de Autoimunidades Diagnósticos da América SA Laboratório Diagnósticos da América SA setor de Imunologia Universidade Federal de Minas Gerais Faculdade de Medicina UFMG Hospital das Clínicas Serviço de Medicina Laboratorial Hospital Universitário de Brasília Laboratório de Reumatologia União Educacional do Planalto Central Centro Universitário Euro-Americano Imunotech Sistemas Diagnósticos Importação e Exportação UNIFESP, Programa de Pós-Graduação da disciplina de Reumatologia SciELO

Background: Malaria represents one of the most important infectious disease threats to deployed military forces; most personnel from developed countries are nonimmune personnel and are at high risk of infection and clinical malaria. This is especially true for forces deployed to highly-endemic areas in Africa and Southeast Asia where drug-resistant malaria is common. Methods: We conducted an outbreak investigation of malaria cases in Angola where a total of 439 nonimmune Brazilian troops were deployed for a 6-month period in 1995–1996. A post-travel medical evaluation was also performed on 338 (77%) of the 439 soldiers upon return to Brazil. Questionnaire, medical record, thick/thin smear, and serum anti-Plasmodium falciparum antibody titer (by IFA) data were obtained. Peak serum mefloquine (M) and methylmefloquine (MM) metabolite levels were measured in a subsample of 66 soldiers (42 cases, 24 nonmalaria controls) who were taking weekly mefloquine prophylaxis (250 mg). Results: Seventy-eight cases of malaria occurred among the 439 personnel initially interviewed in Angola (attack rate = 18%). Four soldiers were hospitalized, and 3 subsequently died of cerebral malaria. Upon return to Brazil, 63 (19%) of 338 soldiers evaluated were documented to have had clinical symptoms and a diagnosis of malaria while in Angola. In addition, 37 (11%) asymptomatically infected individuals were detected upon return (< 1% parasitemia). Elevated, post-travel anti-P. falciparum IFA titers (≥ 1:64) were seen in 101 (35%) of 292 soldiers tested, and was associated with a prior history of malaria in-country (OR = 3.67, 95% CI 1.98–6.82, p < .001). Noncompliance with weekly mefloquine prophylaxis (250 mg) was associated with a malaria diagnosis in Angola (OR = 3.75, 95% CI 0.97–17.41, p = .03) but not with recent P. falciparum infection (by IFA titer). Mean peak levels (and ratios) of serum M and MM were also found to be lower in those who gave a history of malaria while in Angola. Conclusions: Malaria was a significant cause of morbidity among Brazilian Army military personnel deployed to Angola. Mefloquine prophylaxis appeared to protect soldiers from clinical, but not subclinical, P. falciparum infections. Mefloquine noncompliance and an erratic chemoprophylaxis prevention policy contributed to this large outbreak in nonimmune personnel. This report highlights the pressing need for development of newer, more efficacious and practical, prophylactic drug regimens that will reduce the malaria threat to military forces and travelers.