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Background: Some studies indicated that body mass index (BMI) is inversely proportional to serum testosterone concentrations in men. Purposes: This study aimed to analyze the effects of aging and obesity on total testosterone (TT), free testosterone (FT), bioavailable testosterone (BT), luteinizing hormone (LH), and sex hormone-binding globulin (SHBG) levels. Methods: A cross-sectional study was performed to assess the clinical and laboratory profiles of 701 patients treated at a private urology clinic in Ponta Grossa, Brazil, from January 2016 to December 2018. Results: Patients’ age ranged from 16 to 88 years (mean, 56.9 ± 13.62 years). Age did not significantly influence serum TT concentrations, except compared to patients aged >70 years. However, changes were observed in FT and BT (p < 0.05). The mean SHBG increased with age (p < 0.05). A tendency toward LH elevation was observed in older patients, but it was not statistically significant. An inverse proportional relationship between TT, FT, and BT and the testosterone deficiency rate (TT < 300 ng/dL) was observed within BMI groups (p < 0.05). The testosterone deficiency rate was 21.5% in individuals with normal BMI, 29% in overweight individuals, and 37% in obese individuals. Conclusions: Aging affected the testosterone concentrations in men and became increasingly evident using FT and BT instead of TT. SHBG increased with age. Obesity was associated with a decrease in TT, FT, and BT but also increased the rate of hypogonadism.

Purpose: We aimed to assess anxiety among medical interns and to identify changes regarding their perspective about the profession during the pandemic period in Brazil, between November 2020 and February 2021. Methods: This is a cross-sectional descriptive study which medical interns answered an online survey questionnaire. The assessment was performed using the validated questionnaire General Anxiety Disorder Scale (GAD-7). Results: 162 responses were collected, mean age of 24.9 years, majority female (66.7%); 83.3% had the option of returning to practical assistance. Among these, 35% claimed to have had contact with suspects COVID-19 patients and 13% had a positive test for COVID-19. GAD-7 scores showed that 33.4% were qualified as “Normal”, while mild (37%), moderate (22.8%) or severe symptoms of anxiety (6.8%). A GAD-7 score positive for TAG was found in 29.6% of them. Anxiety was significantly associated (p=0.013) with questioning the choice of Medicine as a profession. Conclusions: We found a high frequency of interns with symptoms of anxiety, higher compared to similar studies prior to the pandemic. In addition, medical interns with anxiety were the ones who most questioned the choice of profession.

Resumo Objetivo: Avaliar e comparar a taxa de sucesso da intubação monocanalicular ou bicanalicular em pacientes com obstrução congênita do ducto lacrimonasal (OCDLN), levando-se em consideração a taxa de sucesso, a dificuldade do procedimento e o custo dos tubos. Métodos: Foram analisados retrospectivamente 54 prontuários, totalizando 58 vias lacrimais com diagnóstico de OCDLN, que realizaram intubação das vias lacrimais monocanalicular ou bicanalicular com tubos de silicone. Anamnese, exame oftalmológico geral, testes específicos, como o Teste do Desaparecimento do Corante (TDC) e Teste de Observação de Fluoresceína na Orofaringe (TOFO), e, caso necessário, exames complementares como a dacriocistografia, foram utilizados para diagnóstico e inclusão na pesquisa. Foram tratados com intubação os pacientes sem resposta adequada ao tratamento prévio, ou seja, que permaneceram com sintomas de secreção e epífora contínua após a realização de massagem de Crigler e sondagem. Resultados: A intubação monocanalicular foi realizada em 27 vias lacrimais e a intubação bicanalicular, em 31 vias lacrimais. A taxa de sucesso foi alta em ambos os métodos, com melhora em 26 (96,3%) vias lacrimais com sonda monocanalicular e em 30 (96,8%), com sonda bicanalicular (p=0,718). As duas técnicas apresentaram 100% de sucesso nos pacientes com até 2 anos e acima de 4 anos de idade (p=1). A taxa de sucesso entre os 2 e 4 anos de idade foi de 91,5% para as monocanaliculares e 87,5% para as bicanaliculares, (p=0,652). Conclusão: o presente estudo não mostrou diferença significativa no sucesso da intubação quando utilizando sondas mono ou bicanaliculares. A intubação monocanalicular mostrou-se de mais fácil execução, ao passo que o tubo bicanalicular possui menor custo.

Introdução: As pessoas transexuais encontram uma série de dificuldades no atendimento médico, tanto na rede privada como na pública no Brasil. Objetivo: Demonstrar aos profissionais da área da saúde a realidade vivida pelas pessoas transexuais, quando necessitam de atendimento médico no Brasil, visando aprimorar os conhecimentos sobre o atendimento a este grupo populacional. Métodos: Coleta de dados realizada em fevereiro de 2020 com buscas nas bases eletrônicas: PubMed, Scielo, Lilacs e Google Scholar. Utilizou-se os descritores em associação: transgender; medical care; transexual; cross-sex hormone therapy, no período entre 2000 a 2020. Resultados: Encontramos 720 publicações com as palavras-chave transgender persons e medical care, 30 com as palavras-chave transgender, medical care e cross-sex hormone therapy, sendo escassos os estudos feitos no Brasil. Conclusão:Para que ocorra uma melhora no atendimento à saúde das pessoas transexuais é necessário que sejam inseridas disciplinas específicas sobre este tema na grade curricular dos cursos técnicos, de graduação e de pós-graduação da área da saúde.

Despite some variability in ideal serum Adalimumab (ADA) concentrations, there is increasing evidence that higher concentrations of anti-TNF-α agents can be associated with sustained efficacy, and low or undetectable levels may lead to loss of response. This study aims to correlate serum ADA concentrations with clinical and endoscopic activity in patients with Crohn’s disease (CD). A cross-sectional and multicentric study was performed with patients with CD, who used ADA for at least 24 weeks. Patients were allocated into groups according to the presence of clinical or endoscopic disease activity. Serum ADA concentrations were measured and compared between groups. Overall, 89 patients were included. A total of 27 patients had clinically active CD and 62 were in clinical remission. Forty patients had endoscopic disease activity and 49 were in endoscopic remission. The mean serum ADA concentration was 10.2 μg/mL in patients with clinically active CD and 14.3 μg/mL in patients in clinical remission (p = 0.395). The mean serum ADA concentration in patients with endoscopic activity was 11.3 μg/mL as compared to 14.5 μg/mL in those with endoscopic remission (p = 0.566). There was no difference between serum ADA concentrations regarding clinical or endoscopic activity in CD, as compared to patients in remission

Introdução: O perfil da mulher vítima de violência sexual deve ser conhecido para elaboração de medidas preventivas. Objetivos: Avaliar o perfil epidemiológico e a aplicação do protocolo de atendimento para mulheres vítimas de violência sexual nos casos acolhidos no Hospital Universitário Evangélico Mackenzie (HUEM), em Curitiba-PR. Metodologia: Foram avaliados os dados da Ficha de Violência Interpessoal/Autoprovocada de mulheres com idade maior ou igual a 12 anos, acolhidas no serviço de atenção à vítima de violência sexual do HUEM em Curitiba-PR, entre janeiro de 2015 a dezembro de 2018. Foram buscados dados sociodemográficos da vítima, da ocorrência em si, clínicos e laboratoriais, sobre o provável autor da violência e sobre o retorno ao serviço. Principais resultados: Foram estudadas 252 vítimas de violência sexual. No período, a idade das vítimas nos anos 2015 e 2016 (mediana de 19 anos) em relação aos anos 2017 e 2018 (mediana de 17 anos) reduziu de forma significativa (p=0,026). Já a escolaridade não influenciou a violência sexual (p=0,64) e ser solteira conferiu maior risco (p

Objetivos: Avaliar o grau de luto causado pela perda gestacional ou neonatal em pais e mães, associando com variáveis sócio-demográficas. Adicionalmente, comparar o grau de luto de acordo com o momento da perda. Métodos: Estudo transversal, realizado com aplicação de questionário sociodemográfico e questionário validado (Escala de Luto Perinatal–ELP) em pais que tiveram perda de seu filho em qualquer perído gestacional ou no neonatal. Resultados: 542 pais e mães estavam aptos para participação do estudo e após serem convidados para responder à pesquisa, 104 (19,1%) concordaram em participar. Os 104 participantes foram divididos em dois grupos: perda no primeiro trimestre gestacional (76,9%), e demais trimestres somados ao período neonatal (23,1%). Evidenciou-se predomínio materno das respostas (89,4%) e idade média de 29,1±15,58 anos. A mediana do escore na ELP foi de 90 pontos, não havendo diferença entre as pontuações de acordo com o momento da perda. Primigestas e mulheres com idade

Pemphigus foliaceus is an autoimmune disease that is sporadic around the world but endemic in Brazil, where it is known as fogo selvagem (FS). Characterized by autoantibodies against the desmosomal cadherin desmoglein 1, FS causes painful erosions, and crusts that may be widespread. The recognition of antigens, including exposed sugar moieties, activates the complement system. Complement receptor 1 (CR1, CD35), which is responsible for the Knops blood group on erythrocytes (York and McCoy antigens), is also expressed by antigen-presenting cells. This regulates the complement system by removing opsonized antigens, blocking the final steps of the complement cascade. Membrane-bound CR1 also fosters antigen presentation to B cells, whereas soluble CR1 has anti-inflammatory properties. CR1 gene polymorphisms have been associated with susceptibility to complex diseases. In order to investigate the association of CR1 polymorphisms with FS susceptibility, we developed a multiplex sequence-specific assay to haplotype eleven polymorphisms in up to 367 FS patients and 242 controls from an endemic area and 289 from a non-endemic area. We also measured soluble CR1 (sCR1) in the serum of 53 FS patients and 27 controls and mRNA levels in the peripheral blood mononuclear cells of 63 genotyped controls. The haplotypes CR1*3B2B (with the York antigen–encoded by p.1408Met) and CR1*3A2A (with p.1208Arg) were associated with protection against FS (OR = 0.57, P = 0.027, and OR = 0.46, P = 0.014, respectively). In contrast, the CR1*1 haplotype (with the McCoy antigen – encoded by p.1590Glu) was associated with FS susceptibility (OR = 4.97, P < 0.001). Heterozygote rs12034383*A/G individuals presented higher mRNA expression than homozygotes with the G allele (P = 0.04). The lowest sCR1 levels occurred in patients with active disease before treatment (P = 0.036). Patients in remission had higher levels of sCR1 than did healthy controls (P = 0.013). Among those under treatment, patients with localized lesions also presented higher sCR1 levels than those with generalized lesions (P = 0.0073). In conclusion, the Knops blood group seems to modulate susceptibility to the disease. Furthermore, corticosteroid treatment might increase sCR1 serum levels, and higher levels may play an anti-inflammatory role in patients with FS, limiting the distribution of lesions. Based on these results, we suggest CR1 as a potential new therapeutic target for the treatment of FS.

Abstract: BACKGROUND: Occupational dermatitis affects the quality of life and productivity of workers. Studies on the subject are scarce in Brazil. It is estimated that the disease is underreported and that many affected patients do not seek health care. OBJECTIVES: To conduct an epidemiological analysis of occupational dermatitis notified via SINAN in Brazil from January 2007 to December 2012; evaluate the profile of patients assisted; and check the main etiological agents involved. METHODS: We analyzed the compulsory notification forms of cases of occupational dermatitis filled nationwide during January 2007 to December 2012. RESULTS: During the study period 3027 cases of occupational dermatitis were notified in Brazil. In 61.4% of cases patients were men aged between 35-49 years (39.6%). The most described etiological agent was chromium (13.9%). The location of the body most affected was the hands, with 28.4% of cases. The construction sector is implicated in 28.7% of cases and domestic services by 18%. Allergic contact dermatitis is the most prevalent occupational dermatitis (20.6%) and the region with the highest number of notifications was the Midwest, with 376.4 cases per million inhabitants. CONCLUSIONS: The profile of patients most affected by occupational dermatitis in Brazil during the study period was: men with elementary school, aged between 20 and 49 years old and working in the construction industry. The most common occupational dermatitis were allergic contact dermatitis caused by chromium after years of exposure, being the hands and head the parts of the body most affected.

BACKGROUND:Pathophysiological mechanisms are still incompletely understood for leprosy, an urgent public health issue in Brazil. Complement receptor 1 (CR1) binds complement fragments C3b/C4b deposited on mycobacteria, mediating its entrance in macrophages. We investigated CR1 polymorphisms, gene expression and soluble CR1 levels in a case-control study with Brazilian leprosy patients, aiming to understand the role of this receptor in differential susceptibility to the disease. METHODOLOGY:Nine polymorphisms were haplotyped by multiplex PCR-SSP in 213 leprosy patients (47% multibacillary) and 297 controls. mRNA levels were measured by qPCR and sCR1 by ELISA, in up to 80 samples. PRINCIPAL FINDINGS:Individuals with the most common recombinant haplotype harboring rs3849266*T in intron 21 and rs3737002*T in exon 26 (encoding p.1408Met of the York Yka+ antigen), presented twice higher susceptibility to leprosy (OR = 2.43, p = 0.017). Paucibacillary patients with these variants presented lower sCR1 levels, thus reducing the anti-inflammatory response (p = 0.040 and p = 0.046, respectively). Furthermore, the most ancient haplotype increased susceptibility to the multibacillary clinical form (OR = 3.04, p = 0.01) and presented the intronic rs12034383*G allele, which was associated with higher gene expression (p = 0.043), probably increasing internalization of the parasite. Furthermore, there was an inverse correlation between the levels of sCR1 and mannose-binding lectin (initiator molecule of the lectin pathway of complement, recognized by CR1) (R = -0.52, p = 0.007). CONCLUSIONS:The results lead us to suggest a regulatory role for CR1 polymorphisms on mRNA and sCR1 levels, with haplotype-specific effects increasing susceptibility to leprosy, probably by enhancing parasite phagocytosis and inflammation.

Background Determination of fecal calprotectin can provide an important guidance for the physician, also in primary care, in the differential diagnosis of gastrointestinal disorders, meanly between inflammatory bowel diseases and irritable bowel syndrome. Objectives The aims of the present study were to prospectively investigate, in Brazilian adults with gastrointestinal complaints, the value of fecal calprotectin as a biomarker for the differential diagnosis between functional and organic disorders and to correlate the concentrations with the activity of inflammatory bowel diseases. Methods The study included consecutive patients who had gastrointestinal complaints in which the measurement levels of fecal calprotectin were recommended. Fecal calprotectin was measured using a Bühlmann (Basel, Switzerland) ELISA kit Results A total of 279 patients were included in the study, with median age of 39 years (range, 18 to 78 years). After clinical and laboratorial evaluation and considering the final diagnosis, patients were allocated into the following groups: a) Irritable Bowel Syndrome: 154 patients (102 female and 52 male subjects). b) Inflammatory Bowel Diseases group: 112 patients; 73 with Crohn’s disease; 38 female and 35 male patients; 52.1% (38/73) presented active disease, and 47.9% (35/73) had disease in remission and 39 patients with ulcerative colitis;19 female and 20 male patients; 48.7% (19/39) classified with active disease and 49.3% (20/39) with disease in remission. A significant difference (P

Resumo: Fundamento: Defeitos cardíacos congênitos (DCC) têm alta prevalência em pacientes com síndrome de Down (SD). Além disso, crianças com SD que possuem DCC são mais suscetíveis às infecções pulmonares do que aqueles que não possuem cardiopatia. Objetivos: Investigar a prevalência, tipos de DCC e a sua associação com infecções graves em crianças com SD do sul do Brasil, atendidas em um ambulatório de referência. Métodos: Durante o período de maio de 2011 a maio de 2012, foram incluídas consecutivamente no estudo crianças entre 6-48 meses de idade, diagnosticadas com SD nas quais foram investigadas, classificadas e analisadas as cardiopatias e infecções graves (sepse e pneumonia). Resultados: Foram incluídos no estudo 127 pacientes. Desses, 89 (70,1%) possuíam algum tipo de cardiopatia, sendo necessária a correção cirúrgica em 33 (37,7%) deles. Com relação à presença de infecções graves, pneumonia e sepse foram diagnosticadas respectivamente em 23,6 e 5,5% dos casos. Dentre os casos de pneumonia, 70% das crianças apresentavam cardiopatia (p = 0,001) e nos casos de sepse em 85% eram cardiopatas (p = 0,001). Conclusões: O presente estudo demonstrou alta prevalência de diferentes formas de DCC e a sua associação com infecções graves em crianças com SD atendidas no sul do Brasil. Abstract: Introduction: There is a high prevalence of congenital heart disease (CHD) in Down syndrome (DS) patients. Children with DS and CHD also present greater susceptibility to pulmonary infections than those without CHD. Aim: To investigate the prevalence and types of CHD and their association with severe infections in children with DS in southern Brazil seen in a reference outpatient clinic. Methods: Children aged between six and 48 months with a diagnosis of DS were included consecutively in the period May 2001 to May 2012, and the presence of CHD and severe infections (pneumonia and sepsis) was investigated, classified and analyzed. Results: A total of 127 patients were included, of whom 89 (70.1%) had some type of CHD, 33 (37.7%) of them requiring surgical correction. Severe infections (pneumonia and sepsis) were seen in 23.6% and 5.5%, respectively. Of the cases of pneumonia, 70% had associated CHD (p=0.001) and of those with sepsis, 85% presented CHD (p=0.001). Conclusions: Our study showed a high prevalence of CHD and its association with severe infections in children with DS seen in southern Brazil. Palavras-chave: Síndrome de Down, Cardiopatias, Infecções, Keywords: Down syndrome, Congenital heart disease, Infections

CONTEXT: Anti-Saccharomyces cerevisiae antibodies (ASCA), considered serologic markers for Crohn's disease, were described in patients with celiac disease, disappearing after a gluten-free diet. OBJECTIVES: Evaluation of ASCA positivity in patients with Crohn's disease and celiac disease in relation to healthy individuals. METHODS: A total of 145 individuals were studied: 36 with Crohn's disease and 52 with celiac disease, that fulfilled the diagnostic criteria for both affections, and 57 healthy individuals for control. The celiac patients were divided as follow: group CeD I at diagnosis (n = 34), group CeD II with gluten-free diet compliance (n = 13) and group CeD III with transgressions to the diet (n = 5). ASCA IgA and IgG were determined by ELISA. RESULTS: With statistical significance, ASCA IgA were positive in Crohn's disease, celiac disease at diagnosis and celiac disease with diet transgressions; ASCA IgG in Crohn's disease and in all groups with celiac disease. CONCLUSIONS: The detection of ASCA in patients with celiac disease allows to suggest that ASCA is not a specific marker for Crohn's disease, but was associated with the inflammation of the small intestine. The increased levels of positive ASCA may be due to genetic factors and increased intestinal permeability.RACIONAL: Anticorpos anti-Saccharomyces cerevisiae antibodies, considerados marcadores sorológicos para a doença de Crohn, foram descritos em pacientes com doença celíaca, desaparecendo após dieta isenta de glúten. OBJETIVOS: Avaliação da positividade de anti-Saccharomyces cerevisiae antibodies em pacientes com doença de Crohn e doença celíaca, em relação a indivíduos sadios da mesma área geográfica. MÉTODOS: Foram estudados 145 pacientes, 36 com doença de Crohn e 52 com doença celíaca que preencheram os critérios diagnósticos para ambas as afecções, e 57 indivíduos sadios para controle. Os pacientes celíacos foram divididos como segue: ao diagnóstico (grupo doença celíaca I: n = 34), obedientes à dieta isenta de glúten (grupo doença celíaca II: n = 13) e não-aderentes à dieta isenta de glúten (grupo doença celíaca III: n = 5). Anti-Saccharomyces cerevisiae antibodies IgA e IgG foram determinados por ELISA. RESULTADOS: Anti-Saccharomyces cerevisiae antibodies IgA foi positivo na doença de Crohn, nos celíacos ao diagnóstico e nos transgressores à dieta, com significado estatístico. Anti-Saccharomyces cerevisiae antibodies IgG foi positivo na doença de Crohn e em todos os grupos de celíacos, com significado estatístico. CONCLUSÕES: A detecção de anti-Saccharomyces cerevisiae antibodies em pacientes com doença celíaca permite sugerir que o mesmo não seja marcador específico para a doença de Crohn, mas que esteja associado à inflamação do intestino delgado. A positividade de anti-Saccharomyces cerevisiae antibodies pode ser decorrente de fatores genéticos e aumento da permeabilidade intestinal.

RACIONAL: A doença celíaca representa, na atualidade, a doença intestinal mais comum em populações caucasóides e apresenta prevalência que varia de 8% a 18% nos familiares dos pacientes. A pesquisa dos anticorpos anti-endomísio (EmA-IgA) e antitransglutaminase tecidual (anti-tTG-IgA) constitui importante recurso não-invasivo e sensível de triagem e diagnóstico da doença celíaca em grupos de risco e populações. OBJETIVO: Avaliar a prevalência do EmA e anti-tTG em um grupo de familiares de celíacos e verificar o grau de concordância entre os dois métodos. MÉTODOS: Foram estudados 177 familiares (76(feminino); 101(masculino); 2-79 anos) e 93 indivíduos voluntários e sadios (34 (feminino); 59 (masculino); 2-71 anos) como grupo controle. O EmA foi detectado por imunofluorescência indireta (substrato: cordão umbilical humano) e o anti-tTG pelo método de ELISA (kit comercial). RESULTADOS: A positividade total de anticorpos nos familiares em estudo foi de 21% (37/177), mostrando significativa diferença em relação aos controles (0%; 0/93). Doze por cento (21/177) dos familiares foram positivos para o EmA e 13,56% (24/177) para o anti-tTG, sendo 4,52% (8/177) positivos concomitantemente para os dois anticorpos. A concordância de resultados entre os dois métodos foi de 83,6% (148/177) e a discordância de 16,4% (29/177), caracterizando uma correlação positiva significante (r= 0.435) entre ambos. Dentre os concordantes, 79,1% (140/177) eram negativos para o anti-tTG e EmA, e 4,52% (8/177) positivos para ambos. Nos casos discordantes, 7,34% (13/177) apresentaram EmA positivo e anti-tTG negativo e 9,04% (16/177) eram anti-tTG positivo e EmA negativo. CONCLUSÃO: Embora a alta positividade obtida para o EmA e anti-tTG destaque a importância da triagem sorológica em familiares de pacientes com doença celíaca, as discordâncias detectadas no estudo permitem ressaltar que o uso isolado de um único método pode incorrer em reações falso-negativas. O impacto desse fato implica que tais familiares deixarão de ser submetidos a biopsia intestinal para confirmação do diagnóstico da doença, e conseqüentemente, ao tratamento adequado e precoce.BACKGROUND: Celiac disease is the most common intestinal disorder of caucasian populations and presents a prevalence of 8% to 18% between the relatives of patients. The anti-endomysial (IgA-EmA) and anti-tissue transglutaminase antibodies (IgA-tTG) have represented an important non invasive and sensitivity method of screening and diagnosis of celiac disease in risk groups and populations. AIM: To investigate the prevalence of IgA-EmA and IgA-tTG antibodies in relatives of celiac patients and verify the degree of concordance between them. METHODS: One hundred and seventy seven relatives of celiac patients (76(feminino); 101(masculino); 2-79 years) and 93 healthy individuals were evaluated (34(feminino); 59(masculino); 2-71 years). IgA-EmA were detected by indirect immunofluorescence, with human umbilical cord as substrate, while anti-IgA-tTG titers were measured by enzyme-linked immunosorbent assay (ELISA), using commercial kit. RESULTS: Total positivity to antibodies in relatives of celiac patients was of 21% (37/177), and showed significant difference compared to control group (0%; 0/93). Twelve percent (21/177) of celiac disease relatives were positive to IgA-EmA, 13.56% (24/177) to IgA-tTG, and 4.52% (8/177) to both assays simultaneously. The concordance between both methods was 83.6% (148/177) and the discordance was 16.4% (29/177), with a positive and significant correlation (r = 0.435). Among the concordant results, 79.1% (140/177) were negative and 4.52% (8/177) were positive to both antibodies. Among the discordant results, 7.34% (13/177) were positive to IgA-EmA and negative to IgA-tTG, while 9.04% (16/177) were negative to IgA- EmA and positive to IgA-tTG. CONCLUSION: Although the high positivity to IgA-EmA and IgA-tTG emphasizes the importance of the serological screening in relatives of celiac patients, the discordances detected in this study showed that the use of only one method can lead to false negative results. Consequently these relatives will not be submitted to intestinal biopsy to confirm the diagnosis of celiac disease, and to the correct and earlier treatment.

Background — Literature data have shown high specificity of antiendomysial antibodies (EmA IgA) in celiac disease. The scarcity of Brazilian reports concerning this subject motivated the present study. Objectives - To determine the sensitivity and specificity of antiendomysial IgA antibodies in Brazilian celiac patients at diagnosis and after treatment, to confirm patient adherence to a gluten-free diet and to screen first-degree relatives. Methods - An extensive clinical and serological study was performed by investigating the presence of these antibodies in 392 individuals from Southern Brazil. Indirect immunofluorescence using human umbilical cord as substrate was employed and the total levels of IgA were determined by turbidimetry in all groups. The study was conducted on 57 celiac patients (18 at diagnosis, 24 who adhered to a gluten-free diet and 15 with marked or slight transgression of the diet), 115 relatives of celiac patients (39 families), 94 patients with other gastrointestinal diseases, and 126 healthy individuals from the general population. Results - The results demonstrated 100% positivity for the recently diagnosed patients and for those consuming gluten, in contrast to the patients who complied with the diet (0%). In the control group one individual was positive, but refused to undergo a biopsy. In the group of other gastrointestinal diseases, one positive patient presented ulcerative colitis, Down's syndrome and epilepsy, and the intestinal biopsy was diagnostic for celiac disease. These data showed 99.3% specificity for the test. Eighteen relatives were positive for antiendomysial antibodies IgA (15.65%), and comparison with the healthy population revealed a significant difference. An intestinal biopsy was obtained from seven subjects (one with total villous atrophy and six withouth alterations in the mucosal architecture, but all with a high number of intra-epithelial lymphocytes). Conclusions - The method revealed 100% sensitivity and 99.3% specificity. Because it is not an invasive method it can be used for the screening of atypical and latent forms of celiac disease to avoid serial biopsies and to control adherence to a gluten-free diet with implications in the prevention of malignancy in celiac disease.

Sensibilidade ao glúten é um estado de elevada resposta iamunológica (celular e humoral) à ingestão de proteínas do glúten do trigo, centeio, cevada e aveia, em indivíduos geneticamente predispostos. A doença celíaca é sua expressão mais freqüente, variando as formas de apresentação. Tem como tratamento a exclusão de alimentos contendo as gliadinas tóxicas. Embora a biopsia do intestino delgado proximal seja necessária, tem-se ressaltado a importância de testes sorológicos no rastreamento, diagnóstico e monitorização da dieta isenta de glúten em pacientes com doença celíaca. O objetivo do presente estudo foi investigar a presença dos anticorpos antiendomísio (EmA-IgA) e anti-reticulina (ARA-IgA) em 56 pacientes celíacos (17 recém diagnosticados; 24 aderentes à dieta; 15 com transgressão à dieta). Os anticorpos foram detectados por imunofluorescência indireta, utilizando como substrato cordão umbilical humano para os EmA-IgA, fígado e rim de rato para os ARA-IgA. Nos pacientes recém diagnosticados e no grupo com transgressão à dieta houve positividade total de 100% para os EmA-IgA e 59,4% para ARA-IgA. Nos pacientes aderentes à dieta nenhum dos anticorpos foi detectado. Dentre os 32 pacientes positivos, a concordância foi de 59,4% (19), sendo que 40,6 % (13/32) eram ARA-IgA negativo e EmA-IgA positivo. Nenhum paciente mostrou-se positivo para os ARA-IgA e negativo para os EmA-IgA. Portanto, a sensibilidade para os EmA-IgA foi de 100% e de 59,4% para os ARA-IgA. A associação dos dois testes não aumentou os índices de positividade total nas amostras. Conclui-se que, atualmente, a pesquisa dos EmA-IgA pode constituir teste sorológico de escolha, seja para diagnóstico, seja para seguimento dos pacientes celíacos, pelo alto valor preditivo, alta sensibilidade e especificidade e relativo baixo custo quando se utiliza cordão umbilical humano como substrato.Sensibility to gluten is a condition with high immunological reaction against gluten proteins from wheat, barley, rye and oats in individuals genetically susceptible. Celiac disease is its most frequent expression with various forms of clinical presentation. The treatment consists in gluten free diet. Although the biopsy of proximal small bowel is necessary, the importance of serological tests is increasing in the screening, diagnosis and monitoring of gluten free diet in celiac patients. The aim of this study was to investigate the presence of antiendomysium (EmA-IgA) and anti-reticulin (ARA-IgA) antibodies in 56 celiac patients (17 at diagnosis, 24 adherent to the diet and 15 with transgression to the diet). The antibodies were detected by indirect immunofluorescence, using human umbilical cord as substrate for the EmA-IgA and rat liver and kidney for the ARA-IgA. In the patients at diagnosis and in the group with transgression to the diet the total positivity was 100% for EmA-IgA and 59.4% for ARA-IgA. Antibodies were not detected in gluten-free diet patients. Among the 32 positive patients, the concordance of both tests was of 59.4% (19/32), being 40,6% (13/32) negative to ARA-IgA and positive to EmA-IgA. No patient was positive for ARA-IgA and negative for EmA-IgA. Thus, the sensitivity for EmA-IgA was of 100% and 59,4% for ARA-IgA. The association of the two tests did not improve the positivity in the samples. In conclusion, EmA-IgA can be considered the best serological test for diagnosis and follow up of celiac patients, because it presents high predictive value, high specificity and sensibility and is not expensive if using human umbilical cord as substrate.

ABSTRACT Objective To determine the incidence of infections in a population of systemic lupus erythematosus individuals and the characteristics of infections regarding original site, as well as to study the possible associations between infections and treatment. Methods An analytical retrospective study using data from medical charts of systemic lupus erythematosus patients from a single university hospital. A total of 144 patients followed up for five years were included. Data collected comprised age of patients and age at onset of lupus, sex and ethnicity, disease duration before the study period, medications, cumulative dose of prednisone, occurrence of infections and their original site. Results The most frequent infections were urinary tract infections (correlated to use of prednisone − p

ABSTRACT Objective: To evaluate the profile and severity of age-related macular degeneration (AMD) in ophthalmology ambulatory of Federal University of Parana in Curitiba, Parana, Brazil. Methods: This was a cross-sectional study with data collected among the 6155 outpatients ophthalmic appointments (november 2011 to november 2013). In this 6155 patients, a total of 346 patients had retinal diseases and were screened by two retinal specialists for signs of AMD. If present, they were submitted to a protocol including a new ophthalmic evaluation comprising visual acuity, tonometry, biomicroscopy, dilated fundus examination and optical coherence tomography (OCT). Results: A total of 6155 patients underwent ophthalmologic evaluation for several reasons. Three hundred and forty six patients had retinal diseases (incidence of 5.6%) and 68 of these (incidence of 19.6% in retinal patients) had AMD. The mean age of all patients was 53 years and in retinal patients was 60 years. In AMD patients mean age was 73 years. Ethnicity, body-mass index (BMI) and smoking habits were evaluated in the 68 patients diagnosed with AMD (34 exudative and 34 non-exudative) but none of those parameters were statistically significant comparing exudative and non-exudative forms. Conclusion: Most of the patients were European descendants. A higher proportion of advanced cases of AMD comparing with literature was found (50% of exudative form). Regarding ethnicity, iris color, smoking habit and BMI, there was no difference comparing exudative and non-exudative forms. These results may be compared to available AMD studies, since there is little information about AMD in Brazil.

ABSTRACT Objective To describe the profile of lawsuits related to drug requests filled at the Federal Justice of the State of Paraná. Methods A cross-sectional study, and the data were obtained through consulting the lawsuits at the online system of the Federal Justice of Paraná. Results Out of 347 lawsuits included in the study, 55% of plaintiffs were women, with a median age of 56 years. Oncology was the field with more requests (23.6%), and the highest mean costs. A wide variety of diseases and broad variety of requested drugs were found in the lawsuits. Approximately two-thirds of them were requested by the brand name, and the most often requested drugs were palivizumab and tiotropium bromide. Only 14.5% of the requested medicines were registered in the National Medication Register. The Public Defender’s Office filled actions in 89.6% of cases and all lawsuits had an interim relief. The mean time for approval was 35 days and 70% of requests were granted. Conclusion Oncology was the field with the highest demand for medicines at the Federal Justice of Paraná in 2014. A great variety of medications was requested. The Public Defender´s Office represented most lawsuits. All demands had an interim relief, and the majority of requests were granted, within an average of 35 days.