Consenso Técnico para a determinação do status da proteína HER2 por imunocitoquímica em carcinoma da mama

A determinação do status da proteína HER2 por imunocitoquímica é uma metodologia fundamental para o diagnóstico, prognóstico e indicação terapêutica no carcinoma da mama, nomeadamente para o encaminhamento terapêutico com Herceptin®/trastuzumab. O estabelecimento desta terapêutica nas vertentes adjuvante ou neoadjuvante, e até em doença metastática, tem vindo a acentuar a importância da determinação do referido status de modo a melhor responder às necessidades dos doentes. Sendo a imunocitoquímica o método validado para determinação do status HER2 em carcinoma da mama, é de extrema importância definir linhas de orientação para a sua correta performance como tem sido estabelecido em diversos países em todo o mundo. A área científica de Anatomia Patológica, Citológica e Tanatológica da Escola Superior de Tecnologia da Saúde de Lisboa (APCT-ESTeSL) e a Associação Portuguesa de Técnicos de Anatomia Patológica (APTAP) reuniram um painel de especialistas para a construção e estabelecimento de linhas de orientação técnica para a determinação do status HER2 em carcinoma da mama para a realidade portuguesa. Pretende-se com este consenso criar linhas de orientação técnicas para a construção, validação e manutenção do teste imunocitoquímico para determinação do status HER2 em carcinoma da mama, no que diz respeito à realidade portuguesa. Todas as orientações aqui descritas têm em conta o estado da arte atual no que diz respeito à determinação do status HER2 por imunocitoquímica em carcinoma da mama, bem como a experiência pessoal e académica de cada um dos membros do painel de especialistas que a subscrevem.

Solubility of Ethene in Water and in a Medium for the Cultivation of a Bacterial Strain

The solubility of ethene in water and in the fermentation medium of Xanthobacter Py(2) was determined with a Ben-Naim-Baer type apparatus. The solubility measurements were carried out in the temperature range of (293.15 to 323.15) K and at atmospheric pressure with a precision of about +/- 0.3 %. The Ostwald coefficients, the mole fractions of the dissolved ethene, at the gas partial pressure of 101.325 kPa, and the Henry coefficients, at the water vapor pressure, were calculated using accurate thermodynamic relations. A comparison between the solubility of ethene in water and in the cultivation medium has shown that this gas is about 2.4 % more soluble in pure water. On the other hand, from the solubility temperature dependence, the Gibbs energy, enthalpy, and entropy changes for the process of transferring the solute from the gaseous phase to the liquid solutions were also determined. Moreover, the perturbed-chain statistical associating fluid theory equation of state (PC-SAFT EOS) model was used for the prediction of the solubility of ethene in water. New parameters, k(ij), are proposed for this system, and it was found that using a ky temperature-dependent PC-SAFT EOS describes more accurately the behavior solubilities of ethene in water at 101.325 kPa, improving the deviations to 1 %.

Deformação miocárdica analisada por 2D strain em indivíduos com lúpus eritematoso sistémico

Mestrado em Tecnologia de Diagnóstico e Intervenção Cardiovascular. Área de especialização: Ultrassonografia Cardiovascular.

Implementação da técnica Silver In Situ Hibridization para avaliação do status do gene EGFR em doentes com CPNPC

Avaliação do estado do gene Epidermal Growth Factor Receptor (EGFR), por Silver In Situ Hibridization (SISH), tem-se destacado como biomarcador preditivo na resposta à terapêutica. O principal objectivo foi optimizar a etapa de recuperação por calor da metodologia automatizada SISH Dual-Colour, em carcinomas pulmonares fixados em formol durante 24 e 72 horas. A optimização levou a um aumento da preservação do contorno nuclear e da intensidade e contraste dos sinais para os dois tempos de fixação, permitindo avaliar o estado do EGFR em 83,3% dos casos em estudo. A SISH Dual-Colour é uma alternativa para avaliar o estado do EGFR.

Neonatal anthropometry: a tool to evaluate the nutritional status and predict early and late risks

Neonatal anthropometry is an inexpensive, noninvasive and convenient tool for bedside evaluation, especially in sick and fragile neonates. Anthropometry can be used in neonates as a tool for several purposes: diagnosis of foetal malnutrition and prediction of early postnatal complications; postnatal assessment of growth, body composition and nutritional status; prediction of long-term complications including metabolic syndrome; assessment of dysmorphology; and estimation of body surface. However, in this age group anthropometry has been notorious for its inaccuracy and the main concern is to make validated indices available. Direct measurements, such as body weight, length and body circumferences are the most commonly used measurements for nutritional assessment in clinical practice and in field studies. Body weight is the most reliable anthropometric measurement and therefore is often used alone in the assessment of the nutritional status, despite not reflecting body composition. Derived indices from direct measurements have been proposed to improve the accuracy of anthropometry. Equations based on body weight and length, mid-arm circumference/head circumference ratio, and upper-arm cross-sectional areas are among the most used derived indices to assess nutritional status and body proportionality, even though these indices require further validation for the estimation of body composition in neonates.

Avaliação ecocardiográfica da função sistólica ventricular direita em doentes com disfunção ventricular esquerda: parâmetros convencionais versus strain bidimensional

Mestrado em Tecnologia de Diagnóstico e Intervenção Cardiovascular.

Nutritional status influences generic and disease-specific quality of life measures in haemodialysis patients

Background: Poor nutritional status and worse health-related quality of life (QoL) have been reported in haemodialysis (HD) patients. The utilization of generic and disease specific QoL questionnaires in the same population may provide a better understanding of the significance of nutrition in QoL dimensions. Objective: To assess nutritional status by easy to use parameters and to evaluate the potential relationship with QoL measured by generic and disease specific questionnaires. Methods: Nutritional status was assessed by subjective global assessment adapted to renal patients (SGA), body mass index (BMI), nutritional intake and appetite. QoL was assessed by the generic EuroQoL and disease specific Kidney Disease Quality of Life-Short Form (KDQoL-SF) questionnaires. Results: The study comprised 130 patients of both genders, mean age 62.7 ± 14.7 years. The prevalence of undernutrition ranged from 3.1% by BMI ≤ 18.5 kg/m2 to 75.4% for patients below energy and protein intake recommendations. With the exception of BMI classification, undernourished patients had worse scores in nearly all QoL dimensions (EuroQoL and KDQoL-SF), a pattern which was dominantly maintained when adjusted for demographics and disease-related variables. Overweight/obese patients (BMI ≥ 25) also had worse scores in some QoL dimensions, but after adjustment the pattern was maintained only in the symptoms and problems dimension of KDQoL-SF (p = 0.011). Conclusion: Our study reveals that even in mildly undernourished HD patients, nutritional status has a significant impact in several QoL dimensions. The questionnaires used provided different, almost complementary perspectives, yet for daily practice EuroQoL is simpler. Assuring a good nutritional status, may positively influence QoL.

Lack of association between iron status at birth and growth of preterm infants

OBJECTIVE: To assess the association between iron status at birth and growth of preterm infants. METHODS: Ninety-five premature babies (26 to 36 weeks of gestational age) born from July 2000 to May 2001 in a public hospital in Rio de Janeiro, Southeastern Brazil, were followed up for six months, corrected by gestational age. Iron measurements at birth were available for 82 mothers and 78 children: hemoglobin, hematocrit, mean corpuscular volume and plasma iron. All children received free doses of iron supplement (2 mg/kg/day) during the follow-up period and up to two years of age. Multivariate linear regression analyses with repeated measurements were performed to assess factors associated to linear growth. RESULTS: Growth was more pronounced up to 40 weeks of gestational age, increasing about 1.0 cm/week and then slowing down to 0.75 cm/week. The multivariate analysis showed growth was positively associated with birth weight (0.4 cm/100 g; p<0.001) and negatively associated with gestational age at birth (-0.5 cm/week; p<0.001). There was no association between cord iron and mother iron measurements and growth (p>0.60 for all measures). Only two children had anemia at birth, whereas 43.9% of mothers were anemic (hemoglobin <11 g/dl). Also, there was no correlation between anemia indicators of mothers and children at birth (r<0.15; p>0.20). CONCLUSIONS: Maternal anemia was not associated with anemia in preterm infants and iron status of mothers and children at birth was not associated with short-term growth of preterm infants.

Impact of socioeconomic status on Brazilian elderly health

OBJECTIVE: To investigate the impact of socioeconomic status on elderly health. METHODS: The study was based on cross-sectional data from Survey on Health, Well-Being, and Aging in Latin America and the Caribbean. The sample comprised 2,143 non-institutionalized elderly aged 60 years and older living in the urban area of São Paulo, southeastern Brazil. Linear regression models estimated the effect of socioeconomic status indicators (years of schooling completed, occupation and purchasing power) on each one of the following health indicators: depression, self-rated health, morbidity and memory capacity. A 5% significance level was set. RESULTS: There was a significant effect of years of education and purchasing power on self-rated health and memory capacity when controlled for the variables number of diseases during childhood, bed rest for at least a month due to health problems during childhood, self-rated health during childhood, living arrangements, sex, age, marital status, category of health insurance, intake of medicines. Only purchasing power had an effect on depression. Despite the bivariate association between socioeconomic status indicators and number of diseases (morbidity), this effect was no longer seen after including the controls in the model. CONCLUSIONS: The study results confirm the association between socioeconomic status indicators and health among Brazilian elderly, but only for some dimensions of socioeconomic status and certain health outcomes.

Relationship between the iron status of pregnant women and their newborns

OBJECTIVE: To determine the relationship between iron nutritional status of pregnant women and their newborns using a combination of hematological and biochemical parameters for the diagnosis of iron deficiency. METHODS: A cross-sectional study was conducted in Jundiaí, Southeastern Brazil, in 2000. Venous blood samples collected from 95 pregnant women and from their umbilical cord and used for the determination of complete blood count, serum iron, total iron-binding capacity, serum ferritin, zinc protoporphyrin, and transferrin saturation. Women were classified into three groups: anemic, iron deficient and non-iron deficient. Statistical analysis included the Tukey-HSD test, Pearson's correlation coefficient and multiple linear regression analysis. RESULTS: Among pregnant women, 19% were anemic (97.9% mildly anemic and 2.1% moderately anemic) and 30.5% were iron deficient. No significant difference was seen in mean values of any parameter studied between newborns in the three groups (p>0.05). Multiple linear regression analysis showed weak association between neonatal and maternal parameters. CONCLUSIONS: The iron nutritional status of pregnant women with iron deficiency or mild anemia does not seem to have a significant impact on the iron levels of their children.

Assessing the conservation status of the strict endemic Desertas wolf spider, Hogna ingens (Araneae, Lycosidae)

The Desertas Islands (Madeira, Portugal) are the sole home of one of the largest and rarest wolf spiderspecies, Hogna ingens (Blackwall 1857) (Araneae, Lycosidae). Despite its size, it inhabits a single valleyin the North of the Deserta Grande Island, Vale da Castanheira, currently invaded by the herb Phalarisaquatica. This invasive species competes with the native flora and was subject to several eradicationexperiments, namely through fire and chemicals. The objectives of this work were to: (1) estimate thecurrent distribution and abundance of H. ingens and respective trends; (2) evaluate the impact of theinvasive plant and eradication methods on the spider population; (3) suggest future measures for therecovery of the species; and (4) evaluate its conservation status according to the IUCN criteria. The current distribution of H. ingens covers 23 ha, a recent reduction from its original 83 ha, correspond-ing to the entire Vale da Castanheira. A total of 4447 and 4086 adults and 71,832 and 24,635 juvenileswere estimated to live in the valley during 2011 and 2012, respectively. We found a significant negativeimpact of P. aquatica cover on the presence and abundance of H. ingens and that chemical treatmentspecifically directed towards the invasive plant species may be the only way to effectively recover thespider's habitat. We suggest (1) regular monitoring; (2) extend chemical treatments; (3) ex-situ conserva-tion with future reintroduction of adults. Based on the current area of occupancy (AOO) of H. ingens and itsrecent decline in both AOO and number of individuals, it was recently classified as Critically Endangeredby IUCN and we suggest its urgent inclusion in the Habitats Directive species lists.

Nutritional status and overhydration: can bioimpedance spectroscopy be useful in haemodialysis patients?

Background: Protein-energy wasting (PEW), associated with inflammation and overhydration, is common in haemodialysis (HD) patients and is associated with high morbidity and mortality. Objective: Assess the relationship between nutritional status, markers of inflammation and body composition through bioimpedance spectroscopy (BIS) in HD patients. Methods: This observational, cross-sectional, single centre study, carried out in an HD centre in Forte da Casa (Portugal), involved 75 patients on an HD programme. In all participating patients, the following laboratory tests were conducted: haemoglobin, albumin, C-reactive protein (CRP) and 25-hydroxyvitamin D3 [25(OH)D3]. The body mass index of all patients was calculated and a modified version of subjective global assessment (SGA) was produced for patients on dialysis. Intracellular water (ICW) and extracellular water (ECW) were measured by BIS (Body Composition Monitor®, Fresenius Medical Care®) after the HD session. In statistical analysis, Spearman’s correlation was used for the univariate analysis and linear regression for the multivariate analysis (SPSS 14.0). A P value of <.05 was considered statistically significant. Results: PEW, inversely assessed through the ICW/body weight (BW) ratio, was positively related to age (P<.001), presence of diabetes (P=.004), BMI (P=.01) and CRP (P=.008) and negatively related to albumin (p=.006) and 25(OH)D3 (P=.007). Overhydration, assessed directly through the ECW/BW ratio, was positively related with CRP (P=.009) and SGA (P=.03), and negatively with 25(OH)D3 (P=.006) and BMI (P=.01). In multivariate analysis, PEW was associated with older age (P<.001), the presence of diabetes (P=.003), lower 25(OH)D3 (P=.008), higher CRP (P=.001) and lower albumin levels (P=.004). Over-hydration was associated with higher CRP (P=.001) and lower levels of 25(OH)D3 (P=.003). Conclusions: Taking these results into account, the ICW/BW and ECW/BW ratios, assessed with BIS, have proven to be good markers of the nutritional and inflammatory status of HD patients. BIS may be a useful tool for regularly assessing the nutritional and hydration status in these patients and may allow nutritional advice to be improved and adjusted.

A comprehensive approach to evaluate nutritional status in Crohn's patients in the era of biologic therapy: a case-control study

Objectives - Evaluate the nutritional status of patients with inactive or mildly active Crohn's disease (CD), and identify possible causes for potential deficiencies. Methods - A total of 78 CD patients and 80 healthy controls were evaluated in respect of nutritional status, dietary intake, and life styles factors. Results - These 73/78 CD patients were on immunomodulating therapies. Mean body mass index (BMI) was lower in patients as compared to controls (P= 0.006) but 32% of CD patients and 33.8% of controls had a BMI > 25, whereas 8% and 23.8% in each group, respectively, were obese (BMI > 30Kg/m(2)). Fat free mass was significantly decreased in both genders (P < 0.05) whereas fat mass was decreased only in males (P= 0.01). Energy intake was significantly lower in CD patients (P < 0.0001) and we observed significantly lower adjusted mean daily intakes of carbohydrates, monounsaturated fat, fiber, calcium, and vitamins C, D, E, and K (P < 0.05). 29% of patients had excluded grains from their usual diet, 28% milk, 18% vegetables, and 11% fruits. Milk exclusion resulted in a significantly lower consumption of calcium and vitamin K (P < 0.001) and the exclusion of vegetables was associated to a lower consumption of vitamins C and E (P < 0.05). Physical activity was significantly lower in CD patients (P= 0.01) and this lack of physical activity was inversely correlated with increased fat mass percentage (r=-0.315, P= 0.001). Conclusions - Results showed that the most prevalent form of malnutrition in CD patients was an excess of body weight, which was concomitant with an inadequate dietary intake, namely micronutrients, clearly related to dietary exclusion of certain foods.

Análise por dados em painel do status de saúde no Nordeste Brasileiro

OBJETIVO: Analisar fatores determinantes do status de saúde em cada estado da Região Nordeste do Brasil. MÉTODOS: Estudo utilizando a metodologia de dados em painel, com informações agregadas para municípios. Os dados compreendem os anos de 1991 e 2000, e foram obtidos no Atlas do Desenvolvimento Humano do Programa das Nações Unidas para o Desenvolvimento, e Secretaria do Tesouro Nacional. Utilizou-se como indicador do status de saúde, a taxa de mortalidade infantil, e como determinantes as variáveis: gastos com saúde e saneamento per capita, números de médicos por mil habitantes, acesso à água tratada, taxa de fecundidade e de analfabetismo, percentual de mães adolescentes, renda per capita e índice de Gini. RESULTADOS: As taxas de mortalidade infantil na região Nordeste reduziram-se em 31,8% no período analisado, desempenho pouco superior ao apresentado para a média nacional. No entanto, em alguns estados, como Rio Grande do Norte, Bahia, Ceará e Alagoas, a redução foi mais significativa. Isso pode ser atribuído à melhora de alguns indicadores que são os principais determinantes da redução da taxa de mortalidade infantil: maior acesso à educação, redução da taxa de fecundidade, aumento da renda, e do acesso à água. CONCLUSÕES: Os estados que apresentaram maiores ganhos no acesso à água tratada, educação, renda e redução da taxa de fecundidade, foram também os que obtiveram maiores ganhos na redução da mortalidade de menores de um ano de idade.

Evidence of inadequate docosahexaenoic acid status in Brazilian pregnant and lactating women

Recently published data concerning dietary intake of fat and food sources of (n-3) long-chain polyunsaturated fatty acids (LCPUFA) in Brazil are reviewed together with data on biochemical indices of PUFA status during pregnancy and lactation and PUFA composition of breast milk in Brazilian adolescents and adults. Potential inadequacies of docosahexaenoic acid (DHA) status among Brazilian pregnant and lactating women have not yet been thoroughly evaluated. The data reviewed show that dietary intake of food sources of n-3 LCPUFA is low and possibly deficient in Brazil, and that biochemical indices of maternal DHA status and breast milk DHA content are low compared to the international literature. These data indicate inadequate DHA status among Brazilian women during pregnancy and lactation, but this evidence needs confirmation through comprehensive and specific population-based studies.