ABSTRACT Background: The spread of carbapenemase- and extended-spectrum β-lactamase (ESBL)-producing gram-negative bacilli (GNB) represent a global public health threat that limits therapeutic options for hospitalized patients. This study aimed to evaluate the in-vitro susceptibility of β-lactam-resistant GNB to ceftazidime-avibactam (C/A) and ceftolozane-tazobactam (C/T), and investigate the molecular determinants of resistance. Methods: Overall, 101 clinical isolates of Enterobacterales and Pseudomonas aeruginosa collected from a general hospital in Brazil were analyzed. Susceptibility to the antimicrobial agents was evaluated using an automated method, and the minimum inhibitory concentrations (MIC50/90) of C/A and C/T were determined using Etest®. The β-lactamase-encoding genes were investigated using polymerase chain reaction. Results: High susceptibility to C/A and C/T was observed among ESBL-producing Enterobacterales (100% and 97.3% for CLSI and 83.8% for BRCAST, respectively) and carbapenem-resistant P. aeruginosa (92.3% and 87.2%, respectively). Carbapenemase-producing Klebsiella pneumoniae exhibited high resistance to C/T (80%- CLSI or 100%- BRCAST) but high susceptibility to C/A (93.4%). All carbapenem-resistant K. pneumoniae isolates were susceptible to C/A, whereas only one isolate was susceptible to C/T. Both antimicrobials were inactive against metallo-β-lactamase-producing K. pneumoniae isolates. Resistance genes were concomitantly identified in 44 (44.9%) isolates, with bla CTX-M and bla SHV being the most common. Conclusions: C/A and C/T were active against microorganisms with β-lactam-resistant phenotypes, except when resistance was mediated by metallo-β-lactamases. Most C/A- and C/T-resistant isolates concomitantly carried two or more β-lactamase-encoding genes (62.5% and 77.4%, respectively). Background carbapenemase extendedspectrum extended spectrum βlactamase β lactamase ESBLproducing ESBL producing gramnegative gram negative (GNB patients invitro vitro βlactamresistant lactam resistant ceftazidimeavibactam ceftazidime avibactam CA C A (C/A ceftolozanetazobactam ceftolozane tazobactam C/T, CT , T (C/T) Methods Overall 10 analyzed method MIC50/90 MIC5090 MIC MIC50 90 (MIC50/90 Etest Etest® βlactamaseencoding encoding reaction Results 100% 100 (100 973 97 3 97.3 838 83 8 83.8 BRCAST respectively carbapenemresistant carbapenem P 92.3% 923 92 (92.3 872 87 2 87.2% respectively. . Carbapenemaseproducing Carbapenemase 80% 80 (80% 93.4%. 934 93.4% 93 4 (93.4%) K metalloβlactamaseproducing metallo 44.9% 449 9 (44.9% CTXM CTX M common Conclusions phenotypes metalloβlactamases. metalloβlactamases lactamases. lactamases metallo-β-lactamases C/Tresistant CTresistant 62.5% 625 62 5 (62.5 774 77 77.4% (C/T 1 MIC50/9 MIC509 MIC5 (MIC50/9 (10 97. 83. 92.3 (92. 87.2 (80 93.4 (93.4% 44.9 (44.9 Tresistant 62.5 6 (62. 7 77.4 MIC50/ (MIC50/ (1 92. (92 87. (8 93. (93.4 44. (44. 62. (62 77. (MIC50 ( (9 (93. (44 (6 (MIC5 (93 (4 (MIC

Resumo Introdução: A diálise peritoneal de início urgente (US-PD) foi proposta como modalidade segura de terapia renal substitutiva (TRS) para pacientes com doença renal em estágio 5 (DRC-5) com indicação de início de diálise de emergência. Buscamos comparar características, complicações em 30 dias e desfechos clínicos de pacientes em US-PD e diálise peritoneal planejada (DP-plan) no primeiro ano de terapia. Métodos: Estudo retrospectivo de centro único, que incluiu pacientes adultos incidentes em DP acompanhados por até um ano. Considerou-se US-PD quando os pacientes iniciaram terapia até 7 dias após implante do cateter Tenckhoff. O grupo DP-plan consistiu de pacientes iniciando terapia após período break-in (15 dias). Compararam-se complicações mecânicas e infecciosas 30 dias após o início da DP. Hospitalização e falha da técnica durante os primeiros 12 meses em terapia foram avaliados por curvas Kaplan-Meier e os seus determinantes foram analisados por modelos de regressão de Cox. Resultados: Analisaram-se todos os pacientes iniciando DP entre Outubro/2016-Novembro/2019 que preencheram os critérios de inclusão. Avaliamos 137 pacientes (70 US-PD x 67 DP-plan). As principais complicações nos primeiros 30 dias foram migração da ponta do cateter (7,5% DP-plan x 4,3% US-PD - p= 0,49) e extravasamento (4,5% DP-plan x 5,7% US-PD - p=0,74). A maioria dos cateteres foi implantada pela técnica de Seldinger. A principal causa de saída da terapia foi óbito em pacientes em US-PD (15,7%) e transferência para HD em pacientes em DP-plan (13,4%). A ocorrência de complicações nos primeiros 30 dias foi o único fator de risco para saída da terapia (OR = 2,9; IC 95% 1,1-7,5, p = 0,03). Taxas de hospitalização e sobrevida da técnica foram similares em ambos os grupos. Conclusão: A ausência de diferenças significativas nos desfechos dos pacientes entre os grupos reforça que DP é um método de diálise seguro e aplicável em pacientes que necessitam diálise imediata. Introdução USPD US PD (US-PD TRS (TRS DRC5 DRC (DRC-5 emergência características 3 DPplan plan (DP-plan Métodos Considerouse Considerou se Tenckhoff breakin break in 15 (1 dias. . dias) Compararamse Compararam 1 KaplanMeier Kaplan Meier Cox Resultados Analisaramse Analisaram Outubro/2016Novembro/2019 Outubro2016Novembro2019 OutubroNovembro Outubro/2016 Novembro/2019 Outubro 2016 Novembro 2019 Outubro/2016-Novembro/201 inclusão 13 70 (7 6 DPplan. DP-plan) 7,5% 75 (7,5 43 4 4,3 0,49 049 0 49 4,5% 45 (4,5 57 5,7 p=0,74. p074 p=0,74 74 p=0,74) Seldinger 15,7% 157 (15,7% 13,4%. 134 13,4% (13,4%) OR 2,9 29 2 9 95 1,17,5, 1175 1,1 7,5, 1,1-7,5 0,03. 003 0,03 03 0,03) Conclusão imediata (DRC- ( 2016Novembro Outubro/2016Novembro/201 Outubro2016Novembro201 Outubro2016 Outubro/201 Novembro2019 Novembro/201 201 Outubro/2016-Novembro/20 7,5 (7, 4, 0,4 04 4,5 (4, 5, p07 p=0,7 15,7 (15,7 13,4 (13,4% 2, 17 1,17,5 117 11 1, 1,1-7, 00 0,0 (DRC Outubro/2016Novembro/20 Outubro2016Novembro20 Outubro201 Outubro/20 Novembro201 Novembro/20 20 Outubro/2016-Novembro/2 7, 0, (4 p0 p=0, 15, (15, 13, (13,4 1,17, 1,1-7 Outubro/2016Novembro/2 Outubro2016Novembro2 Outubro20 Outubro/2 Novembro20 Novembro/2 Outubro/2016-Novembro/ p=0 (13, 1,17 1,1- Outubro/2016Novembro/ Outubro2016Novembro Outubro2 Outubro/ Novembro2 Novembro/ Outubro/2016-Novembro (13 Outubro/2016Novembro

Abstract Introduction: Urgent-start peritoneal dialysis (US-PD) has been proposed as a safe modality of renal replacement therapy (RRT) for end-stage renal disease (ESRD) patients with an indication for emergency dialysis initiation. We aimed to compare the characteristics, 30-day complications, and clinical outcomes of US-PD and planned peritoneal dialysis (Plan-PD) patients over the first year of therapy. Methods: This was a single-center retrospective study that included incident adult patients followed for up to one year. US-PD was considered when incident patients started therapy within 7 days after Tenckhoff catheter implantation. Plan-PD group consisted of patients who started therapy after the breaking period (15 days). Mechanical and infectious complications were compared 30 days from PD initiation. Hospitalization and technique failure during the first 12 months on PD were assessed by Kaplan-Meier curves and the determinants were calculated by Cox regression models. Results: All patients starting PD between October/2016 and November/2019 who fulfilled the inclusion criteria were analyzed. We evaluated 137 patients (70 in the US-PD x 67 Plan-PD). The main complications in the first 30 days were catheter tip migration (7.5% Plan-PD x 4.3% US-PD - p= 0.49) and leakage (4.5% Plan-PD x 5.7% US-PD - p=0.74). Most catheters were placed using the Seldinger technique. The main cause of dropout was death in US-PD patients (15.7%) and transfer to HD in Plan-PD patients (13.4%). The occurrence of complications in the first 30 days was the only risk factor for dropout (OR = 2.9; 95% CI 1.1-7.5, p = 0.03). Hospitalization rates and technique survival were similar in both groups. Conclusion: The lack of significant differences in patients’ outcomes between groups reinforces that PD is a safe and applicable dialysis method in patients who need immediate dialysis. Introduction Urgentstart Urgent start USPD US (US-PD RRT (RRT endstage end stage ESRD (ESRD initiation characteristics 30day day PlanPD Plan (Plan-PD Methods singlecenter single center implantation 15 (1 days. . days) 3 1 KaplanMeier Kaplan Meier models Results October2016 October 2016 October/201 November2019 November 2019 November/201 analyzed 13 70 (7 6 PlanPD. Plan-PD) 7.5% 75 5 (7.5 43 4 4.3 0.49 049 0 49 4.5% 45 (4.5 57 5.7 p=0.74. p074 p=0.74 74 p=0.74) 15.7% 157 (15.7% 13.4%. 134 13.4% (13.4%) OR 2.9 29 2 9 95 1.17.5, 1175 1.1 7.5, 1.1-7.5 0.03. 003 0.03 03 0.03) Conclusion ( October201 201 October/20 November201 November/20 7.5 (7. 4. 0.4 04 4.5 (4. 5. p07 p=0.7 15.7 (15.7 13.4 (13.4% 2. 17 1.17.5 117 11 1. 1.1-7. 00 0.0 October20 20 October/2 November20 November/2 7. 0. (4 p0 p=0. 15. (15. 13. (13.4 1.17. 1.1-7 October2 October/ November2 November/ p=0 (13. 1.17 1.1- (13

RESUMO Antecedentes: O acidente vascular cerebral isquêmico (AVCI) é uma doença multifatorial que apresenta altas taxas de morbimortalidade no Brasil. Vários estudos provaram que existe uma ligação entre o sistema ABO de grupos sanguíneos e a ocorrência de eventos trombóticos. No entanto, sua associação com AVCI não está bem estabelecida. Objetivo: Por essa razão, o objetivo deste trabalho foi investigar a relação entre os grupos sanguíneos ABO e a ocorrência de AVCI em uma coorte brasileira de doenças cerebrovasculares. Métodos: Ao longo de 12 meses foram incluídos 529 indivíduos, dos quais 275 apresentaram um episódio de AVCI e 254 compuseram o grupo controle. Amostras de sangue foram coletadas para sorotipagem direta e reversa. Os grupos controle e AVCI foram comparados em relação aos fatores de risco tradicionais e à distribuição dos grupos sanguíneos ABO. Resultados: O grupo AVCI apresentou maior prevalência de hipertensão arterial sistêmica (HAS), diabetes mellitus, tabagismo, história familiar, cardiopatia e estilo de vida sedentário em comparação ao grupo controle. O tipo sanguíneo AB prevaleceu entre os pacientes (5,1 vs. 1,6%; p<0,05) e apresentou mais casos de HAS em comparação ao tipo O (92,9 vs. 67,3%; p<0,05). Conclusões: Nossos resultados sugerem que a ocorrência de AVCI é mais frequente entre os pacientes do tipo sanguíneo AB.

ABSTRACT Background: Ischemic stroke (IS) is a multifactorial disease that presents high rates of morbimortality in Brazil. Several studies proved that there is a link between the ABO blood group system and the occurrence of thrombotic events. Nonetheless, its association with IS is not well established. Objective: For that reason, the purpose hereof was to investigate the relation between the ABO blood groups and the occurrence of IS in a Brazilian cohort of cerebrovascular diseases. Methods: Five hundred and twenty-nine subjects were included over 12 months, from which 275 presented an IS episode and 254 composed the control group. Blood samples were drawn for direct and reverse serotyping. The control and IS groups were compared regarding the traditional risk factors and the distribution of the ABO blood groups. Results: The IS group presented a higher prevalence of systemic arterial hypertension (SAH), diabetes mellitus, smoking habits, family history, cardiopathy, and sedentary lifestyle in comparison with the control group. The AB blood type prevailed among the patients (5.1 vs. 1.6%; p<0.05) and this group had more SAH cases in comparison with the O type group (92.9 vs. 67.3%; p<0.05). Conclusions: Our results suggest that the occurrence of IS is more frequent among patients of the AB blood type.

Abstract We report the occurrence in Brazil of the bla NDM-1 gene in Acinetobacter pittii, prior to the previously described first reports regarding the species Providencia rettgeri and Enterobacter hormaechei. Clinical isolates were investigated by polymerase chain reaction followed by bidirectional sequencing, and species was confirmed by 16S rDNA sequencing and matrix-assisted laser desorption-ionization time-of-flight spectrometry. A. pittii carrying bla NDM-1 was confirmed in a patient with no national or international travel history, or transfer from another hospital. The findings warn of the possibility of silent spread of bla NDM-1 to the community.

RESUMO Com o objetivo de contribuir para estudos que utilizam informações clínicas e genômicas de biobancos, apresentamos os resultados iniciais do primeiro Biobanco Latinoamericano em Acidente Vascular Cerebral (AVC). Métodos: Foram coletadas amostras de sangue de pacientes recrutados pelo Registro de AVC de Joinville e posteriormente de quatro cidades brasileiras. Foram registrados dados socioeconômicos demográficos, fatores de risco cardiovasculares, Causative Classification System (CCS), Trial of Org 10172 in Acute Stroke Treatment, National Institutes of Health, estado funcional (Rankin modificado) e imagens cerebrais. Adicionalmente, foram recrutados controles das regiões geográficas correspondentes. Obteve-se DNA genômico de todos participantes. Resultados: Foram incluídos 2688 pacientes e 3282 controles. Entre os pacientes, 76% tiveram AVC isquêmico, 12% ataques isquêmicos transitórios, 9% AVC hemorrágico e 3% hemorragia subaracnóidea. Os casos indeterminados foram os mais frequentes e classificados de acordo com TOAST (40%) e CCS (47%). Um quarto dos pacientes tinham menos de 55 anos no primeiro evento. Conclusões: Estabelecemos o Joinville Stroke Biobank, e discutimos aqui seu potencial na compreensão dos fatores de risco do AVC.

ABSTRACT Aiming to contribute to studies that use detailed clinical and genomic information of biobanks, we present the initial results of the first Latin American Stroke Biobank. Methods: Blood samples were collected from patients included in the Joinville Stroke Registry and four Brazilian cities. Demographic socio-economic data, cardiovascular risk factors, Causative Classification System for Ischemic Stroke, Trial of Org 10172 in Acute Stroke Treatment and National Institutes of Health scores, functional stroke status (modified Rankin) and brain images were recorded. Additionally, controls from both geographic regions were recruited. High-molecular-weight genomic DNA was obtained from all participants. Results: A total of 2,688 patients and 3,282 controls were included. Among the patients, 76% had ischemic stroke, 12% transient ischemic attacks, 9% hemorrhagic stroke and 3% subarachnoid hemorrhage. Patients with undetermined ischemic stroke were most common according the Trial of Org 10172 in Acute Stroke Treatment (40%) and Causative Classification System for Ischemic Stroke (47%) criteria. A quarter of the patients were under 55 years of age at the first-ever episode. Conclusions: We established the Joinville Stroke Biobank and discuss its potential for contributing to the understanding of the risk factors leading to stroke.

Abstract: INTRODUCTION: Members of the Acinetobacter genus are key pathogens that cause healthcare-associated infections, and they tend to spread and develop new antibiotic resistance mechanisms. Oxacillinases are primarily responsible for resistance to carbapenem antibiotics. Higher rates of carbapenem hydrolysis might be ascribed to insertion sequences, such as the ISAba1 sequence, near bla OXA genes. The present study examined the occurrence of the genetic elements bla OXA and ISAba1 and their relationship with susceptibility to carbapenems in clinical isolates of the Acinetobacter calcoaceticus-Acinetobacter baumannii complex. METHODS: Isolates identified over 6 consecutive years in a general hospital in Joinville, Southern Brazil, were evaluated. The investigation of 5 families of genes encoding oxacillinases and the ISAba1 sequence location relative to bla OXA genes was conducted using polymerase chain reaction. RESULTS: All isolates presented the bla OXA-51-like gene (n = 78), and 91% tested positive for the bla OXA-23-like gene (n = 71). The presence of ISAba1 was exclusively detected in isolates carrying the bla OXA-23-like gene. All isolates in which ISAba1 was found upstream of the bla OXA-23-like gene (n = 69) showed resistance to carbapenems, whereas the only isolate in which ISAba1 was not located near the bla OXA-23-like gene was susceptible to carbapenems. The ISAba1 sequence position of another bla OXA-23-like-positive isolate was inconclusive. The isolates exclusively carrying the bla OXA-51-like gene (n = 7) showed susceptibility to carbapenems. CONCLUSIONS: The presence of the ISAba1 sequence upstream of the bla OXA-23-like gene was strongly associated with carbapenem resistance in isolates of the A. calcoaceticus-A. baumannii complex in the hospital center studied.

Abstract: INTRODUCTION: Carbapenems are the therapy of choice for treating severe infections caused by the Acinetobacter calcoaceticus-Acinetobacter baumannii complex. We aimed to assess the prevalence and antimicrobial susceptibility profiles of producers of distinct oxacillinases among nosocomial isolates of the A. calcoaceticus-A. baumannii complex in a 249-bed general hospital located in Joinville, Southern Brazil. METHODS: Of the 139 A. baumannii clinical isolates with reduced susceptibility to carbapenems between 2010 and 2013, 118 isolates from varying anatomical sites and hospital sectors were selected for genotypic analysis. Five families of genes encoding oxacillinases, namely blaOXA-23-like, blaOXA-24-like, blaOXA-51-like, blaOXA-58-like, and blaOXA-143-like, wereinvestigated by multiplex polymerase chain reaction (PCR). RESULTS: Most (87.3%) isolates simultaneously carried the blaOXA-23-likeand blaOXA-51-likegenes, whereas three (2.5%) isolates harbored only blaOXA-51-likeones. The circulation of carbapenem-resistant isolates increased during the study period: from none in 2010, to 22 in 2011, 64 in 2012, and 53 in 2013. CONCLUSIONS: Isolates carrying the blaOXA-23-likeand blaOXA-51-likegenes were widely distributed in the hospital investigated. Because of the worsening scenario, the implementation of preventive measures and effective barriers is needed.

<sec><title>OBJETIVO:</title><p> Investigar a associação entre fatores de risco genéticos, comportamentais, biológicos e médicos e a ocorrência da prematuridade.</p></sec><sec><title>MÉTODOS:</title><p> Realizou-se estudo retrospectivo do tipo caso-controle. A técnica de reação em cadeia da polimerase em tempo real foi utilizada para analisar a influência dos polimorfismos rs12473815 do gene codificante para o receptor do hormônio folículo estimulante (<italic>FSHR</italic>) e rs1942836 do gene codificante para o receptor da progesterona (<italic>PGR</italic>). A avaliação dos outros fatores de risco se deu por meio da aplicação de questionários validados ou especificamente desenvolvidos e análise de dados em prontuário eletrônico. Foram incluídas 157 gestantes (45 casos com gestação <37 semanas e 112 controles com gestação >37 e ≤42 semanas).</p></sec><sec><title>RESULTADOS:</title><p> Os genótipos CT do polimorfismo rs12473815 e TC e CC do polimorfismo rs1942836 mostraram-se associados a uma maior chance de desenvolver parto prematuro. Observou-se associação entre o nascimento prematuro e a ingestão alcoólica quando o consumo ocorreu em duas ou mais ocasiões mensais. O baixo índice de massa corporal pré-gestacional se mostrou preditor do nascimento prematuro espontâneo, enquanto o elevado índice de massa corporal reduziu a sua probabilidade.</p></sec><sec><title>CONCLUSÕES:</title><p> Os resultados encontrados sugerem que a ingestão alcoólica excessiva, o baixo índice de massa corporal pré-gestacional e os alelos de risco dos polimorfismos rs12473815 e rs1942836 dos genes <italic>FSHR</italic>e <italic>PGR</italic>, respectivamente, influenciam a ocorrência de nascimento prematuro.</p></sec>

<sec><title>PURPOSE:</title><p> To investigate the association between genetic, behavioral, biological and medical risk factors and the occurrence of preterm birth.</p></sec><sec><title>METHODS:</title><p> A retrospective case-control study was conducted. The real-time polymerase chain reaction was used to analyze the influence of the rs12473815 polymorphism of the follicle stimulating hormone receptor gene (<italic>FSHR</italic>) and the rs1942836 polymorphism of the progesterone receptor gene (<italic>PGR</italic>). Other proposed risk factors were assessed using validated or specifically developed questionnaires and analysis of electronically recorded medical data. A total of 157 patients were included (45 cases who went into labor before 37 weeks of pregnancy and 112 controls who went into labor after 37 and before 42 weeks of pregnancy).</p></sec><sec><title>RESULTS:</title><p> The genotypes CT of rs12473815 and CT and CC of rs1942836 were associated with a higher chance of premature delivery. There was an association between preterm birth and alcohol intake when consumption occurred 2 or more times per month. Low pre-pregnancy body mass index was a predictor of spontaneous preterm birth, while high body mass index reduced this likelihood.</p></sec><sec><title>CONCLUSIONS:</title><p> The results suggest that excessive alcohol intake, a low level of pre-pregnancy body mass and the risk alleles of rs12473815 and rs1942836 polymorphisms of the FSHR and PGR genes, respectively, influence the occurrence of preterm birth.</p></sec>

Objetivo Analisar a influência da associação do polimorfismo G54D (rs1800450) do gene MBL2 no diabetes melito gestacional (DMG) quanto à necessidade de tratamento complementar e ocorrência de recém-nascidos grandes para a idade gestacional. Sujeitos e métodos Cento e cinco pacientes com DMG segundo parâmetro da OMS (Organização Mundial da Saúde) foram avaliadas no período de novembro de 2010 a outubro de 2012. As gestantes foram divididas em dois grupos correspondentes à presença (n = 37) ou à ausência (n = 68) do alelo mutante. As variantes do polimorfismo G54D foram identificadas por meio da técnica de polimorfismos de comprimentos de fragmentos de restrição (RFLP). Parâmetros antropométricos e bioquímicos da mãe e do recém-nascido (RN) e a necessidade de terapia complementar associada à dietoterapia foram avaliados como desfechos primários. Resultados Das pacientes analisadas, 35,2% carregavam pelo menos um alelo mutante do polimorfismo G54D. Os dois grupos não apresentaram diferença significativa quanto a ganho de peso, paridade, idade, índice de massa corporal e idade gestacional de chegada à maternidade. Os grupos de pacientes portadoras ou não do alelo mutante não diferiram quanto à necessidade de tratamento complementar à dietoterapia (16,2% vs. 26,7%) respectivamente e à ocorrência de recém-nascidos grandes para a idade gestacional (24,3% vs. 13,2%). Conclusão Nossos dados demonstraram que o polimorfismo G54D do gene MBL2 não teve efeito sobre a necessidade de tratamento complementar acrescido à dietoterapia e à ocorrência de recém-nascidos grandes para a idade gestacional na população estudada. Arq Bras Endocrinol Metab. 2014;58(9):900-5

Objective To assess the association of the G54D (rs1800450) polymorphism of the gene MBL2 in the gestational diabetes mellitus with the need for additional treatment and the occurrence of large newborns for the gestational age. Subjects and methods One hundred and five patients recruited in Joinville – Brazil were evaluated between November 2010 and October 2012. Pregnant women were divided in two groups correspondents to the presence (n = 37) or absence (n = 68) of the mutant allele. The variants of the polymorphism G54D were identified by restriction fragment lengths polymorphisms (RFLP). Anthropometric and biochemical parameters of the mother and the newborn, and the necessity of additional therapy associated with diet were assessed as the primary outcomes. Results Thirty-five point two percent of the evaluated patients carried at least one mutated allele of G54D polymorphism. There were no significant differences in weight gain, parity, age, body mass index and gestational age of arrival at maternity between the two groups. The groups of patients with or without the mutated allele did not differ in the need for additional treatment associated with diet (16.2% vs. 26.7%) respectively and with the occurrence of large newborns for gestational age (24.3% vs. 13.2%). Conclusion Our data showed that the polymorphism G54D of the gene MBL2 had no effect in the need for additional treatment associated with the diet-based therapy and in the occurrence of large newborns for gestational age in the studied population. Arq Bras Endocrinol Metab. 2014;58(9):900-5

Introdução: Células glandulares atípicas (CGA) são portadoras de alterações nucleares insuficientes para o diagnóstico de adenocarcinoma, mas excedem os critérios para classificação como células glandulares reacionais. Trata-se de um diagnóstico incomum, porém pode relacionar-se com lesões neoplásicas. Objetivo: Avaliar o significado clínico do diagnóstico citológico primário indicando CGA por meio da correlação com os resultados de exames histológicos subsequentes. Materiais e métodos: Estudo retrospectivo de 10 anos com base em resultados colpocitológicos indicando CGA, classificados como "possivelmente não neoplásicas" ou "não se pode afastar lesão intraepitelial de alto grau". Realizou-se a correlação cito-histopatológica nos casos que foram submetidos ao exame histopatológico até dois anos após a análise colpocitológica. Resultados: CGA foram relatadas em 380 (0,06%) exames, dispondo-se de 160 casos com biópsia subsequente. Destes, 85 (53,1%) apresentavam alterações benignas e 75 (46,9%), lesões neoplásicas. Dos 114 resultados citológicos "possivelmente não neoplásicas", 71 (62,3%) apresentavam alterações histológicas benignas e 43 (37,7%), neoplásicas, correspondendo a um valor preditivo negativo (VPN) equivalente a 62,3%. Contrariamente, entre os 46 resultados de CGA "não se pode afastar lesão intraepitelial de alto grau", 14 (30,4%) apresentavam alterações benignas e 32 (69,6%), neoplásicas (valor preditivo positivo [VPP] = 69,6%). Discussão: As altas taxas de neoplasias associadas ao diagnóstico de CGA reafirmam a importância do reconhecimento dessas atipias. A classificação em "possivelmente não neoplásicas" e "não se pode afastar lesão intraepitelial de alto grau" pode sugerir a origem das alterações citológicas. Conclusão: Nossos resultados reforçam a importância do seguimento adequado das pacientes com diagnóstico de CGA no exame colpocitológico.

Introduction: Atypical glandular cells (AGC) are carriers of insufficient nuclear abnormalities for the diagnosis of adenocarcinoma, but exceed the criteria for classification as reactive glandular cells. This is an uncommon diagnosis, which may be associated with neoplastic lesions. Objective: To evaluate the clinical significance of primary cytological diagnosis of AGC through correlation with results of subsequent cyto-histologic examination. Materials and methods: 10 years retrospective study based on cervical cytologic results indicating AGC, classified as "possibly non-neoplastic" or "cannot exclude high-grade intraepithelial lesion". It was performed cyto-histopathological correlation in cases that were submitted to subsequent histopathological examination up to two years after cervical cytology analysis. Results: AGC were reported in 380 (0.06%) exams, providing 160 cases with subsequent biopsy. 85 (53.1%) of these, presented benign changes and 75 (46.9%) neoplastic lesions. From 114 "possibly non-neoplastic" cytological results, 71 (62.3%) had benign histological changes, and 43 (37.7%) neoplastic lesions, corresponding to a negative predictive value (NPV) of 62.3%. In contrast, among the 46 AGC "cannot exclude high-grade intraepithelial lesion" results, 14 (30.4%) presented benign changes and 32 (69.6%) neoplastic lesions (positive predictive value [PPV] = 69.6%). Discussion: The high rate of cancer associated with the diagnosis of AGC reassures the importance of recognizing these atypical cells in pap smears. The classification of "possibly non-neoplastic" and "cannot exclude high-grade intraepithelial lesion" may suggest the origin of cytological changes. Conclusion: Our results reinforce the importance of adequate follow-up of patients with AGC diagnosis on cervical cytology.

ContextoA doença de Crohn caracteriza-se por uma desordem inflamatória, crônica e debilitante do trato gastrointestinal. Diversos fatores contribuem para seu desenvolvimento. A partir da realização de estudos amplos do genoma, o polimorfismo T300A do gene ATG16L1 (autophagy-related 16-like 1) tem sido relacionado com aumento de susceptibilidade ao desenvolvimento desta doença.ObjetivosAnalisar a incidência do polimorfismo T300A (rs2241880) em pacientes com doença de Crohn.MétodosForam analisadas 238 amostras de doadores de sangue (grupo controle) e 106 amostras de pacientes com doença de Crohn, procedentes de cinco centros. A genotipagem consistiu em amplificação do segmento gênico T300A, via reação em cadeia da polimerase, seguidos da análise de polimorfismo de comprimentos dos fragmentos de restrição. Os amplicons e fragmentos foram separados via eletroforese em gel de agarose e visualizados sob luz ultravioleta.ResultadosO genótipo AG foi mais prevalente entre os pacientes e controles (50% vs 44,8%), seguido dos genótipos AA (26,4% vs 35,1%) e GG (23,6% vs 20,1%). A freqüência do alelo G do polimorfismo T300A foi maior no grupo de pacientes com doença de Crohn (48,6%) do que nos controles (42,4%), embora sem significância estatística.ConclusõesNão foi possível confirmar o aumento de susceptibilidade à doença de Crohn conferido pelo polimorfismo T300A.

ContextCrohn’s disease is characterized by a chronic and debilitating inflammatory disorder of the gastrointestinal tract. Several factors may contribute to its development. From extensive studies of the human genome, the polymorphism T300A of the gene ATG16L1 (autophagy-related 16-like 1) has been related to increased risk of developing this disease.ObjectivesAnalyze the role of polymorphism T300A (rs2241880) in patients with Crohn’s disease.Methods238 samples from (control group) and 106 samples from patients with Crohn’s disease recruited at five Southern Brazilian reference centers were evaluated. The genotyping consisted of the amplification via Polymerase Chain Reaction of the genomic segment encompassing T300A, followed by Restriction Fragment Length Polymorphism analysis. The amplicons and fragments were separated by agarose gel electrophoresis and confirmed under ultraviolet light.ResultsThe genotype AG was more prevalent among patients and controls (50% vs 44.8%), followed by genotypes AA (26.4% vs 35.1%) and GG (23.6% vs 20.1%). The frequency of the allele G of the polymorphism T300A was higher in the group of patients with Crohn’s disease (48.6%) than in controls (42.4%), although not reaching statistical significance.ConclusionsIt was not possible to confirm the increased susceptibility on development of Crohn’s disease conferred by polymorphism T300A.

CONTEXTO: A utilização de drogas tiopurinas como a azatioprina e a 6-mercaptopurina tem se tornado bastante frequente no tratamento de doenças inflamatórias intestinais, transplantes e leucemias agudas. Apesar de sua efetividade, estas drogas são capazes de causar toxicidade droga-induzida com risco de morte através de mielossupressão. Sabe-se hoje que estas complicações ocorrem em decorrência de polimorfismos genéticos da enzima tiopurina metiltransferase (TPMT), responsável por sua metabolização. OBJETIVOS: Avaliar a prevalência do polimorfismo do gene da TPMT na população de Joinville, SC. MÉTODOS: Foi analisada a frequência das quatro principais variantes alélicas do gene da TPMT em 199 doadores de sangue da cidade de Joinville, SC, no período de fevereiro a abril de 2010. RESULTADOS: O alelo normal ("selvagem") foi encontrado em 93,9% dos indivíduos estudados. Variantes da TPMT foram detectadas em 12 sujeitos (6,03%). CONCLUSÕES: A partir do presente estudo, pode-se estimar em cerca de 6% o risco de toxicidade na administração de azatioprina e 6-mercaptopurina a pacientes em Joinville.

CONTEXT: The use of thiopurine drugs such as azathioprine and 6-mercaptopurine has become quite common in the treatment of inflammatory bowel disease, transplantation and acute leukemias. Despite their effectiveness, these drugs are capable of causing drug-induced toxicity with the risk of death by myelosuppression. It is now known that these complications occur because of genetic polymorphisms of the thiopurinemethyltransferase (TPMT) enzyme, responsible for its metabolism. OBJECTIVE: To assess the prevalence of thiopurine methyltransferase polymorphisms in the population of Joinville, SC, Brazil. METHODS: We analyzed the frequency of four main allelic variants of the TPMT gene in 199 blood donors from Joinville, from February to April 2010. RESULTS: The normal allele ("wild-type") was found in 93.9% of subjects studied. TPMT variants were detected in 12 subjects (6.03%). CONCLUSIONS: From this study, it was estimated at 6% the risk of toxicity by the administration of azathioprine and 6-mercaptopurine to patients in Joinville.

INTRODUÇÃO: A sepse é uma resposta inflamatória sistêmica relacionada com altas taxas de mortalidade no meio hospitalar. O diagnóstico etiológico tardio e terapia antimicrobiana inadequada se associam a falhas do tratamento. Exames moleculares baseados na reação em cadeia da polimerase são considerados métodos mais rápidos e precisos do que técnicas de hemocultura para identificação microbiana, proporcionando uma taxa mais elevada de sucesso terapêutico. OBJETIVO: Desenvolver um painel de seqüências iniciadoras (primers) para fragmentos de DNA de microrganismos associados à sepse. MÉTODOS: Seqüências iniciadoras para amplificação de Enterobacter spp., Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus e Candida spp. foram desenvolvidos e testados quanto a sensibilidade e especificidade com base em suas respectivas cepas padrão. RESULTADOS: A especificidade pretendida foi obtida para os primers de P. aeruginosa, S. aureus e Candida spp. O teste de sensibilidade mostrou um limite de detecção de 5 ng a 500 fg em amostras de sangue contaminado com DNA microbiano. CONCLUSÕES: O painel molecular apresentado oferece a vantagem de constituir um sistema flexível "aberto" em comparação a outros métodos de detecção múltipla.

INTRODUCTION: Sepsis is a systemic inflammatory response related to high mortality rates in the hospital environment. Delayed etiological diagnosis and inadequate antimicrobial therapy are associated with treatment failures. Molecular tests based on polymerase chain reaction are regarded as faster and more accurate procedures than culture techniques for microbial identification, providing a higher rate of therapeutic success. OBJECTIVE: To develop a panel of primers for DNA fragments of sepsis-related microorganisms. METHODS: Primers for amplification of Enterobacter spp., Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus and Candida spp. were designed and tested for sensitivity and specificity on the basis of their respective standard strains. RESULTS: The intended specificity was obtained for P. aeruginosa, S. aureus and Candida spp primers. Sensitivity tests showed a threshold for detection from 5 ng to 500 fg in blood samples contaminated with microbial DNA. CONCLUSIONS: The molecular panel presented offers the advantage of a flexible 'open' system when compared to other multiplex detection methods.