Objective - To correlate blood pressure and inflammatory markers with urine albumin analysed with a point-of-care testing (POCT) instrument, nephelometric determination of albumin and creatinine related urine albumin in elderly males. Methods and Results - The study population consisted of 103 diabetic and 603 nondiabetic males (age 77 years) in a cross-sectional study in central Sweden. We analyzed urine albumin with a HemoCue® Urine Albumin POCT instrument and a ProSpec® nephelometer and creatinine related urine albumin. There were strong correlation between both systolic and diastolic blood pressure and all three urine albumin methods (p<0.0001). There were also significant correlations between the different urine albumin measurements and SAA, hsCRP and IL-6. Conclusions - Hypertension has a strong impact on hyperfiltration in diabetic and nondiabetic elderly males.

Bisphenol A (BPA), a widely used chemical in plastic, has drawn wide attention due to its presence in many consumer products and the environment. The purpose of this study was to examine the association between urinary BPA and the reporting of cardiovascular diseases (CVD), and then to examine the effect of C-reactive protein (CRP) as a moderating variable. The data used in this research were extracted from the National Health and Nutrition Examination Survey collected in 2009-2010. Guided by the advanced epidemiological triangle, analysis involved 2 stepwise binary logistic regressions. The first step suggested that the controls were significant in predicting CVD (Ï?2 (5) = 83.72, p < .001, R2 = .15). The Nagelkerke R2 coefficient of determination indicated that the controls explained approximately 15% of the variance in instances of CVD. The second step of the binary logistic regression included the controls and BPA level in the model together. The regression analysis suggested that the Nagelkerke coefficient of determination (Ï?2 (6) = 83.76, p < .001, R2 = .15) did not increase from the 15% explained by the controls, and BPA level was found to be a nonsignificant predictor of CVD (p = .853). Due to lack of association between BPA and CVD, the analysis was shifted to examine the association between urinary BPA and serum CRP. The association between urinary BPA and serum CRP was also statistically nonsignificant (Spearman correlation coefficient, rs= .06, p = .015). The results may have positive social change by contributing to the body of knowledge on BPA and by increasing scientific scrutiny for substances used in people's daily lives.

Note: / Clinical chemistry is a medical discipline whose aim is to diagnose and assess disease by analysis of biological specimens. Modem laboratories can perform several hundred different tests using many different methods developed over the last century. The classical, more traditional assays are typically labour-intensive, not multiplexed (only measure one analyte or disorder per assay), expensive, require a long turnaround time, and may not provide adequate sensitivity and specificity. Developments in mass spectrometry (MS) and related technologies over the last two decades have provided solutions for many if not all of these shortcomings. While MS based applications have not yet been widely implemented in clinical chemistry laboratories, current developments will encourage the replacement of traditional methods as well as the expansion of clinically diagnostic endpoints. Indeed, modem MS can be used to simultaneously analyze and quantitate multiple biomarkers in a single analysis. Currently, no other technique exists that can provide a comparable multiplexed analysis. In this thesis, current MS and related technologies were developed and applied to several important but distinct clinical chemistry applications. [...] / La chimie clinique est une discipline medicale qui a pour but de diagnostiquer la presence et la progression d'une maladie par l'analyse d'echantillons biologiques. Les laboratoires modemes peuvent executer des centaines d'analyses en utilisant plusieurs methodes developpees au courrant des cent demieres annees. Les essaisc1assiques, et plus traditionnels, sont souvent laborieux, non multiplexe (mesurent seulement un analyte par essai), cher, exige un long temps de rotation et risque de ne pas fournir une specificite adequate. Pendant les deux dernieres decennies, les developpements dans Ie domaine de la spectrometrie de masse (MS) et les technologies rattachees ont foumi des solutions a plusieurs, pour ne pas dire tous, manques retrouves dans les methodes d'analyse traditionnelles.

Motivation: Cardiovascular heart disease (CVD) is the leading cause of death worldwide. Risk markers for CVD include, amongst others, the haemostatic factors tissue-type plasminogen activator (t-PA), plasminogen activator inhibitor type 1 (PAI-1), factor VII (FVII) and fibrinogen and more recently, C-reactive protein (CRP), a sensitive marker of inflammation. Epidemiological studies have demonstrated an inverse association between dietary fibre (DF) consumption and risk factors for CVD and CVD prevalence. Some research indicates that this protection may be related to favourable changes in the haemostatic profile and inflammatory markers. This is applicable for the consumption of total DF, as well as soluble and insoluble fibre. However, clinical intervention trials report conflicting data on the effects of DF on t-PA, PAI-1, FVII, fibrinogen and CRP. In addition, available literature is not clear on the mechanisms through which DF may have favourable effects. Objective: The main objective of this study was to review the results of randomised controlled trials systematically on the effects of DF on the above-mentioned selected haemostatic variables and CRP in healthy adults and subjects with hypertriglyceridaemia and the metabolic syndrome. Methods: Human adult intervention trials, at least two weeks in duration, with an increased and measurable consumption of DF were included. Electronic databases were searched from the earliest record to May/July 2006 and supplemented by crosschecking reference lists of relevant publications. From the literature search, two reviewers identified studies that were rated for quality based on the published methodology. No formal statistical analysis was performed due to the large differences in the study designs of the dietary intervention trials. The primary outcome measures were percentage changes between intervention and control groups, or baseline to end comparisons for t-PA, PAI-1, FVII, fibrinogen and CRP. Results t-PA activity increased significantly (14-167%) over the short and long-term following increased fibre intakes. PAI-1 activity decreased significantly between 15-57% over periods ranging from two to six weeks. These favourable changes in t-PA and PAI-1 occurred in healthy, hypertriglyceridaemic and metabolic syndrome subjects following consumption of diets containing ≥3.3 g/MJ DF and ≥4.5 g/MJ DF respectively. Mechanisms through which DF may affect t-PA and PAI-1 include its lowering effect on insulinaemic and glycaemic responses, decreasing triglycerides which are a precursor of very-low-density lipoproteins, fermentation of DF to short-chain fatty acids, which may reduce free fatty acid concentrations, as well as the role of DF in promoting weight loss. High DF intakes did not have a significant effect on fibrinogen concentrations possibly because of relatively little weight loss, too low DF dosages and maintaining a good nutritional status. Inadequate study designs deterred from meaningful conclusions. Significant decreases in FVll coagulant activity (6-16%) were observed with DF intakes of ≥3.3 g/MJ and concomitant decreased saturated fat intakes and weight loss in healthy and hypertriglyceridaemic subjects. Confounding factors include weight loss and a simultaneous decreased intake of saturated fats. The type of fibre seems to play a role as well. Mechanisms through which DF may reduce FVll concentrations include its effects on triglyceride-rich lipoproteins, insulin and weight loss. Increased DF consumption with dosages ranging between 3.3-7.8 g/MJ were followed by significantly lower CRP concentrations (25-54%), however, simultaneous weight loss and altered fatty acid intakes were also present in all the studies. Mechanisms are inconclusive but may involve the effect of DF on weight loss, insulin, glucose, adiponectin, interleukin-6, free fatty acids and triglycerides. Conclusions: Epidemiological evidence indicates an association between DF and the CVD risk factors t-PA, PAI-1, FVII, fibrinogen and CRP. In general, the risk of CVD may improve with high-fibre intakes as indicated by the favourable changes in some of the parameters. However, simultaneous reduced fat intakes and weight loss presented difficulties in separating out the effects of specific components. Furthermore, DF is consumed in a variety of different forms and different dosages that may have different effects. Overall, the study designs used in the intervention trials prevented significant conclusions. DF did, however, play a role in modifying t-PA, PAI-1, FVII and CRP. Potential effects on fibrinogen were not quantifiable. Recommendations: The results from this investigation provide the motivation for additional controlled clinical research to establish the effect and mechanisms of DF on haemostatic variables and CRP. A critical aspect of future studies would be to set up suitable protocols. The amount of subjects, duration of the trials, confounding factors such as weight loss and altered fat intakes and differentiation between types and dosage of DF are important. DF supplemental studies are recommended as they may be the most suitable method to reach meaningful conclusions. / Thesis (Ph.D. (Nutrition))--North-West University, Potchefstroom Campus, 2007

Systemic inflammation is associated with impaired lung function. Inflammation is part of asthma and chronic obstructive pulmonary disease (COPD), but the local and systemic inflammatory pattern differs. The overall aim was to evaluate systemic inflammatory markers in obstructive lung diseases and more specifically: To determine if CRP is related to respiratory symptoms, asthma, atopy and bronchial responsiveness (paper I), in a population sample from three countries (paper I and II); to evaluate if CRP is related to COPD, lung function and rate of lung function decline (paper II); to investigate the association of serum MMP-9 and TIMP-1 with lung function in a cross-sectional population based study (paper III); and finally, to study possible gender differences in the longitudinal association between CRP and lung function in a prospective population based study (paper IV). In the first study we reported that CRP was related to non-allergic asthma but not allergic asthma, and that CRP was related to respiratory symptoms such as wheeze, nocturnal cough and breathlessness after effort, but not associated with atopy or bronchial responsiveness. In the second study we found that COPD was more common in subjects in the highest CRP quartiles and higher CRP levels were associated with lower FEV1 values in both men and women, but the negative association between CRP and FEV1 was larger in men than women. The FEV1 decline was larger in men with high CRP levels, whereas no such association was found for women. In the third study we reported that lower FEV1 was associated with higher levels of MMP-9, TIMP-1 and their ratio MMP-9/TIMP-1. After stratification for gender this association was significant in men but not women. In the fourth study we found that CRP levels were associated with change in both FEV1 and FVC in men but not women. This association was found for both baseline CRP and change in CRP, confirming a stronger association between systemic inflammation and lung function decline in men than women. In conclusion, systemic inflammation is associated with non-allergic asthma but not allergic asthma. Our findings of a stronger association between the systemic inflammation and lung function impairment in men, but not women, may indicate a gender difference in the mechanisms of lung function decline.

Diss. (sammanfattning) Umeå : Umeå universitet, 2010.

A leptospirose é uma zoonose de ampla distribuição mundial, causada pela infecção por sorovares patogênicos do gênero Leptospira. Assim como outras espécies de animais acometidos, os cães que sobreviverem à fase aguda da doença podem se tornar portadores, excretando a bactéria através da urina. Algumas alterações no hemograma, bioquímica sérica e urinálise, juntamente com o histórico do paciente e fatores de risco, auxiliam na suspeita da doença; porém, o diagnóstico definitivo é realizado através de testes mais específicos. Estes testes incluem sorologia, técnicas moleculares como a reação em cadeia da polimerase (PCR) e cultura para isolamento do sorovar. O presente trabalho caracterizou e comparou a leptospirose em três populações caninas de Porto Alegre. Foram avaliados 33 cães com suspeita da doença, atendidos no Hospital de Clínicas Veterinárias (HCV) da Universidade Federal do Rio Grande do Sul (UFRGS); 65 cães provenientes do Centro de Controle de Zoonoses (CCZ) de Porto Alegre; e 155 cães residentes no bairro Arquipélago na zona urbana de Porto Alegre, onde existe uma alta incidência de leptospirose humana. O diagnóstico da leptospirose canina foi baseado na sorologia e PCR no soro e urina. Um total de 14,6% (37/253) dos cães apresentaram resultado positivo na PCR no sangue (leptospiremia) e 14,2 % (36/253) na urina (leptospirúria). Em relação à sorologia, 48,2% (122/253) foram positivos para um ou mais sorovares. Os sorovares mais prevalentes foram canicola, icterohaemorrhagiae e copenhageni. A presença de ratos no ambiente foi associada a leptospirúria (P=0,02). Na população do HCV, o aumento da creatinina sérica (P=0,009), icterícia (P=0,004) e glicosúria (P=0,04) foram associados com leptospirúria. Apesar destas associações encontradas, observou-se que a ausência de sinais clínicos ou de alterações no hemograma, bioquímica sérica ou urinálise não excluíram a infecção (P>0.05). Em um segundo estudo, foi investigada a eficácia da doxiciclina na eliminação do estado de portador renal em quatro cães assintomáticos. Destes, três estavam infectados com o sorogrupo Canicola e um com o sorogrupo Icterohaemorrhagiae. Os cães foram acompanhados por 30 dias após o início do tratamento, e a ausência de leptospiras na urina foi confirmada através de três resultados seriados de PCR negativa em cada cão. Finalmente, valor preditivo da proteína C reativa (C-RP) na leptospirose foi investigado em 62 cães, comparando sua concentração sérica e urinária com os resultados de sorologia e PCR. Sorologia positiva foi associada com C-RP urinária (P= 0,038). Houve apenas associação fraca entre proteína C-reativa sérica e PCR no sangue (área sob a curva= 0,68), e não foi observada associação entre C-RP urinária e PCR na urina. Não foram observadas vantagens de se incluir a C-RP como um teste de triagem para leptospirose em cães. As informações obtidas com os estudos aqui citados mostra a importância do diagnóstico definitivo, preferencialmente realizado através de PCR; a necessidade de se testar cães expostos a fatores de risco, independente de seu estado aparente de saúde; a importância de medidas sanitárias para a prevenção da doença e o tratamento adequado para que se elimine o possível estado de portador renal dos cães. / Leptospirosis is a zoonosis of worldwide distribution, caused by infection with pathogenic serovars of the genus Leptospira. As other affected species of animals, the dogs that survive the acute phase of the disease can become carriers, excreting the bacteria in the urine. Some alterations in blood count, serum biochemistry and urinalysis, along with patient history and risk factors, may contribute to a presumptive diagnosis, but the definitive diagnosis is made using more specific tests. These tests include serology, molecular techniques like polymerase chain reaction (PCR) and culture for the serovar isolation. The present study characterized and compared leptospirosis in three canine populations of Porto Alegre, RS. Thirty three dogs with suspected disease were evaluated at the Veterinary Hospital of the Federal University of Rio Grande do Sul, 65 dogs from the Control Center of Zoonoses from Porto Alegre and 155 dogs from Archipelago neighborhood, where there is a high incidence of human leptospirosis. The diagnosis of canine leptospirosis was based on serology and PCR in serum and urine. A total of 14.6% (37/253) of dogs tested positive in PCR in blood (leptospiremia) and 14.2% (36/253) in the urine (leptospiruria). With regard to serology, 48.2% (122/253) were positive for one or more serovars. The most prevalent serovars were canicola, icterohaemorrhagiae and copenhageni. The presence of rats in the environment was associated with leptospiruria (P = 0.02). In the Veterinary Hospital population, increased serum creatinine (P = 0.009), jaundice (P = 0.004) and glucosuria (P = 0.04) were associated with leptospiruria. Despite these associations, it was observed that the absence of clinical signs or changes in blood count, serum biochemistry and urinalysis did not exclude infection (P> 0.05). In a second study, we investigated the effectiveness of doxycycline to eliminate the carrier state in four asymptomatic dogs. Three were infected with serogroup Canicola and one with serogroup Icterohaemorrhagiae. The dogs were followed for 30 days after starting treatment, and the absence of leptospires in urine was confirmed by three serial results of negative PCR in each dog. Finally, the predictive value of C-reactive protein (C-RP) in leptospirosis was investigated in 62 dogs, comparing its serum and urinary concentrations with serology and PCR. Seropositivity was associated with urinary C-RP (P = 0.038). There was only a weak association between C-RP and serum PCR in blood (AUC = 0.68), and no association was found between urinary C-RP and PCR in urine. There were no advantages to include the C-RP as a screening test for leptospirosis in dogs. The information gathered from the studies cited here shows the importance of the definitive diagnosis, preferably performed by PCR; the need to test dogs exposed to risk factors, regardless of their apparent health condition, the importance of sanitary surveillance for the prevention of the disease, and adequate treatment to eliminate the carrier state.

Evidências sugerem o envolvimento de um estado de inflamação crônica de baixo grau na fisiopatologia do transtorno bipolar (TB). Os estudos apresentados nesta tese tiveram como objetivo explorar o papel da inflamação crônica nos mecanismos fisiopatológicos do TB através da avaliação dos níveis séricos de proteína C-reativa (PCR). A PCR é um marcador de inflamação sistêmica comumente utilizado na prática clínica, sendo considerado fator de risco para várias patologias, incluindo câncer e doença cardiovascular. O primeiro artigo, através de um estudo de meta-análise, teve como objetivo avaliar o tamanho de efeito da associação entre níveis de PCR em pacientes bipolares nas diferentes fases de humor (n=730) comparado a indivíduos controles (n=888). Pacientes bipolares apresentaram níveis de PCR significativamente elevados em comparação ao grupo controle, com moderado tamanho de efeito (effect size, ES = 0.39; 95% IC, 0.24 – 0.55; P < 0.0001). Níveis de PCR foram significativamente maiores em pacientes maníacos (ES = 0.73; 95% IC, 0.44 – 1.02; P < 0.001) e em eutímicos (ES = 0.26; 95% IC, 0.01 – 0.51; P = 0.04). O segundo artigo se propôs a revisar dados da literatura relacionados a biomarcadores periféricos potencialmente implicados na progressão do TB. Pacientes em diferentes estágios do TB apresentaram níveis alterados de marcadores de estresse oxidativo, neurotrofinas e de inflamação, incluindo a PCR, o que reforça a hipótese da inflamação crônica exercer um papel importante na fisiopatologia do TB. Em seguida, considerando a abordagem multidimensional no TB, o terceiro artigo avaliou a reatividade emocional como uma dimensão relevante para caracterizar pacientes bipolares apresentando sintomas subclínicos de humor durante a fase de remissão (N=613). Apesar de todos pacientes estarem em remissão, a maioria deles (68%) apresentou reatividade emocional anormal (hipo ou hiper-reatividade emocional). Esse estudo avaliou, também, o funcionamento psicossocial nesses pacientes e os níveis de PCR ultra-sensível como um possível marcador objetivo de hiper-reatividade emocional no TB. Os pacientes com hiper-reatividade emocional, em comparação aos pacientes com hipo- ou normal reatividade emocional, apresentaram prejuízo cognitivo e níveis de PCR significativamente mais elevados (P < 0.001). Esses resultados provêm de um estudo transversal e, portanto, conclusões sobre causalidade dessas associações não podem ser inferidas, já que outros fatores, além dos níveis de PCR, podem também contribuir para o estado inflamatório crônico observado nesses pacientes. Em suma, os resultados desta tese sugerem que a inflamação crônica de baixo grau, evidenciada pelas alterações nos níveis de PCR, parece estar implicada na fisiopatologia e na progressão do TB. Novas intervenções terapêuticas com alvo em mecanismos inflamatórios e na modulação dos níveis de PCR devem ser priorizados em estudos futuros. / Evidence suggests that chronic low-grade inflammation appears to be involved in the pathophysiology of bipolar disorder (BD). The studies presented in this thesis aimed at exploring the role of chronic inflammation in the BD pathophysiological mechanisms by assessing serum levels of C-reactive protein (CRP). CRP is a marker of low-grade inflammation widely used in clinical practice, and a risk factor for cardiovascular and malignant diseases. The first article, a meta-analysis, aimed at evaluating the effect size of the association between CRP levels in bipolar patients (n=730) compared to healthy subjects (n=888). Overall, CRP levels were significantly elevated in patients with BD versus controls (effect size, ES = 0.39; 95% CI, 0.24 to 0.55; P < .0001). CRP levels were significantly higher in manic (ES = 0.73; 95% CI, 0.44 to 1.02; P < 0.001) and euthymic (ES = 0.26; 95% CI, 0.01 to 0.51; P = 0.04). The second paper aimed at reviewing the scientific literature regarding peripheral biomarkers potentially implicated in the progression of BD. Bipolar patients within different disease’s stages presented altered levels of oxidative stress, neurotrophins and inflammatory markers, including PCR. These findings reinforce the hypothesis of the potential role of the chronic inflammation in BD pathophysiology. Regarding the multidimensional approach in BD, the third article assessed emotional reactivity as a major dimension for better characterizing remitted bipolar patients with subthreshold mood symptoms (N=613). Although all patients were in remission, most of them (68%) showed abnormal emotional reactivity (hipo- or hyper-reactivity). In addition, this study assessed the psychosocial functioning in these patients as well as the levels of high-sensitivty PCR (hsCRP) as an objective marker of emotional hyper-reactivity in BD. Patients with emotional hyper-reactivity had higher levels of PCR and cognitive impairment compared to patients with emotional hypo or normal emotional reactivity (P < 0.001). This was a crosssectional study of emotional reactivity, hsCRP levels and functional status in remitted bipolar patients, and no conclusions regarding the causality of these associations can be substantiated. Others factors could also be contributing to the chronic inflammatory state in these patients. In conclusion, the results of this thesis suggest that low-grade chronic inflammation, as evidenced by alteration in CRP levels, may be implicated in the pathophysiology as well as in the BD progression. Novel therapeutic interventions targeting inflammatory mechanisms and the modulation of CRP levels should be prioritized in future studies.

A leptospirose é uma zoonose de ampla distribuição mundial, causada pela infecção por sorovares patogênicos do gênero Leptospira. Assim como outras espécies de animais acometidos, os cães que sobreviverem à fase aguda da doença podem se tornar portadores, excretando a bactéria através da urina. Algumas alterações no hemograma, bioquímica sérica e urinálise, juntamente com o histórico do paciente e fatores de risco, auxiliam na suspeita da doença; porém, o diagnóstico definitivo é realizado através de testes mais específicos. Estes testes incluem sorologia, técnicas moleculares como a reação em cadeia da polimerase (PCR) e cultura para isolamento do sorovar. O presente trabalho caracterizou e comparou a leptospirose em três populações caninas de Porto Alegre. Foram avaliados 33 cães com suspeita da doença, atendidos no Hospital de Clínicas Veterinárias (HCV) da Universidade Federal do Rio Grande do Sul (UFRGS); 65 cães provenientes do Centro de Controle de Zoonoses (CCZ) de Porto Alegre; e 155 cães residentes no bairro Arquipélago na zona urbana de Porto Alegre, onde existe uma alta incidência de leptospirose humana. O diagnóstico da leptospirose canina foi baseado na sorologia e PCR no soro e urina. Um total de 14,6% (37/253) dos cães apresentaram resultado positivo na PCR no sangue (leptospiremia) e 14,2 % (36/253) na urina (leptospirúria). Em relação à sorologia, 48,2% (122/253) foram positivos para um ou mais sorovares. Os sorovares mais prevalentes foram canicola, icterohaemorrhagiae e copenhageni. A presença de ratos no ambiente foi associada a leptospirúria (P=0,02). Na população do HCV, o aumento da creatinina sérica (P=0,009), icterícia (P=0,004) e glicosúria (P=0,04) foram associados com leptospirúria. Apesar destas associações encontradas, observou-se que a ausência de sinais clínicos ou de alterações no hemograma, bioquímica sérica ou urinálise não excluíram a infecção (P>0.05). Em um segundo estudo, foi investigada a eficácia da doxiciclina na eliminação do estado de portador renal em quatro cães assintomáticos. Destes, três estavam infectados com o sorogrupo Canicola e um com o sorogrupo Icterohaemorrhagiae. Os cães foram acompanhados por 30 dias após o início do tratamento, e a ausência de leptospiras na urina foi confirmada através de três resultados seriados de PCR negativa em cada cão. Finalmente, valor preditivo da proteína C reativa (C-RP) na leptospirose foi investigado em 62 cães, comparando sua concentração sérica e urinária com os resultados de sorologia e PCR. Sorologia positiva foi associada com C-RP urinária (P= 0,038). Houve apenas associação fraca entre proteína C-reativa sérica e PCR no sangue (área sob a curva= 0,68), e não foi observada associação entre C-RP urinária e PCR na urina. Não foram observadas vantagens de se incluir a C-RP como um teste de triagem para leptospirose em cães. As informações obtidas com os estudos aqui citados mostra a importância do diagnóstico definitivo, preferencialmente realizado através de PCR; a necessidade de se testar cães expostos a fatores de risco, independente de seu estado aparente de saúde; a importância de medidas sanitárias para a prevenção da doença e o tratamento adequado para que se elimine o possível estado de portador renal dos cães. / Leptospirosis is a zoonosis of worldwide distribution, caused by infection with pathogenic serovars of the genus Leptospira. As other affected species of animals, the dogs that survive the acute phase of the disease can become carriers, excreting the bacteria in the urine. Some alterations in blood count, serum biochemistry and urinalysis, along with patient history and risk factors, may contribute to a presumptive diagnosis, but the definitive diagnosis is made using more specific tests. These tests include serology, molecular techniques like polymerase chain reaction (PCR) and culture for the serovar isolation. The present study characterized and compared leptospirosis in three canine populations of Porto Alegre, RS. Thirty three dogs with suspected disease were evaluated at the Veterinary Hospital of the Federal University of Rio Grande do Sul, 65 dogs from the Control Center of Zoonoses from Porto Alegre and 155 dogs from Archipelago neighborhood, where there is a high incidence of human leptospirosis. The diagnosis of canine leptospirosis was based on serology and PCR in serum and urine. A total of 14.6% (37/253) of dogs tested positive in PCR in blood (leptospiremia) and 14.2% (36/253) in the urine (leptospiruria). With regard to serology, 48.2% (122/253) were positive for one or more serovars. The most prevalent serovars were canicola, icterohaemorrhagiae and copenhageni. The presence of rats in the environment was associated with leptospiruria (P = 0.02). In the Veterinary Hospital population, increased serum creatinine (P = 0.009), jaundice (P = 0.004) and glucosuria (P = 0.04) were associated with leptospiruria. Despite these associations, it was observed that the absence of clinical signs or changes in blood count, serum biochemistry and urinalysis did not exclude infection (P> 0.05). In a second study, we investigated the effectiveness of doxycycline to eliminate the carrier state in four asymptomatic dogs. Three were infected with serogroup Canicola and one with serogroup Icterohaemorrhagiae. The dogs were followed for 30 days after starting treatment, and the absence of leptospires in urine was confirmed by three serial results of negative PCR in each dog. Finally, the predictive value of C-reactive protein (C-RP) in leptospirosis was investigated in 62 dogs, comparing its serum and urinary concentrations with serology and PCR. Seropositivity was associated with urinary C-RP (P = 0.038). There was only a weak association between C-RP and serum PCR in blood (AUC = 0.68), and no association was found between urinary C-RP and PCR in urine. There were no advantages to include the C-RP as a screening test for leptospirosis in dogs. The information gathered from the studies cited here shows the importance of the definitive diagnosis, preferably performed by PCR; the need to test dogs exposed to risk factors, regardless of their apparent health condition, the importance of sanitary surveillance for the prevention of the disease, and adequate treatment to eliminate the carrier state.

Introdução: A readmissão de pacientes nas unidades de terapia intensiva (UTIs) está associada a piores desfechos durante a internação hospitalar. Através da análise de preditores existe a possibilidade de identificar os pacientes sob risco de readmissão e planejar possíveis intervenções visando melhorar a segurança destes pacientes. Objetivos: Avaliar o desempenho da saturação venosa central (SvcO2), do lactato, do déficit de bases (DB), dos níveis de proteína C reativa (PCR), do Sequential Organ Failure Assessment (SOFA), do Stability and Workload Index for Transfer (SWIFT) escore do dia da alta da UTI como preditores e fatores de risco para readmissão de pacientes na unidade de terapia intensiva (UTI), além de verificar a frequência de readmissões na UTI. Métodos: O estudo avaliou pacientes criticamente enfermos internados consecutivamente na unidade de terapia intensiva do Hospital Nossa Senhora da Conceição que receberem alta da UTI, no período entre Agosto/2011 e Agosto/2012. Resultados principais: Utilizando análise multivariada o SOFA e o SWIFT da alta foram identificados como fatores de risco independentemente associados à readmissão na UTI. Entretanto, com uma área sob a curva receiver operating characteristic (ROC) de 0,63 e 0,66 respectivamente, estes escores podem não ter grande aplicabilidade clínica em nossa população. A PCR, a SvcO2, o DB e o lactato não estão associados a readmissão de pacientes críticos. Conclusões: Apesar do grande impacto clínico e econômico associado à readmissão de pacientes na UTI, nossa capacidade para discriminar os pacientes sob risco de readmissão e objetivar os critérios de alta dos pacientes críticos segue inadequada. / Background: Readmission of patients in intensive care units (ICUs) is associated with worse outcomes during hospitalization. Possibly, identifying patients at risk for readmission through the analysis of predictors, some intervention may be planned for the security of these patients. Objectives: To evaluate the performance of central venous oxygen saturation (ScvO2), lactate, base deficit (BD), C-reactive protein (CRP), the Sequential Organ Failure Assessment (SOFA) score and the Stability and Workload Index for Transfer (SWIFT) score at the day of discharge from the intensive care unit (ICU) as predictors and risk factors for readmission or unexpected death among critically ill patients and to identify the frequency of readmissions in the ICU. Design: Prospective observational study. Location: academic tertiary hospital in Brazil. Patients: A total of 1,360 patients admitted to a 59 beds medical-surgical ICU from August 2011 to August 2012. Methods: We compared the characteristics and laboratory data of readmitted patients and not readmitted patients discharged from the ICU. Through multivariate analysis we identified potential risk factors independently associated with readmission. Main results: SOFA and SWIFT were identified as significant risk factors for ICU readmission. However, with an area under the ROC curve of 0.63 and 0.66, these scores would appear to have limited clinical applicability in our population. CRP, ScvO2, BD and lactate were not associated with readmission of critically ill patients. Conclusions: Perfusion and inflammatory markers are not good predictors of ICU readmission. Despite the clinical and economic impact associated with readmission in ICU, our ability to predict which patients will be readmitted is still inadequate.