Thesis (M.S.)--Uniformed Services University of the Health Sciences, 2005. / Typescript (photocopy).

Thesis (M.S.)--Uniformed Services University of the Health Sciences, 2005. / Typescript (photocopy).

Thesis (M.S.)--Uniformed Services University of the Health Sciences, 2005. / Typescript (photocopy).

O objetivo desse estudo foi comparar a habilidade da avaliação subjetiva do disco óptico e da camada de fibras nervosas (CFN) por oftalmologistas generalistas e por um glaucomatólogo com medidas objetivas pela tomografia de coerência óptica (Stratus OCT), oftalmoscopia confocal de varredura a laser (HRTIII), e a polarimetria de varredura a laser (GDxECC) para discriminar olhos glaucomatosos de olhos normais. 61 olhos glaucomatosos e 57 olhos normais de 118 indivíduos foram incluídos nesse estudo. Três oftalmologistas generalistas independentes e um glaucomatólogo avaliaram fotografias estereoscópicas do disco óptico. Curvas ROC (Receiver Operator Characteristic) foram construídas para cada técnica de imagem e a sensibilidade a uma especificidade fixa foi determinada. Comparações das áreas sob essas curvas (AROC) e a concordância (k) foram determinadas entre a graduação das fotografias estereoscópicas e o melhor parâmetro de cada exame de imagem computadorizado. O melhor parâmetro de cada técnica de imagem computadorizada (CFN temporal inferior do Stratus OCT = 0,92; área integrada vertical da topografia do disco óptico pelo Stratus OCT = 0,86; espessura macular do setor inferior externo fornecido pelo Stratus OCT = 0,82; NFI do GDxECC = 0,91; razão área E/D do HRT3 = 0,83) mostrou AROC maior do que a graduação das fotografias estereoscópicas por oftalmologistas generalistas (0,80) para separar olhos glaucomatosos de olhos normais. A graduação por glaucomatólogo forneceu AROC igual ou maior (0,92) do que o melhor parâmetro de exame computadorizado de imagem. A avaliação das fotografias estereoscópicas por glaucomatólogo mostrou melhor concordância com o melhor parâmetro de cada técnica de imagem quantitativa na classificação de olhos como glaucomatosos ou normais comparadas à avaliação de fotografias estereoscópicas por oftalmologistas generalistas. A combinação da avaliação subjetiva do disco óptico por oftalmologistas generalistas com parâmetros objetivos da CFN melhorou a identificação de olhos com glaucoma em uma proporção maior do que a combinação desses parâmetros objetivos com a avaliação do disco óptico por um glaucomatólogo (29,5% versus 19,7%, respectivamente). Os resultados sugerem que a habilidade diagnóstica de todos os exames de imagem computadorizados estudados mostrou melhor desempenho que a avaliação subjetiva do disco óptico por oftalmologistas generalistas, mas não por um glaucomatólogo. Medidas objetivas da CFN podem permitir um aperfeiçoamento na detecção de glaucoma quando combinados com a avaliação subjetiva do disco óptico por oftalmologistas generalistas ou por um glaucomatólogo. / The purpose of this study was to compare the ability of subjective assessment of optic nerve head and retinal nerve fiber layer by general ophthalmologists and by a glaucoma expert with objective measurements by optical coherence tomography (Stratus OCT, Carl Zeiss Meditec, Inc.), confocal scanning laser ophthalmoscope (HRT III; Heidelberg Engineering, Heidelberg, Germany), and scanning laser polarimetry (GDx ECC; Carl Zeiss Meditec, Inc., Dublin, CA) in discriminating glaucomatous and normal eyes. 61 glaucomatous and 57 normal eyes of 118 subjects were included in the study. Three independent general ophthalmologists and one glaucoma expert evaluated ONH stereophotographs. Receiver operating characteristic curves were constructed for each imaging technique and sensitivity at fixed specificity was estimated. Comparisons of areas under these curves (aROC) and agreement (k) were determined between stereophoto grading and best parameter from each technique. Best parameter from each technique showed larger aROC (StratusOCT RNFL = 0.92; StratusOCT ONH vertical integrated area = 0.86; StratusOCT macular thickness = 0.82; GDxECC = 0.91; HRT3 global cup-to-disc area ratio = 0.83) compared to stereophotograph grading by general ophthalmologists (0.80) in separating glaucomatous and normal eyes. Glaucoma expert stereophoto grading provided equal or larger aROC (0.92) than best parameter of each computerized imaging device. Stereophoto evaluated by a glaucoma expert showed better agreement with best parameter of each quantitative imaging technique in classifying eyes either as glaucomatous or normal compared to stereophoto grading by general ophthalmologists. The combination of subjective assessment of the optic disc by general ophthalmologists with RNFL objective parameters improved identification of glaucoma patients in a larger proportion than the combination of these objective parameters with subjective assessment of the optic disc by a glaucoma expert (29.5% versus 19.7%, respectively). The results suggests that the diagnostic ability of all imaging techniques showed better performance than subjective assessment of the ONH by general ophthalmologists, but not by a glaucoma expert. Objective RNFL measurements may provide improvement in glaucoma detection when combined with subjective assessment of the optic disc by general ophthalmologists or by a glaucoma expert.

A ecocardiografia com perfusão miocárdica em tempo real (EPMTR) permite a quantificação do fluxo sangüíneo miocárdico e, quando realizada durante o estresse, da reserva de fluxo miocárdico (reserva Axß). Essa técnica tem potencial para ser uma importante ferramenta para o diagnóstico não-invasivo da doença arterial coronariana (DAC). Apesar do conhecimento atual das alterações fisiológicas que ocorrem com o uso de agentes vasodilatadores ou catecolaminas na circulação coronariana, não há dados na literatura comparando diretamente o valor da EPMTR, sob estresse pela dobutamina e pela adenosina, para a detecção de DAC em humanos. Os objetivos deste estudo foram: avaliar, em um mesmo grupo de pacientes, a exeqüibilidade e a acurácia da EPMTR, sob estresse pela dobutamina e pela adenosina, para a detecção de estenose arterial coronariana angiograficamente significativa e determinar o valor adicional da análise quantitativa da perfusão miocárdica sobre o eletrocardiograma de 12 derivações, da motilidade segmentar e da análise qualitativa da perfusão miocárdica obtidas durante o estresse pela dobutamina e pela adenosina. Estudamos 54 pacientes (média etária de 60±9 anos, 33 homens) com suspeita clínica de DAC e indicação de angiografia coronariana. Todos os pacientes foram submetidos à EPMTR sob estresse pela adenosina na dose de 140 g/kg/min por seis minutos e, após um intervalo de três a cinco horas, à EPMTR sob estresse pela dobutamina-atropina. O contraste ecocardiográfico utilizado foi o PESDA (Perfluorocarbon-Exposed Sonicated Dextrose and Albumin), administrado por via intravenosa periférica de forma contínua. Para ambas as EPMTR sob estresse pela dobutamina e pela adenosina, foram feitas análises do eletrocardiograma em 12 derivações (ECG), da motilidade segmentar e análise qualitativa e quantitativa da perfusão miocárdica. A quantificação da velocidade do fluxo miocárdico (ß) e do fluxo sangüíneo miocárdico (Axß) foi realizada por meio da utilização do programa computacional QLab 3.0 (Philips Medical Systems, Bothell, WA, USA). Todos os pacientes foram submetidos à angiografia coronariana quantitativa (ACQ) em um intervalo de até 30 dias da EPMTR. Foi considerada DAC a presença de lesão coronariana > 50% do diâmetro luminal. Dos 54 pacientes estudados, 25 (46%) apresentaram lesão coronariana >50% e 29 (54%) não apresentaram lesão coronariana significativa. A exeqüibilidade da quantificação da reserva Axß foi semelhante para a EPMTR sob estresse pela adenosina e pela dobutamina (91% versus 90% dos territórios arteriais; p = ns). A variabilidade da quantificação interobservador para os parâmetros de reserva ß e Axß foi de 6,8% (r = 0,98) e 5,5% (r = 0,97), respectivamente. A variabilidade intra-observador para os mesmos parâmetros foi de 2,1 % (r = 0,99) e 7,4 % (r = 0,95), respectivamente. A análise quantitativa da perfusão miocárdica, obtida pela EPMTR sob estresse pela dobutamina, apresentou sensibilidade de 84%, especificidade de 76% e acurácia de 80% para a detecção de DAC, enquanto que a EPMTR sob estresse pela adenosina apresentou sensibilidade de 88%, especificidade de 72% e acurácia de 80%. O valor incremental das modalidades estudadas para o diagnóstico de DAC foi analisado em modelo que incluiu o ECG, ECG e motilidade segmentar, ECG e motilidade segmentar e perfusão qualitativa e, por último, ECG e motilidade segmentar e perfusão qualitativa e quantitava, tanto para a EPMTR sob estresse pela dobutamina como pela adenosina (2 de 4,9 versus 20,1 versus 23,7 versus 38,4) e (2 de 9,9 versus 20,1 versus 26,7 versus 59,4), respectivamente. Concluímos que a avaliação quantitativa da EPMTR apresenta boa exeqüibilidade. A EPMTR sob estresse pela dobutamina e a pela adenosina apresentam acurácias diagnósticas similares para a detecção de lesão angiograficamente significativa. A análise quantitativa da perfusão miocárdica apresenta valor diagnóstico adicional aos outros parâmetros obtidos durante o estresse pela dobutamina e adenosina. / Real time myocardial contrast echocardiography (RTMCE) has allowed for the quantification of myocardial blood flow reserve (MBFR). This technique is a valuable tool for the noninvasive detection of coronary artery disease (CAD). Both adenosine and dobutamine are currently used stressor agents during RTMCE. Although it has already been shown the effects of these drugs on the coronary physiology, no study has directly compared both agents during RTMCE. The aims of this study were to determine the feasibility and diagnostic accuracy of adenosine versus dobutamine stress RTMCE for the detection of angiographically significant CAD. In addition, we sought to determine the additional value of quantitative RTMCE over the electrocardiogram, wall motion, and qualitative analysis of myocardial perfusion. The study involved 54 patients (60±9 years, 33 men) with suspected CAD. Patients underwent RTMCE at rest and during continuous infusion of 140g/kg/min of adenosine for six minutes, and dobutamine stress. The contrast agent used in the study was PESDA (Perfluorocarbon-Exposed Sonicated Dextrose and Albumin) administered in continuous intravenous infusion. Quantification of plateau of acoustic intensity (A) and microbubble velocity () was performed off line using a specific software (QLab 3.0, Philips Medical Systems, Bothell, WA, USA). Myocardial blood flow was determined as Ax. Quantitative coronary angiography was performed in all patients within 30 days of RTMCE, and CAD was defined as >50% luminal diameter coronary stenosis. There were 25 (46%) patients with CAD and 29 (54%) patients without obstructive lesion. The feasibility of quantitative MBFR was the same for adenosine and dobutamine stress RTMCE (91% versus 90% in all arterial territories; p=ns). The intraobserver variabilities for the measurements of ß and Axß reserve were 2.1% (r = 0.99) and 7.4% (r = 0.95), respectively. The interobserver variabilities for the same parameters were 6.8% (r = 0.98) and 5.5% (r = 0.97), respectively. The sensitivity, specificity and diagnostic accuracy of ß reserve obtained during dobutamine stress RTMCE for detecting CAD were 84%, 76%, and 80%, respectively, and during adenosine stress RTMCE they were 88%, 72% and 80%. The incremental value for the diagnosis of CAD was analyzed in a model that included the EKG, EKG and wall motion, EKG and wall motion and qualitative perfusion analysis and finally, EKG and wall motion and qualitative and quantitative perfusion analysis, for dobutamine and adenosine RTMCE (2= 4,9 versus 20,1 versus 23,7 versus s 38,4) and (2= 9,9 versus 20,1 versus 26,7 versus 59,4), respectively. In conclusion, quantitative RTMCE is a feasible technique in patients with suspected CAD. Dobutamine and adenosine stress RTMCE had similar diagnostic accuracy for the detection of angiographically significant lesion. Quantitative analysis of myocardial perfusion had incremental diagnostic value over the other parameters obtained during both dobutamine and adenosine stress RTMCE.

Para o diagnóstico de rejeição celular foi utilizado o Doppler tecidual para o estudo da movimentação miocárdica de 14 regiões de 54 pacientes transplantados que realizaram 129 biópsias endomiocárdicas do ventrículo direito. Foram comparadas as médias e desvios padrão das velocidades de movimentação entre os pacientes com e sem rejeição celular = 3A.Verificou-se que a velocidade de movimentação diastólica tardia do anel lateral do ventrículo esquerdo quando menor do que 5,6 cm/s, isoladamente, apresentou sensibilidade de 73,8% e na análise multivariada encontrou-se modelo matemático com um conjunto de seis parâmetros, com sensibilidade de 88,2% para o diagnóstico de rejeição celular = 3A / For the diagnosis of cellular acute cardiac allograft rejection pulsed tissue Doppler imaging was used for measuring myocardial wall motion of 14 sites of 54 transplant patients who underwent 129 endomyocardial biopsies.The mean and standard deviation of myocardial velocities among patients displaying or not acute rejection = 3A were compared.It was observed that the analysis of late diastolic mitral annular motion at lateral site on its own showed a sensibility of 73.8% (5.6 cm/s was the best cut off value) and in the multivariate analysis a mathematical model was found with a set of 6 parameters with a sensibility of 88.2% for the diagnosis of cellular rejection = 3A

We have compared two gastric string tests for obtaining gastric juice for culture of Helicobacter pylori and for nested-PCR detection and PCR-based combined single- and double-stranded conformational polymorphism (SDSCP) discrimination of infecting strains. String test specimens were obtained from one seropositive volunteer for 13 consecutive weeks. The distal 10 cm of each string was suspended in 1 ml saline and quantitatively cultured. An additional nine volunteers with histories of upper-gastrointestinal complaints were given a string test for culture and nested-PCR assay. H. pylori isolates and/or gastric juice from each volunteer were extracted for DNA and analyzed by PCR-based SDSCP. Quantitative culture showed that the Entero-test was four times as sensitive as the Gastro-test but was more prone to contamination by oral flora. However, the two string tests are equally sensitive by PCR assays. Thus, the Gastro-test is more suitable for culture detection of H. pylori, since it is less prone to oral contamination and its shorter length is better tolerated. SDSCP analysis of H. pylori DNA from four PCR-positive volunteers without requiring culture showed four distinct profiles, indicating different infecting strains. SDSCP analysis of strains isolated before and after treatment of one volunteer had the same SDSCP profile, suggesting endogenous reinfection by the same strain.

PURPOSE: To investigate cerebrospinal fluid (CSF) dynamics in the aqueduct of Sylvius in multiple sclerosis (MS) patients and healthy controls (HC) using cine phase contrast imaging. MATERIALS AND METHODS: In all, 67 MS patients (48 relapsing-remitting [RR] and 19 secondary-progressive [SP]), nine patients with clinically isolated syndrome (CIS), and 35 age- and sex-matched HC were examined. CSF flow and velocity measures were quantified using a semiautomated method and compared with clinical and magnetic resonance imaging (MRI) disease outcomes. RESULTS: Significantly decreased CSF net flow was detected in MS patients compared to HC (-3.7 vs. -7.1 muL/beat, P = 0.005). There was a trend for increased net positive flow between SP, RR, and CIS patients. Altered CSF flow and velocity measures were associated with more severe T1 and T2 lesion volumes, lateral and fourth ventricular volumes, and third ventricular width in MS and CIS patients (P < 0.01 for all). In CIS patients, conversion to clinically definite MS in the following year was related to decreased CSF net flow (P = 0.007). There was a trend between increased annual relapse rate and altered CSF flow/velocity measures in RRMS patients (P < 0.05). CONCLUSION: CSF flow dynamics are altered in MS patients. More severe clinical and MRI outcomes in RRMS and CIS patients relate to altered CSF flow and velocity measures.

Contexte: Le cancer colo-rectal est la deuxième cause de décès, par ordre de fréquence. L’utilisation de l’imagerie dans la stadification du cancer colo-rectal est un élément important de la prise en charge de la maladie. L’échographie endoscopique est une modalité qui permet de préciser la profondeur de l’atteinte néoplasique. Les données probantes concernant la performance diagnostique dans l’identification de cancers peu avancés sont variables. Objectif : Effectuer une revue systématique sur la performance diagnostique de l’échographie endoscopique dans l’identification de cancer de stade T1 et T2. Devis : Revue systématique. Sources bibliographiques : PubMed, EMBASE, Ovid and Cochrane library Méthodes: Dans un premier temps, une recherche de revue systématique publiée dans les 15 dernières années fût effectuée sur la précision diagnostique de l’échographie endoscopique dans les banques PubMed, Cochrne et trip database. Deux revues systématiques, publiées en 2008 et 2009 fûrent identifiées. Une deuxième recherche portant sur des études primaires a été effectuée pour la période 2009 à 2016, dans les mêmes banques bibliographiques. La qualité des études primaires a été évaluée à l’aide de la grille QUADAS2. Les mots clés utilisés étaient échographie endoscopique, EUS, cancer rectal, histo-pathologie, staging. Sélection d’études : Les critères d’inclusion : population adulte avec diagnostic de cancer du rectum pas avancé, articles complets publiés dans des revues avec comité de pairs, articles en anglais. Critères d’exclusion : population pédiatrique, cancers avancés avec atteinte métastatique, patients évalués avec d’autres modalités (CT ou IRM) sans échographie endoscopique, absence de confirmation histologique. Résultats : Dix articles, publiés depuis 2009, répondaient aux critères d’inclusion. Ces articles furent ajoutés aux articles retenus dans les revues systématiques déjà publiées. Au total,49 articles sont inclus dans cette revue systématique. La performance diagnostique de l’échographie endoscopique a été évaluée en calculant la sensitivité et la spécificité des études regroupées. Pour le stade T1, les valeurs de sensitivité et spécificité étaient 0.84 (CI 0.75-0.91) et 0.93 (CI 0.86–0.97), respectivement. Pour le stade T2 les valeurs de sensitivité et spécificité étaient 0.83 (CI 0.74–0.90) et 0.93 (CI 0.86–0.97), respectivement. Conclusion: L’échographie endoscopique présente une performance diagnostique pour l’identification de cancers de stade T1 et T2. Ceci permet d’orienter des patients vers des chirurgies moins invasives avec une survie égale et un taux de complications inférieures comparativement à des chirurgies plus invasives. / Background: Colorectal cancer (CRC) is the second leading cause of death. The use of preoperative imaging in the staging of (CRC) plays a major role in the management. Endorectal ultrasound (ERUS) is a precise imaging modality to determine the depth of penetration. The data on the precision of (ERUS) to predict early stage of rectal cancer has been variable Objectives: To conduct a systematic review, on the diagnostic performance of (ERUS) in the staging of T1 and T2 CRC. Design: Systematic review. Data sources: A literature search via PubMed, EMBASE, Ovid and Cochrane library. METHODS: An initial search for systematic review articles published in the last 15 years on the diagnostic accuracy of EUS in the staging of CRC using PubMed, Cochrane library, and trip database was conducted. After finding two systematic reviews that were published in 2008 and 2009, a second search of original studies published since the systematic reviews were conducted using the same databases from 2009 to 2016. The primary studies included in the systematic reviews and the primary studies published afterwards were included in the review. Methodological quality was applied using a modified version of the quality assessment of diagnostic accuracy studies (QUADAS2) tool. Terms used for search were endoscopic ultrasound, EUS, rectal cancer, histo-pathological finding, and staging. Study selection: Inclusion criteria includes adult people diagnosed with early stage CRC, all articles in english language and must be a full manuscripts published in peer-reviews journals. Exclusion criteria includes any recurrent or metastasis cancer and children with rectal cancer. Patients who were staged preoperatively by other imaging modality (MRI or CT) and no comparison with post operative pathology. Results: The search identified 420 articles, 97 articles were duplicate and excluded, and 232 refined articles were screened for title and abstract, reviewed. Thirty-two full text studies were assessed for eligibility, and ten published as full text and met the inclusion criteria; they were added to the articles identified in the earlier systematic reviews a total of 49 articles. Results of the evaluation of the accuracy of ERUS analyzed according to the diagnostic measures of sensitivities and specificities calculated for each study. The pooled sensitivity and specificity of EUS for stage T1 CRC was 0.84 (CI 0.75-0.91) and 0.93 (CI 0.86–0.97), and for T2 was 0.83 (CI 0.74–0.90) and 0.93(CI 0.86–0.97) respectively. Conclusion: The range of sensitivity and specificity values suggest that EUS performs well in accurately staging T1 and T2 cancers. Further advancement in this technology will lead to an improved diagnosis, clinical decision-making, and reduce the over staging drawback.

Introdução: Atualmente, o diagnóstico das reações de hipersensibilidade a anti-inflamatórios não esteroidais (AINEs) baseia-se na história relatada pelo paciente e, em determinados casos, é realizado o Teste de Provocação. Todavia, este teste pode expor os pacientes a riscos graves, inclusive anafilaxia. Em busca de ferramenta mais segura, tem-se estudado o Teste de Ativação de Basófilos (BAT). Trata-se de um teste in vitro, no qual é possível testar diversos estímulos em uma única amostra de sangue, avaliando a ativação dos basófilos (indicativo de reação de hipersensibilidade), através do aumento da expressão de moléculas na superfície desses leucócitos, como o CD63. Objetivo: Padronizar e validar o BAT para ácido acetilsalicílico (AAS), diclofenaco, dipirona e paracetamol em pacientes com hipersensibilidade a AINEs. Metodologia: Participaram 20 (testados com os quatro AINEs) + 33 (testados somente com AAS) pacientes atendidos no Serviço de Imunologia Clínica e Alergia do HCFMUSP, que apresentaram manifestações cutâneas em até 24 horas após exposição a um ou múltiplos AINEs, bem como 13 (quatro AINEs) + 26 (AAS) controles. A técnica consistiu em incubar sangue total com os AINEs já mencionados e, depois, marcar as amostras com anticorpos monoclonais (CD45, anti-IgE e CD63) para posterior leitura por citometria de fluxo. Os resultados obtidos foram comparados com as histórias clínicas e os testes de provocação oral, quando realizados. Resultados: Utilizando os critérios de positividade do BAT empregados na literatura (isto é, porcentagem de CD45+IgE+highCD63+ e índice de estimulação), a sensibilidade e a especificidade variaram de acordo com o AINE: para ácido acetilsalicílico foram 75,0% e 16,7%, respectivamente, diclofenaco, 100% e 0%, dipirona, 23,5% e 66,7%, paracetamol, 40,0% e 42,9%. Após a realização de curvas dose-resposta e tempo-resposta somente com AAS, foi encontrado novo critério de positividade: média de intensidade de fluorescência (MFI) menor do que 6575 representava BAT positivo; com isso, os valores de sensibilidade e especificidade foram: 84,4% e 34,6%, respectivamente. O BAT foi mais sensível em pacientes cuja última reação ocorreu há menos de um ano da data de execução do BAT (93,7%). Conclusão: Devido aos baixos valores de sensibilidade e/ou especificidade, não foi possível padronizar e, por conseguinte, validar o BAT para ácido acetilsalicílico, diclofenaco, dipirona e paracetamol. / Introduction: Currently, the diagnosis of nonsteroidal antiinflammatory drugs (NSAIDs) hypersensivitity is based on patients´ clinical history and drug provocation tests, which are done in selected cases. Nevertheless, this test may expose patients to severe risks, including anaphylaxis. Looking for a safer tool, Basophil Activation Test (BAT) for allergy diagnosis has been studied in the last years. It is an in vitro method where a wide variety of stimuli can be tested, incubating them with the patient\'s blood sample, and observing basophil activation (indication of hypersensitivity) through upregulation of CD63 (or other basophil activation markers) on this leucocyte\'s membrane. Objective: To standardize and validate BAT stimulated with acetylsalicylic acid (ASA), diclophenac, dipyrone and paracetamol in NSAID hypersensitive patients. Methods: Patients which reported immediate reactions (less than 24 hours) after exposure to one or multiple NSAIDs, with cutaneous symptoms were enrolled from Clinical Immunology and Allergy outpatient clinic from HC-FMUSP. BAT with the four NSAIDs was tested on 20 patients and 13 controls and BAT with ASA only, on 33 patients and 26 controls. BAT consisted of incubating whole blood with NSAIDs, then triple-labeled with monoclonal antibodies (CD45, anti-IgE, CD63) for analysis by flow cytometry. BAT results were compared to clinical history and oral provocation tests, when available. Results: According to literature\'s positivity criteria (percentage of CD45+IgE+highCD63+ and stimulation index), sensitivity and specificity varied according to the NSAID tested: for ASA was 75.0% and 16.7% respectively, diclophenac, 100.0% and 0.0%, dipyrone, 23.5% and 66.7%, paracetamol, 40.0% and 42.9%. A new positivity criterion was possible to be defined after further dose-response and time-response curves only for ASA: Mean Fluorescence Intensity lower than 6575 (positive BAT). Accordingly, new sensitivity and specificity for BAT in ASA hypersensitivity were 84,4% and 34,6%. Patients that presented the last reaction in the last year were more likely to present a positive BAT (93.7%). Conclusion: Due to low values for sensitivity and/or specificity, it was not possible to standardize and validate BAT for ASA, diclophenac, dipyrone and paracetamol.