A determinação de Intervalos de Referência (IR) é uma árdua tarefa para os laboratórios clínicos, porém indispensável e de fundamental importância para a tomada de decisão médica. Para parâmetros como os lípides séricos, os IR tem sido estabelecidos consensos nacionais ou internacionais definindo limites de decisão (CLSI, 2008). O objetivo deste estudo foi determinar os IR para colesterol total, HDL-colesterol, colesterol não-HDL, LDL- colesterol e triglicérides séricos em crianças e adolescentes saudáveis do município de Cuiabá, capital do estado de Mato Grosso. Trata-se de um estudo transversal, descritivo, realizado em 1.866 crianças e adolescentes saudáveis de creches e escolas municipais desta capital, obtidas por amostragem aleatória. Foi aplicado um questionário avaliando antecedentes do indivíduo e de seus familiares além de dados demográficos e antropométricos. Foram definidos como critérios de inclusão do estudo, crianças e adolescentes nas faixas etárias de 1 a 12 anos 11 meses e 29 dias, sem nenhuma doença de base diagnosticada ou queixas clínicas no momento da coleta. Além disto, os participantes não deveriam fazer uso regular de medicamento. As amostras foram coletadas em jejum. As amostras foram processadas no equipamento cobas® 6000 (analyser series - Roche Diagnostics), em laboratório da rede DASA na cidade de Cuiabá. Em relação à metodologia estatística, foi analisada a homogeneidade das variâncias através do teste de Bartlett para cada analito por idade e, posteriormente, testados pelo teste ANOVA ou Kruskal-Wallis para verificar a existência de diferença entre as faixas etárias. O teste \"post hoc\" de Bonferroni foi aplicado quando se constatou a diferença para reagrupar as faixas etárias similares, constituindo assim novos grupos etários. Aplicou-se então, o teste de Bartlett e, conforme seu resultado, realizou-se ANOVA ou Kruskal-Wallis para verificar se os agrupamentos nas faixas se mantinham. Em seguida, procedeu-se a exclusão de valores extremos (outiliers) tomados como sendo aqueles valores acima ou abaixo da média ± 3 desvios-padrão. Depois de excluídos os outiliers, obteve-se o IR como sendo a média ± 2 desvios-padrão dos valores remanescentes. Adicionalmente, foi calculada a distribuição em percentis, sendo adotado o critério do NHLBI 2012 como proposta de limite de decisão para a população estudada. Em todos os testes, o nível de significância adotado foi de 5%. As análises estatísticas foram realizadas pelos programas MINITAB (versão 15) e SPSS (versão 16). Este projeto foi aprovado pelas Comitês de Ética em Pesquisa das instituições envolvidas e das Secretarias Municipais de Educação e Saúde de Cuiabá. Os valores encontrados para o colesterol total, nos percentis 75 e 95 foram: 1 a 2 anos de 160 mg/dL e 189 mg/dL; 3 a 8 anos de 170 mg/dL e 199 mg/dL; 9 a 12 anos de 176 mg/dL e 205 mg/dL, respectivamente. Para o colesterol não-HDL, na única faixa etária de 1 a 12 anos, os valores nestes percentis foram de 122 mg/dL e 150 mg/dL, respectivamente. Para o LDL-colesterol, os valores correspondentes aos percentis acima, na faixa etária de 1 a 8 anos e de 9 a 12 anos, foram de 104 mg/dL e 132 mg/dL; 106 mg/dL e 139 mg/dL, respectivamente. Para os triglicérides, os valores correspondentes aos referidos percentis foram: 1 ano de 127 mg/dL e 189 mg/dL; 2 a 5 anos de 98 a 139 mg/dL; 6 a 12 anos de 92 mg/dL e 139 mg/dL. Para as faixas etárias propostas para o HDL-colesterol os valores correspondentes ao percentil 10 foram: 1 ano de 24 mg/dL; 2 anos de 28 mg/dL; 3 anos de 32 mg/dL e de 4 a 12 anos foi de 36 mg/dL. Os valores dos parâmetros aqui avaliados, definidos em diferentes faixas etárias em crianças e adolescentes brasileiros da cidade de Cuiabá, podem representar limites de decisão para a população pediátrica brasileira contribuindo para aprimorar o diagnóstico neste grupo específico em nosso país / Establishment of Reference Intervals (RI) is an arduous task for clinical laboratories however vital and fundamental importance to medical decision making. For some parameters, such as serum lipids, RI have been established by national and international consensus defining decision limits (CLSI 2008). The aim of this study was to determine pediatric RI of total cholesterol, HDL-cholesterol, cholesterol non- HDL, LDL-cholesterol and triglycerides in healthy children and adolescents in Cuiabá, capital of Mato Grosso. This is a descriptive study, conducted in 1,866 healthy children and adolescents from kindergartens and schools of the capital city, obtained by random sampling. A questionnaire assessing the individual background and their relatives besides demographic and anthropometric data had beeb also carried out. Were defined as inclusion criteria of the study, children and adolescents in the group 1-12 years 11 months and 29 days without any underlying disease or diagnosed clinical complaints at the time of collection. In addition, participants should not take any regular medication. The samples were collected during fasting period and were determined using cobas® 6000 (analyser series - Roche Diagnostics). Regarding statistic methodology, we did analyse the homogeneity of variances by Bartlett´s test for each parameter by age and subsequently by ANOVA or Kruskal-Wallis test to check the differences between age groups. The test \"pos hoc\" Bonferroni was applied when it was found the difference to regroup similar age groups, thus constituting a new age bracket. After this procedure the Bartllet test was applied, as it result, we did conduct ANOVA or Kruskal-Wallis to check if the groups remained. Then proceeded to the exclusion of extreme values (outliers) taken as those values above or below the mean ± 3 standard deviations. After excluding outliers, obtained the RI as the mean ± 2 standard deviations of the remaining values. Additionally, we calculated the percentile distribution, and adopted the criteria of NHLBI 2012 as proposed decision limit for the population studied. In all tests, the significance level was 5%. Statistical analyzes were performed by Minitab software (version 15) and SPSS (version 16). The project was approved by the Research Ethics Committees of the institutions involved and Municipal Departments of Education and Health of Cuiabá city The values obtained for total cholesterol, 75 and 95 percentiles, were: 1 to 2 years, 160 mg/dL and 189 mg/dL; 3 to 8 years, 170 mg/dL and 199 mg/dL; 9 to 12 years, 176 mg/dL and 205 mg/dL, respectively. For the non-HDL cholesterol, the only age group 1 to 12 years, this percentiles values were 122 mg/dL and 150 mg/dL, respectively. For the LDLcholesterol, the values corresponding to the percentiles above, aged 1 to 8 years and 9 to 12 years, were 104 mg/dL and 132 mg/dL; 106 mg/dL and 139 mg/dL, respectively. For the triglycerides, the values corresponding to these percentiles were: 1 year, 127 mg/dL and 189 mg/dL; 2 to 5 years, 98 to 139 mg/dL; 6 to 12 years, 92 mg/dL and 139 mg/dL. For ages proposed for HDL-cholesterol the corresponding values to 10th percentile were: 1 year, 24 mg/dL; 2 years, 28 mg/dL; 3 years, 32 mg/dL and 4 to 12 years were 36 mg/dL. The values of the parameters evaluated here, defined in different age groups in Brazilian children and adolescents in the city of Cuiabá, can represent decision limits for the Brazilian pediatric population contributing to improve the diagnosis in this particular group in our country

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The purpose of this presentation is to describe the normal reference intervals and the intra- and inter-examiner reliability for horizontal VOR gain obtained with two different video head impulse test devices in young normal adult participants.

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La numération plaquettaire est une analyse délicate et le résultat est souvent erroné notamment du fait d’une tendance à l’agrégation in vitro dans certaines espèces animales. Il a ainsi pu être démontré chez le Chat que ce phénomène peut être inhibé par l’association d’un anticoagulant avec des inhibiteurs plaquettaires : le CTAD (Citrate, Théophylline, Adénosine et Dipyridamole). Cette association permet ainsi l’obtention de numérations plaquettaires fiables sans affecter les autres populations sanguines, mais également d’effectuer des analyses d’hémostase et de biochimie. De nouveaux intervalles de référence ont dû être établis pour certaines variables hématologiques avec les analyseurs utilisés en laboratoire et dans les cliniques vétérinaires. Par ailleurs, si les effets antiagrégants du CTAD sont moins nets chez le Chien, il peut également servir d’anticoagulant « universel », permettant de réduire le nombre de prélèvements et d’améliorer ainsi le bien-être des animaux. / The platelet count is a delicate measurement, which may often be erroneous because of the tendency of platelets from some animal species to aggregate in vitro. This study demonstrated that this effect can be inhibited in cats using CTAD (Citrate, Theophylline, Adenosine and Dipyridamole) composed of an anticoagulant and platelet inhibitors. This association provides reliable platelet counts without affecting other blood populations and also allows hemostasis and biochemical analyses. New hematological reference intervals have been established for some variables with analyzers used in clinical pathology laboratories and veterinary clinics. Furthermore, if the antiplatelet clumping effects of CTAD are less marked in canine species, the CTAD can also serve as "universal" anticoagulant, reducing the number of blood samples and thus improving animal welfare.

O sangue é uma suspensão de células contidas num líquido complexo chamado plasma. O termo sangue total refere-se a amostras de sangue com a totalidade de seus constituintes, parte sólida e líquida. Sendo os elementos químicos responsáveis por funções essenciais, como regulação osmótica, frequência cardíaca e contratibilidade, coagulação sanguínea e excitabilidade neuromuscular. A determinação de elementos químicos em fluidos corporais como sangue, soro, plasma, tecido e urina é usada como monitor de parte ou de todo o organismo. Nesse trabalho, utilizou-se a técnica de fluorescência de raios X (EDXRF) para análise de amostras de sangue total humano e animal, hamsters da espécie dourada (Mesocricetus auratus) e cavalos da raça crioula (Equus caballus). Nas amostras de sangue humano, foram determinados intervalos de referência de Na (1788 - 1826 μg g-1), Mg (63 - 75 μg g-1), P (602 - 676 μg g-1), S (1519 - 1718 μg g-1), Cl (2743 - 2867 μg g-1), K (1508 - 1630 μg g-1), Ca (214 - 228 μg g-1), Cu (4 - 6 μg g-1) e Zn (1 - 3 μg g-1). Foram determinados intervalos de referência de Na (1714 - 1819 μg g-1), Mg (51 - 79 μg g-1), P (970 - 1080 μg g-1), S (1231 - 1739 μg g-1), Cl (2775 - 2865 μg g-1), K (1968 - 2248 μg g-1), Ca (209 - 257 μg g-1), Cu (4 - 6 μg g-1) e Zn (3 - 5 μg g-1) para amostras de sangue de hamster dourado. As amostras de sangue de cavalo da raça crioula apresentaram os intervalos de: Na (1955 - 2013 μg g-1), Mg (51 - 75 μg g-1), P (443 - 476 μg g-1), S (1038 - 1140 μg g-1), Cl (2388 - 2574 μg g-1), K (1678 - 1753 μg g-1), Ca (202 - 213 μg g-1), Cu (4,1 - 4,5 μg g-1) e Zn (2,0 - 2,2 μg g-1). Estudo comparativo dos resultados entre as técnicas de análise por ativação neutrônica (NAA) e EDXRF indica a igualdade de desempenho das técnicas analíticas na análise de matrizes biológicas. Os resultados contribuem no estabelecimento de intervalos de referência para a população brasileira saudável e para as referidas espécies de animais. / Blood is a suspension of cells contained in a complex liquid called plasma. The term whole blood refers to samples with both solid and liquid parts. Inorganic elements are responsible for essential functions, such as osmotic regulation, cardiac frequency and contractibility, blood clotting and neuromuscular excitability. The determination of inorganic elements in corporeal fluids such as blood, serum, plasma, tissue and urine is used as a monitor for a part or the whole organism. In this work, the X-Ray fluorescence technique (EDXRF) was used for the determination of inorganic elements in whole blood samples from humans and animals (golden hamsters, Mesocricetus auratus and crioula breed horses, Equus caballus). The reference intervals of Na (1788 - 1826 μg g-1), Mg (63 - 75 μg g-1), P (602 - 676 μg g-1), S (1519 - 1718 μg g-1), Cl (2743 - 2867 μg g-1), K (1508 - 1630 μg g-1), Ca (214 - 228 μg g-1), Cu (4 -6 μg g-1) e Zn (1 - 3 μg g-1) were determined for human blood. The reference intervals, for golden hamster blood were found to be: Na (1714 - 1819 μg g-1), Mg (51 - 79 μg g-1), P (970 - 1080 μg g-1), S (1231 - 1739 μg g-1), Cl (2775 - 2865 μg g-1), K (1968 - 2248 μg g-1), Ca (209 - 257 μg g-1), Cu (4 - 6 μg g-1) e Zn (3 -5 μg g-1). The reference intervals, for crioula breed horse blood, showed to be: Na (1955 - 2013 μg g-1), Mg (51 - 75 μg g-1), P (443 - 476 μg g-1), S (1038 - 1140 μg g-1), Cl (2388 - 2574 μg g-1), K (1678 - 1753 μg g-1), Ca (202 - 213 μg g-1), Cu (4,1 - 4,5 μg g-1) e Zn (2,0 - 2,2 μg g-1). Comparative study between NAA and EDXRF, both techniques showed the same performance for the analyses of biological matrices. The results contribute for the establishment of reference intervals for the Brazilian healthy population and the referred animal species.

Diabetes mellitus is a frequent endocrinopathy in dogs. Exogenous insulin and nutritional management are the mainstays of therapy. High carbohydrate and fibre diets have been traditionally recommended for canine diabetes mellitus. However, recent studies in healthy and diabetic dogs have challenged the use of these traditional diabetic diets. In addition, dietary carbohydrate content was found to be the main determinant of postprandial blood glucose concentrations over 1.5 hours in healthy dogs. Increasing carbohydrate content increased blood glucose concentration. In a search of the literature, no studies in dogs were found comparing the effects on postprandial plasma glucose, insulin, triglyceride and free fatty acid concentrations of a traditionally recommended high carbohydrate and fibre diabetes diet with a moderate carbohydrate and fibre diet, or a commercially-available maintenance diet. Although fasting plasma triglyceride concentrations are commonly used for diagnosis and management of canine hyperlipidemia, a review of the literature found that in human beings, it may not to be predictive of the highest postprandial concentration. Importantly, in overweight and obese dogs with postprandial plasma triglyceride concentrations >5 mmol/L (>445 mg/dL), it was found there was a 6 fold increase in risk of laboratory evidence of exocrine pancreatic disease. However, there are limited studies on the effect of maintenance diets on postprandial plasma triglyceride concentrations in dogs, and no reference intervals determined for a triglyceride meal challenge test in healthy dogs. For the dietary studies in this thesis, animal welfare was of paramount importance, and minimally invasive peripheral venous catheterization and blood collection techniques were needed to collect 4 mL blood samples over 13 hours in conscious dogs. A search of the literature found no studies evaluating the reliability of using peripheral catheterization via the cephalic vein for the collection of larger blood volumes (for example, 4 mL). The aims of this thesis were firstly, to investigate the influence of three diets with varying carbohydrate and fibre content on postprandial plasma glucose, insulin, triglyceride and free fatty acid concentrations in healthy dogs over 12 hours; secondly, to develop a triglyceride meal challenge test and associated reference intervals; and finally, to evaluate a minimally invasive catheterization and blood collection technique for reliability in collecting the blood volumes required for these studies. For the studies in this thesis, twelve healthy dogs were fed each of three diets for three weeks in a three period cross-over design. For the meal response test at the end of each three-week period, 10 blood samples were collected over 13 hours. Reference intervals for fasting and postprandial triglyceride concentrations at single and multiple time points after eating a standard meal were determined in healthy dogs. Associations between fasting and postprandial triglyceride concentrations, and time to measure highest postprandial triglyceride concentration were also evaluated. Blood volume obtained, resistance on aspirating the blood sample, and methods used to improve blood flow during collection were recorded for the 358 samples collected. The results of the studies in this thesis demonstrated that a moderate carbohydrate diet resulted in lower peak and postprandial glucose concentrations compared with a traditional diabetic diet (CHO 55 %ME) and a maintenance diet (CHO 45 %ME). Fasting triglyceride concentrations were found not to be predictive of peak postprandial triglyceride concentrations. The highest triglyceride concentration measured at 2, 5, and 6 hours after eating had the closest agreement with peak postprandial triglyceride concentration. Glucose, insulin and triglyceride concentrations in some dogs were significantly above baseline concentrations at 12 hours after eating each of the diets. Of 358 blood samples collected, 93 % achieved the required 4 mL volume, while the remaining samples were greater than 1.5 mL, and 87 % were obtained with minimal resistance. It was concluded that the moderate carbohydrate and fibre test diet warrants evaluation in diabetic dogs. It was found that when following the same protocol, blood samples should be collected 2, 5, and 6 hours after eating to determine the highest postprandial plasma triglyceride concentration. For future nutritional studies, dogs may need to be fasted for at least 12 hours, and analytes measured over at least 12 hours after feeding to evaluate fasting and postprandial plasma analyte concentrations. Finally it was demonstrated that percutaneous catheterization of the cephalic vein using a 20-gauge catheter allows for successful collection of multiple 4 mL blood samples over 13 hours in conscious dogs. This thesis presents new information for future nutritional studies in healthy and diabetic dogs by suggesting that there may be no glycemic benefit feeding the high carbohydrate and fibre diet compared with a moderate carbohydrate and fibre diet. A triglyceride meal challenge test was developed to assist the diagnosis of canine hyperlipidemia. Finally, a minimally invasive method for obtaining serial blood samples was evaluated and described. These findings are expected to help in designing future studies in the nutritional management in healthy dogs, and dogs with diabetes mellitus and hyperlipidemia.