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OBJECTIVES: In this study, we present a strategy for RHD gene screening based on real-time polymerase chain reaction (PCR) using dried blood spots of pooled samples. BACKGROUND: Molecular analysis of blood donors may be used to detect RHD variants among the presumed D-negative individuals. RHD genotyping using pooled samples is a strategy to test a large number of samples at a more reasonable cost. MATERIALS AND METHODS: RHD gene detection based on real-time PCR using dried blood spots of pooled samples was standardised and used to evaluate 1550 Brazilian blood donors phenotyped as RhD-negative. Positive results were re-evaluated by retesting single samples using real-time PCR and conventional multiplex PCR to amplify five RHD-specific exons. PCR-sequence-specific primers was used to amplify RHDψ allele. RESULTS: We devised a strategy for RHD gene screening using dried blood spots of five pooled samples. Among 1550 serologically D-negative blood donors, 58 (3.74%) had the RHD gene. The non-functional RHDψ allele was detected in 47 samples (3.02%). CONCLUSION: The present method is a promising strategy to detect the RHD gene among presumed RhD-negative blood donors, particularly for populations with African ancestry.

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BACKGROUND: A nephrologist with expertise in ultrasonography noticed that patients with longstanding renal grafts had smaller spleens than subjects undergoing initial post-transplantation imaging. This putative finding prompted us to pursue a further investigation into splenic function based on Doppler ultrasound and hematologic parameters. METHODS: We enrolled 47 patients with functioning long-standing kidney grafts, measuring longitudinal diameter of the spleen, hilar and intrasplenic peak systolic velocities (PSV), and hilar and intrasplenic resistivity indices of the splenic artery as well as mean arterial blood pressure (MAP). Giemsa-stained peripheral blood smears were examined for the presence of Howell-Jolly bodies (HJBs) using light microscopy. The patients were then divided into HJB present (HJ(+)) or absent (HJ(-)) groups for further comparison. RESULTS: The overall mean age of 21 females and 26 males was 47.8 ± 12.0 years, and the mean time after transplantation was 2750 ± 1818 days (range, 208-6446). HJBs were detected in 23/47 patients (48.9%). The intrasplenic artery PSV was significantly lower and MAP higher in the HJ(+) group (P < .05). There was no difference in spleen size between the groups. DISCUSSION: HJBs in peripheral blood red cells, an indicator of hyposplenism, was associated with reduced intrasplenic artery PSV, suggesting dysfunction, which may play a role in the known vulnerability of renal transplant recipients to infections.

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Increased susceptibility to infection has long been observed among patients with systemic lupus erythematosus, and still represents a chief cause of morbidity and mortality in these patients. This is due in part to the severity of infection and to the difficulty of early diagnosis owing to the similarity between SLE flares and infection. Epidural infection is an uncommon condition, and a most rare condition caused by salmonella, which accounts for a broad spectrum of human illnesses from gastroenteritis and typhoid fever to the asymptomatic carrier state. We report the first case of epidural abscess caused by Salmonella enteritidis in a female with SLE with protean manifestations treated by intravenous antibiotics and surgery with full recovery of neurological symptoms, illustrating the importance of performing an early diagnosis and prompt treatment.

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Hypocitraturia (HCit) is one of the most remarkable features of renal tubular acidosis, but an acidification defect is not seen in the majority of hypocitraturic patients, whose disease is denoted idiopathic hypocitraturia. In order to assess the integrity of urinary acidification mechanisms in hypocitraturic idiopathic calcium stone formers, we studied two groups of patients, hypocitraturic (HCit, N = 21, 39.5 +/- 11.5 years, 11 females and 10 males) and normocitraturic (NCit, N = 23, 40.2 +/- 11.7 years, 16 females and 7 males) subjects, during a short ammonium chloride loading test lasting 8 h. During the baseline period HCit patients showed significantly higher levels of titratable acid (TA). After the administration of ammonium chloride, mean urinary pH (3rd to 8th hour) and TA and ammonium excretion did not differ significantly between groups. Conversely, during the first hour mean urinary pH was lower and TA and ammonium excretion was higher in HCit. The enhanced TA excretion by HCit during the baseline period and during the first hour suggests that the phosphate buffer mechanism is activated. The earlier response in ammonium excretion by HCit further supports other evidence that acidification mechanisms react promptly. The present results suggest that in the course of lithiasic disease, hypocitraturia coexists with subtle changes in the excretion of hydrogen ions in basal situations.

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Hypocitraturia (HCit) is one of the most remarkable features of renal tubular acidosis, but an acidification defect is not seen in the majority of hypocitraturic patients, whose disease is denoted idiopathic hypocitraturia. In order to assess the integrity of urinary acidification mechanisms in hypocitraturic idiopathic calcium stone formers, we studied two groups of patients, hypocitraturic (HCit, N = 21, 39.5 + or - 11.5 years, 11 females and 10 males) and normocitraturic (NCit, N = 23, 40.2 + or - 11.7 years, 16 females and 7 males) subjects, during a short ammonium chloride loading test lasting 8 h. During the baseline period HCit patients showed significantly higher levels of titratable acid (TA). After the administration of ammonium chloride, mean urinary pH (3rd to 8th hour) and TA and ammonium excretion did not differ significantly between groups. Conversely, during the first hour mean urinary pH was lower and TA and ammonium excretion was higher in HCit. The enhanced TA excretion by HCit during the baseline period and during the first hour suggests that the phosphate buffer mechanism is activated. The earlier response in ammonium excretion by HCit further supports other evidence that acidification mechanisms react promptly. The present results suggest that in the course of lithiasic disease, hypocitraturia coexists with subtle changes in the excretion of hydrogen ions in basal situations

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PURPOSE: To divulge information on the chemical composition and physical-chemical features of some mineral waters from Brazilian natural sources that will be of useful protocol investigation and patient advice. METHODS: The survey was based on bottle labels of non-gaseous mineral waters commercially available in the city of Rio de Janeiro. The íon concentration of each mineral was calculated from the salt content. RESULTS: 36 springs were enralled from different states of the country. The pH (25 degrees C), 4.1 to 9.3, varied on dependence of the source and it was linearey correlated with the cations calcium, magnesium and sodium and the anion bicarbonate. It was atributed to high alkalinity (about 70% of bicarbonate in the molecula-gram) of these salts. The calcium (0.3 to 42 mg/l), magnesium (0.0 to 18 mg/l) and bicarbonate (4 to 228 mg/l) contents are relatively low. CONCLUSION: The mineral content of the Brazilian springs enrolled in this survey is low; about 70% of the sources having calcium and magnesium less than 10 mg/l and 1.0 mg/l, respectively, similar to local tap water.

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Paciente de litíase renal é estimulado a aumentar a ingestão hídrica, principalmente na forma de água tratada da torneira, pela irrelevante biodisponibilidade de mineerais em sua composição. O benefício é atribuído à redução da saturação dos sais urinários. Não está claro se as águas minerais naturais comercialmente disponíveis também é benéfica. Objetivo. Divulgar as informações sobre as características químicas e físico-químicas de águas minerais naturais de algumas das diversas fontes brasileiras. Essas informações serão de utilidade na análise de protocolos de pesquisa e na orientação do paciente. Métodos. Foi feito uma coletânea das informações que constam nos rótulos de garrafas de águas minerais naturais, predominantemente não-gasosas, acessíveis ao consumo carioca. A partir da composição salina provável, foi calculada a concentração iônica de cada mineral. Resultados. Foram estudadas as informações de 36 fontes situadas em alguns estados brasileiros. O pH, a 25 graus Celsius, variou de 4,1 a 9,3 na dependência da fonte e foi linearmente correlacionando com as concentrações dos cátions cálcio, magnésio, sódio e do anion bicarbonato. Isto foi atribuído à alta alcalinidade desses sais, que contêm cerca de 70 por cento de bicarbonato na molécula. Os teores de cálcio (0,3 a 42 mg/l), de magnésia (0,0 a 18 mg/l) e de bicarbonato (4 a 228 mg/l) foram considerados relativamente baixos. Conclusão. O teor mineral das fontes brasileiras que compuseram esse levantamente é baixo, com cerca de 70 por cento delas apresentando teores de cálcio e de magnésio abaixo de 10 mg/l e 1 mg/l, respectivamente, semelhantes ao da água tratada da torneira.

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