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Introduction: Significant evidence suggests that plasma-rich in growth factors (PRGF) favor the repair of chronic wounds, enabling a rapid return to functionality. However, components of PRGF and their effects on persistent ulcers and epithelial tissues are not well characterized. The goals of this research were to analyze the biological properties of platelet-derived factors, to examine their effectiveness on healing of venous ulcers, and to establish a correlation with clinical and sociodemographic data. Methods: For the preparation of PRGF, the centrifugation technique was used, obtaining a 100 % autologous and biocompatible blood sample that was treated with sodium citrate and calcium chloride. The patients were attended weekly at the outpatient clinic for nursing consultation and wound dressing changes, with PRGF application every 15 days. The treatment protocols are described, and follow-up results are reported. Results: Initially, the patients' ulcers ranged in sizes from 4 to 84 cm2. After 12 weeks of treatment, there was a significant mean reduction of 46.2 % in ulcer area. At baseline, epithelial tissue was absent in all venous ulcers, but its presence grew significantly by the treatment period. However, the reduction of the area of the ulcers did not show significant correlation with the concentrations of the patient's growth factors. Conclusions: Using the established protocol for PRGF isolating, it was possible to obtain a product with the presence of the six growth factors related to tissue regeneration and observed a positive response on wound healing following treatment of venous ulcers, with capacity to accelerate re-epithelialization and restore the skin functional integrity.

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ABSTRACT Objective: To evaluate the presence of anemia in patients with chronic lower limb ulcers based on profile and hematometric indices. Method: This is a cross-sectional study carried out in a university hospital in Rio de Janeiro. The sample was composed of 64 participants with lower limb ulcers and evolution time greater than 12 weeks. Data was collected between May/2016 and December/2017 from hematological analyses, records from medical records, and wound assessment form. Results: 36 (56.2%) were male; 38 (59.4%) between 60 and 80 years old; 56 (87.5%) with chronic diseases and 52 (81.2%) with venous ulcers. 6 years mean of active ulceration. Anemia was detected in 36 (56.2%), 27 (75%) of which were normochromic and normocytic; 14 (38.8%) had deficiency anemia recorded in their medical chart. Conclusion: The low hemoglobin concentration is recurrent among the participants characterizing an anemia condition, whose profile reveals congruence to the anemia of chronic disease.

RESUMEN Objetivo: Evaluar la presencia de anemia en pacientes con úlceras crónicas de miembros inferiores desde el perfil e índices hematimétricos Método: Este estudio seccional transcurrió en un hospital universitario de Río de Janeiro, con una muestra de 64 participantes con úlceras en los miembros inferiores y tiempo de evolución superior a 12 semanas. Los datos se recopilaron entre mayo/2016 y diciembre/2017 investigando los análisis hematológicos, registros en las historias clínicas y formularios de evaluación de la herida. Resultados: 36 (56,2%) eran hombres; 38 (59,4%) tenían entre 60 y 80 años; 56 (87,5%) padecían de enfermedades crónicas y 52 (81,2%), de úlceras venosas. El promedio era de 6 años de úlcera activa. Se detectó anemia en 36 (56,2%), siendo que en 27 (75%) era normocrómica/normocítica; 14 (38,8%) presentaban anemia carencial registrada en la historia clínica. Conclusión: La baja concentración de hemoglobina es recurrente entre los participantes caracterizando un cuadro de anemia que coincide con el de anemia de enfermedad crónica.

RESUMO Objetivo: Avaliar a presença de anemia em pacientes com úlceras crônicas de membros inferiores a partir do perfil e dos índices hematimétricos. Método: Estudo seccional realizado em um hospital universitário do Rio de Janeiro. Amostra composta por 64 participantes com úlceras de membros inferiores e tempo de evolução maior que 12 semanas. Dados coletados entre maio/2016 e dezembro/2017, a partir de análises hematológicas, registros nos prontuários e em formulário de avaliação da ferida. Resultados: 36 (56,2%) eram do sexo masculino; 38 (59,4%) entre 60 e 80 anos; 56 (87,5%) com doenças crônicas e 52 (81,2%) com úlceras venosas. Média de 6 anos de úlcera ativa. Detectou-se anemia em 36 (56,2%), sendo 27 (75%) normocrômica e normocítica; 14 (38,8%) apresentavam anemia carencial registrada em prontuário. Conclusão: A baixa concentração de hemoglobina é recorrente entre os participantes, caracterizando um quadro de anemia cujo perfil revela congruência ao da anemia da doença crônica.

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OBJECTIVE: To evaluate the presence of anemia in patients with chronic lower limb ulcers based on profile and hematometric indices. METHOD: This is a cross-sectional study carried out in a university hospital in Rio de Janeiro. The sample was composed of 64 participants with lower limb ulcers and evolution time greater than 12 weeks. Data was collected between May/2016 and December/2017 from hematological analyses, records from medical records, and wound assessment form. RESULTS: 36 (56.2%) were male; 38 (59.4%) between 60 and 80 years old; 56 (87.5%) with chronic diseases and 52 (81.2%) with venous ulcers. 6 years mean of active ulceration. Anemia was detected in 36 (56.2%), 27 (75%) of which were normochromic and normocytic; 14 (38.8%) had deficiency anemia recorded in their medical chart. CONCLUSION: The low hemoglobin concentration is recurrent among the participants characterizing an anemia condition, whose profile reveals congruence to the anemia of chronic disease.

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Hemophagocytic lymphohistiocytosis (HLH) is a syndrome characterized by persistent activation of the mononuclear phagocytic system, systemic inflammation, and hypercytokinaemia, which can lead to liver failure, "sepsis-like syndrome" and ultimately, to multiple organ failure and death. These disorders can be divided into primary and secondary (or reactive), the first, also known as familial HLH, is a genetic condition of childhood, which affects the function of TCD8 and NK cells, and usually presents in the first year of life. The secondary HLH affects mainly adults and adolescents and, it's more related to dysregulation of the immune system. In face of the COVID-19 pandemic and several reports of HLH by SARS-CoV-2, it is necessary to discuss the pathophysiology of HLH in adults more clearly. Thus, we present, for the first time, a didactic approach using illustrations and tables, compiling the most recent and relevant information to better understand this entity.

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OBJECTIVE: The scientific community is constantly assessing the clinical and laboratory manifestations of COVID-19 in the organism. In view of the fragmentation of the large amount of information, knowledge gaps in relation to laboratory markers, and scarcity of papers in Portuguese, we propose a Literature review on laboratory changes observed in patients infected with SARS-CoV-2. METHODS: Analysis of articles published between December 2019 and May 2020 on the PubMed and SciELO databases. The articles were identified, filtered, and evaluated based on the approach to the subject, language, and impact. Then, the articles were subjected to a thorough reading, in full, by 4 (four) independent researchers. RESULTS: Leukopenia and lymphopenia were included in most studies, even in case definitions. Platelet count and platelet-lymphocyte ratio, at peak platelet, were associated with advanced age and longer hospital stay. Eosinopenia showed a sensitivity of 74.7% and specificity of 68.7% and, together with increased CRP, these are one of the future prospects for screening for disease. A high level of procalcitonin may indicate bacterial co-infection, leading to a worse prognosis. COVID-19 manifests itself with increased levels of many inflammatory markers such as IL-1, IL-2, IL-6, IL-7, IL-12, IP10, IFN-γ, MIP1A, MCP1, GSCF, TNF-α, and MCP1/CCL2, as well as LDH, ESR, D-dimer, CK, ALT, and AST. CONCLUSION: There is a need for further studies on the new SARS-CoV-2. So far, there is no consensus regarding laboratory findings and their usefulness, whether as a prognostic marker, mortality, or disease severity.

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SUMMARY OBJECTIVE The scientific community is constantly assessing the clinical and laboratory manifestations of COVID-19 in the organism. In view of the fragmentation of the large amount of information, knowledge gaps in relation to laboratory markers, and scarcity of papers in Portuguese, we propose a Literature review on laboratory changes observed in patients infected with SARS-CoV-2. METHODS Analysis of articles published between December 2019 and May 2020 on the PubMed and SciELO databases. The articles were identified, filtered, and evaluated based on the approach to the subject, language, and impact. Then, the articles were subjected to a thorough reading, in full, by 4 (four) independent researchers. RESULTS Leukopenia and lymphopenia were included in most studies, even in case definitions. Platelet count and platelet-lymphocyte ratio, at peak platelet, were associated with advanced age and longer hospital stay. Eosinopenia showed a sensitivity of 74.7% and specificity of 68.7% and, together with increased CRP, these are one of the future prospects for screening for disease. A high level of procalcitonin may indicate bacterial co-infection, leading to a worse prognosis. COVID-19 manifests itself with increased levels of many inflammatory markers such as IL-1, IL-2, IL-6, IL-7, IL-12, IP10, IFN-γ, MIP1A, MCP1, GSCF, TNF-α, and MCP1/CCL2, as well as LDH, ESR, D-dimer, CK, ALT, and AST. CONCLUSION There is a need for further studies on the new SARS-CoV-2. So far, there is no consensus regarding laboratory findings and their usefulness, whether as a prognostic marker, mortality, or disease severity.

RESUMO OBJETIVO A comunidade científica avalia a todo momento, as manifestações clínicas e laboratoriais da COVID-19 no organismo e, em vista da fragmentação da grande quantidade de informações, lacunas de conhecimento em relação aos marcadores laboratoriais e escassez de trabalhos em português, propomos uma revisão de Literatura sobre alterações laboratoriais observadas em pacientes infectados por SARS-CoV-2. MÉTODOS Análise de artigos publicados entre dezembro de 2019 a maio de 2020 nas plataformas PubMed e SciELO. Os artigos foram identificados, filtrados e avaliados com base na abordagem ao assunto, idioma e impacto. Depois, os artigos foram submetidos a uma minuciosa leitura, na íntegra, por 4 (quatro) pesquisadores independentes. RESULTADOS A leucopenia e a linfopenia constaram na maioria dos trabalhos, presente até em definições de caso. A contagem de plaquetas e a razão plaquetas-linfócitos, no pico plaquetário, foram associados à idade avançada e maior tempo de hospitalização. A eosinopenia apresentou sensibilidade de 74,7% e especificidade de 68,7% e, juntamente com aumento da PCR, são uma das perspectivas futuras de triagem para doença. O alto nível de procalcitonina pode indicar uma co-infecção bacteriana, levando a pior prognóstico. A COVID-19 se manifesta com níveis aumentados de muitos marcadores inflamatórios como IL-1, IL-2, IL-6, IL-7, IL-12, IP10, IFN-γ, MIP1A, MCP1, GSCF, TNF-α e MCP1/CCL2, bem como LDH, VHS, dímero-D, CK, ALT e AST. CONCLUSÃO Há necessidade de estudos adicionais sobre o novo SARS-CoV-2. Até agora, não há unanimidade em relação aos achados laboratoriais e sua utilidade, seja como marcador prognóstico, de mortalidade, ou de severidade de doença.

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BACKGROUND Hereditary hemorrhagic telangiectasia (HHT), also known as Rendu-Osler-Weber syndrome, is a rare autosomal dominant disease. CASE REPORT Here, we report a case of a 49-year-old Brazilian woman with a history of multiple hospitalizations, sometimes life-threatening anemia, and uncommon clinical manifestations. CONCLUSIONS We provide a brief literature review regarding the most common signs and symptoms, history, diagnosis, and treatment. Special attention is given to the techniques for identifying hemorrhagic areas, to the presence of angiodysplasia in gastric tissue, and the identification of sickle cell trait, this being an unprecedented hematological condition in the presentation of the disease. Thus, further studies on the relationship between sickle cell trait and the syndrome are needed.

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INTRODUCTION: Cardiovascular disease (CVD) is especially prevalent in patients with chronic kidney disease (CKD). OBJECTIVE: To evaluate the role of CKD and metabolic syndrome (MS), which is a cluster of risk factors for CVD, as predictors of CVD. METHODS: Observational, cross-sectional study with a random sample aged 45 or more years extracted from the population assisted by the primary care program in Niterói city in the state of Rio de Janeiro, Brazil. CKD was diagnosed by the K/DOQI guidelines and MS, by the harmonized criteria. CVD was said to be present if the participant had one or more of the following findings: echocardiographic abnormalities, and history of myocardial infarction, stroke or heart failure. A logistic regression model was developed to analyze risk factors for CVD using CKD as the variable of primary interest. RESULTS: Fifty hundred and eighty-one participants (38.2% male) with a mean age of 59.4 ± 10.2 years were analyzed. The prevalence rate of CKD was 27.9%. In participants without CKD, MS was associated with a slight but statistically significant increase in the risk for CVD (OR = 1.52, p = 0.037); in those with CKD but without MS the risk for CVD was also statistically significant and at a greater magnitude (OR = 2.42, p = 0.003); when both were present the risk for CVD was substantially higher (OR = 5.13, p < 0.001). CONCLUSION: In this study involving a population assisted by a primary care program, CKD was confirmed as an independent risk factor for CVD. The presence of MS concurrent with CKD substantially amplified the risk for CVD.

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Abstract Background: Heart failure (HF) is a major public health issue with implications on health-related quality of life (HRQL). Objective: To compare HRQL, estimated by the Short-Form Health Survey (SF-36), in patients with and without HF in the community. Methods: Cross-sectional study including 633 consecutive individuals aged 45 years or older, registered in primary care. The subjects were selected from a random sample representative of the population studied. They were divided into two groups: group I, HF patients (n = 59); and group II, patients without HF (n = 574). The HF group was divided into HF with preserved ejection fraction (HFpEF - n = 35) and HF with reduced ejection fraction (HFrEF - n = 24). Results: Patients without HF had a mean SF-36 score significantly greater than those with HF (499.8 ± 139.1 vs 445.4 ± 123.8; p = 0.008). Functional capacity - ability and difficulty to perform common activities of everyday life - was significantly worse (p < 0.0001) in patients with HF independently of sex and age. There was no difference between HFpEF and HFrEF. Conclusion: Patients with HF had low quality of life regardless of the syndrome presentation (HFpEF or HFrEF phenotype). Quality of life evaluation in primary care could help identify patients who would benefit from a proactive care program with more emphasis on multidisciplinary and social support. (Arq Bras Cardiol. 2017; [online].ahead print, PP.0-0)

Resumo Fundamento: A insuficiência cardíaca (IC) é um importante problema de saúde pública, com implicações na qualidade de vida relacionada à saúde (QVRS). Objetivo: Comparar a QVRS, estimada através do Questionário SF-36 (Short-Form Health Survey), em pacientes com e sem IC na comunidade. Métodos: Estudo transversal incluindo 633 indivíduos consecutivos com idade igual ou superior a 45 anos, registrados na atenção primária e selecionados de uma amostra aleatória representativa da população estudada. Foram divididos em dois grupos: grupo I, pacientes com IC (n = 59); e grupo II, pacientes sem IC (n = 574). O grupo I foi dividido em pacientes com IC com fração de ejeção preservada (ICFEP - n = 35) e pacientes com IC com fração de ejeção reduzida (ICFER - n = 24). Resultados: Pacientes sem IC tiveram um escore médio do SF-36 significativamente maior do que aqueles com IC (499,8 ± 139,1 vs 445,4 ± 123,8; p = 0,008). A capacidade funcional - habilidade e dificuldade para realizar atividades comuns da vida diária - foi significativamente pior (p < 0,0001) nos pacientes com IC independentemente de sexo e idade. Não houve diferença entre ICFEP e ICFER. Conclusão: Pacientes com IC mostraram baixa qualidade de vida a despeito da apresentação da síndrome (fenótipo ICFEP ou ICFER). A avaliação da qualidade de vida na atenção primária poderia auxiliar a identificar pacientes que se beneficiariam de um programa de atenção à saúde pró-ativo com maior ênfase em suporte multidisciplinar e social. (Arq Bras Cardiol. 2017; [online].ahead print, PP.0-0)

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Abstract Introduction: Cardiovascular disease (CVD) is especially prevalent in patients with chronic kidney disease (CKD). Objective: To evaluate the role of CKD and metabolic syndrome (MS), which is a cluster of risk factors for CVD, as predictors of CVD. Methods: Observational, cross-sectional study with a random sample aged 45 or more years extracted from the population assisted by the primary care program in Niterói city in the state of Rio de Janeiro, Brazil. CKD was diagnosed by the K/DOQI guidelines and MS, by the harmonized criteria. CVD was said to be present if the participant had one or more of the following findings: echocardiographic abnormalities, and history of myocardial infarction, stroke or heart failure. A logistic regression model was developed to analyze risk factors for CVD using CKD as the variable of primary interest. Results: Fifty hundred and eighty-one participants (38.2% male) with a mean age of 59.4 ± 10.2 years were analyzed. The prevalence rate of CKD was 27.9%. In participants without CKD, MS was associated with a slight but statistically significant increase in the risk for CVD (OR = 1.52, p = 0.037); in those with CKD but without MS the risk for CVD was also statistically significant and at a greater magnitude (OR = 2.42, p = 0.003); when both were present the risk for CVD was substantially higher (OR = 5.13, p < 0.001). Conclusion: In this study involving a population assisted by a primary care program, CKD was confirmed as an independent risk factor for CVD. The presence of MS concurrent with CKD substantially amplified the risk for CVD.

Resumo Introdução: A doença cardiovascular (DCV) é especialmente prevalente em pacientes com doença renal crônica (DRC). Objetivo: Avaliar o papel da DRC e da síndrome metabólica (SM), que é um conjunto de fatores de risco para DCV, como previsores de DCV. Métodos: Estudo observacional, transversal, com uma amostra representativa da população assistida pelo programa de atenção primária em Niterói, RJ, Brasil, incluindo pacientes com idade igual ou maior do que 45 anos. A DRC foi diagnosticada segundo o K/DOQI e a SM, pelo critério harmonizado. A DCV foi dita estar presente diante de um ou mais dos seguintes achados: anormalidades ecocardiográficas ou história de infarto do miocárdio, acidente vascular cerebral ou insuficiência cardíaca. Um modelo de regressão logística foi desenvolvido para analisar os fatores de risco cardiovasculares usando a DRC como a variável de interesse primário. Resultados: Foram analisados 581 participantes (38,2% homens), com idade média de 59,4 ± 10,2 anos. A taxa de prevalência da DRC foi de 27,9%. Em participantes sem DRC, a SM foi associada com um ligeiro, mas estatisticamente significativo aumento no risco cardiovascular (OR = 1,52, p = 0,04); naqueles com DRC, mas sem SM, o risco para DCV também foi estatisticamente significativo e com maior magnitude (OR = 2,42, p = 0,003); quando ambos estavam presentes, o risco para DCV foi substancialmente mais elevado (OR = 5,13, p < 0,001). Conclusão: Neste estudo, envolvendo uma população assistida por um programa de atenção primária, a DRC foi confirmada como um fator de risco independente para DCV. A presença da SM concomitante com a DRC ampliou substancialmente esse risco.

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