Categoria: Blog

CHROMOENDOSCOPY

Nowadays there is a great advance in diagnostic techniques in Gastroenterology. Among them, Chromoendoscopy stands out, a technique that consists in the application of dyes on the digestive mucosa to facilitate and improve the quality of diagnosis, and the staining of the mucosa also allows to visualize it in a more evident way, highlight the characteristics of the lesions already detected, detect abnormal lesions more quickly, since the details of its surface stand out with the staining, besides conferring greater sensitivity and specificity in the diagnosis of dysplasias, metaplasias or carcinoma in the various segments of the digestive tract.

Renylab manufactures a high quality endoscopic line. All dyes are registered with ANVISA and have a Certificate of Good Manufacturing Practices.

  Dyes for Endoscopy

  METHYLENE BLUE

Dye solution used to enhance Barret’s epithelium. The methylene blue when used in the esophagus, allows to confirm the presence of intestinal epithelium specialized in patients with short segments of columnar mucosa, to lift the map of extension and distribution of Barret’s epithelium, to make less likely the diagnosis of Barret’s esophagus, when the segment of mucosa of the terminal esophagus is not colored by this methodology and to orient biopsies to areas of higher risk of dysplasia and adenocarcinoma.

https://en.renylab.ind.br/produto/azul-de-metileno/

  INDIGO CARMINE

Dye solution used throughout the digestive tract, to highlight the contours of the mucosa, highlighting polyps and small flat lesions, filling folds, crypts, erosions and ulcers. It can be used in multiple situations: to highlight the villous character of Barret’s mucosa and to identify flat areas of high grade dysplasia or carcinoma, to highlight irregularities of gastric mucosa corresponding to areas of metaplasia or dysplasia and in the duodenum to highlight the atrophic aspect of the mucosa. It should be used in the detailed characterization of macroscopic lesions and in the study of high risk neoplastic mucosa without apparent lesions. There is no contraindication to its use and it does not need washing before or after its instillation.

https://en.renylab.ind.br/produto/indigo-carmim/

  CHINA INK

Dye solution usually used in colonoscopy to highlight the contours of the mucosa, highlighting polyps and small flat lesions and filling folds, crypts, erosions and ulcers. It is used for the demarcation of small and multiple lesions of the mucosa as a preoperative resource that facilitates their handling. There is no contraindication to its use and it does not require washing before or after its instillation.

https://en.renylab.ind.br/produto/tinta-nanquim/

  LUGOL

Dye solution of particular interest in the early detection of epidermal adenocarcinoma of the esophagus. The areas of the mucosa that turn yellow or pink after instillation deserve particular attention.

Lugol’s instillation is useful in the early detection of epidermoid carcinomas in the population considered at high risk (individuals with head and neck carcinoma, consumers of alcohol and tobacco in large quantities). In addition, Lugol allows a better definition of the margins of a known lesion, to design other lesional foci in the esophageal mucosa and to evaluate the existence of residual lesion after endoscopic musectomy. For some authors, the great advantage of Lugol is not in its diagnostic power, but in its ability to delimit a lesion. Other authors attribute  Lugol a significant ability to increase the sensitivity to detect high grade dysplasia or carcinoma (from 62% to 96%).

https://en.renylab.ind.br/produto/lugol/

The objective of this guide is to clarify the mechanism of action together with the techniques of application of different dyes and show the various clinical applications that endoscopic dyes have.

  PROPERTIES

The dyes used in Chromoendoscopy have particular characteristics and distinct objectives, being classified as absorption dyes, contrast dyes and reactive dyes.

  Absorption Dyes

Dyes that have this property have the ability to pass to the intracellular environment through absorption or diffusion, when they identify epithelial cells and their constituents. The chemical properties of the dye determine its fixation and its use in several situations.

  Contrast Dyes

Contrast stains have the function of highlighting the contour and topography of the mucosa, since they do not penetrate the intracellular environment.

  Reactive Dyes

Reactive dyes identify the acid producing gastric cells.

  PREPARATION OF THE MUCOSA

Before the chromoendoscopy procedure it is common to make a preparation of the mucosal surface, since it is covered with a variable amount of mucoid material. For this, mucolytic agents are used, which are substances that break and rupture the peptidic bonds of the proteins that constitute the mucus, making it more easily eliminated, because it becomes less viscous.  Ex: Acetylcysteine, dimethyl-polisiloxane, n-acetylcysteine, acetic acid.

Endoscopic dyes can be applied directly through the endoscope channel, using syringes or catheters or through spray, the most commonly used technique. The choice depends on the type of staining and the purpose for which it is applied.

 Table 1.

  CONCLUSION

The use of the Chromoendoscopy technique is simple, safe, easy to perform and inexpensive. The careful choice of dyes according to the situations presented allows greater sensitivity and specificity, making the diagnosis more reliable, safe and of higher quality.

Bibliographic References

1- Fennerty MB. Tissue staining. Gastrointestinal endoscopy. Clin N Am 1994;4:297-311.

2- Gostout C. Early lesions: staining magnifying scopes and mucosectomy. Frontiers oftherapeutic endoscopy. Post graduate course. Colonoscopy 1997; 63.

3- Kim C, Fleischer D. Colonic chromoscopy. Gastrointestinal Endoscopy Clinics N.Am. 1997; 4(3): 423-37.

4- Misumi a , ETAL. Role of lugol dye endoscopy in the diagnosis of early esophageal cancer. Endoscopy 1990; 22: 12-6.

5- Ratilal, P.0; Pires, E.C; Deus, J,R; Novais, L.A: Cromoendoscopia: Porquê colorir? GE vol. 9 2002:340-346

6- Canto M. Methylene blue chromoendoscopy for Barrett’s esophagus: Coming soon to your lgl unit? \endoscopy 2001; 54:560-8

At a time when the new coronavirus pandemic continues to advance in Brazil and in the world, the need for massive tests to detect the disease and to know the true number of infected people is growing. An accurate and correct diagnosis is essential to propose any measure related to the prevention and prognosis of infections.

The gold standard technique, considered the most accurate for diagnosis, is RT-PCR (an acronym for reverse transcription followed by polymerase chain reaction). It consists of the detection of viral RNA sequences. The test has the disadvantage of requiring a few days to be processed and the report must be issued by the laboratory.

Serological tests, on the other hand, detect the presence of class M (IgM) and G (IgG) immunoglobulins, produced by the body in response to infection by the virus. IgM is the main immunoglobulin that is formed after infection and begins to be detected between days 3 and 5 after infection, with a detection peak after the seventh day. As the infection progresses, IgM levels decrease and, conversely, IgG levels increase rapidly, with maximum detection after day 14 of infection.

The rapid test can be performed on whole blood, serum or plasma samples and the result will be available in approximately 15 minutes. The possibility of infection, however, cannot be ruled out with a negative result. This is because the production of antibodies, at the beginning of the disease, may not have been detected by TR, which caused the false negative. In such cases, it is suggested to repeat the test, to confirm, or not, the absence of infection. In addition, rapid tests can identify if the person has been previously infected, even without experiencing symptoms.

Rapid tests play an important role in understanding the dynamics of virus transmission in the population and in identifying groups at high risk of infection. They can also determine the proportion of the population that has been infected, helping to identify which communities have had a high rate of infection.

Sources:

https://www.cdc.gov/coronavirus/2019-ncov/hcp/testing-overview.html

https://saude.abril.com.br/blog/com-a-palavra/a-importancia-do-teste-rapido-para-conter-a-covid-19/

RenyLab In Vitro Diagnostics, Chemical and Pharmaceutical Industry of Barbacena-MG, carried out massive tests of its employees for Covid-19 between 07 and 08 July 2020. The test was carried out through rapid serological tests, with the aim of prioritizing the well-being and safety of employees, as well as contributing to the control of pandemic rates in Barbacena and region. All employees were tested and 100% of the results were negative for the new coronavirus.

According to the Ministry of Health, the state of Minas Gerais has the lowest incidence rate of the disease among all Brazilian states. On July 10, 2020, the state had 302.5 confirmed cases per 100,000 inhabitants, and a total of 64,035 infected by the new coronavirus, a figure much lower than São Paulo, which already has stable cases and a possible drop, and in Rio de Janeiro and Espírito Santo, which are on the rise like Minas Gerais. Large laboratories in the state of Minas Gerais point to an increase in the percentage of tests carried out mainly in the interior of the state, where only in June 60% more tests were carried out than in the previous month.

Massive tests play an important role in understanding the dynamics of virus transmission, in identifying high-risk groups and with the possibility of verifying if those analyzed have been infected or have had contact with Sars-COV-2, contributing to establish infection rates. In addition, it allows the health authorities to understand the city’s indexes and decide on the flexibility of security measures for the recovery of the economy.

RenyLab In Vitro Diagnostics is committed to the fight against coronavirus, providing products with a high quality guarantee, with a rapid test for Covid-19 with 100% accuracy (proximity between the experimentally obtained value and the true measurement value) certified by Anvisa, by FDA – Federal Agency of the United States and by the National Institute of Quality Control in Health-NIQCH.

Dengue is a disease caused by an arbovirus that has four antigenically distinct serotypes: DEN-1, DEN-2, DEN-3, and DEN-4.

Currently in Brazil circulate the four serotypes that intersect in the occurrence of epidemics, which are generally associated with the introduction of new serotypes in previously unreached areas or alteration of the predominant serotype. Dengue virus is transmitted by the bite of the mosquito of the genus Aedes, which is also responsible for the transmission of other viral diseases.

The World Health Organization (WHO) estimates that 4 billion people live in areas at risk of infection from the disease. Annually, approximately 390 million cases are recorded worldwide. In Brazil, transmission has been occurring continuously, in cyclical outbreaks, the largest of which had around 2 million reported cases.

Dengue can have different clinical presentations and an unpredictable prognosis, its incubation period varies from 3 to 15 days. The illness begins suddenly with a high fever, severe pain in the head and eyes, as well as muscle and joint pain. In the most severe cases, when the fever subsides, around the third or fourth day, bleeding occurs due to bleeding from the skin vessels and internal organs that characterize dengue hemorrhagic fever. In these cases, the clinical picture worsens rapidly, showing signs of circulatory insufficiency, intense and continuous abdominal pain, pale skin, bleeding from the nose, mouth and gums and red spots on the skin, which can cause death.

Dengue diagnosis is usually made by serology to determine the presence of antibodies against the virus in the blood or specific antigens, varying their plasma concentrations according to the moment of initiation of the infection.

NS1 is a protein that appears in detectable concentrations during dengue infection, it appears on the first day with a decrease from the fourth day, disappearing around the fifth, sixth day after the onset of symptoms.

IgM appears on average 5 to 8 days after symptoms and can last 30 to 90 days, while IgG appears on average after 14 days and can persist for life.

Given the importance of this disease, RenyLab is committed to quality by providing rapid tests with results in 20 minutes, with high rates of sensitivity and specificity with certified efficacy and strict quality control.

The Renylab Dengue Immunotest is a solid phase immunochromatographic test that qualitatively and differentially detects IgG, IgM antibodies against the four serotypes of dengue virus in human serum and plasma.

The test is fast, safe and represents an important tool for the treatment of patients with suspected dengue.

RenyLab is determined to contribute and support its clients and partners in this difficult time of the COVID-19 pandemic. We would like to share with you an article on gastrointestinal endoscopy (GIE) on the impact of coronavirus on endoscopic procedures. In this article you will find recommendations with a specific focus on personal protection and dress code, to prevent the spread of COVID-19.

We have summarized the most important steps below. If you want to access the full article click here.

Some important steps we would like to point out:

• Every patient entering the endoscopy room must wear a mask to protect others. Patients considered at risk should also wear gloves;
• For clinic staff and physicians, the recommendation is to maintain a safe distance from patients throughout the procedure. According to the article, it is mandatory to wash your hands with soap and water or an alcohol-based disinfectant:

1. Before and after interaction with the patient;
2. Contact with potentially infected surfaces;
3. Before putting on and after taking off any personal protective equipment, including gloves.

• In the article you will find the minimum composition of an individual protection kit in endoscopic procedures, which can be modified depending on the risk.

What is coronavirus?

Coronavirus (ICD10) is a family of viruses that cause respiratory infections. The new coronavirus agent was discovered on the 31th December 2019 after cases registered in China. It causes the disease called coronavirus (COVID-19).

Most people are infected with common coronaviruses throughout their lives, with young children being more likely to become infected with the most common type of virus. The most common coronaviruses that infect humans are the alpha coronavirus 229E and NL63 and beta coronavirus OC43, HKU1.

The incubation period is the time it takes for the first symptoms to show since the infection by coronavirus, which can vary from 2 to 14 days.

In general, the transmission occurs only as long as symptoms last. Transmission may occur after symptoms go away, but the transmissibility period duration is unknown for the coronavirus. During incubation period and asymptomatic cases are not contagious.

What are the types of coronavirus?

Types of coronavirus known to date are:

• Alpha coronavirus 229E and NL63.
• Beta coronavirus OC43 and HKU1.
• SARS-CoV (causing Severe Acute Respiratory Syndrome or SARS).
• MERS-CoV (causing Middle East Respiratory Syndrome or MERS).
• SARS-CoV-2: a new type of coronavirus agent virus, called the coronavirus, which appeared in China on December 31, 2019.

How is the coronavirus transmitted?

Investigation on how transmission of the coronavirus takes place are still ongoing, but virus is thought to spread mainly from person-to-person, that is, contamination happens by respiratory droplets or contact. Anyone who are in close contact (within about 1 meter) with someone with respiratory symptoms is at risk of being exposed to the infection.

It is important to note that person to person spread can occur continuously.

Some viruses are highly contagious (like measles), while others are less. It is not clear yet on how easily the coronavirus spreads from person to person.

Despite this, the transmission of coronaviruses usually occurs through the air or through personal contact with contaminated secretions, such as:

• Saliva droplets;
• sneeze;
• cough;
• phlegm;
• close person-to-person contact, such as touching or shaking hands;
• contact with contaminated objects or surfaces, followed by contact with the mouth, nose or eyes.

Coronavirus show less transmission rate compared to the flu virus.

The average incubation period for coronavirus is 5 days, with longer periods that can reach 12 days, period for the first symptoms to show after the infection.

How is coronavirus diagnosed?

The coronavirus is diagnosed by finding evidence of the virus in respiratory samples collected by aspiration of the airways or sputum induction. It is necessary to collect two samples in case of suspected coronavirus.

Both samples will be urgently sent to the Central Public Health Laboratory (Lacen).

One of the samples will be sent to the National Influenza Center (NIC) and  the other will be sent for metagenomic analysis.

To diagnose the disease, it is necessary to perform molecular biology tests to detect viral RNA. The diagnosis of the coronavirus is made with sample collection, which is indicated whenever a suspected case is identified.

The collection of nasopharyngeal aspirate (ANF) or combined swabs (nasal/oral) or a sample of lower respiratory secretion (sputum or tracheal lavage or lavage bronchial lavage) is recommended.

How is coronavirus treated?

There is no specific treatment for infections caused by human coronavirus. Rest and consumption of plenty of water are indicated, in addition to some measures to relieve symptoms, according to each case, such as:

• Use of medication for pain and fever (antipyretics and analgesics).
• Use of a humidifier in the bedroom or a hot shower to help relieve pain from sore throat and coughing.

As soon as the first symptoms appear, it is essential to seek immediate medical help to confirm the diagnosis and start the treatment.

All patients who are discharged during the first 7 days after the first symptoms (independent of fever), should be alerted to the possibility of late worsening of clinical conditions and warning signs of complications such as: fever (there may be initial cases without fever), increase or reappearance of fever or respiratory signs, tachycardia (increased heart beat rate), pleuritic pain (chest pain), fatigue (tiredness) and dyspnea (shortness of breath).

What are the symptoms of coronavirus?

Coronavirus symptoms are mainly respiratory, similar to a cold. They can also cause infection of the lower respiratory tract, such as pneumonia. However, the coronavirus (SARS-CoV-2) still needs further studies and investigation to better characterize the symptoms of the disease.

The main symptoms known to date are:

• Difficulty breathing.

How to prevent coronavirus?

The Health Ministry provides basic care guidelines to reduce the overall risk of contracting or transmitting acute respiratory infections, including the coronavirus. Among the measures are:

• Wash your hands frequently with soap and water for at least 20 seconds, respecting the 5 moments of hygiene. If there is no soap and water available, use an alcohol-based hand sanitizer.
• Avoid touching eyes, nose and mouth with unwashed hands.
• Avoid close contact with sick people.
• Stay home during sickness period.
• Cover your mouth and nose when you cough or sneeze with a tissue and discard it.
• Clean and disinfect frequently objects and surfaces.

Health professionals should use standard precautions measures, for contact and droplet (surgical mask, gloves, non-sterile apron and goggles).

Source: www.saude.gov.br

www.anvisa.gov.br

According to a study by 24 researchers from universities in six countries based on medical records from 195 nations, 11 million people die every year from septicemia, more than cancer.

The researchers state that numbers are “alarming” because they doubled from previous estimates.

Most cases occur in low or middle income countries, but more and more wealthy nations are dealing with the problem.

Sepsis (or septicemia) is known as a “silent killer” because it is very difficult to be detected.

Sepsis is a systemic answer of the body to an infection, which can be caused by bacteria, viruses, fungi or protozoa.

Normally, the immune system fightback the infection and prevent it from spreading. But, if the infection manages to advance through the body, the body’s defense releases a systemic inflammatory response in attempt to fight it so the immune system can collapse because, when fighting an infection, it also damages other parts of the body itself.

Ultimately it causes organ systems failure, and survivors can have serious sequelae.

When not diagnosed and treated quickly, it can compromise one or more organs of the patient and lead to death.

When the patient develops septic shock, blood pressure drops to low and dangerous levels, reducing the oxygenation of organs, compromising their function. Septic shock, according to the British Health Service (NHS), can occur as a complication of sepsis.

Any infectious process, pneumonia or urinary tract infection for example, can progress to sepsis.

Why was there a increase in numbers?

Previous global estimates, which reached 19 million cases and 5 million deaths per year, were based only on a few Western countries.

But the University of Washington analysis, published in the Lancet scientific journal and based on medical records from 195 nations, states about 49 million cases per year.

The 11 million deaths from sepsis represent 1 in 5 deaths worldwide.

“I worked in rural Uganda and we see cases of sepsis every day”, says researcher and assistant professor Kristina Rudd, from the University of Pittsburgh.

“So this discovery was not a surprise, but I didn’t expect it to be the double from previous estimates”.

The good news from the analysis is that the number of cases and deaths has been decreasing since 1990. There has been a 50% drop in the past two decades.

What can be done?

The reduction in the number of infections can lead to a reduction in numbers of sepsis cases.

For many countries, this means better basic sanitation, clean water and access to vaccines.

Another major challenge is to improve the diagnose system for sepsis so patients can be treated before it is too late.

Early treatment with antibiotics or antivirals to eliminate the infection can make a big difference.

“We need to renew the focus on preventing sepsis among newborns and fightback antibiotics resistance, an important factor in this disease”, said Mohsen Naghavi, researcher at the University  of Washington.

Source: bbc.com

Campylobacter is considered the most common bacterial cause of human gastroenteritis. It is one of the four major causes of diarrhea in the world, making it of great socioeconomic importance.

What is Campylobacter?

Campylobacter is a genus composed of zoonotic bacteria, with bacillary shape, which causes campylobacteriosis, a food poisoning. It is widely found in nature, being considered normal flora in several domestic and wild animals. The vast majority of species of the genus Campylobacter grows at a temperature of 37ºC, except for C. jejuni, C. coli and C. lari, which can grow at temperatures up to 42ºC. It is formed by one or more spiral flagella, which contributes to its pathogenicity increase.

Mechanism of virulence and infection

Campylobacter is an eukaryotic intracellular parasite. Colonization begins in the small intestinal cells, causing a decrease in its absorption capacity and subsequently it moves to the colon. The flagellum has a complex role in pathogenicity that includes, among others, protein secretion.

Recently, several virulence factors that may be involved in the pathogenicity of Campylobacter have been identified. Among the main ones are motility due to the flagellum, adherence abilitie and invasion of eukaryotic cells, lipopolysaccharide LPS with endotoxic activity and production of cytotoxins, such as CDTs that kills the infected cell.

What are the authorities doing about it?

The growing trend, which started in 2005, affects many countries, regardless of their level of development. The high incidence is found even in countries with a high development level, with chicken carcasses being the most important route of contamination. Thus, many national and international organizations, such as WHO and FDA, have identified the need for changes in regulations, through several studies carried out over the last decade.

This change is associated with microbiological criteria and resulted in ISO 10272: 2017 Microbiology of the food chain. Horizontal method for detection and enumeration of Campylobacter spp., formed by two parts: “Detection method” and “Colony-count technique”. The last part contains the techniques for sampling fresh chicken carcasses and meat. The sampling plan is intended to follow the same hygiene criteria approach established for Salmonella.

With the new regulations, a decrease in cases of campylobacteriosis is expected, contributing to a reduction in public health problems.

In December, the awareness ribbon is red. The month marks the fight against AIDS and other sexually transmitted infections, known as STIs. In this fight, information is essential. In addition to knowing the disease and its forms of transmission, it is important to share information throughout the year, on how to prevent it and give support for people with HIV, the human immunodeficiency virus.

Throughout the text, you will find the main aspects about this infectious agent and how its action in our organism can lead to the development of AIDS. Lets go?

What is HIV?

HIV is a retrovirus that attacks the immune system, infects and alters the function of lymphocytes, the body’s protective cells. They organize our immune response and prevent us from becoming more susceptible to other diseases. With the alteration of the DNA of these cells, the vírus increases its multiplication capacity. Thus, the infection spreads throughout the body.

It is also important to know that HIV is not synonym for AIDS. All over the world, there are people who live with the virus without developing the disease. However it remains transmissible. HIV is spread only through the exchange of body fluids such as blood, semen, vaginal secretions and breast milk.

Day-to-day interactions, such as hugging, kissing and sharing objects, do not transmit the virus or AIDS. Raising awareness of friends, family and the population about this is a way to reduce prejudice against those who deal directly with HIV.

What are the preventive measures?

About prevention, there are strategies to prevent infection and strategies to prevent the virus from evolving to AIDS. In general, using condoms in all sexual relations is the main measure against HIV transmission. Never share syringes, needles and other sharp objects is also a necessary measure.

In case of exposure to risky situations, it is recommended get examed for a correct diagnose. The exam is simple and can be done by anyone. It is mandatory for pregnant women at the beginning of prenatal care. If the result is positive, it is possible to start a treatment that prevents the virus of being transmitted to the baby throughout pregnancy and at the delivery.

In 1980, the first antiretroviral drugs appeared, which inhibit the multiplication of the virus. The evolution of medicines has made AIDS, which before was almost always fatal, become a controllable condition. Although there is no cure, research with high technology, which is the basis for our work, continues to be carried out to change this scenario.

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