Dias ALA, da Silva RG, Cunha FGP, Morcillo AM, Lorand-Metze I, Vilela MMS, Riccetto AGL. Managing costs in primary immunodeficiency: minimal immunophenotyping and three national references. APMIS 2019; 127: 228-235.Our aim was to evaluate the cost-effectiveness of a minimal lymphocyte subset quantification (LSQ) by flow cytometry as the first screening in children with clinically suspected primary immunodeficiency (PID). Two hundred sixty-eight Brazilian patients (0-21 years old) were studied. They were divided by clinical and phenotypical features into those fulfilling criteria for PID (PID phenotype) according to the 2017 International Union of Immunological Societies (IUIS) classification and those not fulfilling these criteria (non-PID phenotype). We evaluated how many patients had values below the 10th percentile for five lymphocyte subsets in peripheral blood, (suggestive of PID) according to reference values for Brazil, Italy and USA. Three lymphocyte subsets (T CD3/CD4, B CD19 and NK CD16/CD56) had p-value < 0.05 and Odds Ratio (OR) indicating a risk at least two times higher for the diagnosis of a PID phenotype. The application of Kappa coefficient (k) on Brazilian vs Italian and Brazilian vs US data sets resulted in k compatible with strong or excellent level of agreement between the three classification systems. The authors conclude that a number of CD3 + / CD4 + , CD19 + and CD16 + /CD56 + (NK) cells in peripheral blood <10th percentile represented a significant risk for the diagnosis of PID in this cohort. Natural killer (NK) deficiency is quite rare and has a very specific clinical profile. So, the analysis of these cells could be requested only in some cases, saving even more costs. The minimal immunophenotyping, with quantification of T CD4 + , CD19 + and in some cases CD16 + /CD56 + cells, may be a useful tool for the first screening of PID, saving costs, especially in developing countries.
Analyses of contaminants in sediments, such as trace elements, are fundamental to characterize normality or alterations in aquatic environments. These are important data to evaluate areas used for aquaculture, particularly those where there is a closer interaction between sediments and organisms cultured, as in oyster cultivation. The concentrations of trace elements (Al, Cd, Co, Cr, Cu, Fe, Ni, Mg) were assessed in the sediments of six oyster farming areas in the Amazon estuary. Sediment sampling was carried out in the months of November 2013 (dry season) and April 2014 (rainy season) and central areas were prioritized. Levels of trace elements were quantified by induced plasma optical emission spectrometry (ICP-MS). Possible effects on aquatic biota were evaluated by comparing the levels of metals in the sediments with the reference values proposed in the TEL and PEL protocols. The concentrations of trace elements in sediments in all evaluated areas were higher in the rainy season, except for copper. Following the order of concentration, in most of the locations Al> Fe> Mg> Cr> Ni> Co> Cu> Cd. Only Cd levels were higher than the TEL and PEL.
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