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Acute kidney injury (AKI) is a common finding in Neotatal Intensive Care Units (NICU). Sepsis is one the main causes of AKI in preterm newborns. AKI has been associated with significant death rates. Early detection of the condition is the first step to improving prevention, treatment, and outcomes, while decreasing length of hospitalization, care costs, and morbimortality. AKI may progress to chronic kidney disease (CKD), a condition linked with dialysis and greater risk of cardiovascular disease. This review article aims to discuss cases of AKI in preterm newborns with sepsis, the use of biomarkers in lab workup, and the use of non-conventional biomarkers for the early identification of AKI. Resumo A lesão renal aguda (LRA) é comum na Unidade de Terapia Intensiva Neonatal (nUTI) e a sepse é uma de suas principais causas, especialmente em prematuros. Apresenta altas taxas de mortalidade e sua detecção precoce é o primeiro passo para a prevenção dessa condição, pois permite o tratamento adequado e melhora o desfecho, diminui o tempo de internação, os custos não médicos e a morbimortalidade. Destaca-se ainda que a LRA pode evoluir para doença renal crônica (DRC), havendo a necessidade de diálise, com maior risco de desenvolver doenças cardiovasculares. Este artigo de revisão tem como objetivo discutir a LRA em recém-nascidos (RNs) prematuros com sepse, abordando biomarcadores utilizados na rotina laboratorial e principalmente a utilização de biomarcadores não tradicionais para identificação precoce de LRA.

Sickle cell anemia (SCA) is a genetic disease that causes important clinical manifestations due to chronic hemolysis and vascular occlusion. The aim of this study was to report a rare case of monozygotic twins diagnosed with SCA, presenting a different clinical characteristic. An interview with the patients was carried out and the medical records were consulted. One patient has a history of malleolar ulcer in the left back, while the other does not. Both patients used hydroxyurea at the same dosage. This study shows that SCA presents, in addition to genetic factors, non-genetic factors involved in the severity of the disease and its clinical manifestations. Studies are needed that may contribute to the understanding of the clinical heterogeneity of SCA. A anemia falciforme (AF) é uma doença genética que causa importantes manifestações clínicas devido à hemólise crônica e à oclusão vascular. O objetivo deste estudo foi relatar um caso raro de gêmeas univitelinas com diagnóstico de AF, apresentando uma característica clínica diferente. Uma entrevista com as pacientes foi realizada, e os prontuários foram consultados. Uma paciente tem história de úlcera maleolar na região esquerda, enquanto a outra não. Ambas as pacientes faziam tratamento com hidroxiureia na mesma dosagem. Este estudo mostra que a AF apresenta, além de fatores genéticos, fatores não genéticos envolvidos na gravidade da doença e suas manifestações clínicas, sendo necessários estudos que possam contribuir para o entendimento da heterogeneidade clínica da AF. La anemia de células falciformes (ACF) es una enfermedad genética que causa importantes manifestaciones clínicas debido a la anemia hemolítica crónica y a la oclusión vascular. El objetivo de este estudio fue reportar un caso raro de gemelas monocigóticas con diagnóstico de ACF, presentando una característica clínica diferente. Se realizó una entrevista con las pacientes, consultándose sus fichas médicas. Una paciente tiene historia de úlcera maleolar en la región izquierda, mientras la otra no. Ambas hacían tratamiento con hidroxiurea en la misma dosis. Este estudio demuestra que la ACF presenta, además de factores genéticos, factores no genéticos involucrados en la severidad de la enfermedad y sus manifestaciones clínicas. Son necesarios estudios que contribuyan para la comprensión de la heterogeneidad clínica de la ACF.

Wernick’s Encephalopathy (WE) is an acute neuropsychiatric syndrome caused by thiamine deficiency post hematopoietic stem cell transplant (HSCT). WE is associated with high mortality and morbidity rates, but due to its rare occurrence, it is rarely considered in patients submitted to this procedure. Considering that, the manuscript reports the clinical characteristics and the possible factors that predisposed the occurrence of WE in a patient with non-Hodgkin’s lymphoma post-Autologous HSCT. We conclude that WE should be considered in patients submitted to autologous HSCT associated with prolonged use of TPN and malnutrition.

Background: Visceral leishmaniasis is a zoonosis characterized by chronic evolution of symptoms; it usually appears 2 to 4 months after the initial infection, with multiple cutaneous lesions and systemic involvement, which if left untreated results in death in 90 % of cases. Case presentation: We present a case of 29-year-old white male farmer, with chronic myeloid leukemia treated with imatinib who developed significant pancytopenia, leading to discontinuation of treatment. His neutrophil count fell to 0.5 × 10 9 /L, his platelets dropped to 85 × 10 9 / μ L, and his hemoglobin was 6.4 g/dL. A bone marrow study was performed, showing complete remission of chronic myeloid leukemia and numerous Leishmania amastigotes within the macrophages. He used pentavalent antimonials replaced by amphotericin B due to acute cardiac toxicity. After 3 months, imatinib was restarted, and he again showed adequate control of the disease. The last polymerase chain reaction assessment showed a deep molecular response. Conclusion: The hypothesis of an adverse event or secondary resistance to tyrosine kinase inhibitors, with subsequent progression to advanced disease, was initially raised, although a detailed evaluation has shown that it was an associated infectious disease.

Introduction: Hematopoietic stem cell transplantation (HSCT) is a procedure widely performed in patients with hematological, malignant or not, autoimmune diseases and metabolic disorders, with an increase in overall survival. Despite this, acute kidney injury remains a frequent complication, affecting 10-70% of patients, contributing to an expressive mortality. Objectives: Analyze the occurrence of Acute Kidney Injury (AKI) in patients undergoing hematopoietic stem cell transplantation. Correlate the sociodemographic and clinical profile and variables related to HSCT with the onset and evolution of AKI, in addition to the impact on overall and event-free survival. Material and Methods: Retrospective cohort study, with descriptive and analytical approach, including all patients undergoing HSCT between jan/2014 and dec/2019 at Hospital Universitário Walter Cantídio (HUWC). Patients with chronic kidney disease on dialysis were excluded. Data were collected from multidisciplinary medical records and Master platform for laboratory tests and were tabulated in Microsoft Excel® 2016. The analysis was performed using software R version 4.0.3, adopting a confidence level of 95%. For identification and stratification of AKI, the KDIGO method was used. The association of variables with the presence of AKI was performed using the Chi-square test or Fisher's exact test 2x2. Normality test used was Shapiro Wilk. For quantitative or ordinal variables, Student's t test or Mann-Whitney test was considered when data were not normal. Serum creatinine was used as a marker of glomerular filtration rate (GFR) at time Zero, d0--30, d31-60 and d61-100 after HSCT. We used the CKD-EPI formula for estimation and the comparison of the four measures was made by the ANOVA test or Friedman test. Analysis of the impact of AKI on survival was performed using the Kaplan-Meyer survival curve and the log rank test. Results: 391 patients were included in the analysis, who were predominantly men (54.99%), with a median age of 47 years, mostly from the public network (57.29%). The most prevalent underlying disease was multiple myeloma (35.04%), followed by lynphoma (28,38%). We had 264 autologous (67.52%) and 127 halogen (32.48%) HSCT. AKI was diagnosed in 129 patients (32.99%). The majority of patients (53.48%) were classified as stage 1 in the KDIGO system. The non-oliguric form predominated (84.49%), with an average installation time of 32 days after HSCT and an average 8 recovery time of 35 days. Thirteen patients (10.07%) used renal replacement therapy (RRT). Seventy-three patients (56.58%) recovered their kidney function, while twentytwo (17.05%) died and fifteen (11.62%) progressed to chronic kidney disease. In bivariate analysis, the variables independently associated with AKI were: Halogen transplantation (RR 4.31 95%CI p

Hypoxia and hemoglobin S (HbSS) polymerization are the two cardinal triggers responsible for both erythrocyte sickling as well as of all clinical events in sickle cell anemia (SCA), a disease with many pathophysiological and molecular aspects that remain unclear. Despite being a permanent feature of SCA, there is still no consensus on the definition or management of hypoxia in sickle cell patients, and studies on its role in the pathogenic mechanisms of the disease, or on how it influences the clinical complications or hydroxyurea (HU) treatment, gold standard in the treatment of SCA, are lacking. Therefore, this study aimed to investigate the expression of hypoxia response genes in SCA and to analyze the dose-response to HU of angiogenesis, DNA damage and repairs, and clinicallaboratorial markers. The study population comprised 97 patients of both sexes, of ages ranging from 18 to 68 years, stratified into two groups: SS group (no HU, n=29) and SSHU group (treated with HU, n=68). The SSHU group was further stratified into subgroups according to the daily dose of the drug that patients already used: SSHU-0.5g (n=13); SSHU-1g (n=40) and SSHU-≥1.5g (n=15). A control group included 73 healthy individuals who were voluntary blood donors. The mRNA expression of the HIF-1α, VEGF, ATM, and ATR genes was measured by qPCR and associated with clinical and laboratory characteristics of the patients as well as with the daily dose of the drug. The main results included overexpression of all hypoxia-responsive genes tested here (p

For the control and prevention of coagulation disorders, numerous polysaccharides can be used, with unfractionated heparin (UFH) and fractionated heparin (HF) being the most promi-nent. As these glycosaminoglycans have limitations of use, many studies have been conducted in order to identify substances with similar effects. In this context, the literature states that sulfated polysaccharides are polymers with anticoagulant potential. In order to find an alterna- tive to heparins, tests on the anticoagulant activity of three isolated and chemically sulfated natural polysaccharides were carried out: galactomannans extracted from Carolina [Adenan- thera pavonina (L.)] and Flamboyant [ Delonyx regia (Boger ex Hook.)], And pectin extract- ed from Japanese melon (Cucumis melo var. Acidulus). Of these, sulfated pectin (PS) was selected because it has the most promising anticoagulant activity. Complementing the in vitro assays, this polysaccharide was subjected to the activated partial thromboplastin time (APTT), prothrombin time (PT) and thrombin time (TT) tests, where it was possible to verify linear and dose-dependent APTT results. Considering that polymeric nanoparticles play an im- portant role in future therapies, this study also proposed the preparation and characterization of Poly D, L-Lactide-co-glycolide (PLGA) nanoparticles containing sulfated pectin, through the double emulsion method with solvent evaporation, using polyvinyl alcohol (PVA) as a surfactant. Subsequently, the nanoparticles obtained were properly characterized in terms of their physical-chemical characteristics, and analyzed for stability, release, morphology, and rheological behavior. Scanning electron microscopy (SEM) exhibited spherical and homoge- neous nanoparticles. Differential Scanning Calorimetry (DSC) and Thermogravimetry (TG) revealed compatibility between the system components. The nanoparticles produced obtained an average diameter of 301.03 nm, zeta potential -16.63 mV, and IPD 0.18. The encapsulation efficiency (EE) was 76.31%. Within 5 days, 49% of PS was released. The rheological behav- ior of sulfated pectin formulations was similar to that of commercial heparin, suggesting good syringability. The results of in vitro tests for the anticoagulant activity of sulfated pectin con- firmed the slow and effective release for controlled release systems. In view of the results presented, it was possible to verify that sulfated pectin has dose-dependent anticoagulant po- tential, and its nanoencapsulated form is stable and represents a proposal for controlled anti- coagulant therapy in a possible subcutaneous administration route. Para o controle e prevenção dos distúrbios de coagulação inúmeros polissacarídeos podem ser utilizados, sendo a heparina não fracionada (HNF) e a heparina fracionada (HF), os que apresentam maior destaque. Como esses glicosaminoglicanos apresentam limitações de uso, muitos estudos têm sido direcionados a fim de se identificar substâncias com efeito semelhante. Nesse contexto, a literatura afirma que os polissacarídeos sulfatados são polímeros com potencial anticoagulante. Com o objetivo de encontrar uma alternativa às heparinas, foram realizados ensaios da atividade anticoagulante de três polissacarídeos naturais isolados e quimicamente sulfatados: as galactomananas extraídas das sementes de Carolina [Adenanthera pavo-nina (L.)] e do Flamboyant [Delonyx regia (Boger ex Hook.)], e a pectina extraída do melão japonês (Cucumis melo var. acidulus). Destes, foi selecionada a pectina sulfatada (PS) por apresentar atividade anticoagulante mais promissora. Complementando os ensaios in vitro, submeteu-se esse polissacarídeo aos testes tempo de tromboplastina parcial ativada (TTPA), tempo de protrombina (TAP) e tempo de trombina (TT), onde foi possível constatar resultados de TTPA lineares e dose dependentes. Considerando que as nanopartículas poliméricas desempenham um papel importante nas futuras terapias, foi também proposta deste estudo, a preparação e a caracterização de nanopartículas de Poly D, L-Lactide-co-glycolide (PLGA) contendo pectina sulfatada, através do método de dupla emulsão com evaporação do solvente, usando e álcool polivinílico (PVA) como surfactante. Posteriormente as nanopartículas obtidas foram devidamente caracterizadas quanto suas características físico-químicas, e analisadas quanto à estabilidade, liberação, morfologia e comportamento reológico. A microscopia eletrônica de varredura (MEV) exibiu nanopartículas esféricas e homogêneas. A Calorimetria Exploratória Diferencial (DSC) e Termogravimetria (TG) revelaram compatibilidade entre os componentes do sistema. As nanopartículas produzidas obtiveram diâmetro médio de 301,03 nm, potencial zeta -16,63 mV, e IPD 0,18. A eficiência de encapsulação (EE) foi de 76,31%. Em 5 dias ocorreu liberação de 49% de PS. O comportamento reológico das formulações de pectina sulfatada foi semelhante ao da heparina comercial, sugerindo boa seringabilidade. Os resultados dos testes in vitro da atividade anticoagulante da pectina sulfatada confirmaram a liberação lenta e eficaz para sistemas de liberação controlada. Perante dos resultados apresentados, foi possível constatar que a pectina sulfatada tem potencial anticoagulante dose dependente, e sua forma nanoencapsulada é estável e representa uma proposta de terapia anticoagulante controlada em possível via de administração subcutânea.

Sickle cell anemia (SCA) is an inherited disease characterized by homozygous hemoglobin S (HbSS). It is characterized by the long mortality rate due to chronic, endothelial damage and vaso-occlusion episodes, generating multiple damages. Changes in renal function are frequent in SCA, especially in adulthood. New renal function biomarkers are being studied in order to detect early renal changes in patients with SCA, such as kidney injury molecule 1 (KIM-1) and monocyte chemotactic protein (MCP-1). The aim of this study was to evaluate the renal biomarkers KIM-1 and MCP-1, associating them with biomarkers of hemolysis and endothelial damage. This is a cross-sectional, analytical and analytical study involving 92 SCA patients (62 using hydroxyurea and 25 non-use) of both sexes, attended at the hematology outpatient clinic of the Walter Cantídio University Hospital (HUWC) and Hemocenter (HEMOCE) in FortalezaCeará and 34 healthy cases as a control group. Biomarkers KIM-1, MCP-1, sindecano-1 and VCAM-1 were detected by immunoassay and as biomarkers of hemolysis and clinical data were collected from the medical records. The data were used using the statistical program GraphPad Prism. The level of significance was set at 5% (p

Classical Hodgkin's lymphoma (CHL), a type of cancer that originates in lymph nodes, arises when a lymphocyte turns into an uncontrolled malignant cell that affects the lymph node chains. The stage of CLH may vary from I to IV according to the extent of the disease. The ways of treating CHL depend on the stage of the disease, which may be through chemotherapy (CT), radiotherapy (RT) and / or hematopoietic stem cell transplantation (HSCT). The aim of the study was to describe the epidemiological and clinical characteristics of patients undergoing treatment with the ABVD protocol associating them with overall survival (OS) and event free survival (EFS). Descriptive and retrospective study of patients diagnosed with CHL seen at the Walter Cantídio University Hospital (HUWC) from 2000 to 2018 who underwent ABVD treatment. Patients were grouped in decades from 2000 to 2009 and from 2010 to 2018, and into patients with and without immunohistochemically examination. Chi-square test was performed to establish the association between mortality and relapse variables through univariate analysis. Subsequently a multivariate analysis of predictors through binary logistic regression. Survival was determined using the Kaplan-Meier Log-Rank test method. A total of 314 patients were included in the study group from 2000 to 2018. The age group with the highest incidence of the disease was the less and/or equal of 45 years 278 (88.54%), with a majority of males 159 (50.5%), NE histological subtype with 234 (74.52%), presence of B symptoms in 230 (73.25%), first-line treatment with 6 cycles of ABVD in 145 (45.8%), RT treatment was used in 133 (42.2%) and complete response in 197 (62.74). When distributed over decades, from 2000 to 2009 and 2010 to 2018, similarities were observed in the mean age of patients, with a predominance of the age group younger than 45 years, urban origin, stage II, presence of symptoms B, advanced stage and subtype nodular sclerosis. In the total patient group, bivariate analysis were predictive factors for mortality, age over 45 years (p = 0.0273), clinical staging IIIB and IVB (p = 0.0064), use of radiotherapy (p < 0.0011) and the complete answer (p = 0.0001) were significant. Multivariate analysis confirmed that the age greater than 45 years (p = 0.02) had a higher chance of death. While the complete response (p = 0.000) and the use of radiotherapy (p = 0.008) were protective factors for death. In the univariate analysis of relapse predictors, treatment without radiotherapy (p = 0.0080) and time longer than 1 year for diagnosis (p = 0.0040) had a higher chance of recurrence while complete response (p

Immune hemolysis is a well-recognized complication in allogeneic haematopoietic stem cell transplantation (HSCT). The generation of autoantibodies or alloantibodies triggered by the stem cell infusion, transfusion of blood components and exposure to medications, contribute to clinically significant complications in patients undergoing HSTC. The aim of this study was to evaluate the development of immune hemolysis in HSTC. Between July and December 2018, 21 patients were submitted to HSTC. Pretransplant samples were evaluated twice a week going through the hospitalization period and weekly up to 100 days after transplantation were evaluated with hemogram, reticulocytes, lactate dehydrogenase (LDH), indirect bilirubin (BI) and immunohematologic tests. The descriptive statistics (with median, mean and frequency distribution) and analysis using the Mann-Whitney test (non-parametric data), SPSS 2.0, with p 0.05). The development of autoantibodies and alloantibodies against erythrocyte antigens is not common in patients which undergo allogeneic haematopoietic stem cell transplantation; however, complications related to ABO incompatibility between recipient and donor of HSTCs occurred in 9.52% of transplants. A hemólise imune é uma complicação reconhecida no transplante alogênico de células-tronco hematopoiéticas (TCTHalo). A formação de autoanticorpos ou aloanticorpos, desencadeados pela infusão das células-tronco, transfusões de hemocomponentes e exposição a medicamentos, contribuem para complicações clinicamente significativas em pacientes submetidos ao TCTHalo. O objetivo deste estudo foi avaliar o desenvolvimento da hemólise imune no TCTHalo. Foram incluídos, entre julho e dezembro de 2018, 21 pacientes submetidos ao TCTHalo. Amostras pré-transplante, duas vezes na semana, no período de internação e, semanalmente, até 100 dias após o transplante, foram avaliadas com hemograma, reticulócitos, lactato desidrogenase (LDH), bilirrubina indireta (BI) e testes imuno-hematológicos. Adotaram-se para análise dos dados a estatística descritiva (com mediana, média e distribuição de frequência) e a analítica pelo teste de Mann-Whitney (dados não paramétricos), programa SPSS 2.0, com p0,05). O desenvolvimento de auto e aloanticorpos contra antígenos eritrocitários não é comum em pacientes submetidos ao transplante alogênico de células-tronco hematopoiéticas, no entanto, complicações relacionadas à incompatibilidade ABO entre receptor e doador das CTH ocorreram em 9,52% dos transplantes.

Sickle cell anemia (SCA) is the most prevalent monogenic disease in Brazil, characterized by the presence of hemoglobin S (HbS) in homozygosity. In the deoxygenated state, the HbS polymerizes by modifying the morphology and compromising the function of the red blood cells. Intravascular hemolysis promotes the release of free hemoglobin, the formation of free radicals that degrade nitric oxide (NO), and the release of arginase, which consume arginine, the substrate for NO formation, both mechanisms contribute to the reduction of synthesis of this potent vasodilator. The pathophysiology of the disease is characterized by recurrent events of hemolysis and vaso-occlusion crises, as well as a systemic inflammatory process with endothelial damage, increased oxidative stress and procoagulant status, presenting a high rate of comorbidities and mortality. In Brazil, continuous use of hydroxyurea (HU) is recommended for the treatment of AF in order to raise the concentration of fetal hemoglobin (HbF), the main clinical modality of the disease. However, the cytotoxicity of HU coupled with resistance by some patients has contributed to the search for alternatives that aid in the treatment, reducing the adverse effects and improving the quality of life. L-arginine is an amino acid that has no listed adverse effects, being the substrate of NO formation, thus improving microcirculation and reducing primarily endothelial damage. Thus, this study aimed to analyze the efficacy of L-arginine as a therapeutic protocol to support the use of HU in the treatment of patients with SCA. It is a randomized, double-blind, placebo-controlled clinical trial of adult patients of both sexes in continuous use of HU for at least two months at a dose of 500mg mg / kg / day in follow-up in the Blood Center of the State of Ceará (HEMOCE). This study was performed in 50 patients, with 25 receiving HU + L-arginine (500mg / day) and 25 patients receiving HU + placebo. The treatment was in the period of four months, with clinical and laboratory evaluations. Before starting the treatment (M0) and every two months of the same (M2, M4), samples of peripheral blood were collected for the laboratory tests: complete blood count, by automatic method, determination of NO by ELISA, determination of HbF, by HPLC and determination of reticulocytes by bright cresyl blue. Arginase dosage was also performed by specific Arginase Activity Assay Kit at the time before treatment with L-arginine (M0) and four months of treatment (M4). The clinical approach was performed through a medical avaliation from the Hematology Department, to evaluate the clinical evolution and possible adverse reactions. Statistical analysis was performed using the statistical program GraphPad Prism® and SPSS®. The level of statistical significance considered for all analyzes was p

Myelodysplastic Syndrome (MDS) is a complex set of diseases in which the diagnosis can be challenging, especially in patients who do not meet the criteria for MDS, but have unexplained cytopenias. The expression of genes involved in n eoplasias and the presence of substances in the medullary microenvironment may be relevant in the study of these conditions, since they interact directly with the healthy and neoplastic ce lls of the marrow. The aim of the study was to evaluate the expressi on of the TP53, HIF1 α and VEGFA genes and the cytokine levels VEGFA, IL 6, TNFα and IFN ᵧ in patients with MDS, Idiopathic Cytopenia of Indeterminate Significance (ICUS), Clonal Cytopenia of Undete rmined Significance (CCUS) and N on Neoplastic Cytopenias (C NN), associating the results with clinical, laboratory and prognostic factors. Initiall y, 85 patients were included. From these, 13 were excluded after confirming other diagnoses, remaining 72 participants: MDS (n = 34), ICUS (n = 31) and CNN (n = 7). Bone marrow samples were collected in EDTA to extract the genetic material and obtain the plasma. Gene e xpression was performed through the polymerase chain reac tion (PCR) in real time, with TaqMan ® system. Quantification of VEGF A, IL 6, TNFα and IFN ᵧ was performed by enzyme immunoassay (ELISA), according to the manufacturer's instructions. Epidemiological, clinical and laboratory data were taken from medical records. Statistical analysis was performed using GraphPadPrism5.0 and S PSS 24.1. The comparisons between the means of the groups were performed using Student's t test or Mann Whitney test or analysis of variance (ANOVA), depending on the n umber of groups. The overall survival curve was performed by the Kaplan Meier curve, thr ough the Cutt off finder program. Values of p

Sickle cell anemia is a monogenic disease caused by a point mutation in the β-globin gene that results in the production of an abnormal hemoglobin S (HbS) in homozygous. PA is characterized by a chronic inflammatory process, increased oxidative stress, and increased cell turnover in the bone marrow, which together with hypoxia have been associated with genetic instability and function as a risk factor for the development of genetic alterations. This instability may arise from a resistance to hypoxia-mediated apoptosis and / or compromised DNA repair mechanisms, leading to increased mutagenesis rates. Thus, two protein kinases the mutated telangiectasia ataxia (TMJ) and related ataxia telangiectasia Rad3 (ATR) play an important role, since they participate in the mechanism of repair of double-stranded DNA damage. The main pharmacological agent used in AF is Hydroxyurea (HU), which increases the concentration of fetal hemoglobin (HbF), a clinical modulator of the disease. An important gene associated with HbF expression is the BCL11A gene whose polymorphisms are associated with variations in HbF concentrations, which may minimize clinical events associated with the disease. In this context, the study aimed to evaluate the polymorphisms of BCL11A gene and double-tape repair genes (ATM and ATR), associating them with laboratory and clinical data of patients with FA. This is a cross-sectional, analytical study with 125 patients with clinical and molecular diagnosis of AF, with and without HU and baseline. Statistical analyzes were performed using software SPSS version 20 and values of p