Abstract Introduction: low 25-hydroxyvitamin D [25(OH)D] levels occur after kidney transplantation (KTx), and can be associated with increase the risk of graft loss. This longitudinal study aimed to evaluate the vitamin D status and association with biomarkers of the renal graft function after KTx. Methods: this longitudinal study included 42 patients evaluated at baseline, 3 and 6 months after KTx. Biodemographic, clinical, and biochemical parameters such as 25(OH)D and parathyroid hormone (PTH), and biomarkers of renal graft function, such as creatinine, estimated glomerular filtration rate (eGFR), and urinary albumin/creatinine ratio (ACR), were assessed. Sun exposure was also evaluated. Patients were categorized according to their 25(OH)D levels. Results: at baseline, 25(OH)D levels < 30 ng/mL were found in 43 % patients, and 38 % of these patients failed to improve their 25(OH)D levels by 6 months after KTx. Low 25(OH)D levels occurred regardless of sun exposure. Further, 44 % patients developed albuminuria at 6 months. An increased ACR was observed in patients with 25(OH)D levels < 30 ng/mL (p = 0.002) compared to that in patients with 25(OH)D > 30 ng/mL. Additionally, 25(OH)D levels were negatively correlated with ACR at 6 months post-KTx (r = -0.444; p = 0.003). Twelve (28.6 %) patients with 25(OH)D levels < 30 ng/mL showed no eGFR recovery until 6 months after KTx. Conclusion: low vitamin D levels and increased albuminuria were observed at 6 months after KTx, even in a region with high sun exposure. The association between vitamin D status and biomarkers of renal graft function after KTx should be explored in further studies.

Resumen Introducción: los bajos niveles de 25-hidroxivitamina D [25(OH)D] ocurren después del procedimiento de trasplante de riñón (KTx) y pueden estar asociados con un aumento del riesgo de pérdida del injerto. Este estudio longitudinal tuvo como objetivo evaluar el estado de la vitamina D y la asociación con los biomarcadores de función del injerto renal después del KTx. Métodos: este estudio longitudinal incluyó a 42 pacientes que fueron evaluados al inicio del estudio, y 3 y 6 meses después del KTx. Se evaluaron los parámetros biodemográficos, clínicos y bioquímicos, como 25(OH)D y hormona paratiroidea (PTH), y los biomarcadores de función del injerto renal, como creatinina, tasa de filtración glomerular estimada (eGFR) y relación albúmina/creatinina (ACR). También se evaluó la exposición al sol. Los pacientes se clasificaron según sus niveles de 25(OH)D. Resultados: al inicio del estudio se encontraron niveles de 25(OH)D < 30 ng/ml en el 43 % de los pacientes, mientras que el 38 % de estos pacientes no lograron mejorar sus niveles de 25(OH)D a los 6 meses después del KTx. También se produjeron niveles bajos de 25(OH)D independientemente de la exposición al sol. Asimismo, el 44 % de los pacientes desarrollaron albuminuria a los 6 meses. Se observó un aumento de la ACR en los pacientes con niveles de 25(OH)D < 30 ng/mL (p = 0,002) en comparación con los pacientes con 25(OH)D > 30 ng/mL. Además, los niveles de 25(OH)D se correlacionaron negativamente con la ACR a los 6 meses después del KTx (r = -0,444; p = 0,003). Doce (28,6 %) pacientes con niveles de 25(OH)D < 30 ng/ml no mostraron recuperación de la TFGe hasta 6 meses después del KTx. Conclusión: se observaron niveles bajos de vitamina D y un aumento de la albuminuria a los 6 meses después del KTx, incluso en una región con alta exposición solar. La asociación entre el estado de la vitamina D y los biomarcadores de función del injerto renal después del KTx debe explorarse en estudios adicionales.

Abstract Introduction: Glomerulonephritis are the third cause of chronic kidney disease (CKD) requiring dialysis in Brazil. Mineral and bone disorder (MBD) is one of the complications of CKD and is already present in the early stages. Assessment of carotid intima-media thickness (CIMT) and flow-mediated vasodilatation (FMV) are non-invasive ways of assessing cardiovascular risk. Hypothesis: Patients with primary glomerulonephritis (PG) have high prevalence of atherosclerosis and endothelial dysfunction, not fully explained by traditional risk factors, but probably influenced by the early onset of MBD. Objective: To evaluate the main markers of atherosclerosis in patients with PG. Method: Clinical, observational, cross-sectional and controlled study. Patients with PG were included and those under 18 years of age, pregnants, those with less than three months of follow-up and those with secondary glomerulonephritis were excluded. Those who, at the time of exams collection, had proteinuria higher than 6 grams/24 hours and using prednisone at doses higher than 0.2 mg/kg/day were also excluded. Results: 95 patients were included, 88 collected the exams, 1 was excluded and 23 did not undergo the ultrasound scan. Patients with PG had a higher mean CIMT compared to controls (0.66 versus 0.60), p = 0.003. After multivariate analysis, age and values for systolic blood pressure (SBP), FMV and GFR (p = 0.02); and FMV and serum uric acid (p = 0.048) remained statistically relevant. Discussion and conclusion: The higher cardiovascular risk in patients with PG was not explained by early MBD. Randomized and multicentric clinical studies are necessary to better assess this hypothesis.

Resumo Introdução: Glomerulopatias são a terceira causa de doença renal crônica (DRC) com necessidade de diálise no Brasil. Distúrbio mineral e ósseo (DMO) é uma das complicações da DRC e está presente já nos estágios iniciais. A avaliação da espessura médio-intimal de carótidas (EMIC) e da vasodilatação fluxo-mediada (VFM) são maneiras não invasivas de avaliação do risco cardiovascular. Hipótese: Pacientes com glomerulopatias primárias (GP) apresentam alta prevalência de aterosclerose e disfunção endotelial, não explicada totalmente pelos fatores de risco tradicionais, mas provavelmente influenciada pela instalação precoce do DMO. Objetivo: Avaliar os principais marcadores de aterosclerose em pacientes com GP. Método: Estudo clínico, observacional, transversal e controlado. Foram incluídos portadores de GP e excluídos menores de 18 anos, gestantes, menos de três meses de seguimento e os com glomerulopatia secundária. Também foram excluídos aqueles que, no momento da coleta, apresentavam proteinúria maior que 6 gramas/24 horas e uso de prednisona em doses superiores a 0,2 mg/kg/dia. Resultados: 95 pacientes foram incluídos, 88 colheram os exames, 1 foi excluído e 23 não realizaram a ultrassonografia. Os pacientes com GP apresentaram maior EMIC média em relação ao controle (0,66 versus 0,60), p = 0,003. Após análise multivariada, mantiveram relevância estatística a idade e os valores de pressão arterial sistólica (PAS), VFM e TFG (p = 0,02) e VFM e ácido úrico sérico (p = 0,048). Discussão e conclusão: Pacientes com GP apresentaram maior risco cardiovascular, entretanto esse risco não foi explicitado pelo DMO precoce. Estudos clínicos randomizados e multicêntricos são necessários para melhor determinação dessa hipótese.

BACKGROUND Schistosomiasis is a disease caused by Schistosoma. Due to its complex life cycle, evolutionary position and sexual dimorphism, schistosomes have several mechanisms of gene regulation. MicroRNAs (miRNAs) are short endogenous RNAs that regulate gene expression at the post-transcriptional level by targeting mRNA transcripts. OBJECTIVES Here, we tested 12 miRNAs and identified their putative targets using a computational approach. METHODS We performed the expression profiles of a set of miRNAs and their putative targets during the parasite’s life cycle by quantitative reverse transcription-polymerase chain reaction (qRT-PCR). FINDINGS Our results showed differential expression patterns of the mature miRNAs sma-miR-250; sma-miR-92a; sma-miR-new_4-3p; sma-miR-new_4-5p; sma-miR-new_5-5p; sma-miR-new_12-5p; sma-miR-new_13-3p and sma-miR-new_13-5p. Interestingly, many of the putative target genes are linked to oxidative phosphorylation and are up-regulated in adult-worms, which led us to suggest that miRNAs might play important roles in the post-transcriptional regulation of genes related to energetic metabolism inversion during parasite development. It is noteworthy that the expression of sma-miR-new_13-3p exhibited a negative correlation on SmNADH:ubiquinone oxidoreductase complex I. MAIN CONCLUSIONS Our analysis revealed putative miRNA genes related to important biological processes, such as transforming growth factor beta (TGF-β) signaling, proteasome regulation, glucose and lipid metabolism, immune system evasion and transcriptional regulation.

ABSTRACT Introduction: Despite the many published techniques, there are difficulties in satisfactorily achieving a nipple areola complex (NAC) with long-lasting results. The objective is to demonstrate results using the triangular cutaneous flap technique in nipple reconstructions and compare it with previously published techniques. Methods: A prospective study of nipple reconstruction using the triangular cutaneous flap technique from January 1, 2015, to March 1, 2016. Surgical technique: Marking of an equilateral triangle; decortication of the three points of the triangle that are united in the form of an envelope, with the central area adhered to the neo-breast; total skin grafting for construction of the areola. The patients were evaluated and results classified as fully satisfactory, satisfactory, partially satisfactory, or unsatisfactory. Primary type of breast reconstruction, postoperative or neoadjuvant chemo- or radiotherapy complications, comorbidities, and postoperative complications were evaluated. Statistical evaluation was performed using Fisher’s exact test, chi-square test, and post hoc analysis (significance p < 0.05). Results: Thirty-one patients underwent nipple reconstruction using the triangular cutaneous flap technique, 17 unilateral and 14 bilateral, totaling 45 reconstructions. Mean age was 50 years, mean body mass index was 24.95 kg/m 2, and mean follow-up period was 14 months. Rated: demographic data, complications of patients versus the type of primary breast reconstruction and completion of chemo- and/or radiotherapy, types of breast reconstruction performed, evaluation of the nipples versus reconstruction, evaluation of the nipple reconstruction technique versus satisfaction of evaluators, and nipple complications versus reconstruction technique. Conclusion: The original triangular cutaneous flap technique presents the advantages of easy execution and safety in reconstruction of the NAC.

RESUMO Introdução: Apesar das muitas técnicas publicadas, há dificuldades para se atingir de forma satisfatória uma placa areolopapilar (PAP) com resultado duradouro a longo prazo. O objetivo é demonstrar resultados pela técnica do retalho cutâneo triangular nas reconstruções de papila e comparar com as técnicas já descritas na literatura. Métodos: Estudo prospectivo da reconstrução papilar pela técnica do retalho cutâneo triangular de 1 janeiro de 2015 a 1 de março de 2016. Técnica cirúrgica: Marcação em triângulo equilátero; decorticação dos três vértices do triângulo que são unidos em forma de envelope, com a área central aderida à neomama; Enxertia de pele total para confecção da neoareolar. Os pacientes foram avaliados e classificados como totalmente satisfatórios, satisfatórios, parcialmente satisfatórios ou insatisfatórios. Tipo de reconstrução mamária primária, realização de quimio ou radioterapia pós-operatórias ou neoadjuvantes, comorbidades, complicações pós-operatórias foram avaliados. Avaliação estatística por testes exato de Fisher, Qui quadrado e análise post hoc (p < 0,05 significativo). Resultados: Trinta e uma pacientes submetidas à reconstrução mamilar pela técnica do retalho cutâneo triangular, sendo 17 unilaterais e 14 bilaterais, totalizando 45 reconstruções. Média de idade de 50 anos, IMC médio de 24,95 kg/m2 e acompanhamento médio de 14 meses. Avaliados: dados demográficos, complicações dos pacientes versus o tipo de reconstrução primária mamária e realização de quimio e/ou radioterapia, tipos de reconstrução mamária realizados, avaliação das papilas versus reconstrução, avaliação da técnica de reconstrução papilar versus satisfação dos avaliadores e complicações papilares versus técnica de confecção. Conclusão: A técnica original do retalho cutâneo triangular apresenta as vantagens de fácil execução e segurança na reconstrução das placas areolopapilares.

RESUMO Introdução: Atualmente, os testes rápidos representam importante ferramenta diagnóstica, fornecendo resultados em curto espaço de tempo e dispensando a utilização de grandes automações. Objetivo: Avaliar o desempenho de cinco kits de testes rápidos para pesquisa sérica de troponina I. Materiais e métodos: Foram selecionadas 100 amostras de pacientes com suspeita de infarto agudo do miocárdio (IAM) de um hospital do município de Barbacena, Minas Gerais, Brasil. As amostras foram testadas nos cinco kits comerciais de teste rápido de troponina I e o resultado foi comparado com o método considerado referência no estudo (imunoensaio quimioluminescente quantitativo). Em seguida, foram definidos níveis de sensibilidade, especificidade, valor preditivo positivo (VPP), valor preditivo negativo (VPN) e coeficiente de correlação dos testes rápidos em relação ao método de referência. Resultados: Os kits Abon®, Interteck®, Medtest® e Wama® apresentaram o mesmo desempenho, atingindo níveis iguais de sensibilidade (98,08%), especificidade (100%), VPP (100%), VPN (97,96%) e coeficiente de correlação (0,99). O kit Eco Diagnóstica® apresentou 82,69% de sensibilidade, 0,91 de coeficiente de correlação e 84,21% de VPN, não atingindo os níveis ideais, mesmo dentro do intervalo de confiança. Discussão: Os resultados obtidos com os kits Abon®, Interteck®, Medtest® e Wama® confirmam dados preexistentes na literatura sobre a exatidão diagnóstica dos testes rápidos para detecção de troponina. Esses testes permitem a tomada de decisão imediata pelo médico e podem ser usados para reduzir tempo e custos de internações desnecessárias na suspeita de IAM. Conclusão: Os kits Abon®, Interteck®, Medtest® e Wama® apresentaram excelente desempenho diagnóstico e constituem importante ferramenta diagnóstica em laboratórios menores, sem equipamentos automatizados.

ABSTRACT Introduction: Rapid tests represent an important diagnostic tool, providing results in a short period of time and eliminating the use of large automated equipment. Objective: To evaluate the performance of five rapid test kits for troponin I detection in serum. Materials and methods: Samples from 100 patients with suspected acute myocardial infarction (AMI) were selected from a hospital in Barbacena, MG, Brazil. They were tested in the five troponin I commercial rapid test kits and the results were compared with the study reference method (quantitative chemiluminescent immunoassay). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and correlation coefficients of the rapid tests against the reference method were defined. Results: The kits from Abon®, Interteck®, Medtest® and Wama® presented the same performance, reaching equal levels of sensitivity (98.08%), specificity (100%), PPV (100%), NPV (97.96%), and correlation coefficient (0.99). The Eco Diagnostica® kit presented lower sensitivity (82.69%), low correlation coefficient (0.91) and NPV (84.21%), not reaching ideal levels even though lying within the confidence interval. Discussion: The results obtained with the Abon®, Interteck®, Medtest® and Wama® test kits corroborate pre-existing literature data on the diagnostic accuracy of rapid tests for troponin detection. These tests are allowed for immediate decision making by physicians and can be used to reduce unnecessary hospitalization time and costs associated with a suspected AMI. Conclusion: The kits from Abon®, Interteck®, Medtest® and Wama® showed excellent diagnostic performance, what makes them an important diagnostic tool in smaller laboratories without automated equipment.

RESUMEN Introducción: Hoy en día, las pruebas rápidas representan importante herramienta diagnóstica, ofrecen resultados en corto espacio de tempo y dispensan el uso de equipos automatizados. Objetivo: Evaluar el desempeño de cinco kits de pruebas rápidas para detectar troponina I en suero. Material y métodos: Se eligieron 100 especímenes de pacientes sospechosos de infarto agudo de miocardio (IAM) de un hospital en el municipio de Barbacena, Minas Gerais, Brasil. Los especímenes fueron testados en los cinco kits comerciales de prueba rápida de troponina I y el resultado se comparó con el método considerado referencia en el estudio (inmunoensayo quimioluminiscente cuantitativo). Luego, se establecieron los niveles de sensibilidad, especificidad, valor predictivo positivo (VPP), valor predictivo negativo (VPN) y coeficiente de correlación de las pruebas rápidas con respecto al método de referencia. Resultados: Las marcas Abon®, Interteck®, Medtest® y Wama® tuvieron el mismo desempeño, alcanzando niveles iguales de sensibilidad (98,08%), especificidad (100%), VPP (100%), VPN (97,96%) y coeficiente de correlación (0,99), mientras la marca Eco Diagnóstica® presentó 82,69% de sensibilidad, 0,91 de coeficiente de correlación y 84,21% de VPN, no alcanzando los niveles ideales, aunque dentro del intervalo de confianza. Discusión: Los resultados obtenidos con las marcas Abon®, Interteck®, Medtest® e Wama® confirman datos preexistentes en la literatura sobre la precisión diagnóstica de las pruebas rápidas para detectar troponina. Esas pruebas permiten a los médicos adoptar decisiones de forma inmediata y pueden ser usados para reducir tiempo y costos de internaciones innecesarias cuando hay sospecha de IAM. Conclusión: Las marcas Abon®, Interteck®, Medtest® e Wama® presentaron excelente desempeño diagnóstico y representan importante herramienta diagnóstica en laboratorios menores, sin equipos automatizados.

INTRODUCCIÓN: Vivir con VIH, además de ser una enfermedad sin cura y con una alta carga de estigmatización, se considera un fenómeno social que coexiste con el sufrimiento físico que representa una gran fuente de estrés. OBJETIVO: Evaluar la prevalencia, los factores asociados y los síntomas físicos y psicológicos del estrés en personas con VIH comparándolo por género. METODOLOGÍA: Este es un estudio analítico transversal realizado con personas que viven con VIH en atención ambulatoria en el sudeste de Brasil. Se utilizó un cuestionario para la caracterización sociodemográfica y clínica, y para la evaluación de los síntomas de estrés, se utilizó el Inventario de Síntomas de Estrés de Lipp (ISSL), que identifica la presencia de estrés, la sintomatología predominante y la fase del paciente. La prueba de asociación de chi-cuadrado se aplicó para el análisis, adoptando p <0,05. RESULTADOS: 340 personas participaron en el estudio, de los cuales el 47,6% fueron diagnosticados con estrés. El estrés se asoció con la edad (p = 0,018), el tiempo desde el diagnóstico (p=0,025) y el tiempo de tratamiento (p=0,016). Las mujeres tuvieron una mayor frecuencia de síntomas de estrés en las fases de alerta (60,8%), casi agotamiento (75,0%) y agotamiento (54,8%), con predominio de síntomas físicos, destacando la imposibilidad de trabajar (p=0,03), el deseo de alejarse de todo (p=0,004) y pensar / hablar sobre el mismo tema (p=0,02). CONCLUSIONES: El presente estudio mostró una alta prevalencia de estrés, con una asociación entre la edad, el tiempo desde el diagnóstico y la duración del tratamiento antirretroviral; y predominio entre signos y síntomas en mujeres.

INTRODUÇÃO: O viver com o HIV, além de ser uma doença sem cura e com uma alta carga estigmatizadora, é considerada um fenômeno social que convive com o sofrimento físico representando uma alta fonte de estresse. OBJETIVO: Avaliar a prevalência, fatores associados e sintomas físicos e psicológicos do estresse em pessoas vivendo com HIV, comparando-o segundo o sexo. MÉTODOS: Trata-se de um estudo analítico de corte transversal, realizado com pessoas que vivem com HIV em atendimento ambulatorial na região sudeste do Brasil. Foi utilizado questionário para caracterização sociodemográfica e clínica, e para avaliação dos sintomas de estresse foi utilizado o Inventário de Sintomas de Stress de Lipp (ISSL), o qual identifica a presença de estresse, a sintomatologia predominante e a fase em que o paciente se encontra. Para análise foi aplicado o teste de associação Qui-quadrado, adotando p<0,05. RESULTADOS: Participaram do estudo 340 pessoas, das quais 47,6% foram diagnosticadas com estresse. Houve associação do estresse com a idade (p=0,018), tempo de diagnóstico (p=0,025) e tempo de tratamento (p=0,016). As mulheres apresentaram maior frequência de sintomas de estresse nas fases de alerta (60,8%), quase-exaustão (75,0%) e de exaustão (54,8%), com predomínio dos sintomas físicos, destacando a impossibilidade de trabalhar (p=0,03), a vontade de fugir de tudo (p=0,004) e pensar/falar sobre o mesmo assunto (p=0,02). CONCLUSÕES: O presente estudo evidenciou uma alta prevalência do estresse em PVHIV, com associação entre a idade, o tempo de diagnóstico e o tempo de tratamento com antirretroviral; e predomínio entre sinais e sintomas nas mulheres.

BACKGROUND: Living with HIV, besides being a disease without cure and with a high stigmatizing burden, is considered a social phenomenon that coexists with physical suffering representing a high source of stress. AIM: To evaluate the prevalence, associated factors, and physical and psychological symptoms of stress in people living with HIV by comparing stress by sex. METHODS: This is a cross-sectional analytical study conducted with people living with HIV in outpatient care in southeastern Brazil. A questionnaire was used for sociodemographic and clinical characterization; and for the evaluation of stress symptoms, the Lipp Stress Symptom Inventory (ISSL) was used, which identifies the presence of stress, the predominant symptomatology and the phase of the patient. The chi-square association test was applied for analysis, adopting p <0.05. RESULTS: 340 people participated in the study, of which 47.6% were diagnosed with stress. Stress was associated with age (p=0.018), time of diagnosis (p = 0.025) and time of treatment (p=0.016). Women presented a higher frequency of stress symptoms in the alert (60.8%), near-exhaustion (75.0%) and exhaustion (54.8%) phases, with a predominance of physical symptoms, highlighting the impossibility of working (p= 0.03), the desire to escape from everything (p=0.004) and think/talk about the same subject (p=0.02). CONCLUSIONS: The present study showed a high prevalence of stress, with an association between age, time since diagnosis and duration of antiretroviral treatment; and predominance between signs and symptoms of stress in women.

Resumo Objetivo Avaliar os fatores associados à estimativa da Taxa de Filtração Glomerular (eTFG) em pessoas vivendo com HIV. Métodos Estudo transversal e analítico, com avaliação de 340 pessoas em atendimento ambulatorial no município de Ribeirão Preto-SP. Calculou-se a eTFG através da fórmula Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI). Foi realizado análise univariada com os testes Qui-quadrado e Exato de Fisher, com p<0,05. Resultados Identificou que 114 (34,1%) dos participantes apresentaram alterações na Filtração Glomerular, dos quais (90) 27,5% foram classificadas em estágio 2, 15 (4,5%) em estágio 3A e 07 (2,1%) em estágio 3B. Conclusão O estudo evidenciou que as variáveis sexo, idade, hipertensão, diabetes, IMC e tempo de diagnóstico apresentaram associação com a Taxa de Filtração Glomerular. Ressalta-se a importância do acompanhamento integral de PVHIV para a tomada de decisões de modo a prevenir a ocorrência de disfunções renais.

Abstract Objective To evaluate the factors associated with the estimated Glomerular Filtration Rate (eGFR) in people living with HIV. Methods Cross-sectional and analytical study evaluating 340 people in outpatient care in the city of Ribeirão Preto-SP. eGFR was calculated by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula. Univariate analysis was performed with Chi-square and Fisher’s exact tests, with p <0.05. Results It was identified that 114 (34.1%) of the participants presented changes in Glomerular Filtration, of which (90) 27.5% were classified in stage 2, 15 (4.5%) in stage 3A and 07 (2.1%) in stage 3B. Conclusion The study demonstrated that the variables gender, age, hypertension, diabetes, BMI and time of diagnosis were associated with Glomerular Filtration Rate. The importance of the complete follow-up of PLHIV is emphasized, as it can prevent renal dysfunction.

Resumen Objetivo evaluar los factores asociados a la estimación de la tasa de filtración glomerular (eTFG) en personas que viven con el VIH. Métodos estudio transversal y analítico, con evaluación de 340 personas que reciben atención ambulatoria en el municipio de Ribeirão Preto, São Paulo. Se calculó la eTFG a través de la fórmula Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI). Se realizó un análisis univariado con la prueba χ2 de Pearson y la prueba exacta de Fisher, con p<0,05. Resultados se identificó que 114 participantes (34,1%) presentaron alteraciones en la filtración glomerular, de los cuales 90 (27,5%) fueron clasificados como nivel 2, 15 (4,5%) como nivel 3A y 7 (2,1%) como nivel 3B. Conclusión el estudio demostró que las variables sexo, edad, hipertensión, diabetes, IMC y tiempo de diagnóstico presentaron relación con la tasa de filtración glomerular. Se destaca la importancia del seguimiento integral de PVV para la toma de decisiones a fin de prevenir el desarrollo de una insuficiencia renal.

Abstract Objective To evaluate the factors associated with the estimated Glomerular Filtration Rate (eGFR) in people living with HIV. Methods Cross-sectional and analytical study evaluating 340 people in outpatient care in the city of Ribeirão Preto-SP. eGFR was calculated by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula. Univariate analysis was performed with Chi-square and Fisher’s exact tests, with p <0.05. Results It was identified that 114 (34.1%) of the participants presented changes in Glomerular Filtration, of which (90) 27.5% were classified in stage 2, 15 (4.5%) in stage 3A and 07 (2.1%) in stage 3B. Conclusion The study demonstrated that the variables gender, age, hypertension, diabetes, BMI and time of diagnosis were associated with Glomerular Filtration Rate. The importance of the complete follow-up of PLHIV is emphasized, as it can prevent renal dysfunction.

Resumen Objetivo evaluar los factores asociados a la estimación de la tasa de filtración glomerular (eTFG) en personas que viven con el VIH. Métodos estudio transversal y analítico, con evaluación de 340 personas que reciben atención ambulatoria en el municipio de Ribeirão Preto, São Paulo. Se calculó la eTFG a través de la fórmula Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI). Se realizó un análisis univariado con la prueba χ2 de Pearson y la prueba exacta de Fisher, con p<0,05. Resultados se identificó que 114 participantes (34,1%) presentaron alteraciones en la filtración glomerular, de los cuales 90 (27,5%) fueron clasificados como nivel 2, 15 (4,5%) como nivel 3A y 7 (2,1%) como nivel 3B. Conclusión el estudio demostró que las variables sexo, edad, hipertensión, diabetes, IMC y tiempo de diagnóstico presentaron relación con la tasa de filtración glomerular. Se destaca la importancia del seguimiento integral de PVV para la toma de decisiones a fin de prevenir el desarrollo de una insuficiencia renal.

Resumo Objetivo Avaliar os fatores associados à estimativa da Taxa de Filtração Glomerular (eTFG) em pessoas vivendo com HIV. Métodos Estudo transversal e analítico, com avaliação de 340 pessoas em atendimento ambulatorial no município de Ribeirão Preto-SP. Calculou-se a eTFG através da fórmula Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI). Foi realizado análise univariada com os testes Qui-quadrado e Exato de Fisher, com p<0,05. Resultados Identificou que 114 (34,1%) dos participantes apresentaram alterações na Filtração Glomerular, dos quais (90) 27,5% foram classificadas em estágio 2, 15 (4,5%) em estágio 3A e 07 (2,1%) em estágio 3B. Conclusão O estudo evidenciou que as variáveis sexo, idade, hipertensão, diabetes, IMC e tempo de diagnóstico apresentaram associação com a Taxa de Filtração Glomerular. Ressalta-se a importância do acompanhamento integral de PVHIV para a tomada de decisões de modo a prevenir a ocorrência de disfunções renais.

ABSTRACT Objective: Glycemic control has been increasingly recognized as a critical element in inpatient care, but optimal management of blood glucose in the hospital setting remains challenging. The aims of this study were to describe and evaluate the impact of the implementation of an inpatient multidisciplinary glucose control management program on glucose control in hospitalized patients. Materials and methods: Retrospective analysis of medical records and glucose monitoring data obtained by point- of-care testing (POCT) in hospitalized patients before (May 2014) and after (June 2015 and May 2017) the implementation of the program. Results: We analyzed 6888, 7290, and 7669 POCTs from 389, 545, and 475 patients in May 2014, June 2015, and May 2017, respectively. Hyperglycemia (≥ 180 mg/ dL) occurred in 23.5%, 19.6%, and 19.3% POCTs in May 2014, June 2015, and May/2017, respectively (p < 0.001), while severe hyperglycemia (≥ 300 mg/dL) was observed in 2.5%, 2.2%, and 1.8% of them, respectively (p = 0.003). Hyperglycemia (≥ 180 mg/dL) reduced significantly from May 2014 to June 2015 (16.3%, p < 0.001) and from May 2014 to May 2017 (178%, p < 0.001). No significant changes occurred in hypoglycemic parameters. Conclusions: The implementation of an inpatient multidisciplinary glucose control management program led to significant reductions in hyperglycemic events. The key elements for this achievement were the development of institutional inpatient glycemic control protocols, establishment of a multidisciplinary team, and continuing educational programs for hospital personnel. Altogether, these actions resulted in improvements in care processes, patient safety, and clinical outcomes of hospitalized patients.

ABSTRACT Objective: The present study has investigated the association between low-density lipoprotein receptor-related protein 5 (LRP5) 4037C>T polymorphism and type 1 diabetes mellitus (T1DM) susceptibility in a Brazilian population. Subjects and methods: A total number of 134 T1DM patients and 180 normoglycemic individuals (NG) aged 6-20 years were studied. Glycated hemoglobin and glucose levels were determined. Genotyping of LRP5 4037C>T (rs3736228) was performed. Results: T1DM patients showed poor glycemic control. Genotypes in the codominant (CT: OR = 2.99 [CI 95%: 1.71-5.24], p < 0.001; TT: OR = 5.34 [CI 95%: 1.05-2702], p < 0.001), dominant (CT + TT: OR = 3.16 [CI 95%: 1.84-5.43], p < 0.001) and log-additive (OR = 2.78 [CI 95%: 1.70-4.52], p < 0.001) models, and LRP5 4037T allele (OR = 2.88, [CI 95%: 1.78-4.77], p < 0.001) were associated with an increased risk of developing T1DM. LRP5 4037CT and CT+TT carriers in T1DM group showed higher concentrations of serum glucose and glycated hemoglobin when compared with CC carriers. Conclusion: The LRP5 4037C>T may represent a candidate for T1DM susceptibility, as well as poor glycemic control.

Objectives Primary aldosteronism (PA) is characterized by the autonomous overproduction of aldosterone. Its prevalence has increased since the use of the aldosterone (ALD)/plasma renin activity (PRA) ratio (ARR). The objective of this study is to determine ARR and ARC (ALD/plasma renin concentration ratio) cut-off values (COV) and their diagnostic concordance (DC%) in the screening for PA in an Argentinian population.Design multicenter prospective study.Subjects and methods We studied 353 subjects (104 controls and 249 hypertensive patients). Serum aldosterone, PRA and ARR were determined. In 220 randomly selected subjects, 160 hypertensive patients and 60 controls, plasma renin concentration (PRC) was simultaneously measured and ARC was determined.Results According to the 95th percentile of controls, we determined a COV of 36 for ARR and 2.39 for ARC, with ALD ≥ 15 ng/dL. In 31/249 hypertensive patients, ARR was ≥ 36. PA diagnosis was established in 8/31 patients (23/31 patients did not complete confirmatory tests). DC% between ARR and ARC was calculated. A significant correlation between ARR and ARC (r = 0.742; p < 0.0001) was found only with PRA > 0.3 ng/mL/h and PRC > 5 pg/mL. DC% for ARR and ARC above or below 36 and 2.39 was 79.1%, respectively.Conclusion This first Argentinian multicenter study determined a COV of 36 for ARR and 2.39 for ARC. Applying an ARR ≥ 36 in the hypertensive group, we confirmed PA in a higher percentage of patients than the previously reported one in our population. As for ARC, further studies are needed for its clinical application, since DC% is acceptable only for medium range renin values.

Objetivo: Este estudo teve como objetivo avaliar a associação de degeneração macular relacionada à idade (DMRI) com variantes de alipoproteína E (APOE) e perfil lipídico sérico, incluindo níveis séricos de colesterol total (TC) e frações de proteínas relacionadas a receptor de LDL (LDLc) e HDL colesterol (HDLc), e triglicérides (TG). Métodos: Realizouse genotipagem de APOE-HhaI em 134 pacientes (grupo de estudo SG) e 164 indivíduos sem a doença (grupo controle CG), na faixa etária entre 5089 anos. O perfil lipídico sérico foi analisado em um subgrupo de 30 indivíduos de ambos os grupos, pareados por idade e sexo. Admitiuse nível de significância para valorP<0,05. Resultados: APOE E3/E3 prevaleceu (SG=74,6%; CG=77,4%), sem diferença entre os grupos (P=0,667), o mesmo ocorreu para genótipos de risco (APOE /E2: SG=7,4%; CG=10,3%,P=0,624).Níveis séricos de TC, LDLc e TG mostraram medianas semelhantes entre SG (193,5; 116; 155 mg/dL, respectivamente) e CG (207,5; 120; 123,5 mg/dL respectivamente; P>0,05). Para HDLc notouse valor de mediana elevado em SG (53,3 mg/dL) versus CG (42,5 mg/dL; P=0,016), constatado também na análise de regressão logística, cuja razão HDLc/TC mostrou coeficiente 11,423 (P=0,014), confirmando acréscimo de HDLc em SG. A relação entre perfil lipídico sérico e genótipos de APOE mostrou semelhança entre os grupos (P>0,05). Conclusão: APOE-HhaI não se associa a DMRI, no entanto, o acréscimo no nível sérico de HDLc parece ter efeito protetor contra a doença, independente de variantes genéticas da apoE.

Purpose: This study aimed to evaluate the association of age-related macular degeneration (AMD) with apolipoprotein E (APOE) variants and serum lipid profiles, including levels and fractions of total serum cholesterol (TC), low-density lipoprotein cholesterol (LDLc), and high-density lipoprotein cholesterol (HDLc), and triglycerides (TG). Methods: Genotyping of APOE-HhaI was performed in 134 patients (study group, SG) and 164 individuals without AMD (control group, CG), aged 50-89 years. Lipid profiles were analyzed in a subgroup of 30 subjects of both groups, matched according to age and sex. The significance level was set at P<0.05. Results: APOE E3/E3 was more prevalent (SG=74.6%; CG=77.4%), with no difference between both groups (P=0.667). The same result was observed for risk genotypes (APOE E -/2: SG=7.4%; CG=10.3%, P=0.624). Serum levels of TC, LDLc, and TG revealed similar median values between SG (193.5, 116, and 155 mg/dL, respectively) and CG (207.5, 120, and 123.5 mg/dL, respectively; P >0.05). For HDLc, a higher median value was observed in SG (53.3 mg/dL) versus CG (42.5 mg/dL; P=0.016). Logistic regression analysis showed the same value, and the HDLc/TC ratio was -11.423 (P=0.014), as also confirmed by an increase in HDLc in SG. The association between lipid profiles and apolipoprotein E genotypes was similar in both groups (P>0.05). Conclusion: APOE-HhaI is not associated with AMD. However, an increase in serum HDLc level appears to exert a protective effect against the disease, irrespective of the genetic variants of apoE.

Introdução: O tratamento da doença renal crônica (DRC) anterior ao início da hemodiálise (HD) tem impacto sobre o prognóstico. Objetivo: Comparar diferenças entre pacientes incidentes em HD de acordo com a distância entre moradia e a unidade de diálise. Métodos: Foram incluídos 179 pacientes com DRC em HD. Os pacientes foram divididos em dois grupos: "residentes perto da unidade de diálise" (moradia até 100 km da unidade de diálise) e "residentes longe da unidade de diálise" (moradia a mais de 100 km da unidade de diálise). Nível socioeconômico, resultados laboratoriais, conhecimento sobre DRC antes de iniciar HD, consulta com nefrologista antes da primeira sessão de HD e tipo de acesso vascular ao iniciar HD foram comparados entre os dois grupos. As comparações entre variáveis contínuas e categóricas foram feitas pelos testes t de Student e qui-quadrado, respectivamente. Resultados: Noventa (50,3%) pacientes foram classificados como "morando perto" e 89 (49,7%) "morando longe". Havia mais pacientes morando perto da unidade de diálise com conhecimento sobre DRC do que os pacientes morando longe, respectivamente, 46,6% versus 28,0% (p = 0,015). Mesmo sem significado estatístico, havia mais pacientes morando perto da unidade de diálise que se consultaram previamente com nefrologista (55,5% versus 42,6%; p = 0,116) e que iniciaram HD por fístula (30,0% versus 191,1%; p = 0,128) do que os pacientes morando longe. Conclusão: Existem vantagens potenciais em relação ao conhecimento da DRC, encaminhamento ao nefrologista e início de HD por fístula entre os pacientes que moram perto da unidade de diálise.

Introduction: The treatment offered to chronic kidney disease (CKD) patients before starting hemodialysis (HD) impacts prognosis. Objective: We seek differences among incident HD patients according to the distance between home and the dialysis center. Methods: We included 179 CKD patients undergoing HD. Patients were stratified in two groups: "living near the dialysis center" (patients whose hometown was in cities up to 100 km from the dialysis center) or as "living far from the dialysis center" (patients whose hometown was more than 100 km from the dialysis center). Socioeconomic status, laboratory results, awareness of CKD before starting HD, consultation with nephrologist before the first HD session, and type of vascular access when starting HD were compared between the two groups. Comparisons of continuous and categorical variables were performed using Student's t-test and the Chi-square test, respectively. Results: Ninety (50.3%) patients were classified as "living near the dialysis center" and 89 (49.7%) as "living far from the dialysis center". Patients living near the dialysis center were more likely to know about their condition of CKD than those living far from the dialysis center, respectively 46.6% versus 28.0% (p = 0.015). Although without statistical significance, patients living near the dialysis center had more frequent previous consultation with nephrologists (55.5% versus 42.6%; p = 0.116) and first HD by fistula (30.0% versus 19.1%; p = 0.128) than those living far from the dialysis center. Conclusion: There are potential advantages of CKD awareness, referral to nephrologists and starting HD through fistula among patients living near the dialysis center.

INTRODUCTION: Obesity can cause deleterious effects on respiratory function and impair health and quality of life. OBJECTIVE: To evaluate the effects of obesity on the pulmonary function of adult women. METHODS: An obese group, constituted of 20 women between 20 and 35 years old with a BMI of 35 - 49.99 kg/m² who were non-smokers and sedentary and had no lung disease were recruited. The non-obese group consisted of 20 women between 20 and 35 years old who were sedentary and non-smokers and had no lung disease and a body mass index between 18.5 and 24.99 kg/m². Spirometry was performed in all subjects. The statistical analysis consisted of parametric or non-parametric tests, depending on the distribution of each variable, considering p < 0.05 to be statistically significant. RESULTS: The obese group presented a mean age of 25.85 ± 3.89 years and a mean BMI of 41.1 ± 3.46 kg/m², and the non-obese group presented a mean age of 23.9 ± 2.97 years and a mean body mass index of 21.91 ± 1.81 kg/m². There were no significant differences between the obese group and the non-obese group as to the age, vital capacity, tidal volume, forced vital capacity, and forced expiratory volume in one second. However, the obese group presented a greater inspiratory reserve volume (2.44 ± 0.47 L vs. 1.87 ± 0.42 L), a lower expiratory reserve volume (0.52 ± 0.32 L vs. 1.15 ± 0.32 L), and a maximal voluntary ventilation (108.5 ± 13.3 L/min vs. 122.6 ± 19.8 L/min) than the non-obese group, respectively. CONCLUSION: The alterations evidenced in the components of the vital capacity (inspiratory reserve volume and expiratory reserve volume) suggest damage to the chest mechanics caused by obesity. These factors probably contributed to a reduction of the maximal voluntary ventilation.

Três linhagens genética suína A, B e C comercializadas no Brasil, foram submetidas ao insensibilizador elétrico manual (Karl Schermer 220-230/250 volts, 45-60 Hz e 1,4 - 1,5 A) e ao sistema gasoso coletivo (COMBI-BUTINA 90% CO2) . A insensibilização elétrica proporcionou níveis mais elevados de salpicamento nas regiões do coxão mole (0,477 e 0,26, p < 0,01), paleta/cranial (0,154 e 0,039, p < 0,05), paleta/central (0,261 e 0,052, p < 0,001), paleta/caudal (0,180 e 0,030, p < 0,01), lombo/central (0,185 e 0,065, p < 0,01), lombo/caudal (0,06 e 0,207, p < 0,01) e lombo/lateral externa (0,061 e 0,013, p < 0,05), assim como salpicamento mais difuso nas regiões do coxão-mole (0,461 e 0,279, p < 0,05), paleta/cranial (0,154 e 0,039, p < 0,01), paleta/central (0,231 e 0,039, p < 0,001) e paleta/caudal (0,185 e 0,026, p < 0,001). O sistema elétrico também proporcionou maiores índices de escoriações da pele nas regiões da paleta (1,098 e 0,795, p < 0,001), corpo (1,04 e 0,948, p < 0,05) e pernil (0,84 e 0,68, p < 0,001), assim como elevados índices de reflexo palpebral (11,57%) comparativamente ao gasoso (2,86%), de um total de 426 suínos. Pequenos índices de fraturas ósseas e contusões musculares em animais de ambos os sistemas foram observados.

Three pig genetics lineages A, B and C marketed in Brazil, were stunning with the manual electric stunning (Karl Schermer 220-230/250 volts, 45-60 Hz and 1.4 - 1.5 A) and the collective gaseous system (COMBI-BUTINA 90% CO2). The electric stunning provided higher blood splashed levels in the areas of the inside round (0.477 and 0.26, p < 0.01), shoulder/cranial (0.154 and 0.039, p < 0.005), shoulder/central (0.261 e 0.052, p < 0.001), shoulder/caudal (0.180 and 0.030, p < 0.01), loin/central (0.185 and 0.065, p < 0.01), loin/caudal (0.06 and 0.207, p < 0.01) and loin/lateral external (0.061 and 0.013, p < 0.05), as well as more diffuse blood splashed in the areas of the inside round (0.461 and 0.279, p < 0.05), shoulder/cranial (0.154 and 0.039, p < 0.001), shoulder/central (0.231 and 0.039, p < 0.001) and shoulder/caudal (0.185 and 0.026, p < 0.001). The electric stunning also provided higher skin damage levels in the areas of the shoulder (1.098 and 0.795, p < 0.001), body (1.04 and 0.948, p < 0.05) and ham (0.84 and 0.68, p < 0.001), as well as higher eyelid reflex levels (11.57%) comparatively to the gaseous system (2.86%) of a total of 426 pigs. Small indexes of bone fractures and muscle bruises were found in both systems.