Uso de la ultrasonografía en la evaluación de la retención urinaria en pacientes críticos / Use of ultrasonography in the evaluation of urinary retention in critically ill patients / Utilização da ultrassonografia na avaliação de retenção urinária em pacientes críticos

Objetivo: medir el volumen urinario por medio de la ecografía vesical, realizado por una enfermera en pacientes críticos, después de la retirada de la sonda urinaria permanente y verificar los factores relacionados en la retención urinaria. Método: estudio cuantitativo, observacional y transversal, realizado con 37 pacientes críticos de ambos sexos, mayores de 18 años, con retiro de catéter vesical permanente en las últimas 48 horas. Se utilizó un cuestionario con variables sociodemográficas y clínicas y el examen ecográfico. Se utilizó un cuestionario con variables sociodemográficas y clínicas y el examen ecográfico. Los datos fueron presentados a través de distribución de frecuencias, medidas de centralidad y variabilidad, asociación mediante la prueba exacta de Fisher y, para el análisis, regresión logística binomial múltiple. Resultados: de los 37 pacientes, en su mayoría fue de sexo masculino, con una edad média de 54,9 años. La medición del volumen urinario por ecografía osciló entre 332,3 y 950 ml, y el 40,54% de los pacientes presentó retención urinaria. La retención urinaria se asoció significativamente a la aparición de infección urinaria, estreñimiento intestinal y diuresis por rebosamiento espontáneo. Los pacientes con infección del tracto urinario tenían 7,4 veces más probabilidades de tener retención urinaria. Conclusión: la ecografía vesical fue eficaz para medir el volumen urinario después de retirar el catéter urinario permanente y puede contribuir a la detección de retención urinaria.

Objective: to measure urinary volume through bladder ultrasound, performed by a nurse in critically ill patients, after removal of the indwelling urinary catheter and to verify the related factors on urinary retention. Method: quantitative, observational and cross-sectional study, carried out with 37 critically ill patients of both sexes, over 18 years of age, with removal of indwelling urinary catheter in the last 48 hours. A questionnaire containing sociodemographic and clinical variables and an ultrasound examination were used. Data were presented through frequency distribution, centrality and variability measures, association using Fisher`s exact test and, for analysis multiple binomial logistic regression analysis. Results: the 37 patients were mostly male, with a mean age of 54.9 years. The measurement of urinary volume by ultrasound ranged from 332.3 to 950 ml, and 40.54% of patients had urinary retention. Urinary retention was significantly associated with the occurrence of urinary tract infection, intestinal constipation and spontaneous overflow diuresis. Patients with urinary tract infection were 7.4 times more likely to have urinary retention. Conclusion: bladder ultrasonography was effective in measuring urinary volume after removal of the indwelling urinary catheter and and may contribute to the detection of urinary retention.

Objetivo: mensurar o volume urinário por meio da ultrassonografia de bexiga, realizada por enfermeiro em pacientes críticos, após a remoção do cateter vesical de demora, e verificar os fatores relacionados na retenção urinária. Método: estudo quantitativo, observacional e transversal, realizado com 37 pacientes críticos de ambos os sexos, idade superior a 18 anos, com retirada de cateter vesical de demora nas últimas 48 horas. Foram utilizados um questionário contendo as variáveis sociodemográficas e clinicas e o exame de ultrassonografia. Os dados foram apresentados por meio da distribuição de frequência, medidas de centralidade e de variabilidade, associação pelo teste exato de Fisher e, para análise a regressão logística binomial múltipla. Resultados: dos 37 pacientes, a maioria era do sexo masculino, com média de idade de 54,9 anos. A mensuração do volume urinário pela ultrassonografia variou de 332,3 a 950 ml, sendo que 40,54% dos pacientes apresentaram retenção urinária. A retenção urinaria apresentou associação significativa para a ocorrência de infecção do trato urinário, constipação intestinal e diurese espontânea por transbordamento. Pacientes com infecção urinária tiveram 7,4 vezes mais chance de apresentar retenção urinária. Conclusão: ultrassonografia de bexiga foi eficaz para mensurar o volume urinário após a remoção do cateter vesical de demora e poderá contribuir na detecção da retenção urinária.

Risk factors for low humoral response to BNT-162b2 in hemodialysis patients.

INTRODUCTION: Maintenance hemodialysis (HD) patients are at higher risk of both infection and mortality associated with the new SARS-CoV-2. Immunization through large-scale vaccination is the cornerstone of infection prevention in this population. This study aims to identify risk factors for low response to the BNT-162b2 (Pfizer BioNTech) vaccine in an HD cohort. MATERIALS AND METHODS: Observational prospective study of an HD group followed in a Portuguese Public Founded Hemodialysis Center who received BNT-162b2 vaccination. Specific anti-Spike IgG was evaluated as arbitrary units per milliliter (AU/mL) and compared against risk factors. RESULTS: Humoral response evaluated by IgG anti-Spike levels showed a strong correlation with Charlson comorbidity index (CCI) and intact parathormone (iPTH) after each inoculation (1st dose: rho = -0.64/0.54; 2nd dose: rho = -0.66/0.63, respectively; p < 0.01 throughout). After completing both doses: 1) no response (NR) was associated with female sex (p < 0.01), lower albumin and iPTH (p = 0.01); 2) weak response (WR) showed higher CCI, older age, lower iPTH, and lower albumin (p = < 0.01, p = 0.03, p < 0.01, p = 0.05, respectively). A binary regression model using CCI, sex (male), and central venous catheter (CVC) was statistically significant in prediction of WR after the 2nd dose with OR (95% CI): 1.81 (1.06 - 3.08); 0.05 (0.01 - 0.65); 13.55 (1.06 - 174.18), respectively (p = 0.01). CONCLUSION: Older age, higher CCI, lower iPTH and albumin as well as CVC as vascular access were associated with lower response to vaccination in our study. Comorbidity burden is suggested as a preferred indirect method to predict worst response when compared to age alone.

Use of ultrasonography in the evaluation of urinary retention in critically ill patients. / Uso de la ultrasonografía en la evaluación de la retención urinaria en pacientes críticos.

OBJECTIVE: to measure urinary volume through bladder ultrasound, performed by a nurse in critically ill patients, after removal of the indwelling urinary catheter and to verify the related factors on urinary retention. METHOD: quantitative, observational and cross-sectional study, carried out with 37 critically ill patients of both sexes, over 18 years of age, with removal of indwelling urinary catheter in the last 48 hours. A questionnaire containing sociodemographic and clinical variables and an ultrasound examination were used. Data were presented through frequency distribution, centrality and variability measures, association using Fisher`s exact test and, for analysis multiple binomial logistic regression analysis. RESULTS: the 37 patients were mostly male, with a mean age of 54.9 years. The measurement of urinary volume by ultrasound ranged from 332.3 to 950 ml, and 40.54% of patients had urinary retention. Urinary retention was significantly associated with the occurrence of urinary tract infection, intestinal constipation and spontaneous overflow diuresis. Patients with urinary tract infection were 7.4 times more likely to have urinary retention. CONCLUSION: bladder ultrasonography was effective in measuring urinary volume after removal of the indwelling urinary catheter and and may contribute to the detection of urinary retention. (1) Ultrasonography of the bladder showed an advantage for a better nursing diagnosis. (2) Critical patients had urinary retention after removal of urinary catheter. (3) Overflow incontinence was detected after removal of the urinary catheter. (4) Patients with urinary tract infection were 7.4 times more likely to have retention.

Eculizumab discontinuation in a patient with atypical hemolytic uremic syndrome after ChAdOx1 nCoV-19 vaccination.

Eculizumab has proven to be effective in patients with atypical hemolytic uremic syndrome (aHUS) in clinical trials and in the real world, but the optimal duration of therapy remains unknown. Standard maintenance treatment is often life-long, but the possibility of discontinuation has not yet been systematically tested. We describe a case of aHUS after ChAdOx1 nCoV-19 vaccination in a patient with homozygous CFHR3/CFHR1 gene deletion who discontinued eculizumab maintenance therapy 24 weeks after achieving disease remission. We report the safety of discontinuing eculizumab treatment with the aim of minimizing the risk of adverse reactions, reducing the risk of meningitis, improving quality of life, and reducing the considerable treatment costs.

Efficient fusion requires a membrane anchor on the vacuolar Qa-SNARE.

As a prelude to fusion, the R-SNARE on one membrane zippers with Qa-, Qb-, and Qc-SNAREs from its apposed fusion partner, forming a four-helical bundle that draws the two membranes together. Because Qa- and Qb-SNAREs are anchored to the same membrane and are adjacent in the 4-SNARE bundle, their two anchors might be redundant. Using the recombinant pure protein catalysts of yeast vacuole fusion, we now report that the specific distribution of transmembrane (TM) anchors on the Q-SNAREs is critical for efficient fusion. A TM anchor on the Qa-SNARE supports rapid fusion even when the other two Q-SNAREs are unanchored, while a TM anchor on the Qb-SNARE is dispensable and is insufficient for rapid fusion as the sole Q-SNARE anchor. This does not depend on which specific TM domain is attached to the Qa-SNARE but rather is due to the Qa-SNARE being anchored per se. The need for Qa-SNARE anchoring is even seen when the homotypic fusion and vacuole protein sorting protein (HOPS), the physiological catalyst of tethering and SNARE assembly, is replaced by an artificial tether. The need for a Qa TM anchor is thus a fundamental property of vacuolar SNARE zippering-induced fusion and may reflect the need for the Qa juxtamembrane (JxQa) region to be anchored between its SNARE and TM domains. This requirement for Qa-SNARE anchoring and correct JxQa position is bypassed by Sec17/Sec18, exploiting a platform of partially zippered SNAREs. Because Qa is the only synaptic Q-SNARE with a TM anchor, the need for Qa-specific anchoring may reflect a general requirement for SNARE-mediated fusion.

Enhanced expression of OsNAC5 leads to up-regulation of OsNAC6 and changes rice (Oryza sativa L.) ionome.

NAC transcription factors are plant-specific proteins involved in many processes during the plant life cycle and responses to biotic and abiotic stresses. Previous studies have shown that stress-induced OsNAC5 from rice (Oryza sativa L.) is up-regulated by senescence and might be involved in control of iron (Fe) and zinc (Zn) concentrations in rice seeds. Aiming a better understanding of the role of OsNAC5 in rice plants, we investigated a mutant line carrying a T-DNA insertion in the promoter of OsNAC5, which resulted in enhanced expression of the transcription factor. Plants with OsNAC5 enhanced expression were shorter at the seedling stage and had reduced yield at maturity. In addition, we evaluated the expression level of OsNAC6, which is co-expressed with OsNAC5, and found that enhanced expression of OsNAC5 leads to increased expression of OsNAC6, suggesting that OsNAC5 might regulate OsNAC6 expression. Ionomic analysis of leaves and seeds from the OsNAC5 enhanced expression line revealed lower Fe and Zn concentrations in leaves and higher Fe concentrations in seeds than in WT plants, further suggesting that OsNAC5 may be involved in regulating the ionome in rice plants. Our work shows that fine-tuning of transcription factors is key when aiming at crop improvement.

Maternal visceral adiposity and fetal biometry in women with obesity and diabetes

SUMMARY OBJECTIVE: The aim of this study was to compare the correlation of maternal visceral adiposity with sonographic variables related to fetal biometry in the second trimester of pregnancy in mothers who were previously obese versus nonobese and gestational diabetic versus nondiabetic. METHODS: This cross-sectional study included 583 pregnant women who received prenatal care between October 2011 and September 2013 at the Instituto de Medicina Integral Prof. Fernando Figueira, northeast of Brazil. Maternal visceral adiposity was measured by ultrasound examination at the same time as fetal biometry. Gestational age was 14.9±3.2 weeks. The correlation between maternal visceral adiposity and fetal biometric variables was evaluated using Pearson's correlation coefficient. Among the groups, the correlation coefficients were compared using Fisher's Z-test. This test was also used to evaluate the null hypothesis of correlation coefficients between pairs of variables. RESULTS: Maternal visceral adiposity positively correlated with fetal abdominal circumference, estimated fetal weight, head circumference, femur length, and biparietal diameter in pregnant women with obesity, nonobesity, gestational diabetes, and nondiabetes, but the correlation coefficients were statistically similar among the groups. CONCLUSION: Maternal visceral adiposity positively correlated with fetal biometry in the second trimester of pregnancy in the same manner in pregnant women previously obese and nonobese, as well as in pregnant women with gestational diabetes and nondiabetes.

Maternal visceral adiposity and fetal biometry in women with obesity and diabetes.

OBJECTIVE: The aim of this study was to compare the correlation of maternal visceral adiposity with sonographic variables related to fetal biometry in the second trimester of pregnancy in mothers who were previously obese versus nonobese and gestational diabetic versus nondiabetic. METHODS: This cross-sectional study included 583 pregnant women who received prenatal care between October 2011 and September 2013 at the Instituto de Medicina Integral Prof. Fernando Figueira, northeast of Brazil. Maternal visceral adiposity was measured by ultrasound examination at the same time as fetal biometry. Gestational age was 14.9±3.2 weeks. The correlation between maternal visceral adiposity and fetal biometric variables was evaluated using Pearson's correlation coefficient. Among the groups, the correlation coefficients were compared using Fisher's Z-test. This test was also used to evaluate the null hypothesis of correlation coefficients between pairs of variables. RESULTS: Maternal visceral adiposity positively correlated with fetal abdominal circumference, estimated fetal weight, head circumference, femur length, and biparietal diameter in pregnant women with obesity, nonobesity, gestational diabetes, and nondiabetes, but the correlation coefficients were statistically similar among the groups. CONCLUSION: Maternal visceral adiposity positively correlated with fetal biometry in the second trimester of pregnancy in the same manner in pregnant women previously obese and nonobese, as well as in pregnant women with gestational diabetes and nondiabetes.

Vascular access type and mortality in elderly incident hemodialysis patients.

INTRODUCTION: The ideal vascular access type for elderly hemodialysis (HD) patients remains debatable. The aim of this study was to analyze the association between patterns of vascular access use within the first year of HD and mortality in elderly patients. METHODS: Single-center retrospective study of 99 incident HD patients aged≥80 years from January 2010 to May 2021. Patients were categorized according to their patterns of vascular access use within the first year of HD: central venous catheter (CVC) only, CVC to arteriovenous fistula (AVF), AVF to CVC, and AVF only. Baseline clinical data were compared among groups. Survival outcomes were analyzed using Kaplan-Meier survival curves and Cox's proportional hazards model. RESULTS: When compared with CVC to AVF, mortality risk was significantly higher among CVC only patients and similar to AVF only group [HR 0.93 (95% CI 0.32-2.51)]. Ischemic heart disease [HR 1.74 (95% CI 1.02-2.96)], lower levels of albumin [HR 2.16 (95% CI 1.28-3.64)] and hemoglobin [HR 4.10(95% CI 1.69-9.92)], and higher levels of c-reactive protein [HR 1.87(95% CI 1.11-3.14)] were also associated with increased mortality risk in our cohort, p<0.05. CONCLUSION: Our findings suggested that placement of an AVF during the early stages of dialysis was associated with lower mortality compared to persistent CVC use among elderly patients. AVF placement appears to have a positive impact on survival outcomes, even in those who started dialysis with a CVC.

Atypical Hemolytic Uremic Syndrome after ChAdOx1 nCoV-19 Vaccination in a Patient with Homozygous CFHR3/CFHR1 Gene Deletion.

Hemolytic uremic syndrome (HUS) is a thrombotic microangiopathy (TMA) affecting the kidneys. Compared with typical HUS due to an infection from shiga toxin-producing Escherichia coli, atypical HUS involves a genetic or acquired dysregulation of the complement alternative pathway. In the presence of a mutation in a complement gene, a second trigger is often necessary for the development of the disease. We report a case of a 54-year-old female, with a past medical history of pulmonary tuberculosis, who was admitted to the emergency service with general malaise and reduction in urine output, 5 days after vaccination with ChAdOx1 nCoV-19. Laboratory results revealed microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury. Given the clinical picture of TMA, plasma exchange (PEX) was immediately started, along with hemodialysis. Complementary laboratory workup for TMA excluded thrombotic thrombocytopenic purpura and secondary causes. Complement study revealed normal levels of factors H, B, and I, normal activity of the alternate pathway, and absence of anti-factor H antibodies. Genetic study of complement did not show pathogenic variants in the 12 genes analyzed, but revealed a deletion in gene CFHR3/CFHR1 in homozygosity. Our patient completed 10 sessions of PEX, followed by eculizumab, with both clinical and laboratorial improvement. Actually, given the short time lapse between vaccination with ChAdOx1 nCoV-19 and the clinical manifestations, we believe that vaccine was the trigger for the presentation of aHUS in this particular case.

Thrombotic microangiopathy in a patient with systemic lupus erythematosus and anti-factor H autoantibodies.

Thrombotic microangiopathy (TMA) is a serious complication that may occur in patients with systemic lupus erythematosus (SLE), adversely affecting the prognosis and increasing mortality. The pathogenesis of TMA in these patients may be multifactorial and overlap between different entities may exist. We present a case of a 24-year-old man, previously diagnosed with SLE, class IV lupus nephritis, and antiphospholipid antibody syndrome, who was admitted with acute kidney injury, severe pancytopenia, and other features consistent with lupus flare. A clinical TMA diagnosis was made and the patient was treated with plasmapheresis, rituximab and immunoglobulin endovenous (EV) infusions. Hemodialysis was initiated during hospitalization and, despite the hematological recovery, the patient remained dialysis dependent. The complementary study revealed high levels of anti-factor H (fH) autoantibodies with no pathogenic mutations on complement genes (namely CFHR1 and CFHR3). Initially, the most likely cause of TMA seemed to be secondary to SLE, but the presence of anti-fH antibodies in our patient may suggest a concomitant complement-mediated TMA.

Humoral response to BNT162b2 mRNA COVID-19 vaccine in peritoneal and hemodialysis patients: A comparative study.

INTRODUCTION: Maintenance dialysis patients (MDP) are at higher risk of exposure with increased mortality from COVID-19 with generalized immunization becoming the cornerstone in prevention. This study aims to compare humoral response between hemodialysis (HD) and peritoneal dialysis (PD) patients. MATERIALS AND METHODS: Observational prospective study following HD and PD programs from a Portuguese Center receiving BNT162b2 vaccine. Specific anti-Spike IgG quantification to compare both for absolute value and non-responders (NR) between modalities and against risk factors. RESULTS: Of 67 MDP, 42 were HD and 25 PD patients. PD developed higher antibody titers after both first (median 5.44 vs. 0.99 AU/ml, p < 0.01) and second dose (median 170.43 vs. 65.81 AU/ml; p < 0.01). HD associated with NR after the first dose (p < 0.01). CONCLUSION: This study demonstrated improved humoral immunogenicity with BNT162b2 in PD compared to HD patients. These differences are attributed to comorbidity burden and age differences, rather than dialysis modality.

Vantagens da ultrassonografia de bexiga na mensuração do volume urinário em pacientes críticos: revisão integrativa / Ventajas de la ecografía vesical en la medición del volumen urinario en pacientes críticos: revisión integradora / Advantages of bladder ultrasound in measuring urine volume in critically ill patients: an integrative review

RESUMO Objetivo identificar as evidências científicas presentes na literatura quanto ao uso da ultrassonografia de bexiga na mensuração do volume urinário em pacientes críticos adultos e idosos em ambiente intra-hospitalar. Método revisão integrativa baseada nas recomendações PRISMA, realizada em março de 2021, utilizado os descritores "Retenção Urinária", "Cuidados Críticos", "Unidade de Terapia Intensiva", "Ultrassonografia", "Adulto" e "Idoso", nas bases Lilacs, PubMed, Scopus, CINAHL, Web of Science. Foi realizada análise de conteúdo. Resultados entre cinco selecionados, emergiram duas categorias: vantagens do uso da ultrassonografia para mensuração do volume urinário e perfil dos pacientes críticos com predisposição para manifestação da retenção urinária no ambiente hospitalar. Conclusão dentre as vantagens destacou-se eficiência na mensuração do volume urinário e a redução do uso desnecessário de cateter vesical de demora. Quanto ao perfil dos pacientes, verificou-se que a idade maior ou igual a 60 anos e o uso prolongado de cateter vesical de demora contribuíram para ocorrência de retenção urinária.

RESUMEN Objetivo identificar las evidencias científicas presentes en la literatura sobre el uso de la ecografía vesical para medir el volumen urinario en pacientes críticos adultos y ancianos en un ambiente intrahospitalario. Método revisión integradora basada en recomendaciones PRISMA, realizada en marzo de 2021, utilizando los descriptores: "Retención Urinaria", "Cuidados Críticos", "Unidad de Cuidados Intensivos", "Ecografía", "Adulto" y "Anciano" en las bases Lilacs, PubMed, Scopus, CINAHL y Web of Science. Se realizó análisis de contenido. Resultados entre los cinco artículos seleccionados, surgieron dos categorías: las ventajas de usar ecografía para medir el volumen urinario y el perfil de los pacientes críticos con predisposición a manifestar retención urinaria en el ambiente hospitalario. Conclusión entre las ventajas se destacó la eficiencia en la medición del volumen urinario y la reducción del uso innecesario de catéteres vesicales permanentes. En cuanto al perfil de los pacientes, se encontró que la edad mayor o igual a 60 años y el uso prolongado de catéteres vesicales permanentes contribuyeron a la ocurrencia de retención urinaria.

ABSTRACT Objective to identify the scientific evidence in the literature regarding the use of bladder ultrasonography to measure urine volume in critically ill adults and elderly hospital in-patients. Method this integrative review based on PRISMA recommendations was conducted in March 2021, using the descriptors "Urine Retention", "Critical Care", "Intensive Care Unit", "Ultrasonography", "Adult" and "Elderly", in the Lilacs, PubMed, Scopus, CINAHL, and Web of Science databases. Content analysis was performed. Results in the five articles selected, two categories emerged: advantages of using ultrasound to measure urine volume and the profile of critically ill patients with a predisposition to urine retention in the hospital environment. Conclusion salient advantages included efficiency in measuring urine volume and reduced need to use indwelling urinary catheters. Patient profiling showed that age of 60 years or more and prolonged use of indwelling urinary catheters contributed to urine retention.

Vantagens da ultrassonografia de bexiga na mensuração do volume urinário em pacientes críticos: revisão integrativa / Advantages of bladder ultrasound in measuring urine volume in critically ill patients: an integrative review / Ventajas de la ecografía vesical en la medición del volumen urinario en pacientes críticos: revisión integradora

Objetivo: identificar as evidências científicas presentes na literatura quanto ao uso da ultrassonografia de bexiga na mensuração do volume urinário em pacientes críticos adultos e idosos em ambiente intra-hospitalar. Método: revisão integrativa baseada nas recomendações PRISMA, realizada em março de 2021, utilizado os descritores "Retenção Urinária", "Cuidados Críticos", "Unidade de Terapia Intensiva", "Ultrassonografia", "Adulto" e "Idoso", nas bases Lilacs, PubMed, Scopus, CINAHL, Web of Science. Foi realizada análise de conteúdo. Resultados: entre cinco selecionados, emergiram duas categorias: vantagens do uso da ultrassonografia para mensuração do volume urinário e perfil dos pacientes críticos com predisposição para manifestação da retenção urinária no ambiente hospitalar. Conclusão: dentre as vantagens destacou-se eficiência na mensuração do volume urinário e a redução do uso desnecessário de cateter vesical de demora. Quanto ao perfil dos pacientes, verificou-se que a idade maior ou igual a 60 anos e o uso prolongado de cateter vesical de demora contribuíram para ocorrência de retenção urinária.

Objective: to identify the scientific evidence in the literature regarding the use of bladder ultrasonography to measure urine volume in critically ill adults and elderly hospital in-patients. Method: this integrative review based on PRISMA recommendations was conducted in March 2021, using the descriptors "Urine Retention", "Critical Care", "Intensive Care Unit", "Ultrasonography", "Adult" and "Elderly", in the Lilacs, PubMed, Scopus, CINAHL, and Web of Science databases. Content analysis was performed. Results: in the five articles selected, two categories emerged: advantages of using ultrasound to measure urine volume and the profile of critically ill patients with a predisposition to urine retention in the hospital environment. Conclusion:salient advantagesincluded efficiency in measuring urine volume and reduced need to use indwelling urinary catheters. Patient profiling showed that age of 60 years or more and prolonged use of indwelling urinary catheters contributed to urine retention.

Objetivo: identificar las evidencias científicas presentes en la literatura sobre el uso de la ecografía vesical para medir el volumen urinario en pacientes críticos adultos y ancianos en un ambiente intrahospitalario. Método: revisión integradora basada en recomendaciones PRISMA, realizada en marzo de 2021, utilizando los descriptores: "Retención Urinaria", "Cuidados Críticos", "Unidad de Cuidados Intensivos", "Ecografía", "Adulto" y "Anciano" en las bases Lilacs, PubMed, Scopus, CINAHL y Web of Science. Se realizó análisis de contenido. Resultados: entre los cinco artículos seleccionados, surgieron dos categorías: las ventajas de usar ecografía para medir el volumen urinario y el perfil de los pacientes críticos con predisposición a manifestar retención urinaria en el ambiente hospitalario. Conclusión: entre las ventajas se destacó la eficiencia en la medición del volumen urinario y la reducción del uso innecesario de catéteres vesicales permanentes. En cuanto al perfil de los pacientes, se encontró que la edad mayor o igual a 60 años y el uso prolongado de catéteres vesicales permanentes contribuyeron a la ocurrencia de retención urinaria.

Prevalence and clinical significance of fetal tricuspid regurgitation during the third trimester of pregnancy / Prevalência e significado clínico da regurgitação tricúspide em fetos no terceiro trimestre da gestação

Abstract Objectives: the aim of this study was to determine the prevalence of fetal tricuspid valve regurgitation (TR) during the third trimester of low-risk pregnancies and to assess its clinical significance on neonates. Methods: this is a cross-sectional study including 330 singleton fetuses referred for routine fetal echocardiography during 3rd trimester in a fetal medicine center in Recife, Brazil. The presence and degree of tricuspid regurgitation were analyzed. Whenever TR was identified on fetal echocardiography, postnatal data, including the results of postnatal echocardiography were reviewed. Results: the prevalence of tricuspid regurgitation was 10.0% (n=33) in the study population. Regarding regurgitation degree, 90.9% (n=30) presented mild regurgitation and none presented important TR. Postnatal data was obtained from 21 neonates. Twenty of them were discharged without any complications, and one presented respiratory distress due to prematurity. Transthoracic echocardiography was performed in 66.7% (n=14) of the neonates and it was normal in 92.9% (n=13) of them. One neonate, 7.1%, persisted with tricuspid regurgitation, but had no other findings. Conclusions: tricuspid regurgitation in fetuses with normal cardiac anatomy during the 3rd trimester is a common condition in low-risk pregnancies, and is not associated with cardiac abnormalities or need for neonatal intervention.

Resumo Objetivos: determinar a prevalência da regurgitação tricúspide (RT) em fetos no terceiro trimestre de gestações de baixo risco e investigar sua repercussão clínica nos recémnascidos. Métodos: trata-se de um estudo transversal incluindo 330 fetos encaminhados para realização de ecocardiograma fetal de rotina no terceiro trimestre da gestação num centro de medicina fetal em Recife, Brasil. A presença e o grau de insuficiência tricúspide foram estudados. Quando RT estava presente ao ecocardiograma fetal dados pós-natais, incluindo ecocardiograma, também foram analisados. Resultados: a prevalência de RT foi de 10,0% na população estudada, sendo que 90,9% (n=30) dos casos foram classificados como RT leve, e nenhum caso de RT importante foi identificado. Foram obtidos dados pós-natais de 21 recém-nascidos. Destes, 20 receberam alta hospitalar sem nenhuma complicação, enquanto 1 apresentou desconforto respiratório associado à prematuridade. Ecocardiograma transtorácico foi realizado em 66.7% (n=14) dos recém-nascidos avaliados, e foi normal em 92.9% (n=13) deles. Apenas 1 recém-nascido, 7.1%, persistiu com RT mas sem outros achados significativos. Conclusões: a RT em fetos com anatomia cardíaca normal é comum no terceiro trimestre de gestações de baixo risco e não parece associar-se a anomalias cardíacas ou necessidade de intervenção no período neonatal.

Hypertension-associated thrombotic microangiopathy in an adult patient with complement factor H autoantibodies and a rare heterozygous variant in the CFH gene.

Atypical hemolytic uremic syndrome (aHUS) is a rare disease characterized by microangiopathic hemolytic anemia, thrombocytopenia, and renal injury, which results from thrombotic microangiopathy (TMA) within the glomerular capillaries and arterioles. We report a case of a biopsy-proven renal TMA attributed to hypertension in a 42-year-old woman with undiagnosed alternative complement pathway dysregulation resulting from a rare association between complement factor H (CFH) autoantibodies and a heterozygous variant in the CFH gene. We propose that severe hypertension triggered an over-activation of the alternative complement pathway in a patient with genetic predisposition. In this case, blood pressure control allowed normalization of hematologic parameters and partial recovery of renal function, supporting the idea that shear stress is an important complement-amplifying factor.

Expulsion rate of intrauterine device: mediate vs. immediate puerperium period

Objective: To evaluate the rate of expulsion of intrauterine device (IUD) inserted during the immediate and mediate puerperium. To evaluate whether the type of delivery is a predictor of expulsion of the IUD when inserted in the puerperium period. Material and Methods: This was a prospective observational study. Patients whose IUD (TCU-380 copper) was placed during the puerperal period were divided in two groups according to the time of placement: immediate and mediate puerperium. The decision regarding the time of IUD insertion was made in a non-randomized manner. Analysis was performed using chi-square, Mann-Whitney U, and Spearman's correlation tests and logistic regression analysis. Results: The total rate of IUD expulsions was 28.8% (49/170). There was no significant association between the occurrence of expulsion and the timing of IUD insertion (immediate vs mediate puerperium; 26.6% vs 34.78%, p=0.296). Among patients experiencing expulsion, 79.6% (39/49) underwent insertion after vaginal delivery and 20.4% (10/49) during cesarean section (CS). The type of delivery was a significant predictor for IUD expulsion (p<0.0001). Vaginal delivery was fourfold more likely to be associated with IUD expulsion inserted in the puerperal period than CS (odds ratio: 4.23, 95% confidence interval: 1.94-9.25). There was no significant correlation between the period between IUD insertion and the diagnosis of expulsion in regard to number of pregnancies (r=-0.160, p=0.271) or gestational age at delivery (r=-0.058, p=0.939). Conclusion: Vaginal delivery was the most prevalent type of delivery in patients who underwent IUD insertion during the immediate and mediate puerperium. The risk of IUD expulsion after vaginal delivery was greater than CS.

Effect of Libidibia ferrea bark and seed in maternal reproductive and biochemical outcomes and fetal anomaly in rats.

BACKGROUND: Unhealthy pregnant women living in underdeveloped regions are usually treated by traditional healers, inadvertent of the potential toxic effects of plant-derivative substances. Thus, we investigated whether exposure to a hydroalcoholic extract of bark and seed of Libidibia ferrea during pregnancy results in fetotoxicity and maternal toxicity. The main constituents of both extracts were analyzed by High Performance Liquid Chromatography (HPLC). METHODS: Pregnant rats were divided into three groups: control (C), group exposed to extract of bark (Lfb-1.0 g/kg/day), and group exposed to extract of the seed (Lfs-1.0 g/kg/day). Biochemical parameters, reproductive capacity, morphological effects in the offspring were analyzed. RESULTS: HPLC fingerprint confirmed the presence of ellagic in both bark and seed extracts, and the absence of detectable concentrations of gallic and catechin. Fetuses exposed to L. ferrea extracts presented shorter mean lengths for head and body sections when compared to those in C and exhibited visceral and skeletal anomalies. Pregnant rats exposed to Lfs extracts show alterations in serum creatinine levels and yield amniotic fluid with abnormal biochemical composition. CONCLUSION: Bark or seed extracts of L. ferrea do not exhibit safety level compatible to be used in the gestational period.