[Cross-cultural adaptation of the PAIR instrument: Pharmacotherapy Assessment in Chronic Renal Disease for application in Brazil]. / Adaptação transcultural do instrumento PAIR: Pharmacotherapy Assessment in Chronic Renal Disease para aplicação no Brasil.

Individuals suffering from chronic kidney disease (CKD) are often on multiple medications, which exposes them to drug-related problems (DRP). There are no available tools in Brazil to assess the pharmacotherapy and management of DRPs systematically in this population. The scope of this study was to perform a cross-cultural adaptation of PAIR criteria (Pharmacotherapy Assessment in Chronic Renal Disease) to Brazilian Portuguese. PAIR criteria consist of 50 DRP clinically significant items for CKD. The process of cross-cultural adaptation involved translation, synthesis, back-translation, and an analysis by an expert committee as well as a pre-test of the first draft document. A review committee consisting of 2 pharmacists and 2 nephrologists analyzed the semantic, linguistic, experiential, and conceptual equivalence between the original and translated versions. All items that obtained a score below 80% were reviewed. Word adjustments were made, as well as the exclusion of 6 DRP due to non-applicability to the Brazilian context. Thus, the final version of PAIR defined as "Avaliação da farmacoterapia na doença renal crônica" was translated and adapted into the Brazilian Portuguese language.

Indivíduos com doença renal crônica (DRC) frequentemente utilizam polifarmácia o que os expõe ao risco de problemas relacionados a medicamentos (PRMs). No Brasil, não existem instrumentos que possam sistematizar a avaliação da farmacoterapia e a gestão de PRMs nesta população. Portanto, o objetivo deste trabalho foi realizar a adaptação transcultural do instrumento PAIR (Pharmacotherapy Assessment in Chronic Renal Disease) para o português brasileiro. O PAIR consiste numa lista de 50 PRMs considerados clinicamente significativos para renais crônicos. O processo de adaptação transcultural envolveu as etapas de tradução, síntese, retrotradução, análise por um comitê de especialistas e pré-teste da versão preliminar. O comitê de 2 farmacêuticos e 2 nefrologistas analisou a equivalência semântica, idiomática, experiencial e conceitual entre as versões original e traduzida. Todos os itens que obtiveram acordo inferior a 80% foram revisados. Foram realizados ajustes de palavras, assim como a exclusão de 6 PRMs devido à não aplicabilidade ao contexto brasileiro. Assim, foi obtida a versão final do PAIR definida como "Avaliação da farmacoterapia na doença renal crônica", traduzida e adaptada na língua portuguesa do Brasil.

Pharmacotherapy assessment in chronic kidney disease: validation of the PAIR instrument for use in Brazil.

Individuals with chronic kidney disease (CKD) use polypharmacy, which, in combination with renal impairment, exposes them to the risk of drug-related problems (DRPs). There are no available tools in Brazil to systematically assess the pharmacotherapy and management of DRPs in this population. Therefore, the objective of this work was to validate the PAIR instrument (Pharmacotherapy Assessment in Chronic Renal Disease) for use in Brazilian Portuguese. This is a retrospective longitudinal observational study. Medical records from 100 CKD patients under conservative treatment, between 2016 and 2017, in a nephrology clinic, were analyzed. PAIR was applied by pharmacists in two consultations of the same patient, with an interval of 6 months. Reliability, conceptual validity, responsiveness of the instrument and prevalence of DRPs in the studied sample were assessed. A mean of 1.26 ± 0.96 DRPs/patient was identified. Inter-rater reliability coefficients (k) ranged from 0.58 to 0.94 and from 0.79 to 1.00 for test-retest, revealing moderate to perfect level of agreement. In conceptual validity, a mean of 1.60 ± 1.24 DRPs/patient was identified by the nephrologist through clinical judgment, compared to 1.33±0.76 DRPs/patient identified by the pharmacist using PAIR (p = 0.07). Therefore PAIR allowed the identification of clinically significant DRPs. In responsiveness, a mean of 1.26 ± 0.96 DRPs/patient was identified at the first consultation and 1.11 ± 1.02 DRPs/patient at the subsequent consultation (p = 0.17) by the pharmacist using PAIR. The number of DRPs between the periods did not change. As a conclusion, the PAIR allowed the identification of clinically significant DRPs in CKD, constituting a new validated instrument to be used in Brazil.

Dialogue between primary and secondary health care providers in a Brazilian hypertensive population.

OBJECTIVE: To describe clinical and epidemiological profiles of patients with hypertension referred to a secondary care unit and to assess the adequacy of the referral criteria. METHOD: This descriptive transversal study analysed 943 hypertensive patients referred to a secondary healthcare unit from September 2010 to August 2012. Clinical and sociodemographic data as well as data regarding the liaison between secondary and primary care services were collected. RESULTS: Patients' mean age was 59±13.1 years, and 61.3% were female. Sedentary lifestyle, alcohol consumption, and smoking were observed in 80.3%, 31.1%, and 18.1% of the patients, respectively. Uncontrolled blood pressure was observed in 72.5% of the sample, and 80.1% of individuals were overweight or obese. There was a high prevalence of dyslipidaemia (73.1%), cardiovascular disease (97.5%), and reduced glomerular filtration rate (49.9%). Thirty-eight percent of patients did not meet the referral criteria, of whom approximately 25% were not hypertensive. CONCLUSION: Even in a universal-access healthcare system, poor control of hypertension and high prevalence of obesity and cardiovascular diseases were observed. Inadequate referrals and the presence of clinical complications suggest low efficiency of the assistance provided in primary care and reinforce the need for sharing care with the secondary level.

Severe sepsis from a Ciprofloxacin resistant salmonellosis in a kidney transplant recipient.

INTRODUCTION: Salmonellosis is a relatively rare complication in kidney transplant recipients that cannot be clinically distinguished from other forms of enteritis. Among kidney transplant patients, it varies broadly in intensity, and is highly associated with extra-intestinal disease, bacteremia, and, in this case, a high mortality rate. CASE REPORT: Here we describe a clinical case of ciprofloxacin resistant salmonellosis in a kidney transplant patient. CONCLUSION: This case illustrates how immunosuppressed patients can be exposed to rare forms of infection, often clinically difficult to identify, and possibly with severe clinical courses and poor outcomes despite evidence-based empiric antibiotic therapy.

Heme oxygenase 1 and renal ischemia and reperfusion injury: the impact of immunosuppressive drug.

UNLABELLED: Ischemia and reperfusion injury (IRI) is the main etiology of acute renal failure in native and transplanted kidneys. In the transplantation field, immunosuppressive drugs may play an additional role in acute graft dysfunction. Acute cyclosporine nephrotoxicity (ATN) can result from vasoconstriction of the afferent arterioles, which may exacerbate deceased renal transplantation. HO-1 is a protective gene with anti-inflammatory and anti-apoptotic actions. We investigated whether HO-1 played a role in cyclosporine-induced renal dysfunction in an established model of IRI. METHODS: Cyclosporine (100 mg/kg) was administered to mice before being subjected to 45 min of ischemia. Blood and kidney samples were collected at 24, 48 and 120 h after surgery. Acute tubular necrosis and tubular regeneration were quantified. HO-1 gene transcripts were amplified by real-time PCR. RESULTS: Animals subjected to IRI presented with impaired renal function that peaked at 24 h (2.05 +/- 0.23 mg/dL), decreasing thereafter. Treatment with cyclosporine caused even more renal dysfunction at 48 h, sustained up to 120 h after reperfusion (1.53 +/- 0.6 mg/dL), when compared to the controls (0.63 +/- 0.09 mg/dL, p < 0,05). Cyclosporine delayed tubular regeneration that was normally higher in controls at day 5 (67.0% vs. 37.6%, p < 0.05). HO-1 was markedly up-regulated after IRI, and its expression was decreased by cyclosporine (2.06 folds). However, prior induction of HO-1 by cobalt protoporphyrin improved renal dysfunction. CONCLUSIONS: These results demonstrated that cyclosporine used in ischemic injured organs might also negatively affect post-transplantation recovery.

Influence of TH1/TH2 switched immune response on renal ischemia-reperfusion injury.

BACKGROUND/AIMS: Recent evidence shows a critical role of the CD4+ T cell with the Th1/Th2 paradigm as a possible effector mechanism in ischemia and reperfusion injury. We hypothesize that a polarized Th1 activation response may negatively influence the renal IRI through its relationship with chemokine production (MCP-1) and with a protective tissue response (HO-1). METHODS: We subjected mice to renal ischemia for 45 min using IL-4 and IL-12 knockout C57BL/6. We then measured serum urea levels, performed histomorphometric analysis for tubular necrosis and regeneration, and evaluated the mRNA expression of HO-1, t-bet, Gata-3 and MCP-1 by real-time PCR at 24, 48 and 120 h after surgery. RESULTS/CONCLUSIONS: The IL-4 knockout mice had a statistically significant rise in serum urea levels post IRI compared with control animals. The IL-12-deficient mice were not affected. The IL-4-deficient mice had a statistically significant increase in tubular injury and impairment in cell regeneration. The IRI in IL-4-deficient mice was accompanied by higher levels of HO-1, t-bet and later up-regulation of MCP-1. These findings suggest that the deleterious effects of the Th1 cell involve increased production of chemokines such as MCP-1.

[Transcultural adaptation of scales for treatment adherence in hemodialysis: Renal Adherence Behaviour Questionnaire(RABQ) and Renal Adherence Attitudes Questionnaire(RAAQ)]. / Adaptação transcultural de escalas de aderência ao tratamento em hemodiálise: Renal Adherence Behaviour Questionnaire (RABQ) e Renal Adherence Attitudes Questionnaire (RAAQ).

Treatment adherence in hemodialysis is important for guaranteeing better results for patients, but Brazil still lacks validated assessment tools for this purpose. The current study aimed to perform a cross-cultural adaptation of the Renal Adherence Behaviour Questionnaire (RABQ) and the Renal Adherence Attitudes Questionnaire (RAAQ). The two questionnaires were submitted to the following cross-cultural adaptation procedures: translation, back-translation, expert panel review, and pilot study. Changes were made in the items' wording and application, which requires a face-to-face interview. It was not necessary to change the choices of answers. The Brazilian versions of the RABQ and RAAQ showed semantic and cultural equivalence to the original versions and are easy for the target population to understand. The two scales still require validity and reliability studies before use in the field.

Impact of social vulnerability on the outcomes of predialysis chronic kidney disease patients in an interdisciplinary center.

INTRODUCTION: Numerous studies examined the associations between socio-demographic, economic and individual factors and chronic kidney disease (CKD) outcomes and observed that the associations were complex and multifactorial. Socioeconomic factors can be evaluated by a model of social vulnerability (SV). OBJECTIVE: To analyze the impact of SV on the outcomes of predialysis patients. METHODS: Demographic, clinical and laboratory data were collected from a cohort of patients with predialysis stage 3 to 5 who were treated by an interdisciplinary team (January 2002 and December 2009) in Minas Gerais, Brazil. Factor, cluster and discriminant analysis were performed in sequence to identify the most important variables and develop a model of SV that allowed for classification of the patients as vulnerable or non-vulnerable. Cox regression was performed to examine the impact of SV on the outcomes of mortality and need for renal replacement therapy (RRT). RESULTS: Of the 209 patients examined, 29.4% were classified as vulnerable. No significance difference was found between the vulnerable and non-vulnerable groups regarding either mortality (log rank: 0.23) or need for RRT (log rank: 0.17). In the Cox regression model, the hazard ratios (HRs) for the unadjusted and adjusted impact of SV on mortality were found to be 1.87 (confidence interval [CI]: 0.64-5.41) and 1.47 (CI: 0.35-6.0), respectively, and the unadjusted and adjusted impact of need for RRT to be 1.85 (CI: 0.71-4.8) and 2.19 (CI: 0.50-9.6), respectively. CONCLUSION: These findings indicate that SV did not influence the outcomes of patients with predialysis CKD treated in an interdisciplinary center.

Standardization of renal function evaluation in Wistar rats (Rattus norvegicus) from the Federal University of Juiz de Fora's colony.

INTRODUCTION: There is great interest in the use of animal models in the study of renal pathophysiology requires standardization of parameters. OBJECTIVE: Standardize assessment of renal function in rats from in the Center for Reproductive Biology of Federal University of Juiz de Fora's colony. METHODS: Thirty Wistar rats were used and performed measurements of creatinine (serum and urine), serum urea and proteinuria. Were evaluated: the urine collection interval in metabolic cages (24 hours or 12 hours), the need for 12-hour fast, the need of urine and serum deproteinization for creatinine measurement, need of serum deproteinization in animals with acute kidney injury to a spectrophotometer and ELISA, and the comparison of 24-hour proteinuria (PT 24 hours) with the protein/creatinine ratio (rP/C). Means were compared by the Student's t test, Pearson correlation, Bland-Altman plot for agreement and linear regression model to estimate PT 24 hours from rP/C. RESULTS: The 24 hours urine output was greater than 12 hours, interfering with the creatinine clearance calculation. In the fasting group showed less water intake and lower urinary creatinine. There was great variability for the deproteinized whey and readings performed in the two devices were similar. There was a strong correlation between PT 24 hours and rP/C and the equation was generated: PT 24 hours = (8.6113 x rP/C) + 1.0869. CONCLUSION: Was standardized: 24-hour urine collection without fasting. The deproteinization showed no benefit. The measurements were performed with spectrophotometer reliability. It generated a practical formula for estimating PT 24 hours through rP/C.

Edital 45 anos / Editorial 45 years

Perspectiva históricaA HU Revista é um dos muitos projetos que abracei ao longo de minha trajetória no Hospital Universitário. Este periódico foi criado em 1974 por um grupo de professores idealistas que, àquela época, já pensavam o hospital como produtor de assistência de qualidade e instituição formadora. Nesta linha, uma publicação que disseminasse conhecimento e publicasse a produção acadêmica de seus colaboradores, foi o ponto de partida para o lançamento da HE Revista. O periódico teve grande desenvolvimento tendo sido inclusive indexado no PubMed. O tempo passou, o hospital cresceu e as dificuldades atingiram também a revista que neste meio do caminho passou a se chamar HU Revista. Não consigo citar quantos colegas se empolgaram e tentaram mantê-la com periodização e alcançar indexação em bases nacionais e internacionais. Em 2006 assumi o papel de editora-chefe, com o desafio de retorno das publicações, mas a impressão em papel, a forma de submissão e de avaliação dos manuscritos precisavam de nova abordagem. Adotamos a plataforma Open Journals System (OJS), ousando lançar o sistema de submissão on-line e recolocando no fluxo os manuscritos que estavam parados na submissão. Montamos uma equipe com voluntários dedicados e em dezembro de 2007 lançamos os números de 2006 e 2007, com critérios de revisão por pares e conseguimos fazer um pequeno rol de pareceristas. Estava assim iniciado novo caminho para a HU Revista, do qual fui juntamente com muitos colegas dedicados iniciadores.Uma nova jornadaEm fevereiro de 2018, a convite da então Gerente de Ensino e Pesquisa, Profa. Dra. Angela Maria Gollner, recebemos o desafio de reconduzir as atividades da HU Revista e constituir o Grupo de Trabalho (GT) provisório pela Gerência de Ensino e Pesquisa (GEP) do Hospital Universitário da Universidade Federal de Juiz de Fora (HU-UFJF/EBSERH).Dada a relevância da tarefa e de todos os desafios apresentados no início, o grupo não poupou esforços na capacitação, aprimoramento e desenvolvimento de novas estratégias voltadas para a retomada das atividades regulares da HU Revista, preservando suas raízes e abrindo as portas para novas ideias, conceitos, tendências e diretrizes, com o objetivo de tornar o periódico mais interessante não só para seus leitores, mas para autores, revisores e editores, personagens principais dessa longa e vitoriosa história. Nesses 45 anos, centenas de trabalhos foram publicados, o que se reflete em difusão constante de conhecimento. Inúmeros desafios ainda estão por vir, como a indexação a novas bases de dados, aprimoramento do fluxo editorial, versão em dois ou mais idiomas, maior robustez no corpo de revisores, bem como aumento da qualidade dos artigos a serem publicados na revista. Desta forma, com a visão em longo prazo e a certeza de que onde há trabalho honesto, transparente, profissional e, sobretudo, com apreço pelo que se faz, temos a convicção de que é questão de tempo para a HU Revista se tornar referência não somente em Juiz de Fora e região, mas no meio acadêmico nacional. E, assim que isso acontecer, esforços não serão poupados para que a internacionalização deste importante veículo de divulgação científica seja o próximo passo. Parabéns, HU Revista

Baixo letramento em saúde em pacientes idosos com pressão arterial não controlada em nível secundário de atenção à saúde / Low health literacy in older patients with uncontrolled blood pres-sure at secondary care

Introdução: O baixo letramento em saúde (BLS) é comum entre pacientes com doenças crônicas. Os estudos sobre a associação entre o BLS e a pressão arterial não controlada estão limitados aos níveis primário e terciário de atenção à saúde. Objetivo: Avaliamos a prevalência e a associação entre BLS e pressão arterial não controlada em pacientes hipertensos em um centro de atenção secundária à saúde no Brasil. Material e métodos: Nosso estudo teve delineamento transversal e incluiu 485 pacientes, no período de Agosto/2014 a Março/2016. Avaliamos letramento em saúde, pelo Short Assessment of Health Literacy for Portuguese-Speaking Adults (SAHLPA-18), e controle pressórico. Indivíduos com um escore ≤14 em SAHLPA-18 foram considerados com BLS, e indivíduos com pressão arterial ≥140/90 (ou ≥130/80 em pacientes diabéticos) foram considerados como tendo pressão arterial não controlada. Resultados:Um total de 56,0% eram mulheres, com média de idade de 62,0±12,6 anos. Os participantes analfabetos eram 61,6% e 65,4% recebiam até um salário mínimo. Tanto a pressão arterial não controlada quanto o BLS foram muito prevalentes (75,1% e 70,9%, respectivamente), entretanto não houve associação entre esses dois parâmetros. Na análise multivariada, a pressão arterial não controlada foi associada à idade (OR:0,96, IC:0,94-0,98, p<0,001), diabetes mellitus (OR:4,36, IC:2,54-7,51; p<0,001) e número de comprimidos (OR:1,16, Cl:1,08-1,25, p<0,001). Conclusão: Mesmo encontrando alta prevalência de BLS, a falta de associação entre BLS e pressão arterial não controlada pode ser devido às características demográficas da amostra, ou seja, idosos com baixa renda e baixa escolaridade. A avaliação do letramento em saúde fornece informações importantes que apoiam ações para melhorar o controle e o tratamento da hipertensão.

Background: Low health literacy (LHL) is common among patients with chronic diseases. Studies on the association between LHL and uncontrolled blood pressure are limited to primary and tertiary levels of healthcare. Objective:We evaluated the prevalence and association between LHL and uncontrolled blood pressure in hypertensive patients in a secondary healthcare in Brazil. Material and methods: Our study had a cross-sectional design and included 485 patients, between August/2014 to March/2016. We evaluated health literacy, by Short Assessment of Health Literacy for Portuguese-Speaking Adults (SAHLPA-18), and the blood pressure control. Individuals with a score ≤14 in SAHLPA-18 were considered as LHL, and individuals with blood pressure ≥140/90 (or ≥130/80 in diabetic patients) were considered as having uncontrolled blood pressure. Results: A total of 56.0% female, with mean age 62.0±12.6 years. Illiterate participants were 61.6%, and 65.4% earned up to one reference wage. Both uncontrolled blood pressure and LHL were highly prevalent (75.1% and 70.9%, respectively), but there was no association between these two parameters. In multivariate analysis, uncontrolled blood pressure was associated with age (OR:0.96, CI:0.94-0.98, p<0.001), diabetes mellitus (OR:4.36, CI:2.54-7.51; p<0.001) and number of pills (OR:1.16, CI:1.08-1.25, p<0.001). Conclusion: Even we found a high prevalence of LHL, the lack of association between LHL and uncontrolled blood pressure may be due to demographic characteristics of the sample, i.e., elderly people with low income and low schooling. HL assessment provides important information that supports actions to improve hypertension control and treatment.

Obesidade: da fisiopatologia ao tratamento / Obesity: from pathophysiology to treatment

O mundo mudou. O Brasil mudou. Nossa população que até meados do século 20 enfrentava o fantasma da desnutrição proteico-calórica agora vive as consequências do ganho excessivo de peso corporal e da obesidade. O sistema de saúde, em nosso país passa então enfrentar a chamada tripla carga de doenças na qual ao lado da desnutrição e das doenças infecciosas crescem as consequências das causas externas e a prevalência das condições crônicas de saúde. Dentre as condições crônicas de saúde, a obesidade se destaca como enfermidade de etiologia multifatorial e complexa, que representa fator de risco importante para uma série de outras doenças de elevada prevalência e relevância clínica, tais como o diabetes mellitus, a hipertensão arterial, as doenças cardiovasculares, a doença renal crônica, a esteatohepatite não alcoólica e certos tipos de cânceres. Dessa forma, o melhor entendimento de sua epidemiologia, fisiopatologia, características clínicas e tratamento podem contribuir para o enfrentamento e a prevenção de uma série de outras doenças de grande impacto sobre a saúde de várias populações. Nesta edição temática da HU Revista, pretendemos abordar vários aspectos relacionados a questões fisiopatológicas e clínicas da obesidade, além de propostas preventivas e terapêuticas, sob a forma de artigos originais, de revisão e relato de experiência. Os artigos foram elaborados por autores de diversas áreas com experiência no estudo da obesidade e de aspectos relacionados a essa doença. Convidamos os leitores a visitar tópicos inusitados e pouco lembrados, como a saúde óssea e risco de fraturas no obeso, e questões relacionadas à etiopatogenia da doença renal relacionada à obesidade. Além disso, será possível revisitar os mecanismos ligados à inflamação e ao risco de diabetes mellitus tipo 2 e se atualizar na abordagem laboratorial, além de ampliar as possibilidades de intervenção terapêutica, seja medicamentosa ou não farmacológica, com revisão detalhada sobre a orientação nutricional e a prescrição de exercício físico. Dentre estas estratégias, destacamos a confecção do guia educativo para prevenção e tratamento do excesso de peso, ferramenta pedagógica que visa orientar e motivar os indivíduos a modificarem hábitos de vida focando em autonomia e atitudes do paciente. Dessa forma, pretendemos contribuir para atualização científica a respeito dessa condição crônica de saúde tão prevalente na prática clínica atual, divulgando informações e contribuindo assim para um enfrentamento potencialmente mais afetivo. Fica aqui o nosso convite!

Modelos experimentais de obesidade: análise crítica do perfil metabólico e da aplicabilidade / Experimental models of obesity: critical analysis of the metabolic profile and of aplicability

ntrodução: a prevalência da obesidade e de outras doenças relacionadas está aumentando em todo o mundo de forma preocupante. Caracterizada pelo aumento do peso corporal ou do acúmulo excessivo de gordura corporal, a obesidade tem sido associada ao aumento da mortalidade decorrente de maior incidência de hipertensão, diabetes e vários tipos de câncer. Os modelos animais fornecem dados fundamentais para a compreensão dos parâmetros básicos que regulam os componentes do nosso balanço energético. Objetivo: esta revisão selecionou artigos que utilizaram modelos animais (ratos e camundongos) de obesidade focando nas principais alterações metabólicas causadas pela obesidade com o objetivo de apresentar os principais modelos utilizados nos últimos 5 anos. Material e Métodos:Foram realizadas duas buscas na base de dados PubMed utilizando as expressões: "obesity" AND "metabolism" AND "animal model" AND "mice" e "obesity" AND "metabolism" AND "animal model" AND "rat", sendo selecionados os estudos considerados mais relevantes a partir dos critérios: descrição detalhada do modelo experimental e análise dos parâmetros metabólicos de interesse: peso, perfil lipídico e perfil glicêmico. Outras referências foram utilizadas para elucidar melhor os modelos encontrados e também aqueles que não foram citados, mas, que possuem importância no entendimento da evolução dos modelos animais de obesidade. Resultados: A espécie mais utilizada foi o camundongo, o sexo predominante foi o masculino, a faixa etária dos roedores variou de neonatos até 44 semanas e o período de acompanhamento chegou até 53 semanas. A obesidade foi confirmada pelo aumento significativo do peso e na maioria dos estudos foram encontradas alterações no metabolismo lipídico e glicêmico. Encontramos cinco grupos de mecanismos de indução da obesidade porém a maioria dos estudos utilizou dietas hiperlipídicas, modelo que mais se assemelha às alterações metabólicas encontradas em humanos. Conclusão: Investigar as causas e efeitos da obesidade induzida em modelos experimentais pode fornecer uma melhor compreensão da fisiopatologia da obesidade, e proporcionar novas opções de prevenção e tratamento.

Introduction: The prevalence of obesity and other related diseases is increasing worldwide worrisome. Characterized by increased body weight or excessive accumulation of body fat, obesity has been associated with increased mortality due to higher incidence of hypertension, diabetes and many types of cancer. Animal models provide key data for understanding the basic parameters that regulate the components of our energy balance. Objective: This review selected articles that used animal models (mice and mice) for obesity focusing on the main metabolic changes caused by obesity in order to present the main models used in the last 5 years. Material and Methods: Two searches were performed in the PubMed database using the expressions "obesity" AND "metabolism" AND "animal model" AND "mice" and "obesity" AND "metabolism" AND "animal model" AND "rat". We selected the papers considered more relevant from the criteria: detailed description of the experimental model and analysis of the metabolic parameters of interest: weight, lipid profile and glycemic profile. Other references were used to better elucidate the models found and also those that were not mentioned, but we considered important for the understanding of the evolution of animal models of obesity. Results: Mouse was the most used species, the predominant gender was male, the rodent age ranged from neonates up to 44 weeks and the follow-up period reached up to 53 weeks. Obesity was confirmed by a significant weight gain and most studies showed alterations in lipid and glycemic metabolism. We found five groups of induction of obesity, but the majority of studies applied hiperlipidic diets, model which better mimics metabolic chances found in humans. Conclusion: Investigating the causes and effects of induced obesity in experimental models may provide a better understanding of the pathophysiology of obesity, creating new options for prevention and treatment.

Avaliação do efeito da quercetina em ratos Wistar com síndrome metabólica / Evaluation of the effect of quercetin in Wistar rats with metabolic syndrome

Introdução: O tratamento da síndrome metabólica (SM) é um desafio, uma vez que terapias não medicamentosas são de difícil implementação e o tratamento farmacológico ideal não está totalmente estabelecido. Objetivo: Avaliar o efeito da quercetina na pressão arterial (PA), dislipidemia e acúmulo de gordura visceral em modelo experimental de SM induzida por dieta hiperlipídica. Material e Métodos: Ratos Wistar receberam ração hiperlipídica a partir da quarta semana de vida, por 20 semanas. O grupo tratado recebeu quercetina a partir da oitava semana de vida. Avaliou-se semanalmente o peso corporal e a PA de cauda por pletismografia. Ao final do experimento foram realizados testes de perfil glicêmico e lipídico. Resultados:A administração de dieta hiperlipídica se associou ao desenvolvimento de SM, caracterizada por acúmulo central de gordura, hipertensão arterial, hiperglicemia e hipertrigliceridemia. A quercetina não apresentou eficácia no tratamento das comorbidades que compõem a SM. Conclusão: A administração crônica diária da quercetina em modelo experimental de SM induzida por dieta hiperlipídica não alterou de forma significante o perfil nutricional, metabólico e pressórico dos animais.

Introduction: The treatment of the metabolic syndrome (MetS) is a challenge, since nonpharmacologic therapies are difficult to implement and the ideal pharmacologic treatment has not been completely established. Aim: To evaluate the effect of quercetin in blood pressure (BP), dyslipidemia, visceral fat accumulation, in an experimental model of MetS induced by a hyperlipidic diet. Material and Methods: Wistar rats received high fat diet feed from the fourth week of life for 20 weeks. The treatment group received quercetin from the eighth week of life. Body weight and tail BP through pletysmography were evaluated weekly. At the end of the experiment, tests of glucose and lipid profile. Results: The administration of a high fat diet was associated to the development of MetS, characterized by an accumulation of central fat, arterial hypertension, hyperglycemia, and hypertriglyceridemia. Quercetin was not effective in the treatment of comorbidities associated with MetS. Conclusion: Chronic daily administration of quercetin in an experimental model of MetS induced by a hyperlipidic diet did not significantly alter the nutritional, metabolic, and pressure profile of the animals.

Dialogue between primary and secondary health care providers in a Brazilian hypertensive population

SUMMARY OBJECTIVE To describe clinical and epidemiological profiles of patients with hypertension referred to a secondary care unit and to assess the adequacy of the referral criteria. METHOD This descriptive transversal study analysed 943 hypertensive patients referred to a secondary healthcare unit from September 2010 to August 2012. Clinical and sociodemographic data as well as data regarding the liaison between secondary and primary care services were collected. RESULTS Patients' mean age was 59±13.1 years, and 61.3% were female. Sedentary lifestyle, alcohol consumption, and smoking were observed in 80.3%, 31.1%, and 18.1% of the patients, respectively. Uncontrolled blood pressure was observed in 72.5% of the sample, and 80.1% of individuals were overweight or obese. There was a high prevalence of dyslipidaemia (73.1%), cardiovascular disease (97.5%), and reduced glomerular filtration rate (49.9%). Thirty-eight percent of patients did not meet the referral criteria, of whom approximately 25% were not hypertensive. CONCLUSION Even in a universal-access healthcare system, poor control of hypertension and high prevalence of obesity and cardiovascular diseases were observed. Inadequate referrals and the presence of clinical complications suggest low efficiency of the assistance provided in primary care and reinforce the need for sharing care with the secondary level.

RESUMO OBJETIVO Descrever os perfis clínicos e epidemiológicos de pacientes hipertensos encaminhados para uma unidade de atendimento secundário e avaliar a adequação dos critérios de referência. MÉTODO Estudo transversal que analisou 943 pacientes hipertensos encaminhados a uma unidade de atenção secundária à saúde de setembro de 2010 a agosto de 2012. Foram coletados dados clínicos e sociodemográficos, bem como dados de interlocução entre os serviços de atenção primária e secundária. RESULTADOS A idade média dos pacientes era de 59 ± 13,1 anos e 61,3% eram do sexo feminino. O estilo de vida sedentário, o consumo de álcool e o tabagismo foram observados em 80,3%, 31,1% e 18,1% dos pacientes, respectivamente. A pressão arterial descontrolada foi observada em 72,5% da amostra, e 80,1% dos indivíduos apresentavam excesso de peso. Houve uma alta prevalência de dislipidemia (73,1%), doença cardiovascular (97,5%) e taxa de filtração glomerular estimada reduzida (49,9%). Trinta e oito por cento dos pacientes não atendiam aos critérios de encaminhamento, dos quais aproximadamente 25% não eram hipertensos. CONCLUSÃO Mesmo em um sistema de saúde de acesso universal, observou-se um controle insuficiente da hipertensão e uma alta prevalência de obesidade e doenças cardiovasculares. Encaminhamentos inadequados e a presença de complicações clínicas sugerem uma baixa eficiência da assistência prestada na atenção primária e reforçam a necessidade de compartilhar cuidados com o nível secundário.

Severe sepsis from a Ciprofloxacin resistant salmonellosis in a kidney transplant recipient / Sepse grave por salmonelose Ciprofloxacino-resistente em paciente transplantado renal

Abstract Introduction: Salmonellosis is a relatively rare complication in kidney transplant recipients that cannot be clinically distinguished from other forms of enteritis. Among kidney transplant patients, it varies broadly in intensity, and is highly associated with extra-intestinal disease, bacteremia, and, in this case, a high mortality rate. Case Report: Here we describe a clinical case of ciprofloxacin resistant salmonellosis in a kidney transplant patient. Conclusion: This case illustrates how immunosuppressed patients can be exposed to rare forms of infection, often clinically difficult to identify, and possibly with severe clinical courses and poor outcomes despite evidence-based empiric antibiotic therapy.

Resumo Introdução: A salmonelose é uma complicação relativamente rara em transplantados renais, e não pode ser diferenciada de outras formas de enterite pela apresentação clínica. Em pacientes transplantados renais, a salmonelose varia em gravidade, e é frequentemente associada com formas extra intestinais, bacteremia, e, neste caso, com elevada mortalidade. Relato de Caso: Descrevemos o caso clínico de um paciente transplantado renal com salmonelose Ciprofloxacino-resistente. Conclusão: Este caso ilustra o risco, relacionado à imunossupressão, da ocorrência de formas raras de infecção, por vezes de difícil diagnóstico, e com cursos clínicos potencialmente graves e prognóstico ruim, apesar do emprego de antibioticoterapia empírica adequada e de acordo com as evidências disponíveis.

[Dissociation of antihypertensive and metabolic response to losartan and spironolactone in experimental rats with metabolic sindrome]. / Dissociação da resposta anti-hipertensiva e metabólica à losartana e espironolactona em ratos com síndrome metabólica experimental.

INTRODUCTION: The treatment of arterial hypertension (AH) in patients with metabolic syndrome (MS) is a challenge, since non drug therapies are difficult to implement and optimal pharmacological treatment is not fully established. OBJECTIVE: To assess the blockade of the rennin angiotensin aldosterone system (RAAS) in blood pressure (BP) in renal function and morphology in an experimental model of MS induced by high fat diet. METHODS: Wistar rats were fed on high fat diet from the fourth week of life, for 20 weeks. The groups received Losartan or Spironolactone from the eighth week of life. We weekly evaluated the body weight and BP by tail plethysmography. At the end of the experiment oral glucose tolerance, lipid profile, creatinine clearance tests, and the direct measurement of BP were performed. A morphometric kidney analysis was performed. RESULTS: The administration of high-fat diet was associated with the development of MS, characterized by central fat accumulation, hypertension, hyperglycemia and hypertriglyceridemia. In this model there were no changes in renal histomorphometry. The blockade of angiotensin II (Ang II) receptor AT1 prevented the development of hypertension. The mineralocorticoid blockage did not have antihypertensive efficacy but was associated with reduction of abdominal fat. CONCLUSION: The dissociation of the antihypertensive response to the blockades of Ang II receptors and mineralocorticoid indicates the involvement of Ang II in the pathogenesis of hypertension associated with obesity. Reduction of central obesity with Spironolactone suggests the presence of mineralocorticoid adipogenic effect.