Depression among patients with end-stage renal disease in hemodialysis.

Depression is frequent in end-stage renal disease (ESRD) and predicts mortality in dialysis patients. The aim of this study was to investigate the occurrence of depression among patients on hemodialysis. We conducted an observational cross-sectional study at two hemodialysis centres in the metropolitan area of Fortaleza, Ceará, Brazil, between September and October 2010. The occurrence of depression was evaluated according to Beck Depression Inventory II. Among 148 patients interviewed, the mean age was 46 ± 13 years and 54% were male. The average time on dialysis was 5.3 ± 5.2 years. Depression was found in 101 (68.2%) cases. Depression was classified as mild (49.5%), moderate (41.5%) and severe (9%). Only 15.5% had prior depression diagnosis. Follow-up with Psychologist was being done in only 32.4% of cases. Patients with depression had a higher frequency of antidepressant use (20.7% vs. 4.2%, p=.01) and benzodiazepines (33.6% vs. 8.5%, p=.001). Among patients using antidepressant, improvement of symptoms was reported by 81.6%. Depression is one potentially modifiable risk factor in ESRD. The investigation and multidisciplinary approach of depression should be part of routine evaluation of patients on dialysis.

[Effect of congenital infection by Trypanosoma cruzi on intrauterine development and the fetal-neonatal immune response]. / Efecto de la infección congénita por Trypanosoma cruzi sobre el desarrollo intrauterino y la respuesta inmune fetal-neonatal.

In congenital infection by Trypanosoma cruzi, morbidity and mortality vary from asymptomatic cases to severe clinical forms of the disease. It has been found that there is no specific clinical profile in newborns infected by T. cruzi, since during intrauterine development diverse pathological changes take place, causing alterations in the serological and parasitological profiles. Some intrinsic factors of the host, such as: the placental barrier and the ability of both, mother and fetus, to develop a specific immune response to control parasite multiplication, could be involved in such differences. Another possibility includes the genetic polymorphism of T. cruzi, since it is considered that strains of greater virulence can cross the placenta more easily and are more pathogenic to the fetus and/or the neonate.

Quality of sleep and day-time sleepiness in chronic hemodialysis: a study of 400 patients.

OBJECTIVE: Impaired sleep has potential health consequences in chronic hemodialysis patients. To date, this issue has not been examined in studies involving a large number of subjects. This study aimed to identify factors associated with poor sleep quality and excessive day-time sleepiness (EDS) in dialysis patients. MATERIAL AND METHODS: This cross-sectional observational study involved 400 patients (59% male) from three hemodialysis centers (SD-HEMOFOR). Quality of sleep was evaluated by the Pittsburgh Sleep Quality Index (PSQI), EDS by the Epworth Sleepiness Scale (ESS), risk of obstructive sleep apnea (OSA) by the Berlin questionnaire and comorbidity severity by the Charlson Comorbidity Index (CCI). RESULTS: Poor sleep quality (PSQI >5) was found in 227 individuals (57%) and was associated with older age (p = 0.001), diabetes (p = 0.03), heart failure (p < 0.005), hypoalbuminemia (p = 0.01), low transferrin saturation (TSAT) (p = 0.009), higher CCI score (p = 0.01) and depression (p < 0.005). Independent factors were older age, heart failure, low TSAT and depressive symptoms. Day-time somnolence was present in 108 patients (27%) and was independently associated with stroke [odds ratio (OR) = 2.84, CI 1.03-7.76), lower hemoglobin concentration (OR = 2.45, CI 0.95-3.03) and high risk of OSA (OR = 1.65, CI 1.03-2.63). High risk of OSA (n = 120; 30%), was associated with hypertension (p < 0.001), overweight/obesity (p = 0.001), older age (p = 0.003) and symptoms of depression (p = 0.01). CONCLUSIONS: Poor sleep quality and EDS were prevalent on chronic hemodialysis. Heart failure, low TSAT and depressive symptoms were independently associated with poor sleep quality. Stroke, anemia and high risk of OSA were independently associated with EDS. These results provide new insight into possible treatment strategies.

RIFLE and Acute Kidney Injury Network classifications predict mortality in leptospirosis-associated acute kidney injury.

AIM: Acute kidney injury (AKI) is a common complication in leptospirosis. The aim of this study is to investigate the association between RIFLE and AKIN classifications with mortality in leptospirosis-associated AKI. METHODS: A retrospective study was conducted in patients with leptospirosis admitted to tertiary hospitals in Brazil. The association between RIFLE and AKIN classifications with mortality was investigated. Univariate and multivariate analysis was performed to investigate risk factors for death. RESULTS: A total of 287 patients were included, with an average age of 37 ± 16 years, and 80.8% were male. Overall mortality was 13%. There was a significant association between these classifications and death. Among non-survivors, 86% were in the class 'failure' and AKIN 3. Increased mortality was observed according to the worse classifications: 'risk' (R; 2%), 'injury' (I; 8%) and 'failure' (F; 23%), as well as in AKIN 1 (2%), AKIN 2 (8%) and AKIN 3 (23%) (P < 0.0001). The worst classifications were significantly associated with death: RIFLE F (odds ratio = 11.6, P = 0.018) and AKIN 3 (odds ratio = 12.8, P = 0.013). Receiver-operator curve for patients with AKI showed high areas under the curve (0.71, 95% confidence interval = 0.67-0.74) for both RIFLE and AKIN classifications in determining the sensitivity for mortality. CONCLUSION: There is a significant association between RIFLE and AKIN classifications with mortality in patients with leptospirosis. Initiation of dialysis in patients with RIFLE F and AKIN 3 should always be considered.

[Trypanosoma cruzi infection in pregnant mice induces a cellular immune response with citokines production in their fetuses]. / La infección por Trypanosoma cruzi en ratones gestantes induce una respuesta inmune celular con producción de citocinas en sus fetos.

The objective of this study was to detect the cytokines IFN-gamma, IL-4 and IL-10 expressed by CD4+ T cells in tissues of fetal mice with acute chagasic infection. For this, we examined the fetuses of NMRI mice whose mothers were infected with 22x10(3) metacyclic trypomastigotes of the M/HOM/BRA/53/Y strain of T. cruzi and made pregnant during the acute phase of infection. For the detection and localization of inflammatory infiltrates, nest parasites, antigens of T. cruzi a nd cytokines w eused hematoxylin-eosin techniques, peroxidase-anti-peroxidase and immunofluorescence. The immunohistochemical study revealed the presence of inflammatory infiltrates and antigens with amastigote nests in fetal skeletal muscle. CD4 + T cells producing IFN-gamma, as well as deposits of IFN-gamma and IL-10, were detected in sections of placenta, heart and skeletal muscle of fetuses of mice infected, while CD4+/IL-10+ was found only in skeletal muscle; in addition, deposits of IL-4 were detected only in placentas of healthy mice. These results indicate that fetuses are capable of generating their own immune response to antigens transmitted by their mother, which induces the secretion of cytokines and that, acting in synergy with the maternal antibodies, confer them a state of protection against infection; and that the transmission of the parasite depends on factors specific to each mother, which may modify its ability to control such transmission at the placental or systemic levels.

Metacyclogenesis of Trypanosoma cruzi in B. ferroae (Reduviidae: Triatominae) and feces infectivity under laboratory conditions / Metaciclogénesis de Trypanosoma cruzi en Belminus ferroae (Reduviidae: Triatominae) y capacidad infectiva de las heces en condiciones de laboratorio.

Introduction: Belminus ferroae is a triatominae with entomophagous behavior. However, it may occasionally feed on vertebrates. Currently, there is no evidence of natural infection with Trypanosoma cruzi or the occurrence of metacyclogenesis in this species. Objective: To test T. cruzi metacyclogenesis in B. ferroae and the infectivity of their feces or intestinal contents in rodents under laboratory conditions. Materials and methods: Twenty nymphs of B. ferroae were infected with an autochthonous strain of T. cruzi (M/HOM/VE/09/P6). Fecal and urine samples were collected from spontaneous droppings or by compressing the bugs' abdomens and, eventually, by removing their gut contents, and then examined at 10, 20, 30, 40, 50, and 60 days. We quantified T. cruzi parasitic load, as well as the evolutionary forms in feces, urine, and intestinal contents by Giemsa staining. Similarly, we evaluated the infectivity of T. cruzi metacyclic trypomastigotes in albino mice. Results: The parasitological analysis showed three insects (15%) infected with T. cruzi at 30 (n=1), 40 (n=1), and 50 (n=1) days post-infection. We observed parasitic loads of up to 1.62 x 105 trypanosomes/mm3 and metacyclogenesis percentages between 3.5% and 6.78%. Conclusions: This is the first time that T. cruzi metacyclogenesis is reported in a species of the genus Belminus under laboratory conditions and the infectivity of Belminus' feces is demonstrated on a vertebrate host.

Introducción. Belminus ferroae es un triatomino de comportamiento entomófago, sin embargo, puede alimentarse de vertebrados ocasionalmente. No se ha demostrado infección natural por Trypanosoma cruzi en esta especie, como tampoco la metaciclogénesis del parásito. Objetivo. Examinar la metaciclogénesis de T. cruzi en B. ferroae y la capacidad infectiva de las heces o sus contenidos intestinales en roedores. Materiales y métodos. Se analizaron las heces y la orina expulsadas espontáneamente por los insectos o mediante compresión abdominal o extracción del contenido intestinal a los 10, 20, 30, 40, 50 y 60 días. Se cuantificó la carga parasitaria de T. cruzi y sus formas evolutivas se identificaron con tinción de Giemsa. Asimismo, se evaluó en ratones albinos la apacidad infectiva de los tripomastigotes metacíclicos de T. cruzi obtenidos de las heces o contenidos intestinales de los especímenes infectados. Resultados. El análisis parasitológico reveló tres (15 %) insectos infectados con T. cruzi a los 30 (n=1), 40 (n=1) y 50 (n=1) días después de la infección con cargas parasitarias de hasta 1,62 x 105 tripanosomas/mm3 y porcentajes de metaciclogénesis entre el 3,5 y el 6,78 %. Conclusiones. Se demuestra por primera vez, en una especie del género Belminus, la metaciclogenésis de T. cruzi en condiciones de laboratorio y la capacidad infectiva de las heces para un huésped vertebrado.

Introducing PIONEER: a project to harness big data in prostate cancer research.

Prostate Cancer Diagnosis and Treatment Enhancement Through the Power of Big Data in Europe (PIONEER) is a European network of excellence for big data in prostate cancer, consisting of 32 private and public stakeholders from 9 countries across Europe. Launched by the Innovative Medicines Initiative 2 and part of the Big Data for Better Outcomes Programme (BD4BO), the overarching goal of PIONEER is to provide high-quality evidence on prostate cancer management by unlocking the potential of big data. The project has identified critical evidence gaps in prostate cancer care, via a detailed prioritization exercise including all key stakeholders. By standardizing and integrating existing high-quality and multidisciplinary data sources from patients with prostate cancer across different stages of the disease, the resulting big data will be assembled into a single innovative data platform for research. Based on a unique set of methodologies, PIONEER aims to advance the field of prostate cancer care with a particular focus on improving prostate-cancer-related outcomes, health system efficiency by streamlining patient management, and the quality of health and social care delivered to all men with prostate cancer and their families worldwide.

Author Correction: Introducing PIONEER: a project to harness big data in prostate cancer research.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Predictors of oliguric acute kidney injury in leptospirosis. A retrospective study on 196 consecutive patients.

BACKGROUND: Acute kidney injury (AKI) occurs in 10 to 60% of patients with leptospirosis. The aim of this study is to investigate markers for oliguric AKI in leptospirosis. METHODS: A retrospective study was performed with 196 consecutive patients with leptospirosis-associated AKI. These patients were categorized into either oliguric or non-oliguric according to their urine output. Clinical and laboratory characteristics were compared between the two groups. RESULTS: Among these patients, 64 (32.6%) were oliguric and 132 (67.4%) nonoliguric. Markers for oliguria were age higher than 40 years (OR = 1.02, p = 0.04), hyponatremia (OR = 0.94, p = 0.03), elevated serum creatinine (OR = 1.11, p = 0.04), low arterial pH (OR = 1.0002, p = 0.01), high levels of AST (OR = 1.005, p = 0.01), crackles (OR = 3.83, p < 0.001) and direct bilirubin (OR = 1.03, p = 0.03). Elevated activated prothrombin time (OR = 0.97, p = 0.03) was a factor associated with nonoliguric AKI. Independent markers for oliguria were crackles (OR = 5.17, p = 0.0016) and direct bilirubin levels (OR = 1.051, p = 0.04). Mortality was significantly higher in oliguric than nonoliguric (27 vs. 8%, p < 0.001). Renal function at discharge was similar in oliguric and nonoliguric patients. CONCLUSION: Age higher than 40 years, hyponatremia, elevated serum creatinine, low arterial pH, high levels of AST, crackles and direct bilirubin levels would be useful to early identify patients with oliguric AKI in leptospirosis.

[Detection of Trypanosoma cruzi DNA in the placenta and fetuses of mice with Chagasic acute infection]. / Detección de ADN de Trypanosoma cruzi en la placenta y fetos de ratones con infección chagásica aguda.

The objective of the present study was to detect the presence of Trypanosoma cruzi DNA in the placenta and fetal tissues of NMRI mice (Mus musculus) inoculated with 22 x 10(3) trypomastigotes metacyclic of the M/HOM/BRA/53/Y strain by intraperitoneal route. Mice were pregnant in the acute phase of the infection. The course of patent parasitemia by T. cruzi was evaluated before mating and during pregnancy. At day twenty of gestation, animals were sacrificed and the fetuses and their placentas were removed to evaluate T. cruzi infection. Samples of fetal placenta, heart and skeletal muscle were fixed in 10%, formalin, included in paraffin and stained with hematoxilin and eosin (HE). The histopathological study of sections of fetal tissues revealed inflammatory infiltrates with mononuclear and polymorphonuclear cells and without parasitism in these tissues. The amplification of T. cruzi DNA by Polymerase Chain Reaction (PCR) showed a positive reaction in 18% of placental tissue of pregnant infected mice. The samples of heart and skeletal muscle of the fetuses of mothers infected with T. cruzi did not show the presence T. cruzi DNA. The placenta and skeletal muscle of the fetuses analyzed by Peroxidase anti Peroxidase inmunostaining showed T. cruzi antigens in those tissues. Negative results by PCR in fetal tissues might be related with the virulence and tropism associated with the biological and genetic characteristic Of the T. cruzi strain used in the experimental infection of female mice.

Standardized Observational Cancer Research Using the OMOP CDM Oncology Module.

Observational research in cancer requires substantially more detail than most other therapeutic areas. Cancer conditions are defined through histology, affected anatomical structures, staging and grading, and biomarkers, and are treated with complex therapies. Here, we show a new cancer module as part of the OMOP CDM, allowing manual and automated abstraction and standardized analytics. We tested the model in EHR and registry data against a number of typical use cases.

Acute kidney injury in an infectious disease intensive care unit - an assessment of prognostic factors.

BACKGROUND: Acute kidney injury (AKI) is a common complication in many infectious diseases. There are few studies to investigate risk factors for death in infectious diseases-associated AKI. METHODS: This is a retrospective study including all patients with acute kidney injury (AKI) admitted to an infectious diseases intensive care unit (ICU) in Brazil between October 2003 and September 2006. RESULTS: A total of 722 patients were admitted to the infectious disease ICU in the study period. AKI occurred in 147 cases (17.7%). The mean age was 45 +/- 5.6 years, and 77% were male. The mean length of hospital stay was 11.5 +/- 10.3 days. The main causes of ICU hospitalization were acquired immunodeficiency syndrome (AIDS)-related diseases (28 .6%), pneumonia 13%), leptospirosis (11.6%), meningitis (8.2%), disseminated histoplasmosis (6.8%) and tetanus (5.4%). The main cause of AKI was sepsis (41.5%). Patients were classified according to RIFLE as "Risk" (5.6%), "Injury" (21.7%) and "Failure" (72.7%). Patients in "Failure" showed a higher mortality (p = 0.007). Multivariate analysis showed that dependent risk factors for death were oliguria (OR = 5.59, P = 0.002), metabolic acidosis (OR = 5.13, P = 0.01), sepsis (OR = 4.79, P = 0.001), hypovolaemia (OR = 4.11, P = 0.01), use of vasoactive drugs (OR = 3.34, P = 0.02), use of mechanical ventilation (OR = 2.94, P = 0.03) and high APACHE II score (OR = 1.14, P = 0.001). CONCLUSION: There are important risk factors for death among critically ill patients with infectious diseases associated with AKI.

Comparison between early and delayed acute kidney injury secondary to infectious disease in the intensive care unit.

BACKGROUND: Results from a number of studies suggest that the delayed manifestation of acute kidney injury (AKI) is associated with higher in-hospital mortality, while other studies were unable to demonstrate any difference among early and delayed AKI in terms of in-hospital mortality. OBJECTIVE: The aim of this study was to investigate differences in outcome among patients with AKI upon admission to an intensive care unit (ICU) and those who develop AKI post-admission. METHODS: We studied patients with AKI secondary to infectious diseases admitted to the ICU. We retrospectively compared data on patients admitted with AKI (early AKI) with data on those who developed AKI 24 h after admission (delayed AKI). RESULTS: Acute kidney injury occurred in 147 of 829 (17.7%) patients admitted to the ICU. Of these, 96 (65%) had early AKI and 51 (35%) had delayed AKI. Renal failure was classified according to RIFLE criteria-an AKI-specific severity score that is used to place patients into one of five categories: risk, injury, failure, loss or end-stage renal disease. Based on these criteria, 6% of the early AKI and 4% of the delayed AKI patients were in risk category, 18% of the early AKI and 27% of the delayed AKI patients were in the injury category and 76% of the early AKI and 69% of the delayed AKI patients were in the failure category. We found no significant association between RIFLE and death. On admission, patients with early AKI had statistically significantly higher serum urea and creatinine levels than delayed AKI patients (P<0.0001). Arterial bicarbonate was lower in early AKI (P=0.02). Sepsis, hypotension and use of mechanical ventilation were more frequent in delayed AKI (P<0.05). The APACHE II score was higher in early AKI (P=0.05) patients. In total, 98 (66.7%) patients died, with a tendency towards higher mortality in patients with delayed AKI (61.5 vs. 76.5%, P=0.07). CONCLUSION: Mortality among patients with infectious diseases-associated AKI admitted to the ICU is high, with a trend to be higher in those who developed delayed AKI.

[Anxiety disorders and physical exercise]. / Transtornos de ansiedade e exercício físico.

OBJECTIVE: Until the mid 90's, most of the studies on the anxiolytic effects of exercise were carried out through the evaluation of the anxiety state of young individuals. They were college students or athletes who might be considered pre-fit, thus limiting the validity of the conclusions as regards populations with pathological anxiety. The number of studies involving patients with anxiety disorder is increasing nowadays. Therefore, the objective of the study is to review the articles that discuss the influence of physical exercise on anxiety disorders. METHOD: We ran a MEDLINE search between 1966-1995 and 1996-2006 using the keywords anxiety, panic, phobic disorders, exercise, and physical fitness, in addition to the cross-reference of the articles selected and further analyses of bibliographical references on the topic. RESULTS: Our findings showed heterogeneous designs and methodological limitations. The latest publications are promising and point to the use of physical exercise as an aid to traditional therapies in the treatment of anxiety disorders. CONCLUSION: We observed that aerobic exercises below the lactate threshold might be the most adequate. However, they do not clarify the implications of anaerobic exercise, which suggests caution in the prescription of exercise, mainly the anaerobic kind, to individuals with pathologic anxiety.

Calidad de vida y sarcopenia en pacientes adultos con insuficiencia renal crónica / Quality of life and sarcopenia in adult patients with chronic renal failure

RESUMEN Introducción: la calidad de vida puede alterarse en los pacientes con insuficiencia renal crónica, sobre todo si sufren concomitantemente de sarcopenia. Objetivo: determinar la relación entre sarcopenia y calidad de vida en pacientes adultos con insuficiencia renal crónica del Hospital Nacional (Itauguá) y Hospital Militar (Asunción) entre abril y noviembre del 2021. Metodología: se utilizó un diseño observacional, descriptivo, transversal. Se incluyó a sujetos adultos de ambos sexos, portadores de insuficiencia renal crónica. Se midieron variables antropométricas, clínicas y laboratoriales. La calidad de vida se evaluó con el cuestionario EQ-5D y la sarcopenia con la fuerza de prensión palmar y el índice de masa muscular. Los datos se sometieron a estadística descriptiva y analítica con el programa Epi Info 7™. El estudio contó con la aprobación del Comité de Ética de la Universidad Privada del Este, Paraguay. Resultados: ingresaron al estudio 62 varones con edad media 56 ± 15 años y 57 mujeres con edad media 51 ± 16 años. La más frecuente de la insuficiencia renal fue la hipertensión arterial asociada a la diabetes mellitus (45,4 %). La sarcopenia se confirmó en 38,6 % de los pacientes. La calidad de vida fue buena en 30,25 %, regular en 39,5 % y mala en 30,25 %. Conclusión: en pacientes adultos con insuficiencia renal crónica, la sarcopenia predominó en los sujetos con regular y mala calidad de vida.

ABSTRACT Introduction: the quality of life can be altered in patients with chronic renal failure, especially if they suffer concomitantly from sarcopenia. Objective: to determine the relationship between sarcopenia and quality of life in adult patients with chronic renal failure at the Hospital Nacional (Itauguá) and the Hospital Militar (Asunción) between April and November 2021. Methodology: an observational, descriptive, cross-sectional design was used. Adult subjects of both sexes, carriers of chronic renal failure were included. Anthropometric, clinical and laboratory variables were measured. Quality of life was evaluated with the EQ-5D questionnaire and sarcopenia with palm grip strength and muscle mass index. The data was submitted to descriptive and analytical statistics with the Epi Info 7™ program. The study was approved by the Ethics Committee of the Universidad Privada del Este, Paraguay. Results: 62 men with a mean age of 56 ± 15 years and 57 women with a mean age of 51 ± 16 years entered the study. The most frequent renal failure was arterial hypertension associated with diabetes mellitus (45.4 %). Sarcopenia was confirmed in 38.6 % of the patients. The quality of life was good in 30.25 %, regular in 39.5 % and bad in 30.25 %. Conclusion: in adult patients with chronic renal failure, sarcopenia prevailed in subjects with fair and poor quality of life.

Metaciclogénesis de Trypanosoma cruzi en Belminus ferroae (Reduviidae: Triatominae) y capacidad infectiva de las heces en condiciones de laboratorio / Metacyclogenesis of Trypanosoma cruzi in B. ferroae (Reduviidae: Triatominae) and feces infectivity under laboratory conditions

Resumen | Introducción. Belminus ferroae es un triatomino de comportamiento entomófago, sin embargo, puede alimentarse de vertebrados ocasionalmente. No se ha demostrado infección natural por Trypanosoma cruzi en esta especie, como tampoco la metaciclogénesis del parásito. Objetivo. Examinar la metaciclogénesis de T. cruzi en B. ferroae y la capacidad infectiva de las heces o sus contenidos intestinales en roedores. Materiales y métodos. Se analizaron las heces y la orina expulsadas espontáneamente por los insectos o mediante compresión abdominal o extracción del contenido intestinal a los 10, 20, 30, 40, 50 y 60 días. Se cuantificó la carga parasitaria de T. cruzi y sus formas evolutivas se identificaron con tinción de Giemsa. Asimismo, se evaluó en ratones albinos la capacidad infectiva de los tripomastigotes metacíclicos de T. cruzi obtenidos de las heces o contenidos intestinales de los especímenes infectados. Resultados. El análisis parasitológico reveló tres (15 %) insectos infectados con T.cruzi a los 30 (n=1), 40 (n=1) y 50 (n=1) días después de la infección con cargas parasitarias de hasta 1,62 x 105 tripanosomas/mm3 y porcentajes de metaciclogénesis entre el 3,5 y el 6,78 %. Conclusiones. Se demuestra por primera vez, en una especie del género Belminus, la metaciclogenésis de T. cruzi en condiciones de laboratorio y la capacidad infectiva de las heces para un huésped vertebrado.

Abstract | Introduction: Belminus ferroae is a triatominae with entomophagous behavior. However, it may occasionally feed on vertebrates. Currently, there is no evidence of natural infection with Trypanosoma cruzi or the occurrence of metacyclogenesis in this species. Objective: To test T. cruzi metacyclogenesis in B. ferroae and the infectivity of their feces or intestinal contents in rodents under laboratory conditions. Materials and methods: Twenty nymphs of B. ferroae were infected with an autochthonous strain of T. cruzi (M/HOM/VE/09/P6). Fecal and urine samples were collected from spontaneous droppings or by compressing the bugs' abdomens and, eventually, by removing their gut contents, and then examined at 10, 20, 30, 40, 50, and 60 days. We quantified T. cruzi parasitic load, as well as the evolutionary forms in feces, urine, and intestinal contents by Giemsa staining. Similarly, we evaluated the infectivity of T. cruzi metacyclic trypomastigotes in albino mice. Results: The parasitological analysis showed three insects (15%) infected with T. cruzi at 30 (n=1), 40 (n=1), and 50 (n=1) days post-infection. We observed parasitic loads of up to 1.62 x 105 trypanosomes/mm3 and metacyclogenesis percentages between 3.5% and 6.78%. Conclusions: This is the first time that T. cruzi metacyclogenesis is reported in a species of the genus Belminus under laboratory conditions and the infectivity of Belminus' feces is demonstrated on a vertebrate host.

Molecular and genetic mechanisms of obesity: implications for future management.

Obesity has become a worldwide public health problem affecting millions of people. A disruption of the balance between energy intake and energy expenditure is believed to be the major cause of obesity. Substantial progress has been made in deciphering the pathogenesis of energy homeostasis over the past few years. The fact that obesity is under strong genetic control has been well established. Human monogenic obesity is rare in large populations, the most common form of obesity is considered to be a polygenic disorder arising from the interaction of multiple genetic and environmental factors. Here, we attempt to briefly review the most recent understanding of molecular mechanisms involved in energy homeostasis and adipogenesis. We discuss the advantages and disadvantages of various approaches commonly used in search for susceptibility genes for obesity. The main results from these genetic studies are summarized, with comments made on the most striking or representative findings. Finally, the implications of the recent advances in the understanding of molecular genetic mechanisms of body weight regulation on prevention and therapeutic intervention of obesity will be discussed.

Fatores de risco materno-fetais para o nascimento pré-termo em hospital de referência de Minas Gerais / Maternal and fetal risk factors for preterm birth in a reference hospital in Minas Gerais

Introdução. São considerados prematuros, os bebês nascidos antes de completar 37 semanas de gestação e, no Brasil, sua prevalência chega a aproximadamente 10%. A prematuridade pode comprometer a saúde do recém-nascido (RN) e levar a repercussões socioeconômicas. Portanto, é fundamental rastrear gestantes sob risco através de pré-natal adequado, a fim de afastá-las dessas condições ou minimizar suas implicações. Objetivos. Avaliar os principais fatores de risco maternos e fetais associados ao parto pré- termo em um hospital de referência em Barbacena. Métodos. Estudo transversal, retrospectivo, analítico, realizado no Hospital Santa Casa de Misericórdia de Barbacena. Avaliou-se prontuários materno-fetais impressos, disponibilizados de todos os nascimentos pelo Sistema Único de Saúde (SUS), em 2017. Foram analisados dados como: idade, profissão e patologias maternas; exames realizados durante gestação e informações do RN. Resultados. Dentre os 1278 prontuários, foram encontrados 177 prematuros. Verificou-se que diabetes mellitus (DM) ou diabetes mellitus gestacional (DMG), infecções do trato urinário (ITU), síndromes hipertensivas na gravidez, sífilis materna, gemelaridade e parto cesáreo foram estatisticamente relevantes como fatores de risco para prematuridade; e as gestantes trabalhadoras rurais tiveram menos partos prematuros de forma estatisticamente significativa quando comparadas às outras ocupações. Primiparidade e extremos de idade reprodutiva não foram significativos. Quanto aos RN, malformações e peso pequeno para a idade gestacional (PIG) também foram fatores de risco. Conclusões. Os principais fatores de risco maternos e fetais associados ao parto pré-termo na amostra foram DM, ITU, síndromes hipertensivas na gravidez, sífilis materna, gemelaridade, parto cesáreo, malformações fetais e PIG. (AU)

Introduction. Babies born before 37 weeks of gestation are considered premature and, in Brazil, their prevalence reaches approximately 10%. Prematurity can compromise the newborn's health and lead to socioeconomic repercussions. Therefore, it is essential to track pregnant women at risk through an adequate prenatal care, in order to remove them from these conditions or minimize their implications. Objective. To evaluate the main maternal and fetal risk factors associated with preterm birth in a reference hospital in Barbacena. Methods. A retrospective cross-sectional study, non-experimental made in Santa Casa de Misericórdia de Barbacena hospital. This study evaluated print medical records available of all births in Sistema Único de Saúde (SUS) in 2017. Some data were analyzed, such as: age, profession and maternal pathologies; examinations performed during pregnancy and information about the newborn. Results. The sample consisted of 1278 records of births, and there were 177 preterm births. It was checked that previous diabetes or gestational diabetes, urinary tract infections (UTI), pregnancy-induced hypertension, maternal syphilis, twinning and caesarean delivery were statistic relevant factors for prematurity; pregnant women who had a rural occupation had fewer premature deliveries in a statistically significant way than other occupations. First time pregnant women and those at extreme fertile age were not significant. About newborn data, malformations and small for gestational age (SGA) were risk factors for preterm birth. Conclusions. The main maternal and fetal risk factors associated with preterm birth on this study were diabetes, UTI, hypertension syndrome during pregnancy, maternal syphilis, twinning, caesarean delivery, malformations and SGA. (AU)

Leprosy nephropathy: a review of clinical and histopathological features.

Leprosy is a chronic disease caused by Mycobacterium leprae, highly incapacitating, and with systemic involvement in some cases. Renal involvement has been reported in all forms of the disease, and it is more frequent in multibacillary forms. The clinical presentation is variable and is determined by the host immunologic system reaction to the bacilli. During the course of the disease there are the so called reactional states, in which the immune system reacts against the bacilli, exacerbating the clinical manifestations. Different renal lesions have been described in leprosy, including acute and chronic glomerulonephritis, interstitial nephritis, secondary amyloidosis and pyelonephritis. The exact mechanism that leads to glomerulonephritis in leprosy is not completely understood. Leprosy treatment includes rifampicin, dapsone and clofazimine. Prednisone and non-steroidal anti-inflammatory drugs may be used to control acute immunological episodes.

The renal osteodystrophy pattern in Brazil and Uruguay: an overview.

BACKGROUND: The prevalence of the types of renal osteodystrophy (ROD) has changed in the last two decades. This study evaluates the prevalence and determining factors of the types of ROD in two countries in South America. METHODS: Symptomatic patients who underwent bone biopsies for diagnostic purposes (1985 through 2001) were included in the study. In Brazil, a total of 2340 patients were reviewed, 93.1% on hemodialysis (HD), and 6.9% on continuous ambulatory peritoneal dialysis (CAPD). In Uruguay, 167 patients on hemodialysis were included. Uncalcified bone samples were analyzed in order to diagnose the different types of ROD. RESULTS: Comparing the 1980s to the 1990s, the prevalence of Brazilian patients with hyperparathyroid bone disease (HP) increased from 32.3% to 44.0%, while Al overload decreased from 61.3% to 42.4%. A logistic regression analysis showed that the main factors associated with HP included female gender, age of less than 40 years, black patients, longer time on dialysis, and absence of Al overload. In Uruguay, HP also increased over time from 31.8% to 70.5% (P < 0.05), while Al overload decreased from 42% to 27% (P < 0.05). CONCLUSION: A better control of Al overload may lead to a change in histologic pattern, as evidenced by the increasing prevalence of HP.