Introducing the portable AttentionTrip: An engaging tool for measuring the networks of attention.

BACKGROUND: Measurement of the efficacy of the networks of attention is a frequent component of research in cognitive and clinical neuroscience. Developed in 2002, the Attention Network Test (ANT), has become the most widely used tool for this purpose. NEW METHOD: In 2017 a more engaging, game-like tool based on the ANT, called the AttentionTrip was described. The network scores from five studies which used AttentionTrip are shown to be robust. NEWER METHOD: That version of AttentionTrip required a steering wheel and desk-top computer. Here we describe a new, portable version of the AttentionTrip that is administered using a hand-held tablet (iPad) RESULTS: Three samples of participants (total = 44) completed the portable version of AttentionTrip. The network scores generated using the portable AttentionTrip were also robust. Effect sizes compare favourably with those generated by the ANT and the desktop version. CONCLUSIONS: The findings support the use of the portable AttentionTrip as an alternative to the ANT when user engagement is important, such as when participants are prone to boredom, and when repeated administrations are required.

One-year impact of COVID-19 pandemic on renal replacement therapy and kidney transplantation in a tertiary center in Southern Brazil.

INTRODUCTION: Patients on renal replacement therapy (RRT) and kidney transplant recipients (KTR) present multiple factors that may increase the risk of death from coronavirus disease 2019 (COVID-19). This study aimed to evaluate the incidence and impact of COVID-19 in RRT patients and KTRs. METHODS: Between March 2020 and February 2021, we monitored the RRT population of thirteen dialysis facilities that refer patients for transplantation to our center, a tertiary hospital in Southern Brazil. In the same period, we also monitor COVID-19 incidence and mortality in our KTR population. Demographical, clinical, and COVID-19-related information were analyzed. RESULTS: We evaluated 1545 patients in the dialysis centers, of which 267 (17.4%) were infected by COVID-19 and 53 (19.9%) died. Among 275 patients on the kidney transplant waiting list, 63 patients (22.9%) were infected and seven (11.1%) died. COVID-19 was the leading cause of death (29.2%) among patients on the waiting list. Within the population of 1360 KTR, 134 (9.85%) were diagnosed with COVID-19 and 20 (14.9%) died. The number of kidney transplants decreased by 56.7% compared with the same period in the previous twelve months. CONCLUSION: In the study period, patients on RRT and KTRs presented a high incidence of COVID-19 and high COVID-19-related lethality. The impact on the patients on the transplant waiting list was less pronounced. The lethality rate observed in both cohorts seems to be related to age, comorbidities, and disease severity.

One-year impact of COVID-19 pandemic on renal replacement therapy and kidney transplantation in a tertiary center in Southern Brazil / Impacto de um ano da Pandemia COVID 19 na terapia renal substitutiva e no transplante renal em centro terciário no Sul do Brasil

ABSTRACT Introduction: Patients on renal replacement therapy (RRT) and kidney transplant recipients (KTR) present multiple factors that may increase the risk of death from coronavirus disease 2019 (COVID-19). This study aimed to evaluate the incidence and impact of COVID-19 in RRT patients and KTRs. Methods: Between March 2020 and February 2021, we monitored the RRT population of thirteen dialysis facilities that refer patients for transplantation to our center, a tertiary hospital in Southern Brazil. In the same period, we also monitor COVID-19 incidence and mortality in our KTR population. Demographical, clinical, and COVID-19-related information were analyzed. Results: We evaluated 1545 patients in the dialysis centers, of which 267 (17.4%) were infected by COVID-19 and 53 (19.9%) died. Among 275 patients on the kidney transplant waiting list, 63 patients (22.9%) were infected and seven (11.1%) died. COVID-19 was the leading cause of death (29.2%) among patients on the waiting list. Within the population of 1360 KTR, 134 (9.85%) were diagnosed with COVID-19 and 20 (14.9%) died. The number of kidney transplants decreased by 56.7% compared with the same period in the previous twelve months. Conclusion: In the study period, patients on RRT and KTRs presented a high incidence of COVID-19 and high COVID-19-related lethality. The impact on the patients on the transplant waiting list was less pronounced. The lethality rate observed in both cohorts seems to be related to age, comorbidities, and disease severity.

Resumo Introdução: Pacientes em terapia renal substitutiva (TRS) e receptores de transplante renal (RTR) apresentam múltiplos fatores que podem aumentar o risco de óbito por doença do coronavírus 2019 (COVID-19). Este estudo teve como objetivo avaliar incidência e impacto da COVID-19 em pacientes em TRS e RTR. Métodos: Entre Março de 2020 e Fevereiro de 2021, monitoramos a população em TRS de treze unidades de diálise que encaminham pacientes para transplante ao nosso centro, um hospital terciário no Sul do Brasil. No mesmo período, também monitoramos a incidência e mortalidade da COVID-19 em nossa população de RTR. Foram analisadas informações demográficas, clínicas e relacionadas à COVID-19. Resultados: Avaliamos 1545 pacientes nos centros de diálise, dos quais 267 (17,4%) foram infectados pela COVID-19 e 53 (19,9%) foram a óbito. Entre 275 pacientes na lista de espera para transplante renal, 63 (22,9%) foram infectados e sete (11,1%) foram a óbito. COVID-19 foi a principal causa de óbito (29,2%) entre pacientes na lista de espera. Dentre a população de 1360 RTR, 134 (9,85%) foram diagnosticados com COVID-19 e 20 (14,9%) foram a óbito. O número de transplantes renais diminuiu em 56,7% comparado ao mesmo período nos doze meses anteriores. Conclusão: No período do estudo, pacientes em TRS e RTR apresentaram alta incidência de COVID-19 e alta letalidade relacionada à COVID-19. O impacto nos pacientes na lista de espera para transplante foi menos pronunciado. A taxa de letalidade observada em ambas as coortes parece estar relacionada à idade, comorbidades e gravidade da doença.

Effect of cholecalciferol supplementation on urine podocyte-associated messenger RNAs in patients with chronic kidney disease. / Efeito da suplementação de colecalciferol nos RNA mensageiros urinários associados ao podócito em pacientes com doença renal crônica.

INTRODUCTION: Vitamin D reduces albuminuria in patients with chronic kidney disease (CKD) but its effects on glomerular podocytes are not entirely understood. OBJECTIVE: To evaluate if cholecalciferol supplementation reduces the levels of podocyte-associated urine mRNAs in patients with CKD. METHODS: A total of 27 patients with stages 2 to 4 CKD and suboptimal serum vitamin D [25(OH)D] levels were treated with cholecalciferol for 6 months. Serum 25(OH)D level, estimated glomerular filtration rate (eGFR), proteinuria, and urine mRNA of nephrin, podocin, podocalyxin, transient receptor potential cation channel 6, vascular endothelial growth factor A, and transforming growth factor beta were assessed before and after intervention. RESULTS: eGFR declined at an average rate of -4.71 mL/min/1.73 m2 (p = 0.010 vs. baseline), being 28 ± 16 mL/min/1.73 m2 at six months. No changes in proteinuria or mineral and bone metabolism parameters were observed after cholecalciferol supplementation. Urinary podocyte-associated mRNAs did not change significantly after treatment. However, patients who achieved 25(OH)D level > 20 ng/mL at six months showed a trend of reduction of urinary nephrin and podocin mRNA levels; in patients with 25(OH)D that remained < 20 ng/mL there was a significant increase in urinary podocalyxin, and a trend of higher expression of urinary nephrin and podocin mRNA. CONCLUSION: Six months of cholecalciferol supplementation had no effect on urine podocyte-associated mRNA profile of patients with advanced CKD. The protective effect of vitamin D or its analogues on the glomerular podocyte should be investigated in early stages of CKD with a longer treatment period.

Gerador de alta frequência no tratamento de lesão por pressão em idosos / High frequency generator in the treatment of injury by pressure in elderly

Objetivo: investigar os efeitos no tratamento de Lesões Por Pressão (LPP) sobre o tamanho e tempo de cicatrização, com a utilização do gerador de alta frequência (AF), em idosos acometidos por doenças neurológicas. Método: estudo descritivo, exploratório, do tipo pesquisa de intervenção não farmacológica, realizado com três usuários, em uma Unidade de Reabilitação Física, com LPPs em estágio II e III, submetidos a tratamento com gerador de AF, duas vezes por semana. A cicatrização foi avaliada no início do estudo, após a oitava e a décima sexta sessões. Resultados: os três participantes eram idosos, sedentários e hipertensos. Dois sofreram Acidente Vascular Encefálico (AVE) e um, traumatismo raquimedular. Nos com AVE, ocorreu cicatrização completa das LPPs e no outro, redução da área da LPP de 64,5%. Conclusão: o uso do gerador portátil de AF foi efetivo no tratamento de LPPs nos idosos participantes desta pesquisa.

Efeito da suplementação de colecalciferol nos RNA mensageiros urinários associados ao podócito em pacientes com doença renal crônica / Effect of cholecalciferol supplementation on urine podocyte-associated messenger RNAs in patients with chronic kidney disease

RESUMO Introdução: A vitamina D reduz a albuminúria em pacientes com doença renal crônica (DRC), mas o seu efeito sobre os podócitos glomerulares ainda não é claro. Objetivos: Avaliar se a suplementação de colecalciferol reduz os RNAm urinários associados ao podócito em pacientes com DRC. Métodos: Vinte e sete pacientes com DRC estágios 2 a 4 e níveis sub-ótimos de 25-hidroxi-vitamina D [25(OH)D] sérica foram tratados com colecalciferol por seis meses. Foram medidos antes e após a intervenção a 25(OH)D sérica e o RNAm urinário da nefrina, podocina, podocalixina, receptor transitório potencial do canal de cátions, subfamília C, membro 6 (TRPC6), fator A de crescimento do endotélio vascular (VEGF-A) e fator de crescimento transformador beta (TGF-β1). Resultados: A TFGe reduziu em média 4,71 mL/min/1,73 m2 (p = 0,010 vs. basal), sendo 28 ± 16 mL/min/1,73 m2 aos seis meses. Os RNAm dos produtos do podócito na urina não tiveram alteração significativa após o tratamento. Entretanto, pacientes que atingiram níveis de 25(OH)D ≥ 20 ng/mL aos 6 meses tiveram tendência de redução do RNAm da nefrina e da podocina na urina; nos pacientes em que a 25(OH)D permaneceu < 20 ng/mL houve aumento significativo da podocalixina, e tendência de maior expressão do RNAm da nefrina e da podocina. Conclusão: A reposição de colecalciferol por seis meses não teve efeito sobre os RNAm associados ao podócito nestes pacientes com DRC avançada. O efeito protetor da vitamina D ou seus análogos sobre o podócito glomerular deve ser investigado em estágios mais precoces da DRC e com maior tempo de tratamento.

ABSTRACT Introduction: Vitamin D reduces albuminuria in patients with chronic kidney disease (CKD) but its effects on glomerular podocytes are not entirely understood. Objective: To evaluate if cholecalciferol supplementation reduces the levels of podocyte-associated urine mRNAs in patients with CKD. Methods: A total of 27 patients with stages 2 to 4 CKD and suboptimal serum vitamin D [25(OH)D] levels were treated with cholecalciferol for 6 months. Serum 25(OH)D level, estimated glomerular filtration rate (eGFR), proteinuria, and urine mRNA of nephrin, podocin, podocalyxin, transient receptor potential cation channel 6, vascular endothelial growth factor A, and transforming growth factor beta were assessed before and after intervention. Results: eGFR declined at an average rate of -4.71 mL/min/1.73 m2 (p = 0.010 vs. baseline), being 28 ± 16 mL/min/1.73 m2 at six months. No changes in proteinuria or mineral and bone metabolism parameters were observed after cholecalciferol supplementation. Urinary podocyte-associated mRNAs did not change significantly after treatment. However, patients who achieved 25(OH)D level > 20 ng/mL at six months showed a trend of reduction of urinary nephrin and podocin mRNA levels; in patients with 25(OH)D that remained < 20 ng/mL there was a significant increase in urinary podocalyxin, and a trend of higher expression of urinary nephrin and podocin mRNA. Conclusion: Six months of cholecalciferol supplementation had no effect on urine podocyte-associated mRNA profile of patients with advanced CKD. The protective effect of vitamin D or its analogues on the glomerular podocyte should be investigated in early stages of CKD with a longer treatment period.

Arterite de Takayasu com estenose de artéria renal diagnosticada em paciente com 65 anos de idade / Takayasu's arteritis with renal artery stenosis diagnosed in a patient with 65 years old

Resumo Arterite de Takayasu é uma doença rara, de etiologia desconhecida, que acomete a aorta e seus principais ramos. É uma patologia, geograficamente mais comum no Sudeste Asiático, que acomete principalmente mulheres em idade reprodutiva. A apresentação clínica é inespecífica, com sinais e sintomas que variam de acordo com o seguimento arterial acometido. O vaso mais comumente afetado é a artéria subclávia, enquanto a estenose de artéria renal é relativamente incomum. Comprometimento cardíaco e associação com outras patologias também podem estar presentes. Apresentamos neste relato o caso de uma paciente idosa com diagnóstico tardio de arterite de Takayasu e várias comorbidades ou complicações relacionadas.

Abstract Takayasu arteritis is a rare disease of unknown etiology that affects the aorta and its main branches. It is a condition, geographically more common in Southeast Asia, which mainly affects women of reproductive age. The clinical presentation is nonspecific, with signs and symptoms that vary according to the affected arterial segment. The most commonly affected vessel is the subclavian artery, while renal artery stenosis is relatively uncommon. Cardiac involvement and association with other diseases may also be present. We present in this report the case of an elderly patient with late diagnosis of Takayasu's arteritis and various comorbidities or related complications.

Comprometimento renal na leptospirose: relato de caso da doença de Weil / Renal impairment in leptospirosis: a case report of Weil’s disease

A leptospirose é uma doença de distribuição mundial e epidêmica de determinadas regiões tropicais. A apresentação clínica é inespecífica e pode ser autolimitada. Na sua forma mais severa, caracterizada por icterícia, injúria renal aguda e diátese hemorrágica, é chamada de doença de Weil. Neste relato descrevemos o caso de um paciente com oligúria, azotemia franca e injúria renal aguda. O tratamento baseou-se em hemodiálise diária e tratamento antibiótico empírico, com recuperação total da função renal. O diagnóstico foi realizado através de teste sorológico e confirmado que se tratava de um caso de leptospirose associado a comprometimento renal.

Leptospirosis is a worldwide disease and epidemic in certain tropical regions. The clinical presentation is nonspecifi c and can be self-limited. In its most severe form, characterized by jaundice, acute kidney injury and bleeding diathesis, it is called Weil’s disease. We report the case of a patient with oliguria, steady azotemia, and acute kidney injury. The treatment was based on daily hemodialysis and empirical antibiotic therapy, with full recovery of renal function. The diagnosis was made by serologic testing and confi rmed that it was a case of leptospirosis associated with renal impairment.

Síndrome de Nutcracker: relato de caso / Nutcracker of syndrome: case report

JUSTIFICATIVA E OBJETIVOS: A síndrome do pinçamento aorto-mesentérico da veia renal esquerda - síndrome de Nutcracker - acarreta hipertensão venosa renal e consequentemente o aparecimento de sintomas como dor no baixo ventre, varicocele e hematúria. A dificuldade no diagnóstico nestes casos pode atrasar o tratamento, submeter o paciente a procedimentos desnecessários e resultar em complicações relacionadas à compressão venosa. O objetivo deste estudo foi relatar o caso de um paciente atendido no ambulatório de Nefrologia do Hospital de Clínicas de Porto Alegre. RELATO DO CASO: Paciente do sexo masculino, 22 anos, branco, com queixa de dor no baixo ventre, hematúria e obstrução urinária; com investigação básica etiológica inconclusiva. Investigações futuras, após aproximadamente dois anos de sintomas, revelaram a síndrome de Nutcracker. O manuseio terapêutico inclui tratamento conservador, cirurgia aberta, endovascular ou cauterização química. CONCLUSÃO: A síndrome de Nutcracker é rara, sendo que o conhecimento desta condição é fundamental para suspeita clínica acurada, diagnóstico precoce e manuseio terapêutico adequado.

BACKGROUND AND OBJECTIVES: Mesoaortic compression of the left renal vein, known as Nutcracker syndrome, causes renal venous hypertension and, consequently, the appearance of symptoms such as lower abdominal pain, varicocele and hematuria. The difficulty in the diagnosis may delay treatment, subject the patient to unnecessary procedures and complications of the venous compression. We report a case of a patient with hematuria treated at the Division of Nephrology in the Hospital de Clinicas de Porto Alegre - Universidade Federal do Rio Grande do Sul (Brazil). CASE REPORT: Male patient, 22 years of age, Caucasian, with complaints of pain in the lower abdominal, macroscopic hematuria and urinary obstruction, with basic investigation was inconclusive. Further investigation, after two years, revealed a nutcracker syndrome. Management can be conservative, open surgery, stent placement or intra-pelvic chemical cauterization. CONCLUSION: The Nutcracker syndrome is rare and the knowledge of this condition is the cornerstone to accurate diagnosis and proper management.

Diálise peritoneal (DP) como tratamento da insuficiência cardíaca congestiva (ICC) em pacientes com doença renal crônica estágio IV / Peritoneal dialysis for treating congestive heart failure in patients with stage IV chronic kidney disease

A insuficiência Cardíaca Congestiva (ICC) é uma patologia com incidência crescente e que representa uma codição de grande impacto na saúde pública, com alta morbidade e mortalidade. O excesso de volume é uma complicação prevalente, presente em 80% dos pacientes atendidos com o diagnóstico de ICC. Estaratégias farmacológicas e não farmacológicas no manejo terapêutico da ICC visam ao melhor manejo do volume e à redução no uso de diuréticos. A ultrafiltração extracorpórea tem evidenciado melhor controle de peso, redução nos dias de hospitalização e re-hospitalização dos pacientes com ICC. Neste artigo, relatamos dois casos atendidos no Hospital de Clínicas de Porto Alegre, relativos a pacientes com diagnóstico de ICC tratados com diálise peritoneal.

Congestive heart failure (CHF) is a disease with increasing incidence and codição representing a great impact on public health with high morbidity and mortality. Excess volume is a prevalent complication in 80% of patients treated with the diagnosis of CHF. Estaratégias pharmacological and nonpharmacological treatment of CHF in the aim to better manage the volume and reduce the use of diuretics. Extracorporeal ultrafiltration has shown better weight control, reduction in days of hospitalization and rehospitalization in patients with CHF. We report two cases treated at the Hospital de Clinicas de Porto Alegre, relative to patients with CHF treated with peritoneal dialysis.