Ex vivo C5b-9 Deposition Test to Monitor Complement Activity in Clinical and Subclinical Atypical Hemolytic Uremic Syndrome and in Transplantation-Associated Thrombotic Microangiopathy.

Introduction: Atypical hemolytic uremic syndrome (aHUS) is a complement system (CS)-mediated ultrarare disease that manifests as thrombotic microangiopathy (TMA) with preferential small kidney vessels involvement. Transient CS activation is also observed in secondary TMA or in patients at risk of developing aHUS. There is no gold standard test to monitor disease activity; however, the ex vivo C5b-9 deposition test seems to be a good approach. Methods: We assessed the C5b-9 deposition induced by serum samples of patients with aHUS (n = 8) and with TMA associated with kidney (n = 2), lung (n = 1) or hematopoietic stem cell (HSC) transplantation (HSCT, n = 2) during the acute phase of the disease or in remission. As control for transplant-associated TMA (TA-TMA), we analyzed samples of clinically stable kidney and HSC-transplanted patients without signs of TMA. In addition, we studied 1 child with genetic risk of aHUS during an acute infection. Results: In the acute disease phase or in patients with disease activity despite C5 blockade, a significant increase of C5b-9 deposition was detected. In all patients with clinical response to C5 blockade but one, levels of C5b-9 deposition were within the normal range. Finally, we detected increased C5b-9 deposition levels in an asymptomatic child with genetic risk of aHUS when a concomitant otitis episode was ongoing. Conclusion: The ex vivo C5b-9 deposition test is an auspicious tool to monitor CS activity in aHUS and TA-TMA. In addition, we demonstrate that the test may be useful to detect subclinical increase of CS activity, which expands the spectrum of patients that would benefit from a better CS activity assessment.

Women's health access in the context of forced migration in portugal: vulnerabilities and adaptation / Acesso à saúde de mulheres em contexto de migração forçada em Portugal: vulnerabilidades e adaptação / Acceso a la salud de las mujeres en el contexto de la migración forzada en Portugal: vulnerabilidades y adaptación

This article presents, the vulnerabilities related with regarding access to health services facedby refugee women, of a research project conducted in Portugal between 2020 and 2022 as part of the Masters in Intercultural Relations program at Universidade Aberta. Objective: The overall goal was to gain a better understanding of the psychosocial reality of women who arrived in Portugal as a result of forced migration, focusing on the main difficulties of the migratory and adaptation journey -highlighting vulnerabilities related to health and access to health services at the present article -and the protective factors that facilitated their processes of resilience, adaptation, and social integration. Methodology:The meaningsof the protagonists' experiences were disclosed through nine semi-structured and in-depth interviews with a woman from Iraq, seven from Syria, and one from Libya, which were conducted separately, recorded and transcribed. Following the transcription and translation of the interviews, the content analysis began with the coding and categorization of the obtained data. Results:The investigationuncovered a number of vulnerabilities triggered by the migratory experience and gender belonging, such as prejudice, social isolation, and cultural shock (mostly linked to religion and clothing), which validated the intersectional analysis. The findings highlight a number of obstacles in the host nation, including access to health care, the quality of institutional interactions, and knowledge of the Portuguese language.Conclusions:The current investigation led to theconclusion that there are flawsin Portugal in terms of ensuring full access to health care for forced migrant women, highlighting as major obstacles: a lack of information in languagesother than Portuguese, a lack of offers tolearn and masterthe Portugueselanguage, a lack of knowledge about how health institutions work, and a lack of sensitivity and intercultural skills inhealthcareservices (AU).

Este artigo apresenta as vulnerabilidades relacionadas no acesso aos serviços de saúde sentidas por mulheres refugiadas, de um projeto de investigação realizado em Portugal entre 2020 e 2022 no âmbito do Mestrado em Relações Interculturais da Universidade Aberta. Objetivo:O objetivo geral foi conhecer melhor a realidade psicossocial das mulheres que chegaram a Portugal como resultado da migração forçada, focando as principais dificuldades do percurso migratório e de adaptação,destacando as vulnerabilidades relacionadas com a saúde e acesso aos serviços de saúde, além dos fatores de proteção que facilitaram seus processos de resiliência, adaptação e integração social. Metodologia:Os significados das vivências das protagonistasforam relevados por meio de nove entrevistas semiestruturadas e em profundidade, realizadas individualmente, gravadas e transcritas, com umamulher do Iraque, seteda Síria e umada Líbia. Após transcrição e tradução das entrevistas, a análise de conteúdopartiu da codificação e categorização da informação recolhida.Resultados:A investigação desvelou uma série de vulnerabilidadescausadas pela experiência migratória epertença de gênero,como a discriminação sentida sob a forma de preconceitos, o isolamento social e o choque cultural (sobretudo relacionado com a religião e o vestuário utilizado), o que justificou a análise intersecional. Os resultados revelam umconjuntode desafiosno país de acolhimento, como o acesso à saúde, a qualidade das relações institucionais e o domínio da língua portuguesa.Conclusões: A presente investigação permitiu concluir que existem algumas carências em Portugal no que diz respeito à garantia do pleno acesso aos cuidados de saúde sentidas pelasmulheres migrantes forçadas, destacando-se como principais obstáculos: a falta de informação numa língua que não o português, a falta de domínio da língua portuguesa, o desconhecimento sobre o funcionamento das instituições de saúde e falta de sensibilidade e de competências interculturais nos cuidados de saúde (AU).

Este artículo presenta, las vulnerabilidades relacionadasconen el acceso a los servicios de salud que sienten las mujeres refugiadas, de un proyectorealizado en Portugal entre 2020 y 2022 en el ámbito del Máster en Relaciones Interculturales de la Universidade Aberta.Objetivo: El objetivo fue comprender la realidad psicosocial de las mujeres que llegaron a Portugal como resultado de la migración forzada, centrándose en las principales dificultades del viaje de migración y adaptación, destacandovulnerabilidades relacionadas con la salud y el acceso a los servicios de salud, además de los factores de protección que facilitaron sus procesos de resiliencia, adaptación e integración social. Metodología: Los significados de las experiencias fueron revelados através de nueve entrevistas semiestructuradas y en profundidad, realizadas individualmente, grabadas y transcritas, con una mujer de Irak, siete de Siria y una de Libia. Luego de la transcripción y traducción, se inició el análisis de contenido con la codificación y categorización de la información.Resultados: La investigación reveló vulnerabilidades provocadas por la experiencia migratoria y la pertenencia de género,como la discriminación sentida en forma de prejuicio, el aislamiento social y el choque cultural (principalmente relacionado con la religión y la vestimenta), que justificaron el análisis interseccional.Los resultados revelan desafíos en Portugal,como el acceso a la salud, la calidad de las relaciones institucionales y el dominio de la lengua portuguesa.Conclusiones: La presente investigación llevó a la conclusión de que existen fallas en Portugal en cuanto a garantizar el pleno acceso a la atención de la salud de las refugiadas,destacándose: falta de información en un idioma diferenteal portugués, falta de dominio de la lengua portuguesa, falta de conocimiento sobre el funcionamiento de las instituciones de salud y falta de sensibilidad y habilidades interculturales en la atención de la salud (AU).

[Characterization of hospitalized patients with acute kidney injury associated with COVID-19 in Spain: Renal replacement therapy and mortality. FRA-COVID SEN Registry Data]. / Caracterización de la población con fracaso renal agudo durante la hospitalización por COVID-19 en España: tratamiento renal sustitutivo y mortalidad. Datos del Registro FRA-COVID SEN.

Background and objectives: Acute kidney injury (AKI) is common among hospitalized patients with COVID-19 and associated with worse prognosis. The Spanish Society of Nephrology created the AKI-COVID Registry to characterize the population admitted for COVID-19 that developed AKI in Spanish hospitals. The need of renal replacement therapy (RRT) therapeutic modalities, and mortality in these patients were assessed. Material and method: In a retrospective study, we analyzed data from the AKI-COVID Registry, which included patients hospitalized in 30 Spanish hospitals from May 2020 to November 2021. Clinical and demographic variables, factors related to the severity of COVID-19 and AKI, and survival data were recorded. A multivariate regression analysis was performed to study factors related to RRT and mortality. Results: Data from 730 patients were recorded. A total of 71.9% were men, with a mean age of 70 years (60-78), 70.1% were hypertensive, 32.9% diabetic, 33.3% with cardiovascular disease and 23.9% had some degree of chronic kidney disease (CKD). Pneumonia was diagnosed in 94.6%, requiring ventilatory support in 54.2% and admission to the ICU in 44.1% of cases.The median time from the onset of COVID-19 symptoms to the appearance of AKI (37.1% KDIGO I, 18.3% KDIGO II, 44.6% KDIGO III) was 6 days (4-10). A total of 235 (33.9%) patients required RRT: 155 patients with continuous renal replacement therapy, 89 alternate-day dialysis, 36 daily dialysis, 24 extended hemodialysis and 17 patients with hemodiafiltration. Smoking habit (OR 3.41), ventilatory support (OR 20.2), maximum creatinine value (OR 2.41) and time to AKI onset (OR 1.13) were predictors of the need for RRT; age was a protective factor (0.95). The group without RRT was characterized by older age, less severe AKI, shorter kidney injury onset and recovery time (p < 0.05). 38.6% of patients died during hospitalization; serious AKI and RRT were more frequent in the death group. In the multivariate analysis, age (OR 1.03), previous chronic kidney disease (OR 2.21), development of pneumonia (OR 2.89), ventilatory support (OR 3.34) and RRT (OR 2.28) were predictors of mortality while chronic treatment with ARBs was identified as a protective factor (OR 0.55). Conclusions: Patients with AKI during hospitalization for COVID-19 had a high mean age, comorbidities and severe infection. We defined two different clinical patterns: an AKI of early onset, in older patients that resolves in a few days without the need for RRT; and another more severe pattern, with greater need for RRT, and late onset, which was related to greater severity of the infectious disease. The severity of the infection, age and the presence of CKD prior to admission were identified as risk factors for mortality in these patients. In addition chronic treatment with ARBs was identified as a protective factor for mortality.

Drug Repurposing in Oncology: A Systematic Review of Randomized Controlled Clinical Trials.

Quality pharmacological treatment can improve survival in many types of cancer. Drug repurposing offers advantages in comparison with traditional drug development procedures, reducing time and risk. This systematic review identified the most recent randomized controlled clinical trials that focus on drug repurposing in oncology. We found that only a few clinical trials were placebo-controlled or standard-of-care-alone-controlled. Metformin has been studied for potential use in various types of cancer, including prostate, lung, and pancreatic cancer. Other studies assessed the possible use of the antiparasitic agent mebendazole in colorectal cancer and of propranolol in multiple myeloma or, when combined with etodolac, in breast cancer. We were able to identify trials that study the potential use of known antineoplastics in other non-oncological conditions, such as imatinib for severe coronavirus disease in 2019 or a study protocol aiming to assess the possible repurposing of leuprolide for Alzheimer's disease. Major limitations of these clinical trials were the small sample size, the high clinical heterogeneity of the participants regarding the stage of the neoplastic disease, and the lack of accounting for multimorbidity and other baseline clinical characteristics. Drug repurposing possibilities in oncology must be carefully examined with well-designed trials, considering factors that could influence prognosis.

Life Habits of Healthcare Professionals during the Third Wave of COVID-19: A Cross-Sectional Study in a Spanish Hospital.

(1) Background: To describe sleep quality, eating behaviour and alcohol, tobacco and illicit drug use among healthcare staff in a Spanish public hospital. (2) Methods: Cross-sectional descriptive study examining sleep quality (Pittsburg Sleep Quality Index), eating behaviour (Three Factor Eating Questionnaire (R18)), tobacco and drug use (ESTUDES questionnaire) and alcohol use (Cut down, Annoyed, Guilty, Eye-opener). (3) Results: 178 people, of whom 87.1% (155) were women, with an average age of 41.59 ± 10.9 years. A total of 59.6% of the healthcare workers had sleep problems, to a greater or lesser degree. The average daily consumption was 10.56 ± 6.74 cigarettes. The most commonly used drugs included cannabis, occasionally used by 88.37%, cocaine (4.75%), ecstasy (4.65%) and amphetamines (2.33%). A total of 22.73% of participants had increased their drug use, and 22.73% had increased their consumption during the pandemic, with beer and wine accounting for 87.2% of drinks consumed during this period. (4) Conclusions: In addition to the psychological and emotional impact already demonstrated, the COVID-19 crisis has repercussions on sleep quality, eating behaviour and alcohol, tobacco and drug consumption. Psychological disturbances have repercussions on physical and functional aspects of healthcare workers. It is feasible that these alterations are due to stress, and it is necessary to act through treatment and prevention as well as promote healthy habits.

Long-term follow-up of HCV-infected patients with end-stage chronic kidney disease after sustained virological response with direct-acting antiviral therapy.

BACKGROUND AND AIM: Patients with chronic kidney disease (CKD) and hepatitis C infection can be safely and effectively treated with direct-acting antivirals (DAAs). However, there is scarce data on the long-term impact of hepatitis C cure on CKD. The aim of this study was to assess the long-term mortality, morbidity and hepatic/renal function outcomes in a cohort of HCV-infected individuals with CKD treated with DAAs. METHODS: 135 HCV patients with CKD stage 3b-5 who received ombitasvir/paritaprevir/ritonavir±dasabuvir in a multicenter study were evaluated for long-term hepatic and renal outcomes and their associated mortality. RESULTS: 125 patients achieved SVR and 66 were included. Prior to SVR, 53 were under renal replacement therapy (RRT) and 25 (37.8%) had liver cirrhosis. After a follow-up of 4.5 years, 25 (38%) required kidney transplantation but none combined liver-kidney. No changes in renal function were observed among the 51 patients who did not receive renal transplant although eGFR values improved in those with baseline CKD stage 3b-4. Three (5.6%) subjects were weaned from RRT. Eighteen (27.3%) patients died, mostly from cardiovascular events; 2 developed liver decompensation and 1 hepatocellular carcinoma. No HCV reinfection was observed. CONCLUSIONS: Long-term mortality remained high among end-stage CKD patients despite HCV cure. Overall, no improvement in renal function was observed and a high proportion of patients required kidney transplantation. However, in CKD stage 3b-4 HCV cure may play a positive role in renal function.

Recurrence of immune complex and complement-mediated membranoproliferative glomerulonephritis in kidney transplantation.

INTRODUCTION: Membranoproliferative glomerulonephritis (MPGN) represents a histologic pattern of glomerular injury that may be due to several aetiologies. Few studies have comprehensively analysed the recurrence of MPGN according to the current classification system. METHODS: We collected a multicentre, retrospective cohort of 220 kidney graft recipients with biopsy-proven native kidney disease due to MPGN between 1981 and 2021 in 11 hospitals. Demographic, clinical and histologic parameters of prognostic interest were collected. The main outcomes were time to kidney failure, time to recurrence of MPGN and disease remission after recurrence. RESULTS: The study group included 34 complement-mediated and 186 immune complex-mediated MPGN. A total of 81 patients (37%) reached kidney failure in a median follow-up of 79 months. The main predictors of this event were the development of rejection episodes and disease recurrence. In all, 54 patients (25%) had a disease recurrence in a median of 16 months after kidney transplantation. The incidence of recurrence was higher in patients with dysproteinaemia (67%) and complement-mediated MPGN (62%). In the multivariable model, complement-mediated MPGN emerged as a predictor of recurrence. A total of 33 patients reached kidney failure after recurrence. The main determinants of no remission were early time to recurrence (<15 months), estimated glomerular filtration rate <30 mL/min/1.73 m2 and serum albumin <3.5 g/dL at the time of recurrence. CONCLUSIONS: One-fourth of the patients with native kidney disease due to MPGN developed clinical recurrence in the allograft, especially in cases with complement-mediated disease or in those associated with dysproteinaemia. The kidney outcomes of disease recurrence with currently available therapies are heterogeneous and thus more effective and individualized therapies are needed.

Ouçam Mirtes, mãe de Miguel: precarização e resistência no emprego doméstico durante a pandemia / Listen to Mirtes, Miguel's mother: precarization and resistance in domestic employment during the pandemic

Este artigo é fruto de pesquisa de iniciação científica da PUC Minas sobre trabalho doméstico e pandemia. Em junho de 2020, morreu Miguel, de cinco anos, filho da empregada doméstica Mirtes Renata, que trabalhava durante a pandemia de covid-19. Miguel caiu do edifício enquanto estava sob os cuidados da patroa de Mirtes. A partir do estudo de caso do "caso Miguel", aliado à bibliografia sobre trabalhadoras domésticas e relações étnico-raciais, buscou-se: (1) observar as relações entre raça, classe e gênero e a naturalização da precarização deste trabalho; (2) analisar o caso Miguel em sua relação com a profissão e movimentos de resistência na luta por direitos, reconhecimento e justiça. Como resultados, observa-se a potência das mobilizações de coalizão entre movimentos sociais e redes de solidariedade para a identificação do caráter estrutural do fenômeno, atuando em forma ampla pela justiça e transformação dessas estruturas. Conclui-se que a pandemia de covid-19 evidenciou a linha direta entre precarização da profissão e a desvalorização das vidas das trabalhadoras domésticas, sendo a morte de Miguel uma consequência da violência e precarização histórica do lugar da mulher negra

This article is the result of PUC Minas' scientific initiation research on domestic work and pandemic. In June 2020, five-year-old Miguel, son of the domestic worker Mirtes Renata, who was working during the COVID-19 pandemic, died. Miguel fell of the building while in the care of Mirtes' employer. From the case study of "Caso Miguel," combined with the bibliography on domestic workers and ethnic racial relations, we sought to: (1) observe the relationships between race, class, and gender and the naturalization of the precariousness of this work; (2) analyse Miguel's case related with the profession and with resistance movements in the fight for rights, recognition, and justice. As results the potential of coalition mobilizations between social movements and solidarity networks to identify the structural character of the phenomenon, acting broadly for justice and transformation of these structures, is observed. In conclusion, the COVID-19 pandemic evidenced the direct line between the profession precarization and the devaluation of the domestic workers lives, with Miguel's death a consequence of violence and historical precarization of black women place

The Presence of ANCA in IgA Crescentic Nephropathy Does Not Lead to Worse Prognosis with Intensive Rescue Treatment.

BACKGROUND: Immunoglobulin A nephropathy (IgAN) is the most common glomerulonephritis worldwide. The concomitant presence of both crescentic proliferation and anti-neutrophil cytoplasmic autoantibodies (ANCA) in this pathology represents a rare coincidence. However, it is not clear to what extent the presence of ANCA (IgA or IgG) in these patients could have any clinical significance. The aim of the current work is to describe the presence of ANCA (IgA or IgG) in patients with IgAN and crescentic proliferation and its possible clinical implications. METHODS: We retrospectively recruited all patients in our center with a histological diagnosis of IgAN with crescentic proliferation between January 2013 and December 2020. The main demographic and clinicopathologic data, fundamental histological characteristics, as well as the treatments implemented and main kidney outcomes, were collected and analyzed at a 6 and 12-month follow-up. RESULTS: Between January 2013 and December 2020, a total of 17 adults were diagnosed with concomitant crescentic proliferation through a kidney biopsy of IgAN. Five (29.4%) patients showed ANCA, three (60%) showed IgA-ANCA and two (40%) showed IgG-ANCA. All ANCA-positive patients had some degree of crescentic proliferation. At diagnosis, the mean age of patients was 48 years old (range: 27-75). Nine of them were women (52%) and the most common clinical presentation was hypertension (71%). At the time of biopsy, the mean serum creatinine and proteinuria were 2.2 mg/dL (DS 1.42) and 3.5 g/mgCr (DS 1.22), respectively, with no statistical differences between ANCA-positive and -negative patients. Histological analyses showed that 11 out of the 12 (91%) ANCA-negative IgAN patients displayed less than 25% cellular crescents, whereas 100% of ANCA-positive IgAN patients displayed more than 25% cellular crescents (p = 0.04). Notably, five (30%) patients displayed fibrinoid necrosis, with four of them (80%) being IgAN-ANCA-positive (p = 0.01). Only one ANCA-negative patient needed renal replacement therapy (RRT) upon admission (5%). The mean serum creatinine and proteinuria were 1.94 mg/dL (DS 1.71) and 1.45 g/gCr (DS 1.78), respectively, within 6 months of immunosuppressive therapy. At 12-month follow-up, the mean creatinine was 1.57 mg/dL (DS 1). Four (23.5%) patients needed RRT at the end of the follow-up and four (23.5%) patients died. CONCLUSIONS: Probably due to the limited number of IgAN-ANCA-positive and IgAN-ANCA-negative patients, no significant differences were found between the clinical and laboratory characteristics. IgAN-ANCA-negative patients seemed to display less extracapillary proliferation than IgAN-ANCA-positive patients, who tended to show significantly higher fibrinoid necrosis. There were no differences regarding renal prognosis and patient survival after aggressive immunosuppressive therapy within 6 and 12 months when comparing the two samples.

Uso de jogos ativos na reabilitação de crianças e adolescentes: Uma revisão da literatura / Use of active videogames on rehabilitation of children and adolescents: a literature review / Uso de juegos activos en la rehabilitación de niños y adolescentes: revisión de la literatura

Introdução: O Transtorno do Desenvolvimento da Coordenação (TDC) tem prevalência de 5% a 6% nas crianças em idade escolar de cinco a onze anos. No Brasil, o TDC ainda é pouco reconhecido e as crianças, geralmente, recebem pouca ou nenhuma assistência. O transtorno pode persistir na adolescência e idade adulta. Tecnologias emergentes, como realidade virtual e videogames, têm sido o foco de pesquisas recentes de intervenção. Objetivos: Revisar a literatura para identificar estudos que abordam o uso de jogos ativos com crianças e adolescentes com transtorno do desenvolvimento da coordenação. Método: Revisão de escopo, cuja busca foi realizada entre os meses de maio e julho de 2021, na base de dados PubMed, com recorte de 10 anos de publicação, em inglês, português e espanhol, descritores "motor skills disorder", "virtual reality" e "transtorno do desenvolvimento da coordenação" nas três revistas brasileiras de Terapia Ocupacional. Foram excluídos editoriais e estudos com crianças e adolescentes com autismo associado. Resultados: Foram encontrados 16 artigos. Embora a literatura ainda seja escassa neste sentido, os estudos relataram ganhos significativos no desempenho motor de crianças com TDC. Foram identificadas algumas dificuldades em apontar e esclarecer sobre o jogo, instrumento ou mecanismo responsável pelas mudanças no desempenho. Conclusão: A utilização de protocolos sistematizados pode levar ao desenvolvimento de novos estudos para avaliar a eficácia dessas intervenções, bem como a sustentabilidade das melhorias obtidas a longo prazo.

Introduction. Developmental Coordination Disorder (DCD) has a prevalence of 5 to 6% in school-aged children from five to eleven years old. In Brazil, TDC is still poorly recognized, and children generally receive little or no assistance. The disorder can persist into adolescence and adulthood. Emerging technologies such as virtual reality and video games have been the focus of recent intervention research. Objectives. To perform a literature review to identify studies which used active games with children and adolescents with DCD. Method. Scoping review, between May and July 2021, at PubMed database, within 10 years of publication in English, Portuguese and Spanish, terms "motor skills disorder", "virtual reality", and "developmental coordination disorder" in the three Brazilian Occupational Therapy journals. Editorials and studies with children and adolescents with associated autism were excluded. Results. 16 articles were found. Although the literature is still scarce, studies have reported significant gains in the motor performance of children with DCD. Some difficulties were identified in pointing out and clarifying about the game, instrument or mechanism responsible for changes in performance. Conclusion. The use of systematized protocols can lead to the development of new studies to assess the effectiveness of these interventions as well as the sustainability of the improvements obtained in the long term.

Introducción. El trastorno del desarrollo de la coordinación (DCD) tiene una prevalencia del 5 al 6% en niños en edad escolar de cinco a once años. En Brasil, el DCD todavía es poco reconocido y los niños generalmente reciben poca o ninguna asistencia. El trastorno puede persistir hasta la adolescencia y la edad adulta. Las tecnologías emergentes, como la realidad virtual y los videojuegos, han sido el foco de investigaciones recientes sobre intervenciones. Metas. Revisar la literatura para identificar estudios que aborden el uso de juegos activos con niños y adolescentes con trastorno del desarrollo de la coordinación . Método. Revisión del alcance, cuya búsqueda se realizó entre mayo y julio de 2021, en la base de datos PubMed, con 10 años de publicación en inglés, portugués y español, descriptores "trastorno de las habilidades motoras", "realidad virtual" y "trastorno del desarrollo de la coordinación". en las tres revistas brasileñas de Terapia Ocupacional. Se excluyeron las editoriales y los estudios con niños y adolescentes con autismo asociado. Resultados. Se encontraron 16 artículos. Aunque la literatura todavía es escasa al respecto, los estudios han reportado ganancias significativas en el desempeño motor de los niños con DCD. Se identificaron algunas dificultades para señalar y aclarar sobre el juego, instrumento o mecanismo responsable de los cambios en el rendimiento. Conclusión. El uso de protocolos sistematizados puede conducir al desarrollo de nuevos estudios para evaluar la efectividad de estas intervenciones así como la sostenibilidad de las mejoras obtenidas en el largo plazo.

COVID-19 infection and renal injury: where is the place for acute interstitial nephritis disease?

Novel coronavirus disease infection (coronavirus disease 2019, COVID-19) was declared a global pandemic in March 2020 and since then has become a major public health problem. The prevalence of COVID-19 infection and acute kidney injury (AKI) is variable depending on several factors such as race/ethnicity and severity of illness. The pathophysiology of renal involvement in COVID-19 infection is not entirely clear, but it could be in part explained by the viral tropism in the kidney parenchyma. AKI in COVID-19 infection can be either by direct invasion of the virus or as a consequence of immunologic response. Diverse studies have focused on the effect of COVID-19 on glomerulonephritis (GN) patients or the 'novo' GN; however, the effect of COVID-19 in acute tubulointerstitial nephritis (ATIN) has been scarcely studied. In this article, we present five cases with different spectrums of COVID-19 infection and ATIN that may suggest that recent diagnosis of ATIN is accompanied by a worse clinical prognosis in comparison with long-term diagnosed ATIN.

Podocytopathy in patients with monoclonal gammopathy: three patients and literature review.

BACKGROUND: Renal manifestations of monoclonal gammopathies are of increasing interest among nephrologists. Typical manifestations include light chain cast nephropathy, amyloidosis or renal damage mediated by monoclonal immunoglobulin deposition. Podocytopathies in the setting of an underlying monoclonal gammopathy constitute a rare manifestation of these diseases and, although being described in the literature, remain a challenge since most data derive from case reports. METHODS: A retrospective review of the clinical data of Hospital del Mar and Hospital Vall d'Hebron was performed to identify patients with minimal change disease (MCD) or focal and segmental glomerulosclerosis (FSGS) in the setting of neoplasms that produce monoclonal (M) protein. Additionally, a literature review on this topic was performed. This study aims to describe the clinical characteristics and outcomes of these patients. RESULTS: Three patients were identified to have podocytopathy and monoclonal gammopathy between the years 2013 and 2020. All three were males and  >65 years of age. Two patients were diagnosed with MCD and one patient was diagnosed with FSGS. All patients underwent a kidney biopsy and light and electron microscopic studies were performed. The underlying causes of monoclonal gammopathy were multiple myeloma in two cases and Waldeström macroglobulinemia in one case. Two patients developed nephrotic syndrome during the follow-up. All patients were under active hematological treatment. One patient presented a complete remission of proteinuria whereas the other two presented a partial remission. CONCLUSIONS: Podocytopathies may infrequently be found in patients with monoclonal gammopathies. Patients with overt glomerular proteinuria and hematological disorders with M protein should undergo a kidney biopsy for prompt diagnosis and to specify a prognosis. In addition, further study on this matter must be done to understand the pathophysiology and treat these patients appropriately.

The reproducible normality of the crystallographic B-factor.

Reproducibility determines the utility of a measurement. In structural biology the reproducibility permeate areas such as mechanics, data measurement, data analysis and refinement. In order to access the reproducibility of the combined contribution of these sources in uncertainties of protein crystallography we evaluated four groups of parameters from data collection to final structural model. We used lysozyme as a model, with 20 datasets collected at 1.6 Å resolution using two dissimilar x-ray diffraction setups and refined through a single automatic pipeline without arbitrary interpretation. Besides statistical differences in some structural parameters, the reproducibility of the final refined models allowed the determination of positional uncertainty, in good agreement with the Luzzati coordinate error. While the raw B-factor was found non-reproducible, an empirical scaling/normalization resulted in reproducible B-factors. The validity of this empirical scaling was corroborated by the reproducibility of normalized B-factors of independently solved datasets from proteins (insulin and myoglobin) from varying space groups available from structural database. The reproducibility of normalized B-factor may reposition this displacement parameter in the analysis of chemical (ligands, pH) and physical (pressure, temperature, space groups) variables.

C3 glomerulopathy associated with monoclonal gammopathy: impact of chronic histologic lesions and beneficial effects of clone-targeted therapies.

BACKGROUND: C3 glomerulopathy associated with monoclonal gammopathy (C3G-MIg) is a rare entity. Herein we analysed the clinical and histologic features of a cohort of C3G-MIg patients. METHODS: We conducted a retrospective, multicentre, observational study. Patients diagnosed with C3G-MIg between 1995 and 2021 were enrolled. All had genetic studies of the alternative complement pathway. The degree of disease activity and chronicity were analysed using the C3G histologic index. Descriptive statistics and propensity score matching (PSM) analysis were used to evaluate the main outcome of the study [kidney failure (KF)]. RESULTS: The study group included 23 patients with a median age 63 of years [interquartile range (IQR) 48-70], and 57% were males. Immunoglobulin G kappa was the most frequent MIg (65%). The diagnosis of C3G-MIg was made in transplanted kidneys in seven patients (30%). Five (22%) patients had C3 nephritic factor and five (22%) had anti-factor H antibodies. One patient carried a pathogenic variant in the CFH gene. During a follow-up of 40 months (IQR 14-69), nine patients (39%) reached KF and these patients had a significantly higher total chronicity score on kidney biopsy. Patients who received clone-targeted therapy had a significantly higher survival compared with other management. Those who achieved haematological response had a significantly higher kidney survival. Outcome was remarkably poor in kidney transplant recipients, with five of them (71%) reaching KF. By PSM (adjusting for age, kidney function, proteinuria and chronicity score), no significant differences were observed in kidney survival between C3G patients with/without MIg. CONCLUSIONS: The C3G histologic index can be used in patients with C3G-MIg to predict kidney prognosis, with higher chronicity scores being associated with worse outcomes. Clone-targeted therapies and the development of a haematological response are associated with better kidney prognosis.

Integrating electronic health data records to develop and validate a predictive model of hospital-acquired acute kidney injury in non-critically ill patients.

BACKGROUND: Models developed to predict hospital-acquired acute kidney injury (HA-AKI) in non-critically ill patients have a low sensitivity, do not include dynamic changes of risk factors and do not allow the establishment of a time relationship between exposure to risk factors and AKI. We developed and externally validated a predictive model of HA-AKI integrating electronic health databases and recording the exposure to risk factors prior to the detection of AKI. METHODS: The study set was 36 852 non-critically ill hospitalized patients admitted from January to December 2017. Using stepwise logistic analyses, including demography, chronic comorbidities and exposure to risk factors prior to AKI detection, we developed a multivariate model to predict HA-AKI. This model was then externally validated in 21 545 non-critical patients admitted to the validation centre in the period from June 2017 to December 2018. RESULTS: The incidence of AKI in the study set was 3.9%. Among chronic comorbidities, the highest odds ratios (ORs) were conferred by chronic kidney disease, urologic disease and liver disease. Among acute complications, the highest ORs were associated with acute respiratory failure, anaemia, systemic inflammatory response syndrome, circulatory shock and major surgery. The model showed an area under the curve (AUC) of 0.907 [95% confidence interval (CI) 0.902-0.908), a sensitivity of 82.7 (95% CI 80.7-84.6) and a specificity of 84.2 (95% CI 83.9-84.6) to predict HA-AKI, with an adequate goodness-of-fit for all risk categories (χ2 = 6.02, P = 0.64). In the validation set, the prevalence of AKI was 3.2%. The model showed an AUC of 0.905 (95% CI 0.904-0.910), a sensitivity of 81.2 (95% CI 79.2-83.1) and a specificity of 82.5 (95% CI 82.2-83) to predict HA-AKI and had an adequate goodness-of-fit for all risk categories (χ2 = 4.2, P = 0.83). An online tool (predaki.amalfianalytics.com) is available to calculate the risk of AKI in other hospital environments. CONCLUSIONS: By using electronic health data records, our study provides a model that can be used in clinical practice to obtain an accurate dynamic and updated assessment of the individual risk of HA-AKI during the hospital admission period in non-critically ill patients.

Development and Validation of a Model to Predict Severe Hospital-Acquired Acute Kidney Injury in Non-Critically Ill Patients.

BACKGROUND: The current models developed to predict hospital-acquired AKI (HA-AKI) in non-critically ill fail to identify the patients at risk of severe HA-AKI stage 3. OBJECTIVE: To develop and externally validate a model to predict the individual probability of developing HA-AKI stage 3 through the integration of electronic health databases. METHODS: Study set: 165,893 non-critically ill hospitalized patients. Using stepwise logistic regression analyses, including demography, chronic comorbidities, and exposure to risk factors prior to AKI detection, we developed a multivariate model to predict HA-AKI stage 3. This model was then externally validated in 43,569 non-critical patients admitted to the validation center. RESULTS: The incidence of HA-AKI stage 3 in the study set was 0.6%. Among chronic comorbidities, the highest odds ratios were conferred by ischemic heart disease, ischemic cerebrovascular disease, chronic congestive heart failure, chronic obstructive pulmonary disease, chronic kidney disease and liver disease. Among acute complications, the highest odd ratios were associated with acute respiratory failure, major surgery and exposure to nephrotoxic drugs. The model showed an AUC of 0.906 (95% CI 0.904 to 0.908), a sensitivity of 89.1 (95% CI 87.0-91.0) and a specificity of 80.5 (95% CI 80.2-80.7) to predict HA-AKI stage 3, but tended to overestimate the risk at low-risk categories with an adequate goodness-of-fit for all risk categories (Chi2: 16.4, p: 0.034). In the validation set, incidence of HA-AKI stage 3 was 0.62%. The model showed an AUC of 0.861 (95% CI 0.859-0.863), a sensitivity of 83.0 (95% CI 80.5-85.3) and a specificity of 76.5 (95% CI 76.2-76.8) to predict HA-AKI stage 3 with an adequate goodness of fit for all risk categories (Chi2: 15.42, p: 0.052). CONCLUSIONS: Our study provides a model that can be used in clinical practice to obtain an accurate dynamic assessment of the individual risk of HA-AKI stage 3 along the hospital stay period in non-critically ill patients.

Desafios das mulheres na carreira científica no Brasil: uma revisão sistemática / Challenges faced by women pursuing scientific carrer in Brasil: a systematic review / Desafios de las mujeres en la carrera científica en Brasil: revisión sistemática

Este artigo apresenta uma revisão sistemática da produção sobre a carreira científica das mulheres no Brasil, publicada no período de 2005 a 2019. Consultaram-se as bases de dados: Portal de Periódicos da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES/Brasil), Scielo, Web of Science e Scopus. Os descritores utilizados foram "Mulheres na ciência" AND Brasil* em português, inglês e espanhol. Os resultados evidenciam desafios enfrentados pelas pesquisadoras, como as dificuldades para avançar na carreira científica, os estereótipos sobre as mulheres na sociedade, situações de violência verbal, assédio, sobrecarrega de trabalho, dificuldades para conciliar o trabalho doméstico e de cuidado, com o de cientista. Conclui-se que a desigualdade de gênero ainda marca o contexto da ciência no Brasil.

This article presents a systematic review on the production about scientific career of Brazilian women, published between 2005 and 2019. The authors consulted the following databases: Portal of Scientific Journals from the Coordination for the Improvement of Higher Education Personnel (CAPES/Brazil), Scielo, Web of Science, and Scopus. The descriptors used were "Women in Science" AND Brazil * in Portuguese, English, and Spanish. Results show challenges faced by the researchers, such as difficulties in advancing their scientific careers, stereotypes about women in society, situations of verbal violence, harassment, work overload, difficulties in reconciling domestic and caregiver work with that of a scientist. The conclusion is that gender inequality still characterizes the context of science in Brazil.

Este artículo presenta una revisión sistemática de la producción sobre la carrera científica de mujeres Brasileras, publicada en el periodo de 2005 a 2019. Fueron consultadas las bases de datos: Portal de Periódicos da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Scielo, Web of Science y Scopus. Los descriptores utilizados fueron "Mujeres en la ciencia" AND Brasil* en portugués, inglés y español. Los resultados evidencian desafíos que enfrentan las investigadoras, como dificultades para avanzar en la carrera, estereotipos sobre las mujeres, violencia verbal, acoso, sobrecarga de trabajo, dificultades para conciliar trabajo doméstico con trabajo científico. Se concluye que la desigualdad de género aún está presente en el contexto de la ciencia en Brasil.

Intervención en duelo y mindfulness / Grief intervention and Mindfulness

Resumen El presente estudio evalúa el efecto de una intervención adaptada del Programa Inteligencia Emocional Plena (PINEP) en adultos que han sufrido la pérdida de un ser querido. La intervención tuvo una duración de doce sesiones, de dos horas y media por semana. La muestra estuvo compuesta por 17 adultos de un rango de edad de entre 26 y 71 años (M= 50.59; SD = 14.44). Los participantes que completaron la intervención mostraron una mayor tolerancia al malestar desarrollando habilidades en mindfulnessy una disminución en ansiedad estado, ansiedad rasgo y depresión. De esta forma PINEP como programa de gestion emocional, promueve la aceptacion como estrategia psicologica, ante la vulnerabilidad emocional y sufrimiento psicológico.

Abstract This study assesses the effect of an intervention adapted from the Full Emotional Intelligence Program (PINEP, for its initials in Spanish) in adults who have suffered the loss of a loved one. The intervention lasted twelve sessions, two and a half hours per week. The sample consisted of 17 adults ranging in age from 26 to 71 years (M= 50.59; SD = 14.44). Participants who completed the intervention showed an increased tolerance to distress by developing mindfulness skills, and a decrease in state anxiety, trait anxiety, and depression. Therefore, PINEP, as an emotional management program promotes acceptance as a psychological strategy, in the face of emotional vulnerability and psychological suffering.

Is there a link between plasma progesterone 1-2 days before frozen embryo transfers (FET) and ART outcomes in frozen blastocyst transfers?

OBJECTIVE: To study the efficacy of combined administration of subcutaneous and vaginal progesterone for priming frozen blastocysts transfers, looking at progesterone levels and ART outcome. DESIGN: Retrospective study. SETTING PATIENTS: Three hundred and twenty frozen blastocyst transfer cycles conducted in 213 women aged up to 42 years, BMI between 18 and 30 kg/m2, with anatomically normal uterus who underwent frozen embryo transfers (FETs) from February 2019 to December 2019 with a combined luteal-phase support (LPS) associating subcutaneous and vaginal progesterone. Patients with recurrent pregnancy loss (RPL) were excluded. RESULTS: When using combined vaginal and subcutaneous LPS, SPL >10.50 ng/mL in 95% of cases, with a minimum value of 7.02 ng/mL. CPR, OPR, and global miscarriage rates were 38.4%, 30.9%, and 19.5%, respectively. Analyzing results per quartiles, revealed that miscarriage rates were significantly inferior, and IR were higher in the upper two quartiles of serum progesterone (>21.95 ng/mL) on the day before FET, while there was no difference in CPR and OPR. CONCLUSIONS: We report ART outcome of frozen blastocyst transfers performed using a combination of vaginal and subcutaneous progesterone for LPS. ART results were honorable and SPL favorable 1-2 days before FET in 99% of cases.

Validation of a Histologic Scoring Index for C3 Glomerulopathy.

RATIONALE & OBJECTIVE: A previous study that evaluated associations of kidney biopsy findings with disease progression in patients with C3 glomerulopathy (C3G) proposed a prognostic histologic index (C3G-HI) that has not yet been validated. Our objective was to validate the performance of the C3G-HI in a new patient population. STUDY DESIGN: Multicenter, retrospective cohort study. SETTING & PARTICIPANTS: 111 patients fulfilling diagnostic criteria of C3G between January 1995 and December 2019, from 33 nephrology departments belonging to the Spanish Group for the Study of Glomerular Diseases (GLOSEN). PREDICTORS: Demographic, clinical parameters, C3G-HI total activity score, and the C3G-HI total chronicity score. OUTCOME: Time to kidney failure. ANALYTICAL APPROACH: Intraclass correlation coefficients and κ statistic were used to summarize inter-rater reproducibility for assessment of histopathology in kidney biopsies. The nonlinear relationships of risk of kidney failure with the total activity score and total chronicity score were modeled using Cox proportional hazards analysis that incorporated cubic splines. RESULTS: The study group included 93 patients with C3 glomerulonephritis and 18 with dense-deposit disease. Participants had an overall meanage of 35±22 (SD) years. Forty-eight patients (43%) developed kidney failure after a mean follow-up of 65±27 months. The overall inter-rater reproducibility was very good for the total activity score (intraclass correlation coefficient [ICC]=0.63) and excellent for total chronicity score (ICC=0.89). Baseline estimated glomerular filtration rate (eGFR), 24-hour proteinuria, and treatment with immunosuppression were the main determinants of kidney failure in a model with only clinical variables. Only tubular atrophy and interstitial fibrosis were identified as predictors in a model with histological variables. When the total activity score and total chronicity score were added to the model, only the latter was identified as an independent predictor of kidney failure. LIMITATIONS: Only a subset of the kidney biopsies was centrally reviewed. Residual confounding. CONCLUSIONS: We validated the performance of C3G-HI as a predictor of kidney failure in patients with C3G. The total chronicity score was the principal histologic correlate of kidney failure.