Efeitos do exercício intradialítico sobre a qualidade do sono e a modulação autonômica cardíaca / Effects of intradialytic exercise on sleep quality and cardiac autonomic modulation / Efectos del ejercicio intradialítico sobre la calidad del sueño y la modulación autonómica cardíaca

Objetivo: avaliar os efeitos de um programa de exercício resistido intradialítico sobre a qualidade do sono e a modulação autonômica cardíaca de pacientes em hemodiálise. Método: ensaio clínico não randomizado, realizado entre fevereiro de 2019 e outubro de 2020, com 52 indivíduos renais crônicos dialíticos, alocados em grupo intervenção (GI; n=32) e grupo controle (GC; n=20). O GI realizou 12 semanas de treinamento físico intradialítico, três vezes por semana. Foram mensurados índices de qualidade do sono e modulação autonômica cardíaca. Resultados: houve incremento nos índices desvio padrão dos intervalos batimento a batimento (SDNN) (ms) (p=0,0004), raiz quadrada da média do quadrado dos intervalos batimento a batimento adjacentes (RMSSD) (ms) (p<0,0001), desvio padrão 1 (SD1) (ms) (p=0,03) e razão desvio padrão 1/desvio padrão 2 (SD1/SD2) (p=0,0003). Não houve melhora da qualidade do sono. Conclusão: O exercício resistido intradialítico, é capaz de melhorar a modulação autonômica cardíaca em pacientes com doença renal crônica

Objective: to evaluate the effects of an intradialytic resistance exercise program on sleep quality and cardiac autonomic modulation in hemodialysis patients. Method: non-randomized clinical trial, carried out between February 2019 and October 2020, with 52 individuals with chronic renal failure on dialysis, divided into an intervention group (IG; n=32) and a control group (CG; n=20). The IG performed 12 weeks of intradialytic physical training, three times a week. Indices of sleep quality and cardiac autonomic modulation were measured. Results: there was an increase in the standard deviation indices of beat-to-beat intervals (SDNN) (ms) (p=0.0004), square root of the mean square of adjacent beat-to-beat intervals (RMSSD) (ms) (p<0. 0001), standard deviation 1 (SD1) (ms) (p=0.03) and standard deviation 1/standard deviation 2 (SD1/SD2) ratio (p=0.0003). There was no improvement in sleep quality. Conclusion: Intradialytic resistance exercise is able to improve cardiac autonomic modulation in patients with chronic kidney disease

Objetivo: evaluar los efectos de un programa de ejercicios de resistencia e intradialíticos sobre la calidad del sueño y la modulación autonómica cardíaca en pacientes en hemodiálisis. Método: ensayo clínico no aleatorizado, realizado entre febrero de 2019 y octubre de 2020, junto a 52 individuos en diálisis con insuficiencia renal crónica, divididos en grupo intervención (GI; n=32) y grupo control (GC; n=20). El GI realizó 12 semanas de entrenamiento físico intradialítico, tres veces por semana. Se midieron índices de calidad del sueño y modulación autonómica cardíaca. Resultados: hubo un aumento en los índices de desviación estándar de los intervalos entre latidos (SDNN) (ms) (p=0,0004), raíz cuadrada del cuadrado medio de los intervalos entre latidos adyacentes (RMSSD) (ms) (p<0,0001), desviación estándar 1 (DE1) (ms) (p=0,03) y relación desviación estándar 1/desviación estándar 2 (DE1/DE2) (p=0,0003). No hubo mejoría en la calidad del sueño. Conclusión: el ejercicio de resistencia intradialítico puede mejorar la modulación autonómica cardíaca en pacientes con enfermedad renal crónica.

Chikungunya virus as a trigger for different renal disorders: an exploratory study.

INTRODUCTION: Chikungunya virus was detected in cases of acute chikungunya fever in renal tissue. However, chikungunya virus-related kidney injury still lacks characterization, and it is unknown whether the kidneys are reservoirs for the virus. We sought to detect histopathological changes and viral antigens in renal tissue, and to evaluate kidney injury markers in different phases of chikungunya fever. METHODS: Two groups were evaluated in this exploratory study: patients with biopsy-proven kidney injury established after chikungunya fever, and patients with post-chikungunya fever chronic joint manifestations without known kidney injury, in whom we actively searched for kidney injury markers. RESULTS: In the first group, 15 patients had kidney injury 0.5-24 months after chikungunya fever. The most frequent histopathological diagnoses were glomerular lesions. No viral antigens were detected in renal tissue. High-risk genotypes were detected in patients with atypical hemolytic uremic syndrome and focal and segmental glomerulosclerosis. In the second group, 114 patients had post-chikungunya fever joint manifestations on average for 35.6 months. Mean creatinine and proteinuria were 0.9 mg/dl and 71.5 mg/day, respectively. One patient had isolated hematuria. There was no indication for renal biopsy in this group. CONCLUSIONS: Several histopathological features were found after chikungunya fever, without virus detection in renal tissue. These findings suggest that chikungunya virus may trigger kidney lesions with varying degrees of severity at different stages of infection. However, the probability that this virus replicates in the renal tissue seems unlikely.

Effect of treatment with carvacrol and aerobic training on cardiovascular function in spontaneously hypertensive rats.

NEW FINDINGS: What is the central question of this study? Can two non-drug therapies, carvacrol and aerobic physical training, together have additive effects on the reduction of cardiovascular risks and control of arterial hypertension? What is the main finding and its importance? The oral use of carvacrol (20 mg/kg/day) can control sustained hypertension in spontaneously hypertensive rats, and when this use is associated with aerobic physical training, there is a more pronounced effect on the reduction of blood pressure values, making these therapies an adjunct option in the drug treatment of hypertension. ABSTRACT: Systemic arterial hypertension is considered the foremost cardiovascular risk factor, and it is important to examine different therapies that help prevent and treat it, especially when associated with other cardiovascular risk factors. In this context, it is known that both carvacrol and aerobic physical training benefit the cardiovascular system. This study investigated the effects of treatment with carvacrol combined with aerobic exercise on hypertensive rats with cardiovascular risk parameters. We used an experimental design with six groups: normotensive control (Wistar rats); hypertensive control (spontaneously hypertensive rats, SHR); positive control rats treated with amlodipine (Aml-20 mg); rats treated with carvacrol (Carv-20 mg); rats trained with exercise (Exer); and rats treated with carvacrol and exercise (ExerCarv). The treatment lasted for 4 weeks, monitoring heart rate and systolic blood pressure (SBP). At the end of the treatment, vascular reactivity tests were performed in addition to biochemical measurements of urea, creatinine, aspartate aminotransferase, alanine aminotransferase, triglycerides, total cholesterol, high density lipoprotein cholesterol, low density lipoprotein cholesterol, very low density lipoprotein cholesterol, atherogenic indexes, relative heart weight and histopathological analysis of cardiac perivascular tissue. Significant reductions in SBP were observed after the training period, with the ExerCarv group showing a greater magnitude of reduction (∆SBP = 88 ± 10.0 mmHg, 42%). This group also experienced reductions in atherogenic indices and improvement in all analysed lipid parameters, with no differences observed in the Exer group. The findings indicated that the interaction between aerobic exercise and carvacrol offers a greater BP reduction. Exercise is particularly effective for controlling biochemical parameters of cardiovascular risk, regardless of carvacrol use.

Sensitivity and specificity of the body mass index in the diagnosis of obesity in patients with non-dialysis chronic kidney disease: a comparison between gold standard methods and the cut-off value purpose.

INTRODUCTION: Introduction: nutritional status is an important predictor of prognosis in chronic kidney disease (CKD), including pre-dialysis. Anthropometric measures universally used for the diagnosis of obesity in the general population may not present the same performance in individuals with CKD. Objective: to verify the sensitivity and specificity of body mass index (BMI) in relation to the percentage of body fat (%BF) obtained by dual energy X-ray absorptiometry (DEXA) and air displacement plethysmography (PDA) for patients with non-dialysis chronic kidney disease. Methods: BMI was obtained. DEXA and ADP were used to determine %BF and they were considered as gold standard methods. Results: a total of 78 patients were evaluated, with a mean age of 54.4 ± 13.9 years old. There was a higher prevalence of overweight/obesity (55.2%), according to BMI, and high %BF, according to DEXA (69.2%) and ADP (53.8%). BMI showed a statistically significant correlation with the %BF obtained by both methods and in both sexes (p < 0.05). To detect high %BF, a BMI of 25 kg/m2 had better sensitivity and specificity values for DEXA (73.3% and 66.7%, respectively) and ADP (77.3% and 52.9%, respectively) in men, and for DEXA (79.9% and 46.7%, respectively) in women. However, a BMI of 26 kg/m2 for ADP in women would be more accurate (70.0% and 73.7%, respectively). Conclusion: the prevalence of patients with excess body fat was high. The conventional cut-off points for BMI were not adequate in these patients and suggested that BMI ≥ 25 kg/m2 were more accurate for diagnosing obesity.

INTRODUCCIÓN: Introducción: el estado nutricional es un importante predictor de pronóstico en la enfermedad renal crónica (ERC), incluso en la fase de prediálisis. Las medidas antropométricas universalmente usadas para el diagnóstico de la obesidad en la población general pueden no presentar el mismo desempeño en individuos con ERC. Objetivo: verificar la sensibilidad y especificidad del índice de masa corporal (IMC) en relación con el porcentaje de grasa corporal (%GC), obtenido por la absorciometría con rayos X de doble energía (DEXA) y pletismografía de desplazamiento aéreo (PDA) de pacientes renales crónicos no dialíticos. Métodos: se obtuvo el IMC. La DEXA y la PDA se utilizaron para determinar el porcentaje de GC y se consideraron métodos patrón-oro. Resultados: se evaluaron 78 pacientes con una media de edad de 54,4 ± 13,9 años. Se observó una elevada prevalencia de sobrepeso/obesidad (55,2%), según el IMC, y de porcentaje de GC alto, de acuerdo con la DEXA (69,2%) y la PDA (53,8%). El IMC presentó una correlación estadísticamente significativa con el porcentaje de GC obtenido por los dos métodos y en ambos sexos (p < 0,05). Para detectar un %GC alto, el IMC de 25 kg/m2 presentó mayor sensibilidad y especificidad para DEXA (73,3% y 66,7%, respectivamente) y PDA (77,3% y 52,9%, respectivamente) en los hombres y para DEXA (79,9% y 46,7%, respectivamente) en mujeres, pero el IMC de 26 kg/m2 para la PDA en mujeres sería más preciso (70,0% y 73,7%, respectivamente). Conclusión: la prevalencia de pacientes con exceso de grasa corporal fue elevada. Los puntos de corte convencionales para el IMC no fueron adecuados en esos pacientes y esto sugiere que los valores de IMC ≥ 25 kg/m2 presentan mayor exactitud para el diagnóstico de obesidad.

Increased urinary cystatin C level is associated with interstitial fibrosis and tubular atrophy in kidney allograft recipients.

AIM: The objective of this study was to investigate the correlation between the urinary excretion of cystatin C (CysC) and the presence of interstitial fibrosis/tubular atrophy (IF/TA) in renal transplant (RT) recipients. METHODS: This prospective study included 21 adult patients who had undergone renal biopsy and RT ≥6 months prior. According to the renal biopsy reports, the patients were divided into groups with (n=12) or without (n=9) IF/TA. Analytical parameters included the following: serum and urinary levels of CysC, creatinine (Cr) and sodium (Na), total urinary protein, urinary CysC/creatinine ratio [u(CysC/Cr)], fractional excretion of sodium (FENa) and estimated glomerular filtration rate (eGFR) based on the Chronic Kidney Disease Epidemiology Collaboration equation. RESULTS: The values of uCysC, u(CysC/Cr), proteinuria, and FENa were significantly higher in patients with IF/TA than in patients without IF/TA. The values of eGFR were statistically lower in patients with IF/TA (p=0.001). Values of uCysC significantly correlated with those of serum Cr, FENa, and eGFR (p<0.001). Among the patients with IF/TA, 67% presented with glomerulosclerosis (segmental/global). CONCLUSION: Elevated levels of urinary CysC are associated with interstitial fibrosis and tubular atrophy in RT recipients and may become a useful tool for monitoring kidney allografts.

Comparison of metaraminol, phenylephrine and ephedrine in prophylaxis and treatment of hypotension in cesarean section under spinal anesthesia / Avaliação comparativa entre metaraminol, fenilefrina e efedrina na profilaxia e no tratamento da hipotensão em cesarianas sob raquianestesia / Evaluación comparativa entre el metaraminol, la fenilefrina y la efedrina en la profilaxis y en el tratamiento de la hipotensión en cesáreas bajo anestesia espinal

Maternal hypotension is a common complication after spinal anesthesia for cesarean section, with deleterious effects on the fetus and mother. Among the strategies aimed at minimizing the effects of hypotension, vasopressor administration is the most efficient. The aim of this study was to compare the efficacy of phenylephrine, metaraminol, and ephedrine in the prevention and treatment of hypotension after spinal anesthesia for cesarean section. Ninety pregnant women, not in labor, undergoing cesarean section were randomized into three groups to receive a bolus followed by continuous infusion of vasopressor as follows: phenylephrine group (50 μg + 50 μg/min); metaraminol group (0.25 mg + 0.25 mg/min); ephedrine group (4 mg + 4 mg/min). Infusion dose was doubled when systolic blood pressure decreased to 80% of baseline and a bolus was given when systolic blood pressure decreased below 80%. The infusion dose was divided in half when systolic blood pressure increased to 120% and was stopped when it became higher. The incidence of hypotension, nausea and vomiting, reactive hypertension, bradycardia, tachycardia, Apgar scores, and arterial cord blood gases were assessed at the 1st and 5th minutes. There was no difference in the incidence of hypotension, bradycardia, reactive hypertension, infusion discontinuation, atropine administration or Apgar scores. Rescue boluses were higher only in the ephedrine group compared to metaraminol group. The incidence of nausea and vomiting and fetal acidosis were greater in the ephedrine group. The three drugs were effective in preventing hypotension; however, fetal effects were more frequent in the ephedrine group, although transient.

Hipotensão materna é uma complicação comum após raquianestesia em cirurgia cesariana, trazendo efeitos deletérios para o feto e a mãe. Entre as estratégias com o objetivo de minimizar os efeitos da hipotensão, a administração de vasopressores é a mais eficiente. O objetivo deste estudo foi comparar a eficácia da fenilefrina, metaraminol e efedrina na prevenção e tratamento de hipotensão após raquianestesia em cirurgia cesariana. Noventa gestantes que não estavam em trabalho de parto submetidas à cesariana eletiva foram randomizadas em três grupos para receber um bolus, seguido de infusão contínua de vasopressor da seguinte forma: Grupo Fenilefrina (50 μg + 50 μg/min); Grupo Metaraminol (0,25 mg + 0,25 mg/min); Grupo Efedrina (4 mg + 4 mg/min). A dose da infusão foi dobrada quando a pressão arterial sistólica (PAS) decresceu até 80% dos valores basais e um bolus foi dado quando a PAS decresceu para valores abaixo de 80%. A dose da infusão foi dividida ao meio quando a PAS aumentou até 120% e foi interrompida quando mais elevada. Foram analisadas as incidências de hipotensão, náuseas e vômitos, hipertensão reativa, bradicardia, taquicardia e escores de Apgar no primeiro e quinto minutos e gases de sangue arterial do cordão umbilical. Não houve diferenças nas incidências de hipotensão, bradicardia, hipertensão reativa, interrupção da infusão, administração de atropina ou escores de Apgar. A administração de bolus de resgate foram superiores apenas no Grupo Efedrina em comparação com Metaraminol. A incidência de náuseas e vômitos e acidose fetal foram superiores no Grupo Efedrina. Os três fármacos foram eficazes na prevenção de hipotensão, mas repercussões fetais foram mais frequentes no Grupo Efedrina, embora transitórias.

La hipotensión materna es una complicación común posterior a la anestesia espinal en cirugía de cesárea, lo que trae efectos perjudiciales para el feto y la madre. Entre las estrategias cuyo objetivo es minimizar los efectos de la hipotensión, la administración de vasopresores es la más eficaz. El objetivo de este estudio fue comparar la eficacia de la fenilefrina, del metaraminol y de la efedrina en la prevención y el tratamiento de la hipotensión posterior a la aplicación de la anestesia espinal en cirugía de cesárea. Noventa gestantes que no estaban de parto y sometidas a la cesárea electiva, fueron aleatorizadas en 3 grupos para recibir un bolo, seguido de infusión continua de vasopresor de la siguiente forma: grupo fenilefrina (50 μg + 50 μg/min); grupo metaraminol (0,25 mg + 0,25 mg/min); grupo efedrina (4 mg + 4 mg/min). La dosis de la infusión se duplicó cuando la presión arterial sistólica cayó al 80% de los valores basales y un bolo se administró cuando la presión arterial sistólica cayó a valores por debajo del 80%. La dosis de la infusión se dividió en 2 cuando la presión arterial sistólica aumentó alcanzando los 120% y fue interrumpida cuando se elevó. Se analizaron las incidencias de hipotensión, náuseas y vómitos, hipertensión reactiva, bradicardia, taquicardia y puntuaciones de Apgar en el primer y en el quinto minutos, y gases de sangre arterial del cordón umbilical. No hubo diferencias en las incidencias de hipotensión, bradicardia, hipertensión reactiva, interrupción de la infusión, administración de atropina o puntuaciones de Apgar. La administración de bolos de rescate fue superior solo en el grupo efedrina en comparación con el metaraminol. La incidencia de náuseas y vómitos y la acidosis fetal fueron superiores en el grupo efedrina. Los 3 fármacos fueron eficaces en la prevención de la hipotensión y las repercusiones fetales fueron más frecuentes en el grupo efedrina, aunque hayan sido transitorias.

Atypical size and location of a right atrial myxoma: a case report.

INTRODUCTION: Primary intracardiac tumors are rare and approximately 50% are myxomas. The majority of myxomas are located in the left atrium and have variable clinical presentation. We report a case of a large myxoma in the right atrium, which is an uncommon location for this type of tumor. CASE PRESENTATION: A 45-year-old Caucasian woman with a history of palpitation had dyspnea on great exertion and discrete weight loss. A cardiac evaluation showed splitting of S1. An echocardiogram showed a large mass in the right atrium, suggesting myxoma; chest computed tomography confirmed the diagnostic hypothesis. Our patient underwent surgical treatment with excision of a 10 cm multilobulated mass. She presented with supraventricular tachycardia during the operation. She was placed in the intensive care unit and her condition improved after the use of amiodarone. The diagnosis of myxoma was confirmed by histopathological study. CONCLUSIONS: In this case report, we emphasize the rarity of large myxomas in the right atrium and the difficulty of differential diagnosis given their dimension and location.