Crystalluria in adolescent and adult patients with congenital heart disease.

INTRODUCTION: Crystalluria is a frequent finding in normal individuals and in patients suffering from urolithiasis. As nephrolithiasis has been associated with cardiovascular risk factors and most congenital heart disease (CHD) patients reach adulthood, the objective of this study is to determine the presence of crystalluria and if it influences their cardiovascular outcome. METHODS: Case-control and observational prospective study design of patients with CHD older than 14 years with a stable CHD verified with imaging tests and a control population. RESULTS: 214 patients with CHD [median age 21 (17-35) years and 41 (19%) males] and 345 controls were studied and followed up. None of them had symptoms of renal calculi. Nine (4%) patients with CHD and 24 (7%) patients in the control group showed crystalluria (p = 0.180), all of them composed of calcium oxalate. No significant differences were seen in age, sex, body mass index, CHD complexity, cardiovascular risk factors, NYHA functional class, cyanosis, and medical treatment between CHD patients with and without crystalluria. In relation to survival, 18 patients with CHD had a major acute cardiovascular event (MACE) (3 strokes, 2 myocardial infarction, 9 cardiovascular death and 4 non cardiovascular mortality) during the follow up time [7.3 (4.4-8.5) years] without significant differences in the Kaplan-Meier analysis (p = 0.358) between patients with and without crystalluria. CONCLUSION: No significant differences were found between CHD and control patients in relation to crystalluria and it had no impact on the occurrence of cardiovascular events in the medium term follow up of patients with CHD.

Calcium salt crystalluria in a captive chimpanzee (Pan troglodytes) population.

BACKGROUND: Urinalysis is a rapid, non-invasive method used to obtain diagnostic information on primates. While several studies have investigated dipstick and specific gravity values in chimpanzees, urine sediment analysis is often excluded. Crystalluria, observed during urine sediment analysis, can be benign or indicate renal pathologies. METHODS: In total, 665 urine samples from sanctuary-housed chimpanzees were analyzed over the course of 17 months for pH, specific gravity, time of collection, and crystalluria. RESULTS AND CONCLUSIONS: Calcium salt crystalluria was seen in 9.0% of the samples from 23.7% of the individuals in the study. Urinary pH and specific gravity were significantly higher in samples with crystalluria than in those lacking crystalluria, while time of collection did not differ between the two groups. While diet is the most likely cause of the crystalluria in this population, several medications could also cause urinary crystallization. Further exploration of the significance of calcium salt crystalluria in chimpanzees is warranted.

Drug-induced crystalluria attributable to tosufloxacin in children.

BACKGROUND: Drug-induced crystalluria is reportedly caused by a large number of drugs. Tosufloxacin (TFLX), a second-generation fluoroquinolone antibiotic, is reported to cause kidney injury and crystalluria. We retrospectively analyzed patients with crystalluria caused by TFLX to clarify the clinical course of TFLX-induced crystalluria in children. METHODS: This study was designed as a retrospective case series using the database of the National Center for Global Medicine covering the period from January 1, 2020 to March 31, 2021. We enrolled pediatric patients aged 15 years or younger with crystalluria attributable to TFLX treated in our pediatric department and collected clinical data. RESULTS: Thirteen patients were diagnosed with crystalluria attributable to TFLX. The median age of the patients at diagnosis was 4.0 years (range, 0.8-15 years; interquartile range = 1.2-8.8 years), and five patients (38%) were male. Six patients (46%) had gastrointestinal symptoms such as vomiting and abdominal pain, and 12 patients (92%) had decreased oral intake. The median time to diagnosis after TFLX administration was 4 days (range, 2-7 days; interquartile range = 3-6 days). All patients received TFLX at the appropriate dose. Two patients (17%) were diagnosed with acute kidney injury, and both had gastrointestinal symptoms such as vomiting and abdominal pain. CONCLUSIONS: Crystalluria induced by TFLX occurred despite administration of the appropriate dose of TFLX. Physicians should recognize crystalluria and renal injury attributable to TFLX. It may be possible to prevent renal injury by discontinuing drug therapy.

Meta-analysis guided development of a standard artificial urine.

In this study, we present the first meta-analysis of human urine reported in the literature, drawing data from a total of 35 articles with a combined participant count of 14,021. Through this analysis, we have developed an artificial urine (AU) composition that can be adjusted within typical physiological parameters for in vitro applications. Our findings demonstrate the utility of this AU in determining the solubility of nitrofurantoin, particularly in the context of crystalluria. Notably, we observe that in saline, nitrofurantoin solubility, within the framework of its urinary pharmacokinetics, suggests a risk of crystalluria. However, in AU, this risk is mitigated due to complexation with urea. More broadly, we anticipate that our developed formulation will serve as a foundation for translational studies across biomedical and pharmaceutical sciences.

Sulfamethoxazole-induced crystal nephropathy: characterization and prognosis in a case series.

Cotrimoxazole (Trimethoprim/Sulfamethoxazole-SMX) is frequently used in critically ill and immunocompromised patients. SMX is converted to N-acetyl-sulfamethoxazole (NASM) and excreted by the kidneys. NASM may form crystals in urine, especially in acid urine, that may induce a crystalline nephropathy. However, the imputability of crystals in acute kidney injury (AKI) has not been proven. We aimed to assess whether NASM crystals may promote AKI and to investigate risk factors associated with NASM crystalline nephropathy. Patients from Ile-de-France, France who developed AKI under SMX treatment introduced during hospitalization and had a crystalluria positive for NASM crystals were selected. Patients with excessive preanalytical delay for crystalluria or missing data regarding SMX treatment were excluded. We used the Naranjo score to assess the causal relationship between SMX and the development of AKI in patients with positive NASM crystalluria. Fourteen patients were included. SMX was the probable cause of AKI for 11 patients and a possible cause for 3 patients according to Naranjo score. Patients were exposed to high doses of SMX (but within recommended ranges), and most of them had a preexisting chronic kidney disease and were hypoalbuminemic. Urine pH was mildly acid (median 5.9). AKI occured more rapidly than expected after introduction of SMX (median 4 days) and recovered rapidly after drug discontinuation in most, but not all, cases. SMX is a probable cause of crystalline nephropathy. Monitoring of crystalluria in patients exposed to SMX may be of interest to prevent the development of crystalline nephropathy. Approval number of the study: BPD-2018-DIAG-008.

Satisfacción con la vida y Conductas de salud en estudiantes universitarios de nuevo ingreso / Satisfaction with life and health behaviors in incoming college students / Satisfação com a Vida e Comportamentos de Saúde em Novos Estudantes Universitários

En la actualidad resultan escasos los estudios que relacionen la satisfacción con la vida y las conductas saludables en estudiantes que inician sus estudios universitarios, aun cuando se sabe que la transición a la etapa universitaria puede originar diversos cambios con repercusiones importantes para la salud de los estudiantes. OBJETIVO: determinar la relación entre la satisfacción con la vida y las conductas de salud en estudiantes de primer semestre de una universidad pública venezolana. MÉTODO: estudio de naturaleza cuantitativa, no experimental, descriptivo, correlacional y transversal, utilizó una muestra conformada por 636 estudiantes (65% mujeres y 35% hombres) con edades entre los 15 y 27 años, seleccionados bajo un muestreo no probabilístico intencional. RESULTADOS: los estudiantes se caracterizan por estar satisfechos con su vida y presentan niveles moderados de conductas saludables en general. Asimismo, la satisfacción con la vida difiere según el sexo y el estrato socioeconómico, mientras que algunas conductas de salud difieren según el sexo, el estrato socioeconómico y la edad. Por otra parte, la satisfacción con la vida presenta relación significativa con las conductas de salud a nivel general y en las dimensiones conductas preventivas, sueño, actividad física, control en el consumo de drogas y chequeo médico. CONCLUSIÓN: la satisfacción con la vida resulta ser una variable protectora que fomenta conductas saludables en estudiantes universitarios, en especial los que recién inician los estudios, siendo importante considerarla en futuras intervenciones y programas de promoción de la salud.

Currently, there are few studies that relate satisfaction with life and healthy behaviors in students starting their university studies, even though it is known that the transition to the university stage can cause various changes with important repercussions on the health of students. OBJECTIVE: to determine the relationship between life satisfaction and health behaviors in first semester students at a Venezuelan public university. METHOD: a quantitative, non-experimental, descriptive, correlational, and cross-sectional study, using a sample of 636 students (65% women and 35% men) between 15 and 27 years of age, selected under a non-probabilistic intentional sampling. RESULTS: the students are characterized by being satisfied with their lives and present moderate levels of healthy behaviors in general. Also, life satisfaction differs by gender and socioeconomic status, while some health behaviors differ by gender, socioeconomic status, and age. On the other hand, life satisfaction is significantly related to health behaviors at the general level and in the dimension's preventive behaviors, sleep, physical activity, drug use control and medical check-up. CONCLUSION: life satisfaction turns out to be a protective variable that promotes healthy behaviors in university students, especially those who are just starting their studies, and it is important to consider it in future interventions and health promotion programs.

Atualmente, há poucos estudos que relacionam a satisfação com a vida e comportamentos saudáveis em estudantes que iniciam seus estudos universitários, embora se saiba que a transição para a etapa universitária pode causar diversas mudanças com repercussões importantes para a saúde dos alunos. OBJETIVO: determinar a relação entre satisfação com a vida e comportamentos de saúde em alunos do primeiro semestre de uma universidade pública venezuelana. MÉTODO: um estudo quantitativo, não experimental, descritivo, correlacional e transversal utilizou uma amostra de 636 estudantes (65% mulheres e 35% homens) com idade entre 15 e 27 anos, selecionados em amostragem não probabilística intencional. RESULTADOS: os alunos se caracterizam por estarem satisfeitos com suas vidas e apresentam níveis moderados de comportamentos saudáveis em geral. Além disso, a satisfação com a vida difere por sexo e status socioeconômico, enquanto alguns comportamentos de saúde diferem por sexo, estrato socioeconômico e idade. Por outro lado, a satisfação com a vida apresenta uma relação significativa com os comportamentos de saúde em nível geral e nas dimensões comportamentos preventivos, sono, atividade física, controle no uso de drogas e check-up médico. CONCLUSÃO: a satisfação com a vida acaba por ser uma variável protetora que incentiva comportamentos saudáveis em estudantes universitários, especialmente aqueles que estão apenas iniciando seus estudos, e é importante considerá-lo em intervenções futuras e programas de promoção da saúde.

Lidocaine infusión, basics and clinical issues / Lidocaína endovenosa, fundamentos y usos clínicos

Abstract Optimum pain management, minimizing chronic complications and ensuring a good safety profile, is growing in importance day by day. Lidocaine infusion has an adequate safety profile and several desirable characteristics in the clinical setting. This review describes the characteristics of this drug, as well as its potential indications. Moreover, it describes the basic concepts around lidocaine use, mechanisms of action and clinical applications, as well as the use of infusions in acute pain and repercussions in chronic pain. A review of the literature in English and Spanish was conducted in several databases, with no publication date limit. Articles considered relevant, without including the grey literature, were selected independently. Lidocaine infusion is an option for acute postoperative pain control in major surgery and contributes to opioid sparing and reduced length of stay, with ample evidence in abdominal surgery, rendering it an option to recommend in various protocols. It has an acceptable safety profile in special populations and it is considered useful to diminish the incidence of persistent, chronic and neuropathic pain related to the surgical procedure.

Resumen El manejo óptimo del dolor, minimizando las complicaciones crónicas y cumpliendo con un buen perfil de seguridad, cada día resulta más importante. La lidocaína en infusión tiene un perfil de seguridad adecuado con diversas propiedades deseables en el ámbito clínico. En la presente revisión se describen las características de este medicamento, así como sus potenciales indicaciones. Este artículo describe los conceptos básicos de la lidocaína, sus mecanismos de acción y utilidades clínicas, así como su uso en infusión en el dolor agudo y su repercusión en el dolor crónico. Se realizó una revisión de la literatura en varias bases de datos, sin fecha límite de publicación, en inglés y español. Se realizó la selección independiente de los artículos considerados relevantes, sin incluir literatura gris. La lidocaína en infusión es una alternativa para el control del dolor agudo postoperatorio en la cirugía mayor y contribuye a la disminución del consumo de opioides y la estancia hospitalaria, con amplia evidencia en cirugía abdominal que permite recomendarla en diversos protocolos. Tiene un perfil de seguridad aceptable en poblaciones especiales y se considera útil para disminuir la incidencia de dolor postoperatorio persistente, crónico y neuropático ligado al procedimiento quirúrgico.

O atendimento médico de pacientes com doenças imunoalérgicas no Brasil: reflexões e propostas para a melhoria ­ Carta de Belo Horizonte / Caring for patients with immunoallergic diseases in Brazil: reflections and proposals for improvement ­ The Belo Horizonte Charter

Apesar do aumento na prevalência e gravidade das doenças imunoalérgicas no Brasil, como em todo o mundo, o acesso a atendimento especializado, exames complementares e terapias que possibilitam o controle adequado delas, especialmente as com potencial fatal, é restrito a poucos centros no Brasil, e muitas dessas condições e terapias não estão contempladas nos Protocolos Clínicos e Diretrizes Terapêuticas do Ministério da Saúde. No presente trabalho, analisamos a realidade atual e carências na assistência a pacientes com doenças alérgicas como anafilaxia, alergia ao leite de vaca, asma, dermatite atópica e urticária crônica e com imunodeficiências primárias. São apresentadas, também, propostas de ações em que a Associação Brasileira de Alergia e Imunologia poderia trabalhar em parceria com o Ministério da Saúde para reduzir o impacto médico, social e financeiro dessas doenças.

Despite the increase observed in the prevalence and severity of immunoallergic diseases, both in Brazil and worldwide, access to specialized care and to complementary tests and therapies that allow adequate disease control, especially in potentially fatal cases, is restricted to a few centers in Brazil. In addition, many of these conditions and therapies are not included in the Brazilian Ministry of Health's Clinical Protocols and Therapeutic Guidelines. In the present study, we analyze the current situation and weaknesses in the care of patients with allergic diseases such as anaphylaxis, cow's milk allergy, asthma, atopic dermatitis, and chronic urticaria, as well as those with primary immunodeficiencies. Possible actions that could be undertaken by the Brazilian Association of Allergy and Immunology in partnership with the Brazilian Ministry of Health are proposed, with the aim of reducing the medical, social, and financial impact associated with these diseases.