Peptidylarginine deiminase 4 concentration, but not PADI4 polymorphisms, is associated with ICU mortality in septic shock patients.

The objective of our study was to evaluate the association between peptidylarginine deiminase 4 (PAD4) concentration and its polymorphisms with mortality in patients with septic shock. We prospectively evaluated 175 patients aged over 18 years with septic shock upon intensive care unit (ICU) admission. However, 48 patients were excluded. Thus, 127 patients were enrolled in the study. At the time of the patients' enrollment, demographic information was recorded. Blood samples were taken within the first 24 hours of the patient's admission to determine serum PAD4 concentrations and its polymorphism PADI4_89 [rs11203366], PADI4_94 [rs2240340] and PADI4_104 [rs1748033]. The mean age was 63.3 ± 15.2 years, 56.7% were male, PAD4 concentration was 4.62 (2.48-6.20) ng/mL and the ICU mortality rate was 67.7%. The patients who died in the ICU had higher APACHE II and Sequential Organ Failure Assessment (SOFA) scores. In addition, PAD4 concentration was higher in patients who died during ICU stay. However, there were no differences regarding PADI4 polymorphisms and ICU mortality. In the logistic regression models, PAD4 concentrations were associated with ICU mortality when adjusted for APACHE II score and lactate (OR: 1.477; CI 95%: 1.186-1.839; P < .001), and when adjusted for age, gender and APACHE II score (OR: 1.392; CI 95%: 1.145-1.692; P < .001). In conclusion, PAD4 concentration, but not PADI4_89, PADI4_94 and PADI4_104 polymorphisms, is associated with ICU mortality in septic shock patients.

Erythrocyte superoxide dismutase as a biomarker of septic acute kidney injury.

BACKGROUND: Oxidative stress is a key feature of sepsis and could be a common pathophysiological pathway between septic shock and acute kidney injury (AKI) Our objective was to evaluate the erythrocyte superoxide dismutase (SOD1) activity as predictor of AKI in patients with septic shock. METHODS: This is a prospective observational study that evaluated 175 consecutive patients over the age of 18 years with septic shock upon intensive care unit (ICU) admission. However, 43 patients were excluded (27 due to AKI at ICU admission). Thus, 132 patients were enrolled in the study. At the time of the patients' enrollment, demographic information was recorded. Blood samples were taken within the first 24 h of the patient's admission to determine the erythrocyte SOD1 activity. All patients were followed throughout the ICU stay, and the development of AKI was evaluated. In addition, we also evaluated 17 control subjects. RESULTS: The mean age of patients with septic shock was 63.2 ± 15.7 years, 53 % were male and the median ICU stay was 8 days (4-16). Approximately 50.7 % developed AKI during the ICU stay. The median erythrocyte SOD1 activity was 2.92 (2.19-3.92) U/mg Hb. When compared to control subjects, septic shock patients had a higher serum malondialdehyde concentration and lower erythrocyte SOD1 activity. In univariate analysis, erythrocyte SOD1 activity was lower in patients who developed AKI. The ROC curve analysis revealed that lower erythrocyte SOD1 activity was associated with AKI development (AUC 0.686; CI 95 % 0.595-0.777; p < 0.001) at the cutoff of <3.32 U/mg Hb. In the logistic regression models, SOD1 activity higher than 3.32 U/mg Hb was associated with protection of AKI development when adjusted by hemoglobin, phosphorus and APACHE II score (OR 0.309; CI 95 % 0.137-0.695; p = 0.005) and when adjusted by age, gender, chronic kidney disease, admission category (medical or surgery) and APACHE II score (OR 0.129; CI 95 % 0.033-0.508; p = 0.003). CONCLUSIONS: In conclusion, our data suggest that erythrocyte SOD1 activity could play a role as an early marker of septic AKI and could be seen as a new research avenue in the field of biomarker in AKI. However, our study did not show a strong correlation between SOD activity and AKI. Nevertheless, these original data do warrant further research in order to confirm or not this hypothesis.

Atuação do nutricionista para melhora da qualidade de vida de pacientes oncológicos em cuidados paliativos / Nutritionist's professional practice to improve quality of life of cancer patients undergoing palliative care

Introdução: O cuidado paliativo é uma das formas de tratamento do câncer avançado que objetiva o controle dos sintomas, conforto e a melhora da qualidade de vida dos pacientes e de seusfamiliares. Como membro da equipe multiprofissional, que atua neste âmbito, está o nutricionista,que exerce papel substancial nesses cuidados. Objetivo: Caracterizar a associação entre a atuaçãodo nutricionista e a qualidade de vida de pacientes oncológicos em cuidados paliativos. Material eMétodos: Foi realizada uma revisão bibliográfica integrativa com base no banco de dados Bireme,PubMed, Web of Science, Scopus e Cinahl e Embase, contemplando artigos publicados no períodode 2012 a 2017. Para composição da estratégia de busca foram utilizadas as palavras-chave:nutricionista; cuidados paliativos e câncer em português e inglês. Resultados: Foram encontrados187 artigos e excluídos 183 trabalhos, após leitura dos títulos, resumos e textos por não fazeremreferência ao tema proposto e aos critérios de inclusão. Foram inseridos um total de quatro estudos,sendo dois artigos da base Bireme, um artigo da base Web of Science e um da PubMed. Conclusão:O profissional nutricionista executa papel primordial nos cuidados paliativos, pois a terapianutricional colabora para a redução dos efeitos colaterais ocasionados pelo tratamento, realizandoorientações nutricionais pertinentes a estes indivíduos, além de fazer relação de vínculo entre aequipe, o paciente e seus familiares no tocante à alimentação, contribuindo assim para a melhora daqualidade de vida destes pacientes

Introduction: Palliative care is an alternative to treat cancer in its advanced stage. Treatment aims to control symptoms, comfort, and improve the quality of life of patients and their families. The nutritionist is a member of the multidisciplinary team who plays a substantial role in this care. Objective: Characterize the association between the nutritionist's professional practice and the quality of life of cancer patients in palliative care. Material and Methods: We conducted an integrative review of published literature from 2012 through 2017. Database searched included PubMed, Web of Science, Scopus, Cinahl, and Embase. The following keywords were used separately and combined in all databases and search engines: search terms, "nutritionist", "palliative care", and "cancer". The search was limited to Portuguese and English languages. Results: The integrative literature search resulted in the identification of 187 articles; of which 183 were excluded. Articles were first screened by review of the title. Selected articles were further screened by review of the abstract. The final chosen articles were read and the desired data summarized. Studies were excluded if they did not specifically record the proposed theme. Four studies were identified, two from Bireme, one from the Web of Science, and one from PubMed searches. Conclusion: Nutritionist's professional practice is primordial in the care of the patient. He/she helps to establish the best therapeutic plan, including nutrition therapy, in order to reduce the anxiety and suffering so peculiar in this approach. He/she also helps to reduce side effects caused by the treatment, making pertinent nutritional orientations/counseling to the individuals. The professional can establish a relationship between the team, the patient, and their families regarding nutrition. Thus, this professional might contribute to the improvement of patents' quality of life.

Nephrocalcinosis induced by hyperoxaluria in rats.

PURPOSE: To investigate nephrocalcinosis due to hyperoxaluria induced by two different inducing agents in rats. METHODS: Forty Sprague-Dawley male rats were randomly distributed into four groups: Group 1 (Clinical control, n = 10); Group 2 (0.5% Ethylene Glycol + Vitamin D3, n = 10); Group 3 (1.25% Ethylene Glycol, n = 10); and Group 4 (5%Hydroxy L-proline, n = 10). Five animals from each group were euthanized after one week of follow-up (M1 Moment) and the remaining, after four weeks (M2 Moment). All animals underwent 24h urine dosages of calcium, oxalate, uric acid, citrate and serum creatinine. Histology and histomorphometric analyses were performed using Image J program in the hematoxylin-eosin stains. Calcium deposits in the renal parenchyma were quantified by PIXE technique (Proton Induced X-Ray Emission). RESULTS: 24h urinary parameters did not show any significant variations after 28 days of experiment except by hyperoxaluria that was significantly higher in Group 3. Histomorphometric analyses showed a significantly higher nephrocalcinosis in Group 2 (p<0.01). The calcium deposits in the renal parenchyma were 10 and 100 times higher in Group 2 in comparison to other groups in the M1 and M2 moments, respectively. CONCLUSION: The Group 2 (vitamin D3+Ethylene Glycol 0.5%) was the best model to induce nephrocalcinosis in rats after 28 days.

Nephrocalcinosis induced by hyperoxaluria in rats

PURPOSE: To investigate nephrocalcinosis due to hyperoxaluria induced by two different inducing agents in rats. METHODS: Forty Sprague-Dawley male rats were randomly distributed into four groups: Group1 (Clinical control, n = 10); Group 2 (0.5% Ethylene Glycol + Vitamin D3, n = 10); Group 3 (1.25% Ethylene Glycol, n = 10); and Group 4 (5%Hydroxy L-proline, n = 10). Five animals from each group were euthanized after one week of follow-up (M1 Moment) and the remaining, after four weeks (M2 Moment). All animals underwent 24h urine dosages of calcium, oxalate, uric acid, citrate and serum creatinine. Histology and histomorphometric analyses were performed using Image J program in the hematoxylin-eosin stains. Calcium deposits in the renal parenchyma were quantified by PIXE technique (Proton Induced X-Ray Emission). RESULTS: 24h urinary parameters did not show any significant variations after 28 days of experiment except by hyperoxaluria that was significantly higher in Group 3. Histomorphometric analyses showed a significantly higher nephrocalcinosis in Group 2 (p<0.01). The calcium deposits in the renal parenchyma were 10 and 100 times higher in Group 2 in comparison to other groups in the M1 and M2 moments, respectively. CONCLUSION: The Group 2 (vitamin D3+Ethylene Glycol 0.5%) was the best model to induce nephrocalcinosis in rats after 28 days.