Fatigue by the Chalder Questionnaire and post-hemodialysis recovery in a population of predominantly African descent: The PROHEMO.

BACKGROUND/OBJECTIVE: A high prevalence of fatigue and a positive association between fatigue and post-hemodialysis recovery have been reported in predominantly white populations of maintenance hemodialysis (MHD) patients. The present study evaluates associations between self-reported fatigue by the 11-item Chalder Fatigue Questionnaire (CFQ-11) and the need for post-hemodialysis recovery in a predominantly African-descent MHD population. METHODS: A total of 233 patients (94% Black or Mixed-Race) participating in the "Prospective Study of the Prognosis of Patients on Maintenance Hemodialysis" (PROHEMO), Salvador, Brazil were recruited for this cross-sectional study. The CFQ-11 was used to measure fatigue: <4 for absent or mild, ⩾4 for moderate to severe. Patients were also asked if they needed some time to recover after the hemodialysis. Logistic regression was used to estimate odds ratio (OR) of the association with adjustments for age, sex, race, educational level, economic class level, diabetes, hearth failure, and hemoglobin. RESULTS: Mean age was 51.5 ± 12.5 years. Moderate to severe fatigue (⩾4 points) was observed in 70.8% (165/233), and absent or mild fatigue (<4 points) in 29.2% (68/233). Compared to patients with fatigue scores <4 (20.6%), the need for post-hemodialysis recovery was 2.5 times greater in patients with fatigue scores ⩾4 (52.7%). The covariate-adjusted logistic regression OR was 4.60, 95% CI: 2.27, 9.21. CONCLUSION: This study in MHD patients of predominantly African descent supports self-reported fatigue assessed by the CFQ-11 as a relevant predictor of the need for post-hemodialysis recovery. The results offer a rationale for investigating whether interventions to prevent fatigue reduce the need of post-hemodialysis recovery.

Predictors of nutritional recovery time in children aged 6-59 months with severe acute malnutrition in Sofala Province, Mozambique: survival analysis approach.

BACKGROUND: Malnutrition is a public health problem that affects physical and psychosocial well-being. It manifests as a rapid deterioration in nutritional status and bilateral edema due to inadequate food intake or illness. METHODS: This study is a retrospective cohort of 1208 children with severe acute malnutrition (SAM) in Sofala Province from 2018 to 2022. It includes hospitalized children aged 6-59 months with SAM and related complications. The dependent variable is recovery, and the independent variables include age, sex of the child, vomiting, dehydration, hypoglycemia, nutritional edema and anthropometry. Survival curves were plotted using the Kaplan-Meier method, and bivariable and multivariable Cox regression analyses were performed. RESULTS: The crude analysis revealed significant factors for nutritional recovery in children with SAM, including age, weight, height, malaria, diarrhea and dehydration. Children under 24 months had a 28% lower likelihood of recovery. Weight below 6.16 kg decreased the likelihood by 2%, and height above 71.1 cm decreased it by 20%. Conversely, malaria, diarrhea and dehydration increased the likelihood of recovery. However, after adjustment, only diarrhea remained a significant predictor of nutritional recovery. CONCLUSION: This study found that diarrhea is a predictor of nutritional recovery in children with SAM.

Effect of brief exposures of anesthesia on thermotolerance and metabolic rate of the spotted-wing fly, Drosophila suzukii: Differences between sexes?

The spotted-wing fly, Drosophila suzukii, is a world-wide pest insect for which there is increasing interest in its physiological traits including metabolism and thermotolerance. Most studies focus only on survival to different time exposures to extreme temperatures, mainly in female flies. In addition, it has not been tested yet how anesthesia affects these measurements. We analyzed the effects of anesthesia by brief exposures to cold, anoxia by CO2 or N2 on three standard thermotolerance assays, as well as the aerobic metabolic rate in both sexes. For heat tolerance we measured CTmax by thermolimit respirometry, and CTmin and chill-coma recovery time for cold tolerance. Aerobic metabolism was calculated by CO2 production of individual flies in real time by open flow respirometry. Results showed that females have a significantly higher V̇CO2 for inactive (at 25 °C) and maximum metabolic rate than males. This difference is mainly explained by body mass and disappears after mass correction. Males had a more sensitive MR to temperature than females showed by a significantly higher Q10 (2.19 vs. 1.98, for males and females, respectively). We observed a significantly lower CTmin (X2 = 4.27, P = 0.03) in females (3.68 ± 0.38 °C) than males (4.56 ± 0.39 °C), although we did not find significant effects of anesthesia. In contrast, anesthesia significantly modifies CTmax for both sexes (F3,62 = 7.86, P < 0.001) with a decrease of the CTmax in cold-anesthetized flies. Finally, we found a significantly higher CTmax in females (37.87 ± 0.07 °C) than males (37.36 ± 0.09 °C). We conclude that cold anesthesia seems to have detrimental effects on heat tolerance, and females have broader thermotolerance range than males, which could help them to establish in invaded temperate regions with more variable environmental temperatures.

Effect of hemodiafiltration on measured physical activity: primary results of the HDFIT randomized controlled trial.

BACKGROUND: Dialysis patients are typically inactive and their physical activity (PA) decreases over time. Uremic toxicity has been suggested as a potential causal factor of low PA in dialysis patients. Post-dilution high-volume online hemodiafiltration (HDF) provides greater higher molecular weight removal and studies suggest better clinical/patient-reported outcomes compared with hemodialysis (HD). METHODS: HDFIT was a randomized controlled trial at 13 clinics in Brazil that aimed to investigate the effects of HDF on measured PA (step counts) as a primary outcome. Stable HD patients (vintage 3-24 months) were randomized to receive HDF or high-flux HD. Treatment effect of HDF on the primary outcome from baseline to 3 and 6 months was estimated using a linear mixed-effects model. RESULTS: We randomized 195 patients (HDF 97; HD 98) between August 2016 and October 2017. Despite the achievement of a high convective volume in the majority of sessions and a positive impact on solute removal, the treatment effect HDF on the primary outcome was +538 [95% confidence interval (CI) -330 to 1407] steps/24 h after dialysis compared with HD, and was not statistically significant. Despite a lack of statistical significance, the observed size of the treatment effect was modest and driven by steps taken between 1.5 and 24.0 h after dialysis, in particular between 20 and 24 h (+197 steps; 95% CI -95 to 488). CONCLUSIONS: HDF did not have a statistically significant treatment effect on PA 24 h following dialysis, albeit effect sizes may be clinically meaningful and deserve further investigation.

Impacts of dialysis adequacy and intradialytic hypotension on changes in dialysis recovery time.

BACKGROUND: Dialysis recovery time (DRT) surveys capture the perceived time after HD to return to performing regular activities. Prior studies suggest the majority of HD patients report a DRT > 2 h. However, the profiles of and modifiable dialysis practices associated with changes in DRT relative to the start of dialysis are unknown. We hypothesized hemodialysis (HD) dose and rates of intradialytic hypotension (IDH) would associate with changes in DRT in the first years after initiating dialysis. METHODS: We analyzed data from adult HD patients who responded to a DRT survey ≤180 days from first date of dialysis (FDD) during 2014 to 2017. DRT survey was administered with annual KDQOL survey. DRT survey asks: "How long does it take you to be able to return to your normal activities after your dialysis treatment?" Answers are: < 0.5, 0.5-to-1, 1-to-2, 2-to-4, or > 4 h. An adjusted logistic regression model computed odds ratio for a change to a longer DRT (increase above DRT > 2 h) in reference to a change to a shorter DRT (decrease below DRT < 2 h, or from DRT > 4 h). Changes in DRT were calculated from incident (≤180 days FDD) to first prevalent (> 365-to- ≤ 545 days FDD) and second prevalent (> 730-to- ≤ 910 days FDD) years. RESULTS: Among 98,616 incident HD patients (age 62.6 ± 14.4 years, 57.8% male) who responded to DRT survey, a higher spKt/V in the incident period was associated with 13.5% (OR = 0.865; 95%CI 0.801-to-0.935) lower risk of a change to a longer DRT in the first-prevalent year. A higher number of HD treatments with IDH episodes per month in the incident period was associated with a 0.8% (OR = 1.008; 95%CI 1.001-to-1.015) and 1.6% (OR = 1.016; 95%CI 1.006-to-1.027) higher probability of a change to a longer DRT in the first- and second-prevalent years, respectively. Consistently, an increased in incidence of IDH episodes/months was associated to a change to a longer DRT over time. CONCLUSIONS: Incident patients who had higher spKt/V and less sessions with IDH episodes had a lower likelihood of changing to a longer DRT in first year of HD. Dose optimization strategies with cardiac stability in fluid removal should be tested.

Patient perception of vitality and measured physical activity in patients receiving haemodialysis.

AIM: Fatigue in haemodialysis (HD) patients can be captured in quality of life questionnaires and by the dialysis recovery time (DRT) question. The associations between fatigue and measured physical activity has not been explored until the present. We tested our hypothesis that the patient perception of chronic and post dialysis fatigue would be associated with lower physical activity. METHODS: This study was a cross sectional evaluation of baseline data from HD patients recruited in the HDFIT trial. Vitality scores from the Kidney Disease Quality of Life (KDQOL-36) and the dialysis recovery time (DRT) question were used as indicators of chronic and post dialysis fatigue, respectively. Granular physical activity was measured by accelerometers as part of the study protocol. RESULTS: Among 176 patients, Vitality score was 63 ± 21 and the DRT was ≤30 minutes in 57% of patients. The mean number of steps was 5288 ± 3540 in 24 hours after HD and 953 ± 617 in the 2-hour post-HD period. The multivariable analysis confirmed Vitality scores were associated with physical activity in the 24-hour post-HD period. In contrast, DRT was not associated with physical activity captured by the accelerometer in the period immediately (2 hours) after the HD session. CONCLUSION: Chronic fatigue was negatively associated with step counts, while patient perception of post-dialysis fatigue was not associated with physical activity. These patterns indicate limitations in interpretation of DRT. Since physical activity is an important component of a healthy life, our results may partially explain the associations between fatigue and poor outcomes in HD patients.

Thermal Tolerance Plasticity in Chagas Disease Vectors Rhodnius prolixus (Hemiptera: Reduviidae) and Triatoma infestans.

Temperature is recognized as the most influential abiotic factor on the distribution and dispersion of most insect species including Rhodnius prolixus (Stål, 1859) and Triatoma infestans (Klug, 1834), the two most important Chagas disease vectors. Although, these species thermotolerance range is well known their plasticity has never been addressed in these or any other triatomines. Herein, we investigate the effects of acclimation on thermotolerance range and resistance to stressful low temperatures by assessing thermal critical limits and 'chill-coma recovery time' (CCRT), respectively. We found positive effects of acclimation on thermotolerance range, especially on the thermal critical minimum of both species. In contrast, CCRT did not respond to acclimation in either. Our results reveal the plasticity of these Triatomines thermal tolerance in response to a wide range of acclimation temperatures. This presumably represents a physiological adaptation to daily or seasonal temperature variation with concomitant improvement in dispersion potential.

Anesthetic efficacy of clove oil and 2-phenoxyethanolon doctor fish, Garra rufa (Heckel, 1843) / Eficácia anestésica do petróleo e do 2-fenoxietanol no peixe do doutor, Garra rufa (Heckel, 1843)

This study aimed to determine the anesthetic efficacy of clove oil and 2-phenoxyethanol on doctor fish (Garra rufa) at two different water temperatures. Experimental fish (1.2 ± 0.2 g mean weight) were subjected to 25, 50, 75 and 100 μL L-1 clove oil and 100, 200, 300, 400 and 500 μL L-1 2-phenoxyethanol concentrations at water temperature of 15 and 25 °C, and the induction and recovery times were investigated. Results showed that induction and recovery times in doctor fish were significantly affected by clove oil and 2-phenoxyethanol concentrations as well as water temperature. The interaction of anesthetic concentration and water temperature on all induction stage time was significant in clove oil. Between the anesthetic concentration and temperature interaction was significant for recovery times in both anesthetic agents. The induction time decreased significantly with increasing concentration of both anesthetic agents at water temperature of 15 and 25 °C. The lowest effective concentrations that produced induction within 3 min and recovery within 5 min were 50-75 μL L-1 of clove oil and 300 μL L-1 of 2-phenoxyethanol in both 15 and 25 °C respectively. The results also indicated that clove oil was effective at 4-fold lower concentrations than 2-phenoxyethanol, but the recovery time was longer than 2-phenoxyethanol. These results suggest that clove oil and 2-phenoxyethanol were effective anesthetics and could be used as anesthetic agents in doctor fish.

Este estudo teve como objetivo determinar a eficácia anestésica do óleo de cravo e do 2-fenoxietanol em peixes medicinais (Garra rufa) em duas diferentes temperaturas da água. Os peixes (1,2 ± 0,2 g de peso médio) foram expostos a 25, 50, 75 e 100 μL L-1 de óleo de cravo e 100, 200, 300, 400 e 500 μL L-1 de 2-fenoxietanol a 15 e 25 ° C. temperatura da água e os tempos de indução e recuperação foram investigados. Os resultados mostraram que os tempos de indução e recuperação nos peixes medicinais foram significativamente afetados pelas concentrações de óleo de cravo e 2-fenoxietanol, bem como pela temperatura da água. A interação de concentração e temperatura da água em todos os tempos de estágio de indução foi significativa no óleo de cravo. Concentração de efeito interativa significativa e temperatura no tempo de recuperação foram encontradas para cada agente anestésico. O tempo de indução diminuiu significativamente com o aumento da concentração de ambos os agentes anestésicos a 15 e 25 ° C da temperatura da água. As menores concentrações efetivas que produziram indução dentro de 3 min e recuperação dentro de 5 min foram 50-75 μL L-1 de óleo de cravo e 300 μL L-1 de 2-fenoxietanolem 15 e 25 ° C respectivamente para peixes medicinais. Os resultados também indicaram que o óleo de cravo-da-índia era eficaz em concentrações 4 vezes menores do que o 2-fenoxietanol, mas a recuperação foi maior do que o 2-fenoxietanol. Estes resultados sugerem que o óleo de cravo e o 2-fenoxietanol eram anestésicos eficazes e poderiam ser usados como agentes anestésicos em peixes medicinais.

Anesthetic efficacy of clove oil and 2-phenoxyethanolon doctor fish, Garra rufa (Heckel, 1843) / Eficácia anestésica do petróleo e do 2-fenoxietanol no peixe do doutor, Garra rufa (Heckel, 1843)

This study aimed to determine the anesthetic efficacy of clove oil and 2-phenoxyethanol on doctor fish (Garra rufa) at two different water temperatures. Experimental fish (1.2 ± 0.2 g mean weight) were subjected to 25, 50, 75 and 100 μL L-1 clove oil and 100, 200, 300, 400 and 500 μL L-1 2-phenoxyethanol concentrations at water temperature of 15 and 25 °C, and the induction and recovery times were investigated. Results showed that induction and recovery times in doctor fish were significantly affected by clove oil and 2-phenoxyethanol concentrations as well as water temperature. The interaction of anesthetic concentration and water temperature on all induction stage time was significant in clove oil. Between the anesthetic concentration and temperature interaction was significant for recovery times in both anesthetic agents. The induction time decreased significantly with increasing concentration of both anesthetic agents at water temperature of 15 and 25 °C. The lowest effective concentrations that produced induction within 3 min and recovery within 5 min were 50-75 μL L-1 of clove oil and 300 μL L-1 of 2-phenoxyethanol in both 15 and 25 °C respectively. The results also indicated that clove oil was effective at 4-fold lower concentrations than 2-phenoxyethanol, but the recovery time was longer than 2-phenoxyethanol. These results suggest that clove oil and 2-phenoxyethanol were effective anesthetics and could be used as anesthetic agents in doctor fish.(AU)

Este estudo teve como objetivo determinar a eficácia anestésica do óleo de cravo e do 2-fenoxietanol em peixes medicinais (Garra rufa) em duas diferentes temperaturas da água. Os peixes (1,2 ± 0,2 g de peso médio) foram expostos a 25, 50, 75 e 100 μL L-1 de óleo de cravo e 100, 200, 300, 400 e 500 μL L-1 de 2-fenoxietanol a 15 e 25 ° C. temperatura da água e os tempos de indução e recuperação foram investigados. Os resultados mostraram que os tempos de indução e recuperação nos peixes medicinais foram significativamente afetados pelas concentrações de óleo de cravo e 2-fenoxietanol, bem como pela temperatura da água. A interação de concentração e temperatura da água em todos os tempos de estágio de indução foi significativa no óleo de cravo. Concentração de efeito interativa significativa e temperatura no tempo de recuperação foram encontradas para cada agente anestésico. O tempo de indução diminuiu significativamente com o aumento da concentração de ambos os agentes anestésicos a 15 e 25 ° C da temperatura da água. As menores concentrações efetivas que produziram indução dentro de 3 min e recuperação dentro de 5 min foram 50-75 μL L-1 de óleo de cravo e 300 μL L-1 de 2-fenoxietanolem 15 e 25 ° C respectivamente para peixes medicinais. Os resultados também indicaram que o óleo de cravo-da-índia era eficaz em concentrações 4 vezes menores do que o 2-fenoxietanol, mas a recuperação foi maior do que o 2-fenoxietanol. Estes resultados sugerem que o óleo de cravo e o 2-fenoxietanol eram anestésicos eficazes e poderiam ser usados como agentes anestésicos em peixes medicinais.(AU)

[Safety of reducing the recovery time after percutaneous and laparoscopic liver biopsy]. / Seguridad de la reducción del tiempo de reposo posbiopsia hepática percutánea y por vía laparoscópica.

BACKGROUND: Liver biopsy is the main diagnostic tool for the study of the liver, and as such, its inherent complications have been minimised as much as possible over the years, through the modification of several factors regarding its procedure, including post-biopsy recovery time. The aim of this study was to evaluate the safety in the reduction of post-liver biopsy recovery time. MATERIAL AND METHODS: A non-blinded, randomised clinical trial was conducted in the "Hermanos Ameijeiras" Hospital from November 2011 to October 2012, on 128 patients in order to assess safety when reducing post-biopsy recovery times. The patients were randomised into 2 groups. Group A was allowed a 6-hour recovery time, while Group B was allowed a 2-hour recovery time after liver biopsy. Complications were fully recorded. The Chi squared test of homogeneity and Student t test was used as appropriate, in the statistical analysis, a significance level of 0.05 was set. RESULTS: The main biopsy indication was elevated plasma transaminases. Pain in the puncture site was the most recurrent complication (67.2%), and the most serious complication was subcapsular liver haematoma in two cases (1.6%). There were no differences regarding the liver biopsy technique that could have caused complications in any group. CONCLUSIONS: There were no significant differences between 2 hours and 6 hours post-liver biopsy recovery time in terms of complications, so it is considered that after two hours the patient is incorporated more quickly into their activities, and the institution spends less material and human resources.

Tempo de recuperação entre a pesagem e o início das lutas em competições de judô do Estado de São Paulo / Recovery time between weigh-in and first match in State level judo competitions

A perda rápida de peso é altamente prevalente entre atletas de luta. No judô, há um período entre a pesagem e o início da competição no qual atletas podem se recuperar da perda de peso. Apesar desse tempo ser determinante para o desempenho, nenhum estudo avaliou seu padrão de duração. Este estudo objetivou determinar o padrão de duração do tempo entre a pesagem e o início das lutas em competições oficiais de judô. Foram analisados 117 atletas do sexo masculino (classes juvenil, júnior e sênior) durante duas competições oficiais. Registraram-se o horário de término da pesagem e do início da primeira luta de cada atleta. O tempo médio de recuperação foi de aproximadamente quatro horas. A maior parte dos atletas teve aproximadamente 2,5 - 5 horas entre a pesagem e o início das lutas. O período para a classe sênior foi significantemente maior do que o das classes júnior e juvenil (p < 0,01) e o da classe júnior foi significantemente maior do que o da classe juvenil (p < 0,01). Conclui-se que os tempos de recuperação aqui registrados são provavelmente padrões para competições de mesmo porte e esquema organizacional, embora os tempos específicos para as classes etárias possam se modificar. O período que a maioria dos atletas teve para recuperar-se é suficiente para adequada ingestão de alimentos e líquidos, o que minimiza o impacto da perda de peso sobre o desempenho e estimula a pratica de métodos agressivos de perda rápida de peso.

Rapid weight loss is highly prevalent among combat sport athletes. After the weigh-in, there is a period in which athletes can refeed and rehydrate before the combats. The length of this recovery period is determinant for performance in the subsequent combats. No study, however, has determined the time patterns of such period. The purpose of this study was to determine the patterns of recovery time between the weigh-in and the first combats during judo competitions. One hundred and seventeen juvenile, junior and senior male athletes were analyzed during two São Paulo state competitions. The time at which each athlete has finished the weight-in and the time at which they have started the first combat were recorded and then the recovery period between weigh-in and combats was calculated. Average recovery time was approximately four hours. Most athletes had a 2.5 to 5-hour recovery time between the weigh-in and the first combat. Senior athletes had a significant longer recovery time compared to junior and juvenile (p < 0.001). Junior athletes also had a significant longer recovery time in comparison to juvenile athletes (p < 0.001). In conclusion, the patterns for recovery time presented in this study are likely to be a standard if competitions of similar size and organization are considered. Recovery period for the majority of athletes is enough to allow them to refeed and rehydrate, so the impact of weight loss on performance would be minimal. This can stimulate athletes to engage in potentially harmful rapid weight loss procedures.