ABSTRACT
This paper involves the analysis of the quality of anthropometric data on children under five years of age in two information systems in the State of São Paulo. The sample included 2,117,108 children from the Food and Nutrition Surveillance System (SISVAN), and 748,551 from the State Milk Project (VIVALEITE). Initially, we evaluated the frequency of missing values and others outside the equipment spectrum and calculated the digit-to-weight preference index. After calculating height-for-age (HAZ), weight-for-age (WAZ), and body mass index-for-age (BAZ), we flagged the biologically implausible values (BIV) and calculated the standard deviation (SD). For each municipality, we calculated the mean and the SD of HAZ, WAZ, and BAZ; and plotted the SD values as a function of the mean. The digit-to-weight preference index was greater among children aged between 24 and 59 months in SISVAN. The frequency of BIV for HAZ (SISVAN 2.56%; VIVALEITE 0.98%) was higher than for WAZ (SISVAN 2.10%; VIVALEITE 0.18%). For HAZ, variations among municipalities were more pronounced in VIVALEITE than in SISVAN. The height variable presents low reliability in both systems. The weight variable reveals satisfactory quality in VIVALEITE and unsatisfactory quality in SISVAN.
O objetivo foi analisar a qualidade dos dados antropométricos de crianças menores de cinco anos em dois sistemas de informação no estado de São Paulo. A amostra compreendeu 2.117.108 crianças do Sistema de Vigilância Alimentar e Nutricional (Sisvan) e 748.551 do Projeto Estadual do Leite (Vivaleite). Inicialmente, avaliamos a frequência de valores faltantes e fora do espectro do equipamento, e calculamos o índice de preferência de dígito para peso. Após calcular os índices de altura para idade (A-I), peso para idade (P-I) e índice de massa corporal para idade (IMC-I), identificamos os valores biologicamente implausíveis (VBI) e calculamos o desvio-padrão (DP). Para cada município, calculamos a média e o DP de A-I, P-I e IMC-I; e plotamos os valores de DP em função da média. A preferência de dígito no peso foi maior em crianças de 24 a 59 meses no Sisvan. A frequência de VBI para A-I (SISVAN 2,56%; Vivaleite 0,98%) foi maior do que para P-I (Sisvan 2,10%; Vivaleite 0,18%). Para o índice A-I as variações entre os municípios foram mais acentuadas no Vivaleite do que no Sisvan. A variável altura apresentou baixa confiabilidade nos dois sistemas. A variável peso apresentou qualidade satisfatória no Vivaleite e insatisfatória no Sisvan.
Subject(s)
Anthropometry , Body Height , Body Weight , Information Systems , Brazil , Humans , Infant , Child, Preschool , Female , Male , Information Systems/standards , Body Mass Index , Data Accuracy , Age FactorsABSTRACT
The planning, monitoring, and evaluation of food and nutrition actions depend on reliable estimates based on adequate anthropometric data. The study aimed to analyze the quality of anthropometric data of children aged under 5 years in the Brazilian National Food and Nutrition Surveillance System (SISVAN) from 2008 to 2020. The sample comprised 23,453,620 children aged under 5 years. Initially, we evaluated the distribution of missing values and values outside the spectrum of the instrument, and calculated the digit preference index for weight and height. The nutritional indexes height for age (HAZ), weight for age (WAZ), and body mass index for age (BAZ) were calculated according to the World Health Organization 2006 child growth standards. Then, we identified the biologically implausible values (BIV) and calculated the standard deviation (SD) of the nutritional indexes. For each municipality, we calculated the mean and SD of HAZ and WAZ; and plotted the SD values as a function of the mean. In all Federative Units, the digit preference index reached a minimum value of 80 for height and 20 for weight. For the three nutritional indexes, there was a reduction in the frequency of BIV in the 2008-2020 period. Even after the exclusion of BIV, we identified high variability for the three nutritional indexes. The indicators evaluated showed low quality of measurement, especially in the North and Northeast regions. Our results indicate insufficient quality of anthropometric data in children aged under 5 years, and reinforce the need to invest in actions to improve the collection and recording of anthropometric information.
O planejamento, o monitoramento e a avaliação das ações de alimentação e nutrição dependem de estimativas confiáveis realizadas a partir de dados antropométricos de qualidade adequada. O objetivo deste estudo foi analisar a qualidade de dados antropométricos de crianças menores de 5 anos no Sistema de Vigilância Alimentar e Nutricional (SISVAN) no período de 2008 a 2020. A amostra compreendeu 23.453.620 crianças menores de 5 anos. Inicialmente, avaliamos a distribuição de valores faltantes e de valores fora do espectro do equipamento e calculamos o índice de preferência de dígito para peso e altura. Os índices nutricionais altura para idade (A-I), peso para idade (P-I) e índice de massa corporal para idade (IMC-I) foram calculados com a utilização do padrão de crescimento da Organização Mundial da Saúde, de 2006. Em seguida, sinalizamos os valores biologicamente implausíveis (VBI) e calculamos o desvio padrão (DP) dos índices nutricionais. Para cada município, calculamos a média e o DP de A-I e P-I e plotamos os valores de DP em função da média. Em todas as Unidades Federativas, o índice de preferência de dígito alcançou valor mínimo de 80 para altura e 20 para peso. Para os três índices nutricionais, houve redução da frequência de VBI no período de 2008 a 2020. Mesmo após a exclusão dos VBI, identificamos elevada variabilidade para os três índices nutricionais. Os indicadores avaliados demonstraram baixa qualidade da mensuração principalmente nas regiões Norte e Nordeste. Nossos resultados indicam qualidade insuficiente dos dados antropométricos em crianças menores de 5 anos e reforçam a necessidade de investimento em ações para o aprimoramento da coleta e do registro das informações antropométricas.
La planificación, monitoreo y evaluación de acciones de alimentación y nutrición dependen de estimaciones confiables realizadas a partir de datos antropométricos de calidad adecuada. El objetivo del estudio fue analizar la calidad de datos antropométricos de niños menores de 5 años en el Sistema de Vigilancia Alimentaria y Nutricional (SISVAN) entre los años 2008 y 2020. La muestra se compuso de 23.453.620 niños menores de 5 años. Al principio, evaluamos la distribución de valores faltantes y de valores fueras del espectro del equipo, y calculamos el índice de preferencia de dígito para peso y altura. Los índices nutricionales altura para edad (A-E), peso para edad (P-E) e índice de masa corporal para edad (IMC-E) se calcularon utilizando el patrón de crecimiento de la Organización Mundial de la Salud de 2006. Luego, indicamos los valores biológicamente inverosímiles (VBI) y calculamos la desviación estándar (DE) de los índices nutricionales. Para cada municipio, calculamos la media y la DE de A-E y P-E; y representamos los valores de DE en función de la media. En todas las Unidades Federativas, el índice de preferencia de dígito alcanzó el valor mínimo de 80 para altura y 20 para peso. Para los tres índices nutricionales, hubo una disminución de la frecuencia de VBI entre los años de 2008 y 2020. Incluso tras excluir los VBI, identificamos una alta variabilidad para los tres índices nutricionales. Los indicadores evaluados demostraron una baja calidad de medición, sobre todo en las regiones Norte y Nordeste. Nuestros resultados indican una calidad insuficiente de datos antropométricos en niños menores de 5 años y fortalecen la necesidad de inversión en acciones para mejorar la recolección y registro de las informaciones antropométricas.
Subject(s)
Body Height , Nutritional Status , Humans , Child , Child, Preschool , Body Weight , Brazil , Body Mass Index , AnthropometryABSTRACT
AIM: To assess the impact of adult body mass index (BMI) trajectories on the risk of obesity-related noncommunicable diseases (NCDs) in the U.S. adults after adjustment for sociodemographic and lifestyle factors. METHODS: Data were extracted from the National Health and Nutrition Examination Survey conducted from 2007 to 2018, including male and female participants aged 29-59 years. Rao-Scott adjusted chi-square was employed to detect associations between categorical variables in descriptive analyses. Cox proportional hazards models estimated hazard ratios (HR) and 95% confidence intervals (CI) for NCDs and BMI trajectories, adjusted for sociodemographic and lifestyle factors. Kaplan-Meier curves illustrated the cumulative incidence over time. RESULTS: Analyses were carried out on 15 721 participants and revealing significant differences among BMI trajectories in terms of demographic, lifestyle, and health characteristics. The overall prevalence of NCDs was 28.0% (95%CI:26.6-28.9). The cumulative incidence over time was higher in the high increase, moderate increase, and mixed trajectory groups, with a correspondingly higher cumulative risk (p < 0.001). Non-overweight trajectory was considered reference category in Cox models. The BMI trajectories were independently associated with an increased risk of NCDs, even after adjusting for potential confounders (HR: 1.7; 95%CI: 1.4-1.9 for moderate increase; HR: 3.6; 95%CI: 3.2-4.1 for high increase; and HR: 2.4; 95%CI: 2.1-2.7, for mixed). Furthermore, differences between males and females were also observed. CONCLUSION: The transition to and persistence of obesity into adulthood increases the risk of NCDs. The implementation of targeted interventions with long-term monitoring of BMI may be beneficial in the prevention of future obesity-related NCDs.
Subject(s)
Noncommunicable Diseases , Adult , Humans , Male , Female , Body Mass Index , Nutrition Surveys , Risk Factors , Obesity/epidemiology , Risk AssessmentABSTRACT
BACKGROUND: Out-of-hospital cardiac arrest (OHCA) has a poor prognosis. The optimal timing and role of early coronary angiography (CAG) in OHCA patients without ST-segment elevation remains unclear. The goal of this study is to compare an early CAG versus delayed CAG strategy in OHCA patients without ST elevation. METHODS: We systematically searched PubMed, Embase and Cochrane databases, in June 2022, for randomised controlled trials (RCTs) comparing early versus delayed early CAG. A random effects meta-analysis was performed. RESULTS: A total of seven RCTs were included, providing a total of 1625 patients: 816 in an early strategy and 807 in a delayed strategy. In terms of outcomes assessed, our meta-analysis revealed a similar rate of all-cause mortality (pooled odds ratio [OR] 1.22 [0.99-1.50], P â =â 0.06, I 2 â =â 0%), neurological status (pooled OR 0.94 [0.74-1.21], = 0.65, I 2 â =â 0%), need of renal replacement therapy (pooled OR 1.11 [0.78-1.74], P â =â 0.47, I 2 â =â 0%) and major bleeding events (pooled OR 1.51 [0.95-2.40], P â =â 0.08, I 2 â =â 69%). CONCLUSION: According to our meta-analysis, in patients who experienced OHCA without ST elevation, early CAG is not associated with reduced mortality or an improved neurological status.
Subject(s)
Cardiopulmonary Resuscitation , Out-of-Hospital Cardiac Arrest , Percutaneous Coronary Intervention , ST Elevation Myocardial Infarction , Humans , Coronary Angiography/adverse effects , Out-of-Hospital Cardiac Arrest/diagnostic imaging , Out-of-Hospital Cardiac Arrest/therapy , ST Elevation Myocardial Infarction/diagnostic imaging , ST Elevation Myocardial Infarction/therapy , ST Elevation Myocardial Infarction/complications , Time Factors , Percutaneous Coronary Intervention/adverse effects , Randomized Controlled Trials as TopicABSTRACT
O planejamento, o monitoramento e a avaliação das ações de alimentação e nutrição dependem de estimativas confiáveis realizadas a partir de dados antropométricos de qualidade adequada. O objetivo deste estudo foi analisar a qualidade de dados antropométricos de crianças menores de 5 anos no Sistema de Vigilância Alimentar e Nutricional (SISVAN) no período de 2008 a 2020. A amostra compreendeu 23.453.620 crianças menores de 5 anos. Inicialmente, avaliamos a distribuição de valores faltantes e de valores fora do espectro do equipamento e calculamos o índice de preferência de dígito para peso e altura. Os índices nutricionais altura para idade (A-I), peso para idade (P-I) e índice de massa corporal para idade (IMC-I) foram calculados com a utilização do padrão de crescimento da Organização Mundial da Saúde, de 2006. Em seguida, sinalizamos os valores biologicamente implausíveis (VBI) e calculamos o desvio padrão (DP) dos índices nutricionais. Para cada município, calculamos a média e o DP de A-I e P-I e plotamos os valores de DP em função da média. Em todas as Unidades Federativas, o índice de preferência de dígito alcançou valor mínimo de 80 para altura e 20 para peso. Para os três índices nutricionais, houve redução da frequência de VBI no período de 2008 a 2020. Mesmo após a exclusão dos VBI, identificamos elevada variabilidade para os três índices nutricionais. Os indicadores avaliados demonstraram baixa qualidade da mensuração principalmente nas regiões Norte e Nordeste. Nossos resultados indicam qualidade insuficiente dos dados antropométricos em crianças menores de 5 anos e reforçam a necessidade de investimento em ações para o aprimoramento da coleta e do registro das informações antropométricas.
The planning, monitoring, and evaluation of food and nutrition actions depend on reliable estimates based on adequate anthropometric data. The study aimed to analyze the quality of anthropometric data of children aged under 5 years in the Brazilian National Food and Nutrition Surveillance System (SISVAN) from 2008 to 2020. The sample comprised 23,453,620 children aged under 5 years. Initially, we evaluated the distribution of missing values and values outside the spectrum of the instrument, and calculated the digit preference index for weight and height. The nutritional indexes height for age (HAZ), weight for age (WAZ), and body mass index for age (BAZ) were calculated according to the World Health Organization 2006 child growth standards. Then, we identified the biologically implausible values (BIV) and calculated the standard deviation (SD) of the nutritional indexes. For each municipality, we calculated the mean and SD of HAZ and WAZ; and plotted the SD values as a function of the mean. In all Federative Units, the digit preference index reached a minimum value of 80 for height and 20 for weight. For the three nutritional indexes, there was a reduction in the frequency of BIV in the 2008-2020 period. Even after the exclusion of BIV, we identified high variability for the three nutritional indexes. The indicators evaluated showed low quality of measurement, especially in the North and Northeast regions. Our results indicate insufficient quality of anthropometric data in children aged under 5 years, and reinforce the need to invest in actions to improve the collection and recording of anthropometric information.
La planificación, monitoreo y evaluación de acciones de alimentación y nutrición dependen de estimaciones confiables realizadas a partir de datos antropométricos de calidad adecuada. El objetivo del estudio fue analizar la calidad de datos antropométricos de niños menores de 5 años en el Sistema de Vigilancia Alimentaria y Nutricional (SISVAN) entre los años 2008 y 2020. La muestra se compuso de 23.453.620 niños menores de 5 años. Al principio, evaluamos la distribución de valores faltantes y de valores fueras del espectro del equipo, y calculamos el índice de preferencia de dígito para peso y altura. Los índices nutricionales altura para edad (A-E), peso para edad (P-E) e índice de masa corporal para edad (IMC-E) se calcularon utilizando el patrón de crecimiento de la Organización Mundial de la Salud de 2006. Luego, indicamos los valores biológicamente inverosímiles (VBI) y calculamos la desviación estándar (DE) de los índices nutricionales. Para cada municipio, calculamos la media y la DE de A-E y P-E; y representamos los valores de DE en función de la media. En todas las Unidades Federativas, el índice de preferencia de dígito alcanzó el valor mínimo de 80 para altura y 20 para peso. Para los tres índices nutricionales, hubo una disminución de la frecuencia de VBI entre los años de 2008 y 2020. Incluso tras excluir los VBI, identificamos una alta variabilidad para los tres índices nutricionales. Los indicadores evaluados demostraron una baja calidad de medición, sobre todo en las regiones Norte y Nordeste. Nuestros resultados indican una calidad insuficiente de datos antropométricos en niños menores de 5 años y fortalecen la necesidad de inversión en acciones para mejorar la recolección y registro de las informaciones antropométricas.
ABSTRACT
CONTEXT: Poor anthropometric data quality affect the prevalence of malnutrition and could harm public policy planning. OBJECTIVE: This systematic review and meta-analysis was designed to identify different methods to evaluate and clean anthropometric data, and to calculate the frequency of implausible values for weight and height obtained from these methodologies. DATA SOURCES: Studies about anthropometric data quality and/or anthropometric data cleaning were searched for in the MEDLINE, LILACS, SciELO, Embase, Scopus, Web of Science, and Google Scholar databases in October 2020 and updated in January 2023. In addition, references of included studies were searched for the identification of potentially eligible studies. DATA EXTRACTION: Paired researchers selected studies, extracted data, and critically appraised the selected publications. DATA ANALYSIS: Meta-analysis of the frequency of implausible values and 95% confidence interval (CI) was estimated. Heterogeneity (I2) and publication bias were examined by meta-regression and funnel plot, respectively. RESULTS: In the qualitative synthesis, 123 reports from 104 studies were included, and in the quantitative synthesis, 23 studies of weight and 14 studies of height were included. The study reports were published between 1980 and 2022. The frequency of implausible values for weight was 0.55% (95%CI, 0.29-0.91) and for height was 1.20% (95%CI, 0.44-2.33). Heterogeneity was not affected by the methodological quality score of the studies and publication bias was discarded. CONCLUSIONS: Height had twice the frequency of implausible values compared with weight. Using a set of indicators of quality to evaluate anthropometric data is better than using indicators singly. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration no. CRD42020208977.
ABSTRACT
Fabry disease is a multisystem lysosomal storage disorder caused by mutations in the GLA gene that result in a deficient or absent activity of alpha-galactosidase A. There is a wide spectrum of GLA gene variants, some of which are described as non-pathogenic. The clinical importance of the D313Y variant is still under debate, although in recent years it has been considered as a variant of unknown significance or a benign variant. Despite this prevailing notion, there are multiple case reports of patients with D313Y variant that presented signs and symptoms consistent with FD without any other etiological explanation. In this article, we present two family members with an important renal phenotype and other typical manifestations of FD (white matter lesions and left ventricular hypertrophy) that only had the D313Y variant. These cases suggest that this variant of unknown significance may contribute to the development of common features of FD and should not be undervalued. (AU)
La enfermedad de Fabry (EF) es un trastorno de almacenamiento lisosómico multisistémico causado por mutaciones en el gen GLA que tienen como resultado una actividad deficiente o ausente de alfa-galactosidasa A. Existe un amplio espectro de variantes del gen GLA, algunas de las cuales se describen como no patógenas. La importancia clínica de la variante D313Y aún está en debate, aunque en los últimos años se ha considerado una variante de significado incierto o una variante benigna. A pesar de esta noción predominante, existen múltiples reportes de casos de pacientes con variante D313Y que presentaron signos y síntomas consistentes con EF sin ninguna otra explicación etiológica. En este artículo presentamos 2 familiares con un importante fenotipo renal y otras manifestaciones típicas de la EF (lesiones de la sustancia blanca e hipertrofia ventricular izquierda) que solo presentaban la variante D313Y. Estos casos indican que esta variante de significado incierto puede contribuir al desarrollo de características comunes de la EF y no debe subestimarse. (AU)
Subject(s)
Humans , Male , Female , Young Adult , Adult , Fabry Disease/genetics , Fabry Disease/diagnosis , Kidney Diseases , alpha-Galactosidase/genetics , Mutation/geneticsABSTRACT
There are no scientific data available on the occurrence of the Echinococcus granulosus sensu lato (s.l.) cluster in definitive hosts (domestic dogs), intermediate hosts (domestic livestock) nor humans in Cape Verde. In this pilot study, environmental dog fecal samples (n = 369) were collected around food markets, official slaughterhouses, as well as home and small business slaughter spots in 8 of the 9 inhabited islands from the Cape Verde archipelago, between June 2021 and March 2022. Additionally, during the same period, 40 cysts and tissue lesions were opportunistically collected from 5 islands, from locally slaughtered cattle (n = 7), goats (n = 2), sheep (n = 1) and pigs (n = 26). Genetic characterization by a multiplex polymerase chain reaction assay targeting the 12S rRNA gene confirmed the presence of E. granulosus s.l. in fecal and tissue material. In total, 17 cyst samples from Santiago (n = 9), Sal (n = 7) and São Vicente (n = 1) and 8 G6/G7-positive dog fecal samples from Santiago (n = 4) and Sal (n = 4) were identified as E. granulosus s.l. G7 by sequence analysis (nad2, nad5 and nad1 genes). This study discloses the transmission of E. granulosus s.l. G7, in pig, cattle and dog in Cape Verde.
Subject(s)
Echinococcosis , Echinococcus granulosus , Animals , Humans , Dogs , Cattle , Sheep , Swine , Echinococcosis/epidemiology , Pilot Projects , Cabo Verde , Genotype , GoatsABSTRACT
Fabry disease is a multisystem lysosomal storage disorder caused by mutations in the GLA gene that result in a deficient or absent activity of alpha-galactosidase A. There is a wide spectrum of GLA gene variants, some of which are described as non-pathogenic. The clinical importance of the D313Y variant is still under debate, although in recent years it has been considered as a variant of unknown significance or a benign variant. Despite this prevailing notion, there are multiple case reports of patients with D313Y variant that presented signs and symptoms consistent with FD without any other etiological explanation. In this article, we present two family members with an important renal phenotype and other typical manifestations of FD (white matter lesions and left ventricular hypertrophy) that only had the D313Y variant. These cases suggest that this variant of unknown significance may contribute to the development of common features of FD and should not be undervalued.
Subject(s)
Fabry Disease , Kidney Failure, Chronic , Humans , Fabry Disease/complications , Fabry Disease/genetics , alpha-Galactosidase/genetics , Mutation , Phenotype , Kidney Failure, Chronic/geneticsABSTRACT
Introdução: A Vigilância Alimentar e Nutricional (VAN) possibilita a identificação precoce de alterações do estado nutricional promovendo a realização de intervenções em tempo oportuno. A análise das intervenções, monitoramento e avaliação das políticas de alimentação e nutrição dependem de estimativas confiáveis realizadas a partir de dados antropométricos consistentes. Objetivos: Revisar a literatura sobre VAN e métodos para analisar a qualidade dos dados antropométricos, aplicar estes métodos em dados de VAN, e propor metodologia para lidar com o excesso de variabilidade e o seu impacto no estado nutricional infantil. Métodos: Foi realizada revisões da literatura com base em documentos institucionais e científicos. Em seguida, foram obtidos dados de inquéritos do Brasil e de Portugal, do Sistema de Vigilância Alimentar e Nutricional (SISVAN) e do VIVALEITE-SP. A análise documental abrangeu as ações de VAN do Brasil e de Portugal. A revisão sistemática com meta-análise identificou os métodos para avaliar a qualidade de dados antropométricos. No período de 2008 a 2020, analisou-se a adequação do número de consultas ao calendário mínimo para crianças menores de 5 anos no SISVAN. No mesmo período e faixa etária, foi analisada a qualidade de dados antropométricos no SISVAN. A qualidade dos dados antropométricos do VIVALEITE-SP e do SISVAN-SP foram comparadas. Finalmente, foram comparados três métodos para lidar com o excesso de variabilidade: 1) critério OMS 2006, 2) critério SMART, e 3) uma proposta na qual utilizou-se a variabilidade do SISVAN para o cálculo dos índices nutricionais. Os resultados foram distribuídos em 6 manuscritos. Resultados: No primeiro manuscrito, observou-se que no Brasil e em Portugal as ações de VAN são efetivadas via políticas e programas de saúde. No segundo, entre os métodos identificados para análise da qualidade de dados antropométricos destacam-se sinalização de valores implausíveis, preferência de dígito, e parâmetros da distribuição. No terceiro, a adequação dos registros das crianças nascidas a partir de 2008 ao calendário mínimo de consultas do SISVAN foi de 22,3% com desigualdades sendo menor na região Norte (9,2%) e maior na região Sul (38,7%). No quarto, após a exclusão de valores biologicamente implausíveis (VBI), no índice altura para idade (A-I) (4,1%) e peso para idade (P-I) (2,1%); observou-se variabilidade elevada em A-I (DP: 1,7) e em P-I (DP: 1,3). No quinto, a frequência de VBI foi maior no SISVAN-SP do que no VIVALEITE-SP tanto para A-I (SISVAN-SP 2,6%; VIVALEITE-SP 1,0%) quanto para P-I (SISVAN-SP 2,1%; VIVALEITE-SP 0,2%). No sexto, para lidar com o excesso de variabilidade compararam-se três métodos: 1) o critério OMS 2006 se mostrou inapropriado em situações com alta variabilidade; 2) o critério SMART diminuiu a variabilidade por meio de redução expressiva do tamanho da amostra; e 3) a proposta deste estudo permitiu reduzir a variabilidade, preservando o tamanho e representatividade da amostra. Conclusões: O SISVAN demonstrou qualidade insuficiente na mensuração das variáveis antropométricas. A adequação ao calendário mínimo de consultas e qualidade de dados antropométricos evidenciam as desigualdades regionais. A proposta apresentada se mostrou confiável para descrever as tendências do estado nutricional infantil, preservando a representatividade nacional dos dados.
Introduction: Food and Nutrition Surveillance (FNS) enables early identification of modifications in the nutritional status, promoting the implementation of interventions promptly. The analysis of interventions, monitoring, and food and nutrition policies depend on reliable estimates made from consistent anthropometric data. Objectives: To review the literature about FNS and methods to analyze the anthropometric data quality, apply these methods to FNS data, and propose a methodology to deal with excessive variability and its impact on child nutritional status. Methods: Literature reviews were carried out based on institutional and scientific documents. Next, data were obtained from surveys in Brazil and Portugal, the Food and Nutrition Surveillance System (SISVAN, Portuguese acronym), and VIVALEITE-SP. Document analysis covered FNS actions in Brazil and Portugal. The systematic review with meta-analysis identified methods to assess the quality of anthropometric data. In the period from 2008 to 2020, the adequacy of the number of consultations to the minimum calendar for children under 5 years of age in SISVAN was analyzed. In the same period and age group, the quality of anthropometric data in SISVAN was analyzed. The quality of anthropometric data from VIVALEITE-SP and SISVAN-SP was compared. Finally, three methods for dealing with excessive variability were compared: 1) the WHO 2006 criterion, 2) the SMART criterion, and 3) a proposal in which SISVAN variability was used to calculate the nutritional scores. The results were distributed in 6 manuscripts. Results: In the first manuscript, it was observed that FNS actions are implemented through health policies and programs in Brazil and Portugal. In the second, among the methods identified for analyzing the quality of anthropometric data, the highlights are implausible values signaling, digit preference, and distribution parameters. In the third, the adequacy of the records of children born from 2008 to the minimum consultation calendar of SISVAN was 22.3%, with inequalities being lower in the North region (9.2%), and higher in the South region (38.7%). In the fourth, after excluding biologically implausible values (BIV), in height-for-age (HAZ) (4.1%) and weight-for-age (WAZ) (2.1%); overdispersion was observed in HAZ (SD: 1.7) and in WAZ (SD: 1.3). In the fifth, the frequency of BIV was higher in SISVAN-SP than in VIVALEITE-SP both for HAZ (SISVAN-SP 2.6%; VIVALEITE-SP 1.0%) and WAZ (SISVAN-SP 2.1%; VIVALEITE-SP 0.2%). In the sixth, to deal with overdispersion, three methods were compared: 1) the WHO 2006 criterion showed to be inappropriate in situations with high variability; 2) the SMART criterion decreased variability by reducing the sample size significantly; and 3) the study proposal decreased overdispersion while preserving the size and representativeness of the sample. Conclusions: SISVAN showed insufficient quality in measuring anthropometric variables. The adequacy to the minimum consultation calendar and the quality of anthropometric data show regional inequalities. The presented proposal showed to be reliable for describing trends in childrens nutritional status, preserving the national representativeness of the dataset.
Subject(s)
Humans , Infant, Newborn , Infant , Child, Preschool , Primary Health Care , Food and Nutritional Surveillance , Child , Anthropometry , Nutritional Status , Data AccuracyABSTRACT
PURPOSE: Augmented renal clearance (ARC) is common in critically ill patients and may lead to subtherapeutic levels of antibiotics, thus influencing clinical outcomes and emergence of multidrug-resistant bacteria. The aim of this systematic review was to search the literature for recommendations concerning dosage adjustment for antibiotics administered to critically ill patients with ARC. METHODS: A search of three electronic databases (Pubmed, Embase and Cochrane) was conducted from inception until the end of March 2021, using terms related to: 1) pharmacokinetics/pharmacodynamics (PK/PD), 2) antibiotic, 3) ARC and 4) critically ill. Two reviewers searched for relevant data and included studies suggesting specific doses for critically ill patients with ARC. RESULTS: Forty-seven studies met the inclusion criteria. Dosage recommendations were found for 18 antibiotics. Differences were found in population characteristics, ARC definition, creatinine clearance (CLCR) determination method, PK methodology and definition of PK/PD targets. Cut-off values for CLCR ranged 120-240 mL/min; the most frequently employed method to define CLCR was Cockcroft-Gault estimation; and 83% of studies used population PK models to predict dosing regimens. All antibiotics, except three, needed upward dosing and/or infusion modality adjustments to reach PK/PD targets. CONCLUSION: Despite the lack of high-quality studies and high heterogeneity, incremental dosing adjustment of antibiotics was frequently needed for critically ill patients with ARC to achieve the desired PK/PD targets. More research is needed to enlarge the number of antibiotics with recommendations for ARC and to validate current suggestions based on mathematical models in a clinical scenario.
Subject(s)
Anti-Bacterial Agents , Renal Insufficiency , Anti-Bacterial Agents/pharmacology , Critical Illness , Female , Humans , MaleABSTRACT
Abstract Antineutrophil cytoplasmic antibodies (ANCAs) are associated with small vessel vasculitis but their prevalence is not rare in other immune diseases. In lupus nephritis (LN), their pathological role and clinical relevance have been the target of controversial views. We present a case of acute kidney injury and nephrotic syndrome in a young woman with diffuse global proliferative and membranous nephritis on her kidney biopsy, showing a full-house immunofluorescence pattern, very allusive of class IV + V LN, but lacking associated clinical criteria and laboratory findings to support the diagnosis of systemic lupus erythematosus (SLE). Furthermore, the patient presented with high titers of ANCA, steadily decreasing alongside the renal function and proteinuria improvements, with mycophenolate mofetil (MMF) and steroid treatment. The authors believe this is a case of lupus-like nephritis, in which ANCAs are immunological markers, although they are not directly involved in the pathogenesis.
Resumo Os anticorpos anticitoplasma de neutrófilos (ANCAs) estão associados à vasculite de pequenos vasos, no entanto, a sua prevalência não é rara em outras doenças imunológicas. Na nefrite lúpica (LN), o seu papel patológico e relevância clínica têm sido alvo de pontos de vista controversos. Apresentamos um caso de lesão renal aguda e síndrome nefrótica em uma jovem com nefrite proliferativa difusa e membranosa em sua biópsia renal, muito alusivo a NL classe IV + V, com um padrão full house na imunofluorescência, mas sem critérios clínicos e achados laboratoriais para corroborar o diagnóstico de lúpus eritematoso sistêmico (LES). Não obstante, a paciente apresentou títulos elevados de ANCA, que diminuiram progressivamente com a melhoria da função renal e da proteinúria, após tratamento com micofenolato de mofetil (MMF) e esteróide. Os autores acreditam que se trata de um caso de nefrite semelhante à nefrite lúpica, em que os ANCAs são marcadores imunológicos, embora não estejam diretamente envolvidos na patogênese.
ABSTRACT
Antineutrophil cytoplasmic antibodies (ANCAs) are associated with small vessel vasculitis but their prevalence is not rare in other immune diseases. In lupus nephritis (LN), their pathological role and clinical relevance have been the target of controversial views. We present a case of acute kidney injury and nephrotic syndrome in a young woman with diffuse global proliferative and membranous nephritis on her kidney biopsy, showing a full-house immunofluorescence pattern, very allusive of class IV + V LN, but lacking associated clinical criteria and laboratory findings to support the diagnosis of systemic lupus erythematosus (SLE). Furthermore, the patient presented with high titers of ANCA, steadily decreasing alongside the renal function and proteinuria improvements, with mycophenolate mofetil (MMF) and steroid treatment. The authors believe this is a case of lupus-like nephritis, in which ANCAs are immunological markers, although they are not directly involved in the pathogenesis.
Subject(s)
Lupus Erythematosus, Systemic , Lupus Nephritis , Antibodies, Antineutrophil Cytoplasmic , Antibodies, Antinuclear/therapeutic use , Female , Humans , Lupus Erythematosus, Systemic/complications , Lupus Nephritis/diagnosis , Lupus Nephritis/drug therapy , Mycophenolic Acid/therapeutic useABSTRACT
The scope of this article is to describe the association between BMI variation, eating patterns and physical activity among adults between 21 and 44 years of age from 2007 to 2012. It is a cross-sectional study using the VIGITEL database. Eating patterns were identified with Principal Components Analysis for the period from 2007 to 2012. Components with eigenvalues >1.0 were retained and factor loadings greater than |0.3| were highlighted. For each individual, a score was calculated per pattern. The Body Mass Index (ΔBMI) difference variable was then created. Linear regression with ΔBMI outcome and Poisson regression with obesity outcomes were conducted. Four eating patterns were retained: Prudent, Transition, Western and Traditional. After multivariate adjustment, ΔBMI was inversely associated with the habit of leisure-time physical activity. Obesity revealed a positive association with the Western pattern, watching television ≥3 hours a day and physical inactivity. Obesity was inversely associated with the Prudent pattern, the Traditional pattern, the practice of leisure-time physical activity and the habit of physical activity at work. Eating patterns based on unprocessed and minimally processed foods and practice of physical activity are protective factors against obesity.
O objetivo deste artigo é descrever a associação entre variação de IMC, padrões alimentares e atividade física entre adultos de 21 a 44 anos no período de 2007 a 2012. Estudo transversal com a base de dados do VIGITEL. Padrões alimentares foram identificados com Análise de Principais Componentes para o período de 2007 a 2012. Componentes com autovalores >1,0 foram retidos e cargas fatoriais superiores a |0,3| foram destacadas. Para cada indivíduo, um escore foi calculado por padrão. Em seguida foi criada variável de diferença do Índice de Massa Corporal (ΔIMC). Regressão linear com desfecho ΔIMC e regressão de Poisson com desfecho obesidade foram conduzidas. Quatro padrões alimentares foram retidos: Prudente, Transição, Ocidental e Tradicional. Após ajuste multivariável, ΔIMC mostrou-se inversamente associada à prática de atividade física no lazer. Obesidade apresentou associação positiva com padrão Ocidental, assistir à televisão ≥3 horas por dia e inatividade física. Obesidade mostrou-se inversamente associada com padrão Prudente, padrão Tradicional, prática de atividade física no lazer e prática de atividade física no trabalho. Padrões alimentares baseados em alimentos in natura e minimamente processados e prática de atividade física constituem fatores de proteção para a obesidade.
Subject(s)
Exercise , Sedentary Behavior , Adult , Body Mass Index , Cross-Sectional Studies , Feeding Behavior , Humans , Obesity/epidemiologyABSTRACT
Urinary tract infection (UTI) affects mostly women. Any condition that allows stasis or urinary obstruction predisposes to the development of UTI. The authors report the case of a 37-year-old woman with a recurrent UTI who presented with right lumbar pain irradiating to homolateral inguinal regionand genito-urinary symptoms, and a pelvic extensive lesion was shown in the abdominal-pelvic CT in apparent relationship with L5 nerve root compatible with a Schwannoma. Schwannomas are usually benign tumors that rarely present malignant transformation. Repetitive UTIs may be a consequence of the mass effect or of neurological cause secondary to intraspinal schwannomas that cause urinary retention. Local recurrence or malignant change is possible, so complete tumor resection is important. (AU)
Subject(s)
Humans , Female , Adult , Urinary Tract Infections/diagnostic imaging , Urinary Tract Infections/therapy , Incidental Findings , Neurilemmoma/diagnosis , Neurilemmoma/therapyABSTRACT
Objetivo: Validar intervenções de enfermagem para a prevenção de quedas em pacientes no perioperatório. Método: Pesquisa metodológica desenvolvida com 13 especialistas, no período de Novembro de 2018 a Janeiro de 2019, para a validação de conteúdo de um mapeamento cruzado entre os cuidados de enfermagem encontrados na literatura com as intervenções padronizadas da Nursing Interventios Classification para o diagnóstico de enfermagem "risco de queda". Os especialistas foram selecionados a partir do método de Fehring, os dados coletados através de dois instrumentos e o conteúdo validado com a aplicação do Índice de Concordância (IC) ≥ 0,80. O estudo foi aprovado pelo Comitê de Ética do Centro de Ciências da Saúde da Universidade Federal da Paraíba, sob parecer de número: 2.559.757. Resultados: Das 26 intervenções validadas, 19 foram consideradas sugeridas com IC ≥ 0,80 e 07 consideradas opcionais adicionais com 0,65 ≤ IC ≥ 0,77, sendo Controle da Hipoglicemia, Controle da Sedação e Contenção Física as de maiores índices. Conclusões: Constatou-se que as intervenções mapeadas foram todas validadas e são passíveis de implementação. As atividades que obtiveram IC máximo foram educação sobre os riscos de queda, verificação de sinais vitais, controle da hipoglicemia e da sedação e cuidados com a contenção física. (AU)
Objective: To validate nursing interventions for the prevention of falls in patients in the perioperative period. Methods: Methodological research developed with 13 specialists, from November 2018 to January 2019, for the content validation of a cross mapping between nursing care found in the literature with the standardized interventions of the Nursing Interventios Classification for nursing diagnosis "Risk of falling". The experts were selected using the Fehring method, the data collected through two instruments and the content validated with the application of the Concordance Index (CI) ≥ 0.80. The study was approved by the Ethics Committee of the Health Sciences Center of the Federal University of Paraíba, under opinion number: 2.559.757. Results: Of the 26 validated interventions, 19 were considered suggested with CI ≥ 0.80 and 07 were considered additional optional with 0.65 ≤ CI ≥ 0.77, with Hypoglycemia Control, Sedation Control and Physical Containment being the highest indexes. Conclusion: It was found that the mapped interventions were all validated and are amenable to implementation. The activities that obtained maximum CI were education on the risks of falling, checking vital signs, controlling hypoglycemia and sedation and taking care of physical restraint. (AU)
Objetivo: Validar las intervenciones de enfermería para la prevención de caídas en pacientes en el período perioperatorio. Métodos: Investigación metodológica desarrollada con 13 especialistas, desde noviembre de 2018 hasta enero de 2019, para la validación de contenido de un mapeo cruzado entre el cuidado de enfermería encontrado en la literatura con las intervenciones estandarizadas de la Clasificación de Intervención de Enfermería para el diagnóstico de enfermería "Riesgo de caída". Los expertos fueron seleccionados utilizando el método Fehring, los datos recopilados a través de dos instrumentos y el contenido validado con la aplicación del Índice de Acuerdo (IC) ≥ 0,80. El estudio fue aprobado por el Comité de Ética del Centro de Ciencias de la Salud de la Universidad Federal de Paraíba, con el número de opinión: 2.559.757. Resultados: De las 26 intervenciones validadas, 19 se consideraron sugeridas con IC ≥ 0,80 y 07 se consideraron opcionales adicionales con 0,65 ≤ IC ≥ 0,77, siendo el control de hipoglucemia, el control de la sedación y la restricción física las que tenían las tasas más altas. Conclusión: Se encontró que todas las intervenciones mapeadas fueron validadas y son susceptibles de implementación. Las actividades que alcanzaron el IC máximo fueron la educación sobre los riesgos de caídas, el control de los signos vitales, el control de la hipoglucemia y la sedación y el cuidado de la restricción física. (AU)
Subject(s)
Nursing , Accidental Falls , Perioperative Care , Standardized Nursing TerminologyABSTRACT
This study aimed to describe the estimated means for weight, height, and body mass index (BMI) according to two imputation methods, using data from Vigitel (Risk and Protective Factors Surveillance System for Chronic Non-Communicable Diseases Through Telephone Interview). This was a cross-sectional study that used secondary data from the Vigitel survey from 2006 to 2017. The two imputation methods used in the study were hot deck and Predictive Mean Matching (PMM). The weight and height variables imputed by hot deck were provided by Vigitel. Two models were conducted with PMM: (i) explanatory variables - city, sex, age in years, race/color, and schooling; (ii) explanatory variables - city, sex, and age in years. Weight and height were the outcome variables in the two models. PMM combines linear regression and random selection of the value for imputation. Linear prediction is used as a measure of distance between the missing value and the possible donors, thereby creating the virtual space with the candidate cases for yielding the value for imputation. One of the candidates from the pool is randomly selected, and its value is assigned to the missing unit. BMI was calculated by dividing weight in kilograms by height squared. The result shows the means and standard deviations for weight, height, and BMI according to imputation method and year. The estimates used the survey module from Stata, which considers the sampling effects. The mean values for weight, height, and BMI estimated by hot deck and PMM were similar. The results with the Vigitel data suggest the applicability of PMM to the set of health surveys.
O objetivo deste estudo foi descrever a estimativa das médias de peso, altura e índice de massa corporal (IMC) segundo dois métodos de imputação, usando dados do Vigitel (Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico). O delineamento do estudo é transversal e utilizaram-se dados secundários do Vigitel do período de 2006 a 2017. Os dois métodos para imputação utilizados no estudo foram hot deck e Predictive Mean Matching (PMM). As variáveis peso e altura imputadas por hot deck foram disponibilizadas pelo Vigitel. Dois modelos foram conduzidos com a utilização da PMM: (i) variáveis explicativas - cidade, sexo, idade em anos, raça/cor e escolaridade; (ii) variáveis explicativas - cidade, sexo e idade em anos. Nos dois modelos, as variáveis peso e altura foram as variáveis de desfecho. Na PMM, combinam-se regressão linear e seleção aleatória de valor para imputação. A predição linear é usada como medida de distância entre o valor faltante e os seus possíveis doadores e, com isso, se cria o espaço virtual com os casos candidatos a ceder o valor para imputação. Um dos candidatos do pool é aleatoriamente selecionado, e o seu valor é atribuído à unidade faltante. O IMC foi calculado por meio da divisão do peso em quilogramas pela altura ao quadrado. Nos resultados, apresentamos as médias e erros-padrão de peso, altura e IMC, segundo método de imputação e ano de monitoramento. Nas estimativas, utilizou-se o módulo survey do Stata, que considera os efeitos da amostragem. Observou-se que os valores médios de peso, altura e IMC estimados por hot deck e PMM são similares. Os resultados com os dados do Vigitel sugerem a aplicabilidade do PMM ao conjunto dos inquéritos de saúde.
El objetivo de este estudio fue describir la estimación de medias de peso, altura e índice de masa corporal (IMC), según dos métodos de imputación, usando datos del Vigitel (Vigilancia de Factores de Riesgo y Protección para Enfermedades Crónicas No Transmisibles por Entrevista Telefónica). El diseño del estudio es transversal y se utilizaron datos secundarios de Vigitel, durante el período de 2006 a 2017. Los dos métodos para la imputación utilizados en el estudio fueron hot deck y Predictive Mean Matching (PMM). Las variables peso y altura imputadas por hot deck se recabaron de Vigitel. Se realizaron dos modelos con la utilización de la PMM: (i) variables explicativas -ciudad, sexo, edad en años, raza/color y escolaridad; (ii) variables explicativas -ciudad, sexo y edad en años. En los dos modelos, las variables peso y altura fueron las variables de desenlace. En la PMM, se combinan regresión lineal y selección aleatoria de valor para imputación. La predicción lineal es usada como medida de distancia entre el valor faltante y sus posibles donadores y, de este modo, se crea el espacio virtual con los casos candidatos de ceder su valor para la imputación. Uno de los candidatos del pool se selecciona aleatoriamente, y su valor es atribuido a la unidad faltante. El IMC se calculó mediante la división del peso en kilogramos por la altura al cuadrado. En los resultados, presentamos las medias y errores-patrón de peso, altura e IMC, según el método de imputación y año de seguimiento. En las estimaciones, se utilizó el módulo de encuesta del Stata, que considera los efectos de la muestra. Se observó que los valores medios de peso, altura e IMC estimados por hot deck y PMM son similares. Los resultados con los datos del Vigitel sugieren la aplicabilidad del PMM al conjunto de las investigaciones de salud.
Subject(s)
Body Mass Index , Research Design , Body Height , Body Weight , Brazil , Cross-Sectional Studies , Data Interpretation, Statistical , Health Surveys , HumansABSTRACT
OBJECTIVE: To describe the correlations between eating patterns for the years 2007 to 2012, and for each year of the period from 2007 to 2012. METHOD: Cross-sectional study with data from the System of Surveillance of Risk and Protection Factors to Chronic Diseases by Telephone Survey with the selection of 167,761 individuals aged 18 to 44 years old. Eating patterns were identified with a Principal Component Analysis. To compare the effects of the extraction and the estimate of eating patterns among different surveys we conducted the following analyzes: in the first, we used the total data set for the years from 2007 to 2012; in the second, the patterns were estimated in each annual set of data for the period from 2007 to 2012. Steps 1 and 2 were performed with no rotation, with Varimax rotation and with Promax rotation. After extracting the patterns, standardized scores with zero mean were generated for each pattern. The association between the patterns generated in the analyzes was estimated by the Pearson correlation coefficient (r). RESULTS: In the non-rotated analyzes, the components retained in the set presented correlations that were higher than 0.90, with the retained patterns in each year. In the rotated analyzes, only the first component had correlations that were higher than 0.90. CONCLUSION: Estimates of eating patterns either segmented - year by year - or in general - all of the years - showed high correlation and consistency between the patterns identified when in the same data pool.
Subject(s)
Feeding Behavior , Principal Component Analysis , Adolescent , Adult , Brazil , Cross-Sectional Studies , Humans , Surveys and Questionnaires , Young AdultABSTRACT
OBJECTIVE: To describe and analyze the trend in dietary patterns followed by the adult population aged 18 to 44 years living in Brazilian state capitals between 2007 and 2012. METHODS: We identified dietary patterns using the principal component analysis (PCA). The analysis retained components with eigenvalues >1.0 and highlighted factor loadings (FLs) >|0.2|. After the identification of four patterns, they received standardized scores with zero mean. The mean scores were presented for each pattern according to gender, age group, schooling, and year of data collection. We estimated the temporal variation of the mean scores of the patterns by linear regression. RESULTS: We identified four dietary patterns in the population: prudent, transition, western, and traditional. We found an increasing trend in the mean score of the patterns: prudent, western, and traditional and a reduced mean score in the transition pattern. Individuals with better education showed greater adherence to the prudent pattern. Less-educated individuals presented higher adherence to the western and traditional patterns. CONCLUSION: Public policies targeting the population with lower schooling and men are necessary due to their greater adherence to unhealthy dietary patterns.
Subject(s)
Diet Surveys , Diet/trends , Feeding Behavior , Adolescent , Adult , Age Distribution , Age Factors , Brazil , Cross-Sectional Studies , Female , Humans , Linear Models , Male , Principal Component Analysis , Self Report , Sex Distribution , Sex Factors , Time Factors , Young AdultABSTRACT
Abstract Glomerulopathies are one of the leading causes of end-stage renal disease. In the last years, clinical research has made significant contributions to the understanding of such conditions. Recently, rituximab (RTX) has appeared as a reasonably safe treatment. The Kidney Disease: Improving Global Outcomes guidelines (KDIGO) recommended RTX only as initial treatment in antineutrophil cytoplasm antibody associated vasculitis (AAV) and in non-responders patients with lupus nephritis (LN), but these guidelines have not been updated since 2012. Nowadays, RTX seems to be at least as effective as other immunosuppressive regimens in idiopathic membranous nephropathy (IMN). In minimal-change disease, (MCD) this drug might allow a long-lasting remission period in steroid-dependent or frequently relapsing patients. Preliminary results support the use of RTX in patients with pure membranous LN and immunoglobulin-mediated membranoproliferative glomerulonephritis (MPGN), but not in patients with class III/IV LN or complement-mediated MPGN. No conclusion can be drawn in idiopathic focal segmental glomerulosclerosis (FSGS) and anti-glomerular basement membrane antibody glomerulonephritis (anti-GBM GN) because studies are small, heterogeneous, and scarce. Lastly, immunosuppression including RTX is not particularly useful in IgA nephropathy. This review presents the general background, outcomes, and safety for RTX treatment in different glomerulopathies. In this regard, we describe randomized controlled trials (RCTs) performed in adults, whenever possible. A literature search was performed using clinicaltrials.gov and PubMed.
Resumo As glomerulopatias figuram entre as principais causas de doença renal terminal. Nos últimos anos, a pesquisa clínica efetuou contribuições significativas para a compreensão desse grupo de patologias. Recentemente, o rituximabe (RTX) surgiu como um tratamento razoavelmente seguro. As diretrizes do Kidney Disease: Improving Global Outcomes (KDIGO) recomendam o RTX apenas como tratamento inicial na vasculite associada ao ANCA (VAA) e em pacientes não respondedores com nefrite lúpica (NL), embora não sejam atualizadas desde 2012. Atualmente, o RTX parece ser pelo menos tão eficaz quanto outros esquemas imunossupressores na nefropatia membranosa idiopática (NMI). Na doença por lesão mínima (DLM), o medicamento pode proporcionar um período de remissão duradouro em pacientes córtico-dependentes ou com recidivas frequentes. Resultados preliminares corroboram o uso de RTX em pacientes com NL membranosa pura e glomerulonefrite membranoproliferativa (GNMP) mediada por imunoglobulina, mas não em pacientes com NL classe III/IV ou GNMP mediada por complemento. Os achados a respeito de glomeruloesclerose segmentar e focal (GESF) idiopática e doença por anticorpo antimembrana basal glomerular (anti-MBG) não são conclusivos em função do pequeno número, porte e heterogeneidade dos estudos publicados até o presente momento. Por fim, a imunossupressão com RTX não é particularmente útil na nefropatia por IgA. A presente revisão apresenta o racional da prescrição de RTX nas diferentes glomerulopatias, desfechos e segurança. Nesse sentido, foram incluídos ensaios clínicos randomizados (ECRs) realizados em adultos, sempre que possível. Pesquisas bibliográficas foram realizadas nas bases de dados do clinictrials.gov e no PubMed.