Doença falciforme e o efeito modulador da vitamina D em crianças: uma revisão integrativa / Sickle cell disease and the modulating effect of vitamin D in children: an integrative review

INTRODUÇÃO: A deficiência de Vitamina D (VD) é frequente na doença falciforme (DF) em decorrência do status inflamatório crônico, danos renais, endoteliais, hiperhemólise e melanodermia. Atualmente, a suplementação desse nutriente em falcêmicos tem se mostrado importante devido sua ação sistêmica e imunológica. OBJETIVOS: Analisar o impacto da VD em crianças com DF. MÉTODOS: Trata-se de uma revisão integrativa da literatura, onde foram analisados estudos, publicados originalmente em inglês e português, dos últimos dez anos, em humanos, tendo como referência as bases de dados MEDLINE, SciELO e LILACS. A busca foi efetuada mediante a consulta ao MeSH. Os descritores utilizados foram: "children"; "vitamin D"; "sickle cell anemia"; "supplementation". Foram identificados 32 artigos a partir da frase de pesquisa. Ao aplicar os critérios de inclusão, nove artigos foram eleitos para o estudo. RESULTADOS: A partir da análise dos artigos incluídos, 6 avaliaram a prevalência da deficiência de VD em crianças com anemia falciforme e os outros três artigos relataram sobre a suplementação de VD em crianças também com anemia falciforme. Todos os estudos mostraram que as crianças tratadas com reposição de VD tiveram uma diminuição de idas ao pronto-socorro e maior estabilidade hemodinâmica durante os tratamentos. CONCLUSÃO: Outros ensaios clínicos randomizados devem ser realizados para identificar o papel da DV na qualidade de vida e na redução da morbidade falciforme. A contribuição deste artigo é reconhecer que há evidências sobre a vitamina D fora dos ensaios clínicos randomizados.

INTRODUCTION: Vitamin D (VD) deficiency is frequent in sickle cell disease (SCD) due to chronic inflammatory status, kidney and endothelial damage, hyperhemolysis and melanoderma. Currently, the supplementation of this nutrient in sickle cell patients is important due to its systemic and immunological action. Objectives: To analyze the impact of VD in children with SCD. METHODS: This is an integrative literature review, which analyzed studies, originally published in English and Portuguese, in the last ten years, in humans, using the MedLine, SciELO and LILACS databases as References. The search was performed by consulting the MeSH. The descriptors used were: "children"; "vitamin D"; "sickle cell anemia"; "supplementation". 32 articles were identified from the search phrase. When applying the inclusion criteria, nine articles were chosen for the study. RESULTS: Among the included articles, six evaluated the prevalence of VD deficiency in children with sickle cell anemia, and the other three reported on VD supplementation in children with sickle cell anemia. All studies showed that children treated with VD replacement had a decrease in emergency room visits and greater hemodynamic stability during treatments. CONCLUSION: Further randomized controlled trials should be carried out to identify the role of VD in quality of life and in the reduction of sickle cell morbidity. The contribution of this paper is to recognize that there is evidence about vitamin D outside of randomized controlled trials.

Hemoglobin S identification in blood donors: A cross section of prevalence

ABSTRACT Introduction: In Brazil, the sickle cell trait (SCT) has an average prevalence of 4% in the general population and 6-10% among Afro-descendants. Although SCT is highly prevalent, a large segment of the population ignores their status. The Therapeutic Guidelines prohibit the transfusion of SCT red blood cells into patients with hemoglobin disorders or severe acidosis and newborns. Methods: This was a cross-sectional study with data from 37,310 blood donation candidates. The study included only eligible first-time donors qualified to be tested for the presence of hemoglobin S (HbS) at the Fundação Hemominas Juiz de Fora, Brazil. The variables studied were gender, skin color, age, type of donation, place of birth, blood type, result of the solubility test for hemoglobin S (HbST) and hemoglobin electrophoresis (HbEF). Statistical analysis was performed using the Q square test and the Kappa index of agreement for comparing biochemical methods. This project was approved by the National Research Ethics Committee. Results: The analysis of first-time donor data showed that 7166 were considered eligible. A total of 127 of the 7166 donors were carriers of SCT (1.77%). Among the blood donors, 73.23% were from the local area. The HbST and HbEF were found to be 100% in concordance. Sensitivity was not tested in the present study. Conclusions: The HbST is highly specific for identifying the HbS, but sensitivity was not tested in this study. The screening of blood donors for abnormal hemoglobins is useful, helping to detect and counsel heterozygous people. The study seeks to identify the prevalence of SCT in a region of Brazil.

Hemoglobin S identification in blood donors: A cross section of prevalence.

INTRODUCTION: In Brazil, the sickle cell trait (SCT) has an average prevalence of 4% in the general population and 6-10% among Afro-descendants. Although SCT is highly prevalent, a large segment of the population ignores their status. The Therapeutic Guidelines prohibit the transfusion of SCT red blood cells into patients with hemoglobin disorders or severe acidosis and newborns. METHODS: This was a cross-sectional study with data from 37,310 blood donation candidates. The study included only eligible first-time donors qualified to be tested for the presence of hemoglobin S (HbS) at the Fundação Hemominas Juiz de Fora, Brazil. The variables studied were gender, skin color, age, type of donation, place of birth, blood type, result of the solubility test for hemoglobin S (HbST) and hemoglobin electrophoresis (HbEF). Statistical analysis was performed using the Q square test and the Kappa index of agreement for comparing biochemical methods. This project was approved by the National Research Ethics Committee. RESULTS: The analysis of first-time donor data showed that 7166 were considered eligible. A total of 127 of the 7166 donors were carriers of SCT (1.77%). Among the blood donors, 73.23% were from the local area. The HbST and HbEF were found to be 100% in concordance. Sensitivity was not tested in the present study. CONCLUSIONS: The HbST is highly specific for identifying the HbS, but sensitivity was not tested in this study. The screening of blood donors for abnormal hemoglobins is useful, helping to detect and counsel heterozygous people. The study seeks to identify the prevalence of SCT in a region of Brazil.

Aspectos da assistência em pacientes com Doença Falciforme no contexto da pandemia da COVID-19 / Aspects of care in patients with Sickle Cell Disease in the context of the COVID-19 pandemic

Introdução: A pandemia determinada pelo novo coronavírus (SarsCoV-2), doença intitulada COVID-19, atingiu mais de 219 países com grande agravo e impacto à saúde mundial. A infecção pelo vírus desencadeia uma resposta imune explosiva, hiperativada e descontrolada, com manifestações clínicas graves em pessoas com doenças subjacentes. A Doença falciforme (DF), uma condição genética que determina imunosupressão, coloca os pacientes em maior risco de infecções respiratórias e complicações pulmonares dentro do contexto da pandemia. Objetivo: Analisar o impacto da COVID-19 em portadores de DF e propor uma diretriz de atendimento a esta população. Métodos: Trata- se de uma revisão sistemática de literatura onde foram analisados estudos, publicados originalmente em inglês, entre março a dezembro de 2020, tendo como referência as bases de dados MedLine, SciELO e LILACS. A busca foi efetuada mediante a consulta ao MeSH com os descritores "sickle cell disease", "covid-19"e "guideline". Foram identificados 64 artigos a partir da frase de pesquisa. Ao aplicar os critérios de inclusão, 7 artigos foram eleitos para o estudo. Resultados e Conclusão: A infecção pelo novo coronavírus pode precipitar intercorrências em pacientes com DF, como crises vaso-oclusivas e síndrome torácica aguda. Considerando esses dados, os autores formularam uma diretriz para orientação e cuidado aos indivíduos com DF

Introduction: The pandemic caused by the new coronavirus (SarsCoV-2), a disease called COVID-19, has reached more than 219 countries with great damage and impact on global health. The viral infection triggers an explosive, hyperactive and uncontrolled immune response, with severe clinical manifestations in people with underlying diseases. Sickle Cell Disease (SCD), a genetic condition that determines immunosuppression, causes patients a greater risk of respiratory infections and pulmonary complications within the context of the pandemic. Objective: To analyze the impact of COVID-19 in patients with SCD and propose a guideline to care for this population. Methods: This is a systematic literature review where studies were analyzed, originally published in English, between March and December 2020, using the MedLine, SciELO and LILACS databases as references. The search was carried out by consulting the MeSH with the descriptors "sickle cell disease", "covid-19" and "guideline". 64 articles were identified from the search phrase. When applying the inclusion criteria, 7 articles were chosen for the study. Results and Conclusion: The infection with the new coronavirus could cause complications in patients with SCD, such as vaso-occlusive crises and acute chest syndrome. Considering these data, the authors formulated a guideline for guidance and care for individuals with SCD.

Does Cystatin C have a role as metabolic surrogate in peritoneal dialysis beyond its association with residual renal function? / Teria a Cistatina C um papel como substituto metabólico na diálise peritoneal além de sua associação com a função renal residual?

ABSTRACT Introduction: It has been suggested that cystatin C levels are modified by obesity and inflammation. Furthermore, cystatin C has been associated with cardiovascular events and mortality outcomes. Aim: To study the association of cystatin C with the metabolic profile and cardiovascular disease of peritoneal dialysis patients. Methods: Data collected included clinical, laboratorial, and multifrequency bioimpedance assessment of 52 stable peritoneal dialysis patients. Minimal residual renal function was defined as > 2mL/min/1.73m2. Results: Serum cystatin C was not significantly associated with peritoneal or urinary cystatin C excretion. Negative correlation of cystatin C with normalized protein catabolic rate (rho -0.33, p = 0.02) and a trend towards positive correlation with relative body fat (rho 0.27, p = 0.05) were not independent from residual renal function. Cystatin C was not significantly associated with cardiovascular disease (p = 0.28), nor with glycated hemoglobin (p = 0.19) or c-reactive protein (p = 0.56). In the multivariate model, both age and diabetes were the strongest predictors of cardiovascular disease (odds ratio 1.09, p = 0.029 and odds ratio 29.95, p = 0.016, respectively), while relative body fat was negatively associated with cardiovascular disease (p = 0.038); neither cystatin C (p = 0.096) nor minimal residual renal function (p = 0.756) reached a significant association with cardiovascular disease. Conclusions: In this group of peritoneal dialysis patients, cystatin C did not correlate with the metabolic or inflammatory status, nor cardiovascular disease, after adjustment for residual renal function.

RESUMO Introdução: Tem sido sugerido que os níveis de cistatina C são modificados pela obesidade e inflamação. Além disso, a cistatina C tem sido associada a eventos cardiovasculares e desfechos de mortalidade. Objetivo: Estudar a associação da cistatina C com o perfil metabólico e doença cardiovascular de pacientes em diálise peritoneal. Métodos: Os dados coletados incluíram avaliação clínica, laboratorial e de bioimpedância múltipla de 52 pacientes estáveis em diálise peritoneal. A função renal residual mínima foi definida como > 2mL/min/1,73m2. Resultados: A cistatina C sérica não esteve significativamente associada à excreção peritoneal ou urinária. A correlação negativa da cistatina C com a taxa catabólica protéica normalizada (rho -0,33, p = 0,02) e uma tendência de correlação positiva com a gordura corporal relativa (rho 0,27, p = 0,05) não foram independentes da função renal residual. A cistatina C não se associou significativamente à doença cardiovascular (p = 0,28), nem com hemoglobina glicada (p = 0,19) ou proteína C reativa (p = 0,56). No modelo multivariado, idade e diabetes foram os mais fortes preditores de doença cardiovascular (razões de probabilidade 1,09, p = 0,029 e 29,95, p = 0,016, respectivamente) enquanto a gordura corporal relativa se associou negativamente à doença cardiovascular (p = 0,038). A cistatina C não se associou significativamente com doença cardiovascular (p = 0,096), tampouco a função residual mínima (p = 0,756). Conclusão: Neste grupo de pacientes em diálise peritoneal, a cistatina C não se correlacionou com o estado metabólico ou inflamatório, nem com doença cardiovascular, após ajuste para função renal residual.

Does Cystatin C have a role as metabolic surrogate in peritoneal dialysis beyond its association with residual renal function?

INTRODUCTION: It has been suggested that cystatin C levels are modified by obesity and inflammation. Furthermore, cystatin C has been associated with cardiovascular events and mortality outcomes. AIM: To study the association of cystatin C with the metabolic profile and cardiovascular disease of peritoneal dialysis patients. METHODS: Data collected included clinical, laboratorial, and multifrequency bioimpedance assessment of 52 stable peritoneal dialysis patients. Minimal residual renal function was defined as > 2mL/min/1.73m2. RESULTS: Serum cystatin C was not significantly associated with peritoneal or urinary cystatin C excretion. Negative correlation of cystatin C with normalized protein catabolic rate (rho -0.33, p = 0.02) and a trend towards positive correlation with relative body fat (rho 0.27, p = 0.05) were not independent from residual renal function. Cystatin C was not significantly associated with cardiovascular disease (p = 0.28), nor with glycated hemoglobin (p = 0.19) or c-reactive protein (p = 0.56). In the multivariate model, both age and diabetes were the strongest predictors of cardiovascular disease (odds ratio 1.09, p = 0.029 and odds ratio 29.95, p = 0.016, respectively), while relative body fat was negatively associated with cardiovascular disease (p = 0.038); neither cystatin C (p = 0.096) nor minimal residual renal function (p = 0.756) reached a significant association with cardiovascular disease. CONCLUSIONS: In this group of peritoneal dialysis patients, cystatin C did not correlate with the metabolic or inflammatory status, nor cardiovascular disease, after adjustment for residual renal function.

Phytochemical characterization and bioactivity of ethanolic extracts on eggs of citrus blackfly / Caracterização fitoquímica e bioatividade de extratos etanólicos em ovos de mosca-negra-dos-citros

ABSTRACT: The main objectives of this study were to determine the content of secondary metabolites (carotenoids, flavonoids, phenolic compounds, and tannins) of Argemone mexicana L., Ipomoea carnea Jacq. subsp. Fistulosa (Martius ex Choisy), Amorimia rigida (A.Juss.) W. R. Anderson, Ricinus communis L. and Syzygium aromaticum (L.) Merr. & L. M. Perry using UV-VIS spectroscopy, and evaluating the bioactivity of the ethanolic extracts on citrus blackfly eggs (Aleurocanthus woglumi Ashby, 1915). Pera sweet orange leaves infested with citrus blackfly eggs were treated by immersion in 0.5, 1.0, 5.0, and 10%; each replicate consisted of 30 eggs. The experimental design was completely randomized, with seven treatments and four replications. Three immersions of leaves with eggs were performed, and the mortality was evaluated seven days after the procedure. Leaves were placed in Petri dishes and kept in incubators [25±1°C; relative humidity (RH) 60±5% and 12 hours]. S. aromaticum peduncle presented high content of tannins and phenolic compounds, while R. communis leaves showed high content of phenolic compounds. The commercial product Bioneem© caused egg infeasibility greater than 85% at all concentrations. Treatments (10%) that caused the greatest egg mortality were Bioneem© (94.74%), R. communis extract (81.58%), and the extract of S. aromaticum peduncle (80.57%).

RESUMO: Os principais objetivos deste estudo foram determinar, utilizando espectroscopia UV-VIS, os compostos secundários (carotenoides, flavonoides, compostos fenólicos e taninos) das espécies Argenome mexicana L., Ipomoea carnea Jacq. subsp. Fistulosa (Martius ex Choisy), Amorimia rigida (A.Juss.) W. R. Anderson, Ricinus communis L. e Syzygium aromaticum L. (L.) Merr. & L. M. Perry, bem como avaliar a bioatividade de extratos etanólicos sobre ovos da mosca-negra-dos-citros (Aleurocanthus woglumi Ashby, 1915). Folhas de laranja Pêra infestadas com mosca-negra-dos-citros foram imersas nos tratamentos, a 0,5%, 1,0%, 5,0% e 10% de concentração; cada replicata foi constituída por 30 ovos. O delineamento foi inteiramente casualizado, sete tratamentos e quatro repetições. Foram realizadas três imersões das folhas com ovos, tendo sido avaliada a mortalidade sete dias após as imersões. As folhas foram alocadas em placa de Petri e mantidas em câmaras climáticas (25±1°C; U.R 60±5% e 12 horas). O pedúnculo do craveiro-da-india apresentou alto teor de taninos e compostos fenólicos, e folhas de mamona apresentavam alto teor de compostos fenólicos. O produto comercial Bioneem©, em todas as concentrações, causou inviabilidade de ovos superior a 85%. Os tratamentos (10%) que causaram a maior inviabilidade de ovos foram o Bioneem© (94,74%), o extrato de mamona (81,58%) e o extrato do pedúnculo do craveiro-da-india (80,57%).

Diversity of frugivorous flies (Tephritidae e Lonchaeidae) in three municipalities in southern Bahia / Diversidade de moscas frugívoras (Tephritidae e Lonchaeidae) em três municípios da região sul da Bahia

The main goal of this paper was to know the species diversity of frugivorous flies (Tephritidae and Lonchaeidae) in Ilhéus, Uruçuca and Wenceslau Guimarães, municipalities in southern Bahia. In each sampled place five McPhail traps were used containing 5% corn hydrolyzed protein (Bio Anastrepha(c)), from July 2011 through December 2012. The captured adults were placed in plastic pots containing 70% alcohol, until identification, characterized according to diversity indexes of Shannon-Wiener, Margalef and equitability, and categorized according to the total number of captured flies: 2.24% species of genus Neosilba McAlpine (Lonchaeidae), and 97.76% species of genus Anastrepha Schiner, with 12 species reported, and Ceratitis capitata . The index fly/trap/day (FTD) oscillated from zero to 1.35 with the highest capture in March and April 2012, coinciding with the fructification period. The frugivorous flies captured were Anastrepha antunesi Lima, A. bahiensis Lima, A. consobrina (Loew), A. ­distincta Greene, A. ­fraterculus (Wied.), A. ­grandis (Macquart), A. ­leptozona Hendel, A. ­obliqua (Macquart), A. parallela (Wied.), A. ­serpentina (Wied.), A. ­sororcula Zucchi, A. zenildae Zucchi, C. capitata (Wied.), Neosilba glaberrima (Wied.) and Neosilba zadolicha McAlpine & Steyskal. Anastrepha fraterculus was the species with the highest index of frequency, dominance, abundance and constancy. It is the first register of A. consobrina in the state of Bahia.(AU)

O principal objetivo deste estudo foi conhecer a diversidade de espécies de moscas frugívoras (Tephritidae e Lonchaeidae) em Ilhéus, Uruçuca e Wenceslau Guimarães, municípios da região sul da Bahia. No período de julho/2011 a dezembro/2012, foram instaladas cinco armadilhas do tipo McPhail em cada local de amostragem, tendo como atrativo alimentar proteína hidrolisada de milho (Bio Anastrepha(c)) a 5%. Os adultos capturados nas armadilhas, após a triagem, foram acondicionados em potes plásticos com álcool etílico 70% até a identificação. Cada espécie de Anastrepha foi caracterizada pelos índices de diversidade de Shannon-Wiener, Margalef e equitabilidade e categorizada quanto à sua dominância, abundância, frequência e constância na comunidade. Do total de moscas capturadas, 2,24% corresponderam a exemplares de Neosilba McAlpine (Lonchaeidae) e 97,76% a exemplares de moscas-das-frutas, com registro de 12 espécies de Anastrepha e C. capitata . O índice mosca/armadilha/dia (MAD) variou de 0 a 1,35, com maior captura nos meses de março e abril de 2012, coincidindo com o período de frutificação. Registraram-se as ocorrências de Anastrepha antunesi Lima, A. bahiensis Lima, A. ­consobrina (Loew), A. distincta Greene, A. ­fraterculus (Wied.), A. ­grandis (Macquart), A. leptozona Hendel, A. obliqua (Macquart), A. ­parallela (Wied.), A. ­serpentina (Wied.), A. sororcula Zucchi, A. ­zenildae Zucchi, Ceratitis capitata (Wied.), Neosilba glaberrima (Wied.) e Neosilba zadolicha McAlpine & Steyskal. Anastrepha fraterculus atingiu os índices máximos de dominância, frequência, constância e abundância. Registrou-se, pela primeira vez, a espécie A. consobrina no estado da Bahia.(AU)

Insulin Resistance in Nondiabetic Peritoneal Dialysis Patients: Associations with Body Composition, Peritoneal Transport, and Peritoneal Glucose Absorption.

BACKGROUND AND OBJECTIVES: Insulin resistance has been associated with cardiovascular disease in peritoneal dialysis patients. Few studies have addressed the impact of fast transport status or dialysis prescription on insulin resistance. The aim of this study was to test whether insulin resistance is associated with obesity parameters, peritoneal transport rate, and glucose absorption. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Insulin resistance was evaluated with homeostasis model assessment method (HOMA-IR), additionally corrected by adiponectin (HOMA-AD). Enrolled patients were prevalent nondiabetics attending at Santo António Hospital Peritoneal Dialysis Unit, who were free of hospitalization or infectious events in the previous 3 months (51 patients aged 50.4 ± 15.9 years, 59% women). Leptin, adiponectin, insulin-like growth factor-binding protein 1 (IGFBP-1), and daily glucose absorption were also measured. Lean tissue index, fat tissue index (FTI), and relative fat mass (rel.FM) were assessed using multifrequency bioimpedance. Patients were categorized according to dialysate to plasma creatinine ratio at 4 hours, 3.86% peritoneal equilibration test, and obesity parameters. RESULTS: Obesity was present in 49% of patients according to rel.FM. HOMA-IR correlated better with FTI than with body mass index. Significant correlations were found in obese, but not in nonobese patients, between HOMA-IR and leptin, leptin/adiponectin ratio (LAR), and IGFBP-1. HOMA-IR correlated with HOMA-AD, but did not correlate with glucose absorption or transport rate. There were no significant differences in insulin resistance indices, glucose absorption, and body composition parameters between fast and nonfast transporters. A total of 18 patients (35.3%) who had insulin resistance presented with higher LAR and rel.FM (7.3 [12.3, interquartile range] versus 0.7 [1.4, interquartile range], P<0.001, and 39.4 ± 10.1% versus 27.2 ± 11.5%, P=0.002, respectively), lower IGFBP-1 (8.2 ± 7.2 versus 21.0 ± 16.3 ng/ml, P=0.002), but similar glucose absorption and small-solute transport compared with patients without insulin resistance. FTI and LAR were independent correlates of HOMA-IR in multivariate analysis adjusted for glucose absorption and small-solute transport (r=0.82, P<0.001). CONCLUSIONS: Insulin resistance in nondiabetic peritoneal dialysis patients is associated with obesity and LAR independent of glucose absorption and small-solute transport status. Fast transport status was not associated with higher likelihood of obesity or insulin resistance.

Overhydration prevalence in peritoneal dialysis - A 2 year longitudinal analysis.

BACKGROUND AND OBJECTIVES: Hypervolemia is a major concern in dialysis patients, and is associated with increased cardiovascular risk and death. Cross sectional analysis have previously demonstrated that peritoneal dialysis (PD) patients are not more overhydrated when compared to haemodialysis ones. This study was designed to evaluate longitudinal trends in hydration status and corporal composition in a PD population. METHODS: We conducted a 2 year prospective observational study of 58 PD patients from a single centre. Incident and prevalent patients were included. Yearly measurements were performed using multifrequency electric bioimpedance. Overhydration (OH) was defined as an extra-cellular water (ECW)/total body water (TBW) over 15%. Clinical and biochemical variables were also explored. RESULTS: A total of 30 patients completed evaluation (female 63.3%, mean age 56.9 years, BMI 25.0 kg/m², diabetes 10.0%, APD-50.0%). Median PD vintage was 21.9 months, and 36.7% were anuric. At baseline 6.7% were overhydrated. On longitudinal analysis no significant changes were found in hydration status, systolic blood pressure, pro-BNP, nor albumin levels. Similar results were found among incident (n=11; APD- 45.5%; anuric- 9.1%) and prevalent (n=19; APD- 52.6%; anuric- 52.6%) patients (p>.05). However, at the second year, prevalent patients were moderately overhydrated compared to incident ones (median 10.2% vs 3.5%; p=.009). Nonetheless, no statistical difference was observed considering adequacy, TBW, or ECW. Moreover, nutritional parameters remained stable. CONCLUSIONS: Peritoneal dialysis maintenance without increasing volume status, nor major deleterious corporal composition trends, is feasible under careful therapy strategies. Longitudinal application of BIA may be a useful clinical tool to evaluate adequacy beyond Kt/V.

Overhydration prevalence in peritoneal dialysis –A 2 year longitudinal analysis / Prevalencia de la sobrehidratación en la diálisis peritoneal: estudio longitudinal de 2 años

Background and objectives: Hypervolemia is a major concern in dialysis patients, and is associated with increased cardiovascular risk and death. Cross sectional analysis have previously demonstrated that peritoneal dialysis (PD) patients are not more overhydrated when compared to haemodialysis´ ones. This study was designed to evaluate longitudinal trends in hydration status and corporal composition in a PD population. Methods: We conducted a 2 year prospective observational study of 58 PD patients from a single centre. Incident and prevalent patients were included. Yearly measurements were performed using multifrequency electric bioimpedance. Overhydration (OH) was defined as an extra-cellular water (ECW)/total body water (TBW) over 15%. Clinical and biochemical variables were also explored. Results: A total of 30 patients completed evaluation (female 63.3%, mean age 56.9 years, BMI25.0 kg/m2, diabetes 10.0%, APD-50.0%). Median PD vintage was 21.9 months, and 36.7% were anuric. At baseline 6.7% were overhydrated. On longitudinal analysis no significant changes were found in hydration status, systolic blood pressure, pro-BNP, nor albumin levels. Similar results were found among incident (n=11; APD-45.5%; anuric- 9.1%) and prevalent (n=19; APD- 52.6%; anuric- 52.6%) patients (p>.05). However, at the second year, prevalent patients were moderately overhydrated compared to incidentones (median 10.2% vs 3.5%; p=.009). Nonetheless, no statistical difference was observed considering adequacy, TBW, or ECW. Moreover, nutritional parameters remained stable. Conclusions: Peritoneal dialysis maintenance without increasing volume status, nor major deleterious corporal composition trends, is feasible under careful therapy strategies. Longitudinal application of BIA may be a useful clinical tool to evaluate adequacy beyond Kt/V (AU)

Antecedentes y objetivos: La hipervolemia constituye un gran problema en los pacientes de diálisis, y se asocia a un incremento del riesgo cardiovascular y muerte. Los análisis transversales han demostrado previamente que los pacientes de diálisis peritoneal (DP) no sufren de sobrehidratación, en comparación a los pacientes de hemodiálisis. Este estudio fue diseñado para evaluar las tendencias longitudinales de composición corporal e hidratación en una población de pacientes de DP. Métodos: Realizamos un estudio observacional prospectivo de dos años a 58 pacientes de DP de un único centro. Se incluyó pacientes incidentales y prevalentes. Se realizaron mediciones anuales utilizando bioimpedancia eléctrica de multifrecuencia. La sobrehidratación se definió como el ratio agua extra-celular (ECW)/agua corporal total (ACT) superior al 15%. También se exploraron variables clínicas y bioquímicas. Resultados: Un total de 30 pacientes completarán el estudio (mujeres: 63,3%, edad media 56,9años, IMC 25,0 kg/m2, diabetes 10,0%, DPA-50,0%). La antigüedad media de DP fue de 21,9meses, y el 36,7% padecía anuria. Al inicio, el 6,7% padecía sobrehidratación. En los análisis longitudinales no se hallaron cambios en cuanto a hidratación, presión sanguínea sistólica, pro-BNP, o niveles de albúmina. Se hallaron resultados similares entre los pacientes incidentales (n = 11; APD- 45,5%; anuria- 9,1%) y prevalentes (n = 19; DPA- 52,6%;anuria- 52,6%) (p > 0,05). Sin embargo, al segundo año, los pacientes prevalentes estaban moderadamente sobrehidratados en comparación con los incidentales (media 10,2% frente a3,5%; p = 0,009). En cambio, no se observó una diferencia estadística en cuanto a adecuación, ACT, o ECW. Además, los parámetros nutricionales permanecieron estables. Conclusiones: La a prevalencia de la diálisis peritoneal sin incremento de volumen ni alteración de los índices de composición corporal es factible si se aplican estrategias terapéuticas prudentes. La aplicación longitudinal de BIA puede constituir una herramienta clínica para evaluar la adecuación por encima de Kt/V (AU)

Manganese ore tailing: optimization of acid leaching conditions and recovery of soluble manganese.

Manganese recovery from industrial ore processing waste by means of leaching with sulfuric acid was the objective of this study. Experimental conditions were optimized by multivariate experimental design approaches. In order to study the factors affecting leaching, a screening step was used involving a full factorial design with central point for three variables in two levels (2(3)). The three variables studied were leaching time, concentration of sulfuric acid and sample amount. The three factors screened were shown to be relevant and therefore a Doehlert design was applied to determine the best working conditions for leaching and to build the response surface. By applying the best leaching conditions, the concentrations of 12.80 and 13.64 %w/w of manganese for the global sample and for the fraction -44 + 37 µm, respectively, were found. Microbeads of chitosan were tested for removal of leachate acidity and recovering of soluble manganese. Manganese recovery from the leachate was 95.4%. Upon drying the leachate, a solid containing mostly manganese sulfate was obtained, showing that the proposed optimized method is efficient for manganese recovery from ore tailings.

Adipokines in peritoneal dialysis: relevant clinical impact according to body composition.

Adipokines impact on clinical outcomes is not adequately addressed in peritoneal dialysis (PD). We investigated the impact of leptin/adiponectin ratio (L/A) as a predictor of cardiovascular events (CVE) in PD, taking into consideration patient's body composition and the potential role of glucose load. We prospectively followed 66 prevalent PD patients for 47.0 ± 28.2 months. New CVE were evaluated. Lean tissue index (LTI), relative fat mass (relFM) and relative overhydration (relOH) using multifrequency bioimpedance (BCM) were assessed; serum lipids, interleukin-6 (IL-6), leptin and adiponectin were measured. We established the determinants of L/A using multiple linear regression and the impact of L/A on CVE. Obesity was present in 47 (73.4%) patients according to relFM, and in seven (10.6%) according to body mass index (BMI). Leptin and L/A exhibited a stronger correlation with relFM (both r = 0.62, P < 0.0001) than with BMI (r = 0.46 and r = 0.51, respectively, both P < 0.0001). L/A showed a significant correlation with triglycerides (r = 0.41, P = 0.001) and HDL-cholesterol (r = -0.358, P = 0.003), better than isolated leptin or adiponectin. RelFM (RR = 0.130, 95%confidence interval [CI]:0.086-0.174, P < 0.0001) and LTI (RR = 0.194, 95%CI:0.037-0.351, P = 0.016) were independent predictors of L/A (R(2) = 0.67). Patients who suffered new CVE were older (59.12 ± 12.41 vs. 47.52 ± 13.84years, P = 0.003) and had a higher relOH (11.28 ± 7.29 vs. 6.60 ± 8.16%, P = 0.028). L/A was significantly higher in patients with CVE[2.29 (1.79) vs. 0.65 (1.73), P = 0.028] but this association was only put on evidence after excluding patients with wasting. BMI is an inaccurate method to classify obesity in PD since it underestimates its prevalence compared with body composition assessment using BCM. High adiponectin and low leptin are associated with a more favorable metabolic risk profile in peritoneal dialysis. The L/A is determined by relFM and by LTI. A higher L/A is associated with CVE in PD patients without wasting.

Hepatocyte growth factor signalizes peritoneal membrane failure in peritoneal dialysis.

BACKGROUND: Hepatocyte growth factor (HGF) counteracts peritoneal fibrosis in animal models and in-vitro studies, but no study explored effluent HGF in peritoneal dialysis (PD) patients with ultrafiltration failure (UFF). Our aim was to assess the relationship between effluent HGF with UF profile, free water transport (FWT) and small-solute transport. METHODS: We performed 4-hour, 3.86% PET with additional UF measurement at 60 minutes in 68 PD patients. MTACcreatinine, FWT, small-pore ultrafiltration, and effluent HGF were quantified. RESULTS: Effluent HGF negatively correlated with UF (r=-0.80, p=0.009) and FWT (r=-0.69, p=0.04). Patients with UFF had higher dialysate HGF (103 pg/mL vs 77 pg/mL, p=0.018) and, although not statistically significant, those with FWT compromise had also higher dialysate HGF compared with subgroup of UFF without FWT compromise (104 pg/mL vs 88 pg/mL, p=0.08). FWT≤45% without clinical UFF was documented in some patients who also had increased effluent HGF. CONCLUSIONS: Dialysate HGF concentration is significantly higher among patients with UFF, specially, if FWT is impaired, being a sign of peritoneal membrane deterioration.

Disfunción sexual en pacientes en diálisis peritoneal: relación con factores metabólicos y con la percepción de la calidad de vida / Sexual dysfunction in men and women on peritoneal dialysis: Differential link with metabolic factors and quality of life perception

Introducción: La sexualidad, el estatus psicosocial y la calidad de vida (QoL) son factores importantes, a menudo infravalorados, en los esquemas de diálisis. Objetivos: Evaluar la prevalencia de disfunción sexual y sus asociaciones en los pacientes en diálisis peritoneal (DP). Métodos: Se utilizaron el Índice de Función Sexual Femenina (IFSF), el Índice Internacional de Función Eréctil (IIFE), la Escala de Ansiedad y Depresión Hospitalaria (HADS) y los cuestionarios sobre calidad de vida EQ5D en la población prevalente en DP (57 pacientes). Se realizaron análisis multivariantes para investigar los factores clínicos independientes para disfunción sexual. Resultados: Se diagnosticó disfunción sexual en el 67,9 % de las mujeres y en el 44,8 % de los varones. En las mujeres la albúmina sérica, la creatinina, los niveles de fósforo y EQ5D se relacionaran positivamente con IFSF. En los varones existía una correlación negativa entre el calcio sérico y el score IIEF. En el análisis multivariante los parámetros nutricionales permanecieron asociados de manera independiente con la disfunción sexual en mujeres; en los varones los principales determinantes fueron el aumento de la concentración de calcio y la disminución de la testosterona. En los análisis de regresión logística el riesgo de disfunción sexual en la población global está asociado a niveles menores de albúmina (OR = 6,94) y a un score inferior de EQ5D (OR = 6,93). Conclusiones: La disfunción sexual tiene una alta prevalencia y una fuerte asociación con la percepción de la calidad de vida de los pacientes en DP. Se han encontrado diferentes variables clínicas relacionadas con la disfunción sexual en cada sexo que justifican actitudes preventivas y terapéuticas individualizadas (AU)

Background: Sexual function, psychosocial status and quality of life (QoL) are important dimensions, often underestimated, in dialysis treatment schedules. Objectives: The aim of this study was to evaluate the prevalence of sexual dysfunction and its associations, among peritoneal dialysis (PD) patients. Methods: The Index of Female Sexual Function (IFSF), the International Index of Erectile Function (IIEF), the Hospital Anxiety and Depression Scale (HADS) and the Quality of Life EQ5D questionnaires were applied to a prevalent PD population of 57 enrolled patients. Multivariate analysis was conducted to investigate clinical independent risk factors for sexual dysfunction. Results: Sexual dysfunction was diagnosed in 67.9% of women and 44.8% of men. In females, serum albumin, creatinine and phosphorus levels and EQ5D positively correlated with IFSF score. For males, there was a significant negative correlation between serum calcium levels and the IIEF score. On multivariate analysis, nutritional parameters remained independently associated with sexual dysfunction in women; in males, increase in calcium concentration and decrease of testosterone were main determinants. On logistic regression analysis, the risk of sexual dysfunction in global population was associated with lower values of albumin (OR=6.94) and with a lower QoL score EQ5D (OR=6.93). Conclusions: Sexual dysfunction is highly prevalent and strongly associated with impaired QoL of PD patients. Different clinical variables were related to sexual dysfunction in each gender, justifying an individualized preventive and therapeutic approaches (AU)

Sexual dysfunction in men and women on peritoneal dialysis: Differential link with metabolic factors and quality of life perception.

BACKGROUND: Sexual function, psychosocial status and quality of life (QoL) are important dimensions, often underestimated, in dialysis treatment schedules. OBJECTIVES: The aim of this study was to evaluate the prevalence of sexual dysfunction and its associations, among peritoneal dialysis (PD) patients. METHODS: The Index of Female Sexual Function (IFSF), the International Index of Erectile Function (IIEF), the Hospital Anxiety and Depression Scale (HADS) and the Quality of Life EQ5D questionnaires were applied to a prevalent PD population of 57 enrolled patients. Multivariate analysis was conducted to investigate clinical independent risk factors for sexual dysfunction. RESULTS: Sexual dysfunction was diagnosed in 67.9% of women and 44.8% of men. In females, serum albumin, creatinine and phosphorus levels and EQ5D positively correlated with IFSF score. For males, there was a significant negative correlation between serum calcium levels and the IIEF score. On multivariate analysis, nutritional parameters remained independently associated with sexual dysfunction in women; in males, increase in calcium concentration and decrease of testosterone were main determinants. On logistic regression analysis, the risk of sexual dysfunction in global population was associated with lower values of albumin (OR=6.94) and with a lower QoL score EQ5D (OR=6.93). CONCLUSIONS: Sexual dysfunction is highly prevalent and strongly associated with impaired QoL of PD patients. Different clinical variables were related to sexual dysfunction in each gender, justifying an individualized preventive and therapeutic approaches.

New records of occurrence of five species of Neosilba (Diptera: Lonchaeidae) in the State of Bahia, Brazil / Novos registros de ocorrência de cinco espécies de Neosilba (Diptera: Lonchaeidae) para o Estado da Bahia, Brasil

This paper reports the record of new species of Neosilba in the State of Bahia: Neosilba bella Strikis & Prado; Neosilba cornuphallus Strikis; Neosilba dimidiata (Curran); Neosilba ilheuense Strikis and Neosilba pseudozadolicha Strikis. Frugivorous flies were captured by McPhail traps, using a hydrolyzed protein at 5.0%, as attractant, and also obtained of fruits samples of native and exotic plant species, which were collected in domestic orchards in the South of Bahia. The specimens of Lonchaeidae were identified according to McALPINE & STEYSKAL (1982), STRIKIS & PRADO (2006) and STRIKIS (2011).

Este trabalho refere-se a novos registros de espécies de Neosilba no estado da Bahia: Neosilba bella Strikis & Prado; Neosilba cornuphallus Strikis; Neosilba dimidiata (Curran); Neosilba ilheuense Strikis e Neosilba pseudozadolicha Strikis. Moscas frugívoras foram capturadas em armadilhas do tipo McPhail, tendo como atrativo alimentar proteína hidrolisada a 5,0%, e também obtidas de amostras de frutos de espécies vegetais nativas e exóticas, coletadas em pomares domésticos na região Sul do Estado da Bahia. Os espécimes de Lonchaeidae foram identificados de acordo com McALPINE & STEYSKAL (1982), STRIKIS & PRADO (2006) e STRIKIS (2011).

Two-in-one protocol: simultaneous small-pore and ultrasmall-pore peritoneal transport quantification.

BACKGROUND: Reduced free water transport (FWT) through ultrasmall pores contributes to net ultrafiltration failure (UFF) and should be seen as a sign of more severe functional deterioration of the peritoneal membrane. The modified peritoneal equilibration test (PET), measuring the dip in dialysate Na concentration, estimates only FWT. Our aim was to simultaneously quantify small-solute transport, FWT, and small-pore ultrafiltration (SPUF) during a single PET procedure. METHODS: We performed a 4-hour, 3.86% glucose PET, with additional measurement of ultrafiltration (UF) at 60 minutes, in 70 peritoneal dialysis patients (mean age: 50 ± 16 years; 61% women; PD vintage: 26 ± 23 months). We calculated the dialysate-to-plasma ratios (D/P) of creatinine and Na at 0 and 60 minutes, and the Na dip (Dip(D/PNa60')), the delta dialysate Na 0-60 (ΔDNa(0-60)), FWT, and SPUF. RESULTS: Sodium sieving (as measured by ΔDNa(0-60)) correlated strongly with the corrected Dip(D/PNa60') (r = 0.85, p < 0.0001) and the corrected FWT (r = 0.41, p = 0.005). Total UF showed better correlation with FWT than with indirect measurements of Na sieving (r = 0.46, p < 0.0001 for FWT; r = 0.360, p < 0.0001 for Dip(D/PNa60')). Corrected FWT fraction was 0.45 ± 0.16. A negative correlation was found between time on PD and both total UF and FWT (r = -0.253, p = 0.035 and r = -0.272, p = 0.023 respectively). The 11 patients (15.7%) diagnosed with UFF had lower FWT (89 mL vs 164 mL, p < 0.05) and higher D/P creatinine (0.75 vs 0.70, p < 0.05) than did the group with normal UF. The SPUF correlated positively with FWT in the normal UF group, but negatively in UFF patients (r = -0.709, p = 0.015). Among UFF patients on PD for a longer period, 44.4% had a FWT percentage below 45%. CONCLUSIONS: Measurement of FWT and SPUF is feasible by simultaneous quantification during a modified 3.86% glucose PET, and FWT is a decisive parameter for detecting causes of UFF in addition to increased effective capillary surface.