D313Y variant in two related end-stage renal disease patients – Pathogenic or not yet? / Dos pacientes con enfermedad renal terminal con la variante de significado incierto D313Y: ¿patógena o aún no?

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)

Effectiveness of Acupuncture on Health-Related Quality of Life in Patients Receiving Maintenance Hemodialysis.

Patients with kidney failure (KF) receiving maintenance hemodialysis (HD) experience numerous symptoms that impair their health-related quality of life (HRQOL) and contribute to high mortality rates. Acupuncture is often used for symptom enhancement and HRQOL. This blinded, randomized, controlled patient-assessor trial evaluated the effectiveness of acupuncture compared with sham acupuncture on patients' HRQOL receiving maintenance HD as a secondary analysis. Seventy-two participants were randomly assigned to verum acupuncture (VA), sham acupuncture (SA), or waiting-list (WL) groups. The outcome was an improvement in HRQOL, assessed using the Kidney Disease Quality of Life-Short Form, version 1.3 (KDQOL-SF™ v1.3) at baseline, after treatment, and at 12-week follow-up. Non-parametric tests were used for statistical analysis. Of the 72 randomized patients, 67 were included in the complete analysis set. As for the changes between baseline and after treatment, the VA group showed significantly increased scores on most of the KDQOL-SF™ v1.3 scales compared to SA or WL groups (p < 0.05). No statistically significant differences between groups were observed in the changes from baseline to follow-up (p > 0.05). Compared to the sham treatment, acupuncture improved the HRQOL in patients receiving maintenance HD after treatment but not at follow-up.

Integrating Acupuncture into a Dialysis Center.

A growing interest in integrating traditional Chinese medicine (TCM) and conventional medicine (CM) to create a more comprehensive approach to healthcare has been verified. Scientific evidence supports acupuncture as an integrative treatment for specific health conditions. The aim of this study was to assess the acceptance and feasibility by patients and healthcare professionals of integrating acupuncture in a dialysis center. Individuals undergoing hemodialysis (HD) who participated in a patient-assessor-blinded randomized controlled trial that evaluated the effect of acupuncture on functional capacity and quality of life were included. Acceptance was measured by adherence (percentage of patients who completed treatments and dropouts) and patients' and healthcare professionals' opinions toward acupuncture (pre- and pro-intervention questionnaires). Feasibility was measured by safety (number of reported adverse events) and effectiveness (changes in functional capacity, peripheral muscle strength, and health-related quality of life scores after treatment). Forty-eight patients were included, and forty-five (93.8%) were analyzed. No adverse events were reported. All patients completed the treatment, and only three patients (6.2%) were lost to the 12-week post-treatment follow-up. The attitudes of patients and health professionals were favorable to acupuncture, namely in relation to its use, degree of discomfort, recommendation to others, and interference with routine care and clinical setting. Integrating acupuncture into a dialysis center seems viable and well-accepted by patients with kidney failure on maintenance HD, doctors and nurses.

D313Y variant in two related end-stage renal disease patients - Pathogenic or not yet?

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.

Effect of Acupuncture on Functional Capacity in Patients Undergoing Hemodialysis: A Patient-Assessor Blinded Randomized Controlled Trial.

Decreased functional capacity (FC) in patients undergoing hemodialysis (HD) is associated with adverse health events and poor survival. Acupuncture is recognized as a safe and effective integrative treatment. The aim of this study is to evaluate the effect of acupuncture treatment on the FC in chronic kidney disease with GFR category 5 (CKG G5) patients undergoing HD. In this patient-assessor blinded randomized controlled trial, seventy-two KF patients were randomly assigned to experimental (n = 24), placebo (n = 24) and control groups (n = 24). The primary outcome was the improvement in FC assessed by the 6-Minute Walk Test (6-MWT). Secondary outcomes included assessment of peripheral muscle strength by the Handgrip Strength Test (HGS) and the 30-Second Sit-to-Stand Test (STS-30) at baseline, after treatment and at 12-week follow up. A mixed ANOVA with interaction time*group was used. The experimental group increased walk distance (p < 0.001), lower limbs strength (p < 0.001) and handgrip strength (p = 0.012) after nine acupuncture sessions and stabilized in the follow-up (p > 0.05). In the placebo and control groups the 6-MWT and 30STS results decreased (p < 0.001) and the HGS scores did not change through time (p > 0.05). Acupuncture treatment improved FC and muscle strength in patients undergoing HD.

Lupus-like nephritis with positive anti-neutrophil cytoplasmic antibodies and negative antinuclear antibodies / Nefrite semelhante à lúpica com anticorpos citoplasmáticos antineutrófilos positivos e anticorpos antinucleares negativos

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.

Ketamine and Norketamine: Enantioresolution and Enantioselective Aquatic Ecotoxicity Studies.

Ketamine is a chiral drug used for various clinical purposes but often misused. It is metabolized to norketamine, an active chiral metabolite. Both substances have been detected in environmental matrices, but studies about their enantioselective toxic effects are scarce. In the present study, the enantiomers of ketamine and norketamine were separated by a semipreparative enantioselective liquid chromatography method, and their toxicity was investigated in different aquatic organisms. The enantioseparation was achieved using a homemade semipreparative chiral column. Optimized conditions allowed the recovery of compounds with enantiomeric purity higher than 99%, except for (R)-ketamine (97%). The absolute configuration of the enantiomers was achieved by experimental electronic circular dichroism (ECD). The ecotoxicity assays were performed with the microcrustacean Daphnia magna and the protozoan Tetrahymena thermophila using Toxkit MicroBioTests. Different concentrations were tested (0.1-10 000 µg/L) to include environmental levels (~0.5-~100 µg/L), for racemates (R,S) and the isolated enantiomers (R or S) of ketamine and norketamine. No toxicity was observed in either organism at environmental levels. However, at greater concentrations, (R,S)-ketamine presented higher mortality for D. magna compared with its metabolite (R,S)-norketamine (85 and 20%, respectively), and the (S)-ketamine enantiomer showed higher toxicity than the (R)-ketamine enantiomer. In addition, (S)-ketamine also presented higher growth inhibition than (R)-ketamine for T. thermophila at the highest concentrations (5000 and 10 000 µg/L). Contrary to D. magna, growth inhibition was observed for both enantiomers of norketamine and in the same magnitude order of the (S)-ketamine enantiomer. The results showed that the 2 organisms had different susceptibilities to norketamine and that the toxicity of ketamine at high concentrations is enantioselective for both organisms. Environ Toxicol Chem 2022;41:569-579. © 2020 SETAC.

Lupus-like nephritis with positive anti-neutrophil cytoplasmic antibodies and negative antinuclear antibodies.

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.

Prothrombin time and activated partial thromboplastin time reference intervals in dogs, by gender and age group using the Start®4 (Stago) / Intervalos de referência para o tempo de protrombina e tempo de tromboplastina parcial ativada no cão de acordo com a idade e o gênero utilizando o Start ® 4 (Stago)

Prothrombin time (PT) and the activated partial thromboplastin time (aPTT) are useful tools for the diagnosis and monitoring of coagulation disorders in Veterinary Medicine. Our objectives were: to establish reference intervals (RI) for PT and a PTT for the dog using the Start®4 (Stago), to compare the obtained RI with literature; to evaluate the effects of gender and age on the coagulation profile. Plasma samples of 122 healthy dogs (57 males; 65 females) aged between 4 months and 18 years, divided into three age groups (0-2 years old; 3-10 years old; > 10 years old) and grouped in to males and females were analysed. The RI were estimated following the ASVCP guidelines with the Reference Value Advisor software. The RI were: PT 6.7'' to 10.8''; aPTT 9.0'' to 14.8''. PT was significantly higher in females than in males. Dogs aged 10 years or older have significantly higher mean aPTT times than younger dogs. RI comparison showed a considerable percentage of cases outside the reference RI of the literature (PT - 79.3%; aPTT - 77.1%), demonstrating the need of each laboratory to calculate its own RI. The RI established in this study are applicable for the coagulation profile assessment in dogs.

O tempo de protrombina (TP) e o tempo de tromboplastina parcial ativada (TTPa) são ferramentas úteis para o diagnóstico e monitorização das alterações da coagulação em Medicina Veterinária. Os objetivos deste estudo foram: estabelecer intervalos de referência (IR) para TP e TTPa para o cão utilizando o Start®4 (Stago), de modo a comparar os IR obtidos com a literatura; avaliar os efeitos do sexo e da idade no perfil da coagulação. Foram usadas amostras de plasma de 122 cães saudáveis (57 machos; 65 fêmeas) com idades entre quatro meses e 18 anos, divididos em três grupos (0-2 anos; 3-10 anos; > 10 anos) e agrupados em machos e fêmeas. Os IR foram calculados seguindo as diretrizes da ASVCP com o software Reference Value Advisor. Os IR obtidos foram: PT 6,7 '' a 10,8 ''; TTPa 9,0 '' a 14,8 ''. O TP foi significativamente maior nas fêmeas do que nos machos. Os cães com 10 anos ou mais apresentaram tempos médios de TTPa significativamente maiores do que cães mais jovens. A comparação de IR mostrou uma percentagem considerável de casos fora do IR de referência da literatura (TP - 79,3%; TTPa - 77,1%), confirmando a necessidade de cada laboratório calcular seu próprio IR. Os IR estabelecidos neste estudo são aplicáveis na avaliação do perfil hemostático em cães.

[Association between the consumption of breakfast and the recommendation of physical activity and the nutritional status in children]. / Associação entre o consumo de café da manhã com a recomendação de atividade física e o estado nutricional em crianças.

The scope of this article is to associate breakfast consumption (BC) with moderate to vigorous physical activity (MVPA) intensity and the nutritional status of children aged 9-11. The sample consisted of 432 children from São Caetano do Sul participating in the International Study of Childhood Obesity Lifestyle and the Environment. Data were collected between 2012 and 2013. The weekly BC was obtained using the self-reported method. To measure MVPA, children used accelerometers and were classified into two groups (<60 versus ≥60 min/day). The nutritional status was presented by body mass index (BMI). Logistic regression models were used, adjusted for gender, age, race, parental educational level and eating score. The mean BC was 5.25 (CI95%: 5.1-5.4) days/week and the MVPA was 59.29 (CI95%: 57.3-61.7) min/day. In the total sample, 55.8% of the children did not perform ≥60 min/day of MVPA and 50.2% were overweight or obese. The daily BC was not associated with MVPA, however, it reduced the odds of children being overweight or obese (OR: 0.51; CI95%: 0.34-0.76; p=0.001). Daily BC reduced the odds of excess weight or obesity in children, though it did not increase the chances of children meeting the recommendations of MVPA. Public policies should encourage daily BC to prevent excess weight or obesity.

O objetivo deste artigo é associar o consumo do café da manhã (CM) com atividade física de moderada à vigorosa (AFMV) e estado nutricional de crianças entre 9 e 11 anos. A amostra foi composta por 432 crianças de São Caetano do Sul participantes do International Study of Childhood Obesity Lifestyle and the Environment. Os dados foram coletados entre 2012-2013. O consumo do CM semanal foi obtido pelo método autorreferido. Para mensuração da AFMV, as crianças utilizaram acelerômetro e foram classificadas em dois grupos (<60 versus ≥60 min/dia). O estado nutricional foi apresentado pelo Índice de Massa Corporal (IMC). Foram utilizados modelos de regressão logística. A média do consumo de CM foi de 5,25 (IC95%: 5,1-5,4) dias/sem e da AFMV foi de 59,29 (IC95%: 57,3-61,7) min/dia. No total, 55,8% das crianças não realizavam ≥60 min/dia de AFMV e 50,2% apresentavam excesso de peso ou obesidade. O consumo diário do CM não se associou com a AFMV, porém, diminuiu o risco de terem excesso de peso ou obesidade (OR: 0,51; IC95%: 0,34-0,76; p=0,001). O consumo diário do CM reduziu as chances de excesso de peso ou obesidade em crianças, mas não aumentou a chance das crianças cumprirem as recomendações de AFMV. Politicas públicas devem incentivar o consumo diário do CM para assim prevenir o excesso de peso ou obesidade.

COVID-19 in patients starting hemodialysis in the Alentejo region: case reports.

COVID-19 has a wide spectrum of clinical presentation, ranging from asymptomatic or mild symptoms to severe multiorgan failure. In Portugal, the first cases affecting patients on a chronic hemodialysis program arose in the city of Oporto. The authors report here two cases of COVID-19 infection in patients incident in renal replacement therapy in the Alentejo region and hypothesise that the high serum concentration of urea may decapitate the appearance of typical symptoms of the SARS-CoV-2 infection. The fact that the hemodialysis population can present active infection without fever may lead to a delayed diagnosis and consequently an increased risk of mortality.

Nutritional status, physical activity, sedentary behavior, diet, and lifestyle in childhood: an analysis of respiratory diseases in adolescence / Estado nutricional, atividade física, comportamento sedentário, dieta e estilo de vida na infância: uma análise de doenças respiratórias na adolescência

ABSTRACT Objective: To evaluate the association between nutritional status, physical activity, sedentary behavior, diet, and lifestyle in childhood with respiratory diseases during adolescence. Methods: Prospective study conducted in São Caetano do Sul, São Paulo - Brazil, as part of the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE). During childhood, indicators of lifestyle (body composition, physical activity, sedentary behavior, diet) and family environment were measured in 2012 and 2013. After five years, participants answered the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire for the diagnosis of respiratory diseases (asthma and/or rhinitis). Analyses were determined by logistic regression. Results: A total of 168 schoolchildren (56% boys) were evaluated, and the prevalence of asthma and rhinitis accounted for 15.5 and 25.6%, respectively. Whole milk consumption (Odds Ratio [OR]=1.24; 95% confidence interval [95%CI] 1.03-1.49), having a television in the bedroom (OR=0.29; 95%CI 0.12-0.71), and attending physical education classes ≥2 times/week (OR=0.30; 95%CI 0.11-0.81) in childhood were associated with the presence of asthma in adolescence. Factors significantly associated with rhinitis were as follows: female participants (OR=2.45; 95%CI 1.20-4.98) and whole milk consumption (OR=1.21; 95%CI 1.04-1.40). Conclusions: Higher consumption of whole milk, not having a television in the bedroom, few physical education classes, and being a girl were factors associated with respiratory diseases. Public policies should be directed toward a healthier lifestyle and the prevention of respiratory diseases.

RESUMO Objetivo: Avaliar a associação entre estado nutricional, atividade física, comportamento sedentário, dieta e estilo de vida na infância e doenças respiratórias durante a adolescência. Métodos: Estudo prospectivo realizado em São Caetano do Sul, São Paulo, como parte do International Study of Childhood Obesity, Lifestyle and the Environment. Indicadores do estilo de vida (composição corporal, atividade física, comportamento sedentário, dieta) e do ambiente familiar foram mensurados durante a infância, em 2012 e 2013. Após cinco anos, os escolares responderam o questionário do International Study of Asthma and Allergies in Childhood (ISAAC) para o diagnóstico de doenças respiratórias (asma e/ou rinite). Análises foram determinadas por meio da regressão logística. Resultados: Foram avaliados 168 escolares (56% meninos), e as prevalências de asma e rinite observadas foram 15,5 e 25,6%, respectivamente. Consumir leite integral (Odds Ratio [OR]=1,24; intervalo de confiança 95% [IC95%] 1,03-1,49), ter televisão no quarto (OR=0,29; IC95% 0,12-0,71) e praticar aulas de educação física ≥2 vezes/semana (OR=0,30; IC95% 0,11-0,81) na infância foram associados com a presença de asma na adolescência. Os fatores significativamente associados à rinite foram: ser do sexo feminino (OR=2,45; IC95% 1,20-4,98) e consumir leite integral (OR=1,21; IC95% 1,04-1,40). Conclusões: Consumir mais leite integral, não ter televisão no quarto, ter tido poucas aulas de educação física e ser do sexo feminino foram fatores associados às doenças respiratórias. Políticas públicas devem ser dirigidas para um estilo de vida mais saudável e a prevenção de doenças respiratórias.

Lifestyle and anthropometric indicators have greater associations with steps/day in boys than in girls / Indicadores de estilo de vida e antropométricos possuem maiores associações com passos/dia nos meninos do que nas meninas: iscole brasil

ABSTRACT Objective: To verify the association of lifestyle, anthropometric, sociodemographic, family and school environment indicators with the number of steps/day in children. Methods: The sample consisted of 334 children (171 boys) from nine to 11 years old. Participants used the Actigraph GT3X accelerometer to monitor the number of steps/day, moderate to vigorous physical activity (MVPA) and sedentary time (ST) for seven consecutive days. Height, body weight, body mass index (BMI), waist circumference (WC), and body fat were also measured. Lifestyle indicators such as diet, environment, neighborhood, and parental schooling level were obtained with questionnaires. For the identification of variables associated to the number of steps/day, multiple linear regression models were used. Results: The mean steps/day of boys and girls were statistically different (10,471 versus 8,573; p<001). Among boys, the variables associated to the number of steps/day were: MVPA (β=0.777), ST (β=-0.131), BMI (β=-0.135), WC (β=-0.117), and BF (β=-0.127). Among girls, the variables associated to the number of steps/day were: MVPA (β=0.837), ST (β=-0.112), and parents' educational level (β=0.129). Conclusions: Lifestyle indicators, body composition variables and parental educational level influence the number of steps/day of children, and MVPA and ST are common for both sexes.

RESUMO Objetivo: Verificar a associação dos indicadores de estilo de vida, antropométricos, sociodemográficos, ambiente familiar e escolar com a quantidade de passos/dia em crianças. Métodos: A amostra constituiu-se de 334 crianças (171 meninos) de 9 a 11 anos. Os participantes utilizaram o acelerômetro Actigraph GT3X para monitorar a quantidade de passos/dia, a atividade física moderada a vigorosa (AFMV) e o tempo sedentário (TS) durante sete dias consecutivos. Estatura, massa corporal, índice de massa corpórea (IMC), circunferência de cintura (CC) e gordura corporal também foram mensurados. Indicadores de estilo de vida, como dieta, ambiente, vizinhança e nível de escolaridade dos pais, foram obtidos por questionários. Para identificar as variáveis associadas à quantidade de passos/dia, utilizaram-se modelos de regressão linear múltipla. Resultados: As médias de passos/dia dos meninos e das meninas foram estatisticamente diferentes (10.471 versus 8.573; p<0,001). Nos meninos, as variáveis associadas à quantidade de passos/dia foram: AFMV (β=0,777), TS (β=-0,131), IMC (β=-0,135), CC (β=-0,117) e gordura corporal (β=-0,127). Já entre as meninas, as variáveis associadas à quantidade de passos/dia foram: AFMV (β=0,837), TS (β=-0,112) e nível educacional dos pais (β=0,129). Conclusões: Indicadores de estilo de vida, variáveis de composição corporal e nível educacional dos pais influenciaram a quantidade de passos/dia das crianças. A AFMV e o TS foram comuns para ambos os sexos.

LIFESTYLE AND ANTHROPOMETRIC INDICATORS HAVE GREATER ASSOCIATIONS WITH STEPS/DAY IN BOYS THAN IN GIRLS.

OBJECTIVE: To verify the association of lifestyle, anthropometric, sociodemographic, family and school environment indicators with the number of steps/day in children. METHODS: The sample consisted of 334 children (171 boys) from nine to 11 years old. Participants used the Actigraph GT3X accelerometer to monitor the number of steps/day, moderate to vigorous physical activity (MVPA) and sedentary time (ST) for seven consecutive days. Height, body weight, body mass index (BMI), waist circumference (WC), and body fat were also measured. Lifestyle indicators such as diet, environment, neighborhood, and parental schooling level were obtained with questionnaires. For the identification of variables associated to the number of steps/day, multiple linear regression models were used. RESULTS: The mean steps/day of boys and girls were statistically different (10,471 versus 8,573; p<001). Among boys, the variables associated to the number of steps/day were: MVPA (ß=0.777), ST (ß=-0.131), BMI (ß=-0.135), WC (ß=-0.117), and BF (ß=-0.127). Among girls, the variables associated to the number of steps/day were: MVPA (ß=0.837), ST (ß=-0.112), and parents' educational level (ß=0.129). CONCLUSIONS: Lifestyle indicators, body composition variables and parental educational level influence the number of steps/day of children, and MVPA and ST are common for both sexes.

NUTRITIONAL STATUS, PHYSICAL ACTIVITY, SEDENTARY BEHAVIOR, DIET, AND LIFESTYLE IN CHILDHOOD: AN ANALYSIS OF RESPIRATORY DISEASES IN ADOLESCENCE.

OBJECTIVE: To evaluate the association between nutritional status, physical activity, sedentary behavior, diet, and lifestyle in childhood with respiratory diseases during adolescence. METHODS: Prospective study conducted in São Caetano do Sul, São Paulo - Brazil, as part of the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE). During childhood, indicators of lifestyle (body composition, physical activity, sedentary behavior, diet) and family environment were measured in 2012 and 2013. After five years, participants answered the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire for the diagnosis of respiratory diseases (asthma and/or rhinitis). Analyses were determined by logistic regression. RESULTS: A total of 168 schoolchildren (56% boys) were evaluated, and the prevalence of asthma and rhinitis accounted for 15.5 and 25.6%, respectively. Whole milk consumption (Odds Ratio [OR]=1.24; 95% confidence interval [95%CI] 1.03-1.49), having a television in the bedroom (OR=0.29; 95%CI 0.12-0.71), and attending physical education classes ≥2 times/week (OR=0.30; 95%CI 0.11-0.81) in childhood were associated with the presence of asthma in adolescence. Factors significantly associated with rhinitis were as follows: female participants (OR=2.45; 95%CI 1.20-4.98) and whole milk consumption (OR=1.21; 95%CI 1.04-1.40). CONCLUSIONS: Higher consumption of whole milk, not having a television in the bedroom, few physical education classes, and being a girl were factors associated with respiratory diseases. Public policies should be directed toward a healthier lifestyle and the prevention of respiratory diseases.

Is the perceived neighborhood built environment associated with domain-specific physical activity in Latin American adults? An eight-country observational study.

BACKGROUND: Characteristics of the neighborhood built environment are associated with physical activity (PA). However, few studies with representative samples have examined environmental correlates of domain-specific PA in Latin America. We examined the associations of the perceived neighborhood built environment with domain-specific PA in a large sample of adults from eight Latin American countries. METHODS: This study examined data from 8185 adults (aged 18-65 years) from eight Latin American countries. The Neighbourhood Environment Walkability Survey - Abbreviated (NEWS-A) scale was used to assess perceptions of land use mix-diversity, land use mix-access, street connectivity, walking/cycling facilities, aesthetics, safety from traffic, and safety from crime. Perceived proximity from home to public open spaces (metropolitan parks, playgrounds, public squares) and to shopping centers was also measured. Transport-related and leisure-time PA were assessed using the long form of the International Physical Activity Questionnaire. Both logistic and linear regression models were estimated on pooled data. RESULTS: Perceptions of higher land use mix-access (OR: 1.40; 95% CI: 1.22,1.61), the existence of many alternative routes in the neighbourhood (1.12; 1.04,1.20), slow speed of traffic (1.19; 1.03,1.35) and few drivers exceeding the speed limits (1.09; 1.03,1.15) were associated with greater odds of reporting at least 10 min/week of transport-related PA. Perceptions of higher levels of land use mix-diversity, better aesthetics and greater safety from crime, the presence of crosswalks and pedestrian signals, and greater proximity of shopping centers were associated with more min/week of transport-related PA. Perceptions of higher land use mix-diversity (1.12; 1.05,1.20), higher land use mix-access (1.27; 1.13,1.43), more walking/cycling facilities (1.18; 1.09,1.28), and better aesthetics (1.10; 1.02,1.18) were associated with greater odds of engaging in at least 10 min/week of leisure-time PA versus none. Perceptions of higher land use mix-diversity were associated with more min/week of leisure PA. CONCLUSIONS: Different perceived neighborhood built environment characteristics were associated with domain-specific PA among adults from Latin America countries. Interventions designed to modify perceptions of the neighbourhood built environment might influence initiation or maintenance of domain-specific PA. TRIAL REGISTRATION: ClinicalTrials. Gov NCT02226627 . Retrospectively registered on August 27, 2014.

Association between Perceived Neighborhood Built Environment and Walking and Cycling for Transport among Inhabitants from Latin America: The ELANS Study.

PURPOSE: This study aimed to examine the associations of the perceived neighborhood built environment with walking and cycling for transport in inhabitants from Latin American countries. METHODS: This cross-sectional study involved 9218 participants (15-65 years) from the Latin American Study of Nutrition and Health, which included a nationally representative sample of eight countries. All participants completed the International Physical Activity Questionnaire-Long Form for measure walking and cycling for transport and the Neighborhood Environment Walkability Scale-Abbreviated. Furthermore, perceived proximity from home to public open spaces and shopping centers was assessed. RESULTS: Perceived land use mix-access (OR: 1.32; 95%CI: 1.16,1.50) and the existence of many alternative routes in the neighbourhood (1.09 1.01,1.17) were associated with higher odds of reporting any walking for transport (≥10 min/week). Perceived slow speed of traffic (1.88 1.82,1.93) and few drivers exceeding the speed limits (1.92; 1.86,1.98) were also related to higher odds of reporting any walking for transport. The odds of reporting any cycling for transport (≥10 min/week) were higher in participants perceiving more walking/cycling facilities (1.87 1.76,1.99), and better aesthetics (1.22 1.09,1.38). CONCLUSIONS: Dissimilar perceived neighborhood built environment characteristics were associated with walking and cycling for transport among inhabitants from Latin America.

Soil microbial community, enzyme activity, C and N stocks and soil aggregation as affected by land use and soil depth in a tropical climate region of Brazil.

The impact of agricultural land-use on soil microbial community composition and enzyme activity has not been extensively investigated in Ultisols. We investigated soil health parameters by analyzing phospholipid fatty acids (PLFAs), extracellular enzyme activity, C and N stocks, and soil structure. Four land uses were established in a tropical climate region of Brazil: native Cerrado (savanna), monoculture pasture [Urochloa brizantha (Hochst. Ex A. Rich.) R. Webster 'Marandu'], an integrated crop-livestock system (ICLS), and maize (Zea mays)-fallow in a no-tillage system. Soil microbial biomass was 40% higher in the native Cerrado than in the monoculture pasture, ICLS, and no-tillage maize. Soil organic carbon was positively correlated with microbial community composition (MB; gram-; AC; AMF; Fungi; F: B ratio) and enzyme activity (bG, AP, NAG). Large macroaggregates were positively correlated with bG, AP, and AMF. In summary, the native Cerrado had a higher level of carbon at the soil surface and greater soil structure with increased microbial biomass, gram+ bacteria, AMF, fungi, and F:B ratio in a tropical region of Brazil. However, bG and AP enzyme activities were lower in the ICLS and no-till maize at the soil surface (0-5 cm) compared to the native Cerrado. The conversion of native Cerrado to agricultural systems shifted the soil microbial community composition, enzyme activity, C and N, and soil structure of this sandy soil of the Brazilian Cerrado.

Comparison of self-report versus accelerometer - measured physical activity and sedentary behaviors and their association with body composition in Latin American countries.

BACKGROUND: Most population-based studies from Latin America have used questionnaires to measure physical activity (PA) and sedentary behaviors (SB). Low reliability and validity of the questionnaires has limited the capacity to examine associations between PA and health. The purpose of this study was to compare self-reported and accelerometer-measured PA and SB and their associations with body composition in Latin American countries. METHODS: Data were obtained from the Latin American Study of Nutrition and Health (aged 15-65 years), collected from September 2014 to February 2015. PA and SB were assessed using the International Physical Activity Questionnaire (long version) and the Actigraph GT3X+ accelerometer. Outcomes of interest included: body mass index (BMI), waist (WC) and neck circumference (NC). We used the Pearson and intraclass correlation coefficient, Bland-Altman plots, and multilevel linear regression models. RESULTS: Mean moderate-to-vigorous physical activity (MVPA) by accelerometer and IPAQ were 34.4 min/day (95% CI: 33.4 to 35.4) and 45.6 min/day (95% CI: 43.2 to 48.1), respectively. For SB (accelerometer and IPAQ) the means were 573.1 (95% CI: 568.2 to 577.9) and 231.9 min/day (95% CI: 225.5 to 238.3). MVPA, measured by the accelerometer was negatively associated with BMI (ß = -1.95; 95% CI: -2.83 to -1.08), WC (ß = -5.04; 95% CI: -7.18 to -2.89) and NC (ß = -1.21; 95% CI: -1.79 to -0.63). The MVPA estimated through IPAQ was not significantly associated with any of the three outcome variables. SB, measured by the accelerometer, was positively associated with BMI (ß = 0.26; 95% CI: 0.08 to 0.44) and WC (ß = 0.48; 95% CI: 0.13 to 0.91). SB estimated through IPAQ was positively associated with NC only. CONCLUSIONS: Low correlation coefficients were observed for accelerometer-derived and IPAQ-reported estimates of PA and SB. Caution is advised when making comparisons between accelerometer-measured and self-reported PA and SB. Further, studies examining associations between movement and health should discuss the impact of PA and SB measurement methodology on the results obtained.

Rituximab use in adult glomerulopathies and its rationale / Uso do rituximabe em glomerulopatias em adultos e justificativas

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.