Infecção por parvovírus B19 em receptores de transplante renal: série de caso / Parvovirus B19 infection in kidney transplant recipients: a case series

Os receptores de transplante renal são mais suscetíveis a infecções, entre elas o parvovírus B19, que pode ser transmitido por via respiratória, adquirido por meio do enxerto ou por reativação de infecção latente. A anemia normocítica normocrômica, com diminuição dos reticulócitos e resistência ao tratamento com eritropoietina, é a principal forma de apresentação da infecção por parvovírus B19 em transplante renal. O diagnóstico requer alto índice de suspeição clínica e realização de testes diagnósticos selecionados. Tratamento com imunoglobulina e suspensão dos imunossupressores durante a infecção mostraram-se eficazes. Os autores relatam sua experiência com cinco casos de infecção por parvovírus B19 em receptores de transplante renal de um hospital universitário. Os aspectos clínicos, diagnósticos e terapêuticos são revistos.

Kidney transplant recipients are more susceptible to infections, including by parvovirus B19, spread through the respiratory tract, acquired through the graft or reactivation of latent infection. Normocytic normochromic anemia, with decreased reticulocytes and resistance to erythropoietin treatment, is the most common presentation of Parvovirus B19 infection in renal transplant. Diagnosis requires a higher clinical suspicion and the performance of selected diagnostic tests. Treatment with immunoglobulin and suspension of immunosuppressive therapy during the infection may be effective. The authors report five cases of PB19 infection in kidney transplant patients at a hospital. The clinical, diagnostic, and treatment features are reviewed.

Comparative study between kidney transplantation with deceased donor expanded criteria and donor standard criteria in a single center in Brazil.

Introduction: Kidney transplants with expanded criteria donor have been associated with improved patient survival compared to those who remain on dialysis. Objective: To compare renal function and survival of the kidney graft of deceased donor with expanded criteria and standard criteria over a year in a single transplant center. Methods: 255 kidney transplant recipients with deceased donor were included in the study between the years 2011 to 2013 and they were separated into two groups according to the type of donor (expanded criteria donor - ECD - and standard criteria donor - SCD). Results: 231 deceased donor transplants (90.6%) were performed with standard criteria donor (SCD) and 24 (9.4%) with expanded criteria donor (ECD). There was no difference in the prevalence of delayed graft function - DGF - (62.9% vs. 70.8%; p = 0.44). Expanded criteria donor group had lower glomerular filtration rate (GFR) at the end of the 1st year (56.8 ± 26.9 vs. 76.9 ± 23.7; p = 0.001). Patient survival was significantly lower in the ECD group, but the graft survival was not different after death-censored analysis. Conclusion: The ECD group was associated with significantly lower levels of GFR during the first year of transplant and a lower patient survival at the 1st year when compared to the SCD.

Introdução: A aceitação dos rins com critério expandido de doação tem sido associada com melhor sobrevida do paciente em comparação àqueles que permanecem em terapia dialítica. Objetivo: Comparar a função renal e a sobrevida do enxerto renal de doador falecido critério expandido com os de doador falecido critério padrão ao longo de um ano em um único centro de transplantes. Métodos: Foram incluídos 255 receptores de transplante renal com doador falecido, realizados entre os anos de 2011 a 2013, sendo divididos em dois grupos segundo o tipo de doador (critério expandido - DCE - ou padrão -DCP). Resultados: Foram avaliados 231 receptores com doador critério ideal (90,6%) e 24 com doador critério expandido (9,4%). Não houve diferença na prevalência de função retardada do enxerto - DGF - (62,9% no DCP vs. 70,8% no DCE; p = 0,44) nos dois grupos. Os transplantes com DCE apresentaram uma taxa de filtração glomerular (TFG) significativamente inferior aos 12 meses (56,8 ± 26,9 vs. 76,9 ± 23,7; p = 0,001). A sobrevida dos pacientes em 1 ano foi significativamente inferior no grupo de DCE, mas não houve diferença na sobrevida dos enxertos após exclusão de perdas por óbito com rim funcionante. Conclusão: O grupo com DCE associou-se com níveis significativamente mais baixos de TFG ao longo do primeiro ano de transplante, bem como uma menor sobrevida dos pacientes em 1 ano, quando comparado ao grupo com doador padrão.

Comparative study between kidney transplantation with deceased donor expanded criteria and donor standard criteria in a single center in Brazil / Estudo comparativo entre transplantes renais com doador falecido critério expandido e critério padrão em um único centro no Brasil

Abstract Introduction: Kidney transplants with expanded criteria donor have been associated with improved patient survival compared to those who remain on dialysis. Objective: To compare renal function and survival of the kidney graft of deceased donor with expanded criteria and standard criteria over a year in a single transplant center. Methods: 255 kidney transplant recipients with deceased donor were included in the study between the years 2011 to 2013 and they were separated into two groups according to the type of donor (expanded criteria donor - ECD - and standard criteria donor - SCD). Results: 231 deceased donor transplants (90.6%) were performed with standard criteria donor (SCD) and 24 (9.4%) with expanded criteria donor (ECD). There was no difference in the prevalence of delayed graft function - DGF - (62.9% vs. 70.8%; p = 0.44). Expanded criteria donor group had lower glomerular filtration rate (GFR) at the end of the 1st year (56.8 ± 26.9 vs. 76.9 ± 23.7; p = 0.001). Patient survival was significantly lower in the ECD group, but the graft survival was not different after death-censored analysis. Conclusion: The ECD group was associated with significantly lower levels of GFR during the first year of transplant and a lower patient survival at the 1st year when compared to the SCD.

Resumo Introdução: A aceitação dos rins com critério expandido de doação tem sido associada com melhor sobrevida do paciente em comparação àqueles que permanecem em terapia dialítica. Objetivo: Comparar a função renal e a sobrevida do enxerto renal de doador falecido critério expandido com os de doador falecido critério padrão ao longo de um ano em um único centro de transplantes. Métodos: Foram incluídos 255 receptores de transplante renal com doador falecido, realizados entre os anos de 2011 a 2013, sendo divididos em dois grupos segundo o tipo de doador (critério expandido - DCE - ou padrão -DCP). Resultados: Foram avaliados 231 receptores com doador critério ideal (90,6%) e 24 com doador critério expandido (9,4%). Não houve diferença na prevalência de função retardada do enxerto - DGF - (62,9% no DCP vs. 70,8% no DCE; p = 0,44) nos dois grupos. Os transplantes com DCE apresentaram uma taxa de filtração glomerular (TFG) significativamente inferior aos 12 meses (56,8 ± 26,9 vs. 76,9 ± 23,7; p = 0,001). A sobrevida dos pacientes em 1 ano foi significativamente inferior no grupo de DCE, mas não houve diferença na sobrevida dos enxertos após exclusão de perdas por óbito com rim funcionante. Conclusão: O grupo com DCE associou-se com níveis significativamente mais baixos de TFG ao longo do primeiro ano de transplante, bem como uma menor sobrevida dos pacientes em 1 ano, quando comparado ao grupo com doador padrão.

Estratégia Educacional Baseada em Problemas para Grandes Grupos: Relato de Experiência / Large Group Problem-Based Teaching Strategy: Case Study

RESUMO Nos últimos anos, o olhar sobre a formação dos profissionais de saúde tem se intensificado, particularmente sobre aquela que possa impactar a resolução dos problemas de saúde da população. Um dos aspectos para o alcance desta demanda refere-se a uma formação que incorpore metodologias ativas no processo ensino-aprendizagem de estudantes da saúde. Neste entendimento, tomando como referência metodologias de aprendizagem baseada em problemas, as quais utilizam certos passos para a resolução de problemas, e diante dos desafios de trabalhar com grandes grupos, desenvolveu-se a estratégia educacional denominada Ciclo de Discussão de Problemas (CDP). Este artigo tem por objetivo descrever o CDP como uma estratégia educacional utilizada em grandes grupos no ensino da graduação em saúde. Esta estratégia ancora-se nos princípios de metodologia ativa, pois utiliza problemas com temáticas comuns aos cursos da área da saúde, para desenvolver nos alunos o aprendizado autodirigido, a habilidade de solucionar problemas, o pensamento crítico e o estudo colaborativo, além da visão integrada das ciências básicas. Esta estratégia envolve dois momentos em sala de aula para cada problema: análise e resolução, englobando 12 passos.

ABSTRACT In recent years, the training of health professionals has become an area of increasing scrutiny and focus, particularly regarding what can be done to solve public health problems. One aspect that can respond to such demands is training that incorporates active methodologies in health students’ learning processes. By this understanding, taking problem-based learning methodologies as a reference, which follow certain steps to solve problems, and in light of the challenges in working with large groups, we developed an educational strategy called Cycle of Problem Discussion (CDP). This article aims to describe CPD as a pedagogical strategy used in large groups in undergraduate health courses. This strategy is anchored in principles of active methodology because it applies problems with common themes to healthcare courses in order to develop students’ self-directed learning, problem-solving abilities, critical thinking and collaborative study, in addition to an integrated view of basic sciences. The strategy involves two moments for each problem in the classroom: analysis and resolution, encompassing twelve steps.

Evaluation of the anti-inflammatory and analgesic effects of green tea (Camellia sinensis) in mice.

PURPOSE: To evaluate the anti-inflammatory and analgesic effects of green tea (Camellia sinensis) in mice. METHODS: The anti-inflammatory effect of alcoholic extracts of green tea (AE) was evaluated in a cell migration assay with four groups of six Swiss mice receiving 0.07 g/Kg or 0.14 g/Kg EA (treatment groups), saline (negative control) or 10mg/Kg indomethacin (positive control) by gavage. One hour later 300 µg carrageen an was administered intraperitoneally or subcutaneously. The analgesic effect was evaluated using four groups of six animals receiving 0.07 g/Kg or 0.14 g/Kg EA, saline or 10mg/Kg indomethacin subcutaneously, followed 30 minutes later by 1% acetic acid. RESULTS: When administered subcutaneously at either dose (0.07 g/Kg and 0.14 g/Kg), AE inhibited carrageenan-induced cell migration (p<0.05). However, when administered by gavage, only the latter (0.14 g/Kg) was efficient (p<0.05). AE at both doses (0.07 g/Kg and 0.14 g/Kg) inhibited abdominal contortions (p<0.05), but the effect was not dose-dependent. CONCLUSION: Green tea was shown to have analgesic and anti-inflammatory properties and may constitute a natural treatment option in chronic inflammatory disorders.

Evaluation of the anti-inflammatory and analgesic effects of green tea (Camellia sinensis) in mice

PURPOSE: To evaluate the anti-inflammatory and analgesic effects of green tea (Camellia sinensis) in mice. METHODS: The anti-inflammatory effect of alcoholic extracts of green tea (AE) was evaluated in a cell migration assay with four groups of six Swiss mice receiving 0.07g/Kg or 0.14g/Kg EA (treatment groups), saline (negative control) or 10mg/Kg indomethacin (positive control) by gavage. One hour later 300 µg carrageen an was administered intraperitoneally or subcutaneously. The analgesic effect was evaluated using four groups of six animals receiving 0.07g/Kg or 0.14g/Kg EA, saline or 10mg/Kg indomethacin subcutaneously, followed 30 minutes later by 1% acetic acid. RESULTS: When administered subcutaneously at either dose (0.07g/Kg and 0.14g/Kg), AE inhibited carrageenan-induced cell migration (p<0.05). However, when administered by gavage, only the latter (0.14 g/Kg) was efficient (p<0.05). AE at both doses (0.07g/Kg and 0.14g/Kg) inhibited abdominal contortions (p<0.05), but the effect was not dose-dependent. CONCLUSION: Green tea was shown to have analgesic and anti-inflammatory properties and may constitute a natural treatment option in chronic inflammatory disorders. .

Red blood cell and leukocyte alloimmunization in patients awaiting kidney transplantation

Objective: To determine the rates of red blood cell and leukocyte alloimmunization in patients with chronic kidney disease awaiting kidney transplantation. Methods: In this cross-sectional and prospective study, the serum of 393 chronic kidney disease patients on a transplant waiting list in Ceará, Northeastern Brazil were tested for red cell and leukocyte antibodies. In addition, demographic, clinical and laboratory data were collected. Results: The average age in the sample of 393 patients was 34.1 ± 14 years. Slightly more than half (208; 52.9%) were male. The average numbers of transfusions and gestations were 3.1 ± 3.3 and 1.6 ± 6, respectively. One third (33.6%) were alloimmunized: 78% with leukocyte antibodies, 9.1% with red cell antibodies and 12.9% with both. Red cell antibodies were detected in 29 cases (7.4%), 17 of whom were women, who had received more transfusions than the males (p-value < 0.0001). The most frequently detected red cell antibodies belonged to the Rh (24.1%) and Kell (13.8%) blood group systems. Leukocyte antibodies were detected in 30.5% of cases, 83 of whom were women, who had received more transfusions than the males (p-value < 0.0001) and were more reactive to panel reactive antibodies (p-value < 0.0001). The mean alloreactivity to panel reactive antibodies was 47.7 ± 31.2%. Conclusion: Chronic kidney disease patients on the transplant waiting list in Ceará, Brazil, display high ...

Growth inhibition of Walker carcinosarcoma 256 with alcoholic extract of green tea leaves (Camellia sinensis).

PURPOSE: To evaluate the antitumor activity of alcoholic extracts of green tea (Camella sinensis). METHODS: Four groups of six Wistar rats were inoculated intramuscularly with 10(6) Walker tumor cells/mL. During 10 days, the animals received by gavage either 0.9% saline solution (Group I; negative control), solution containing 20 mg/Kg of tamoxifen (Group II; positive control), solution containing 0.07 g/Kg alcoholic extract of C. sinensis (Group III), or solution containing 0.14 g/Kg alcoholic extract of C. sinensis (Group IV). Following euthanasia on the tenth day, the tumor, liver, kidneys and spleen were excised and weighed, and tumor volume and tumor growth inhibition were quantified. RESULTS: The average weight of the animals was greater in Group IV than in Group II (p=0.0107). Tumor weight was smaller in Group IV than in Group I (p=0.0062), but did not differ from Group II. Tumor volume was smaller in Groups II and IV than in Group I (p=0.0131). Tumor growth inhibition was observed in Groups II (44.67% ± 32.47), III (16.83% ± 53.02) and IV (66.4% ± 25.82) (p>0.05). The groups did not differ with regard to the weight of the excised organs. CONCLUSION: Alcoholic extracts of green tea have antitumor activity.

Growth inhibition of Walker carcinosarcoma 256 with alcoholic extract of green tea leaves (Camellia sinensis) / Inibição do crescimento do carcinossarcoma 256 de Walker pelo extrato alcoólico de folhas de chá verde(Camellia sinensis)

PURPOSE: To evaluate the antitumor activity of alcoholic extracts of green tea (Camella sinensis). METHODS: Four groups of six Wistar rats were inoculated intramuscularly with 10(6) Walker tumor cells/mL. During 10 days, the animals received by gavage either 0.9% saline solution (Group I; negative control), solution containing 20 mg/Kg of tamoxifen (Group II; positive control), solution containing 0.07 g/Kg alcoholic extract of C. sinensis (Group III), or solution containing 0.14 g/Kg alcoholic extract of C. sinensis (Group IV). Following euthanasia on the tenth day, the tumor, liver, kidneys and spleen were excised and weighed, and tumor volume and tumor growth inhibition were quantified. RESULTS: The average weight of the animals was greater in Group IV than in Group II (p=0.0107). Tumor weight was smaller in Group IV than in Group I (p=0.0062), but did not differ from Group II. Tumor volume was smaller in Groups II and IV than in Group I (p=0.0131). Tumor growth inhibition was observed in Groups II (44.67% ± 32.47), III (16.83% ± 53.02) and IV (66.4% ± 25.82) (p>0.05). The groups did not differ with regard to the weight of the excised organs. CONCLUSION: Alcoholic extracts of green tea have antitumor activity.

OBJETIVO: Avaliar a atividade antitumoral do extrato alcoólico do chá verde (C. sinensis). MÉTODOS: Quatro grupos de seis ratos Wistar foram inoculados com 1x10(6) células/mL do tumor de Walker por via intramuscular. Os grupos foram tratados durante 10 dias, por gavagem, com salina 0,9 % (Grupo I, controle negativo), 20 mg/Kg de tamoxifeno (Grupo II, controle positivo) e extrato alcoólico de C. sinensis nas doses de 0,07 g/Kg (Grupo III) ou 0,14 g/Kg (Grupo IV). O volume e a inibição do crescimento tumoral foram calculados. RESULTADOS: A média dos pesos dos animais foi maior no Grupo IV do que no Grupo II (p=0,0107). O peso tumoral do Grupo IV foi menor do que o Grupo I (p=0,0062), mas não houve diferença quando comparado ao Grupo II. O volume tumoral foi menor nos grupos II e IV quando comparados ao Grupo I (p=0,0131). Inibição tumoral foi observada nos Grupos II = 44,67 ± 32,47, III = 16,83 ± 53,02 e IV = 66,4 ± 25,82 (p>0,05). Não houve diferença no peso dos órgãos entre os grupos. CONCLUSÃO: O extrato alcoólico do chá verde possui ação antitumoral.

[Demographic, clinical and laboratory data of patients with urinary lithiasis in Fortaleza, Ceará]. / Dados demográficos, clínicos e laboratoriais de pacientes com litíase urinária em Fortaleza, Ceará

OBJECTIVE: To describe the demographic, clinical and laboratory data of patients with urolithiasis in Fortaleza, Ceará, Brazil. PATIENTS AND METHODS: Secondary data were collected from the medical records of 197 patients with urolithiasis, during the period 1996-2006. Clinical evaluation and 24-h urine collection for measurements of urinary volume, creatinine, calcium, phosphorous, uric acid, sodium, potassium and magnesium were performed. Density and pH value were determined in a first-voided morning urine sample. Cystinuria was detected by stone and/or crystal analysis. RESULTS: The male/female ratio was 1:1.7. The average age of symptom onset was 35.8 ± 13.3 years, with no significant difference between the genders. The most affected age range was 20-39 years (56.3%). Patients reported renal colic (72.4%), emergency room attendance (69.5%), a single episode of lithiasis (46.7%) or recurrent episodes (53.3%). The right kidney was most often affected in women (44.4%), while men suffered predominantly from bilateral lithiasis (39.7%). The main metabolic changes observed were hypernatriuria (80.7%), hypercalciuria (48.7%), hyperuricosuria (17.3%), and cystinuria in 5 patients (2.5%). The average pH value and density were 5.74 ± 0.59 and 1015.6 ± 7.1, respectively. Urinary volume was low in 43% of the cases. CONCLUSION: Lithiasis was most prevalent in adults aged 20-39 years, and affected predominantly women in our region. The most frequent metabolic changes, in descending order, were hypernatriuria, followed by hypercalciuria and hyperuricosuria, associated with low fluid intake.

Dados demográficos, clínicos e laboratoriais de pacientes com litíase urinária em Fortaleza, Ceará / Demographic, clinical and laboratory data of patients with urinary lithiasis in Fortaleza, Ceará

OBJETIVO: Determinar os dados demográficos, clínicos e laboratoriais de pacientes com litíase urinária em Fortaleza (CE). PACIENTES E MÉTODOS: Trata-se de estudo documental baseado em dados secundários de 197 pacientes litiásicos de Fortaleza, entre 1996-2006. Foram realizadas avaliação clínica e metabólica na urina de 24 horas, para medida de volume urinário e dosagens de creatinina, cálcio, fósforo, ácido úrico, sódio, potássio e magnésio. O pH e a densidade foram determinados na primeira urina da manhã. A cistinúria foi definida por meio da análise de cristais e/ou cálculos. RESULTADOS: A relação homem:mulher foi de 1:1,7. A média de idade na primeira sintomatologia foi de 35,8 ± 13,3 anos, não havendo diferença entre os gêneros. A faixa etária mais acometida foi entre 20 e 39 anos (56,3 por cento); 72,4 por cento apresentaram cólica nefrética, 69,5 por cento procuraram a emergência médica, 46,7 por cento apresentaram um episódio de litíase e 53,3 por cento eram recorrentes. O rim direito foi o mais afetado (44,4 por cento) nas mulheres, enquanto que nos homens o acometimento foi bilateral (39,7 por cento). As principais alterações metabólicas encontradas foram hipernatriúria (80,7 por cento), seguida de hipercalciúria (48,7 por cento), hiperuricosúria (17,3 por cento) e cistinúria em 5 (2,5 por cento). A média do pH urinário foi de 5,74 ± 0,59 e da densidade urinária, de 1015,6 ± 7,1. O volume urinário foi baixo em 43 por cento dos casos. CONCLUSÃO: Em nosso meio, a litíase acomete adultos jovens entre 20-39 anos, com predominância do gênero feminino, e os distúrbios mais frequentes, em ordem decrescente, foram hipernatriúria, hipercalciúria e hiperuricosúria, associadas à baixa ingestão de líquidos.

OBJECTIVE: To describe the demographic, clinical and laboratory data of patients with urolithiasis in Fortaleza, Ceará, Brazil. PATIENTS AND METHODS: Secondary data were collected from the medical records of 197 patients with urolithiasis, during the period 1996-2006. Clinical evaluation and 24-h urine collection for measurements of urinary volume, creatinine, calcium, phosphorous, uric acid, sodium, potassium and magnesium were performed. Density and pH value were determined in a first-voided morning urine sample. Cystinuria was detected by stone and/or crystal analysis. RESULTS: The male/female ratio was 1:1.7. The average age of symptom onset was 35.8 ± 13.3 years, with no significant difference between the genders. The most affected age range was 20-39 years (56.3 percent). Patients reported renal colic (72.4 percent), emergency room attendance (69.5 percent), a single episode of lithiasis (46.7 percent) or recurrent episodes (53.3 percent). The right kidney was most often affected in women (44.4 percent), while men suffered predominantly from bilateral lithiasis (39.7 percent). The main metabolic changes observed were hypernatriuria (80.7 percent), hypercalciuria (48.7 percent), hyperuricosuria (17.3 percent), and cystinuria in 5 patients (2.5 percent). The average pH value and density were 5.74 ± 0.59 and 1015.6 ± 7.1, respectively. Urinary volume was low in 43 percent of the cases. CONCLUSION: Lithiasis was most prevalent in adults aged 20-39 years, and affected predominantly women in our region. The most frequent metabolic changes, in descending order, were hypernatriuria, followed by hypercalciuria and hyperuricosuria, associated with low fluid intake.

Prevalência de heterozigotos para hemoglobinopatias em estudantes universitários do Ceará / The prevalence of heterozygotes for hemoglobinopathies among undergraduate students of Ceará

As hemoglobinopatias são doenças genéticas freqüentes que apresentam morbidade significativa em todomundo. A detecção de heterozigotos AS e AC é extremamente importante para a saúde pública, uma vez que essesindivíduos podem originar indivíduos homozigotos SS ou duplos heterozigotos SC. O presente estudo teve como objetivo determinar a prevalência de heterozigotos para hemoglobinopatias em estudantes universitários do Ceará e, em seguida, encaminhá-los para um profissional habilitado em aconselhamento genético. Do total de 235 amostras analisadas, 229(97,5%) apresentaram perfil hemoglobínico normal (Hb AA), enquanto que em 6 (2,5%) foram identificadas hemoglobinas anormais. Destas, 5 (2,1%) apresentaram traços de hemoglobina S (heterozigose AS) e 1 (0,4%) amostra apresentou traços de hemoglobina C (heterozigose AC). A triagem de hemoglobina é importante para a prevenção de hemoglobinopatias, principalmente para os indivíduos que não foram beneficiados com a Portaria n° 822/01 do Ministério da Saúde que incluiu as hemoglobinopatias no Programa Nacional deTriagem Neonatal e, portanto, desconhecem o fato deserem portadores assintomáticos.

Hemoglobinopathies are quite common genetic diseases which present significant morbity worldwide. Theearly detection of AS and AC heterozygotes among prospective couples is of extreme importance in Health Public Policy making, since those individuals may give birth to homozygotes SS or double-heterozygotes, SC. This study aims todetermine the prevalence of heterozygotes for hemoglobinopathies among undergraduate students of Ceará and then direct them to genetic counseling. Of the 235 samples analyzed, 229 (97.5%) had a normal hemoglobinic profile (Hb AA), while 6(2.5%) had abnormal hemoglobin. From the former, 5 (2.1%) samples presented traces of Hemoglobin S (AS heterozygose), and only 1 (0.4%) hemoglobin C (AC heterozygose). Hemoglobin tracing is a vitally important public health policy in the prevention of hemoglobinopathies, especially among individuals who have not benefited from the Brazilian Ministry of Health Directive # 822/01, which includes hemoglobinopathies in the National Neonatal Screening Program consequently they are unaware of being asymptomatic carriers.

Chemical and morphological analysis of kidney stones: a double-blind comparative study / Análise química e morfológica de cálculos renais: estudo comparativo duplo-cego

PURPOSE: To compare chemical to morphological kidney stone composition analysis based on a sample of 50 stones retrieved from patients at a nephrology service. METHODS: The chemical analysis was performed with a Bioclin® kit, while a 10-mm magnifying glass (10x; Prolabo, Paris, France) was employed in the morphological analysis. Findings obtained with the two methods were compared and classified as concordant (100 percent agreement), partly concordant (concordant for major components, discordant for minor components) or discordant (discordant for major components). RESULTS: In the chemical analysis, the most commonly observed major component was calcium (70 percent), followed by oxalate (66 percent), ammonium (56 percent), urate (28 percent) and carbonate (24 percent). In the morphological analysis, the most commonly observed major components were calcium phosphate and magnesium (32 percent each), followed by calcium oxalate monohydrate (24 percent), uric acid and urates (20 percent each), calcium oxalate dihydrate (18 percent) and cystine (6 percent). Infectious kidney stones were identified in 34 percent and 24 percent of cases by morphological and chemical analysis, respectively. Thirty-eight percent of the samples were classified as concordant, 52 percent were partly concordant and 10 percent were discordant. CONCLUSION: We suggest kidney stones be routinely submitted to both types of analysis for a better understanding of the mechanisms involved in lithogenesis.

OBJETIVO: Comparar a análise química com a análise morfológica de 50 cálculos urinários provenientes de pacientes em um serviço de nefrologia. MÉTODOS: A análise química foi realizada utilizando o kit da Bioclin®, enquanto que a morfológica foi realizada com auxílio de uma lupa de 10mm (Prolabo, Paris, France). A comparação entre as técnicas foi classificada em concordante (100 por cento de concordância), parcialmente concordante (componentes majoritários concordantes e minoritários discordantes) e discordante (discordância nos componentes majoritários). RESULTADOS: Na análise química os principais componentes majoritários foram cálcio (70 por cento), oxalato (66 por cento), amônio (56 por cento), urato (28 por cento) e carbonato (24 por cento). Na análise morfológica os principais componentes majoritários foram fosfato cálcico (PCa) e magnesiano-PCa (32 por cento), oxalato de cálcio monohidratado (24 por cento), ácido úrico e uratos (20 por cento), oxalato de cálcio dihidratado (18 por cento) e cistina (6 por cento). Cálculos de infecção foram identificados em 34 por cento e 24 por cento casos pela análise morfológica e química, respectivamente. Concordância total foi observada em 38 por cento, concordância parcial em 52 por cento e discordância em 10 por cento. CONCLUSÃO: Sugere-se a utilização simultânea das duas técnicas para melhor compreensão dos mecanismos litogênicos.

Chemical and morphological analysis of kidney stones: a double-blind comparative study.

PURPOSE: To compare chemical to morphological kidney stone composition analysis based on a sample of 50 stones retrieved from patients at a nephrology service. METHODS: The chemical analysis was performed with a Bioclin® kit, while a 10-mm magnifying glass (10x; Prolabo, Paris, France) was employed in the morphological analysis. Findings obtained with the two methods were compared and classified as concordant (100% agreement), partly concordant (concordant for major components, discordant for minor components) or discordant (discordant for major components). RESULTS: In the chemical analysis, the most commonly observed major component was calcium (70%), followed by oxalate (66%), ammonium (56%), urate (28%) and carbonate (24%). In the morphological analysis, the most commonly observed major components were calcium phosphate and magnesium (32% each), followed by calcium oxalate monohydrate (24%), uric acid and urates (20% each), calcium oxalate dihydrate (18%) and cystine (6%). Infectious kidney stones were identified in 34% and 24% of cases by morphological and chemical analysis, respectively. Thirty-eight percent of the samples were classified as concordant, 52% were partly concordant and 10% were discordant. CONCLUSION: We suggest kidney stones be routinely submitted to both types of analysis for a better understanding of the mechanisms involved in lithogenesis.

Aids no Brasil: uma epidemia em transformação / Aids in Brazil: an epidemic diseases in transformation

O quadro da AIDS no Brasil evidencia uma epidemia que tem sofrido transformações na sua evolução e distribuição geográfica. O presente estudo teve como objetivo descrever o atual perfil epidemiológico da AIDS no Brasil. Trata-se de uma análise retrospectiva, descritiva e observacional dos casos de AIDS notificados ao Minitério da Saúde, no período de 1980 a 2007. No início da epidemia, os casos de AIDS se concentravam nas grandes cidades do Sul e Sudeste, em indivíduos jovens do sexo masculino com nível sócio econômico elevado e considerados de grupo de risco. Atualmente, o perfil epidemiológico da AIDS está passando por grandes transformações. A epidemia está vançando para as regiões Norte e Nordeste, em indivíduos com idade acima de 50 anos, em ambos os sexos. A AIDS passou a atingir as mulheres, principalmente na faixa etária reprodutiva, o que pode acarretar aumenta da transmissão vertical do HIV, de mãe para filho. Observa-se um número maior de casos de AIDS em indivíduos heterosexuais e estabilização do número de casos em homosexuais. É imperativo que toda a sociedade em geral participe ativamente das campanhas de prevenção e conscientização da população para a vulnerabilidade de todos frente ao risco de contrair AIDS.

End-stage renal disease due to delayed diagnosis of renal tuberculosis: a fatal case report.

Renal TB is difficult to diagnose, because many patients present themselves with lower urinary symptoms which are typical of bacterial cystitis. We report a case of a young woman with renal TB and ESRD. She was admitted with complaints of adynamia, anorexia, fever, weight loss, dysuria and generalized edema for 10 months. At physical examination she was febrile (39 degrees C), and her abdomen had increased volume and was painful at palpation. Laboratorial tests showed serum urea = 220 mg/dL, creatinine = 6.6 mg/dL, hemoglobin = 7.9 g/dL, hematocrit = 24.3%, leukocytes = 33,600/mm(3) and platelets = 664,000/mm(3). Urinalysis showed an acid urine (pH = 5.0), leukocyturia (2+/4+) and mild proteinuria (1+/4+). She was also oliguric (urinary volume < 400 mL/day). Abdominal echography showed thick and contracted bladder walls and heterogeneous liquid collection in the left pelvic region. Two laparotomies were performed, in which abscess in pelvic region was found. Anti-peritoneal tuberculosis treatment with rifampin, isoniazid and pyrazinamide was started. During the follow-up, the urine culture was found to be positive for M. tuberculosis. Six months later the patient had complaints of abdominal pain and dysuria. New laboratorial tests showed serum urea = 187 mg/dL, creatinine = 8.0 mg/dL, potassium = 6.5 mEq/L. Hemodialysis was then started. The CT scan showed signs of chronic nephropathy, dilated calyces and thinning of renal cortex in both kidneys and severe dilation of ureter. The patient developed neurologic symptoms, suggesting tuberculous meningoencephalitis, and died despite of support measures adopted. The patient had ESRD due to secondary uropathy to prolonged tuberculosis of urinary tract that was caused by delayed clinical and laboratorial diagnosis, and probably also due to inadequate antituberculous drugs administration.

Glutamine or whey-protein supplementation on alloxan-induced diabetic rats. Effects on CD4+ and CD8+ lymphocytes.

PURPOSE: To evaluate the effects of glutamine (L-Gln) or whey-protein supplementation on CD4+ and CD8+ lymphocytes in alloxan-induced diabetic rats. METHODS: Thirty-two healthy male Wistar rats were used in the experiment. Eight rats served as baseline controls (G-1). The remaining 24 animals received alloxan 150 mg/Kg intraperitonially dissolved in buffer solution and were equally distributed in 3 subgroups, upon induction of diabetes mellitus, and treated as follows: (G2): saline, 2.0 ml; (G3): glutamine solution (0.7 g/kg), 2.0 ml; and (G4): whey-protein (WPS) solution (0.7 g/kg), 2.0 ml. All solutions were administered by daily 7:00 AM gavages during 30 days. Next, arterial blood samples (3.0 ml) were collected from anesthetized rats for CD4+ and CD8+ lymphocyte count through flow cytometry technology. RESULTS: CD4+ and CD8+ counts decreased significantly in all groups compared with baseline values (G1). G2 rats CD4+/CD8+ ratio decreased significantly compared with G1. CD4+/CD8+ ratio increased significantly (>260%) in L-Gln treated group (G3) compared with saline-treated rats (G2). There were no statistical differences in lymphocyte counts (CD4+ and CD8+) between L-Gln (G3) and saline-treated (G2) groups. There was a significant reduction in CD8+ cell count compared with CD4+ cell count in L-Gln treated rats (G3). CONCLUSION: The offer of L-Gln to experimental diabetic rats enhances the immunologic response to infection.

Glutamine or whey-protein supplementation on alloxan-induced diabetic rats. Effects on CD4+ and CD8+ lymphocytes

PURPOSE: To evaluate the effects of glutamine (L-Gln) or whey-protein supplementation on CD4+ and CD8+ lymphocytes in alloxan-induced diabetic rats. METHODS: Thirty-two healthy male Wistar rats were used in the experiment. Eight rats served as baseline controls (G-1). The remaining 24 animals received alloxan 150mg/Kg intraperitonially dissolved in buffer solution and were equally distributed in 3 subgroups, upon induction of diabetes mellitus, and treated as follows: (G2): saline, 2.0ml; (G3): glutamine solution (0.7g/kg), 2.0 ml; and (G4): whey-protein (WPS) solution (0.7g/kg), 2.0 ml. All solutions were administered by daily 7:00 AM gavages during 30 days. Next, arterial blood samples (3.0 ml) were collected from anesthetized rats for CD4+ and CD8+ lymphocyte count through flow cytometry technology. RESULTS: CD4+ and CD8+ counts decreased significantly in all groups compared with baseline values (G1). G2 rats CD4+/CD8+ ratio decreased significantly compared with G1. CD4+/CD8+ ratio increased significantly (>260 percent) in L-Gln treated group (G3) compared with saline-treated rats (G2). There were no statistical differences in lymphocyte counts (CD4+ and CD8+) between L-Gln (G3) and saline-treated (G2) groups. There was a significant reduction in CD8+ cell count compared with CD4+ cell count in L-Gln treated rats (G3). CONCLUSION: The offer of L-Gln to experimental diabetic rats enhances the immunologic response to infection.

OBJETIVO: Avaliar os efeitos da suplementação de glutamina ou proteína do soro de leite ( PSL) sobre os linfócitos CD4+ e CD8+ em ratos diabéticos aloxano induzidos. MÉTODOS: Trinta e dois ratos Wistar machos, saudáveis, foram utilizados no estudo. Oito ratos foram usados como controles basais (G1). Os 24 animais remanescentes foram equitativamente distribuídos em 3 subgrupos, após indução do diabetes mellitus por injeção intraperitonial de aloxano (150mg/Kg) e tratados como se segue: (G2): salina; (G3): 2,0 ml de solução de glutamina (0,75g/Kg);(G4): PSL, (0,7g/Kg), 2,0ml. Todas as soluções foram administradas por gavagem, diariamente, cada 7:00 h, durante 30 dias. Após esse período, foram coletadas amostradas de sangue arterial para contagem de linfócitos CD4+ e CD8+ por citometria de fluxo. RESULTADOS: A população de linfócitos CD4+ e CD8+ diminuiu significantemente em todos os grupos em comparação aos valores encontrados no grupo G1. A razão CD4+/CD8+ foi significantemente maior (>260 por cento) nos ratos tratados com L-Gln que nos ratos tratados com salina (G2). Não se observaram diferenças significantes na população de linfócitos CD4+ e CD8+ entre os grupos G3 e G2. Houve redução significante do número de células CD8+ quando comparado ao número de células CD4+ nos ratos tratados com L-Gln (G3). CONCLUSÃO: A oferta de L-Gln em ratos diabéticos aloxano-induzidos melhora a resposta imunológica à infecção.

End-stage renal disease due to delayed diagnosis of renal tuberculosis: a fatal case report

Renal TB is difficult to diagnose, because many patients present themselves with lower urinary symptoms which are typical of bacterial cystitis. We report a case of a young woman with renal TB and ESRD. She was admitted with complaints of adynamia, anorexia, fever, weight loss, dysuria and generalized edema for 10 months. At physical examination she was febrile (39°C), and her abdomen had increased volume and was painful at palpation. Laboratorial tests showed serum urea=220mg/dL, creatinine=6.6mg/dL, hemoglobin=7.9g/dL, hematocrit=24.3 percent, leukocytes=33,600/mm³ and platelets=664,000/mm³. Urinalysis showed an acid urine (pH=5.0), leukocyturia (2+/4+) and mild proteinuria (1+/4+). She was also oliguric (urinary volume <400mL/day). Abdominal echography showed thick and contracted bladder walls and heterogeneous liquid collection in the left pelvic region. Two laparotomies were performed, in which abscess in pelvic region was found. Anti-peritoneal tuberculosis treatment with rifampin, isoniazid and pyrazinamide was started. During the follow-up, the urine culture was found to be positive for M. tuberculosis. Six months later the patient had complaints of abdominal pain and dysuria. New laboratorial tests showed serum urea=187mg/dL, creatinine=8.0mg/dL, potassium=6.5mEq/L. Hemodialysis was then started. The CT scan showed signs of chronic nephropathy, dilated calyces and thinning of renal cortex in both kidneys and severe dilation of ureter. The patient developed neurologic symptoms, suggesting tuberculous meningoencephalitis, and died despite of support measures adopted. The patient had ESRD due to secondary uropathy to prolonged tuberculosis of urinary tract that was caused by delayed clinical and laboratorial diagnosis, and probably also due to inadequate antituberculous drugs administration.

Cristalúria como um método auxiliar de investigação de pacientes litiásicos: uma experiência na Região Metropolitana de Fortaleza / Cristalluria like method of lithiasis investigation in patients: an experience in the metropolitan region of Fortaleza

Objetivo: identificar, através da cristalúria, os cristais mais freqüentemente observados em portadores de litíase urinária, na região de Fortaleza. Materiais e métodos: 755 cristalúrias proveniente de 464 pacientes, 51,3 porcento masculino, idade de 32,1 ± 1,2 anos, no período de 1993 a 1996. Resultados: A chance de cristalúria positiva nesta população variou de 34,6 porcento a 41,6 porcento. Nos pacientes litiásicos, a cristalúria mostrou uma sensibilidade de 40,7 porcento e especificidade de 63,9 porcento. Os cristais mais freqüentemente, em ordem decrescente: COD, COM, AUD, PACC, bruxita e estruvita. Conclusão: Nossos resultados sugerem que oxalato e ácido úrico podem desempenhar um importante papel na patogênese dos cálculos urinários nesta Região.