Microstructure and Strength of Ti-6Al-4V Samples Additively Manufactured with TiC Heterogeneous Nucleation Site Particles.

Our research aims to investigate the fabrication of additively manufactured (AMed) Ti-6Al-4V samples under reduced power with the addition of TiC heterogeneous nucleation site particles. For this aim, Ti-6Al-4V samples are fabricated with and without TiC heterogeneous nucleation site particles using an EOS M 290 machine under optimal parameters and reduced power conditions. The microstructure and tensile behavior of the produced samples were studied. In addition, a single-track test was performed to obtain a good understanding of the suppression of gas pores and balling formation with the addition of TiC heterogeneous nucleation site particles. It was found that the formation of gas pores and balling was suppressed with the addition of heterogeneous nucleation site particles within the metallic powder.

Prevalence of COVID-19, kidney damage profile and death in intensive care during the pandemic / Prevalência da COVID-19, perfil do acometimento renal e óbito em terapia intensiva durante a pandemia

Introduction: the acute kidney injury is one of the main complications of SARs-Cov-2 infection. Objective: identify the COVID-19 prevalence and kidney damage of evaluated patients followed up by nephrology team in an intensive care unit. Materials and Methods: adults and elderly people of both genders followed up by the nephrology team and performed the RT PCR test for COVID were included on this study. For analysis and comparison, the patients were divided in RTP PCR positive and negative groups. To assess the kidney damage impact on death rates another analysis was performed considering the death or the absence of death as outcome. Results: the prevalence of COVID-19 was 58.5% and the prevalence of AKI was 75.0% among the 176 patients. More than half of patients (55.2%) undergoing renal replacement therapy tested positive for COVID-19. On the evaluation of Charlson Comorbidity Index was identified statistically significant difference in the proportions of the negative and positive COVID-19 groups in scores 0, 1 and 2. The second analysis identified a significant association between kidney disease and death in the ICU (p < 0.05). Patients with CKD died less 13/98 (13.3%) when compared to those with AKI 85/98 (86.7%). When they had both COVID-19 and AKI, the mortality rate was 69.0%. Conclusion: the prevalence of COVID-19 in patients undergoing intensive care during the first semester of 2021 was higher than 50% and the AKI prevalence in patients tested positive for COVID-19 was higher than 80%. The death rates among the patients with AKI and COVID-19 simultaneously were upper than 60%.

Introdução: entre as principais complicações da infecção do SARs-Cov-2 está a Insuficiência renal aguda. Objetivo: identificar a prevalência de COVID-19 e acometimento renal em pacientes avaliados e acompanhados pela equipe de nefrologia em centro de tratamento intensivo. Material e Métodos: participaram adultos e idosos de ambos os sexos acompanhados pela equipe de nefrologia e que realizaram o teste RT PCR para COVID. Para análise e comparação os pacientes foram agrupados em RTP PCR positivo e negativo. Para avaliar o impacto do acometimento renal nas taxas de óbito outra análise foi realizada considerando como desfecho evolução a óbito ou não. Resultados: incluídos 176 pacientes sendo a prevalência de COVID-19 58,5% e IRA 75%. Dos pacientes que realizaram Terapia Renal Substitutiva, mais da metade (55,2%) tinham COVID 19 +. O índice de Charlson identificou-se diferença estatisticamente significativa nas proporções dos grupos COVID-19 negativo e positivo nos índices 0, 1 e 2. A segunda análise identificou associação significativa entre doença renal e óbito no CTI (p < 0,05). Os pacientes com DRC evoluíram menos a óbito 13/98 (13,3%) quando comparados com aqueles com IRA 85/98 (86,7%). E quando tinham simultaneamente o COVID 19 e a IRA a taxa de mortalidade foi de 69,0%. Conclusão: A prevalência da COVID-19 em pacientes internados no CTI adulto durante o primeiro semestre de 2021 foi acima de 50% e a prevalência de IRA nos pacientes positivos ultrapassou a marca dos 80%.  A taxa de óbito entre os pacientes com IRA e COVID 19 + simultâneos ultrapassou 60%.

Severe neuroglycopenic symptoms due to nonketotic hypoglycemia in children with cardio-facio-cutaneous syndrome.

Cardio-facio-cutaneous syndrome (CFC) (OMIM 115150) is a congenital disease caused by constitutive activation of the Raf/MEK/ERK signaling cascade. Unlike aspects of morphological anomalies, metabolic functions related to the disease have garnered little attention. We present severe neuroglycopenic symptoms due to nonketotic hypoglycemia in two children with CFC (Case 1, a 4-year-old male with c.389A > G heterozygous variant in MAP2K1; Case 2, a 3-year-old male with c.770A > G heterozygous variant in BRAF). Case 1 exhibited a nonketotic hypoglycemic coma and clustered left-hemispheric convulsions despite receiving infusion therapy, leading to severe sequelae with choreoathetosis. Brain magnetic resonance imaging of Case 1 showed T2-elongation with restricted diffusion on the bilateral basal ganglia and thalamus, with the dominance of the right putamen. Case 2 presented a prolonged generalized seizure as an initial clinical symptom but fully recovered. The presence of growth hormone and cortisol deficiency was ruled out in both cases. Blood spots acylcarnitine profiles excluded the co-occurrence of mitochondrial HMG-CoA synthase deficiency and HMG-CoA lyase deficiency. These cases demonstrate the potential vulnerability to nonketotic hypoglycemia, especially during lipid shortages. As children with CFC frequently have difficulties feeding, we suggest great attention should be paid to the potential risk of severe nonketotic hypoglycemia.

Distúrbio mineral e ósseo: prevalência subestimada nos estágios iniciais da doença renal crônica / Mineral and bone disorder: underestimated prevalence in the early stages of chronic kidney disease / Trastorno mineral y óseo: prevalencia subestimada en las primeras fases de la enfermedad renal crónica

Introdução: o objetivo foi avaliar a prevalência do distúrbio mineral e ósseo em pacientes com doença renal crônica e a associação entre Taxa de Filtração Glomerular estimada (TFGe) e os indicadores do distúrbio mineral e ósseo (DMO) (cálcio, fósforo e PTH) em pacientes renais crônicos não dialíticos. Materiais e Métodos: estudo seccional da linha de base de uma coorte de dois anos, com adultos e idosos renais crônicos em tratamento conservador. Para identificação do DMO utilizamos os seguintes valores séricos: PTH (> 150 pg/mL) e/ou hipocalcemia (Ca < 8,8mg/dl) e/ou hiperfosfatemia (P > 4,6 mg/dl). Na análise estatística utilizou-se: regressão de Poisson; T de Student, Mann Whitney e correlações de Pearson e Spearman. Nível de significância foi de 5%. Resultados: prevalência de DMO de 54,6% (n=41) (IC 95%: 43,45 - 65,43). A maior prevalência de DMO foi em pessoas do sexo feminino, alfabetizadas, idosas, não etilistas, não tabagistas, sedentárias e de cor de pele branca, porém, sem diferença estatística entre os grupos com e sem DMO. As correlações entre P e PTH com TFGe foram significativas, inversas, de força moderada (p= <0,005 e p = 0,003; coeficientes de correlação = - 0,312 e - 0,379 respectivamente). Discussão:os achados desse estudo mostraram que existe uma lacuna no acompanhamento do DMO-DRC pela atenção primária e a prática clínica deve ser revista. Conclusão:identificou-se prevalência robusta de DMO nos estágios precoces da DRC, além de correlações significativas entre o aumento dos níveis de fósforo e PTH e piora das funções renais.

Introduction: mineral and bone disorder (BMD) is a serious complication of chronic kidney disease (CKD) that increases risks for death from cardiovascular causes and impairs quality of life of affected patients. Objetive: to evaluate the prevalence of BMD in patients with CKD and the association between estimated Glomerular Filtration Rate (eGFR) and BMD indicators (calcium, phosphorus and PTH) in non-dialysis patients. Materials and Methods:sectional study of a two-year cohort of chronic renal adults and elderly patients on conservative treatment. BMD was identified by serum values of: PTH (> 150 pg/mL) and/or hypocalcemia (Ca < 8.8mg/dl) and/or hyperphosphatemia (P > 4.6 mg/dl). The statistical analysis used: Poisson regression; Student's T, Mann Whitney and Pearson and Spearman correlations with 5% significance level. Results:BMD prevalence was 54.6% (n=41) (95% CI: 43.45 - 65.43), more frequent in women, literate, elderly, non-drinkers, non-smokers, sedentary and white skin color. Correlations between P and PTH with GFRe were significant, inverse, moderate strength (p= <0.005 and p = 0.003; correlation coefficients = - 0.312 and - 0.379 respectively). Discussion: the findings of this study highlighted gaps in the monitoring of BMD-DRC by primary care, requiring a review of clinical practices. Conclusion: robust prevalence of BMD in the early stages of CKD was identified, in addition to correlations between increased phosphorus and PTH levels and worsening kidney function.

Introducciòn: el trastorno mineral y óseo (TMO) es una complicación grave de la enfermedad renal crónica (ERC) que aumenta el riesgo de muerte por causas cardiovasculares y deteriora la calidad de vida de los pacientes afectados. Objetivo: evaluar la prevalencia de la DMO en pacientes con RDC y la asociación entre la tasa de filtración glomerular estimada (TFGe) y los indicadores de DMO (calcio, fósforo y PTH) en pacientes no dialíticos. Materiales y Métodos: estudio seccional de una cohorte de dos años de pacientes renales crónicos adultos y ancianos en tratamiento conservador. La DMO se identificó por los valores séricos de: PTH (> 150 pg/mL) y/o hipocalcemia (Ca < 8,8mg/dl) y/o hiperfosfatemia (P > 4,6 mg/dl). El análisis estadístico utilizado: regresión de Poisson; T de Student, Mann Whitney y correlaciones de Pearson y Spearman con un nivel de significación del 5%. Resultados: la prevalencia de DMO fue del 54,6% (n=41) (IC 95%: 43,45 - 65,43), más frecuente en mujeres, alfabetizadas, de edad avanzada, no bebedoras, no fumadoras, sedentarias y de color de piel blanca. Las correlaciones entre el P y la PTH con el GFRe fueron significativas, inversas, de fuerza moderada (p= <0,005 y p = 0,003; coeficientes de correlación = - 0,312 y - 0,379 respectivamente). Discusión: los resultados de este estudio evidencian lagunas en el seguimiento de la DMO-DRC por parte de la atención primaria, lo que requiere una revisión de las prácticas clínicas. Conclusión: se identificó una fuerte prevalencia de la DMO en las primeras fases de la ERC, además de correlaciones entre el aumento de los niveles de fósforo y PTH y el empeoramiento de la función renal.

Exfoliation Resistance, Microstructure, and Oxide Formation Mechanisms of the White Oxide Layer on CP Ti and Ti-Nb-Ta-Zr Alloys.

We found that specific biomedical Ti and its alloys, such as CP Ti, Ti-29Nb-13Ta-4.6Zr, and Ti-36Nb-2Ta-3Zr-0.3O, form a bright white oxide layer after a particular oxidation heat treatment. In this paper, the interfacial microstructure of the oxide layer on Ti-29Nb-13Ta-4.6Zr and the exfoliation resistance of commercially pure (CP) Ti, Ti-29Nb-13Ta-4.6Zr, and Ti-36Nb-2Ta-3Zr-0.3O were investigated. The alloys investigated were oxidized at 1273 or 1323 K for 0.3-3.6 ks in an air furnace. The exfoliation stress of the oxide layer was high in Ti-29Nb-13Ta-4.6Zr and Ti-36Nb-2Ta-3Zr-0.3O, and the maximum exfoliation stress was as high as 70 MPa, which is almost the same as the stress exhibited by epoxy adhesives, whereas the exfoliation stress of the oxide layer on CP Ti was less than 7 MPa, regardless of duration time. The nanoindentation hardness and frictional coefficients of the oxide layer on Ti-29Nb-13Ta-4.6Zr suggested that the oxide layer was hard and robust enough for artificial tooth coating. The cross-sectional transmission electron microscopic observations of the microstructure of oxidized Ti-29Nb-13Ta-4.6Zr revealed that a continuous oxide layer formed on the surface of the alloys. The Au marker method revealed that both in- and out-diffusion occur during oxidation in Ti-29Nb-13Ta-4.6Zr and Ti-36Nb-2Ta-3Zr-0.3O, whereas only out-diffusion governs oxidation in CP Ti. The obtained results indicate that the high exfoliation resistance of the oxide layer on Ti-29Nb-13Ta-4.6Zr and Ti-36Nb-2Ta-3Zr-0.3O are attributed to their dense microstructures composing of fine particles, and a composition-graded interfacial microstructure. On the basis of the results of our microstructural observations, the oxide formation mechanism of the Ti-Nb-Ta-Zr alloy is discussed.

Development of the Protocol to Deliver Graded Stimulation Intensity on Lower Limbs Using Belt-shaped Electrode Skeletal Muscle Stimulation.

OBJECTIVES: Current advancements in neuromuscular electrical stimulation (NMES) include belt-shaped electrode skeletal muscle electrical stimulation (B-SES), which was developed to induce whole leg muscle contraction in a single session. Delivering the optimal amount of stimulation is critical in NMES; therefore, we set out to establish a method to determine the B-SES stimulation intensity needed to induce muscle contraction sufficient for clinical purposes. METHODS: We used the Auto Tens Pro system (Homer Ion Laboratory), which is a B-SES device. Stimulation at 20 Hz was delivered for 5 s, followed by 2 s rest. Twenty-four patients who were hospitalized for musculoskeletal diseases were enrolled at two hospitals. Patients were randomly assigned to one of three groups of subjectively graded stimulation intensities: moderate, strong, or very strong. To achieve each target intensity, we developed a structured verbal instruction protocol that aimed to help therapists deliver the target level of stimulation. As a physiological assessment of muscle contraction, serum lactate levels were measured before and after a single 20-min B-SES session. RESULTS: The electric current intensity required to achieve a target subjective muscle contraction gradually increase according to the subjective contraction level. The increase in serum lactate level was significantly larger in the very strong group than in the moderate group. CONCLUSIONS: B-SES stimulators have the potential to induce efficient muscle strengthening in patients with musculoskeletal diseases. The structured verbal protocol developed here could help therapists achieve the appropriate stimulation intensity for each patient.

Potassium Bromide in the Treatment of Pediatric Refractory Epilepsy.

OBJECTIVE: We evaluated potassium bromide's (KBr's) efficacy and tolerability for pediatric refractory epilepsy. METHODS: We retrospectively reviewed the records of 42 patients treated with KBr in our hospital between 2008 and 2016 (age: 4 months to 19 years; mean: 6.2 years). Thirteen of them had 2 seizure types. The treatment durations ranged from 1 month to 6 years (mean: 15.0 months). RESULTS: KBr had an excellent effect (seizure-free status) in 3 patients (7.1%), a moderate effect (>50% reduction in seizure frequency from the pretreatment baseline) in 21 patients (50.0%), and no effect (<50% reduction in seizure frequency from the pretreatment baseline) in 18 patients (42.9%). The effective daily doses ranged from 20 to 80 mg/kg (mean: 50.0 mg/kg). KBr was effective in 59.1% patients with generalized epilepsy (n = 22), 55.6% patients with focal epilepsy (n = 18), and both patients with Dravet syndrome. An excellent or moderate effect was found in 72.2% patients with tonic seizures (n = 18), 66.6% patients with generalized tonic-clonic seizures (n = 6), 75.0% patients with secondary generalized seizures (n = 4), 46.2% patients with focal seizures (n = 13), and 20% patients with infantile spasms (n = 10) but no patients with myoclonic seizures (n = 2). Adverse effects including drowsiness, excitement, and rashes were reported in 13 patients (31.0%). CONCLUSIONS: These findings suggest that KBr is particularly effective for tonic seizures, generalized tonic-clonic seizures, and secondary generalized seizures. Although the adverse effects need further attention, KBr should be considered for pediatric refractory epilepsy.

Most common histopathological patterns of the Minas Gerais Association of the Centers of Nephrology.

INTRODUCTION: We analyzed the distribution and frequency of glomerular diseases in patients biopsied between 1992 and 2016 in centers that make up the AMICEN (Minas Gerais Association of Nephrology Centers). METHODS: We analyzed the biopsy reports of patients from 9 AMICEN nephrology centers. We took note of their age, gender, ultrasound use, post-biopsy resting time, whether the kidney was native or a graft, number of glomeruli and indication for the biopsy. The kidney biopsy findings were broken down into four categories: glomerular and non-glomerular diseases, normal kidneys and insufficient material for analysis. Those patients diagnosed with glomerular diseases were further divided into having primary or secondary glomerular diseases. RESULTS: We obtained 582 biopsy reports. The median age was 38 years (1 to 85). The number of glomeruli varied between 0 and 70 (median = 13.0). In total, 97.8% of the biopsies were ultrasound guided. The main indication was nephrotic syndrome (36.9%), followed by hematuria-proteinuria association (16.2%). Primary glomerular diseases proved to be the most frequent (75.3%), followed by secondary diseases (24.7%). Among the primary glomerular diseases, FSGS was found at a higher frequency (28.8%), while among the secondary diseases, SLE was the most prevalent (42.4%). Regarding prevalence findings, those for both primary and secondary diseases were similar to those found in the large Brazilian registries published thus far. CONCLUSION: Glomerular disease registries are an important tool to identify the prevalence of such disease in regions of interest and can serve as an instrument to guide public policy decisions concerning the prevention of terminal kidney diseases.

Most common histopathological patterns of the Minas Gerais Association of the Centers of Nephrology

SUMMARY INTRODUCTION: We analyzed the distribution and frequency of glomerular diseases in patients biopsied between 1992 and 2016 in centers that make up the AMICEN (Minas Gerais Association of Nephrology Centers). METHODS: We analyzed the biopsy reports of patients from 9 AMICEN nephrology centers. We took note of their age, gender, ultrasound use, post-biopsy resting time, whether the kidney was native or a graft, number of glomeruli and indication for the biopsy. The kidney biopsy findings were broken down into four categories: glomerular and non-glomerular diseases, normal kidneys and insufficient material for analysis. Those patients diagnosed with glomerular diseases were further divided into having primary or secondary glomerular diseases. RESULTS: We obtained 582 biopsy reports. The median age was 38 years (1 to 85). The number of glomeruli varied between 0 and 70 (median = 13.0). In total, 97.8% of the biopsies were ultrasound guided. The main indication was nephrotic syndrome (36.9%), followed by hematuria-proteinuria association (16.2%). Primary glomerular diseases proved to be the most frequent (75.3%), followed by secondary diseases (24.7%). Among the primary glomerular diseases, FSGS was found at a higher frequency (28.8%), while among the secondary diseases, SLE was the most prevalent (42.4%). Regarding prevalence findings, those for both primary and secondary diseases were similar to those found in the large Brazilian registries published thus far. CONCLUSION: Glomerular disease registries are an important tool to identify the prevalence of such disease in regions of interest and can serve as an instrument to guide public policy decisions concerning the prevention of terminal kidney diseases.

RESUMO INTRODUÇÃO: Analisamos a distribuição e frequência de doenças glomerulares de pacientes biopsiados entre 1992 e 2016 em centros que compõem a Amicen (Associação de Minas Gerais de Nefrologia). MÉTODOS: Analisamos os relatórios de biópsia de pacientes de nove centros de nefrologia da Amicen. Observamos idade, gênero, uso de ultrassom, tempo de descanso pós-biópsia, se o rim era nativo ou um enxerto, número de glomérulos e indicação para a biópsia. Os achados da biópsia do rim foram divididos em quatro categorias: doenças glomerulares e não glomerulares, rins normais e material insuficiente para análise. Os pacientes diagnosticados com doenças glomerulares foram ainda divididos em doenças glomerulares primárias ou secundárias. RESULTADOS: Obtivemos 582 relatórios de biópsia. A idade mediana foi de 38 anos (1 a 85). O número de glomérulos variou entre zero e 70 (mediana = 13,0). No total, 97,8% das biópsias foram guiadas por ultrassom. A principal indicação foi síndrome nefrótica (36,9%), seguida de associação hematúria-proteinúria (16,2%). As doenças glomerulares primárias revelaram-se as mais frequentes (75,3%), seguidas de doenças secundárias (24,7%). Entre as doenças glomerulares primárias, o FSGS foi encontrado em maior frequência (28,8%), enquanto nas doenças secundárias, o lúpus eritematoso sistêmico foi o mais prevalente (42,4%). Quanto aos achados de prevalência, aqueles para doenças primárias e secundárias foram semelhantes aos encontrados nos grandes registros brasileiros publicados até o momento. CONCLUSÃO: Os registros de doenças glomerulares são uma ferramenta importante para identificar a prevalência dessas doenças em regiões de interesse e pode servir como um instrumento para orientar decisões de políticas públicas relativas à prevenção de doenças renais terminais.

A Web-Based Platform to Collect Data from ESRD Patients Undergoing Dialysis: Methods and Preliminary Results from the Brazilian Dialysis Registry.

INTRODUCTION: The methods and initial results of a web-based platform to collect data from patients receiving maintenance dialysis in Brazil are reported. METHODS: Companies providing management software for dialysis centers adapted their system to comply with a formulary of the Brazilian Society of Nephrology. Baseline and follow-up individual patients' data were transmitted via Internet on monthly bases to the coordinating center from 2011 to 2017. RESULTS: 73 dialysis centers provided information of 24,930 patients: 57% were male, 28% were 64 years old or older, and 13% were overweight/obese. Median dialysis vintage was 28 months. Hemodialysis was the most frequent initial therapy (93%) with venous catheters used in 64% of cases. Conventional hemodialysis remained the main current therapy (90%). Seropositivity for hepatitis C, hepatitis B, and HIV was 2.7%, 1.1%, and 0.5%, respectively. Erythropoietin (53.9%), iron (35.1%), and sevelamer (23.4%) were the most used medications. Hemoglobin < 100 g/L and serum P > 1.74 mmol/L were present in 33.1% and 36.6% of the cases, respectively. The 5-year survival of incident cases (n = 7,538) was 57%. CONCLUSION: The initiative represents an innovative strategy to collect clinical and epidemiologic data of dialysis patients which may be applied to other settings and provides information that can contribute to guiding clinical practice and health care policy.

Ovarian teratoma development after anti-NMDA receptor encephalitis treatment.

BACKGROUND: Anti-NMDA-R receptor encephalitis occurs predominantly in younger women and is often comorbid with ovarian teratoma, a feature that is often absent in children. Here, we report our experience with two pediatric patients, in whom no tumors were present during treatment for encephalitis, but in whom ovarian teratomas developed without encephalitis relapse after treatment was completed. CASES: Patient 1 was a 14-year-old girl who was diagnosed due to characteristic symptoms and anti-NMDA-R antibody. MRI scanning during treatment revealed no ovarian tumors, but a tumor developed in the right ovary 10months after onset. Another tumor developed in the left ovary 3years after onset, and a mature ovarian teratoma was confirmed after bilateral partial ovariectomy. Patient 2 was an 11-year old girl who was also diagnosed due to characteristic symptoms and anti-NMDA-R antibody. Imaging during treatment revealed no ovarian tumors, but a 2.5-cm tumor mass was found in the left ovary 10months after onset, and a mature ovarian teratoma was confirmed after partial ovariectomy. DISCUSSION: This case report suggests the need for regular tumor screening after treatment for anti-NMDA receptor encephalitis because of potential subsequent tumor development, even in pediatric patients who initially present with no comorbid tumors. No analysis of relapse risk has yet been reported in cases of tumor development after treatment, and at this point, whether or not resection is needed to prevent relapse remains unclear. However, because teratomas usually grow, have an associated risk of torsion, and can be malignant, tumor removal should be considered.

Drugs indicated for mitochondrial dysfunction as treatments for acute encephalopathy with onset of febrile convulsive status epileptics.

We studied the efficacy of drugs indicated for mitochondrial dysfunction in the treatment of 21 patients with acute encephalopathy with onset of febrile convulsive status epilepticus at our hospital from January 2006 to December 2014. Among them, 11 patients had been treated with a mitochondrial drug cocktail consisting of vitamin B1, vitamin C, biotin, vitamin E, coenzyme Q10, and l-carnitine (prescription group) and 10 patients were not treated with the cocktail (non-prescription group). We retrospectively reviewed age, trigger, clinical form, treatment start time, and sequelae. Clinical form was classified into a biphasic group presenting acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) and a monophasic group. Sequelae were classified as (A) no sequelae group or (B) sequelae group, and differences in the interval between diagnosis and treatment were also evaluated. The sequelae were not different between the mitochondrial drug cocktail prescription and non-prescription groups, but significantly better in the group administered the mitochondrial drug cocktail within 24h (P=0.035). We expect that early treatment with a mitochondrial drug cocktail could prevent sequelae in acute encephalopathy with onset of febrile convulsive status epilepticus.

Direito a informação em saúde no brasil: em busca da legitimação / Derecho a la información en salud en brasil: la búsqueda de la legitimación / Right to information in health in brazil: search for legitimization

Estudo de abordagem qualitativa que buscou identificar e analisar os marcos legais do direito à informação em saúde noBrasil. Utilizou-se da pesquisa documental a partirde normatizações, Relatórios de Conferências Nacionais de Saúde e oPlano Nacional de Saúde. Os dados foram analisadossegundo a Análise de Conteúdo. Verificou-se que a Constituiçãofederal brasileira, a Lei de Acesso a Informação e aLei Orgânica da Saúde compõem a base fundamental dodireito aoacesso às informações em saúde. A política nacionalde informação e informática em saúde, em suas versões, tambémelucida o direito a informação como sua premissa maior. Entretanto, reconhece-se que a garantia do direito a informaçãoem saúde, além das leis, depende de políticas públicas de informação legitimadas, e a melhor estruturação do país no quetange ao acesso, coleta, armazenamento, qualificação, análise e disseminação de informações. Conclui-se que no Brasil, odireito a informação em saúde, apesar de possuir marcos legais explícitos, ainda precisa ter o seu exercício materializado na atual prática informacional.

Qualitative study that sought to identify and analyze the legal marks of the right to health information in Brazil. We usedthe documentary research from norms, reports National Conferences on Health and the National Health Plan. Data wereanalyzed using Content Analysis. It was found thatthe Brazilian Federal Constitution, the Law on Access to Informationand Health Law make up the basic fundamental right of access to health information. However, it is recognized that itsguarantee, beyond the laws, depends on public policies legitimized information, and better structuringof the country interms of access, collection, storage, qualification, analysis and dissemination of information. We conclude that in Brazil,the right to health information, despite having explicit legal marks still need their exercise materialized in the currentinformationalpraxis.

Un estudio cualitativo que buscó identificar y analizar el marco legal del derecho a la información desalud en Brasil. Seutilizó la investigación documental de las normas,los informes de las Conferencias Nacionales de Salud y el Plan Nacionalde Salud. Los datos fueron analizados mediante el análisis de contenido. Se constató que la Constitución Federal de Brasil,la Ley de Acceso a la Información de la Salud y constituyen el derecho fundamental básico de acceso a la informaciónsanitaria. La política nacional de información y lainformática de la salud en sus versiones también aclara el derecho a lainformación como una premisa mayor. Sin embargo, se reconoce que la garantía del derecho a la información de la salud,allá de las leyes, depende de las políticas públicas legitimadas de información y una mejor estructuración del país entérminos de acceso, recogida, almacenamiento, clasificación, análisis y difusión de información. Podemos concluir de queen Brasil, el derecho a la información sanitaria, apesar de contar con marcos legales explícitos siguen necesitando suejercicio materializado en la práctica informativaactual.

[Report of the Brazilian Chronic Dialysis Census 2012]. / Relatorio do Censo Brasileiro de Dialise Cronica 2012.

INTRODUCTION: National chronic dialysis data are fundamental for treatment planning. OBJECTIVE: To report data of the annual survey of the Brazilian Society of Nephrology about chronic kidney disease patients on dialysis in July 2012. METHODS: A survey based on data of dialysis units from the whole country. The data collection was performed by using a questionnaire filled out on-line by the dialysis units in Brazil. RESULTS: 255 (31.9%) of the dialysis units in the country answered the questionnaire. In July 2012, the total estimated number of patients on dialysis in the country was 97,586. The estimated prevalence and incidence rates of chronic kidney disease on maintenance dialysis were 503 and 177 patients per million population, respectively. The estimated number of new patients starting dialysis in 2012 was 34,366. The annual gross mortality rate was 18.8%. For prevalent patients, 31.9% were aged 65 years or older, 91.6% were on hemodialysis and 8.4% on peritoneal dialysis, 30,447 (31.2%) were on a waiting list of renal transplant, 28.5% were diabetics, 36.6% had serum phosphorus > 5.5 mg/dl and 34.4% hemoglobin < 11 g/dl. A venous catheter was the vascular access for 14.5% of the hemodialysis patients. CONCLUSION: The prevalence and incidence rates of chronic kidney disease patients on dialysis increased, while the mortality rate tended to decrease compared with 2011. The indicators of the quality of maintenance dialysis remained stable with a trend towards decrease in levels of anemia. The data highlight the importance of the census to guide chronic dialysis therapy.

Relatorio do Censo Brasileiro de Dialise Cronica 2012 / Report of the Brazilian Chronic Dialysis Census 2012

Introdução: Dados nacionais sobre diálise crônica são fundamentais para o conhecimento e planejamento do tratamento. Objetivo: Apresentar dados do censo da Sociedade Brasileira de Nefrologia sobre os pacientes com doença renal crônica em diálise em julho de 2012. Métodos: Levantamento de dados de unidades de diálise de todo o país. A coleta de dados foi feita utilizando questionário preenchido on-line pelas unidades de diálise do Brasil. Resultados: 255 (39,1%) unidades responderam ao censo. Em julho de 2012, o número total estimado de pacientes em diálise no país foi de 97.586. As estimativas nacionais das taxas de prevalência e de incidência de doença renal crônica em tratamento dialítico foram de 503 e 177 pacientes por milhão da população, respectivamente. O número de pacientes que iniciaram tratamento em 2012 foi 34.366. A taxa anual de mortalidade bruta foi de 18,8%. Dos pacientes prevalentes, 31,9% tinham idade ≥ 65 anos, 91,6% estavam em hemodiálise e 8,4% em diálise peritoneal, 30.447 (31,2%) estavam em fila de espera para transplante, 28,5% tinham diabetes, 36,6% tinham fósforo sérico > 5,5 mg/dl e 34,4% hemoglobina < 11 g/dl. Cateter venoso era usado como acesso em 14,5% dos pacientes em hemodiálise. Conclusão: As taxas de prevalência e incidência de pacientes em diálise aumentaram, e a taxa de mortalidade tendeu a diminuir em relação a 2011. Os dados de indicadores da qualidade da diálise de manutenção encontram-se estáveis com tendência à queda nos níveis de anemia; e mostram a relevância do censo anual para o planejamento da assistência dialítica. .

Introduction: National chronic dialysis data are fundamental for treatment planning. Objective: To report data of the annual survey of the Brazilian Society of Nephrology about chronic kidney disease patients on dialysis in July 2012. Methods: A survey based on data of dialysis units from the whole country. The data collection was performed by using a questionnaire filled out on-line by the dialysis units in Brazil. Results: 255 (31.9%) of the dialysis units in the country answered the questionnaire. In July 2012, the total estimated number of patients on dialysis in the country was 97,586. The estimated prevalence and incidence rates of chronic kidney disease on maintenance dialysis were 503 and 177 patients per million population, respectively. The estimated number of new patients starting dialysis in 2012 was 34,366. The annual gross mortality rate was 18.8%. For prevalent patients, 31.9% were aged 65 years or older, 91.6% were on hemodialysis and 8.4% on peritoneal dialysis, 30,447 (31.2%) were on a waiting list of renal transplant, 28.5% were diabetics, 36.6% had serum phosphorus > 5.5 mg/dl and 34.4% hemoglobin < 11 g/dl. A venous catheter was the vascular access for 14.5% of the hemodialysis patients. Conclusion: The prevalence and incidence rates of chronic kidney disease patients on dialysis increased, while the mortality rate tended to decrease compared with 2011. The indicators of the quality of maintenance dialysis remained stable with a trend towards decrease in levels of anemia. The data highlight the importance of the census to guide chronic dialysis therapy. .

[Chronic dialysis in Brazil: report of the Brazilian dialysis census, 2011].

INTRODUCTION: National data on maintenance dialysis are important for treatment planning. AIM: To describe the results of the dialysis census of the Brazilian Society of Nephrology for 2011 and observed trends from 2000 to 2011. METHODS: A survey was conducted using questionnaire filled online by the dialysis units, with July as reference month for estimates. From a total of 645 units, 353 (54.9%) responded to the survey. RESULTS: The estimated number of patients on dialysis in Brazil was 91,314 in 2011 (42,629 in 2010; 92,091 in 2011). For approximately 85% of the patients the treatment was provided by the Brazilian Unified Health Care System. The estimated prevalence and incidence rates in 2011 were 475 and 149 maintenance dialysis patients per million population, respectively. For prevalent patients, 90.6% were on hemodialysis, 31.5% 65 years of age or older, 28% diabetic and 35.5% (n=32,454) on waiting list for transplantation in 2011. The estimated number of patients starting dialysis in 2011 was 28,680 (18,972 in 2010) and annual mortality rate 19.9% (17.9% in 2010). CONCLUSIONS: The data indicate pronounced increase in the dialysis population across the years in Brazil with a trend for stabilization in the last two years. The reason for the increase in incidence and mortality in 2011 deserves investigation. A large number of patients were on waiting list for renal transplantation. By providing a picture of the situation and trends on maintenance dialysis treatment in Brazil the census is useful to guide resources allocation and interventions to improve treatment quality.

Diálise Crônica no Brasil - Relatório do Censo Brasileiro de Diálise, 2011 / Chronic Dialysis in Brazil - Report of the Brazilian Dialysis Census, 2011

INTRODUÇÃO: Dados nacionais sobre diálise crônica são fundamentais para o planejamento do tratamento. OBJETIVO: Descrever resultados do censo de diálise da Sociedade Brasileira de Nefrologia referentes a 2011 e tendências observadas de 2000 a 2011. MÉTODOS: Levantamento utilizando questionário preenchido "on-line" pelas unidades de diálise do Brasil usando julho de 2011 como referência para estimativas. Do total de 643 unidades com programa dialítico crônico, 353 (54,9%) responderam. RESULTADOS: O número estimado de pacientes em diálise no Brasil em 2011 foi 91.314 (42.629 em 2000, 92.091 em 2010). Para aproximadamente 85% dos pacientes, o tratamento foi pago com recursos do SUS. As estimativas de prevalência e incidência para 2011 foram de 475 e 149 pacientes em diálise por milhão da população, respectivamente. Entre prevalentes, 90,6% estavam em hemodiálise, 31,5% tinham idade > 65 anos, 28% eram diabéticos, e 35,5% (n=32.454) estavam em fila de espera para transplante. Para 2011, o número estimado de pacientes iniciando diálise foi 28.680 (18.972 em 2010) e a taxa anual de mortalidade 19,9% (17,9% para 2010). CONCLUSÕES: Os dados indicam aumento pronunciado da população em diálise no Brasil ao longo dos anos, com tendência a estabilização nos dois últimos anos. As razões para aumento da incidência e mortalidade em 2011 merecem investigação. É grande o número estimado de pacientes em fila de espera para transplante renal. O censo fornece um quadro da situação e tendências da diálise no Brasil, sendo, portanto, útil para orientar alocação de recursos e intervenções que melhorarem a qualidade do tratamento.

INTRODUCTION: National data on maintenance dialysis are important for treatment planning. AIM: To describe the results of the dialysis census of the Brazilian Society of Nephrology for 2011 and observed trends from 2000 to 2011. METHODS: A survey was conducted using questionnaire filled online by the dialysis units, with July as reference month for estimates. From a total of 645 units, 353 (54.9%) responded to the survey. RESULTS: The estimated number of patients on dialysis in Brazil was 91,314 in 2011 (42,629 in 2010; 92,091 in 2011). For approximately 85% of the patients the treatment was provided by the Brazilian Unified Health Care System. The estimated prevalence and incidence rates in 2011 were 475 and 149 maintenance dialysis patients per million population, respectively. For prevalent patients, 90.6% were on hemodialysis, 31.5% 65 years of age or older, 28% diabetic and 35.5% (n=32,454) on waiting list for transplantation in 2011. The estimated number of patients starting dialysis in 2011 was 28,680 (18,972 in 2010) and annual mortality rate 19.9% (17.9% in 2010). CONCLUSIONS: The data indicate pronounced increase in the dialysis population across the years in Brazil with a trend for stabilization in the last two years. The reason for the increase in incidence and mortality in 2011 deserves investigation. A large number of patients were on waiting list for renal transplantation. By providing a picture of the situation and trends on maintenance dialysis treatment in Brazil the census is useful to guide resources allocation and interventions to improve treatment quality.

Use of the Aspergillus oryzae actin gene promoter in a novel reporter system for exploring antifungal compounds and their target genes.

Demand for novel antifungal drugs for medical and agricultural uses has been increasing because of the diversity of pathogenic fungi and the emergence of drug-resistant strains. Genomic resources for various living species, including pathogenic fungi, can be utilized to develop novel and effective antifungal compounds. We used Aspergillus oryzae as a model to construct a reporter system for exploring novel antifungal compounds and their target genes. The comprehensive gene expression analysis showed that the actin-encoding actB gene was transcriptionally highly induced by benomyl treatment. We therefore used the actB gene to construct a novel reporter system for monitoring responses to cytoskeletal stress in A. oryzae by introducing the actB promoter::EGFP fusion gene. Distinct fluorescence was observed in the reporter strain with minimum background noise in response to not only benomyl but also compounds inhibiting lipid metabolism that is closely related to cell membrane integrity. The fluorescent responses indicated that the reporter strain can be used to screen for lead compounds affecting fungal microtubule and cell membrane integrity, both of which are attractive antifungal targets. Furthermore, the reporter strain was shown to be technically applicable for identifying novel target genes of antifungal drugs triggering perturbation of fungal microtubules or membrane integrity.

Fabrication of Al-Al3Ti/Ti3Al Functionally Graded Materials under a Centrifugal Force.

Fabrication of Al-Al3Ti functionally graded materials (FGMs) under the centrifugal force has recently attracted some attention. The controlled compositional gradient of the fabricated FGMs, the low cost of the process, and the good mold filling, are the main advantages of the centrifugal method (CM). Using the conventional CM techniques such as the centrifugal solid-particle method and centrifugal in-situ method, FGMs rings with gradually distributed properties could be achieved. As a more practical choice, the centrifugal mixed-powder method (CMPM) was recently proposed to obtain FGMs containing nano-particles selectively dispersed in the outer surface of the fabricated parts. However, if a control of the particles morphology, compound formulas or sizes, is desired, another CM technique is favored. As a development of CMPM, our novel reaction centrifugal mixed-powder method (RCMPM) has been presented. Using RCMPM, Al­Al3Ti/Ti3Al FGMs with good surface properties and temperature controlled compositional gradient could be achieved. In this short review, this novel method will be discussed in detail and the effect of RCMPM processing temperature on the reinforcement particles morphology, size and distribution through the fabricated samples, will be reviewed.