Comparação de fórmulas para cálculo da taxa de filtração glomerular estimada e seus limiares diagnósticos para doença renal crônica em pessoas idosas: um estudo transversal / Comparison of formulas for calculating estimated glomerular filtration rate and its diagnostic thresholds for chronic kidney disease in older adults: a cross-sectional study

Resumo Objetivo Avaliar e comparar as fórmulas CKD-EPI, BIS1 e MDRD e o limiar diagnóstico de 45 e 60 ml/min/1,73m2 em pacientes idosos. Método Estudo observacional do tipo transversal, de caráter descritivo e analítico. Foram incluídos pacientes atendidos em ambulatório de referência entre janeiro/2020 e junho/2022, com idade ≥65 anos. Foram excluídos pacientes com apenas uma dosagem de creatinina ou com alterações transitórias da TFG. Resultados Observou-se que entre o grupo de pacientes com idade entre 65-74 anos e 75-84 anos as estimativas da TFG feitas pela fórmula CKD-EPI foram superiores às fórmulas BIS1 e MDRD. Enquanto, no grupo de pacientes com 85-94 anos a CKD-EPI não apresentou diferença quando comparada com MDRD, permaneceu com estimativas maiores apenas quando comparada com a BIS1. Observamos maior dispersão entre CKD-EPI e BIS1, mostrando menor concordância entre essas fórmulas, confirmada pelo teste Kappa (76,7%) e a concordância quase perfeita entre CKD-EPI e MDRD. Conclusão A fórmula BIS1 apresentou melhor correlação da diminuição da TFGe conforme o avanço das faixas etárias, podendo-se relacionar com o processo de envelhecimento renal fisiológico, podendo ser uma ferramenta auxiliar na estimativa da TFG em idosos, auxiliando no diagnóstico mais preciso da DRC, assim como, no planejamento de intervenções que possam retardar a progressão da DRC e prever risco de mortalidade por doenças cardiovasculares.

Abstract Objective To evaluate and compare the CKD-EPI, BIS1 and MDRD formulas and diagnostic thresholds of 45 and 60 ml/min/1.73m2 in older patients. Method A cross-sectional, descriptive, analytical observational study was conducted. Patients aged ≥65 years treated at a referral outpatient clinic between January 2020 and June 2022, were assessed. Patients with only one creatinine level or with transient GFR abnormalities were excluded. Results The GFR estimates using the CKD-EPI formula were higher than both the BIS1 and MDRD formulas in patient groups aged 65-74 years and 75-84 years. In the group of patients aged 85-94 years, the CKD-EPI showed no difference when compared with the MDRD, yielding higher estimates only compared with the BIS1. Greater dispersion was found between the CKD-EPI and BIS1, showing less agreement between these formulas, as confirmed by the Kappa test (76.7%), while there was almost perfect agreement between the CKD-EPI and MDRD. Conclusion The BIS1 formula showed stronger correlation of the decrease in eGFR with advancing age, reflecting the physiological renal aging process and serving as a potentially useful tool for estimating GFR in older adults. The formula can help provide a more accurate diagnosis of CKD and aid planning of interventions to slow the progression of CKD and predict the risk of mortality from cardiovascular diseases.

Influence of tramadol on functional recovery of acute spinal cord injury in rats

Abstract Purpose: To evaluate the influence tramadol on functional recovery of acute spinal cord injury in rats. Methods: Ten rats were divided into two groups (n = 5). All animals were submitted by a laminectomy and spinal cord injury at eighth thoracic vertebra. In control group, the rats didn't receive any analgesic. In tramadol group, the rats received tramadol 4mg/Kg at 12/12h until 5 days by subcutaneous. Animals were following by fourteen days. Was evaluated the Basso, Beattie, Bresnahan scale (locomotor evaluation) and Rat Grimace Scale (pain evaluation) at four periods. Results: There no difference between the groups in locomotor evaluation in all periods evaluated (p>0.05) and in both groups there was a partial recover of function. The tramadol group show a lower pain levels at the first, third and seventh postoperatively days when comparing to the control group. Conclusion: The tramadol as an analgesic agent don't influence on functional recovery of acute spinal cord injury in rats

Clinical aspects in patients with pulmonary infection caused by mycobacteria of the Mycobacterium abscessus complex, in the Brazilian Amazon / Aspectos clínicos em pacientes com infecção pulmonar por micobactérias do complexo Mycobacterium abscessus na Amazônia brasileira

ABSTRACT Objective: To describe the clinical manifestations of patients with pulmonary infection caused by mycobacteria of the Mycobacterium abscessus complex (MABSC), and to compare these manifestations with those of patients infected with other nontuberculous mycobacteria (NTM). Methods: This was a retrospective cohort study involving 43 patients divided into two groups: the MABSC group, consisting of patients with pulmonary infection caused by MABSC (n = 17); and the NTM group, consisting of patients with pulmonary infection caused by NTM other than MABSC (n = 26). Patients were previously treated with a regimen of rifampin, isoniazid, pyrazinamide, and ethambutol before the diagnosis of NTM was confirmed by two culture-positive sputum samples. The nucleotide sequences of the hsp65, 16S rRNA, and/or rpoB genes were analyzed to identify the mycobacteria. Data were collected on demographic, clinical, and radiological characteristics, as well as on treatment responses and outcomes. Results: Loss of appetite was the only clinical manifestation that was significantly more common in the MABSC group than in the NTM group (p = 0.0306). The chance of having to use a second treatment regimen was almost 12 times higher in the MABSC group than in the NTM group. Treatment success was significantly higher in the NTM group than in the MABSC group (83.2% vs. 17.6%; p < 0.0001). The chance of recurrence was approximately 37 times higher in the MABSC group than in the NTM group. Conclusions: In the study sample, treatment response of pulmonary disease caused by MABSC was less favorable than that of pulmonary disease caused by other NTM.

RESUMO Objetivo: Descrever as manifestações clínicas de pacientes com infecção pulmonar por micobactérias do complexo Mycobacterium abscessus (CMA) e compará-las com as daqueles infectados com outras micobactérias não tuberculosas (MNT). Métodos: Estudo de coorte retrospectivo envolvendo 43 pacientes divididos em dois grupos: grupo CMA, com pacientes com infecção pulmonar por CMA (n = 17); e grupo MNT, com pacientes com infecção pulmonar por MNT que não CMA (n = 26). Os pacientes foram previamente tratados com o esquema rifampicina, isoniazida, pirazinamida e etambutol antes de o diagnóstico de MNT ser confirmado com culturas positivas em duas amostras de escarro diferentes. As sequências nucleotídicas dos genes hsp65, RNAr 16S e/ou rpoB foram analisadas para a identificação das micobactérias. Foram coletadas características demográficas, clínicas e radiológicas, assim como respostas terapêuticas e desfechos. Resultados: A única manifestação clínica significativamente mais frequente no grupo CMA que no grupo MNT foi hiporexia (p = 0,0306). A chance de haver a necessidade de utilização de um segundo esquema terapêutico foi quase 12 vezes maior no grupo CMA que no grupo MNT. O sucesso terapêutico foi significativamente maior no grupo MNT que no grupo CMA (83,2% vs. 17,6%; p < 0,0001). A chance de recidiva no grupo CMA foi aproximadamente 37 vezes maior que no grupo MNT. Conclusões: Na amostra estudada, a resposta terapêutica da doença pulmonar causada por CMA evoluiu de forma menos favorável do que naquela causada pelas demais MNT.