RESUMEN
Anemia is a frequent complication of chronic kidney disease, and its primary cause is erythropoietin deficiency. After diagnosis, treatment begins with administration of an erythropoiesis-stimulating agent (ESA). However, some patients present with resistance to ESA, which needs to be reversed, as it can increase the risk of death in patients with kidney disease. Therefore, we provide a discussion of the current literature regarding the factors that can modify the response to this class of drugs and the strategies that can be considered to optimize the benefits of treating anemia.
RESUMEN
BACKGROUND: Disorders of mineral metabolism occur in most patients with chronic kidney disease (CKD). The aim of this work was to correlate parathyroid hormone (PTH) levels with urinary magnesium excretion in patients with non-dialysis dependent CKD. METHODS: Cross-sectional study. Concentrations of creatinine, magnesium, calcium, phosphate, parathyroid hormone (PTH), 25-hydroxyvitamin D [25(OH)D] and alkaline phosphatase (ALP) were determined in blood samples. The assessment of urinary magnesium levels was performed by means of total daily excretion and by the excretion fraction (FEMg). RESULTS: The study evaluated 163 patients with a mean age of 60.7 ± 11.7 years and 51.0% were male. In the highest quartile of PTH (>89.5pg/mL), the mean levels of FEMg and ALP were higher (p<0.05). In the unadjusted regression analysis, the following variables were related to serum PTH levels: FEMg (odds ratio (OR) = 1.12; 95% confidence intervals (CI): 1.02-1.23), calcium (OR = 0.45; 95% CI: 0.22-0.90), ALP (OR = 1.02; 95% CI: 1.00-1.03) and eGFR (OR = 0.92; 95% CI: 1.00-1.03). After an adjusted analysis, only one FEMg and ALP will remain correlated with PTH. CONCLUSION: In patients with non-dialysis dependent CKD, FEMg and ALP were some variables that remained associated with PTH.
RESUMEN
Waterborne outbreaks of human toxoplasmosis can have great magnitude due to the number of persons infected while smaller-scale outbreaks are also possible. This is a study based on a historical database investigating a toxoplasmosis outbreak occurred in 2006 in a residential community in São Luís, in the Brazilian state of Maranhão. Ninety of the 110 residents, employees and domestic helping persons had blood samples collected and tested. The diagnosis of toxoplasmosis was established by quantification of anti-Toxoplasma gondii immunoglobulin M and immunoglobulin G antibodies using enzyme immunoassay. The subjects were classified as past infection, acute/recent infection or seronegatives. The definition of acute infection was based on the presence of indicative symptoms and immunoglobulin M positivity. There were 33 cases of acute infection. The outbreak was concluded to be waterborne: consumption of faucet-mount filtered water was indicated as risk factor. We discuss the challenges of investigating waterborne toxoplasmosis outbreaks.
RESUMEN
To evaluate diet quality and relationship between Body Mass Index (BMI), diet quality and inflammatory markers in adolescents of public schools in São Luís-MA. Methodology: A cross-sectional study was conducted with 384 adolescents aged 17 and 18 years. The nutritional status was evaluated through the BMI. The quality of the diet was evaluated through the Revised Diet Quality Index (IQD-R). The inflammatory markers used were C-Reactive Ultrasensitive Protein (hs-CRP), IL-6 (Interleukin-6) and TNF-α (Tumor Necrosis Factor α). Multivariate analysis was performed using a decision tree using the CART (Classification and Regression Trees) algorithm to evaluate the relationship between BMI, diet quality and inflammatory markers. Results: The mean age was 17.3±0.5 years, predominance of females (56.5%) and eutrophic (69.3%). The mean IQD-R score was 55.3±12.7. Adolescents in the lowest tertile of IQD-R (T1) had a higher mean BMI (22.1±4.3 kg/m2 vs 21.5 ± 3.7kg/m2). Higher levels of IL-6 were observed in those located on the IQD-R T1 (1,345 mg/L vs 1,205 mg/L). In the same group (T1), adolescents who had higher IL-6 levels also had a higher mean BMI (23.6±5.1kg/m2 vs 20.8±3.0kg/m2). The adolescents in the largest tertiles of IQD-R (T2 and T3) and who had higher concentrations of IL-6 and CR-us had also a higher mean BMI (23.8±4.9kg/m2). Conclusions: The diet quality of adolescents studied needs modifications. BMI averages varied with diet quality and levels of IL-6 and hs-CRP(AU)
Avaliar a qualidade da dieta e a relação entre Índice de Massa Corporal (IMC), qualidade da dieta e marcadores inflamatórios em adolescentes de escolas públicas de São Luís-MA. Metodologia: Foi realizado um estudo transversal com 384 adolescentes de 17 e 18 anos. O estado nutricional foi avaliado por meio do IMC. A qualidade da dieta foi avaliada por meio do Índice de Qualidade da Dieta Revisado (IQD-R). Os marcadores inflamatórios utilizados foram Proteína C Reativa Ultrassensível (PCR-us), IL-6 (Interleucina-6) e TNF-α (Fator de Necrose Tumoral α). A análise multivariada foi realizada usando uma árvore de decisão usando o algoritmo CART (Classification and Regression Trees) para avaliar a relação entre IMC, qualidade da dieta e marcadores inflamatórios. Resultados: A média de idade foi de 17,3 ± 0,5 anos, predomínio do sexo feminino (56,5%) e eutrófico (69,3%). A pontuação média do IQD-R foi de 55,3 ± 12,7. Os adolescentes no tercil inferior do IQD-R (T1) tiveram uma média de IMC mais alta (22,1 ± 4,3kg/m2 vs 21,5 ± 3,7kg/m2). Níveis mais elevados de IL-6 foram observados naqueles localizados no IQD-R T1 (1.345 mg/L vs 1.205 mg/L). No mesmo grupo (T1), os adolescentes que apresentaram níveis mais elevados de IL-6 também apresentaram média de IMC mais elevada (23,6 ± 5,1kg/m2 vs 20,8 ± 3,0kg/m2). Os adolescentes nos maiores tercis de IQD-R (T2 e T3) e que apresentaram maiores concentrações de IL-6 e CR-us também apresentaram maior IMC médio (23,8 ± 4,9kg/m2). Conclusões: A qualidade da dieta dos adolescentes estudados necessita de modificações. As médias do IMC variaram com a qualidade da dieta e os níveis de IL-6 e PCR-us(AU)