Epoetin alfa resistance in hemodialysis patients with chronic kidney disease: a longitudinal study

Anemia is an inevitable complication of hemodialysis, and the primary cause is erythropoietin deficiency. After diagnosis, treatment begins with an erythropoiesis-stimulating agent (ESA). However, some patients remain anemic even after receiving this medication. This study aimed to investigate the factors associated with resistance to recombinant human erythropoietin therapy with epoetin alfa (αEPO). We performed a prospective, longitudinal study of hemodialysis patients receiving treatment with αEPO at our reference hospital from July 2015 to June 2016. Clinical data was collected, and the response to αEPO treatment was evaluated using the erythropoietin resistance index (ERI). The ERI was defined as the weekly weight-adjusted αEPO dose (U/kg per week)/hemoglobin level (g/dL). A longitudinal linear regression model was fitted with random effects to verify the relationships between clinical and laboratory data and ERI. We enrolled 99 patients (average age, 45.7 (±17.6) years; male, 51.5%; 86.8% with hypertension). The ERI showed a significant positive association with serum ferritin and C-reactive protein, percentage interdialytic weight gain, and continuous usage of angiotensin receptor blocker (ARB) hypertension medication. The ERI was negatively associated with serum iron and albumin, age, urea reduction ratio, and body mass index. Our findings indicate that resistance to αEPO was related to a low serum iron reserve, an inflammatory state, poor nutritional status, and continuous usage of ARBs.

Correlation between serum 25-hydroxyvitamin D levels and carotid intima-media thickness in a Brazilian population descended from African slaves

Hypovitaminosis D has been identified as a possible new cardiovascular risk factor. However, the results of studies correlating serum vitamin D levels with markers of subclinical atherosclerosis have been conflicting. The aim of this study was to correlate serum levels of 25-hydroxyvitamin D [25(OH)D] with carotid intima-media thickness (C-IMT) and conventional cardiovascular risk factors in Afro-descendants. A cross-sectional analysis was performed on a sample of 382 individuals from a cohort of descendants of African slaves, inhabitants of "Quilombola" communities, with a mean age of 57.79 ±15.3 years, 54.5% of whom were women. Socio-demographic and clinical data were collected and biochemical tests were performed, including serum levels of 25(OH)D by electrochemiluminescence and urinary albumin excretion, evaluated by the albumin/creatinine ratio (ACR) in a spot urine sample. All participants underwent high-resolution ultrasonography for C-IMT measurement. Hypovitaminosis D was defined as serum 25(OH)D levels <30 ng/mL. The mean serum 25(OH)D levels were 50.4±13.5 ng/mL, with a low prevalence of hypovitaminosis D (4.86%). By simple linear correlation, a significant inverse association between 25(OH)D levels and C-IMT (r=-0.174, P=0.001) was observed. However, after multiple linear regression analysis, the significance of the association between serum levels of 25(OH)D and C-IMT measurement was lost (β=-0.039, P=0.318) and only male gender, age, smoking, systolic blood pressure, glucose and low density lipoprotein (LDL)-cholesterol remained significantly associated with C-IMT. Levels of 25(OH)D were independently and positively associated with HDL-cholesterol and inversely associated with age and ACR. In conclusion, no independent association between 25(OH)D levels and C-IMT was observed in this population. On the other hand, there was an inverse association with albuminuria, a marker of endothelial lesion.

Evidences that human disturbance simplify the ant fauna associated a Stachytarpheta glabra Cham. (Verbenaceae) compromising the benefits of ant-plant mutualism / Evidências de que os impactos antrópicos simplificam a fauna de formiga associada a Stachytarpheta glabra (Verbenaceae) comprometendo os benefícios do mutualismo formiga-planta

Interaction among species, like ants and plants through extrafloral nectaries (EFNs), are important components of ecological communities’ evolution. However, the effect of human disturbance on such specific interactions and its ecological consequences is poorly understood. This study evaluated the outcomes of mutualism between ants and the EFN-bearing plant Stachytarpheta glabra under anthropogenic disturbance. We compared the arthropod fauna composition between two groups of twenty plant individuals, one in an area disturbed by human activities and one in a preserved area. We also check the plant investment in herbivory defense and the consequential leaf damage by herbivore. Our results indicate that such disturbances cause simplification of the associated fauna and lack of proper ant mutualist. This led to four times more herbivory on plants of disturbed areas, despite the equal amount of EFN and ant visitors and low abundance of herbivores. The high pressure of herbivory may difficult the re-establishment of S. glabra, an important pioneer species in ferruginous fields, therefore it may affect resilience of this fragile ecological community.

As interações entre espécies, como por exemplo formigas e plantas através de nectários extraflorais (NEFs), são importantes componentes na evolução das comunidades. Entretanto, pouco é conhecido sobre os efeitos dos impactos antrópicos em interações específicas e suas consequências ecológicas. Este estudo avaliou os resultados do mutualismo entre formigas e NEF em Stachytarpheta glabra em área impactada pela atividade humana. Nós comparamos a composição e estrutura da fauna de artrópodes, em quarenta plantas de dois grupos, um impactado por atividades humanas e o outro preservado. Nós também avaliamos o investimento da planta em defesas contra herbívoros e os danos foliares causados por herbívoros. Nossos resultados indicam que os distúrbios causam a simplificação da fauna associada e a ausência de uma formiga mutualista anti-herbívoros. Isto leva a quatro vezes mais herbivoria nas plantas da área impactada, a despeito da mesma quantidade encontrada para NEF e formigas visitantes. A grande pressão de herbivoria pode dificultar o reestabelecimento de S. glabra, uma espécie pioneira importante nos campos ferruginosos, dessa forma, afetando a resiliência dessa comunidade ecológica ameaçada.

Immunomodulation of allergic response in children and adolescents: What we can learn from lymphatic filarial infection

Background: Although it is well known that allergic diseases involve a strong Th2 immune response, with production of high levels of specific IgE allergen, knowledge on the association between filarial infection and allergies, among paediatric patients is scarce. Objective: To evaluate the allergic response patterns in cases of filarial infection by comparing peripheral eosinophils, total IgE levels, immediate hypersensitivity and cytokine levels in children and adolescents in Brazil. Methods: This was an exploratory study with three groups: (I) with filarial infection and without allergic diseases; (II) without filarial infection and with allergic diseases; and (III) without filarial infection and without allergic diseases. The prick test and specific IgE tests for aeroallergens were performed using five antigens. Peripheral eosinophils and total IgE were also evaluated. IL-4 and IL-5 were determined using whole-blood culture stimulated by three antigens. Results: Eosinophilia and elevated levels of total IgE (≥ 400IU/dl) were observed in all groups. The prick test was positive in 56.6% of the cases. Group I presented hypersensitive responses similar to the allergic disease groups. In the whole-blood culture stimulated by Dermatophagoides pteronyssinus, average IL-4 production did not differ significantly among the groups, but IL5 production resulting from stimulation was greater in the allergic disease groups (p < 0.05). Conclusions: The allergic response pattern in group with filarial infection was similar to that of the groups with and without allergic diseases, but the response to IL-5 in the culture stimulated by D. pteronyssinus was an exclusive characteristic of the allergic group (AU)

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Dietary supplements for the lactating adolescent mother: influence on plasma micronutrients / Suplementos dietéticos para la madre adolescente en periodo de lactancia: su influencia en micronutrientes del plasma

Introduction: The nutritional status of micronutrients in lactating adolescent women is crucial to guarantee an adequate secretion of these in breast milk and, consequently, an adequate nutritional status of children. Hence, more attention should be given to micronutrient status of adolescent mother who breastfeed. This study aimed to evaluate the influence of multimicronutrients supplementation upon nutritional status of iron, copper, zinc and calcium of lactating adolescent mother from low socioeconomic status in Rio de Janeiro/Brazil. Methods: We conducted a randomized, placebo-controlled trial. During 60 days, 36 adolescents were allocated into two groups: supplemented group (SG) with 17 volunteers, receiving daily multimicronutrients supplement and the placebo group (PG) with 19 volunteers, receiving an inert compound. Plasma iron, copper, zinc and calcium and hemoglobin were determined at 7, 11 and 15 of the postpartum weeks (PPW). The effect of supplementation was analyzed by analysis of variance, comparing the differences between groups and within groups. Results: The average age of volunteers was 17.1 ± 0.8 for the supplemented group and 16.3 ± 1.4 for the placebo group. We observed an increase in the mean concentration of zinc (p < 0.05) and hemoglobin (p < 0.05) in the SG during the study (60 days), while the PG showed reduction (p < 0.05) in the mean concentration of copper between the 7th and 11th PPW. Conclusion: The results of this study show that supplementation with multimicronutrientes exerted positive effect on hemoglobin, copper and zinc (AU)

Introducción: Debido a lo estado nutricional relativo a los micronutrientes de la nutriz ser de fundamental importancia para la adecuada secreción de leche materna, y en consecuencia un adecuado estado nutricional de los niños, se debe prestar una mayor atención a la situación de los micronutrientes de la madre lactante. El trabajo tuvo como objetivo estudiar la influencia de la suplementácion con multimicronutrientes en lo estado nutricional de lo hierro, cobre, zinc y lo calcio de madres lactantes adolescentes de bajo nivel socioeconómico en Rio de Janeiro/Brasil. Métodos: Se realizó un estudio con un ensayo clínico, aleatorizado, controlado con placebo. Durante 60 días, 36 jóvenes lactantes fueron estudiadas y distribuidas en dos grupos: el grupo suplementado (GS) con 17 voluntarias que recibieron un compuesto con multimicronutrientes y el grupo placebo (GP), con 19 voluntarias que recibieron un compuesto inerte. En todas las participantes del estudio se determinaron las concentraciones plasmáticas de hierro, cobre, calcio y zinc y de hemoglobina con 7, 11 y 15 semanas después del parto (SDP). El efecto de los suplementos se analizó por test de comparación de medias (Anova two way) entre los grupos y dentro de los grupos. Resultados: La edad media de las voluntarias fue de 17 ± 0,8 años para el GP y 16,3 ± 1,4 para el GP. Se observó un aumento en las concentraciones medias de zinc y hemoglobina (p < 0,05) en el GS durante el estudio (60 días) y la reducción (p < 0,05) de cobre entre las 7a y 11a SDP en el GP. Conclusión: Los resultados de este estudio muestran que la suplementación con multimicronutrientes tiene un efecto positivo en las concentraciones de hemoglobina, cobre y zinc (AU)

[Epidemiology of meningococcal disease in the city of Rio de Janeiro: changes after vaccination against B and C serogroups] / Epidemiologia da doença meningocócica na cidade do Rio de Janeiro: modificações após vacinação contra os sorogrupos B e C.

Meningococcal disease has been a serious public health problem in the city of Rio de Janeiro, with high attack rates among younger children, high case fatality rates, and predominance of serogroup B. In December 1994 the second vaccination drive against B and C meningococcal disease was performed with the objective of protecting children ages 6 months to 13 years. A total of 950 thousand children received 2 doses of vaccine produced by the Finlay Institute of Cuba. In 1995 a change was observed in the disease pattern with a predominance of serogroup C and a higher global attack rate, particularly among children under 1 year of age, teenagers, and young adults. In vaccinated groups the attack rate was lower than in 1994, due to a decrease in serogroup B. No change was observed in the case fatality rate.

The inverted trophic cascade in tropical plankton communities: impacts of exotic fish in the Middle Rio Doce lake district, Minas Gerais, Brazil

The present study deals with the ecological impacts of the introduction of two alien species of piscivorous fish in several lakes of the Middle Rio Doce lake district in Minas Gerais, Brazil. It was demonstrated that these effects were not restricted only to the fish community. The introduction of the predatory red piranha Pygocentrus nattereri and the tucunaré Cichla cf. ocellaris caused not only a sharp decrease in the number of native fish species, but also major shifts in other trophic levels. Just after the fish were introduced, most lakes began to show conspicuous changes in phytoplankton species composition, in which Cyanophyceae gradually came to dominate. The zooplankton community lost several species, and in some cases, such as Lake Carioca, all the cladoceran species disappeared. On the other hand, invertebrate predators, represented by the dipteran Chaoboridae, boomed in the lake, with higher densities of exotic species, probably as a result of the "ecological release" by reduction of the original fish fauna. There was a general trend of species loss in different trophic levels. All these changes are apparently associated with decreases in water quality. The present situation in these lakes demands new approaches to the management and conservation of these ecosystems.

O presente estudo trata dos impactos ecológicos da introdução de duas espécies invasoras de peixes piscívoros em diversos lagos da região lacustre do médio rio Doce em Minas Gerais, Brasil. Demonstrou-se que estes efeitos não se restringiram às comunidade de peixes. A introdução dos predadores Pygocentrus nattereri (piranha-vermelha) e Cichla cf. ocelaris (tucunaré) não só causou uma forte redução no número de espécies de peixes nativos, como também mudanças nos níveis tróficos inferiores. Pouco depois das introduções, a maioria dos lagos começou a mostrar alterações na comunidade fitoplanctônica, tais como o aparecimento da dominância de Cyanophyceae. A comunidade zooplanctônica perdeu diversas espécies e, em alguns casos, houve o desaparecimento de todas as espécies de cladóceros limnéticos, como é o caso da lagoa Carioca. Por outro lado, predadores invertebrados, representados pelos dípteros da família Chaoboridae, floresceram nos lagos com maiores densidades de espécies exóticas de peixes, provavelmente como resultado da "liberação ecológica" causada pela redução da ictiofauna original. Além de uma tendência geral de perda de espécies em diferentes níveis tróficos, outras mudanças estão aparentemente associadas com a redução da qualidade de água. Dessa forma, esses ecossistemas estão necessitando urgentemente de novas abordagens nas estratégias de manejo e conservação.

Stress em pacientes HIV positivo, residentes em uma casa de apoio

O objetivo deste trabalho foi verificar a presença e o nível de stress em pacientes HIV positivos residentes numa Casa de Apoio, identificar o conceito de stress destes pacientes, se consideram estressantes estar morando numa Casa de Apoio, e se sentem-se estressados. Participaram desta pesquisa 6 sujeitos, travestis, residentes numa Casa de Apoio, com idade de 27 a 47 anos, e diagnóstico positivo de até um ano e que residiam na Casa de Apoio há no máximo dois meses. Na coleta de dados, utilizou-se o Inventário de Sintomas de Stress-ISS, Questionário de Avaliação de Residir numa Casa de Apoio e Ficha de Identificação. Os instrumentos foram aplicados individualmente pelo pesquisador da instituição. Os resultados apontaram que os pacientes, apresentam sintomas de stress, na fase de resistência. O conceito de stress dos sujeitos está relacionado com cansaço e irritabilidade, não percebem os próprios sintomas de stress e não consideram estressante morar numa casa de apoio. Estes resultados atestam a relevância do profissional de psicologia junto a estes pacientes, possibilitando um controle de stress, assim como o desenvolvimento de um programa de prevenção e tratamento de stress para esta população (AU)