RESUMEN

INTRODUCTION: The limited data on survival rates of small children undergoing hemodialysis preclude comparison with other countries. The goal of this study was to determine the mortality rate and its risk factors in children starting hemodialysis during their first year of life. METHODS: We performed a retrospective cohort study, based on data from a reference dialysis center in São Paulo city. Data from 47 (8 females) children who underwent chronic hemodialysis before the first year of age were analyzed. Survival was characterized using Kaplan-Meier methods and log-rank tests, followed by a multivariable Cox regression model. RESULTS: The survival rates were 93%, 75%, and 64% at 1, 2, and 3 years, respectively. Only cardiovascular comorbidity was significantly associated with the mortality outcome (HR = 5.7, 95% CI = 1.7-19.6, p = 0.006). CONCLUSION: The survival rate among children who started hemodialysis in their first year of life was reasonable, similar to international standards.

Asunto(s)

Fallo Renal Crónico , Diálisis Renal , Brasil/epidemiología , Niño , Femenino , Humanos , Fallo Renal Crónico/terapia , Masculino , Modelos de Riesgos Proporcionales , Diálisis Renal/métodos , Estudios Retrospectivos , Factores de Riesgo , Análisis de Supervivencia

RESUMEN

BACKGROUND: The enzyme farnesyl diphosphate synthase (FPPS) is positioned in the intersection of different sterol biosynthesis pathways such as those producing isoprenoids, dolichols and ergosterol. FPPS is ubiquitous in eukaryotes and is inhibited by nitrogen-containing bisphosphonates (N-BP). N-BP activity and the mechanisms of cell death as well as damage to the ultrastructure due to N-BP has not yet been investigated in Leishmania infantum and Giardia. Thus, we evaluated the effect of N-BP on cell viability and ultrastructure and then performed structural modelling and phylogenetic analysis on the FPPS enzymes of Leishmania and Giardia. METHODS: We performed multiple sequence alignment with MAFFT, phylogenetic analysis with MEGA7, and 3D structural modelling for FPPS with Modeller 9.18 and on I-Tasser server. We performed concentration curves with N-BP in Leishmania promastigotes and Giardia trophozoites to estimate the IC50via the MTS/PMS viability method. The ultrastructure was evaluated by transmission electron microscopy, and the mechanism of cell death by flow cytometry. RESULTS: The nitrogen-containing bisphosphonate risedronate had stronger anti-proliferative activity in Leishmania compared to other N-BPs with an IC50 of 13.8 µM, followed by ibandronate and alendronate with IC50 values of 85.1 µM and 112.2 µM, respectively. The effect of N-BPs was much lower on trophozoites of Giardia than Leishmania (IC50 of 311 µM for risedronate). Giardia treated with N-BP displayed concentric membranes around the nucleus and nuclear pyknosis. Leishmania had mitochondrial swelling, myelin figures, double membranes, and plasma membrane blebbing. The same population labelled with annexin-V and 7-AAD had a loss of membrane potential (TMRE), indicative of apoptosis. Multiple sequence alignments and structural alignments of FPPS proteins showed that Giardia and Leishmania FPPS display low amino acid identity but possess the conserved aspartate-rich motifs. CONCLUSIONS: Giardia and Leishmania FPPS enzymes are phylogenetically distant but display conserved protein signatures. The N-BPs effect on FPPS was more pronounced in Leishmania than Giardia. This might be due to general differences in metabolism and differences in the FPPS catalytic site.

Asunto(s)

Proliferación Celular/efectos de los fármacos , Difosfonatos/farmacología , Geraniltranstransferasa/química , Giardia/enzimología , Giardia/ultraestructura , Leishmania/enzimología , Leishmania/ultraestructura , Aminoácidos/genética , Muerte Celular/efectos de los fármacos , Supervivencia Celular/efectos de los fármacos , Geraniltranstransferasa/antagonistas & inhibidores , Giardia/efectos de los fármacos , Concentración 50 Inhibidora , Leishmania/efectos de los fármacos , Microscopía Electrónica de Transmisión , Filogenia , Alineación de Secuencia , Relación Estructura-Actividad

RESUMEN

OBJECTIVE: To identify the risk factors for falls of the community-dwelling elderly in order to update the Taxonomy II of NANDA International. METHOD: A systematic literature review based on research using the following platforms: EBSCOHost®, CINAHL and MEDLINE, from December 2010 to December 2014. The descriptors used were (Fall* OR Accidental Fall) AND (Community Dwelling OR Community Health Services OR Primary health care) AND (Risk OR Risk Assessment OR Fall Risk Factors) AND (Fall* OR Accidental Fall) AND (Community Dwelling OR older) AND Nurs* AND Fall Risk Factors. RESULTS: The sample comprised 62 studies and 50 risk factors have been identified. Of these risk factors, only 38 are already listed in the classification. CONCLUSIONS: Two new categories of risk factors are proposed: psychological and socio-economical. New fall risk factors for the community-dwelling elderly have been identified, which can contribute to the updating of this nursing diagnosis of the Taxonomy II of NANDA International.

Asunto(s)

Accidentes por Caídas/estadística & datos numéricos , Anciano , Humanos , Vida Independiente , Factores de Riesgo

RESUMEN

RESUMO Objetivo Identificar fatores de risco de queda em idosos residentes na comunidade para atualização da taxonomia II da NANDA Internacional. Método Revisão sistemática da literatura, com pesquisa na plataforma EBSCOHost®, na CINAHL e MEDLINE, no período de dezembro de 2010 a dezembro de 2014. Utilizaram-se os descritores (Fall* OR Accidental Fall) AND (Community Dwelling OR Community Health Services OR Primary health care) AND (Risk OR Risk Assessment OR Fall Risk Factors) AND (Fall* OR Accidental Fall) AND (Community Dwelling OR older) AND Nurs* AND Fall Risk Factors. Resultados Obteve-se uma amostra de 62 estudos e um total de 50 fatores de risco, dos quais, apenas 38 estão presentes na classificação. Conclusões São propostas duas novas categorias de fatores: os psicológicos e socioeconômicos. Foram identificados novos fatores de risco de queda dos idosos residentes na comunidade, o que contribui para a atualização deste diagnóstico na taxonomia II da NANDA Internacional.

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RESUMEN Objetivo Identificar los factores de riesgo de caídas en los ancianos residentes en la comunidad. Método Revisión sistemática de la literatura. La búsqueda fue realizada en plataforma EBSCOHost®, en CINAHL y MEDLINE, entre diciembre de 2010 y diciembre de 2014. Los descriptores utilizados fueron (Fall* OR Accidental Fall) AND (Community Dwelling OR Community Health Services OR Primary health care) AND (Risk OR Risk Assessment OR Fall Risk Factors) AND (Fall* OR Accidental Fall) AND (Community Dwelling OR older) AND (Nurs*) AND (Fall Risk Factors). Resultados Fueron seleccionados 62 artículos en los cuales se identificaron 50 factores de riesgo, de los que apenas 38 están presentes en la NANDA Internacional. Conclusiones Se proponen dos nuevas categorías de factores: los psicológicos y los socioeconómicos. Se identificaron nuevos factores de riesgo de caídas en los ancianos residentes en la comunidad, lo que contribuyó para la actualización de la taxonomía II NANDA Internacional.

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ABSTRACT Objective To identify the risk factors for falls of the community-dwelling elderly in order to update the Taxonomy II of NANDA International. Method A systematic literature review based on research using the following platforms: EBSCOHost®, CINAHL and MEDLINE, from December 2010 to December 2014. The descriptors used were (Fall* OR Accidental Fall) AND (Community Dwelling OR Community Health Services OR Primary health care) AND (Risk OR Risk Assessment OR Fall Risk Factors) AND (Fall* OR Accidental Fall) AND (Community Dwelling OR older) AND Nurs* AND Fall Risk Factors. Results The sample comprised 62 studies and 50 risk factors have been identified. Of these risk factors, only 38 are already listed in the classification. Conclusions Two new categories of risk factors are proposed: psychological and socio-economical. New fall risk factors for the community-dwelling elderly have been identified, which can contribute to the updating of this nursing diagnosis of the Taxonomy II of NANDA International.

Asunto(s)

Humanos , Anciano , Accidentes por Caídas/estadística & datos numéricos , Factores de Riesgo , Vida Independiente

RESUMEN

BACKGROUND: Trypanosoma cruzi, the etiological agent of Chagas disease, is auxotrophic for arginine. It obtains this amino acid from the host through transporters expressed on the plasma membrane and on the membranes of intracellular compartments. A few cationic amino acid transporters have been characterized at the molecular level, such as the novel intracellular arginine/ornithine transporter, TcCAT1.1, a member of the TcCAT subfamily that is composed of four almost identical open reading frames in the T. cruzi genome. METHODS: The functional characterization of the TcCAT1.1 isoform was performed in two heterologous expression systems. TcCAT subfamily expression was evaluated by real-time PCR in polysomal RNA fractions, and the cellular localization of TcCAT1.1 fused to EGFP was performed by confocal and immunoelectron microscopy. RESULTS: In the S. cerevisiae expression system, TcCAT1.1 showed high affinity for arginine (K m = 0.085 ± 0.04 mM) and low affinity for ornithine (K m = 1.7 ± 0.2 mM). Xenopus laevis oocytes expressing TcCAT1.1 showed a 7-fold increase in arginine uptake when they were pre-loaded with arginine, indicating that transport is enhanced by substrates on the trans side of the membrane (trans-stimulation). Oocytes that were pre-loaded with [(3)H]-arginine displayed a 16-fold higher efflux of [(3)H]-arginine compared with that of the control. Analysis of polysomal RNA fractions demonstrated that the expression of members of the arginine transporter TcCAT subfamily is upregulated under nutritional stress and that this upregulation precedes metacyclogenesis. To investigate the cellular localization of the transporter, EGFP was fused to TcCAT1.1, and fluorescence microscopy and immunocytochemistry revealed the intracellular labeling of vesicles in the anterior region, in a network of tubules and vesicles. CONCLUSIONS: TcCAT1.1 is a novel arginine/ornithine transporter, an exchanger expressed in intracellular compartments that is physiologically involved in arginine homeostasis throughout the T. cruzi life cycle. The properties and estimated kinetic parameters of TcCAT1.1 can be extended to other members of the TcCAT subfamily.

Asunto(s)

Sistemas de Transporte de Aminoácidos Básicos/metabolismo , Arginina/metabolismo , Enfermedad de Chagas/parasitología , Genoma de Protozoos , Familia de Multigenes , Proteínas Protozoarias/metabolismo , Trypanosoma cruzi/genética , Trypanosoma cruzi/metabolismo , Secuencia de Aminoácidos , Sistemas de Transporte de Aminoácidos Básicos/genética , Animales , Humanos , Masculino , Ratones Endogámicos BALB C , Datos de Secuencia Molecular , Proteínas Protozoarias/genética , Alineación de Secuencia

RESUMEN

BACKGROUND: The aim of this report is to describe the effect of daily hemodialysis on the growth of children with end-stage renal disease (ESRD). METHODS: We performed a prospective, observational study on 24 children with ESRD undergoing daily hemodialysis (DHD). The control group comprised 26 children on concurrent conventional hemodialysis (CHD), and the follow-up for both groups was 9.3 ± 3.0 months. No patient received growth hormone (GH) therapy. RESULTS: At the onset of the study, the height-for-age Z-score was -2.12 ± 1.54 in the CHD group and -2.84 ± 2.27 in the DHD group (p = 0.313). Assuming an increase of 0.5 standard deviation scores (SDS) of the height-for-age parameter as an improvement of growth, there were 33 % of patients in the DHD group and 8 % in the CHD group (p = 0.035). The cumulative probability of gain in height for age at 12 months was 40 % in the DHD group versus 15 % in the CHD group (p = 0.047). Also, 98 % of patients in the DHD group had an adequate total caloric intake, whereas 38 % in the CHD group reached this goal (p < 0.001). No patient left the study due to intensification of the dialysis modality. CONCLUSIONS: Our data show that the DHD favored a 0.5 SDS height gain in a third of patients without GH treatment. Dialysis intensification was not a cause for treatment dropouts, and DHD should be considered as a treatment for selected cases, especially small children.

Asunto(s)

Estatura , Desarrollo Infantil , Fallo Renal Crónico/terapia , Diálisis Renal/métodos , Adolescente , Factores de Edad , Estudios de Casos y Controles , Niño , Preescolar , Ingestión de Energía , Femenino , Trastornos del Crecimiento/etiología , Trastornos del Crecimiento/fisiopatología , Humanos , Lactante , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/diagnóstico , Fallo Renal Crónico/fisiopatología , Masculino , Estado Nutricional , Estudios Prospectivos , Diálisis Renal/efectos adversos , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento

RESUMEN

Chagas disease, caused by the protozoan Trypanosoma cruzi, is an endemic illness in Latin America. Efforts have been made by several groups to develop new effective and safe anti-T. cruzi drugs. In the present work, we show that thiazolidine LPSF SF29 inhibited growth of the epimastigote and amastigote forms and caused lysis in the trypomastigote form of T. cruzi, leading to death of the protozoan. Mitochondrial dysfunction was also observed. The thiazolidine induced ultrastructural alterations such as detachment of the flagellar membrane, intense mitochondrial swelling, formation of myelin-like figures and the appearance of autophagosomes. Taken together, these results suggest that this new thiazolidine is active against T. cruzi and constitutes a promising drug for the therapy of Chagas disease.

Asunto(s)

Antiprotozoarios/farmacología , Tiazolidinas/farmacología , Trypanosoma cruzi/efectos de los fármacos , Supervivencia Celular/efectos de los fármacos , Humanos , América Latina , Microscopía Electrónica , Mitocondrias/efectos de los fármacos , Mitocondrias/fisiología , Trypanosoma cruzi/crecimiento & desarrollo , Trypanosoma cruzi/ultraestructura

RESUMEN

BACKGROUND: Usually the analysis of the various developmental stages of Trypanosoma cruzi in the experimentally infected vertebrate and invertebrate hosts is based on the morphological observations of tissue fragments from animals and insects. The development of techniques that allow the imaging of animals infected with parasites expressing luciferase open up possibilities to follow the fate of bioluminescent parasites in infected vectors. METHODS: D-luciferin (60 µg) was injected into the hemocoel of the whole insect before bioluminescence acquisition. In dissected insects, the whole gut was incubated with D-luciferin in PBS (300 µg/ml) for ex vivo bioluminescence acquisition in the IVIS® Imaging System, Xenogen. RESULTS: Herein, we describe the results obtained with the luciferase gene integrated into the genome of the Dm28c clone of T. cruzi, and the use of these parasites to follow, in real time, the infection of the insect vector Rhodnius prolixus, by a non- invasive method. The insects were evaluated by in vivo bioluminescent imaging on the feeding day, and on the 7 th, 14 th, 21 st and 28 th days after feeding. To corroborate the bioluminescent imaging made in vivo, and investigate the digestive tract region, the insects were dissected. The bioluminescence emitted was proportional to the number of protozoans in regions of the gut. The same digestive tracts were also macerated to count the parasites in distinct morphological stages with an optical microscope, and for bioluminescence acquisition in a microplate using the IVIS® Imaging System. A positive correlation of parasite numbers and bioluminescence in the microplate was obtained. CONCLUSIONS: This is the first report of bioluminescent imaging in Rhodnius prolixus infected with trypomastigotes of the Dm28c-luc stable strain, expressing firefly luciferase. In spite of the distribution limitations of the substrate (D-luciferin) in the insect body, longitudinal evaluation of infected insects by bioluminescent imaging is a valuable tool. Bioluminescent imaging of the digestive tract infected with Dm28c-luc is highly sensitive and accurate method to track the fate of the parasite in the vector, in the crop, intestine and rectum. This methodology is useful to gain a better understanding of the parasite - insect vector interactions.

Asunto(s)

Mediciones Luminiscentes/métodos , Parasitología/métodos , Rhodnius/parasitología , Trypanosoma cruzi/patogenicidad , Animales , Interacciones Huésped-Patógeno , Luciferasas/análisis , Luciferasas/genética , Coloración y Etiquetado/métodos

RESUMEN

Abscesso primario do psoas nao e uma doenca comum. O quadro clinico em crianca muitas vezes e inespecifico, podendo levar a atraso no diagnostico. Os autores descrevem um caso de abscesso primario do psoas em menina de sete anos de idade, com acometimento secundario da articulacao do quadril. O diagnostico foi confirmado atraves de tomografia computadorizada de abdome e pelve. E apresentada uma revisao da literatura sobre as manifestacoes clinicas, patogenese, diagnostico diferencial, etiologia, abordagem diagnostica e terapeutica desta patologia

Asunto(s)

Humanos , Femenino , Niño , Claudicación Intermitente/etiología , Dolor Pélvico/etiología , Absceso del Psoas/diagnóstico , Antibacterianos/uso terapéutico , Drenaje , Tomografía Computarizada por Rayos X