RESUMO
Between 1994-2001 we have performed 57 bone biopsies for diagnostic purposes in symptomatic CRF patients. We analyzed here 52 samples where the material was optimal for study, and divided them into 2 periods according to when the biopsy was performed: 1994-1996 and 1997-2001, to verify changes in the spectrum of renal osteodystrophy. Mean serum values were: serum calcium 9.9 +/- 1.8 mg/dl, phosphate 5.8 +/- 3.2 mg/dl, alkaline phosphatase 693.9 +/- 968.9 Ul/L, iPTH 562.0 +/- 598.5 pg/ml, serum aluminum 65.7 +/- 79.3 ug/L and bone aluminum 22.8 +/- 22.4 ug/g. Hyperparathyroidism was the most common histological diagnosis as severe in 13 patients (25%), or as mild in 14 (27%). Ten patients had osteomalacia (19%), adynamic bone disease was diagnosed in 5 (9.6%) and mixed renal osteodystrophy in 10 (19.2%). Low bone turnover patients showed higher bone and serum aluminum than high bone turnover patients. We observed a relative increment in high turnover bone disease in the later period (1997-2001) without changes in low turnover bone disease. These data showed a high prevalence of hyperparathyroidism and aluminum-related low turnover bone disease, with no significant changes between the two time-periods analyzed here.
Assuntos
Osso e Ossos/patologia , Distúrbio Mineral e Ósseo na Doença Renal Crônica/epidemiologia , Adolescente , Adulto , Idoso , Fosfatase Alcalina/sangue , Alumínio/análise , Argentina/epidemiologia , Biomarcadores , Biópsia , Remodelação Óssea , Osso e Ossos/química , Cálcio/sangue , Distúrbio Mineral e Ósseo na Doença Renal Crônica/sangue , Distúrbio Mineral e Ósseo na Doença Renal Crônica/etiologia , Distúrbio Mineral e Ósseo na Doença Renal Crônica/patologia , Feminino , Humanos , Falência Renal Crônica/sangue , Falência Renal Crônica/complicações , Falência Renal Crônica/patologia , Masculino , Pessoa de Meia-Idade , Hormônio Paratireóideo/sangue , Fósforo/sangueRESUMO
The objective of this study was to assess the relationship between the bone strontium content and bone histomorphometric parameters in bone biopsies from patients with chronic renal failure undergoing hemodialysis. The study was carried out in 74 illiac crest bone biopsies from patients with renal osteodystrophy from different worldwide regions (Argentina, Portugal and Spain). They were underwent to histological and histomorphometric evaluation. The bone strontium/calcium ratio was measured by quadrupole inductively coupled plasma-mass spectrometry. The samples were classified into groups according to histological criteria: hyperparathyroidism (HP), mixed (MX), osteomalacia (OM) and adynamic bone disease (ABD). Serum PTH and alkaline phosphatase before biopsy were available in most of the patients. No correlation was found between the different histomorphometric parameters and the Sr/Ca ratio. The one way ANOVA test showed statistical differences in the Sr/Ca ratio of the different histological forms (HP: 0.58 +/- 0.39; MX: 1.16 +/- 0.74; OM: 1.10 +/- 0.46; ABD: 0.91 +/- 0.40 microgram Sr/mg Ca; p < 0.003). The post-Hoc analysis showed differences between HP and MX. The biopsies having greater or equal values than 1.4 micrograms Sr/mg Ca showed higher levels of bone formation histomorphometric parameters and serum alkaline phosphatase (395 +/- 519 vs 1,022 +/- 989 UI/L, p < 0.05). Although it has been found that the biopsies with higher bone strontium had higher levels of osteoid tissue (characteristic of osteomalacia), the hypothesis of strontium-induced osteomalacia could not be demonstrated.
Assuntos
Osso e Ossos/metabolismo , Distúrbio Mineral e Ósseo na Doença Renal Crônica/metabolismo , Soluções para Hemodiálise/efeitos adversos , Falência Renal Crônica/metabolismo , Osteomalacia/induzido quimicamente , Diálise Renal , Estrôncio/efeitos adversos , Fosfatase Alcalina/sangue , Argentina/epidemiologia , Biópsia , Osso e Ossos/química , Cálcio/análise , Distúrbio Mineral e Ósseo na Doença Renal Crônica/epidemiologia , Distúrbio Mineral e Ósseo na Doença Renal Crônica/etiologia , Soluções para Hemodiálise/química , Humanos , Hiperparatireoidismo Secundário/etiologia , Ílio/química , Ílio/patologia , Falência Renal Crônica/complicações , Falência Renal Crônica/terapia , Osteomalacia/epidemiologia , Osteomalacia/etiologia , Hormônio Paratireóideo/sangue , Portugal/epidemiologia , Diálise Renal/efeitos adversos , Espanha/epidemiologia , Estrôncio/análiseRESUMO
A dual site project was conducted to assess determinants of injection and sex-related risk behaviors among Puerto Rican drug users. The project focused on injection drug users and crack smokers, and was conducted in East Harlem, NY and Bayamón, PR in 1996-2000. Qualitative methods included ethnographic mapping, focus groups, in-depth interviews, and observations. A survey component (East Harlem, n = 800; Bayamón, n = 400) was also conducted. Procedures to ensure integration of methodologies and comparability of data were developed. This paper describes the qualitative and survey methods used, and presents the comparative HIV risk behaviors. The integration of the two methodologies served multiple functions: each component identified issues to be addressed in the other, enhanced cross-site comparability of data, and assisted in interpretation of findings. The survey data showed high levels of risk behaviors in both communities, with significantly higher levels of risk reported in Bayamón. Conducting studies of similar ethnic groups in different communities provides opportunities to examine diverse sources of influence on risk behaviors. The integration of qualitative and quantitative methods can enhance comparability and understanding of findings, particularly when there are differences in behaviors between communities.
Assuntos
Soroprevalência de HIV , Hispânico ou Latino/estatística & dados numéricos , Abuso de Substâncias por Via Intravenosa/epidemiologia , Adulto , Feminino , Grupos Focais , Humanos , Masculino , Uso Comum de Agulhas e Seringas , Cidade de Nova Iorque/epidemiologia , Porto Rico/epidemiologia , Porto Rico/etnologia , Assunção de Riscos , Comportamento SexualRESUMO
This article investigates the association between residential status and human immunodeficiency virus (HIV) risk behaviors among island and New York Puerto Rican injection drug users (IDUs). We assigned 561 subjects from New York City and 312 from Puerto Rico to five residential status categories: living in parent's home, living in own home, living in other's home, living in temporary housing (hotel, single-room occupancy [SRO] hotels), and homeless (living in streets/shelters). Dependent variables included injection- and sex-related risk behaviors (sharing syringes, sharing other injection paraphernalia, shooting gallery use, and having paid sex). Chi square, t tests, and multivariate logistic analysis tests were performed separately by site. About one-quarter of the sample in each site was homeless. Island Puerto Ricans were more likely to live with their parents (44% vs. 12%, p < .001), and more New York IDUs lived in their own home (30% vs. 14%, p < .001). In New York, gallery use and paid sex were associated with living in other's home, living in parent's home, and being homeless. Sharing paraphernalia was related to living in other's home, living in temporary housing, and being homeless. In Puerto Rico, having paid sex was associated with homelessness. High-risk behaviors were more likely among homeless IDUs in both sites. Programs to provide housing and target outreach and other prevention programs for homeless IDUs would be helpful in reducing HIV risk.
Assuntos
Soropositividade para HIV/etnologia , Características de Residência , Assunção de Riscos , Abuso de Substâncias por Via Intravenosa/etnologia , Adulto , Feminino , Seguimentos , Humanos , Masculino , Porto Rico/etnologia , Comportamento Sexual , Estados Unidos/epidemiologiaRESUMO
Frequency of injection has been consistently found to be higher among Puerto Rican Injection drug users (IDUs) than among other groups of IDUs. Several explanations have been suggested, but an empirical explanation has yet to be presented. This study compares the frequency of injection of Puerto Rican IDUs in East Harlem, New York, with that of IDUs in Bayamon, Puerto Rico. Study subjects comprised 521 Puerto Rican IDUs from East Harlem and 303 IDUs from Bayamon. The mean frequency of injection among IDUs in East Harlem was 2.8, the corresponding mean in Bayamon was 5.4. Younger IDUs reported a higher number of daily injection episodes than older IDUs, and the IDU group in Bayamon was 5 years younger than the group in East Harlem. The drug use variables accounted for a greater portion of the between-city difference than the demographic and psychosocial variables. Use of noninjected drugs, as well as the use of prescribed methadone, were found to be associated with a lower number of daily injections. Conversely, injection of cocaine, injection of cocaine mixed with heroin ("speedball"), and injection of larger amounts of drug solution were found to be associated with a higher number of daily injections.
Assuntos
Abuso de Substâncias por Via Intravenosa/psicologia , Adulto , Feminino , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Infecções por HIV/transmissão , Hispânico ou Latino/psicologia , Humanos , Masculino , Cidade de Nova Iorque/epidemiologia , Porto Rico/epidemiologia , Porto Rico/etnologia , Assunção de Riscos , Abuso de Substâncias por Via Intravenosa/complicaçõesRESUMO
This study assessed trends in HIV seroprevalence and needle-sharing behaviors among Puerto Rican injection drug users (IDUs) in Puerto Rico and New York. Data from two studies of IDUs conducted from 1992 through 1995 and 1998 through 1999 in Bayamón, Puerto Rico, and East Harlem, New York, were examined to assess trends over this period. Separate analyses were conducted for IDUs who were current crack smokers. Significant decreasing trends in seroprevalence were found among IDUs in the New York and Puerto Rico samples (p <.001). Significant decreasing trends in receptive and distributive needle sharing were found in the New York sample, and a significant decline in receptive sharing was found in the Puerto Rico sample. Overall, higher levels of needle-sharing behaviors were reported in Puerto Rico compared with New York. Decreasing trends in needle sharing and seroprevalence in both communities are an encouraging finding. Ongoing epidemiologic studies to monitor the epidemic and continued prevention efforts to help maintain or further these declines are needed, particularly to address the higher rates of needle sharing in Puerto Rico.
Assuntos
Soroprevalência de HIV/tendências , Uso Comum de Agulhas e Seringas/tendências , Abuso de Substâncias por Via Intravenosa/epidemiologia , Adolescente , Adulto , Cocaína Crack , Feminino , Anticorpos Anti-HIV/sangue , Humanos , Masculino , New York/epidemiologia , Porto Rico/epidemiologia , Fatores de Risco , Abuso de Substâncias por Via Intravenosa/sangueRESUMO
Epidemic aluminum neurotoxicity has virtually disappeared in the dialysis population; however, sporadic toxic effects caused by contamination of water with aluminum are still reported. In this review, the current situation in Iberoamerica is analyzed. Exposure to aluminum through dialysate shows considerable geographical differences even within the same country, including seasonal variability. Sometimes the tap water showed very high aluminum content that does not permit the water treatment system to efficiently remove all the aluminum, forcing the use of water treatment systems with a double reverse-osmosis filter on line. The use of adequate water treatment systems and a correct control policy has improved the quality of the dialysate, minimizing the aluminum exposure. However, an additional problem in Iberoamerica is the difficulty to obtain aluminum-free concentrates for the preparation of the final dialysis solution. Aluminum still seems to be implicated in a great percentage of symptomatic low-bone remodeling lesions in South America compared with Europe, demonstrating that exposure to aluminum through dialysate is still a cause of concern in some areas of the world.
Assuntos
Alumínio/intoxicação , Soluções para Diálise/efeitos adversos , Falência Renal Crônica/terapia , Alumínio/análise , Soluções para Diálise/análise , Soluções para Diálise/normas , Contaminação de Medicamentos/prevenção & controle , Monitoramento Ambiental/normas , Humanos , Falência Renal Crônica/sangue , Osteomalacia/induzido quimicamente , Osteomalacia/prevenção & controle , Garantia da Qualidade dos Cuidados de Saúde , América do Sul , Espanha , Purificação da Água , Abastecimento de Água/análiseRESUMO
Urinary excretion of aluminium after a successful transplant can reverse pre-transplant aluminium intoxication. We have evaluated the time course of urinary aluminium excretion and its correlation with several parameters of renal function and mineral metabolism in 49 patients (33 men and 16 women) with a wide range of pre-transplant serum aluminium concentrations, performing sequential determinations at pre-transplant time and at 7, 30, 60, and 90 post-transplant days. Mean serum aluminium at pre-transplant was 54.5+/-46.8 microg/l decreasing progressively to 28.7+/-24.4 microg/l at 90 days (P<0.0002), paralleling the decrease in serum creatinine. Urinary aluminium decreased from 63.0+/-77.9 to 52.4+/-55.9 microg/l at 90 days (P<0.0001). The maximum urinary aluminium/creatinine was 1.8+/-2.7 at 7 days and was associated with the greatest fractional excretion of sodium (4.7+/-5.1%), and the lowest tubular reabsorption of phosphate (55.7+/-25.1%). The fractional excretion of aluminium was also greatest at day 7 (1.1+/-0.9%) when serum creatinine was still elevated (3.6+/-2.3 mg/dl). At each period of time after transplantation fractional excretion of aluminium was similar in all patients despite disparate serum aluminium concentrations. Fractional excretion of aluminium was highest in those patients who developed post-Tx acute tubular necrosis (0.7+/-0.5 vs 1.5+/-1.0%, P=0.008). We found a direct positive correlation (r=0.43; P<0.002) between urinary aluminium and urinary phosphate. Basal levels and sequential changes in serum PTH, calcium, and phosphate did not correlated with fractional excretion of aluminium. These findings suggest: (i) urinary aluminium remains elevated during prolonged periods after transplant and is probably a marker of pre-transplant tissue aluminium accumulation; (ii) post-transplant fractional excretion of aluminium seems to correlated positively with other evidences of renal tubular dysfunction. Early post-transplant tubular malfunction could significantly enhance urinary aluminium elimination.
Assuntos
Alumínio/farmacocinética , Transplante de Rim , Adolescente , Adulto , Idoso , Criança , Creatinina/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeAssuntos
Distúrbio Mineral e Ósseo na Doença Renal Crônica , Cálcio/metabolismo , Distúrbio Mineral e Ósseo na Doença Renal Crônica/diagnóstico , Distúrbio Mineral e Ósseo na Doença Renal Crônica/etiologia , Distúrbio Mineral e Ósseo na Doença Renal Crônica/terapia , Humanos , Fósforo/metabolismo , Diálise RenalRESUMO
Varios autores han referido la probable participacion de la inmunidad mediada por celulas en la fisiopatogenia del sindrome nefrotico a cambios minimos (SNCM). El objeto de esta comunicacion fue estudiar cuantitativamente la inmunidad celular y establecer su posible participacion en SNCM. Nuestras observaciones sugieren una disminucion de las celulas T circulantes en SNCM con respecto a los ninos del grupo control. Esta disminucion puede estar dada por un bloqueo del receptor para eritrocitos de carnero a nivel de la membrana linfocitaria por factores sericos o por una reducion real de celulas T circulantes
Assuntos
Pré-Escolar , Criança , Humanos , Imunidade Celular , Síndrome NefróticaRESUMO
Varios autores han referido la probable participacion de la inmunidad mediada por celulas en la fisiopatogenia del sindrome nefrotico a cambios minimos (SNCM). El objeto de esta comunicacion fue estudiar cuantitativamente la inmunidad celular y establecer su posible participacion en SNCM. Nuestras observaciones sugieren una disminucion de las celulas T circulantes en SNCM con respecto a los ninos del grupo control. Esta disminucion puede estar dada por un bloqueo del receptor para eritrocitos de carnero a nivel de la membrana linfocitaria por factores sericos o por una reducion real de celulas T circulantes