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Stone formation is induced by an increased level of urine crystallization promoters and reduced levels of its inhibitors. Crystallization inhibitors include citrate, magnesium, zinc, and organic compounds such as glycosaminoglycans. In the urine, there are various proteins, such as uromodulin (Tamm-Horsfall protein), calgranulin, osteopontin, bikunin, and nephrocalcin, that are present in the stone matrix. The presence of several carboxyl groups in these macromolecules reduces calcium oxalate monohydrate crystal adhesion to the urinary epithelium and could potentially protect against lithiasis. Proteins are the most abundant component of kidney stone matrix, and their presence may reflect the process of stone formation. Many recent studies have explored the proteomics of urinary stones. Among the stone matrix proteins, the most frequently identified were uromodulin, S100 proteins (calgranulins A and B), osteopontin, and several other proteins typically engaged in inflammation and immune response. The normal level and structure of these macromolecules may constitute protection against calcium salt formation. Paradoxically, most of them may act as both promoters and inhibitors depending on circumstances. Many of these proteins have other functions in modulating oxidative stress, immune function, and inflammation that could also influence stone formation. Yet, the role of these kidney stone matrix proteins needs to be established through more studies comparing urinary stone proteomics between stone formers and non-stone formers.
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Resumen Introducción: La hipercalciuria idiopática se define como la excreción de calcio superior a 220 y 300 mg/día en mujeres y hombres respectivamente o bien mayor a 4 mg/kg peso bajo dieta habitual. Objetivo: Revisar el diagnóstico, clasificación y tratamiento del paciente hipercalciúrico con litiasis renal. Material y métodos: Se incluyeron 250 pacientes con litiasis renal e hipercalciuria idiopática y 80 individuos sanos como controles. Todos realizaron un estudio bioquímico para litiasis renal. Resultados: Si bien el estándar de oro es la medición de la calciuria en 24 h, en el presente estudio sugerimos considerar también la relación Ca/Kg >4 mg/Kg o bien el índice de calciuria >140 mg/gr de creatinina urinaria. Con respecto a los tipos de hipercalciuria, luego de someterlos a una dieta restringida, los dividimos en hipercalciuria dieta dependiente y dieta independiente del calcio. Con respecto al tratamiento sugerimos una diuresis entre 2 y 2 ½ litros/d. En casos de hipercalciuria dieta dependiente aconsejamos una dieta de 600-800 mg de calcio y moderada restricción de proteínas animales y sal. En caso de no respuesta y en aquellos con hipercalciuria dieta independiente, el agregado de tiazidas, clortalidona, indapamida y ocasionalmente bisfosfonatos pueden controlar la hipercalciuria con menor riesgo de recurrencia de litiasis renal y un mejor estado óseo. Conclusiones: Consideramos importante no solo tener en cuenta las distintas formas de diagnóstico de hipercalciuria sino también la clasificación de esta, que permita un tratamiento más específico.
Abstract Introduction: Idiopathic hypercalciuria is defined as urine calcium excretion greater than 220 mg/day in women and 300 mg/day in men, or greater than 4 mg/kg under regular dietary conditions. Objective: The aim of this study is to review the diagnosis, classification, and treatment of hypercalciuric patients with renal lithiasis. Methods: We enrolled 250 patients suffering from renal lithiasis and idiopathic hypercalciuria and 80 healthy subjects as control group. Lab tests were performed to diagnose renal lithiasis. Results: Although the 24-hour urine test is the gold standard to determine calciuria, in this study we propose considering the Ca/Kg >4 mg/Kg ratio or an index of >140 mg of Ca per gram urine creatinine. Regarding the different types of hypercalciuria, after following a strict diet, subjects were divided into two groups: diet-dependent and diet-independent hypercalciuria. Concerning the treatment, we suggest diuretic therapy to achieve a urine output of 2-2.5 liters per day. In the case of subjects with diet-dependent hypercalciuria, we advise an intake of 600-800 mg of calcium and a moderate reduction in animal protein and salt intake. In cases of non-response to treatment in subjects with diet-dependent hypercalciuria, thiazides, chlorthalidone, indapamide and, in some cases, bisphosphonates may help control hypercalciuria with a lower risk of lithiasis recurrence and healthier bones. Conclusions: We believe it is important to consider not only the methods to diagnose hypercalciuria but also its classification to provide a better treatment.
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RESUMEN Introducción: Las anormalidades del metabolismo óseo-mineral comienzan desde las primeras etapas de la enfermedad renal crónica, produciendo el desarrollo de enfermedad ósea y el aumento de la morbimortalidad de los pacientes. Objetivos: Conocer en una muestra representativa de nuestra población en hemodiálisis, la prevalencia de pacientes en rango objetivo de valores de parathormona, hiperparatiroidismo secundario y enfermedad ósea adinámica, de acuerdo con las guías KDIGO, evaluando, además, el uso de diferentes medicamentos en el control de estas alteraciones. Material y métodos: Participaron 39 centros de hemodiálisis de nuestro país, quienes enviaron las últimas determinaciones de calcio, fósforo y parathormona, y la medicación recibida en el manejo del metabolismo mineral. Resultados: Se incluyeron 4620 pacientes prevalentes en hemodiálisis, > 18 años, edad media 57 años, hombres 57,4%. Las medias fueron: calcemia 8,6 y fosfatemia 4,9 mg/dl. De esta población, el 56,7% y el 50,3% estaban en rango de calcemia y fosfatemia, respectivamente. La parathormona promedio fue 601 y la mediana 437 pg/ml. El 50,5% tenía parathormona en rango, el 15% por debajo de 150 y el 34,5% por encima de 600 pg/ml. En relación a la medicación, el 47% de la población recibió quelantes cálcicos, con extremos en su uso, que van desde el 4,5% al 8% en algunos centros, y del 83% al 94% en otros. El 28,8% recibió Sevelamer, calcitriol el 38%, paricalcitol el 11% y cinacalcet el 20%, siendo su uso variable según los centros del 3% al 52%. Conclusiones: La presencia de hiperparatiroidismo secundario es más frecuente que la deseada, probablemente vinculado a la dificultad en el uso adecuado de medicamentos.
ABSTRACT Introduction : Abnormalities of bone mineral metabolism begin from the early stages of CKD, causing the development of bone disease and increased morbidity and mortality of patients. Objectives: To know, in a representative sample of our hemodialysis patients, the prevalence of patients in the target range of PTH values, secondary hyperparathyroidism and adynamic bone disease according to the KDIGO guidelines, also evaluating the use of different drugs in the control of these alterations. Methods: 39 hemodialysis centers from our country participated, who sent the latest determinations of calcium, phosphorus and PTH and the medication received in the management of mineral metabolism. Results: 4620 prevalent hemodialysis patients > 18 years were included, mean age 57 years, men 57.4%. The means were calcemia 8.6 and phosphatemia 4.9 mg/dl. 56.7% and 50.3% were in the calcemia and phosphatemia range, respectively. The average PTH was 601 and the median 437 pg/ml. 50.5% had PTH in range, 15% below 150 pg/ml and 34.5% above 600 pg/ml. In relation to medication, 47% of the patients received calcium chelators with extreme use ranging from 4.5-8% in some centers to 83-94%. 28.8% received Sevelamer, calcitriol 38%, paricalcitol 11% and cinacalcet 20%, its use being variable according to the centers from 3% to 52%. Conclusion: the presence of secondary hyperpartyroidism was more frequent than desired, probably linked to the difficulty in the adequate use of medications.
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Introducción: El riñón en esponja es una malformación renal, de los túbulos colectores, que se suele asociar a nefrocalcinosis o acidosis tubular distal. La asociación con la litiasis renal se observa entre un 4-20%. Objetivo: El objetivo de nuestro trabajo fue describir factores de riesgo bioquímicos para litiasis renales, en pacientes con riñón en esponja. Material y métodos: Se realizó un estudio retrospectivo, observacional de corte, entre los años 2000 y 2017 en donde se estudiaron 37 pacientes con riñón en esponja y litiasis renal (26 mujeres y 11 hombres) de 37.3 ± 13.2 años. El diagnóstico de riñón en esponja se hizo mediante urograma excretor. Resultados: Fue observada nefrocalcinosis en el 95%. El diagnóstico bioquímico más frecuente fue la hipercalciuria idiopática que como única y asociada alteración se observó en el 59.4%. La hiperuricosuria fue el segundo diagnóstico encontrado en el 32.4% (única y asociada) seguido por la, hipocitraturia, hipomagnesuria y el pHu persistentemente ácido. En los hombres llamó la atención que un 46.2% no presentaron alteración bioquímica. Conclusiones: En conclusión se destaca la asociación relativamente frecuente de riñón en esponja y litiasis renal. La hipercalciuria idiopática fue la alteración metabólica más frecuente como causa de litogénesis, seguida por la hiperuricosuria, similar a lo descripto en la literatura, aunque en menor proporción. Otras alteraciones, como la hipocitraturia, hipomagnesuria y pHu persistentemente ácido también deben ser consideradas en el estudio de estos pacientes.
Introduction: Sponge kidney is a renal malformation of the collecting tubules, which is usually associated with nephrocalcinosis or distal tubular acidosis. The association with renal lithiasis is observed between 4-20%. Objective: The aim of our work was to describe the biochemical risk factors of renal lithiasis in patients with sponge kidney. Methods: A retrospective, observational, cross-sectional study was conducted between 2000 and 2017, in which 37 patients with sponge kidney and renal lithiasis (26 women and 11 men), aged 37.3 ± 13.2 years, were studied. The diagnosis of sponge kidney was made by excretory urography. Results: Nephrocalcinosis was observed in 95% of patients. The most frequent biochemical diagnosis was idiopathic hypercalciuria, which was observed, as a single and associated alteration, in 59.4% of cases. Hyperuricosuria was the second diagnosis found in 32.4% (single and associated) followed by hypocitraturia, hypomagnesuria and persistently acid pHu. Surprisingly, 46.2% of men presented no biochemical alteration. Conclusions: Our findings highlight the relatively frequent association of sponge kidney and renal lithiasis. Idiopathic hypercalciuria was the most common metabolic alteration as the cause of lithogenesis, followed by hyperuricosuria, similar to that described in the literature, but to a lesser extent. Other alterations, such as hypocitraturia, hypomagnesuria and persistently acid pHu, should also be considered in the study of these patients.
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Humanos , Nefrolitíase/complicações , Nefrolitíase/etiologia , Fenômenos Bioquímicos , Distúrbios do Metabolismo do Cálcio , Hipercalciúria/diagnóstico , Nefrocalcinose/diagnósticoRESUMO
La litiasis renal es una enfermedad frecuente cuya prevalencia ha aumentado en los últimos años. En la actualidad se la considera como una patología sistémica; no limitada al riñón y a las vías urinarias, sino relacionada en gran medida a diabetes mellitus, obesidad, hipertensión arterial, hiperuricemia, hipercolesterolemia y enfermedad renal crónica, todos factores de riesgo cardiovascular que suelen vincularse a eventos severos como accidentes cerebrovasculares, enfermedad coronaria o infarto agudo de miocardio. Numerosos estudios transversales y meta-análisis han demostrado la asociación entre estas dos entidades. En esta revisión intentaremos demostrar los mecanismos involucrados en la fisiopatología de la litiasis renal y su relación con enfermedad cardiovascular. Como mecanismos involucrados, se mencionan tres asociaciones. La primera se refiere al estrés oxidativo y la inflamación. La segunda asociación se refiere a la presencia de mecanismos litogénicos que contribuyen a la calcificación vascular. Como última teoría se realiza la asociación ya conocida, de obesidad, síndrome metabólico, diabetes e hipertensión arterial, todos factores de riesgo para el desarrollo de litiasis renal así como de enfermedad cardiovascular, recordando que la litiasis renal es causa, en un 8%, del desarrollo de enfermedad renal crónica, otro factor de riesgo para enfermedad y muerte cardiovascular. Como conclusión se confirma la teoría de que la litiasis renal no es una enfermedad limitada al riñón y la vía urinaria, si no que se trata de una enfermedad sistémica, con riesgo de eventos cardiovasculares tan severos que pueden llevar a la muerte.
Renal lithiasis is a frequent disease whose prevalence has increased in recent years. Nowadays it is considered as a systemic pathology, not limited to the kidney and the urinary tract, but largely related to diabetes mellitus, obesity, hypertension, hyperuricemia, hypercholesterolemia and chronic kidney disease; all cardiovascular risk factors that are usually linked to severe events such as stroke, coronary heart disease or acute myocardial infarction. Numerous cross-sectional studies and meta-analyzes have proved the association between renal lithiasis and cardiovascular disease. In this review we will try to demonstrate the mechanisms involved in the pathophysiology of these two entities. Three associations are mentioned. The first one refers to oxidative stress and inflammation. The second association refers to the presence of lithogenetic mechanisms contributing to vascular calcification. The last theory is the already known correlation with obesity, metabolic syndrome, diabetes and hypertension; all risk factors for the development of renal lithiasis as well as cardiovascular disease. Let us remember that renal lithiasis is the cause, in 8% of cases, of the development of chronic kidney disease, another risk factor for cardiovascular disease and death. In conclusion, the theory that renal lithiasis is not a disease limited to the kidney and the urinary tract is confirmed; it is rather a systemic disease, with a risk of cardiovascular events so severe that they can lead to death.
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Humanos , Masculino , Feminino , Anormalidades Cardiovasculares , Nefrolitíase/complicações , Nefrolitíase/fisiopatologia , Fatores de Risco de Doenças Cardíacas , Risco , Prevalência , Síndrome MetabólicaRESUMO
Propolis is a resin that honey bees (Apis mellifera) produce by mixing wax, exudates collected from tree shoots, pollen, and enzymes. It has been used for its biological properties against pathogenic microorganisms including those of viral origin. In the present study, we demonstrate the antiviral effect of Mexican propolis, as well as of the three commercial flavonoids (quercetin, naringenin, and pinocembrin) present in its composition, in cell cultures infected with Canine Distemper Virus. The treatments were carried out with propolis, flavonoids individually, and a mixture of the three flavonoids at three different times. Antiviral activity was evaluated by the inhibition of the relative expression of the virus nucleoprotein gene (Real-Time qPCR) and by the determination of cellular viability (MTT assay). Propolis applied before infection decreased viral expression (0.72 versus 1.0, 1.65, and 1.75 relative expressions) and correlated with increased cell viability (0.314 versus 0.215, 0.259, and 0.237 absorbance units (AU)). The administration of a flavonoid mixture containing the three commercial flavonoids before infection induces a slight decrease in viral expression (0.93 versus 1, 1.42, and 1.82 relative expressions); however, it does not improve cellular viability (0.255 versus 0.247, 0.282, and 0.245 AU). Quercetin administrated at the same time of infection decreases viral expression (0.90 versus 1.0, 3.25, and 1.02 relative expressions) and improves cellular viability (0.294 versus 0.240, 0.250, and 0.245 AU). Pinocembrin and naringenin individually did not show any antiviral activity at the administration times evaluated in this study. The present work is the first in vitro study of the effect of propolis in Canine Distemper Virus and demonstrated the antiviral activity of Mexican propolis, in addition to the synergy that exists between the three flavonoids on cell viability and the expression of the nucleoprotein virus gene.
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BACKGROUND: This study cephalometrically compared the dentoskeletal and soft tissue changes consequent to one and three-premolar extraction protocols of class II subdivision malocclusion treatment. METHODS: A sample of 126 lateral cephalometric radiographs from 63 patients was selected and divided into two groups. Group 1 consisted of 31 type 1 class II subdivision malocclusion patients treated with asymmetric extractions of two maxillary premolars and one mandibular premolar on the class I side, with an initial mean age of 13.58 years. Group 2 consisted of 32 type 2 class II subdivision malocclusion patients treated with asymmetric extraction of one maxillary first premolar on the class II side, with an initial mean age of 13.98 years. t test was used for intergroup comparison at the pre- and posttreatment stages and to compare the treatment changes. RESULTS: Group 1 had greater maxillomandibular sagittal discrepancy reduction and greater maxillary first molar extrusion. Group 2 had mandibular incisor labial inclination and protrusion, and group 1 had mandibular incisor lingual inclination and retraction. Maxillary molar asymmetry increased in group 2, while mandibular molar asymmetry increased in group 1. CONCLUSIONS: The treatment changes produced by these two class II subdivision protocols are different to adequately satisfy the different needs for types 1 and 2 class II subdivision malocclusions.
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Dente Pré-Molar/cirurgia , Cefalometria/métodos , Face/diagnóstico por imagem , Má Oclusão Classe II de Angle/diagnóstico por imagem , Má Oclusão Classe II de Angle/cirurgia , Mandíbula/diagnóstico por imagem , Maxila/diagnóstico por imagem , Extração Dentária , Adolescente , Criança , Face/patologia , Feminino , Humanos , Masculino , Má Oclusão Classe II de Angle/classificação , Má Oclusão Classe II de Angle/patologia , Mandíbula/patologia , Maxila/patologia , Radiografia , Estudos RetrospectivosRESUMO
This study aimed to compare the efficiency of 4-premolar extraction protocol in Class I malocclusion and 2-maxillary premolar extraction protocol in complete Class II malocclusions. Group 1 consisted of fifty patients retrospectively selected, initially presenting with Class I malocclusion, with an initial mean age of 13.66 years. Group 2 consisted of 36 patients initially presenting with full Class II malocclusion, with an initial mean age of 14.47 years. To assess the treatment efficiency index of each treatment protocol, the peer assessment rating (PAR) index was evaluated on the initial and final dental casts. Treatment efficiency index was calculated as the ratio between the percentage of PAR reduction and the treatment time. The occlusal outcomes at the post-treatment stage were evaluated by the PAR and OGS (Objective Grading System) indexes. T tests for independent samples were used for intergroup comparisons of the initial age, initial and final PAR, PAR reduction, PAR reduction percentage, treatment time, treatment efficiency, total OGS and OGS variables. Nonparametric Mann-Whitney U-tests were used for intergroup comparison of the FPAR occlusal variables and two OGS variables. There were no intergroup differences regarding PAR reduction, PAR reduction percentage, treatment time and treatment efficiency. Additionally, the occlusal outcomes at the post-treatment stage were similar in the groups. Therefore, it was concluded that the treatment efficiency and the occlusal outcomes were similar for both treatment protocols.(AU)
Este estudo teve como objetivo comparar a eficiência dos tratamentos da má oclusão de Classe I com extrações de quatro pré-molares, e da má oclusão de Classe II completa com extrações de dois pré-molares superiores. O grupo 1 consistiu de 50 pacientes retrospectivamente selecionados, apresentando inicialmente má oclusão de Classe I, com idade inicial média de 13,66 anos. O grupo 2 consistiu de 36 pacientes retrospectivamente selecionados, apresentando inicialmente má oclusão de Classe II completa, com idade inicial média de 14,47 anos. Para mensurar a eficiência de tratamento de cada protocolo de tratamento, foi avaliado o índice PAR (peer assessment rating) nos modelos de gesso iniciais e finais dos pacientes. A eficiência de tratamento foi calculada como a relação entre a porcentagem de redução do índice PAR e o tempo de tratamento. Os resultados oclusais no estágio pós-tratamento foram avaliados pelos índices PAR e OGS (Objective Grading System). Testes t foram utilizados para comparação entre os grupos, da idade inicial, PAR inicial, PAR final, redução do PAR, porcentagem de redução do PAR, tempo e eficiência do tratamento, OGS total e a maioria das variáveis deste índice. Testes não paramétricos de Mann- Whitney foram utilizados para comparação intergrupos das variáveis oclusais do índice PAR final, e para duas variáveis do índice OGS. Não houve diferenças entre os grupos em relação ao tempo de tratamento, PAR final, redução do PAR, porcentagem de redução do PAR e eficiência do tratamento. Além disto, os resultados oclusais no estágio pós-tratamento também foram semelhantes entre os grupos. Portanto, podese concluir que há similaridade em relação à eficiência do tratamento e resultados oclusais, entre os dois protocolos de tratamentos.(AU)
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Humanos , Masculino , Feminino , Adolescente , Dente Pré-Molar/cirurgia , Má Oclusão Classe II de Angle/terapia , Má Oclusão Classe I de Angle/terapia , Extração Dentária/métodos , Reprodutibilidade dos Testes , Estudos Retrospectivos , Estatísticas não Paramétricas , Resultado do TratamentoRESUMO
BACKGROUND: Idiopathic or benign hematuria is diagnosed in children after all other possible causes have been ruled out and test results for renal or urologic pathologies are negative. METHODS: To identify possible urinary risk factors for hematuria in children, we retrospectively evaluated clinical onset, family history, and metabolic risk factors of 60 children with idiopathic hematuria but without renal stones or other pathologic conditions that could explain the hematuria. All patients followed the same ambulatory protocol at that used to evaluate kidney stone-formers. RESULTS: Seven patients had microhematuria, three patients each had microhematuria and gross hematuria, and the remaining 50 patients had gross hematuria onset. A family history of stone disease was found in 63 % of the children. At least one urinary metabolic abnormality was present in 49 patients, while 11 patients had no metabolic abnormality. The most common urinary risk factor was idiopathic hypercalciuria (single or associated), which was found in 43.5 % of patients, followed by hypocitraturia (single or associated), present in 31.7 %. Unduly acidic urine pH as a single abnormality was found in 10 % of this pediatric patient population. We also found hyperoxaluria and, less frequently, hypomagnesuria, and hyperuricosuria. CONCLUSIONS: Asymptomatic idiopathic hematuria in pediatric patients may often be associated to different urinary biochemical abnormalities, similar to what is observed in pediatric kidney stone-formers.
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Hematúria/metabolismo , Urina/química , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Masculino , Estudos Retrospectivos , Fatores de RiscoRESUMO
Nephrolithiasis is a frequent condition in urology that has an important recurrence and high impact in health economy. Knowing the biochemical abnormalities implicated in its pathogenesis is mandatory to establish therapeutic aims. Our objectives are to present the results in 3040 kidney stone formers in Argentina. All patients were selected after completing an ambulatory metabolic protocol with diagnostic purposes. There were 1717 men, (56.48%), with a mean age of 45±12 years, and 1323 women, (43.52%), mean age 44±12 years. 2781 patients had biochemical abnormalities, (91.49%), and were arbitrarily divided in two groups: those who had only one (single) biochemical abnormality (n=2156) and those who had associated abnormalities (n=625). No biochemical abnormalities were found in 259 patients (8.51%). The abnormalities present, single and associated, in order of frequency, were idiopathic hypercalciuria, (56.88%), hyperuricosuria (21.08%), unduly acidic urine (10.95%), hypocitraturia (10.55%), hypomagnesuria (7.9%), primary hyperparathyroidism (3.01%), hyperoxaluria (2.6%), and cystinuria (0.32%). We performed in 484 patient's stone composition and found calcium oxalate stones related to idiopathic hypercalciuria predominantly while uric acid stones to unduly acidic urine. In conclusion, the biochemical abnormalities described are similar to those found in a previous series of our own and to those reported in the literature. Its diagnosis is important to therapeutic purposes to avoid eventual recurrence.
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Hipercalciúria/complicações , Cálculos Renais/etiologia , Doenças Metabólicas/complicações , Adulto , Argentina/epidemiologia , Feminino , Humanos , Hipercalciúria/epidemiologia , Hipercalciúria/urina , Cálculos Renais/epidemiologia , Cálculos Renais/urina , Masculino , Doenças Metabólicas/epidemiologia , Doenças Metabólicas/urina , Pessoa de Meia-IdadeRESUMO
Introducción: el hiperparatiroidismo secundarioes una complicación frecuente de laenfermedad renal crónica. Cinacalcet, un moduladoralostérico del receptor sensor del calcio incrementasu sensibilidad a la activación por partedel calcio iónico extracelular, demostró ser efectivoen reducir los niveles de PTH. Objetivo:Evaluar la eficacia de cinacalcet en pacientes enhemodiálisis con HPTS. Material y métodos: Se realizó un estudio retrospectivo, multicéntrico, observacional, en 76 pacientes que recibieronal menos 3 meses de cinacalcet como tratamientodel HPTS...
Introduction: secondary Hyperparathyroidism is a frequent chronic renal disease complication. Cinacalcet, an allosteric modulator of the calcium sensing receptor, increases its sensitivity to activation by extracellular calcium ions, proved to be effective in reducing PTH levels. Objetive: To evaluate cinacalcet effectiveness in hemodialysis patients with HPTS. Methods: A retrospective, multicenter, observational study was carried out, on 76 patients who received Cinacalcet for at least 3 months, as a treatment for HPTS...
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Masculino , Feminino , Humanos , Distúrbios do Metabolismo do Cálcio , Tratamento Farmacológico , Hiperparatireoidismo Secundário , Hiperparatireoidismo Secundário/terapia , Insuficiência Renal Crônica , Insuficiência Renal Crônica/terapia , Terapêutica , Argentina , Diálise RenalRESUMO
The tropical tree Schizolobium amazonicum is native from the Amazonian forest, naturally occurring in Brazil, Peru and Colombia. This work aimed to study the veneer yield made from this species. For this purpose, 50 logs from S. amazonicum were rotary peeled in a plywood industry installed in Brazilian Amazon region. The results indicated that S. amazonicum had a peeling yield similar or even higher than those usually obtained for species traditionally used for this purpose in Brazil, like those of Pinus and Eucalyptus. It was also observed that the dendrometric parameters of the log can be used to estimate the peeling yield in this species.(AU)
O paricá (Schizolobium amazonicum) é uma espécie nativa da floresta amazônica, que ocorre naturalmente no Brasil, Peru e Colômbia. O objetivo do presente trabalho foi avaliar o rendimento em laminação da madeira de paricá. Para isso foram avaliadas toras da espécie em uma fábrica de compensado instalada na região Amazônica brasileira. Os resultados indicaram que o paricá apresenta um elevado rendimento em laminação, sendo similar ou em alguns casos até superior a espécies tradicionalmente utilizadas para esta finalidade no Brasil, como as dos gêneros Pinus e Eucalyptus. Observou-se ainda que o rendimento em laminação da espécie pode ser estimado por meio dos parâmetros dendrométricos das toras.(AU)
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The tropical tree Schizolobium amazonicum is native from the Amazonian forest, naturally occurring in Brazil, Peru and Colombia. This work aimed to study the veneer yield made from this species. For this purpose, 50 logs from S. amazonicum were rotary peeled in a plywood industry installed in Brazilian Amazon region. The results indicated that S. amazonicum had a peeling yield similar or even higher than those usually obtained for species traditionally used for this purpose in Brazil, like those of Pinus and Eucalyptus. It was also observed that the dendrometric parameters of the log can be used to estimate the peeling yield in this species.
O paricá (Schizolobium amazonicum) é uma espécie nativa da floresta amazônica, que ocorre naturalmente no Brasil, Peru e Colômbia. O objetivo do presente trabalho foi avaliar o rendimento em laminação da madeira de paricá. Para isso foram avaliadas toras da espécie em uma fábrica de compensado instalada na região Amazônica brasileira. Os resultados indicaram que o paricá apresenta um elevado rendimento em laminação, sendo similar ou em alguns casos até superior a espécies tradicionalmente utilizadas para esta finalidade no Brasil, como as dos gêneros Pinus e Eucalyptus. Observou-se ainda que o rendimento em laminação da espécie pode ser estimado por meio dos parâmetros dendrométricos das toras.
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Oral bisphosphonates comprise the most widely prescribed class of antiosteoporotic drugs. Recent reports, however, suggest a link between prolonged bisphosphonate use and atypical low-energy, subtrochanteric fractures. We describe the clinical course of two patient treated for a long term with different bisphosphonates who developed subtrochanteric atypical fractures. They were treated initially with intramedullary rodding without pain disappearance or healing of the fracture. Strontium ranelate, a new orally administered agent for the treatment of osteoporosis, was given to these patients with complete closure of the fracture and pain disappearance after a few months. We conclude that based on the chronology of fracture healing and pain disappearance of our patients and published evidence that strontium ranelate can accelerate fracture healing in a rat model, that strontium ranelate had a positive anabolic effect that contributed to fracture healing that produced the secondary disappearance of pain.
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UNLABELLED: Primary hyperparathyroidism (PHPT) causes hypercalciuria and stone disease in a subset of patients. Hypercalciuria typically normalizes after surgery, although the risk of stone formation may persist up to 10 years. There are few reports in the literature that show persistent hypercalciuria despite normalization of serum calcium after parathyroid surgery. We retrospectively analyzed 111 patients with PHPT from the osteoporosis, and stone clinics seen between 1999 and 2006. We selected only patients who had a complete metabolic profile that included 24-hour collections before and at least 3 months after parathyroidectomy. We excluded patients who had creatinine clearance <60 ml/min/1.73 m(2). Fifty-four patients were selected for further analysis, 46 with baseline hypercalciuria and 8 with normocalciuria. Changes in filtered load of calcium and fractional excretion of calcium were evaluated before and after parathyroid surgery. Total and ionized calcium and phosphorus normalized in all patients after surgery (24 ± 19 months); fractional excretion of calcium decreased, but did not normalize. Hypercalciuria persisted after surgery in 30.7% (n = 12/39) of the women and 50% (n = 4/8) of men. Of the patients in whom calciuria normalized after parathyroidectomy, 43.3% (n = 13/30) had kidney stones before surgery, whereas kidney stones were present in 87.5% (n = 14/16) in those in whom hypercalciuria persisted postsurgery. In hypercalciuric men and women before surgery in whom hypercalciuria persisted after surgery, fractional excretion of calcium was significantly higher than that in patients with normocalciuria. CONCLUSIONS: Persistently increased fractional excretion of calcium could explain the sustained increased risk of stone disease in patients with PHPT for many years after successful parathyroidectomy.
Assuntos
Hipercalciúria/etiologia , Hiperparatireoidismo Primário/urina , Cálculos Renais/etiologia , Idoso , Cálcio/sangue , Cálcio/urina , Creatinina/sangue , Creatinina/urina , Feminino , Humanos , Hipercalciúria/sangue , Hipercalciúria/complicações , Hiperparatireoidismo Primário/complicações , Hiperparatireoidismo Primário/cirurgia , Cálculos Renais/urina , Masculino , Pessoa de Meia-Idade , Hormônio Paratireóideo/sangue , Paratireoidectomia , Fósforo/sangue , Fósforo/urina , Período Pós-Operatório , Período Pré-Operatório , Estudos RetrospectivosRESUMO
It is known that several metabolic abnormalities that favor stone formation have a strong dependence on environmental and nutritional factors. The incidence and prevalence of kidney stone is increasing while there has been a parallel growth in the overweight/obesity rate, and epidemiologic studies have shown a significant association between overweight/obesity and increased nephrolithiasis risk. The aim of this study was to assess if metabolic abnormalities observed in stone patients differ in relation to their BMI. We evaluated 817 renal stone formers (459 men and 358 woman) in an outpatient setting. They were all studied with a standard protocol (two 24 h urine collections and serum parameters) and classified according to their BMI in normal, overweight and obese and according to age in <50 or >50 year old. In the whole population we found that 58.7% were either overweight or obese: 39.4% (n = 322) were OW and 19.3% (n = 158) were OB. The proportion of overweight was significantly higher among men than women. In women of all ages regardless of BMI, hypercalciuria was the most prevalent diagnosis. Hyperuricosuria increased its prevalence significantly only in overweight and obese women <50 years of age (p < 0.01). Hypercalciuria was the predominant diagnosis in normal weight men of both age groups. Hyperuricosuria was the most frequent abnormality in overweight and obese men followed by gouty diathesis and both increased their prevalence significantly from normal weight to obesity and in both age groups (p < 0.05 and <0.01). We conclude that the only abnormalities that increased their prevalence significantly with increasing BMI were hyperuricosuria and gouty diathesis, the first one in men of all ages and women under 50 years of age, while the second one only in men.
Assuntos
Índice de Massa Corporal , Cálculos Renais/etiologia , Adulto , Idoso , Peso Corporal , Feminino , Humanos , Concentração de Íons de Hidrogênio , Cálculos Renais/metabolismo , Masculino , Pessoa de Meia-Idade , Ácido Úrico/urinaRESUMO
Maternal and social behavior in multiparous Pelibuey ewes was assessed under intensive production system. The social behavior was recorded several days before and during birth. Mother-young behavior during the first hour after birth was recorded. A selective maternal test was performed at 2 hours postpartum. Eight hours after birth, a double choice test was done in mothers to asses their ability to discriminate between the own or alien lamb. While a similar double choice test was performed in 12 hours-old lambs. The agitation index when the ewes were tested without companions was lower in parturient ewes than in145 days pregnant ewes and non pregnant ewes [parturient ewes: (-0.59 ± 0.9), 145 days pregnant ewes: (2.6 ± 0.7) and non pregnant ewes (4.2 ± 0.9) P < 0.05]. During the first hour after birth the latency to stand up, to begin to look for the udder and to suck was shorter in male than female lambs, also the male lambs sucked for longer time than females (P < 0.05). During this time mothers emitted more high-pitched bleats than low-pitched bleats (P < 0.05). Besides, the ewes got shorter latencies to lick the area of head and thorax of the lamb than its tail, but they licked more frequently the lamb's tail and thorax (P < 0.03). Two hours postpartum all mothers were selective, they showed clear preference to accept to the udder their own lamb and reject actively the alien ones (P < 0.05). At eight or 12 hours, mothers and lambs spent longer time watching and staying with their own familiar animal than with the alien ones (P < 0.05). It is concluded that Pelibuey ewes show an adequate maternal temperament, and the behavior of the newborn lamb could be affected because of its sex.
Se evaluó el comportamiento materno en ovejas multíparas de raza Pelibuey en estabulación, así como la conducta social, antes y durante el parto. Se evaluó el comportamiento madre-cría durante la primera hora posparto y se realizó una prueba de selectividad a dos horas posparto. A las ocho horas se realizó una prueba de elección entre su cordero y uno ajeno. A las 12 h, a los corderos se les hizo una prueba de elección entre la madre propia y una ajena. El índice de agitación sin compañeras fue menor al parto que en ovejas a 145 días de gestación y en ovejas vacías [al parto: (-0.59 ± 0.9), con 145 días (2.6 ± 0.7) y a vacías (4.2 ± 0.9) P < 0.05]. En la primera hora posparto, los corderos machos se incorporaron, iniciaron la búsqueda de la ubre y se amantaron más rápido y por más tiempo que las hembras (P < 0.05). Las madres emitieron más balidos bajos que altos (P < 0.05); limpiaron más rápido a la cría en la cabeza y el tórax que en la cola (P < 0.05), pero limpiaron más veces la cola que el tórax (P < 0.03). A dos horas posparto, las madres fueron selectivas y rechazaron a la cría ajena (P < 0.05). A las ocho y 12 horas, tanto madres como corderos se miraron y permanecieron más tiempo con su co-familiar que con el ajeno (P < 0.05). Se concluyó que las ovejas de la raza Pelibuey muestran buena aptitud maternal, y que la conducta de la cría varía según su sexo.
RESUMO
In recent decades there has been an increasing prevalence of urolitithiasis in many western countries and at the same time there has been an increasing progression of obesity that has reached epidemic proportions. The aim of the present study was to assess the influence of overweight/obesity on the metabolic risk factors for renal stone formation. We studied 799 renal stone formers (462 men and 337 women) who came to the clinic for metabolic risk factors evaluation. They were all studied with a standard protocol (two 24-h urine collections and serum parameters). They were divided according to their BMI in normal (BMI < 25) overweight (BMI 25-29.9) and obese (BMI > 30). Low-weight individuals were excluded. Overall, 487 of 799 (60.9%) patients had a BMI > 25, including 40.6% overweight and 20.3% obese. Among women 55.2% had normal weight, 25.5 were overweight, and 19.3% were Obese; among men 27.3% had normal weight, 51.7 were overweight, and 21% were obese. Age increased significantly with increasing BMI both in men and women. In women there was a significant increase in the excretion of oxalate, uric acid, phosphorus, creatinine, and sodium with increasing BMI, but no change was observed in calcium, magnesium, citrate, and urine pH. In men there was a significant increase in the excretion of oxalate, uric acid, creatinine, phosphorus, sodium, magnesium, and citrate with increasing BMI, no change in urinary calcium and significant progressive decrease in urinary pH. In this population of stone formers there was a high prevalence of overweight/obesity (60.9%). Both in men and women we found a significant increase in the urinary excretion of two promoters of stone formation, oxalate, and uric acid but no change in urinary calcium. There was either no change or increase in magnesium and citrate, inhibitors of crystallization, and a significant decrease in urine pH only in men.