RESUMO

RESUMEN La ataxia espinocerebelosa tipo 2 (SCA2) es una enfermedad neurodegenerativa hereditaria autosómica dominante, causada por una expansión anormal del trinucleótido CAG en el gen ATXN2. La SCA2 se presenta habitualmente en la edad adulta, con ataxia progresiva asociada a neuropatía periférica, alteración de movimientos oculares, parkinsonismo, entre otros síntomas. Exámenes auxiliares aplicables incluyen pruebas bioquímicas, neuroimágenes, como resonancia magnética cerebral, y estudio genético molecular. Describimos, por primera vez en la población peruana, el caso de una mujer de mediana edad con diagnóstico confirmado de SCA2, cuya resonancia magnética cerebral muestra el signo de la cruz (o hot cross bun sign).

ABSTRACT Spinocerebellar ataxia type 2 (SCA2) is an autosomal dominant inherited neurodegenerative disease, caused by an abnormal CAG trinucleotide expansion in the ATXN2 gene. SCA2 usually occurs in adulthood, with progressive ataxia associated with peripheral neuropathy, impaired eye movements, parkinsonism, and other symptoms. Auxiliary exams include biochemical tests, neuroimaging such as brain MRI, and a molecular genetic study. We describe, for the first time in the Peruvian population, the case of a middle-aged woman with a confirmed diagnosis of SCA2, whose brain MRI shows the "Hot Cross Bun Sign".

RESUMO

INTRODUCTION: In hospitalized patients with acute renal injury (AKI), acute tubulointerstitial nephritis (AIN) constitutes one of the leading etiologies. The objective of this study was to identify clinical and biochemical variables in patients with AKI associated with kidney biopsy-confirmed AIN. METHODS: For our prospective study, we recruited hospitalized patients aged 18 years and older who were diagnosed with AKI based on biochemical criteria. Prior to enrollment, each patient was assessed with a complete metabolic panel and a kidney biopsy. RESULTS: The study consisted of 42 patients (with a mean age of 45 years) and equal numbers of male and female patients. Diabetes and hypertension were the main comorbidities. Nineteen patients had histological findings consistent with AIN. There was a correlation between histology and the BUN/creatinine ratio (BCR) (r = -0.57, p = 0.001). The optimal Youden point for classifying AIN via a receiver operating characteristic (ROC) curve analysis was a BCR ≤ 12 (AUC = 0.73, p = 0.024). Additionally, in diagnosing AIN, BCR had a sensitivity of 76%, a specificity of 81%, a positive predictive value of 81%, a negative predictive value of 76%, and OR of 14 (95% CI = 2.6 to 75.7, p = 0.021). In the multivariable analysis, BCR was the sole variable associated with AIN. CONCLUSION: A BCR ≤ 12 identifies AIN in patients with AKI. This study is the first to prospectively assess the relationship between renal biopsy results and BCR.

Assuntos

RESUMO

Resumo Fundamento Em pacientes com insuficiência cardíaca (IC), devido à relativa deficiência do volume sanguíneo, a ativação do sistema neuro-hormonal leva à vasoconstrição renal, que afeta o teor de nitrogênio ureico (NU) e creatinina (C) no organismo, sendo que NU e C são facilmente afetados por outros fatores. Portanto, a razão NU/C pode ser utilizada como mais um marcador para o prognóstico da IC. Objetivo Explorar o prognóstico do desfecho adverso da IC no grupo NU/C alta em comparação com o grupo NU/C baixa em todo o espectro da fração de ejeção. Métodos De 2014 a 2016, pacientes sintomáticos hospitalizados com IC foram recrutados e acompanhados para observar desfechos cardiovasculares adversos. Foram realizadas análise logística e a análise COX para determinar a significância. Valores de p<0,05 foram considerados estatisticamente significativos. Resultados Na análise de regressão logística univariada, o grupo NU/C alta apresentou maior risco de desfecho adverso na insuficiência cardíaca com fração de ejeção reduzida (ICFEr) e insuficiência cardíaca com fração de ejeção preservada (ICFEp). A análise de regressão logística multivariada mostrou que o risco de morte cardíaca no grupo ICFEr foi maior do que no grupo NU/C baixa, enquanto o risco de morte por todas as causas foi significativo apenas em 3 meses (p<0,05) (Ilustração Central). O risco de morte por todas as causas no grupo NU/C alta no grupo ICFEP foi significativamente maior do que no grupo NU/C baixa em dois anos. Conclusão O grupo NU/C alta está relacionado ao risco de mau prognóstico da ICFEP, não sendo inferior ao valor preditivo da fração de ejeção do ventrículo esquerdo (FEVE).

Abstract Background In patients with heart failure (HF), due to the relative deficiency of blood volume, neurohormone system activation leads to renal vasoconstriction, which affects the content of blood urea nitrogen (BUN) and creatinine (Cr) in the body, while BUN and Cr are easily affected by other factors. Therefore, BUN/Cr can be used as another marker for the prognosis of HF. Objective Explore the prognosis of adverse outcome of HF in the high BUN/Cr group compared with the low BUN/Cr group across the full spectrum of ejection fraction. Methods From 2014 to 2016, symptomatic hospitalized HF patients were recruited and followed up to observe adverse cardiovascular outcomes. Logistic analysis and COX analysis were performed to determine significance. p-values <0.05 were considered statistically significant. Results In the univariate logistic regression analysis, the high BUN/Cr group had a higher risk of adverse outcome in heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF). Multivariate logistic regression analysis showed that the risk of cardiac death in the HFrEF group was higher than that in the low BUN/Cr group, while the risk of all-cause death was significant only in 3 months (p<0.05) (Central Illustration). The risk of all-cause death in the high BUN/Cr in the HFpEF group was significantly higher than that in the low BUN/Cr group at two years. Conclusion The high BUN/Cr group is related to the risk of poor prognosis of HFpEF, and is not lower than the predictive value of left ventricular ejection fraction (LVEF).

RESUMO

RESUMEN Se decidió estudiar el efecto que la cocción y el congelamiento sucesivos tiene sobre contenido de almidones y el índice glicémico (IG) de un alimento a base de harina de maíz (bollo). Se elaboró el alimento y se sometió congelamiento y cocción un par de veces. El contenido de almidones se comparó con el de la harina de maíz pre-cocida y se encontraron diferencias significativas (F = 5,84; p = 0,005), con un incremento importante del contenido de almidón resistente debido a los tratamientos térmicos. Se elaboraron curvas de glicemia a una muestra de individuos sanos, a los que se dio a consumir el alimento sometido a los diferentes tratamientos y pan integral. Se encontraron diferencias significativas (F= 4,21; p= 0,034) y un IG de 67,9 para el bollo sometido a tres procesos de cocción y dos congelamientos. Indicativo de que los procesos térmicos provocaron la aparición de una proporción de almidón retrogradado equivalente a fibra dietética que puede ser beneficioso para el organismo.

ABSTRACT We studied the effect that subsequent cooking and freezing has on the starch content and the glycemic index (GI) of a corn flour-based food (bun). The food was made and exposed to cooking and freezing a couple of times. The starch content was compared with that of precooked corn flour and significant differences were found (F = 5.84; p = 0.005), with an important increase in the retrograded starch content due to thermic treatments. Glycemic response curves were conducted for a sample of healthy individuals, who consumed the food submitted to the treatments and wholegrain bread. Significant differences were found (F = 4.21; p= 0.034) and a GI of 67.9 for the bun submitted to three cooking and two freezing processes. Results suggest that the thermic treatments induced the appearance of a retrograded starch proportion equivalent to dietary fiber which could be beneficial for the body.

Assuntos

RESUMO

Identifying those children with complicated forms of diarrhea-associated hemolytic uremic syndrome (D+HUS) on admission can optimize their management. Recently, the blood urea nitrogen to serum creatinine ratio (BCR) at admission has been proposed as a novel and accurate predictor of complicated clinical outcome in D+HUS; therefore, we performed this retrospective study aimed to validate such observation in a larger series of patients. A complicated course was defined as developing one or more of the following: severe neurological or bowel injury, pancreatitis, cardiac or pulmonary involvement, hemodynamic instability, hemorrhage, and death. Data from 161 children were reviewed, 50 of them with a complicated disease including five deaths. Those with worse evolution presented a lower admission BCR than those with good outcome (22.5 vs. 30.8; p = 0.005). BCR at admission showed a limited ability to identify children at risk of a complicated course, with an AUC of 0.63 (95% CI 0.58-0.71) and an optimal cutoff point of ≤ 26.7, which achieves a sensitivity of 70% (95% CI 55.2-81.7) and a specificity of 56.7% (95% CI 47-66). CONCLUSION: In this validation study, the BCR at admission provided a limited value to predict severe forms of D+HUS. What is Known: • BCR at admission has been proposed as an accurate predictor of complicated clinical course in children with D+HUS. What is New: • In a larger series of children with D+HUS, we were unable to confirm the usefulness of the admission BCR to early identify those at risk of complicated forms of the disease. • Further research is warranted to improve the optimal detection of these high-risk patients.

Assuntos

RESUMO

BACKGROUND: Chronic kidney disease is common among sugarcane workers in Central America. The main risk factor seems to be repeated high-intensity work in hot environments. Several cross-sectional studies have been performed but few longitudinal studies. OBJECTIVES: The aim of the study was to examine whether kidney function changes over a few months of work during the harvest period. METHODS: A group of male sugarcane cutters in Nicaragua (N=29, aged 17-38 years) was examined with renal biomarkers before and after shift on the first day at the start of harvest, on the sixth day during acclimatization, and then in mid-harvest 9 weeks later. A reference group (N=25, mainly office workers) was examined with the same biomarkers at start of harvest, and then at end of harvest 5 months later. RESULTS: The pre-shift renal function decreased significantly during 9 weeks of work in the cane cutters. Mean serum creatinine increased (20%), mean estimated glomerular filtration rate decreased (9%, 10mL/min), serum urea N (BUN) increased (41%), and mean urinary neutrophil gelatinase-associated lipocalin (NGAL) increased (four times). The cane cutters also developed cross-shift increases in these biomarkers, in particular serum creatinine and BUN, and in urinary uric acid. The longitudinal decrease in eGFR tended to be associated with the cross-shift increase in serum creatinine. CONCLUSIONS: There was a remarkable decrease of glomerular kidney function, after only 9 weeks of harvest. The cross-shift increase in serum creatinine may be caused by dehydration (pre-renal dysfunction), and when repeated on a daily basis this may cause permanently reduced GFR.

Assuntos

RESUMO

OBJECTIVE: To compare the effect of 2.5 vs 4 g/kg/d of amino acid (AA) in parenteral nutrition of extremely low birth weight infants on metabolic tolerance, short-term growth, and neurodevelopment. STUDY DESIGN: One hundred thirty-one infants with birth weight between 500 and 1249 g were randomized to 2.5 (standard AA [SAA] group) or 4 (high AA [HAA] group) g/kg/d AA intake, with equal nonprotein energy. The primary outcome was body size at 36 weeks. RESULTS: One hundred thirty-one patients were randomized and 114 analyzed (58 SAA group and 56 HAA group). Study groups had similar demographics and clinical characteristics. Elevated blood urea (BU >70 mg/dL = BU nitrogen >32.6 mg/dL) occurred in 24% vs 59% (P = .000) and hyperglycemia (>175 mg/dL) in 34% vs 11% (P = .003) of the SAA and HAA patients, respectively. Body weight, length, and head circumference at 36 weeks and 2 years were similar between groups. Bayley Scales of Infant and Toddler Development, Third Edition score was 94 ± 13 in the SAA group and 97 ± 15 in the HAA group (P = .35). CONCLUSIONS: The HAA group had higher BU levels and better glucose control. An extra 8 g/kg of AA over the first 10 days of life did not improve growth and neurodevelopment.

Assuntos

RESUMO

OBJECTIVES: Fortification of breast milk is an accepted practice for feeding very low birth weight infants, however, fixed dosage enhancement does not address variations in native breast milk. This could lead to deficiencies in calories and macronutrients. We therefore established the infrastructure for target fortification in breast milk by measuring and adjusting fat, protein, and carbohydrate content daily. We analyzed nutrient intake, growth, and safety variables. STUDY DESIGN: Each 12-hour batch of breast milk was analyzed using near-infrared spectroscopy. Macronutrients were individually added to routine fortification to achieve final contents for fat (4.4 g), protein (3 g), and carbohydrates (8.8 g) (per 100 mL). Fully breast milk fed healthy very low birth weight infants (<32 weeks) were fed the fortified breast milk for at least 3 weeks. Matched pair analysis of 20 infants fed routinely fortified breast milk was performed using birth weight, gestational age, and postnatal age. RESULTS: All 650 pooled breast milk samples required at least 1 macronutrient adjusted. On average, 0.3 ± 0.4 g of fat, 0.7 ± 0.2 g of protein, and 1.2 ± 0.2 g of carbohydrate were added. Biochemistry was normal in the 10 target fortified infants (birth weight: 860 ± 309 g, 26.3 ± 1.6 weeks gestational age); weight gain was 19.9 ± 2.7 g/kg/d; and milk intake was 147 ± 5 mL/kg/d (131 ± 16 kcal/kg/d). Osmolality of fortified breast milk was 436 ± 13 mOsmol/kg. Matched pair analysis of infants indicated a higher milk intake (155 ± 5 mL/kg/d) but similar weight gain (19.7 ± 3.3 g/kg/d). No adverse event was observed. The linear relationship between milk intake and weight gain observed in study babies but not seen in matched controls may be related to the variable composition of breast milk. CONCLUSIONS: Daily target fortification can be safely implemented in clinical routine and may improve growth.

Assuntos

Assuntos

RESUMO

Foram testadas 120 amostras séricas de cães com títulos (³100) perante Icterohaemorrhagiae para a determinação dos níveis séricos de uréia e de creatinina. Os animais com títulos ³800 apresentaram dosagens de uréia bastante superiores aos valores de referência e os com títulos ³200 e £400 apresentaram valores de uréia significativamente menores (P<0,05) do que os anteriores, porém ainda acima dos valores de referência. As amostras com títulos menores que 200 apresentaram dosagens de uréia significativamente menores (P<0,05) do que os observados nos outros grupos e dentro dos valores de referência. No que se refere à dosagem de creatinina sérica, verificou-se que apenas os animais com títulos ³800 apresentaram dosagens acima do padrão normal. Observou-se uma clara correlação entre dano renal e a sororreatividade específica para leptospirose.

One hundred and twenty serum samples from dogs with specific titres (³100) against Leptospira sp. serovar Icterohaemorrhagiae for the dosage of blood urea nitrogen (BUN) and creatinine levels were tested. Animals presenting titres ³800 showed BUN levels higher than reference values while samples with titres ³200 and £400 presented BUN levels significantly lower (P<0.05) than the others, but still higher than the reference values. Samples presenting titres lower than 200 showed BUN dosages according to the reference values. In relation to creatinine dosage, only samples presenting titres ³800 showed dosages higher than the reference values. A correlation between renal damage and specific seroreactivity for leptospirosis was demonstrated.

Assuntos

RESUMO

Foram testadas 120 amostras séricas de cães com títulos (³100) perante Icterohaemorrhagiae para a determinação dos níveis séricos de uréia e de creatinina. Os animais com títulos ³800 apresentaram dosagens de uréia bastante superiores aos valores de referência e os com títulos ³200 e £400 apresentaram valores de uréia significativamente menores (P<0,05) do que os anteriores, porém ainda acima dos valores de referência. As amostras com títulos menores que 200 apresentaram dosagens de uréia significativamente menores (P<0,05) do que os observados nos outros grupos e dentro dos valores de referência. No que se refere à dosagem de creatinina sérica, verificou-se que apenas os animais com títulos ³800 apresentaram dosagens acima do padrão normal. Observou-se uma clara correlação entre dano renal e a sororreatividade específica para leptospirose.(AU)

One hundred and twenty serum samples from dogs with specific titres (³100) against Leptospira sp. serovar Icterohaemorrhagiae for the dosage of blood urea nitrogen (BUN) and creatinine levels were tested. Animals presenting titres ³800 showed BUN levels higher than reference values while samples with titres ³200 and £400 presented BUN levels significantly lower (P<0.05) than the others, but still higher than the reference values. Samples presenting titres lower than 200 showed BUN dosages according to the reference values. In relation to creatinine dosage, only samples presenting titres ³800 showed dosages higher than the reference values. A correlation between renal damage and specific seroreactivity for leptospirosis was demonstrated.(AU)

Assuntos

RESUMO

As aflatoxinas, embora principalmente hepatotóxicas, já foram descritas como nefrotóxicas em várias espécies animais. Neste trabalho, a patologia clínica veterinária foi utilizada para avaliar as alterações renais na aflatoxicose experimental em cães. Utilizaram-se quatro grupos de 5 cães, com colheitas diárias de sangue e urina, durante 12 dias consecutivos; nos quais realizaram-se dosagens séricas de uréia, creatinina e proteína total, e urinálise. O experimento foi dividido em três períodos, sendo o período 0 (dias l a 3) referente a colheita de dados para controle, período 1 (dias 4 a 8) considerando o tempo de administração da toxina e período 2 (dias 9 a 12) ao tempo após a intoxicação. As doses de aflatoxina usada foram de 100, 200, 400, e 600mg/kg/dia, respectivamente para os grupos I, II, III, IV, por via oral, misturada ao alimento, pelo período de cinco dias. As taxas de uréia e creatinina variaram dentro do intervalo normal dos valores de referência da literatura consultada. A proteína total e a densidade urinária estiveram próximas ou acima dos valores máximos de referência devido a hemoconcentração. A análise estatística evidenciou uma diminuição progressiva nos valores de uréia, creatinina e densidade urinária, com relação ao aumento da dose usada em cada grupo. Este fato foi atribuído à maior ingestão de água. Através dos resultados obtidos, concluiu-se que as doses aplicadas não foram suficientes para detectar lesão renal.

Aflatoxins, although primary hepatotoxic agents, were injurious to kidney in several animal species. Veterinary clinical pathology was used to determine renal changes in canine experimental aflatoxicosis. Four groups of five dogs were used. Blood and urine samples were coilected for the twelve following days. BUN, creatinine, total serun protein and urinalysis were done. The experiment was divided in three periods: period 0 (days 1 to 3) refered to the control data, period 1 (days 4 to 8) to the aflatoxin administration days, and period 2 (days 9 to 12) the days after the poisoning. 100, 200, 400 and 600mg/kg/day of aflatoxin for the I, II, III and IV groups respectively, by oral pathway, mixed to the food, were used for five days. BUN and creatinine were within the normal ranges. Total serun protein and urine specific gravity were near or above upper limits due to hemoconcentration. Statistics showed a diminution of BUN, creatinine and urine specific gravity values according to the increased af latoxin doses applied in each group. This was attributed to an increase of water intake. According to the results of this investigation, the conclusion is that the doses used were not sufficient to determine renal damage.

RESUMO

Aflatoxins, although primary hepatotoxic agents, were injurious to kidney in several animal species. Veterinary clinical pathology was used to determine renal changes in canine experimental aflatoxicosis. Four groups of five dogs were used. Blood and urine samples were coilected for the twelve following days. BUN, creatinine, total serun protein and urinalysis were done. The experiment was divided in three periods: period 0 (days 1 to 3) refered to the control data, period 1 (days 4 to 8) to the aflatoxin administration days, and period 2 (days 9 to 12) the days after the poisoning. 100, 200, 400 and 600mg/kg/day of aflatoxin for the I, II, III and IV groups respectively, by oral pathway, mixed to the food, were used for five days. BUN and creatinine were within the normal ranges. Total serun protein and urine specific gravity were near or above upper limits due to hemoconcentration. Statistics showed a diminution of BUN, creatinine and urine specific gravity values according to the increased af latoxin doses applied in each group. This was attributed to an increase of water intake. According to the results of this investigation, the conclusion is that the doses used were not sufficient to determine renal damage.

As aflatoxinas, embora principalmente hepatotóxicas, já foram descritas como nefrotóxicas em várias espécies animais. Neste trabalho, a patologia clínica veterinária foi utilizada para avaliar as alterações renais na aflatoxicose experimental em cães. Utilizaram-se quatro grupos de 5 cães, com colheitas diárias de sangue e urina, durante 12 dias consecutivos; nos quais realizaram-se dosagens séricas de uréia, creatinina e proteína total, e urinálise. O experimento foi dividido em três períodos, sendo o período 0 (dias l a 3) referente a colheita de dados para controle, período 1 (dias 4 a 8) considerando o tempo de administração da toxina e período 2 (dias 9 a 12) ao tempo após a intoxicação. As doses de aflatoxina usada foram de 100, 200, 400, e 600mg/kg/dia, respectivamente para os grupos I, II, III, IV, por via oral, misturada ao alimento, pelo período de cinco dias. As taxas de uréia e creatinina variaram dentro do intervalo normal dos valores de referência da literatura consultada. A proteína total e a densidade urinária estiveram próximas ou acima dos valores máximos de referência devido a hemoconcentração. A análise estatística evidenciou uma diminuição progressiva nos valores de uréia, creatinina e densidade urinária, com relação ao aumento da dose usada em cada grupo. Este fato foi atribuído à maior ingestão de água. Através dos resultados obtidos, concluiu-se que as doses aplicadas não foram suficientes para detectar lesão renal.

RESUMO

Aflatoxins, although primary hepatotoxic agents, were injurious to kidney in several animal species. Veterinary clinical pathology was used to determine renal changes in canine experimental aflatoxicosis. Four groups of five dogs were used. Blood and urine samples were coilected for the twelve following days. BUN, creatinine, total serun protein and urinalysis were done. The experiment was divided in three periods: period 0 (days 1 to 3) refered to the control data, period 1 (days 4 to 8) to the aflatoxin administration days, and period 2 (days 9 to 12) the days after the poisoning. 100, 200, 400 and 600mg/kg/day of aflatoxin for the I, II, III and IV groups respectively, by oral pathway, mixed to the food, were used for five days. BUN and creatinine were within the normal ranges. Total serun protein and urine specific gravity were near or above upper limits due to hemoconcentration. Statistics showed a diminution of BUN, creatinine and urine specific gravity values according to the increased af latoxin doses applied in each group. This was attributed to an increase of water intake. According to the results of this investigation, the conclusion is that the doses used were not sufficient to determine renal damage.

As aflatoxinas, embora principalmente hepatotóxicas, já foram descritas como nefrotóxicas em várias espécies animais. Neste trabalho, a patologia clínica veterinária foi utilizada para avaliar as alterações renais na aflatoxicose experimental em cães. Utilizaram-se quatro grupos de 5 cães, com colheitas diárias de sangue e urina, durante 12 dias consecutivos; nos quais realizaram-se dosagens séricas de uréia, creatinina e proteína total, e urinálise. O experimento foi dividido em três períodos, sendo o período 0 (dias l a 3) referente a colheita de dados para controle, período 1 (dias 4 a 8) considerando o tempo de administração da toxina e período 2 (dias 9 a 12) ao tempo após a intoxicação. As doses de aflatoxina usada foram de 100, 200, 400, e 600mg/kg/dia, respectivamente para os grupos I, II, III, IV, por via oral, misturada ao alimento, pelo período de cinco dias. As taxas de uréia e creatinina variaram dentro do intervalo normal dos valores de referência da literatura consultada. A proteína total e a densidade urinária estiveram próximas ou acima dos valores máximos de referência devido a hemoconcentração. A análise estatística evidenciou uma diminuição progressiva nos valores de uréia, creatinina e densidade urinária, com relação ao aumento da dose usada em cada grupo. Este fato foi atribuído à maior ingestão de água. Através dos resultados obtidos, concluiu-se que as doses aplicadas não foram suficientes para detectar lesão renal.