Influência da manutenção hemodinâmica do doador falecido na função renal do receptor de transplante renal / Influence of deceased donor hemodynamic factors in transplant recipients renal function

INTRODUÇÃO: A incidência de função tardia do enxerto (FTE) e função renal insatisfatória (FRI) após o transplante renal é significativamente maior no Brasil comparada com aquela observada nos Estados Unidos ou na Europa. Fatores relacionados ao doador falecido (DF) devem influenciar diretamente a ocorrência desses dois desfechos. OBJETIVO: Este estudo propõe-se a avaliar a influência das características do DF na incidência de FTE e FRI no Brasil. MÉTODOS: Variáveis clínicas e laboratoriais dos DF foram correlacionadas com a incidência de FTE e FRI. RESULTADOS: Foram avaliados 787 DF cujos órgãos foram transplantados em 1.298 pacientes. Notou-se elevada prevalência de uso de droga vasoativa (90,2%), hipernatremia (66,6%) e disfunção renal (34,8%). A incidência de FTE foi de 60,6% e de FRI foi de 55,2%. Considerando as características dos DF, observamos um aumento progressivo no risco de desenvolvimento de FTE para faixas etárias acima de 30 anos e a partir de tempo de isquemia fria (TIF) maior que 24 horas. O risco de FTE foi duas vezes maior em receptores de rim de doadores com creatinina sérica final (Cr) superior a 1,5 mg/dl. Hipertensão arterial (HA) e o TIF acima de 36 horas associou-se com aumentos de 82% e 99% no risco de FRI, respectivamente. A idade do doador acima de 40 anos associou-se com um aumento progressivo no risco de FRI. CONCLUSÃO: A idade, a função renal e a presença de hipertensão arterial no doador falecido, além do TIF prolongado, associaram-se com maior risco de FTE e FRI.

INTRODUCTION: The incidence of delayed graft function (DGF) and unsatisfactory creatinine clearance (UCC) after renal transplantation is significantly higher in Brazil, when compared with that observed in United States or Europe. Deceased donor (DD) characteristics should directly influence the occurrence of these two outcomes. OBJECTIVE: This study aim to evaluate the influence of DD characteristics on DGF and UCC incidence in Brazil. METHODS: DD clinical and laboratory variables were correlated with outcome's incidence. RESULTS: We evaluated 787 DD whose organs were transplanted in 1298 patients. We noted a high prevalence of vasoactive drugs use (90.2%), hypernatremia (66.6%) and renal dysfunction (34.8%). The incidence of DGF and UCC was 60.6% and 55.2%, respectively. We observed a progressive increase in DGF risk for age groups over 30 years and for cold ischemia time (CIT) greater than 24 hours. DGF risk was two times higher in recipients of donor kidney final serum creatinine (Cr) over than 1.5 mg/dl. Hypertension and CIT over 36 hours was associated with an increasing of 82% and 99% in UCC risk, respectively. Donor age above 40 years was associated with a progressive increase in UCC risk. CONCLUSION: DD age, renal function, hypertension and prolonged CIT were associated with increased risk DGF and UCC.

Toxicidade de produtos fitossanitários utilizados em citros para Apis mellifera / Toxicity of pesticides used in citrus crop to Apis mellifera

O objetivo deste trabalho foi avaliar a toxicidade de inseticidas/acaricidas utilizados em cultura de citros para operárias africanizadas de Apis mellifera Linnaeus. A exposição das abelhas aos compostos foi realizada usando-se técnicas de pulverização, contaminação da dieta e contato em superfícies tratadas (folhas de citros e placas de Petri), empregando-se asdoses máximas recomendadas para a cultura. Os bioensaios foram realizados em laboratório a 25±2°C, UR 70±10% efotofase de 12h, sendo os dados de mortalidade submetidos à análise estatística, e as médias comparadas por contraste, obtendo-se grupos de efeitos semelhantes. Independente do modo de exposição, o acefato foi extremamente tóxico, matando mais de 90,0% das abelhas 24h após a aplicação. Os produtos espirodiclofeno e piriproxifem, quando aplicados diretamente sobre as abelhas, causaram níveis de mortalidade de 11,0 e 15,0%, respectivamente; os compostos buprofezina, enxofre e tetradifona apresentaram níveis de mortalidade ainda menores, com média de 5,0% entre eles. Para os ensaios decontaminação de superfície (folhas de citros e placas de Petri) e contaminação de alimento, foram obtidos dois grupos de toxicidade, um grupo somente com acefato e outro, com buprofezina, enxofre, espirodiclofeno, piriproxifem, tetradifona e água. A mortalidade média para esse segundo grupo, após 96h do início da exposição, foi de 31,0; 8,3 e 15,7%, respectivamente, para cada método de contaminação.

The aim of this research was to evaluate the toxicity of several acaricides/insecticides used in Brazilian citrus crop to africanized workers of Apis mellifera Linnaeus. The expositionof honey bees to the chemicals was performed by direct spraying, contamination of food, and contact in treated surface (citrus leaves and Petri dishes), using recommended rates ofapplication. The assays were carried out at 25±2°C, RH 70±10%, 12h of photophase and the data was statisticallyanalyzed, with mean values of mortality being compared through cluster analysis. In all assays acephate was highly toxic, with mortality at 24 hours around 90.0%. When spirodiclofen and pyriproxyfen, was sprayed directly into the honeybees, they caused mortality levels of 11.0 and 15.0%, respectively; buprofezin, sulphur and tetradifon were less toxic, with mean mortality of 5.0% among these compounds. For the assays from contamination surface (citrus leaves and Petri dishes) and food, two groups of chemicals with the same toxiceffects were observed, one with acephate and other with buprofezin, sulphur, spirodiclofen, pyriproxyfen, tetradifon and water. The average mortality after 96 hours of exposition was 31.0; 8.3 and 15.7%, respectively, for each method of contamination.

Remodeling of hepatic vascular changes after specific chemotherapy of schistosomal periportal fibrosis

Hepatosplenic schistosomiasis was the first human disease in which the possibility of extensive long standing hepatic fibrosis being degraded and removed has been demonstrated. When such changes occurred, the main signs of portal hypertension (splenomegaly, esophageal varices) progressively disappeared, implying that a profound vascular remodeling was concomitantly occurring. Hepatic vascular alterations associated with advanced schistosomiasis have already been investigated. Obstruction of the intrahepatic portal vein branches, plus marked angiogenesis and compensatory hyperplasia and hypertrophy of the arterial tree are the main changes present. However, there are no data revealing how these vascular changes behave during the process of fibrosis regression. Here the mouse model of pipestem fibrosis was used in an investigation about these vascular alterations during the course of the infection, and also after treatment and cure of the disease. Animals representing the two polar hepatic forms of the infection were included: (1) "isolated granulomas" characterized by isolated periovular granulomas sparsely distributed throughout the hepatica parenchyma; and (2) 'pipestem fibrosis' with periovular granulomas and fibrosis being concentrated within portal spaces, before and after treatment, were studied by means of histological and vascular injection-corrosion techniques. Instances of widespread portal vein obstruction of several types were commonly found in the livers of the untreated animals. These obstructive lesions were soon repaired, and completely disappeared four months following specific treatment of schistosomiasis. Treatment was accomplished by the simultaneous administration of praziquantel and oxamniquine. The most impressive results were revealed by the technique of injection of colored masses into the portal system, followed by corrosion in strong acid. The vascular lesions of non-treated pipestem fibrosis were represented...

Angiogenesis and schistosomal granuloma formation

An increasing amount of evidences points to angiogenesis as playing a paramount role in fibrosis development. However, granulomas in general, and periovular schistosomal granulomas in particular, are considered avascular structures, although they usually result in dense areas of focal fibrosis. In order to clarify this apparent paradox, the presence of blood vessels was systematically searched in hepatic schistosomal granulomas of mice, during different stages of the infection, and at different stages of granuloma evolution, by means of vascular injections of colored masses, demonstration of laminin in vascular basement membranes and by ultra structural analysis. Vascular proliferation appeared evident at the early stages of granuloma formation, gradually decreasing thereafter, older granulomas becoming almost avascular structures, sometimes delimited at the periphery by a rich vascular network.

A contribution to the diagnosis of Capillaria hepatica infection by indirect immunofluorescence test

A highly specific pattern of immunofluorescence was noted when sera from Capillaria hepatica-infected rats were tested against the homologous worms and eggs present either in paraffin or cryostat sections from mouse liver. The pattern was represented by a combined apple green fluorescence of the internal contents of worms and eggs, which persisted in serum-dilutions of 1:400 up to 1:1600. Unequivocal fluorescent pattern was observed from 15 days up to 3 months following inoculation of rats with embryonated C. hepatica eggs and such result was confirmed by the ELISA. After the 4th month of infection, the indirect immunofluorescence test turned negative, probably revealing the extinction of parasitism, however the ELISA was contradictory, disclosing high levels of antibodies in this period . The IIF was also negative when control normal rat sera and sera from rats administered by gavage with immature C. hepatica eggs (spurious infection), or for reactions made against Schistosoma mansoni eggs, although a weakly positive pattern occurred with Fasciola hepatica eggs. The indirect immunofluorescence test may be recommended for use with human sera to detect early C. hepatica infection in special clinical instances and in epidemiological surveys, since it is a simple, inexpensive, and reliable test, presenting excellent sensitivity and specificity. Although the diagnosis is positive only during early infection, this is the period when the symptoms are usually more severe and the need for differential diagnosis is greater.