Multisensory effects of mask wearing on speech intelligibility and the benefit of multilingualism / Efeitos multissensoriais do uso de máscara na inteligibilidade da fala e o benefício do multilinguismo

ABSTRACT Purpose Due to the pandemic of the Covid-19 disease, it became common to wear masks on some public spaces. By covering mouth and nose, visual-related speech cues are greatly reduced, while the auditory signal is both distorted and attenuated. The present study aimed to analyze the multisensory effects of mask wearing on speech intelligibility and the differences in these effects between participants who spoke 1, 2 and 3 languages. Methods The study consisted of the presentation of sentences from the SPIN test to 40 participants. Participants were asked to report the perceived sentences. There were four conditions: auditory with mask; audiovisual with mask; auditory without mask; audiovisual without mask. Two sessions were conducted, one week apart, each with the same stimuli but with a different signal-to-noise ratio. Results Results demonstrated that the use of the mask decreased speech intelligibility, both due to a decrease in the quality of auditory stimuli and due to the loss of visual information. Signal-to-noise ratio largely affects speech intelligibility and higher ratios are needed in mask-wearing conditions to obtain any degree of intelligibility. Those who speak more than one language are less affected by mask wearing, as are younger listeners. Conclusion Wearing a facial mask reduces speech intelligibility, both due to visual and auditory factors. Older people and people who only speak one language are affected the most.

RESUMO Objetivo Devido à pandemia da doença Covid-19, o uso de máscaras em espaços públicos tornou-se comum. Ao cobrir a boca e o nariz, reduzem-se amplamente as pistas visuais associadas à fala, assim como se distorce e atenua o sinal auditivo. Este estudo teve como objetivo analisar os efeitos multissensoriais do uso da máscara na percepção da fala e a diferença entre participantes falantes de uma, duas ou três línguas. Método Este estudo consistiu na apresentação de frases do SPIN teste a 40 participantes. Os participantes tinham como tarefa reportar as frases percebidas em quatro condições: Auditiva com máscara, audiovisual com máscara, auditiva sem máscara, audiovisual sem máscara. Conduziram-se duas sessões, com uma semana de intervalo, cada uma com os mesmos estímulos mas com diferente relação sinal-ruído. Resultados Os resultados demonstraram que o uso de máscara reduz a inteligibilidade da fala, tanto devido à diminuição da qualidade do estímulo auditivo, como devido à perda de informação visual. A relação sinal-ruído afeta a inteligibilidade e com o uso de máscara são necessárias relações mais altas para obter qualquer identificação correta. Aqueles que falam mais do que uma língua, assim como os mais novos, são menos afetados na percepção de fala com uso de máscara. Conclusão O uso de máscara facial reduz a inteligibilidade da fala, tanto devido a fatores visuais como auditivos. Indivíduos monolíngues, assim como os mais velhos, são os mais afetados nesta tarefa.

Composición de las urolitiasis y trastornos metabólicos renales en adultos cubanos

Introducción: La litiasis urinaria es una enfermedad común, cuya prevalencia se incrementa a escala nacional y planetaria. Objetivos: Conocer la composición de las urolitiasis en pacientes adultos cubanos y su relación con los trastornos metabólicos renales. Métodos: Estudio descriptivo, transversal. Universo constituido por los pacientes cubanos de 19 años y más de edad, que se realizaron estudio de composición de urolitiasis en el Instituto de Nefrología "Dr. Abelardo Buch", de La Habana, Cuba, en el período comprendido de 2011-2020. De ellos 443 se habían realizado estudio metabólico renal. Los datos fueron recogidos de los informes de resultados, de composición de litiasis y de estudio metabólico. Se utilizó análisis de distribución de frecuencias, y para identificar las relaciones, el test independencia. Resultados: En cuanto a la composición química, predominaron las litiasis de oxalato de calcio. Los trastornos metabólicos más frecuentes fueron excreción de sodio aumentada (46,7 %) y volumen urinario bajo (29,3 %). La frecuencia de pacientes con litiasis cálcicas, fue superior en los que tuvieron excreción de sodio aumentada (78,3 %), y en los que presentaron hipercalciuria (83,3 %), en contraste con las frecuencias de este tipo de litiasis, en los que no presentaron dichos trastornos (p=0,03 en ambos casos). Conclusiones: Las urolitiasis más comunes en adultos cubanos son las cálcicas, especialmente las de oxalato de calcio. Los trastornos metabólicos más frecuentes son: excreción urinaria aumentada de sodio, volumen urinario bajo y pH urinario ácido. La presencia de litiasis cálcicas se relaciona con excreción urinaria aumentada de sodio y con hipercalciuria.

Introduction: Urinary lithiasis is a common disease, whose prevalence is increasing on a national and planetary scale. Objectives: To know the composition of urolithiasis in Cuban adult patients and its relationship with renal metabolic disorders. Methods: Descriptive, cross-sectional study. Universe constituted by Cuban patients aged 19 and over, who underwent a composition study of urolithiasis at the "Dr. Abelardo Buch" Institute of Nephrology, in Havana, Cuba, in the period 2011-2020. In 443 of them, a renal metabolic study had also been carried out. The data were collected from the results reports of stone composition and metabolic study. Frequency distribution analysis was used, and the independence test was used to identify relationships. Results: Regarding chemical composition, calcium oxalate stones predominated. The most frequent metabolic disorders were increased sodium excretion (46.7%) and low urine volume (29.3%). The frequency of patients with calcium stones was higher in those with increased sodium excretion (78.3%) and in those with hypercalciuria (83.3%), in contrast with the frequencies of this type of lithiasis, in those who did not present these disorders (p=0.03 in both cases). Conclusions: The most common urolithiasis in Cuban adults are calcium ones, especially those of calcium oxalate. The most common metabolic disorders are: increased urinary sodium excretion, low urinary volume and acid urinary pH. The presence of calcium lithiasis is related to increased urinary sodium excretion and hypercalciuria.

Presentation and outcomes of chronic kidney disease patients with COVID-19 / Apresentação e desfechos de pacientes com doença renal crônica com COVID-19

Abstract Introduction: COVID-19 is currently a global health issue and an important cause of mortality. Chronic kidney disease (CKD) is one of the risk factors for infection, morbidity and mortality by SARS-CoV-2. In our study, we aimed to evaluate the clinical presentation and outcomes of CKD patients with COVID-19, as well as identify predictors of mortality. Methods: This was a retrospective study of CKD patients admitted in a tertiary-care Portuguese hospital between March and August of 2020. Variables were submitted to univariate and multivariate analysis to determine factors predictive of in-hospital mortality. Results: 130 CKD patients were analyzed (median age 73.9 years, male 60.0%). Hypertension (81.5%), cardiovascular disease (36.2%), and diabetes (54.6%) were frequent conditions. Cough, dyspnea, fever and respiratory failure were also common. Almost 60% had anemia, 50% hypoalbuminemia, 13.8% hyperlactacidemia and 17% acidemia. Mean serum ferritin was 1531 µg/L, mean CRP 8.3 mg/dL and mean LDH 336.9 U/L. Most patients were treated with lopinavir/ritonavir, hydroxychloroquine or corticosteroids and only 2 with remdesivir. Eighty percent had acute kidney injury and 16.2% required intensive care unit admission. The 34 patients who died were older and more likely to have heart failure. They had higher neutrophils/lymphocytes ratio, ferritin, lactate, and LDH levels. Multivariate analysis identified an association between older age [OR 1.1 (CI 1.01-1.24), p=0.027], higher ferritin [OR 1.0 (CI 1.00-1.00), p=0.009] and higher LDH levels [OR 1.0 (CI 1.00-1.01), p=0.014] and mortality. Conclusion: In our cohort of CKD patients with COVID-19, older age, higher ferritin, and higher LDH levels were independent risk factors for mortality.

Resumo Introdução: COVID-19 é atualmente um problema de saúde global e uma causa importante de mortalidade. Doença renal crônica (DRC) é um dos fatores de risco para infecção, morbilidade e mortalidade por SARS-CoV-2. Neste estudo, objetivamos avaliar a apresentação clínica e os outcomes de doentes com DRC com COVID-19, bem como identificar preditores de mortalidade. Métodos: Estudo retrospetivo de doentes com DRC internados num hospital terciário português entre Março-Agosto/2020. As variáveis foram submetidas a análise univariada e multivariada para determinar fatores preditivos de mortalidade hospitalar. Resultados: analisámos 130 pacientes com DRC (média de idades 73,9 anos; 60,0% homens). Hipertensão (81,5%), doença cardiovascular (36,2%) e diabetes (54,6%) foram comorbilidades frequentes. Tosse, dispneia, febre e insuficiência respiratória também foram comuns. Quase 60% apresentavam anemia, 50% hipoalbuminemia e 13,8% hiperlactacidemia, 17% acidemia. A ferritina sérica média foi 1531 µg/L, PCR média 8,3 mg/dL, LDH médio 336,9 U/L. A maioria foi tratada com lopinavir/ritonavir, hidroxicloroquina ou corticosteroides e apenas 2 com remdesivir. Oitenta por cento tiveram lesão renal aguda; 16,2% necessitaram de internamento na unidade de cuidados intensivos. Os 34 pacientes que faleceram eram mais velhos e mais propensos a ter insuficiência cardíaca. Estes apresentaram razão neutrófilos/linfócitos e níveis de ferritina, lactato e LDH mais elevados. A análise multivariada identificou uma associação entre idade avançada [OR 1,1 (IC 1,01-1,24), p=0,027], níveis de ferritina [OR 1,0 (IC 1,00-1,00), p=0,009] e LDH mais elevados [OR 1,0 (IC 1,00-1,01), p=0,014] e mortalidade. Conclusão: Na nossa coorte de doentes com DRC com COVID-19, a idade avançada e níveis mais elevados de ferritina e LDH foram fatores de risco independentes para mortalidade.

The impact of transient and persistent acute kidney injury in hospital mortality in COVID-19 patients / O impacto da lesão renal aguda transitória e persistente na mortalidade hospitalar em pacientes com COVID-19

Abstract Introduction: Acute kidney injury (AKI) has been described in Coronavirus Disease 2019 (COVID-19) patients and is considered a marker of disease severity and a negative prognostic factor for survival. In this study, the authors aimed to study the impact of transient and persistent acute kidney injury (pAKI) on in-hospital mortality in COVID-19 patients. Methods: This was a retrospective observational study of patients hospitalized with COVID-19 in the Department of Medicine of the Centro Hospitalar Universitario Lisboa Norte, Lisbon, Portugal, between March 2020 and August 2020. A multivariate analysis was performed to predict AKI development and in-hospital mortality. Results: Of 544 patients with COVID-19, 330 developed AKI: 166 persistent AKI (pAKI), 164 with transient AKI. AKI patients were older, had more previous comorbidities, had higher need to be medicated with RAAS inhibitors, had higher baseline serum creatine (SCr) (1.60 mg/dL vs 0.87 mg/dL), higher NL ratio, and more severe acidemia on hospital admission, and more frequently required admission in intensive care unit, mechanical ventilation, and vasopressor use. Patients with persistent AKI had higher SCr level (1.71 mg/dL vs 1.25 mg/dL) on hospital admission. In-hospital mortality was 14.0% and it was higher in AKI patients (18.5% vs 7.0%). CKD and serum ferritin were independent predictors of AKI. AKI did not predict mortality, but pAKI was an independent predictor of mortality, as was age and lactate level. Conclusion: pAKI was independently associated with in-hospital mortality in COVID-19 patients but its impact on long-term follow-up remains to be determined.

Resumo Introdução: A lesão renal aguda (LRA) foi descrita em pacientes com doença do Coronavírus 2019 (COVID-19) e é considerada um marcador de gravidade da doença e fator prognóstico negativo para sobrevivência. Neste estudo, os autores visaram estudar o impacto da lesão renal aguda transitória e persistente (LRAp) na mortalidade hospitalar em pacientes com COVID-19. Métodos: Estudo observacional retrospectivo de pacientes internados com COVID-19 no Departamento de Medicina do Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal, entre Março-Agosto de 2020. Realizou-se análise multivariada para prever desenvolvimento de LRA e mortalidade hospitalar. Resultados: De 544 pacientes com COVID-19, 330 desenvolveram LRA: 166 LRA persistente (LRAp), 164, LRA transitória. Pacientes com LRA eram mais velhos, apresentaram mais comorbidades prévias, maior necessidade de serem medicados com inibidores do SRAA, apresentaram creatina sérica basal mais elevada (CrS) (1,60 mg/dL vs 0,87 mg/dL), maior razão NL, e acidemia mais grave na admissão hospitalar, e necessitaram mais frequentemente de internação na UTI, ventilação mecânica, e uso de vasopressores. Pacientes com LRA persistente apresentaram maior nível de CrS (1,71 mg/dL vs 1,25 mg/dL) na admissão hospitalar. A mortalidade hospitalar foi de 14,0% e foi maior em pacientes com LRA (18,5% vs 7,0%). A DRC e ferritina sérica foram preditores independentes de LRA. A LRA não previu mortalidade, mas a LRAp foi um preditor independente de mortalidade, assim como idade e nível de lactato. Conclusão: A LRAp foi associada independentemente à mortalidade hospitalar em pacientes com COVID-19, mas seu impacto no acompanhamento de longo prazo ainda precisa ser determinado.

Rituximab in glomerular diseases: a case series and narrative review / Rituximab em doenças glomerulares: uma série de casos e revisão narrativa

Abstract Introduction: The use of Rituximab (RTX) in glomerular diseases (GD) has increased in the past years, although it is still only used in a small fraction of patients. Methods: A single center retrospective study of adult patients with membranous nephropathy (MN), focal segmental glomerulosclerosis (FSGS), lupus nephritis (LN), and vasculitis treated with RTX as first or second-line therapy was conducted at our center from 2010 to 2020. Results: We identified 19 patients; 36.8% had MN and 25.0% each had FSGS, LN, and vasculitis. RTX was first-line therapy in 26.3% of patients and in 73.7% it was second-line therapy. Mean follow-up time was 7.7 ± 7.2 years. In MN, 2 patients (28.6%) had complete remission (CR), 2 patients (28.6%) had partial remission (PR), and 3 patients (42.9%) had no response (NR). In FSGS, 2 patients (50.0%) presented CR, 1 patient (25.0%) had no response, and 1 patient had renal deterioration. Two patients (50.0%) had a LN class IV with a CR after RTX, 1 patient with LN class IIIC/V had no response, and 1 patient with LN class II had renal deterioration. In vasculitis, 3 patients (75.0%) presented CR and 1 patient had PR. Infusion reactions were present in 2 patients (10.5%) and one patient had multiple infectious complications. Conclusions: The efficacy of RTX in treating different types of immune-mediated GD has been demonstrated with different response rates, but an overall safe profile. In our case series, the results are also encouraging. Longitudinal studies are needed to better understand the effect of RTX in GD.

Resumo Introdução: O uso de Rituximab (RTX) em doenças glomerulares (DG) aumentou nos últimos anos, embora ainda utilizado apenas em uma pequena fração de pacientes. Métodos: Conduzimos em nosso centro, de 2010-2020, um estudo retrospectivo de único centro de pacientes adultos com nefropatia membranosa (NM), glomeruloesclerose segmentar focal (GESF), nefrite lúpica (NL) e vasculite tratada com RTX como terapia de primeira ou segunda linha. Resultados: Identificamos 19 pacientes; 36,8% tinham NM; 25,0% cada apresentava GESF, NL e vasculite. RTX foi terapia de primeira linha em 26,3% dos pacientes e em 73,7% foi terapia de segunda linha. O tempo médio de acompanhamento foi 7,7 ± 7,2 anos. Em NM, 2 pacientes (28,6%) tiveram remissão completa (RC), 2 pacientes (28,6%) remissão parcial (RP), e 3 pacientes (42,9%) não tiveram resposta (NR). Na GESF, 2 pacientes (50,0%) apresentaram RC, 1 paciente (25,0%) não teve resposta e, 1 paciente, deterioração renal. Dois pacientes (50,0%) apresentaram NL classe IV com RC após RTX, 1 paciente com NL classe IIIC/V não teve resposta, e 1 paciente com NL classe II apresentou deterioração renal. Na vasculite, 3 pacientes (75,0%) apresentaram RC e 1 paciente RP. Reações à infusão ocorreram em 2 pacientes (10,5%) e um paciente apresentou múltiplas complicações infecciosas. Conclusões: A eficácia do RTX em tratar diferentes tipos de DG imunomediada tem sido demonstrada com diferentes taxas de resposta, mas com perfil geral seguro. Em nossa série de casos, os resultados também são encorajadores. Estudos longitudinais são necessários para compreender melhor o efeito do RTX na DG.

Uremic lion face syndrome / Face Leonina na Síndrome Urêmica

Abstract Mineral bone disorder is a common feature of chronic kidney disease. Lion face syndrome is rare complication of severe hyperparathyroidism in end-stage renal disease patients, which has been less commonly reported due to dialysis and medical treatment advances in the last decade. The early recognition of the characteristic facial deformity is crucial to prompt management and prevent severe disfigurement. The authors present a rare case of severe hyperparathyroidism presenting with lion face syndrome and bone fractures.

Resumo O distúrbio mineral e ósseo é uma característica comum da doença renal crônica. A síndrome da face leonina é uma complicação rara do hiperparatireoidismo grave em pacientes com doença renal terminal, que tem sido menos relatada devido aos avanços na diálise e tratamento médico na última década. O reconhecimento precoce da deformidade facial característica é crucial para estimular o tratamento precoce e prevenir a desfiguração severa. Os autores apresentam um caso raro de hiperparatireoidismo grave, apresentando síndrome da face leonina e fraturas ósseas.

Fracción de excreción de magnesio y estado del túbulo-intersticio en pacientes nefróticos / Fractional excretion of magnesium and status of tubulointerstitium in nephrotic patients

INTRODUCCIÓN: la fracción de excreción de los electrólitos puede constituir un marcador temprano de daño renal en las glomerulopatías. OBJETIVO: identificar la posible relación existente entre variables clínicas, fracción de excreción de magnesio y estado del túbulo-intersticio, en pacientes con proteinuria nefrótica a los que se les realizó biopsia renal en el Instituto de Nefrología entre abril de 2012 y junio de 2013. MÉTODOS: se realizó un estudio observacional analítico, transversal, en el que se excluyeron los pacientes con factores que modificaran la fracción de excreción de magnesio. A los 40 pacientes incluidos en el estudio se les recogieron datos antropométricos, demográficos y clínicos, se les midió la fracción de excreción de magnesio, se les practicó biopsia renal y se les cuantificó el porcentaje de fibrosis con el programa Image J. La información fue procesada mediante el paquete estadístico SPSS 15.0. Se utilizó la técnica estadística de análisis de distribución de frecuencias, en las variables cuantitativas se calcularon estadígrafos descriptivos. Fueron empleados los tests de Wilcoxon, de Kruskal Wallis y el coeficiente de correlación de Spearman's-rho, en las pruebas de hipótesis. RESULTADOS: se encontró correlación estadísticamente significativa de la fibrosis intersticial con la fracción de excreción de magnesio (rsp= 0,37, p= 0,02) y con la tasa de filtración glomerular (rsp= -0,56, p= 0,00). No fue encontrada asociación de la fracción de excreción de magnesio con el empleo de medicamentos, ni con el antecedente de hipertensión arterial. CONCLUSIÓN: la fibrosis intersticial se relaciona con la fracción de excreción de magnesio y con la tasa de filtración glomerular en pacientes con proteinuria nefrótica.

INTRODUCTION: fractional excretion of electrolytes can be used as an early marker of renal damage in glomerulopathies. OBJECTIVE: to identify the possible relationship between some clinical variables, the fractional excretion of magnesium and the tubulointerstitial status in patients with nephrotic proteinuria assisted at The National Institute of Nephrology from April 2012 to June 2013. METHODS: an observational analytical study was conducted. Patients with conditions that modify the fractional excretion of magnesium were excluded. 40 patients were included in this study at the Institute of Nephrology from April 2012 until June 2013, and their demographic, anthropometric and clinical data were collected; the fractional excretion of magnesium was measured as well. Renal biopsies were practiced to all patients and the percent of fibrosis was measured with the aid of image J program. Data were processed with Statistical package for Social Science (SPSS) version 15.0. The statistical technique of frequency distribution analysis was used; quantitative variables descriptive statistics were calculated. Wilcoxon tests, Kruskal Wallis and correlation coefficient Spearman's- rho were used in hypothesis tests. RESULTS: the percent of interstitial fibrosis was related to fractional excretion of magnesium (rsp= 0,37, p= 0,02) and glomerular filtration rate (rsp= -0,56, p= 0,00). No association of the fractional excretion of magnesium with the use of drugs or with history of hypertension was found. CONCLUSIONS: tubulointerstitial fibrosis is related to the fractional excretion of magnesium and glomerular filtration rate in patients with nephrotic proteinuria.