Alteraciones del estado ácido básico en pacientes adultos con insuficiencia renal crónica / Acid-base status alterations in adult patients with chronic renal failure

RESUMEN Introducción: el portador de insuficiencia renal crónica puede presentar diversas alteraciones del estado ácido básico, siendo la acidosis metabólica la más frecuente. Objetivos: describir las características demográficas y clínicas y las alteraciones del estado ácido básico de pacientes adultos que ingresan con insuficiencia renal crónica en dos centros hospitalarios del Paraguay. Metodología: se aplicó un diseño observacional, descriptivo, transversal. Se incluyó a sujetos adultos de ambos sexos, portadores de insuficiencia renal crónica, que acudieron al Hospital Nacional (Itauguá) y Hospital Militar (Asunción) entre abril y noviembre del 2021. Se midieron variables antropométricas, clínicas y laboratoriales al ingreso. Los datos se sometieron a estadística descriptiva con el programa Epi Info 7™. El estudio contó con la aprobación del Comité de Ética de la Universidad Privada del Este, Paraguay. Resultados: se incluyó a 148 sujetos, siendo 78 (52,7 %) varones con edad media 58 ± 16 años y 70 (47,3 %) mujeres con edad media 54 ± 17 años. Las etiologías más frecuentes de la insuficiencia renal crónica fueron la diabetes mellitus e hipertensión arterial (44,5 %). Se detectó 12 sujetos (8,1 %) con gasometría normal. La alteración del estado ácido básico más frecuente fue la acidosis metabólica (87,2 %), predominando en este grupo los casos con brecha aniónica normal. Conclusiones: las alteraciones del estado ácido básico predominantes en pacientes con insuficiencia renal crónica fue la acidosis metabólica con brecha aniónica normal. Se sugiere aplicar los cálculos de los mecanismos compensadores para llegar al diagnóstico certero de estas alteraciones metabólicas.

ABSTRACT Introduction: the carrier of chronic renal failure can present various alterations of the basic acid state, being the metabolic acidosis the most frequent. Objectives: to describe the demographic and clinical characteristics and alterations in the acid-base status of adult patients admitted with chronic renal failure in two hospitals in Paraguay. Methodology: an observational, descriptive, cross-sectional design was applied. Adult subjects of both sexes, carriers of chronic renal failure, who attended the National Hospital (Itauguá) and the Military Hospital (Asunción) between April and November 2021 were included. Anthropometric, clinical and laboratory variables were measured at admission. The data was submitted to descriptive statistics with the Epi Info 7™ program. The study was approved by the Ethics Committee of the Universidad Privada del Este, Paraguay. Results: 148 subjects were included, being 78 (52.7 %) men with a mean age of 58 ± 16 years and 70 (47.3 %) women with a mean age of 54 ± 17 years. The most frequent etiologies of chronic renal failure were diabetes mellitus and arterial hypertension (44.5 %). 12 subjects (8.1 %) with normal blood gases were detected. The most frequent alteration of the acid-base status was metabolic acidosis (87.2 %), with cases with normal anion gap predominating in this group. Conclusions: the predominant acid-base status alterations in patients with chronic renal failure was metabolic acidosis with normal anion gap. It is suggested to apply the calculations of the compensatory mechanisms to arrive at the accurate diagnosis of these metabolic alterations.

The effect of gingival aging in diabetic and non-diabetic status: an experimental study / El efecto del envejecimiento gingival en el estado diabetico y no diabetico. Estudio experimental

Major gingivalperiodontal changes according to age have been observed in both diabetic and nondiabetic rats. Male Wistar rats weighing 200220 g were divided into two groups: 1) Nondiabetic (ND) and 2) Diabetic (D) by receiving an intraperitoneal (ip) dose of streptozotocin (STZ) (50 mg /kg). Animals from both groups (ND and D) were euthanized at 4, 8, 12, 17 y 25 weeks after treatment with saline solution or STZ. Glycemia values in ND rats were 5 to 6 mmol/L, while in D, glycemia increased progressively between weeks 4 and 25, with values ranging from 18.3±2.1 to 39.3±2.7 mmol/L. Oxidative stress differed significantly in gums of ND and D rats. ND: lipid peroxidation: Malondialdehyde (MDA): 8.52±1.2 to 15.5±2(nmol/mgP); superoxide dismutase (SOD): 37.1±4.2 to 21.2±1.3 (U/100mgP); D: MDA 13.1±1.6 to 22.9±2.7 (nmol/L); superoxide dismutase (SOD): 17.7±0.8 to 9.±0.2 (U/100mgP). Vascular permeability (VP) and gingival edema (E) showed significant changes between ND and D rats from 4 to 25 weeks. ND: PV: 10±0.2 to 16.1±1.3 (EB ug/g dry t); E: 0.9±0.1 to 4.1±1.3 ml; D: PV: 12±1.2 to 24.4±1.6 (EB ug/g dry t); E: 2.2±0.2 to 8.4±1.3 ml. Aging produced progressive natural changes in oxidative stress, VP and gingival E. In diabetic animals, changes in oxidative stress, VP and gingival E were observed early and were progressively more significant than for ND. According to these results, nondiabetic gingival modifications develop naturally with age, while in aging associated to diabetic disease, hyperglycemia increases progressively and early (AU)

Se han observados importantes cambios gingivoperiodontales en función de la edad tanto en ratas no diabéticas como en ratas diabéticas. Ratas machos Wistar de 200220 g de peso corporal fueron separadas en dos grupos: 1) No diabéticas(ND) ; 2) Diabéticas (D), por haber recibido una dosis intraperitoneal (ip) de estreptozotocina (STZ) (50 mg /kg). Ambos grupos de ratas (ND y D) fueron sacrificados a las 4, 8, 12, 17 y 25 semanas de edad después del tratamiento con solución salina o con STZ. En ratas ND las los valores de glucemia fueron de 5 a 6 mmol/L, en tanto que en las D las glucemias se observaron progresivamente aumentadas entre las 4 y las 25 semanas con valores entre 18.3±2.1 a 39.3±2.7 mmol/L. El estrés oxidativo mostró diferencias significativas entre las encías de animales ND respecto a los D; ND: peroxidacion lipidica: Malondihaldeido (MDA): 8.52±1.2 a 15.5±2(nmol/mgP);superoxido dismutasa (SOD):37.1±4.2 a 21.2±1.3 (U/100mgP); D : MDA 13.1±1.6 a 22.9±2.7 (nmol/L); Superoxidodismutasa :SOD 17.7±0.8 a 9.±0.2 (U/100mgP). La permeabilidad vascular(PV) y el edema(E) gingival mostraron cambios significativos entre las 4 y las 25 semanas de edad entre los animales ND respecto a los D : ND : PV : 10±0.2 a 16.1±1.3 (EB ug/g t seco); E :0.9±0.1 a 4.1±1.3 ml; D: PV :12±1.2 a 24.4±1.6 (EB ug/g t seco); E 2.2_/0.2 a 8.4± 1.3 ml. El envejecimiento produjo cambios progresivos naturales en el estrés oxidativo, PV y E gingival. En tanto que en el estado diabético los cambios del estrés oxidativo, PV y E gingival se observan temprano y fueron progresivamente más significa tivos comparados con los ND. De acuerdo a estos resultados las modificaciones gingivales no diabéticas se desarrollan naturalmente en función de la edad, en cambio en la senectud asociada con enfermedad diabética la hiperglucemia aumenta progresiva y tempranamente (AU)

Determination of limited histotrophy as the reproductive mode in Mustelus schmitti Springer, 1939 (Chondrichthyes: Triakidae): analysis of intrauterine growth of embryos

This work analyzed length-mass relationship, growth in length, mass variations and dynamic of yolk sac depletion of Mustelus schmitti embryos, extracted from females catched by the artisanal fishery acting off La Paloma (34°39'S, 54°10'W, Uruguay) during 2006 and 2007. Differences in total length and total mass between sexes were not significant. Embryos showed a negative allometric growth for both years with a slope change near the day 170 of the year, likely to be associated with the depletion of the external yolk sac. Gompertz and Von Bertalanffy curves were adjusted for each year. Parturition date was determined around the day 300 of the year. Yolk depletion followed a logistic dynamic Yt=1/(1+e(-13.749 + 0.072*t)) for 2006 and Yt=1/(1+e(-10.472 + 0.054*t)) for 2007. Embryos showed a mean increase in total dry mass of 5.4g in 187 days which, together with yolk depletion dynamics, indicates additional energetic supply, suggesting that M. schmitti presents limited histotrophy.

Este trabajo analizó las relaciones largo-masa, crecimiento en talla, variaciones en masa y dinámica de consumo del saco vitelino de embriones de Mustelus schmitti extraídos de hembras capturadas por la flota pesquera artesanal del puerto de La Paloma (34°39'S, 54°10'W, Uruguay) durante 2006 y 2007. Las diferencias en largo total y masa total entre sexos no fueron significativas. Los embriones mostraron crecimiento alométrico negativo en ambos años, con un cambio de pendiente cercano al día 170, probablemente asociado con el agotamiento del saco vitelino externo. Se ajustaron curvas de crecimiento de Gompertz y VonBertalanffy para cada año. La fecha de parición se determinó cerca del día 300 del año. El consumo de vitelo siguió una dinámica logística Yt=1/(1+e(-13.749 + 0.072*t)) en 2006 y Yt=1/(1+e(-10.472 + 0.054*t)) en 2007. Los embriones mostraron un aumento promedio de masa seca de 5.4g en 187 días, esto, junto con la dinámica de consumo de vitelo, indicó una provisión adicional de energía, sugiriendo que M. schmitti presenta histotrofía limitada.

Padrão hemodinâmico tardio (> 2 anos) e vasodilatação intrapulmonar, antes e após tratamento cirúrgico da hipertensão portal secundária à forma hepatoesplênica da esquistossomose mansônica: análise comparativa entre desconexão ázigo-port / Sistemic hemodynamics (> 2 years) and intrapulmonary vasodilatation before and after surgical treatment of portal hypertension due to hepatoesplenic mansonic shistosomiasis: comparative analysis of esophagogastric devascularization with splenectomy (EGDS) and distal splenorenal shunt (DSRS)

O presente estudo avaliou comparativamente o padrão hemodinâmico e a presença de vasodilatação intrapulmonar antes e após tratamento cirúrgico tardio (> 2 anos) da hipertensão portal através da desconexão ázigo portal com esplenectomia (DAPE) e anastomose esplenorenal distal (AERD) na esquistossomose mansônica forma hepatoesplênica. Foram estudados prospectivamente 37 pacientes portadores de hipertensão portal secundária a esquistossomose mansônica confirmada por biópsia hepática , sendo 21 pacientes do sexo masculino e 16 do sexo feminino, com idade média de 46,6 + 12 anos, no período de janeiro de 2007 a dezembro de 2008. A avaliação do padrão hemodinâmico sistêmico foi realizada através do Doppler transesofágico (Cardio QÒ) e da ecocardiografia bidimensional com Doppler nos pacientes dos grupos AERD (n=13) e DAPE (n=15) . Os resultados obtidos foram comparados com grupo controle constituído por 10 pacientes sem hipertensão portal submetidos à endoscopia digestiva alta para avaliação de dispepsia. A avaliação da presença de síndrome hepatopulmonar foi realizada em todos os pacientes através da ecocardiografia contrastada com infusão salina 0,9% nos grupos DAPE (n=15), AERD (n=13) e pré-operatório (n=9). Os pacientes que apresentavam vasodilatação intrapulmonar no período pré-operatório repetiram o exame após 30 dias do procedimento cirúrgico. Em relação ao padrão hemodinâmico sistêmico observou-se aumento significativo (p =0,001) do débito cardíaco no grupo AERD (5,08 ± 0,91 L/min) em relação ao controle (4,17 ± 0,52 L/min). Ao contrário, os pacientes submetidos à DAPE (4,36 ± 0,59 L/min) não apresentaram diferença estatística significante (p = 0,47) em relação ao controle (4,17 ± 0,52 L/min). Os pacientes do grupo AERD apresentaram aumento estatisticamente significante (p = 0,001) do volume sistólico (60,1 + 5,6 ml) em relação ao controle (53,2 + 5,6 ml), enquanto que não houve diferença significativa (p = 0,41) nos pacientes submetidos à DAPE...

This study is a comparative analysis of the hemodynamic pattern and presence of intrapulmonary vasodilatation in hepatoesplenic mansoni schistosomiasis before and after surgical treatment (> 2 years) of portal hypertension by esophagogastric devascularization with splenectomy (EGDS) and distal splenorenal shunt (DSRS). 37 patients with portal hypertension secondary to hepatosplenic mansoni schistosomiasis confirmed by liver biopsy were prospectively studied between January 2007 to December 2008. 21 patients were male and 16 were female, with an mean age of 46.6 +12 years. The hemodynamic evaluation was performed by transesophageal doppler (Cardio QÒ) and Doppler echocardiography in DSRS (n=13) and EGDS (n=15) patients. The results were compared with a control group of 10 patients without portal hypertension submitted to upper digestive endoscopy for dyspepsia evaluation The presence of pulmonary vasodilatation was evaluated in all patients by contrastenhanced echocardiography with saline solution 0,9% in DSRS (n=15), EGDS (n=13) and preoperative (n=9) groups. Patients with intrapulmonary vasodilation in the preoperative period repeated the exam 30 days after surgical treatment of portal hypertension by a devascularization procedure. Systemic hemodynamic evaluation by transesophageal Doppler revealed a significant increase in cardiac output (p =0.001) in the DSRS (5,08 ± 0,91 L/min) patients in relation to control group (4,17 ± 0,52 L/min). By contrast, patients submitted to EGDS (4,36 ± 0,59 L/min) present no increase in cardiac output (p = 0.47) when compared with control group (4,17 ± 0,52 L/min). The DSRS patients presented a statistically significant increase (p = 0.001) in systolic volume (60,1 + 5,6 ml) in relation to the control (53,2 + 5,6 ml), while no significant difference (p = 0.41) was observed in EGDS group (56 ± 9,4 ml). There was no statistically significant difference between heart rate and mean arterial pressure between groups...