Fatores associados à hipertensão arterial sistêmica e ao estado nutricional de hipertensos inscritos no programa Hiperdia / Factors associated with systemic hypertension and nutritional status of hypertensive enrolled in the program Hiperdia

OBJETIVO: Analisar fatores associados à Hipertensão Arterial Sistêmica (HAS) e sua relação com o estado nutricional de indivíduos hipertensos cadastrados no programa Hiperdia em um município do Rio Grande do Sul. MÉTODOS: Foram avaliados indivíduos hipertensos cadastrados no Hiperdia. Os dados referentes aos fatores associados à hipertensão foram coletados por meio de um questionário semiestruturado composto pelas seguintes variáveis: idade, escolaridade, exercício físico, tabagismo, medicamentos consumidos, herança genética, doenças crônicas, peso, altura e circunferência da cintura. RESULTADOS: Entre os 402 hipertensos estudados, 138 (34,3%) eram adultos e 264 (65,7%) eram idosos, sendo que a maioria era do gênero feminino. A prevalência de excesso de peso foi de 76,8% em adultos enquanto 35% dos idosos apresentaram peso normal. Quando comparadas as faixas etárias, 11% dos idosos estavam significativamente associados ao analfabetismo. Os adultos e idosos apresentaram média de circunferência da cintura e classificação do IMC acima dos níveis desejados. CONCLUSÃO: Neste estudo, a HAS foi associada a níveis pressóricos aumentados com o avanço da idade, excesso de peso, circunferência da cintura elevada, baixa escolaridade, fumo e consumo de bebida alcoólica. O excesso de peso configurou-se como um dos fatores mais agravantes nessa população.

OBJECTIVE: To analyze factors associated with hypertension and its relation with nutritional status of hypertensive subjects enrolled in the program Hiperdia in a municipality of Rio Grande do Sul. METHODS: We evaluated patients with hypertension enrolled in Hiperdia. The data related with risk factors for hypertension were collected through a semi structured questionnaire composed of the following variables: age, education, exercise, smoking, drugs consumed, genetics, chronic diseases, weight, height and waist circumference. RESULTS: Among the 402 hypertensive patients studied, 138 (34.3%) were adults and 264 (65.7%) were elderly, and the majority were female. The prevalence of overweight was 76.8% in adults, while 35% of them were normal weight. When compared the ages, 11% of the elderly were significantly associated with illiteracy. The adults and the elderly presented waist circumference and BMI classification above desired levels. CONCLUSION: In this study, hypertension was associated with increase of age, excess of weight, waist circumference, low education, smoking and alcohol consumption. Excess of weight was configured as one of the most aggravating factors in this population.

Early HHV-6 replication is associated with morbidity non-related to CMV infection after kidney transplantation

Human herpesvirus type 6-(HHV-6) has been associated with morbidity after liver transplantation. OBJECTIVE: The aim of this study was to determine the HHV-6 seroprevalence among donor-recipient pairs, analyze the incidence of early active infection, its clinical manifestation, interaction with CMV, and the related morbidity in the first year after kidney transplantation. METHODS: 46 donor-recipient pairs had IgG evaluated by ELISA before transplantation: HHV-6(Pambio - USA) and CMV-(Roche - USA). A frozen whole blood sample collected weekly (from the 1st to the 6th week) was retrospectively tested for HHV-6 viral load (VL) determination by real time quantitative PCR (qPCR, Nanogen - Italy). Patients were preemptively surveyed for CMV by pp65 antigenemia (Ag, APAAP, immunohistochemistry, Biotest - Germany) from the 4th to the 12th week after transplantation. Active infection was defined as qPCR-HHV6+ (viral-load/mL-VL) and Ag+ (+cells/100.000 granulocytes), for HHV-6 and CMV, respectively. DCMV was defined as simultaneous positive antigenemia and suggestive signs/symptoms. Concerning +qPCR-HHV6, associated factors, clinical manifestation, interaction with CMV and morbidity were searched. RESULTS: Pre-transplant HHV-6 seroprevalence was significantly higher among kidney recipients compared to their donors (82.6x54.8%; p = 0.005 [3.9 (1.4-10.4)]). Active infection by this virus occurred in 26.1% (12/46), with no association with previous IgG (p = 0.412). Median VL was 125 copies/mL (53-11.264), and the median Ag was 21 +cells (2-740). There was no association between HHV-6 and CMV activation after transplantation (p = 0.441), neither concerning DCMV (p = 0.596). Median highest Ag+ and days of ganciclovir treatment were similar between qPCR-HHV6 + or - (p = 0.206 and p = 0.124, respectively). qPCR-HHV6+ was associated with higher incidence of bacterial (p = 0.009) and fungal (p = 0.001) infections, and higher number (p = 0.001) of hospital admission and longer duration of hospitalization over the first 6 and 12 months post-transplantation (p = 0.033 and p = 0.001). CONCLUSION: Latent HHV-6 infection is more common among recipients than donors before transplantation. Early active infection by this pathogen after transplantation does not increase DCMV incidence or severity during the first 3 months of follow-up. However, early HHV-6 replication is associated with other infections and hospitalizations in the first year.

BKV-infection in kidney graft dysfunction

INTRODUCTION: BKV nephropathy (BKN) causes kidney graft loss, whose specific diagnosis is invasive and might be predicted by the early detection of active viral infection. OBJECTIVE: Determine the BKV-infection prevalence in late kidney graft dysfunction by urinary decoy cell (DC) and viral DNA detection in urine (viruria) and blood (viremia; active infection). METHODS: Kidney recipients with >1 month follow-up and creatinine >1.5 mg/dL and/or recent increasing >20 percent (n = 120) had their urine and blood tested for BKV by semi-nested PCR, DC searching, and graft biopsy. PCR-positive patients were classified as 1+, 2+, 3+. DC, viruria and viremia prevalence, sensitivity, specificity, and likelihood ratio (LR) were determined (Table 2x2). Diagnosis efficacy of DC and viruria were compared to viremia. RESULTS: DC prevalence was 25 percent, viruria 61.7 percent, and viremia 42.5 percent. Positive and negative patients in each test had similar clinical, immunossupressive, and histopathological characteristics. There was no case of viremia with chronic allograft nephropathy and, under treatment with sirolimus, patients had a lower viruria prevalence (p = 0.043). Intense viruria was the single predictive test for active infection (3+; LR = 2.8).1,6-4,9 CONCLUSION: DC, BKV-viruria and -viremia are commun findings under late kidney graft dysfunction. Viremia could only be predicted by intense viruria. These results should be considered under the context of BKN confirmation.

Imunologia da gestação / Pregnancy immunology

Do ponto de vista imunológico, a gestação somente é possível porque uma intrincada rede imunorregulatória é disparada com o objetivo único de desenvolver um estado de tolerância materno-fetal e permitir a implantação e manutenção do concepto até que haja condições de sobrevivência fora da cavidade uterina. Entre os fatores envolvidos nessa complexa rede imunomodulatória para a tolerância e regulação do desenvolvimento fetal e formação da placenta, destacam-se: a influência hormonal sobre o sistema imune materno, o reconhecimento das moléculas do Complexo Principal de Histocompatibilidade paterno (expressas pelo embrião), as citocinas liberadas no meio, o controle da citoxicidade direta das células Natural Killer uterinas e atividade das células T regulatórias. A seguir, uma revisão abrangente e atual da literatura discute de maneira simplificada tais mecanismos.

From the immunological point of view, pregnancy is possible because a complex immunorregulatory network is triggered in order to develop a feto-maternal tolerance from the implantation through the birth. The most important mechanisms involved in the gestational immunotolerance system are debated in this paper and include: maternal hormonal influence on the immune system, the allorecognition of the Human Leukocyte Antigen (HLA) molecules expressed by the embryo, local cytokines profile, Natural Killer cells cytotoxicity and the role of regulatory T cells.