Estimated glomerular filtration rate in clinical practice: Consensus positioning of the Brazilian Society of Nephrology (SBN) and Brazilian Society of Clinical Pathology and Laboratory Medicine (SBPC/ML) / Estimativa da taxa de filtração glomerular na prática clínica: posicionamento consensual da Sociedade Brasileira de Nefrologia (SBN) e Sociedade Brasileira de Patologia Clínica e Medicina Laboratorial (SBPC/ML)

ABSTRACT Chronic kidney disease (CKD) represents one of today's main public health problems. Serum creatinine measurement and estimation of the glomerular filtration rate (GFR) are the main tools for evaluating renal function. There are several equations to estimate GFR, and CKD-EPI equation (Chronic Kidney Disease - Epidemiology) is the most recommended one. There are still some controversies regarding serum creatinine measurement and GFR estimation, since several factors can interfere in this process. An important recent change was the removal of the correction for race from the equations for estimating GFR, which overestimated kidney function, and consequently delayed the implementation of treatments such as dialysis and kidney transplantation. In this consensus document from the Brazilian Societies of Nephrology and Clinical Pathology and Laboratory Medicine, the main concepts related to the assessment of renal function are reviewed, as well as possible existing controversies and recommendations for estimating GFR in clinical practice.

RESUMO A doença renal crônica (DRC) representa um dos principais problemas de saúde pública da atualidade. A dosagem da creatinina sérica e a estimativa da taxa de filtração glomerular (TFG) são as principais ferramentas para avaliação da função renal. Para a estimativa da TFG, existem diversas equações, sendo a mais recomendada a CKD-EPI (Chronic Kidney Disease - Epidemiology). Existem ainda algumas controvérsias com relação à dosagem da creatinina sérica e da estimativa da TFG, uma vez que vários fatores podem interferir nesse processo. Uma importante mudança recente foi a retirada da correção por raça das equações para estimativa da TFG, que superestimavam a função renal, e consequentemente retardavam a implementação de tratamentos como diálise e transplante renal. Neste documento de consenso da Sociedade Brasileira de Nefrologia e Sociedade Brasileira de Patologia Clínica e Medicina Laboratorial são revisados os principais conceitos relacionados à avaliação da função renal, possíveis controvérsias existentes e recomendações para a estimativa da TFG na prática clínica.

Relationship of hemoglobin levels with outcomes in deceased donor kidney transplant: a retrospective cohort study / Relação dos níveis de hemoglobina com desfechos em transplante renal de doador falecido: um estudo de coorte retrospectivo

ABSTRACT Introduction: Anemia is frequent in patients undergoing replacement therapy for kidney failure. Anemia in the pre- and post-transplantation period might be related to kidney transplant outcomes. The current study therefore sought to assess the relationship between anemia, delayed allograft function (DGF), chronic kidney allograft dysfunction (CAD), and death from any cause following kidney transplantation from a deceased donor. Methods: This was a retrospective study with 206 kidney transplant patients of deceased donors. We analyzed deceased donors' and kidney transplant patients' demographic data. Moreover, we compared biochemical parameters, anemia status, and medicines between DGF and non-DGF groups. Afterward, we performed a multivariate analysis. We also evaluated outcomes, such as CAD within one year and death in ten years. Results: We observed a lower frequency of pre-transplant hemoglobin concentration (Hb) but higher frequency of donor-serum creatinine and red blood transfusion within one week after transplantation in the group with DGF. In addition, there was an independent association between Hb concentration before transplantation and DGF [OR 0.252, 95%CI: 0.159-0.401; p < 0.001]. There was also an association between Hb concentration after six months of kidney transplantation and both CAD [OR 0.798, 95% CI: 0.687-0.926; p = 0.003] and death from any cause. Conclusion: An association was found between pre-transplantation anemia and DGF and between anemia six months after transplantation and both CAD and death by any cause. Thus, anemia before or after transplantation affects the outcomes for patients who have undergone kidney transplantation from a deceased donor.

RESUMO Introdução: A anemia é frequente em pacientes submetidos à terapia substitutiva para insuficiência renal. A anemia nos períodos pré e pós-transplante pode estar relacionada aos desfechos do transplante renal. Portanto, o presente estudo buscou avaliar a relação entre anemia, função retardada do enxerto (FRE), disfunção crônica do enxerto renal (DCE) e óbito por qualquer causa após transplante renal de doador falecido. Métodos: Este foi um estudo retrospectivo com 206 pacientes transplantados renais de doadores falecidos. Analisamos dados demográficos de doadores falecidos e pacientes transplantados renais. Além disso, comparamos parâmetros bioquímicos, status de anemia e medicamentos entre os grupos FRE e não-FRE. Posteriormente, realizamos uma análise multivariada. Também avaliamos desfechos, como DCE em um ano e óbito em dez anos. Resultados: Observamos menor frequência de concentração de hemoglobina (Hb) pré-transplante, mas maior frequência de creatinina sérica do doador e transfusão de hemácias no período de uma semana após o transplante no grupo FRE. Além disso, houve associação independente entre a concentração de Hb antes do transplante e a FRE [OR 0,252; IC 95%: 0,159-0,401; p < 0,001]. Houve também associação entre a concentração de Hb após seis meses de transplante renal e ambos, DCE [OR 0,798; IC95%: 0,687-0,926; p = 0,003] e óbito por qualquer causa. Conclusão: Encontrou-se uma associação entre anemia pré-transplante e FRE e entre anemia seis meses após o transplante e ambos, DCE e óbito por qualquer causa. Assim, a anemia antes ou após o transplante afeta os desfechos de pacientes que foram submetidos a transplante renal de doador falecido.

Funcionamiento ejecutivo y metacognición en la alta capacidad intelectual / Executive functioning and metacognition in high intel lectual capacity

Resumen Introducción : Las funciones ejecutivas y la meta cognición se integran para la gestión de recursos inte lectuales, en estrecha relación con la inteligencia, su funcionamiento y resultados, especialmente interesan te para comprender la expresión y desarrollo, más o menos óptimos, de la alta capacidad intelectual (ACI). El Objetivo del trabajo es conocer la relación entre las funciones ejecutivas (y componentes) y la metacognición (y componentes) en escolares con ACI. Materiales y Métodos : Las medidas de funcionamien to y ejecutivo, metacognitivo y de perfeccionismo ex traídas en una muestra de n= 147 escolares con ACI son analizadas estadísticamente mediante el Path análisis. Resultados : Se obtiene un modelo ajustado en el que se relacionan los distintos componentes ejecutivos con los metacognitivos. Discusión : Se concluye y discute el modelo integrador entre función ejecutiva y metacognición y su papel me diador, como endofenotipo entre la dotación genética y la expresión de rendimiento de los recursos, sugiriendo la transferencia de resultados a la educación de la alta capacidad intelectual para la óptima y ética expresión del alto potencial.

Abstract Introduction : Executive functions and Metacogni tion are integrated for the management of intellectual resources in close relation to intelligence its function ing and results; they are specially interesting for un derstanding the expression and development of high intellectual abilility (HIA). The aim of the study is to find out the relationship between executive functions (and components) and metacognition (and components) in schoolchildren with HIA. Materials and Method : Measures of executive and metacognitive functioning and perfectionism were ex tracted from a sample of n= 147 schoolchildren with HIA. Results : statistical analyses using Path analysis, of fered an adjusted model in which the different ex ecutive components are related to the metacognitive components. Discussion : We conclude and discuss the integrative model between executive function and metacognition and its mediating role as an endophenotype between genetic endowment and the expression of resource performance, suggesting the transfer of results to the education of high intellectual ability for the optimal and ethical expression of high potential.

Funções neuropsicológicas de meninas privadas de liberdade em unidade socioeducativa / Neuropsychological functions of girls deprived of liberty in socio-educational unit / Funciones neuropsicológicos de niñas privadas de libertad en unidad socioeducativa

OBJETIVO: A avaliação neuropsicológica tem alta relevância na adolescência e em situação de conflito com a lei, com privação de liberdade em instituições socioeducativas, pode auxiliar, compondo abordagens psicossociais que identifiquem as funções neuropsicológicas, situando-as a partir da historicidade do indivíduo. Deste modo, para compreender esse problema, foi objetivo desse estudo avaliar e descrever as funções neuropsicológicas de adolescentes meninas privadas de liberdade em instituição socioeducativa. MÉTODOS: As participantes foram 19 meninas avaliadas com os instrumentos: Barratt Scale, Inventário de Expressão de Raiva, teste Wisconsin de classificação de cartas, protocolo neuropsicológico, questionário para uso de drogas e Hare Psychopathy Checklist Revised. RESULTADOS: O uso de drogas na vida ocorreu em 80,0% dos casos. Verificaram-se altos escores de impulsividade total (M=75,8, DP=5,4), traço de raiva (M=24,5, DP=7,3) e respostas perseverativas (M =38,5, DP =19,9). Em conjunto com PCL-R total (M=17,5, DP=3,6) e com QI total (M=79,1, DP=16,2), esses níveis auxiliaram na caracterização das funções de autocontrole. CONCLUSÕES: Os dados foram interpretados como indicativos de baixo funcionamento executivo, altos níveis de raiva, de impulsividade, de uso de drogas e de traços de psicopatia. Foram relatadas adversidades durante a infância, o que pode ter contribuído para um desempenho prejudicado nas funções cognitivas e emocionais dessas meninas.

OBJECTIVE: Neuropsychological assessment is highly relevant in adolescence and in situations of conflict with the law, with deprivation of liberty in socio-educational institutions, it can help, composing psychosocial approaches that identify neuropsychological functions, situating them based on the individual's historicity. Therefore, to understand this problem, the objective of this study was to evaluate and describe the neuropsychological functions of adolescent girls deprived of liberty in a socio-educational institution. METHODS: The participants were 19 girls evaluated with the following instruments: Barratt Scale, Anger Expression Inventory, Wisconsin Card Sorting Test, Neuropsychological protocol, drug use questionnaire and Hare Psychopathy Checklist Revised. RESULTS: Lifetime drug use occurred in 80.0% of cases. There were high scores for total impulsivity (M=75.8, SD=5,4), trait anger (M=24.5, SD=7.3) and perseverative responses (M=38.5, SD=19.9). Together with total PCL-R (M=17.5, SD=3.6) and total IQ (M=79.1, SD=16), these levels helped to characterize self-control functions. CONCLUSIONS: The data were interpreted as indicating low executive functioning, high levels of anger, impulsivity, drug use and psychopathic traits. Adversities were reported during childhood, which may have contributed to impaired performance in the cognitive and emotional functions of these girls.

OBJETIVO: La evaluación neuropsicológica es de gran relevancia en la adolescencia y en las situaciones de conflicto con la ley, con privación de libertad en instituciones socioeducativas, puede ayudar, componiendo enfoques psicosociales que identifiquen funciones neuropsicológicas, las situando en función de la historicidad del individuo. Por tanto, para comprender esta problemática, el objetivo de este estudio fue evaluar y describir las funciones neuropsicológicas de niñas adolescentes privadas de libertad en una institución socioeducativa. MÉTODOS: Las participantes fueron 19 niñas evaluadas con los siguientes instrumentos: Escala de Barratt, Inventario de Expresión de Ira, Test de clasificación de cartas de Wisconsin, protocolo neuropsicológico, cuestionario de consumo de drogas y Lista de Verificación de Psicopatía de Hare Revisada. RESULTADOS: El consumo de drogas durante la vida ocurrió en el 80,0% de los casos. Hubo puntuaciones altas en impulsividad total (M = 75,8, DE = 5,4), rasgo de ira (M = 24,5, DE = 7,3) y respuestas perseverativas (M = 38,5, DE = 19,9). Junto con el PCL-R total (M=17,5, DE=3,6) y el CI total (M=79,1, DE=16,2), estos niveles ayudaron a caracterizar las funciones de autocontrol. CONCLUSIONES: Se interpretó que los datos indicaban un bajo funcionamiento ejecutivo, altos niveles de ira, impulsividad, consumo de drogas y rasgos psicopáticos. Se informaron adversidades durante la infancia, que pueden haber contribuido al deterioro del desempeño en las funciones cognitivas y emocionales de estas niñas.

An Assessment of Ankle Function, Oxidative Damage, and Inflammatory Factor Levels in Minimally Invasive Ankle Joint Fusion Surgery for the Treatment of Traumatic Ankle Osteoarthritis

SUMMARY: Traumatic ankle osteoarthritis is a degenerative condition resulting from traumatic injuries. The objective of this study was to evaluate the impact of minimally invasive ankle joint fusion surgery on ankle function, oxidative damage, and inflammatory factor levels in traumatic ankle osteoarthritis patients. A total of 112 traumatic ankle osteoarthritis patients treated in our hospital from January 2022 to January 2023 were enrolled. They were randomly rolled into a control group (Group C) and an experimental group (Group E), with the former undergoing conventional open ankle joint fusion surgery and the latter receiving minimally invasive ankle joint fusion surgery. A comparison was made between the two groups based on American Orthopedic Foot and Ankle Society (AOFAS), bony fusion rates, and visual analog scale (VAS) scores at pre-operation, and at 1, 2, and 3 months post-operation. Additionally, serum oxidative damage indicators and inflammatory factor levels were measured to evaluate the recovery effects in both groups. Relative to Group C, Group E showed drastically increased AOFAS scores and bony fusion rates (P<0.05), as well as greatly decreased VAS scores (P<0.05). Moreover, Group E exhibited more pronounced improvements in oxidative damage indicators and inflammatory factors versus Group C (P<0.05). Minimally invasive ankle joint fusion surgery drastically improves ankle function in traumatic ankle osteoarthritis patients and reduces levels of oxidative damage and inflammatory response. This provides an important clinical treatment option.

La osteoartritis traumática del tobillo es una afección degenerativa resultante de lesiones traumáticas. El objetivo de este estudio fue evaluar el impacto de la cirugía mínimamente invasiva de fusión de la articulación talocrural sobre la función del tobillo, el daño oxidativo y los niveles de factor inflamatorio en pacientes con osteoartritis traumática del tobillo. Se inscribieron un total de 112 pacientes con artrosis traumática de tobillo tratados en nuestro hospital desde enero de 2022 hasta enero de 2023. Fueron divididos aleatoriamente en un grupo de control (Grupo C) y un grupo experimental (Grupo E), donde el primero se sometió a una cirugía de fusión de la articulación talocrural abierta convencional y el segundo recibió una cirugía de fusión de la articulación talocrural mínimamente invasiva. Se realizó una comparación entre los dos grupos según la Sociedad Estadounidense de Ortopedia de Pie y Tobillo (AOFAS), las tasas de fusión ósea y las puntuaciones de la escala visual analógica (EVA) antes de la operación y 1, 2 y 3 meses después de la operación. Además, se midieron los indicadores de daño oxidativo sérico y los niveles de factor inflamatorio para evaluar los efectos de la recuperación en ambos grupos. En relación con el grupo C, el grupo E mostró puntuaciones AOFAS y tasas de fusión ósea drásticamente aumentadas (P <0,05), así como puntuaciones VAS muy disminuidas (P <0,05). Además, el grupo E exhibió mejoras más pronunciadas en los indicadores de daño oxidativo y factores inflamatorios en comparación con el grupo C (P <0,05). La cirugía de fusión de la articulación talocrural mínimamente invasiva mejora drásticamente la función del tobillo en pacientes con osteoartritis traumática del tobillo y reduce los niveles de daño oxidativo y la respuesta inflamatoria. Esto proporciona una importante opción de tratamiento clínico.

Parameters of pubertal growth spurt in children and adolescents living at high altitude in Peru

Abstract Objectives: The aim was to estimate the pubertal growth height of children and adolescents living in a high-altitude region of Peru using the Preece-Baines model 1 (1 PB). Methods: A cross-sectional study was conducted in schoolchildren from the department of Puno (Peru) between 3841 and 3874 masl. The age range was between 4 and 17 years. Standing height was evaluated. 1 PB was used to infer the mathematical and biological parameters of stature. Results: Mathematical parameters estimated by the 1 PB model reflected small residual standard error (RSE) values in both sexes (0.25 in boys and 0.27 in girls). In boys, the age at which peak velocity was reached (APHV) was estimated at 13.21 ± 0.33years. While in girls it was 9.96 ± 0.26years (p < 0.05). In general, girls reached APHV (y) 3.25 years earlier than boys. On the other hand, the growth velocity of maximum height [APHV (cm/y)] of boys was higher (6.33 ± 6.06 cm/y) relative to girls (6.06 ± 0.32 cm/y). Estimated final adult height (EFAH) in boys was reached at 166.020 ± 0.99 cm and height at maximum growth velocity (HPHV) was 153.07 ± 0.67 cm, while in girls they were significantly lower (EFAH; 153.74 ± 0.44 cm and HPHV: 139.73 ± 0.84 cm). Conclusions: This study showed that girls living in Puno at a high altitude in Peru reached APHV 3 years earlier than boys and at the same time reflected slower PHV. These results suggest that pubertal growth at high altitudes is slower in both sexes and especially in girls. Thus, modeling physical growth may be an important step in understanding the onset of puberty at different latitudes.

Renal deficit and associated factors in children born with low birth weight / Déficit renal e fatores associados em crianças nascidas com baixo peso

ABSTRACT Introduction: Kidney problems may be due to low birth weight alone or may occur in association with other conditions. The objective this study was to evaluate the association between maternal and birth characteristics, anthropometric measurements, and kidney function deficit in low birth weight infants. Methods: Cross-sectional study with children who were born weighing < 2500 grams and were under outpatient follow-up. Maternal factors investigated were prenatal care and presence of hypertension, diabetes, and infection during pregnancy. The children's variables were sex, gestational age, birth weight, Apgar score, use of nephrotoxic medications, age, body weight at the time of evaluation, height, and serum creatinine and cystatin C dosages. The glomerular filtration rate (GFR) was estimated with the combined Zapittelli equation. Multivariate logistic regression model was used for identification of associated factors, with renal function deficit (GFR < 60 mL/min/1.73 m2) as the dependent variable. Results: Of the 154 children evaluated, 34.42% had kidney function deficit. Most of them had a gestational age > 32 weeks (56.6%), a mean birth weight of 1439.7 grams, and mean estimated GFR of 46.9 ± 9.3 mL/min/1.73 m2. There was a significant association of GFR < 60 mL/min/1.73 m2 with children's current weight and use of nephrotoxic drugs. Discussion: Children born with low birth weight had a high prevalence of kidney function deficit and current normal weight was a protective factor while the use of nephrotoxic drugs during perinatal period increased the chance of kidney deficit. These findings reinforce the need to evaluate the kidney function in these children, especially those who use nephrotoxic drugs.

RESUMO Introdução: Problemas renais podem ser devido apenas ao baixo peso ao nascer ou podem ocorrer em associação com outras condições. O objetivo deste estudo foi avaliar a associação entre características maternas e de nascimento, medidas antropométricas e déficit da função renal em bebês de baixo peso ao nascer. Métodos: Estudo transversal com crianças que nasceram com peso < 2500 gramas e estavam sob acompanhamento ambulatorial. Os fatores maternos investigados foram cuidados pré-natal e presença de hipertensão, diabetes e infecção durante a gravidez. As variáveis das crianças foram sexo, idade gestacional, peso ao nascer, índice Apgar, uso de medicamentos nefrotóxicos, idade, peso corporal no momento da avaliação, altura e dosagens séricas de creatinina e cistatina C. A taxa de filtração glomerular (TFG) foi estimada com a equação combinada de Zapittelli. Utilizou-se um modelo de regressão logística multivariada para identificação de fatores associados, com déficit da função renal (TFG < 60 mL/min/1,73 m2) como variável dependente. Resultados: Das 154 crianças avaliadas, 34,42% apresentaram déficit da função renal. A maioria tinha idade gestacional > 32 semanas (56,6%), peso médio ao nascer de 1439,7 gramas, e TFG média estimada de 46,9 ± 9,3 mL/min/1,73 m2. Houve uma associação significativa da TFG < 60 mL/min/1,73 m2 com o peso atual das crianças e o uso de medicamentos nefrotóxicos. Discussão: Crianças nascidas com baixo peso apresentaram alta prevalência de déficit da função renal e o peso atual normal foi um fator de proteção, enquanto o uso de medicamentos nefrotóxicos durante o período perinatal aumentou a chance de déficit renal. Estes achados reforçam a necessidade de avaliar a função renal destas crianças, especialmente aquelas que usam medicamentos nefrotóxicos.

Efectividad de la Terapia Acuática en la Función Motora Gruesa en Población Infantojuvenil con Parálisis Cerebral. Una Revisión Narrativa / Effectiveness of Aquatic Therapy on Gross Motor Function in Children and Young People with Cerebral Palsy. A Narrative Review

Introducción. La parálisis cerebral (PC) es una de las principales causas de discapacidad en la población infantil, afectando diversas áreas del desarrollo como la función motora gruesa; equilibrio y marcha. Hay evidencia de los beneficios de la terapia acuática y de cómo puede complementar la rehabilitación. Objetivo. Describir la efectividad de las intervenciones acuáticas en personas con PC, determinar mejoras en la función motora gruesa uso de métodos, protocolos y dosificación. Métodos. Se analizaron 9 estudios aleatorizados controlados desde el 2012 a la fecha, seleccionados por un experto y cuyos sujetos tenían PC espástica, Gross Motor Function Classification System (GMFCS) I a IV, entre los 2 y 20 años. Post intervención acuática se reportan mejoras significativas en el promedio de los ítems medidos por Gross motor function measure (GMFM). De los métodos que contribuyeron a mejoras se encuentra Halliwick y ejercicios acuáticos sin un programa específico. Resultados. Se obtuvieron mejoras de 35 a 100 minutos, y de 12 a 30 sesiones en total. No se logra concluir el tipo de terapia más efectiva, ya que las medidas de resultado y las características de los sujetos eran diversas. Conclusión. Una dosificación mínima de 2 veces por semana, 35 minutos de intervención en un total de 16 sesiones (9,3 horas en total) pareciera mejorar la función motora gruesa, cuyos resultados son transferibles a las actividades en tierra inmediatamente, sin embargo, no se obtiene información si se mantienen a mediano o largo plazo.

Background. Cerebral palsy (CP) is one of the main causes of disability in the child population, affecting various areas of development such as gross motor function; balance and gait. There is evidence of the benefits of aquatic therapy and how it can complement rehabilitation. Objective. to describe the effectiveness of aquatic interventions in people with CP, to determine improvements in gross motor function using methods, protocols, and dosage. Methods. Nine randomized controlled studies were analyzed from 2012 to date, selected by an expert and whose subjects had spastic CP, Gross Motor Function Classification System (GMFCS) I to IV, between 2 and 20 years of age. Results. After the aquatic intervention, significant improvements were reported in the average of the Gross motor function measure (GMFM) items measured. Of the methods that contributed to improvements, there is Halliwick and aquatic exercises without a specific program. Results. Improvements were obtained from 35 to 100 minutes, and from 12 to 30 sessions in total. It is not possible to conclude the most effective type of therapy, since the outcome measures and the characteristics of the subjects were diverse. Conclusion. A minimum dosage of 2 times per week, 35 minutes of intervention in a total of 16 sessions (9.3 hours in total) seems to improve gross motor function, the results of which are immediately transferable to activities on land, however, it is not obtains information if they are maintained in the medium or long term.

Induced acute hyperglycemia modifies the barrier function of the intestinal epithelium by tissue inflammation and tight junction disruption resulting in hydroelectrolytic secretion in an animal model

Abstract Diabetic-metabolic syndrome (MetS-D) has a high prevalence worldwide, in which an association with the rupture of the intestinal epithelium barrier function (IEBF) has been pointed out, but the functional and morphological properties are still not well understood. This study aimed to evaluate the impact of acute hyperglycemia diabetes on intestinal tight junction proteins, metabolic failure, intestinal ion and water transports, and IEBF parameters. Diabetes was induced in male Rattus norvegicus (200-310 g) with 0.5 mL of streptozotocin (70 mg/kg). Glycemic and clinical parameters were evaluated every 7 days, and intestinal parameters were evaluated on the 14th day. The MetS-D animals showed a clinical pattern of hyperglycemia, with increases in the area of villi and crypts, lactulose:mannitol ratio, myeloperoxidase (MPO) activity, and intestinal tissue concentrations of malondialdehyde (MDA), but showed a reduction in reduced glutathione (GSH) when these parameters were compared to the control. The MetS-D group had increased secretion of Na+, K+, Cl-, and water compared to the control group in ileal tissue. Furthermore, we observed a reduction in mRNA transcript of claudin-2, claudin-15, and NHE3 and increases of SGLT-1 and ZO-1 in the MetS-D group. These results showed that MetS-D triggered intestinal tissue inflammation, oxidative stress, complex alterations in gene regulatory protein transcriptions of intestinal transporters and tight junctions, damaging the IEBF and causing hydroelectrolyte secretion.

The duration-dependent and sex-specific effects of neonatal sevoflurane exposure on cognitive function in rats

Clinical studies have found that neonatal sevoflurane exposure can increase the risk of cognitive dysfunction. However, recent studies have found that it can exhibit neuroprotective effects in some situations. In this study, we aimed to explore the effects of sevoflurane neonatal exposure in rats. A total of 144 rat pups (72 males and 72 females) were assigned to six groups and separately according to sevoflurane exposure of different times on the seventh day after birth. Blood gas analysis and western blot detection in the hippocampus were conducted after exposure. The Morris water maze test was conducted on the 32nd to 38th days after birth. The expression of PSD95 and synaptophysin in the hippocampus was detected after the Morris water maze test. We found that neonatal exposure to sevoflurane promoted apoptosis in the hippocampus, and Bax and caspase-3 were increased in a dose-dependent manner. The 2-h exposure had the greatest effects on cognitive dysfunction. However, with the extension of exposure time to 6 h, the effects on cognitive function were partly compensated. In addition, sevoflurane exposure decreased synaptogenesis in the hippocampus. However, as the exposure time was extended, the suppression of synaptogenesis was attenuated. In conclusion, neonatal sevoflurane exposure exhibited duration-dependent effects on cognitive function via Bax-caspase-3-dependent apoptosis and bidirectional effects on synaptogenesis in rats.

Efficacy of Respiratory Muscle Training in the Immediate Postoperative Period of Cardiac Surgery: A Systematic Review and Meta-Analysis

ABSTRACT Introduction: This study aimed to evaluate the efficacy of respiratory muscle training during the immediate postoperative period of cardiac surgery on respiratory muscle strength, pulmonary function, functional capacity, and length of hospital stay. Methods: This is a systematic review and meta-analysis. A comprehensive search on PubMed®, Excerpta Medica Database (or Embase), Cumulative Index of Nursing and Allied Health Literature (or CINAHL), Latin American and Caribbean Health Sciences Literature (or LILACS), Scientific Electronic Library Online (or SciELO), Physiotherapy Evidence Database (or PEDro), and Cochrane Central Register of Controlled Trials databases was performed. A combination of free-text words and indexed terms referring to cardiac surgery, coronary artery bypass grafting, respiratory muscle training, and clinical trials was used. A total of 792 studies were identified; after careful selection, six studies were evaluated. Results: The studies found significant improvement after inspiratory muscle training (IMT) (n = 165, 95% confidence interval [CI] 9.68, 21.99) and expiratory muscle training (EMT) (n = 135, 95% CI 8.59, 27.07) of maximal inspiratory pressure and maximal expiratory pressure, respectively. Also, IMT increased significantly (95% CI 19.59, 349.82, n = 85) the tidal volume. However, no differences were found in the peak expiratory flow, functional capacity, and length of hospital stay after EMT and IMT. Conclusion: IMT and EMT demonstrated efficacy in improving respiratory muscle strength during the immediate postoperative period of cardiac surgery. There was no evidence indicating the efficacy of IMT for pulmonary function and length of hospital stay and the efficacy of EMT for functional capacity.

Development and evaluation of Tamil Matrix Sentence Test Performance in young adults

ABSTRACT Purpose The purpose of the study was to develop the Tamil Matrix Sentence Test (TMST) and evaluate the performance of a group of young adults with normal hearing on the developed test. The developed sentences were also administered at varying intensities to obtain a performance-intensity (PI) function. Methods A base matrix with 10 sentences containing 5 words each with a total of 50 words was used to develop the TMST. The sentences had a fixed semantic sentence structure of Tamil language in the order of noun, number, adjective, object and verb. The developed test consisted of 30 lists with 10 sentences in each list. The performance of 60 young adults with normal hearing aged 18 to 24 years across the 30 lists were compared for list equivalency. To obtain the PI function the sentences were administered on 20 young adults with normal hearing at intensities from 20 dB HL to 100 dB HL in 10 dB increments. The performance across the intensity levels were compared. Results The 30 lists of TMST were found to be acoustically equivalent. However, few lists showed significant difference in the scores obtained on them compared to the rest of the lists. The PI function revealed a saturation in performance beyond 40 dB HL. Conclusion From the results it was construed that TMST can be used to evaluate the speech identification abilities of Tamil speaking listeners. Multiple lists offer the advantage of retesting without the influence of practice or listeners memorizing the test material.

Patients with longstanding psoriatic arthritis can achieve DAPSA remission or low disease activity and it correlates to better functional outcomes: results from a Latin-American real-life cohort

Abstract Background Patients with psoriatic arthritis (PsA) experience reduced physical function and impaired quality of life. Better patient-reported functional outcomes are found when lower disease activity is achieved. Objectives To evaluate the variation of physical function by HAQ-DI over time in PsA patients treated with standard therapy in a real-life setting: to verify predictors of achieving a minimum clinically important difference (MCID) in function by HAQ-DI (ΔHAQ-DI ≤ − 0.35) and to measure the impact of achieving REM/LDA on long-term function by HAQ-DI. Methods This is a longitudinal analysis of a real-life retrospective cohort. Data from PsA patients with at least 4 years of follow-up in the PsA clinic from 2011 to 2019 were extracted from electronic medical records. The variations of physical function by HAQ-DI and disease activity by DAPSA over time were calculated. A multivariate hierarchical regression model was applied to verify predictors of MCID in HAQ-DI. A comparison of HAQ-DI variation between patients with DAPSA REM, LDA, moderate and high disease activity was made using the generalized estimating equation model (GEE), adjusted by Bonferroni test. The Spearman correlation method was applied to verify the correlation of ΔDAPSA and ΔHAQ-DI over time. Statistical analysis was performed in SPSS program version 21.0. Results Seventy-three patients were included in the analysis. Physical function measured by HAQ-DI was determined by PsA disease activity measured by DAPSA (p < 0.000). A moderate and statistically significant correlation between ΔDAPSA and ΔHAQ-DI was observed (rs = 0.60; p < 0.001). Only patients in DAPSA REM demonstrated a constant decline in HAQ-DI scores during the follow-up. White ethnicity and older age at baseline were predictors for not achieving MCID in HAQ-DI [RR 0.33 (0.16-0.6795% CI p = 0.002) and RR 0.96 (0.93-0.9895% CI p < 0.000), respectively, while higher scores of HAQ-DI at baseline were predictors of achieving MCID [RR 1.71 (1.12-2.6095%CI p = 0.013)]. Conclusion In PsA, patients who maintained DAPSA REM/LDA over time had better long-term functional outcomes. Higher HAQ-DI scores at baseline, non-white ethnicity and younger age were predictors for achieving a clinical meaningful improvement of HAQ-DI.

Sociodemographic, Clinical Condition, and Functional Aerobic Capacity in Patients With Heart Failure With Varying Ventricular Ejection Fraction

Abstract Background Recently, a new heart failure (HF) classification was made considering the left ventricular ejection fraction (LVEF) phenotype. Comprehensive assessments of the groups are required to guide patient management. Objective To determine the differences in sociodemographic, clinical, functional aerobic capacity, and health-related quality of life (HRQOL) variables in patients with HF classified with different LVEFs and to explore the correlations between the variables. Methods This work is a cross-sectional descriptive and correlational study. Three groups of patients with HF (LVEF≥50%, LVEF<40%, and LVEF40-49%) were compared. Sociodemographic, clinical variables and functional aerobic capacity with Sit to Stand (STS), 6-minute walk test (6MWT), Duke Activity Status Index (DASI), Minnesota Living with HF Questionnaire (MLFHQ), and Patient Health Questionnaire 9 (PHQ-9) were considered. The Chi-square test, one-way analysis of variance (ANOVA) test, and Spearman's correlation were used for statistical analysis. The statistical significance level was set at 5%. Results A total of 209 patients were admitted with a diagnosis of HF, with a more significant number of men. Marital status was a predominantly stable union in the HF with preserved ejection fraction (HFpEF) and HF with mid-range ejection fraction (HFmrEF) groups. A sedentary lifestyle was lower in the HF with reduced ejection fraction (HFrEF) group 59 (84.3%), p-value = 0.033, and the angina pectoris was higher in the HFpEF 30 (42.9%). Systolic blood pressure at the end of the 6MWT evidenced a higher score in HFpEF 132.0±17.25 concerning HFrEF 128.0±16.57, p-value=0.043. The fat percentage was higher in HFpEF 30.20±8.80 regarding the HFmrEF group 26.51±7.60, p-value = 0.028. Conclusion There were significant differences according to the LVEF classification in marital status, angina symptoms, fat percentage, and blood pressure at rest.

Persistence of symptoms and lung function in mild cases of COVID-19 six months after infection: a cross-sectional study / Persistência de sintomas e função pulmonar em casos leves de COVID-19 seis meses após a infecção: um estudo transversal

ABSTRACT Objectives: To describe persistent symptoms and lung function in mild cases of COVID-19 six months after infection. Methods: Data collection was performed through a semi-structured questionnaire containing information on the participants' demographic and anthropometric data, the disease in the acute phase, and persistent symptoms six months after COVID-19 using spirometry and manovacuometry. Results: A total of 136 participants were evaluated, of whom 64% were male, with a mean age of 38.17 ± 14.08 years and a body mass index (BMI) of 29.71 ± 17.48 kg/m2. The main persistent symptoms reported were dyspnea on exertion (39.7%), memory loss (38.2%), and anxiety (48.5%). Considering lung function, the participants reached 88.87 ± 17.20% of the predicted forced vital capacity (FVC), 86.03 ± 22.01% of the forced expiratory volume in one second (FEV1), and 62.71 ± 25.04% of peak expiratory flow (PEF). Upon manovacuometry, 97.41 ± 34.67% of the predicted inspiratory force (Pimax) and 66.86 ± 22.97% of the predicted expiratory force (Pemax) were observed. Conclusions: Six months after COVID-19 infection, a reduction in PEF and MEP was observed. Among the most commonly reported persistent symptoms were fatigue, tiredness with the slightest exertion, anxiety and depression, memory loss, and deficits in concentration.

RESUMO Objetivos: Descrever os sintomas persistentes e a função pulmonar em casos leves de COVID-19 seis meses após a infecção. Métodos: A coleta de dados foi realizada por meio de um questionário semiestruturado contendo informações sobre dados demográficos e antropométricos dos participantes, a doença na fase aguda e os sintomas persistentes seis meses após a COVID-19, utilizando espirometria e manovacuometria. Resultados: Um total de 136 participantes foram avaliados, dos quais 64% eram do sexo masculino, com uma idade média de 38,17 ± 14,08 anos e índice de massa corporal (IMC) de 29,71 ± 17,48 kg/m2. Os principais sintomas persistentes relatados foram dispneia ao esforço (39,7%), perda de memória (38,2%) e ansiedade (48,5%). Considerando a função pulmonar, os participantes atingiram 88,87 ± 17,20% da capacidade vital forçada (CVF) prevista, 86,03 ± 22,01% do volume expiratório forçado no primeiro segundo (VEF1) e 62,71 ± 25,04% do pico de fluxo expiratório (PFE). Na manovacuometria, observou-se 97,41 ± 34,67% da força inspiratória prevista (Pimáx) e 66,86 ± 22,97% da força expiratória prevista (Pemáx). Conclusões: Seis meses após a infecção por COVID-19, observou-se uma redução no PFE e na PEM. Dentre os sintomas persistentes mais comumente relatados estavam fadiga, cansaço com o mínimo esforço, ansiedade e depressão, perda de memória e déficits de concentração.

Validação das equações para estimativa da filtração glomerular ajustáveis por raça/cor em adultos de Vitória, Espírito Santo, Brasil / Validation of glomerular filtration estimation equations adjustable by race/colour in adults from Vitória, Espírito Santo, Brazil

Resumo A avaliação da função renal é feita por meio da taxa de filtração glomerular (TFG), que pode ser determinada pelo clearance de creatinina (CrCl) e é dependente da coleta urinária de 24 horas (h), o que dificulta o seu uso na atenção primária. As equações que estimam a TFG a partir da creatinina sérica tornam o exame mais acessível, contudo, os seus ajustes por raça/cor têm sido questionados em populações miscigenadas. Para verificar a concordância entre o ClCr e a TFG estimada por fórmulas (Modification of Diet in Renal Disease [MDRD-4] e Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI]), com ou sem ajuste por raça/cor, foram utilizados dados de subestudo da Pesquisa Nacional de Saúde (PNS) com inclusão de 272 adultos de Vitória, Espírito Santo, que fizeram coleta urinária de 24h. Adotou-se análise de variância (ANOVA) e método de Bland-Altman. Houve concordância adequada entre o ClCr e as equações, mas o ajuste por raça/cor diminui a acurácia destas últimas. No fator raça/cor, houve semelhança entre grupos para o ClCr (p=0,21) sugerindo não haver diferença no metabolismo da creatinina em função da cor da pele. Conclui-se que MDRD-4 e CKD-EPI apresentam desempenho satisfatório na avaliação da função renal, não sendo recomendado o uso de correções para raça/cor.

Abstract The assessment of renal function is performed using the glomerular filtration rate (GFR) whose measurement by creatinine clearance (ClCr) and is dependent on a 24-hour urine sample, hindering it use in primary healthcare. The equations that estimate GFR from serum creatinine make the test more accessible, however, their adjustments by race/color have been questioned in mixed populations. To test the agreement between CrCl and GFR estimated by formulas (Modification of Diet in Renal Disease [MDRD-4] and Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI]), with or without adjusting for race/color, data were used from a sub-study of the National Health Survey (NHS) including 272 adults from Vitória/Espírito Santo who underwent a 24-hour urinary sampling. Analysis of variance (ANOVA) and the Bland-Altman method were adopted. There was adequate agreement between ClCr and equations, but the adjustment by race/color decreases the accuracy of both equations. In the race/color factor, there was similarity between groups for CrCl (p=0.21), suggesting that there is no difference in creatinine metabolism induced by skin color. It is concluded that MDRD and CKD-EPI equations perform satisfactorily in the evaluation of renal function, and the use of corrections for race/color is not recommended.

Serum interleukin-33 combined with FEF75% z-score and FeNO improves the diagnostic accuracy of asthma in children

Abstract Objective To investigate the diagnostic efficacy of serum IL-33 single indicator and combined indicators for asthma in children. Methods 132 children were initially diagnosed with asthma during acute exacerbation and 100 healthy children were included. Serum IL-33 concentration differences were compared between asthmatic and normal children. Correlations between IL-33 with pulmonary function parameters, FeNO, peripheral blood EOS counts and serum total IgE were analyzed in asthmatic children. ROC curves were used to assess IL-33 diagnostic efficacy and its combined indicators. To prevent overfitting of the predictive model, the hold-out cross-validation method was used. Results (1) Serum IL-33 concentrations were significantly higher in children with asthma than in normal children (p < 0.001). (2) IL-33 concentration was negatively correlated with FVC z-score, FEV1 z-score and FEF75% z-score in asthmatic children (p < 0.05). (3) The area under the ROC curve of IL-33 was 0.821, which was higher than those of FeNO, FVC z-score, and FEV1 z-score. (4) Cross-validation of the combined indicators showed that IL-33 significantly improved asthma diagnostic efficacy. The combination of IL-33, FEF75% z-score, and FeNO showed the highest diagnostic efficacy, with the AUC, sensitivity, and specificity of the combined indicator being 0.954, 90.1%, and 89. 0%, respectively, and good extrapolation of the predictive model. Conclusion Serum IL-33 is higher in children with asthma and increases with the severity of pulmonary ventilation obstruction. A single indicator of serum IL-33 demonstrates moderate diagnostic accuracy, and its combination with FEF75% z-score and FeNO significantly improves the diagnostic accuracy in childhood asthma.

Extracorporeal Membrane Oxygenation Uses in Refractory Cardiogenic Shock After Open-Heart Surgery

ABSTRACT Introduction: Extracorporeal membrane oxygenation (ECMO) is the first-line therapy for temporary mechanical circulatory support allowing cardiac and pulmonary recovery or as a bridge to further therapeutic alternatives. The aim of this study was to report clinical outcomes in adult patients with refractory cardiac failure after open-heart surgery undergoing ECMO in a single center with an ECMO unit in Chile. Methods: We retrospectively analyzed adults with refractory cardiac failure after open-heart surgery who required a venoarterial (VA) ECMO between 2016 and 2021. Results: Of 16 patients with VA ECMO, 60% were men (n=10), 90% had hypertension (n=14), 69% had < 30% of left ventricular ejection fraction (n=11), and the mean European System for Cardiac Operative Risk Evaluation II score was 12 ± 11%. ECMO support with central cannulation accounts for 81% (n=13), and an intra-aortic balloon pump was used in nine patients (56%). The mean time of support was 4.7 ± 2.6 days (1.5 - 12 days). ECMO weaning was achieved in 88% of patients, and in-hospital mortality was 44% (n=7) after discharge. The freedom from all-cause mortality at one year of follow-up of the entire cohort was 38% (n=6). Conclusion: VA ECMO is now a well-known life-saving therapeutic option, but mortality and morbidity remain high. Implementation of an ECMO program with educational training is mandatory in order to find the proper balance between patient benefits, ethical considerations, and public health financial input in South America.

Predictores del estado de salud funcional posingreso en cuidados intensivos en pacientes sépticos / Predictors of Post-Admission Functional Health Status in Intensive Care in Septic Patients

Introducción: Los pacientes críticos pediátricos son susceptibles de presentar alteraciones del flujo sanguíneo cerebral que impliquen un deterioro de su estado de salud funcional. Objetivo: Identificar factores predictores de mayor riesgo de mala evolución funcional en pacientes pediátricos críticos con sepsis. Métodos: Se realizó un estudio de cohortes retrospectivo con menores de 18 años de edad con sepsis, ingresados en la unidad de cuidados intensivos pediátricos. Se recogieron variables epidemiológicas, clínicas y del estado de salud funcional previas al ingreso, al alta y a los 6 meses. El estado de salud funcional se evaluó mediante la escala de categorías de estado global y cerebral pediátrico. Se evaluó el cambio del estado funcional entre el ingreso y a los 6 meses del alta. Se realizó un análisis univariante para comparar grupos considerando el mal pronóstico y el cambio del estado funcional y su relación con las variables. Resultados: Se incluyeron 46 pacientes. A los 6 meses del alta, cuatro (8,7 por ciento) presentaron mal pronóstico funcional y ocho (17,4 por ciento) empeoramiento funcional respecto al ingreso. No se encontraron asociaciones entre las variables predictoras y la morbilidad, aunque se observó cierta tendencia en algunas como mayor soporte inotrópico (VIS > 20: 12,5 por ciento vs. 50 por ciento, p= 0,075), extracorpóreo y de reemplazo renal (25 por ciento vs. 2,6 por ciento, p= 0,074) y estancia hospitalaria más prolongada (50 por ciento vs. 15,8 por ciento , p= 0,055). Conclusiones: El soporte en la unidad de cuidados intensivos pediátricos no fue un predictor de morbilidad funcional en la muestra(AU)

Introduction: Critically ill pediatric patients are susceptible to cerebral blood flow alterations that imply a deterioration of their functional health status. Objective: To identify predictors of a higher risk of poor functional outcome in critically ill pediatric patients with sepsis. Methods: A retrospective cohort study was conducted with children under 18 years of age with sepsis, who were admitted to the pediatric intensive care unit. Epidemiological, clinical, and functional health status variables were collected prior to admission, discharge, and after 6 months. Functional health status was assessed using the Pediatric Global State and Brain Status Category Scale. The change in performance status between admission and 6 months after discharge was assessed. A univariate analysis was performed to compare groups considering poor prognosis and change in functional status and their relationship with the variables. Results: A total of 46 patients were included. At 6 months after discharge, four (8.7 percent) had a poor functional prognosis and eight (17.4 percent) had functional worsening at admission. No associations were found between the predictor variables and morbidity, although some trends were observed in some variables, such as greater inotropic support (SIV > 20: 12.5 percent vs. 50 percent, p = 0.075), extracorporeal and renal replacement (25 percent vs. 2.6 , percent p = 0.074), and longer hospital stay (50 percent vs. 15.8 percent , p = 0.055). Conclusions: Support in the pediatric intensive care unit was not a predictor of functional morbidity in the sample(AU)

Clinical Efficacy Evaluation of Tanreqing Injection Combined with Ceftazidime in Treatment of Phlegm Heat Obstructing Lung Syndrome in Acute Exacerbation of Chronic Obstructive Pulmonary Disease / 中国实验方剂学杂志

ObjectiveTo explore the effect of Tanreqing injection combined with Ceftazide on the clinical efficacy， lung function， and laboratory inflammatory index of patients suffering from phlegm heat obstructing lung syndrome in acute exacerbation of chronic obstructive pulmonary disease （AECOPD）. MethodFrom June 2021 to June 2023， 76 patients diagnosed with phlegm heat obstructing lung syndrome in AECOPD were enrolled in the respiratory and critical medical department of Jieshou Hospital of Traditional Chinese Medicine. They were randomly divided into a control group and an observation group with 38 cases each. The control group used Ceftazidime intravenous drip and other conventional oxygen inhalation and antispasmodic treatment measures of western medicine. The observation group received Tanreqing injection intravenous drip based on the treatment of the control group， with a course of 10 days. The changes of laboratory indicators such as hs-CRP， calcitonin （PCT）， and interleukin-6 （IL-6） before and after treatment were analyzed， and the improvement of forced expiratory volume in the first second （FEV1）， forced vital capacity （FVC）， one second rate （FEV1/FVC）， assessment and improvement of the British Medical Research Society’s dyspnea index （mMRC）， self-evaluation test of chronic obstructive pulmonary disease patients （CAT）， and traditional Chinese medicine syndrome score was compared. In addition， the total effective rate between the two groups after treatment was compared. ResultAfter treatment， the hs-CRP， PCT， IL-6， FEV1， FVC， FEV1/FVC， mMRC， CAT scores， and traditional Chinese medicine syndrome evaluation of both groups improved （P<0.01）. After treatment， compared with the control group， the observation group showed more significant improvements in hs-CRP， PCT， IL-6， FEV1， FVC， FEV1/FVC， mMRC， CAT scores， and traditional Chinese medicine syndrome evaluation， and the difference was statistically significant （P<0.05，P<0.01）. The total clinical effective rate of the control group was 86.84% （33/38）， while that of the observation group was 94.74% （36/38）. The therapeutic effect of the observation group was better than that of the control group （χ2=8.471， P<0.05）. ConclusionTanreqing injection combined with Ceftazidime has obvious efficacy in the treatment of phlegm heat obstructing lung syndrome in AECOPD， which is better than the treatment of Ceftazidime antibiotics alone. It can reduce the risk of acute exacerbation， alleviate clinical symptoms， and delay the decline of lung function.