Predicting urine output after kidney transplantation: development and internal validation of a nomogram for clinical use

ABSTRACT Purpose: To analyze pre-transplantation and early postoperative factors affecting post-transplantation urine output and develop a predictive nomogram. Patients and Methods: Retrospective analysis of non-preemptive first transplanted adult patients between 2001-2016. The outcomes were hourly diuresis in mL/Kg in the 1st (UO1) and 8th (UO8) postoperative days (POD). Predictors for both UO1 and UO8 were cold ischemia time (CIT), patient and donor age and sex, HLA I and II compatibility, pre-transplantation duration of renal replacement therapy (RRT), cause of ESRD (ESRD) and immunosuppressive regimen. UO8 predictors also included UO1, 1st/0th POD plasma creatinine concentration ratio (Cr1/0), and occurrence of acute cellular rejection (AR). Multivariable linear regression was employed to produce nomograms for UO1 and UO8. Results: Four hundred and seventy-three patients were included, mostly deceased donor kidneys' recipients (361, 70.4%). CIT inversely correlated with UO1 and UO8 (Spearman's p=-0.43 and −0.37). CR1/0 inversely correlated with UO8 (p=-0.47). On multivariable analysis UO1 was mainly influenced by CIT, with additional influences of donor age and sex, HLA II matching and ESRD. UO1 was the strongest predictor of UO8, with significant influences of AR and ESRD. Conclusions: The predominant influence of CIT on UO1 rapidly wanes and is replaced by indicators of functional recovery (mainly UO1) and allograft's immunologic acceptance (AR absence). Mean absolute errors for nomograms were 0.08 mL/Kg h (UO1) and 0.05 mL/Kg h (UO8).

The amount of spermatic cord rotation magnifies the time-related orchidectomy risk in Intravaginal testicular torsion

Abstract Purpose To investigate the roles of age, testicular rotation and time in the surgical outcome of intravaginal testicular torsion (iTT). Patients and Methods We retrieved the records of all iTT patients treated in our unit from January 2012 to January 2014. Explanatory variables were: age (years); presentation delay (PrD, time between symptoms and hospitalization); surgical delay (SurgD, time between hospitalization and surgery) and testicular rotation (rotation), with surgical outcome (orchidopexy, orchidectomy) as response variable. Differences in PrD, SurgD, age and rotation by surgical outcome were evaluated non-parametrically. Step-down logistic regression included age, PrD, SurgD and rotation as predictors. Statistical significance and confidence intervals (CI) were set at p<0.05 and 0.95. Odds ratios (OR) were computed from the model's coefficients. Results Complete variable information was available for 117 patients, and most (61, 52.1%) underwent orchidectomy. Ages were similar between orchidectomy and orchidopexy patients (median 15.8 vs. 16.0 years, p=0.78). In contrast, PrD (85.0 vs. 8.4 hours, p<0.001), SurgD (3.0 vs. 16.0 hours, p<0.001) were different between orchidectomy and orchidopexy patients. SurgD was similar with PrD<24 hours (4.0 vs. 2.8, p=0.1). Orchidectomy patients had greater rotation (3.0π vs. 2.0π radians, p<0.001). Logistic regression revealed that PrD (OR 0.94; 0.92–0.97; p<0.001) and rotation (OR 0.43; 0.27–0.70; p<0.001) were inversely associated with orchidopexy. Conclusion Testicular rotation exerts a multiplicative effect on PrD, so time should not be regarded as the sole predictor of surgical outcome in iTT.

ASPECTS OF THE ECOLOGY OF PHLEBOTOMINES (Diptera: Psychodidae: Phlebotominae) IN AN AREA OF CUTANEOUS LEISHMANIASIS OCCURRENCE, MUNICIPALITY OF ANGRA DOS REIS, COAST OF RIO DE JANEIRO STATE, BRAZIL / Aspectos da ecologia dos flebotomineos (Diptera: Psychodidae: Phlebotominae) em area de ocorrencia de leishmaniose tegumentar, Municipio de Angra dos Reis, orla maritima do estado do Rio de Janeiro, Brasil

Over a complete two-year period, phlebotomine specimens were caught in an area of cutaneous leishmaniasis occurrence in the municipality of Angra dos Reis. A manual suction tube was used to catch phlebotomines on house walls, and also light traps in domestic and peridomestic settings and in the forest. This yielded 14,170 specimens of 13 species: two in the genus Brumptomyia and eleven in the genus Lutzomyia. L. intermedia predominantly in domestic and peridomestic settings, with little presence in the forest, with the same trend being found in relation to L. migonei, thus proving that these species have adapted to the human environment. L. fischeri appeared to be eclectic regarding location, but was seen to be proportionally more endophilic. L. intermedia and L. migonei were more numerous in peridomestic settings, throughout the year, while L. fischeri was more numerous in domestic settings except in March, April, May and September. From the prevalence of L. intermedia, its proven anthropophily and findings of this species naturally infected with Leishmania (Viannia) braziliensis, it can be incriminated as the main vector for this agent of cutaneous leishmaniasis in the study area, especially in the peridomestic environment. L. fischeri may be a coadjuvant in carrying the parasite.

Durante dois anos completos foram feitas capturas de flebotomíneos em área de leishmaniose tegumentar no município de Angra dos Reis. Utilizou-se tubo de sucção manual, para as capturas dos flebotomíneos pousados nas paredes da casa, além de armadilhas luminosas, no domicílio, peridomicílio e na mata. Foram obtidos 14.170 exemplares, de treze espécies, duas do gênero Brumptomyia França & Parrot 1921 e onze do gênero Lutzomyia França 1924. L. intermedia teve supremacia no peridomicílio e no domicílio, com pouca presença na mata, o mesmo ocorreu com L. migonei, comprovando a adaptação dessas espécies ao ambiente humano. L. fischeri aparece com característica eclética quanto ao local, mostrando-se proporcionalmente mais endófila. L. intermedia e L. migonei foram mais numerosas no peridomicílio, durante todos os meses do ano, enquanto L. fischeri, excetuando os meses de março, abril, maio e setembro, foi mais numerosa no domicílio. Pela prevalência, comprovada antropofilia e por ter sido encontrada infectada naturalmente por Leishmania (Viannia) braziliensis, L. intermedia pode ser incriminada como o principal vetor desse agente da leishmaniose tegumentar na área de estudo, sobretudo no ambiente peridomiciliar. L. fischeri, pelas características apresentadas, pode ser um coadjuvante na veiculação do parasita.

Ocorrência de larvas de Aedes albopictus (SKUSE) (Diptera, Culicidae), em recipiente artificial, na ilha de Marambaia, Mangaratiba, RJ, Brasil / Occurrence of Aedes albopictus (SKUSE,1894) (Diptera, Culicidae) larvae, in an artificial container, im Marambaia island, Mangaratiba, RJ, Brazil

Registra-se o encontro de Aedes albopictus Skuse, 1894, na praia do Sino, ilha da Marambaia (CADIM), Mangaratiba, RJ, em um recipiente artificial (copo plástico) sobre uma pedra na beira da praia. Ressalta-se a sua importância epidemiológica e ecológica.