Brazilian Dialysis Census: analysis of data from the 2009-2018 decade / Censo Brasileiro de Diálise: análise de dados da década 2009-2018

ABSTRACT Introduction: National data on chronic dialysis treatment are essential for the development of health policies that aim to improve patient treatment. Objective: To present data from the Brazilian Society of Nephrology on patients with chronic dialysis for kidney disease in July 2018, making a comparative analysis of the past 10 years. Methods: Data collection from dialysis units, with filling in an online questionnaire for 2018. Data from 2009, 2013 and 2018 were compared. Results: 288 (36.6%) centers answered the questionnaire. In July 2018, the estimated total number of patients on dialysis was 133,464. Estimates of the prevalence and incidence rates of patients undergoing dialysis treatment per million of the population (pmp) were 640 and 204, respectively, with average annual increases of 23.5 pmp and 6 pmp for prevalence and incidence, respectively. The annual gross mortality rate was 19.5%. Of the prevalent patients, 92.3% were on hemodialysis and 7.7% on peritoneal dialysis, with 29,545 (22.1%) on the waiting list for transplantation. Median bicarbonate concentration in the hemodialysis bath was 32 mEq/L. Venous catheters were used as access in 23.6% of the hemodialysis patients. The prevalence rate of positive serology for hepatitis C showed a progressive reduction (3.2%). Conclusion: The absolute number of patients and rates of incidence and prevalence in dialysis in the country increased substantially in the period, although there are considerable differences in rates by state. There has been a persistent increase in the use of venous catheters as an access for dialysis; and reduction in the number of patients with positive serology for hepatitis C.

RESUMO Introdução: Dados nacionais sobre o tratamento dialítico crônico são essenciais para a elaboração de políticas de saúde que almejem melhora no tratamento dos pacientes. Objetivo: Apresentar dados do inquérito da Sociedade Brasileira de Nefrologia sobre pacientes com doença renal crônica dialítica em julho de 2018, fazendo análise comparativa dos últimos 10 anos. Métodos: Coleta de dados a partir das unidades de diálise, com preenchimento de questionário on-line referentes a 2018. Foram comparados dados de 2009, 2013 e 2018. Resultados: 288 (36,6%) centros responderam ao questionário. Em julho de 2018, o número total estimado de pacientes em diálise foi de 133.464. Estimativas das taxas de prevalência e incidência de pacientes em tratamento dialítico por milhão da população (pmp) foram de 640 e 204, respectivamente, com médias de aumento anuais de 23,5 pmp e 6 pmp para prevalência e incidência, respectivamente. Taxa anual de mortalidade bruta foi de 19,5%. Dos pacientes prevalentes, 92,3% estavam em hemodiálise e 7,7%, em diálise peritoneal, com 29.545 (22,1%) em fila de espera para transplante. Concentração mediana de bicarbonato no banho de hemodiálise foi de 32 mEq/L. Cateter venoso era usado como acesso em 23,6% dos pacientes em hemodiálise. Taxa de prevalência de sorologia positiva para hepatite C apresentou redução progressiva (3,2%). Conclusão: Número absoluto de pacientes e taxas de incidência e prevalência em diálise no país aumentaram substancialmente no período, embora haja diferenças consideráveis nas taxas por estado. Tem havido persistente aumento no uso de cateter venoso como acesso para diálise; e redução de pacientes com sorologia positiva para hepatite C.

Equilíbrio ácido-básico de embriões e pintos de corte em momentos críticos da incubação e submetidos a diferentes períodos de transferência para o nascedouro / Acid-base balance of embryos and broiler chicks in critical moments of incubation and submitted to different periods of transfer to the hatcher

Foram analisados os níveis de pCO2, pO2, pH e HCO3 - de embriões e pintos de corte provenientes de matrizes novas e velhas, nos momentos anteriores à bicagem interna e externa da casca e ao nascimento, submetidos a diferentes períodos de transferência para as condições ambientais dos nascedouros. Os tratamentos foram definidos pela idade da matriz (33 e 63 semanas) e pela transferência para o nascedouro (aos 15, 17 e 19 dias). O delineamento experimental foi em parcelas subdivididas, sendo a parcela os três momentos de transferência e a subparcela as duas idades das matrizes. Foram utilizadas seis repetições para cada tratamento, e o embrião ou o pinto foi considerado uma repetição. Os dados normais e homogêneos foram submetidos às análises de variância, e as médias comparadas pelos testes F, de Tukey e SNK. Embriões cujos ovos foram transferidos aos 15 dias para o nascedouro apresentaram melhor equilíbrio ácido-básico durante as fases pré-natal e perinatal. Durante o último terço da incubação, independentemente das diferentes condições ambientais às quais os embriões são submetidos e da idade da matriz, há capacidade de resposta fisiológica que permite uma estabilidade no equilíbrio ácido-básico dos pintos após a eclosão...

We analyzed the levels of pCO2, pO2, pH and HCO3 - in embryos and chicks from young and older breeders, in the moments before internal pipping, external pipping and at hatch and submitted to different periods in the environmental conditions of hatchers. The treatments were defined by breeder age (33 and 63 weeks) and transfer to the hatcher (at 15, 17 and 19 days). The experimental design was split plots with three periods in the hatcher and the plots were the two breeder ages. We used six replicates per treatment and the embryo or chick was considered a repetition. The normal data forms were submitted to analysis of variance and means were compared by F, Tukey and SNK tests. Embryos transferred at 15 days to the hatcher had better acid-base balance during the pre-and perinatal phases. During the last third of incubation, regardless of the different environmental conditions which the embryos are subjected and breeder age, there is physiological responsiveness that allows for stability in acid-base balance of the chicks after hatching...

Bicarbonato/CO2 aumenta dano em isquemia-reperfusão: da observação inicial à caracterização molecular / Bicarbonate/CO2 increase damage in ischemia-reperfusion injury: from observation to molecular characterization

Bicarbonato é uma importante espécie química para os seres vivos, sendo o principal tampão celular, alem de apresentar uma negligenciada atividade redox. Isquemia é um evento no qual existe inibição do aporte de nutrientes e oxigênio, sendo a reperfusão o retorno do fluxo de nutrientes e oxigênio, que é acompanhada por alta produção de radicais livres e morte celular. Nessa tese estudamos o efeito da presença de bicarbonato durante a isquemia-reperfusão. Em nosso modelo nós mantivemos o pH constante e modulamos a quantidade de bicarbonato enquanto células, órgãos e animais foram submetidos a isquemia-reperfusão. Utilizamos condições sem a presença de bicarbonato, a concentração basal sanguínea e uma concentração mais alta simulando o acúmulo de bicarbonato em condições isquêmicas. Nesses diversos modelos mostramos que a presença de bicarbonato aumenta o dano provocado por isquemia-reperfusão e provoca um aumento do acúmulo de proteínas oxidadas. A presença do bicarbonato não modifica a respiração, produção de espécies reativas de oxigênio, ou a morfologia mitocondrial, também não detectamos mudança na atividade do proteassoma e nos indicadores de autofagia geral. Entretanto detectamos um acúmulo de marcadores autofágicos na fração mitocondrial indicando inibição da mitofagia. Essa inibição foi confirmada ao detectarmos o acúmulo de uma proteína degradada especificamente por mitofagia enquanto não houve mudança em outra degradada pelo proteassoma. Além disso, ao inibirmos farmacologicamente a autofagia, reproduzimos o fenótipo causado pelo bicarbonato mesmo na sua ausência. Em conclusão, a presença de bicarbonato é deletéria em condições de isquemia/reperfusão devido a inibição da mitofagia

Bicarbonate is an important molecule in all living being, acting as the main cellular buffer. However, its biological and redox activity has been mostly neglected to date. Ischemia is an event in which an inhibition of nutrient availablity and oxygen flow occurs, while reperfusion is the return of nutrients and oxygen, accompanied of a burst of reactive oxygen species production and cell death. Here, we studied the effects of bicarbonate during cardiac ischemia-reperfusion. In our model, we kept the pH stable and changed the concentration of the bicarbonate. We then subjected cells, organs and animals to ischemia-reperfusion under conditions where there was no presence, basal blood concentration or a higher concentration of bicarbonate. In these diverse models, we found that the presence of bicarbonate increased damage after a ischemia-reperfusion, and promoted the accumulation of oxidized proteins. Bicarbonate did not change respiration, production of reactive oxygen species or the morphology of the mitochondria. There were also no changes in proteasome activity and in global autophagy markers, although there was an accumulation of mitophagy markers. We also found that mitophagy was responsible for the increased damage observed, since pharmacological inhibiting of autophagy abolished the increased damage caused by the presence of bicarbonate. In conclusion the presence of bicarbonate is deleterious in ischemia-reperfusion due mitophagy inhibition

Estudios ácido-básicos: interpretación clínica básica / Acid-base balance: practical clinical interpretation

The aim of this report is to describe how to calculate if an acid-base balance is trustworthy.

Base excess significantly corrected for the variations in apparent dissociation constant for human blood gas testing.

We introduce a pragmatic approach towards the corrected Base Excess (BE) by including the large variability of the apparent dissociation constant pK' in non-logarithmic form in Henderson-Hasselbach bicarbonate ion equilibria thereby resulting in a significant correction both in calculated bicarbonate ion concentration and BE at 37 degrees C.

Standard WHO-ORS versus reduced-osmolarity ORS in the management of cholera patients.

The study compared the safety and efficacy of an oral rehydration salts (ORS) solution, containing 75 mmol/L of sodium and glucose each, with the standard World Health Organization (WHO)-ORS solution in the management of ongoing fluid losses, after initial intravenous rehydration to correct dehydration. The study was conducted among patients aged 12-60 years hospitalized with diarrhoea due to cholera. One hundred seventy-six patients who were hospitalized with acute diarrhoea and signs of severe dehydration were rehydrated intravenously and then randomly assigned to receive either standard ORS solution (311 mmol/L) or reduced-osmolarity ORS solution (245 mmol/L). Intakes and outputs were measured every six hours until the cessation of diarrhoea. During maintenance therapy, stool output, intake of ORS solution, duration of diarrhoea, and the need for unscheduled administration of intravenous fluids were similar in the two treatment groups. The type of ORS solution that the patients received did not affect the mean serum sodium concentration at 24 hours after randomization and the relative risk of development of hyponatraemia. However, patients treated with reduced-osmolarity ORS solution had a significantly lower volume of vomiting and significantly higher urine output than those treated with standard WHO-ORS solution. Reduced-osmolarity ORS solution was as efficacious as standard WHO-ORS solution in the management of cholera patients. The results indicate that reduced-osmolarity ORS solution is also as safe as standard WHO-ORS solution. However, because of the limited sample size in the study, the results will have to be confirmed in trials, involving a larger number of patients.

Ground water contamination in the area adjoining zinc smelter effluent stream.

A preliminary survey of the area adjoining to zinc smelter effluent stream was undertaken to assess ground water contamination. Twenty-five ground water samples from the wells located in the study area were collected and grouped into nine groups based on their lateral and longitudinal position from the stream carrying the effluent discharged from zinc smelter, Debari- Udaipur. The study indicate that waters of wells situated in the vicinity of effluent stream (255m radius) were of medium salinity having higher levels of Ca and Mg and lower values of pH as compared to the waters of the reference wells situated far away from the effluent stream. The Fe, Zn, Cd, Cl, F and SO4 contents ofthe water from the wells located within 80m vicinity of the effluent stream were above the permissible limits for drinking purposes. Furthermore the Zn, Cl and SO4 levels in these waters were so high that they were even not suitable for irrigation, indicating a gradual encroachment of effluent into the native ground water.

Analysis of human pancreatic juice in tests of pancreatic function

No abstract available.

Chemical characteristics of the water of Chascomús pond (Província de Buenos Aires, Argentina): limnological implications

As características químicas das águas da lagoa de Chascomús foram as correspondentes a oligoalina (média dos sólidos totais dissolvidos 649 mg/l), alcalina (pH médio 8,6) e do tipo bicarbonatada sódica clorada. Esta lagoa encontrou-se, quase que em permanente circulaçäo vertical o que determinou saturaçäo de oxigênio dissolvido próximo ao fundo. Tal circulaçäo vertical promoveu a existência de uma alta concentraçäo de material em suspensäo (valor médio 112,8 mg/l), o que afetou uem grande parte a transmissäo da luz da coluna de água. A concentraçäo de nutrientes (concentraçäo média de nitrogênio total 1,56 mg N/l, e de fósforo total 249 microng P/l) e pigmentos (concentraçäo média de clorofila a 25,3 microng/l indicaram que este corpo d'água apresentou um elevado grau de trofia. Os valores da relaçäo nitrogênio total/fósforo total sugeriram a limitaçäo de nitrogênio, em relaçäo ao fósforo, para o crescimento algal. A matéria orgânica solúvel foi elevada e atingiu, medida em termos de demanda química de oxigênio, uma média de 13,4 mg de oxigênio consumido por litro. Fenômenos tais como as elevadas precipitaçöes ocorridas no período de estudo provocaram mudanças importantes nas características químicas da água

A study of pancreatic enzymes by duodenal intubation in normal subjects after prostigmine administration.

Twenty healthy subjects have been selected for the present study. There was significant parallelism between trypsin and lipase secretion but frequent dissociation between trypsin and amylase. Lower values of pancreatic volume, bicarbonate and enzymes secretion as compared to the Western reports are explained by the lower weight of Indians in comparison to Western people. Prostigmine an inexpensive and reliable alternative to pancreozmin is recommended for routine clinical studies of pancreatic enzymes.