Comparative analysis between mercury levels in fish tissues evaluated using direct mercury analyzer and inductively plasma-coupled mass spectrometer.

Recent ecotoxicological studies have indicated mercury (Hg) contamination in aquatic ecosystems in the Amazon Basin. Although Hg contamination can be associated with small-scale gold mining, the soils of the Amazon region have naturally high Hg concentrations, and can be transported to aquatic ecosystems via deforestation and mining activities. Biomagnification of Hg can pose risks to the local human population; therefore, its concentration in fish tissues must be monitored consistently. Fast and sensitive Hg determination is required for continuously monitoring ecosystems impacted by mineral exploration. The direct mercury analyzer (DMA-80) is widely used for determining total Hg levels in tissue samples; it is fast and cost-effective, without requiring sample preparation. Here, we determined the sensitivity and specificity of Hg detection accomplished using DMA-80, and whether these results are reliable compared to those obtained using Inductively Coupled Plasma Mass Spectrometer (ICP-MS), which is the gold standard. We obtained 106 paired dried samples of muscle tissue from fish species occupying different trophic levels in the Lower Amazon region, and analyzed them using both equipment (DMA-80 and ICP-MS). The results obtained using DMA-80 had an overall Hg mean of 1.90 ± 0.18 mg/kg which was higher (p < 0.05) than the mean of those obtained using ICP-MS (1.55 ± 0.13 mg/kg). Linear regression analysis comparing the Hg levels obtained using both devices was within the 95% prediction interval, and a high coefficient of correlation showed agreement between the devices (r = 0.979; 0.069 to 0.986, 95% CI). Bland-Altman analysis showed that DMA-80 had a positive bias of 6.5% in relation to ICP-MS, which is more evident in samples with high Hg concentrations. DMA-80 was efficient in determining whether the Hg levels exceeded the maximum allowed levels required by the European Union, USA, and Brazil, showing a specificity and sensitivity of above 95%.

Structural analysis of the Trypanosoma brucei EIF4E6/EIF4G5 complex reveals details of the interaction between unusual eIF4F subunits.

Recognition of the mRNA 5' end is a critical step needed for translation initiation. This step is performed by the cap binding protein eIF4E, which joins the larger eIF4G subunit to form the eIF4F complex. Trypanosomatids have a minimum of five different eIF4F-like complexes formed through specific but not well-defined interactions between four different eIF4E and five eIF4G homologues. The EIF4E6/EIF4G5 complex has been linked with the stage-specific translation of mRNAs encoding the major Trypanosoma brucei virulence factors. Here, to better define the molecular basis for the TbEIF4E6/TbEIF4G5 interaction, we describe the identification of the peptide interacting with TbEIF4E6 in the region comprising residues 79-166 of TbEIF4G5. The TbEIF4E6-TbEIF4G5_79-116 complex reconstituted with recombinant proteins is highly stable even in the absence of cap-4. The crystal structure of the complex was subsequently solved, revealing extensive interacting surfaces. Comparative analyses highlight the conservation of the overall structural arrangement of different eIF4E/eIF4G complexes. However, highly different interacting surfaces are formed with distinct binding contacts occurring both in the canonical and noncanonical elements within eIF4G and the respective eIF4E counterpart. These specific pairs of complementary interacting surfaces are likely responsible for the selective association needed for the formation of distinct eIF4F complexes in trypanosomatids.

Diagnostic Potential for the Detection of Canine Visceral Leishmaniasis of an ELISA Assay Based on the Q5 Recombinant Protein: A Large-Scale and Comparative Evaluation Using Canine Sera with a Positive Diagnosis from the Dual-Path-Platform (DPP) Test.

Dogs are considered the major domestic reservoir for human visceral leishmaniasis, a serious disease caused by the Leishmania infantum parasite. Diagnosis of canine visceral leishmaniasis (CVL) is critical for disease control, with several methods currently available. Among the serological tests, the DPP rapid test and the EIE-LVC, more commonly used in Brazil, are associated with variable sensitivity and specificity. Research with novel recombinant proteins such as the ELISA with the recombinant chimeric protein Q5 may therefore improve the CVL diagnosis. This study aimed to evaluate the true diagnostic potential of Q5 in an ELISA assay using a large number of CVL-suspected sera (406) with a previous positive diagnosis based on the rapid DPP test. Sera from the DPP-positive dogs, also assessed with the EIE-LVC test, were compared with sera from healthy dogs (n = 46) and used for ELISA tests using the recombinant Q5. The resulting data as well as the correlation with the clinical signs and the environmental characteristics of the animals were analyzed using Medal and GraphPad Prism 8.0. Overall, similar levels of lower sensitivity (67-68%) were seen for both the commercial EIE-LVC test and the Q5 ELISA when all assessed sera were considered, but a much greater sensitivity (92%) was seen for those samples from symptomatic dogs only. In contrast, many negative results were observed for the DPP-positive sera from asymptomatic dogs or those with no clinical information available. A selection of those sera were tested yet again in new ELISA assays using a second batch of the recombinant Q5, purified under milder denaturing conditions, as well as using another recombinant protein (Lci13). The results reveal a higher-than-expected incidence of likely false-positive results for DPP, reinforcing the need for other recombinant proteins, such as the chimeric Q5, to be investigated as possible alternatives to the currently used CVL diagnostic methods.

Brazilian Dialysis Survey 2021 / Censo Brasileiro de Diálise 2021

ABSTRACT Introduction: The Brazilian Dialysis Survey (BDS) is an important source of national data about people on chronic dialysis that contributes to the formulation of health policies regarding kidney failure. Objective: To report the 2021 epidemiological data from the BDS of the Brazilian Society of Nephrology (BSN). Methods: A survey was carried out in Brazilian chronic dialysis centers using an online questionnaire covering clinical and epidemiological aspects of patients in chronic dialysis, data on dialysis therapy, characteristics of dialysis centers, and the impact of the COVID-19 pandemic of 2021. Results: Thirty percent (n = 252) of the centers answered the questionnaire. In July 2021, the estimated total number of patients on dialysis was 148,363. The estimated prevalence and incidence rates of patients per million population (pmp) were 696 and 224, respectively. Of the prevalent patients, 94.2% were on hemodialysis (HD) (1.8% of these on hemodiafiltration), and 5.8% on peritoneal dialysis (PD); 21% were on the transplant waiting list. The incidence rate of confirmed COVID-19 between January and July 2021 was 1,236/10,000 dialysis patients, and the case-fatality rate reached 25.5%. Up to July 2021, 88.6% of patients had received at least one dose of the anti-SARS-CoV-2 vaccine. The estimated overall and COVID-19 crude annual mortality rates were 22.3% and 5.3%, respectively. Conclusion: The absolute number and the prevalence rate of patients on chronic dialysis continue to increase. Most dialysis patients were vaccinated against COVID-19 during the year. The COVID-19 pandemic was associated to the overall mortality rate.

RESUMO Introdução: O Censo Brasileiro de Diálise (CBD) constitui importante fonte de dados nacionais sobre pessoas em diálise crônica que contribui para a formulação de políticas de saúde. Objetivo: Relatar dados epidemiológicos de 2021 do CBD da Sociedade Brasileira de Nefrologia (SBN). Métodos: Realizou-se pesquisa em centros brasileiros de diálise crônica utilizando questionário online abrangendo aspectos clínicos e epidemiológicos de pacientes em diálise crônica, dados sobre terapia dialítica, características dos centros de diálise e o impacto da pandemia COVID-19 em 2021. Resultados: Trinta por cento (n = 252) dos centros responderam ao questionário. Em Julho de 2021, o número total estimado de pacientes em diálise foi 148.363. As taxas estimadas de prevalência e incidência de pacientes por milhão da população (pmp) foram 696 e 224, respectivamente. Dos pacientes prevalentes, 94,2% estavam em hemodiálise (HD) (1,8% destes em hemodiafiltração), e 5,8% em diálise peritoneal (DP); 21% estavam na lista de espera para transplante. A taxa de incidência de COVID-19 confirmada entre Janeiro e Julho de 2021 foi 1.236/10.000 pacientes em diálise, e a taxa de letalidade atingiu 25,5%. Até Julho de 2021, 88,6% dos pacientes haviam recebido pelo menos uma dose da vacina anti-SARS-CoV-2. As taxas estimadas de mortalidade bruta anual geral e por COVID-19 foram de 22,3% e 5,3%, respectivamente. Conclusão: O número absoluto e a taxa de prevalência de pacientes em diálise crônica continuam aumentando. A maioria dos pacientes em diálise foram vacinados contra COVID-19 durante o ano. A pandemia COVID-19 contribuiu com a taxa de mortalidade geral.

Prevalence and Determinants of Predialysis Dietitian Follow-Up: Results From the Brazilian Dialysis Registry.

OBJECTIVE: We aimed to evaluate the prevalence and sociodemographic determinants of predialysis dietitian follow-up in a large cohort of Brazilian dialysis patients. METHODS: We retrospectively evaluated data from all incident adult dialysis patients included in the Brazilian Dialysis Registry from January 2011 to September 2021. Predialysis dietitian follow-up was classified as present when a period more than 6 months of dietitian care was reported. Gender, age, skin color, education, body mass index, chronic kidney disease etiology, first chronic dialysis program, healthcare provider, and geographic regions were tested in logistic regression models. RESULTS: Ten thousand three hundred and eighty two patients met the inclusion criteria and 1,254 (12.1%) reported predialysis dietitian follow-up, most of them referred by a nephrologist (94.2%). The independent determinants of dietitian follow-up were older age, white skin color, higher education level, not having diabetes, living in North/Northeast and South (compared to Southeast), and having a nonpublic healthcare provider. When considered only patients under a predialysis care of a nephrologist, higher education, hemodialysis as the first dialysis modality, and living in the North/Northeast and South regions (compared with Southeast) were associated with dietitian follow-up. CONCLUSION: Predialysis dietitian follow-up for more than 6 months in a country where the public health system is the main dialysis provider is still very low. The nephrologist is pivotal for referral to dietitians but socioeconomic factors also seem to play a role in this regard.

Brazilian Dialysis Survey 2021.

INTRODUCTION: The Brazilian Dialysis Survey (BDS) is an important source of national data about people on chronic dialysis that contributes to the formulation of health policies regarding kidney failure. OBJECTIVE: To report the 2021 epidemiological data from the BDS of the Brazilian Society of Nephrology (BSN). METHODS: A survey was carried out in Brazilian chronic dialysis centers using an online questionnaire covering clinical and epidemiological aspects of patients in chronic dialysis, data on dialysis therapy, characteristics of dialysis centers, and the impact of the COVID-19 pandemic of 2021. RESULTS: Thirty percent (n = 252) of the centers answered the questionnaire. In July 2021, the estimated total number of patients on dialysis was 148,363. The estimated prevalence and incidence rates of patients per million population (pmp) were 696 and 224, respectively. Of the prevalent patients, 94.2% were on hemodialysis (HD) (1.8% of these on hemodiafiltration), and 5.8% on peritoneal dialysis (PD); 21% were on the transplant waiting list. The incidence rate of confirmed COVID-19 between January and July 2021 was 1,236/10,000 dialysis patients, and the case-fatality rate reached 25.5%. Up to July 2021, 88.6% of patients had received at least one dose of the anti-SARS-CoV-2 vaccine. The estimated overall and COVID-19 crude annual mortality rates were 22.3% and 5.3%, respectively. CONCLUSION: The absolute number and the prevalence rate of patients on chronic dialysis continue to increase. Most dialysis patients were vaccinated against COVID-19 during the year. The COVID-19 pandemic was associated to the overall mortality rate.

Chronic hemodialysis patients with COVID-19 cared for by the public health system have higher mortality than those treated in private facilities: analysis of the Brazilian dialysis registry.

PURPOSE: Brazil is the third country globally in dialysis patients. Little is known about the impact of the type of health insurance on the outcome of these patients after COVID-19. METHODS: We analyzed comorbidities, sociodemographic factors, and dialysis-related parameters from a retrospective cohort study of 1866 Brazilian chronic hemodialysis patients with COVID-19 from Feb 2020-July 2021. We evaluated the influence of health insurance (private vs. public) on the intensive care unit admission and 90 day fatality risk. RESULTS: From 1866 hemodialysis patients, 455 (24%) were admitted to the intensive care unit, and 350 (19%) died. The mean age was 57.5 years, 88% had public health insurance. Crude case-fatality rate was not different between groups (private vs. public risk ratio 1.11; 95% CI 0.82-1.52, p = 0.498). In fully adjusted multivariate models, patients with private health insurance did not have a higher chance to be admitted to an intensive care unit (odds ratio 0.97; 95% CI 0.63-1.50, p = 0.888), but they presented a lower death risk (hazard ratio 0.56; 95% CI 0.37-0.85, p = 0.006). CONCLUSION: The type of health insurance did not influence the access of hemodialysis patients with COVID-19 to an intensive care unit, but patients with private health insurance had a lower mortality risk.

Culex quinquefasciatus Resistant to the Binary Toxin from Lysinibacillus sphaericus Displays a Consistent Downregulation of Pantetheinase Transcripts.

Culex quinquefasciatus resistance to the binary (Bin) toxin, the major larvicidal component from Lysinibacillus sphaericus, is associated with mutations in the cqm1 gene, encoding the Bin-toxin receptor. Downregulation of the cqm1 transcript was found in the transcriptome of larvae resistant to the L. sphaericus IAB59 strain, which produces both the Bin toxin and a second binary toxin, Cry48Aa/Cry49Aa. Here, we investigated the transcription profiles of two other mosquito colonies having Bin resistance only. These confirmed the cqm1 downregulation and identified transcripts encoding the enzyme pantetheinase as the most downregulated mRNAs in both resistant colonies. Further quantification of these transcripts reinforced their strong downregulation in Bin-resistant larvae. Multiple genes were found encoding this enzyme in Cx. quinquefasciatus and a recombinant pantetheinase was then expressed in Escherichia coli and Sf9 cells, with its presence assessed in the midgut brush border membrane of susceptible larvae. The pantetheinase was expressed as a ~70 kDa protein, potentially membrane-bound, which does not seem to be significantly targeted by glycosylation. This is the first pantetheinase characterization in mosquitoes, and its remarkable downregulation might reflect features impacted by co-selection with the Bin-resistant phenotype or potential roles in the Bin-toxin mode of action that deserve to be investigated.

Pediatric peritoneal dialysis in Brazil: a discussion about sustainability. A document by the Brazilian Society of Nephrology, the Brazilian Society of Pediatrics, the Brazilian Association of Organ Transplantation, and the Brazilian Association of Dialysis and Transplant Centers / Diálise peritoneal pediátrica no Brasil: momento de discutir a sustentabilidade. Um documento da Sociedade Brasileira de Nefrologia, Sociedade Brasileira de Pediatria, Associação Brasileira de Transplante de Órgãos e Associação Brasileira de Centros de Diálise e Transplante

Abstract Introdução: A diálise peritoneal (DP) é importante para a pediatria. Este estudo mostrou dados de centros brasileiros que utilizam DP pediátrica. Método: Estudo transversal, observacional, descritivo com questionário eletrônico. Incluiu-se pacientes de 0-18 anos em DP cadastrados nos bancos de dados dos diversos centros. Questionário preenchido anonimamente, sem dados de identificação. Foi adotada metodologia quantitativa. Resultados: 212 pacientes estão em DP no Brasil (agosto, 2021). 80% têm menos de 12 anos de idade. A maioria realiza DP automatizada e 74% são dependentes do Sistema Único de Saúde. Em 25% dos centros faltou material de DP e em 51% os pacientes pediátricos foram convertidos de DP para HD. Conclusão: A maioria dos pacientes tinha menos de 12 anos e era dependente do SUS. A escassez de insumos aconteceu em 25% dos centros. Esses dados apontam para o problema da sustentabilidade de DP, única alternativa de TRS em crianças muito pequenas.

Resumo Introdução: A diálise peritoneal (DP) é importante para a pediatria. Este estudo mostrou dados de centros brasileiros que utilizam DP pediátrica. Método: Estudo transversal, observacional, descritivo com questionário eletrônico. Incluiu-se pacientes de 0-18 anos em DP cadastrados nos bancos de dados dos diversos centros. Questionário preenchido anonimamente, sem dados de identificação. Foi adotada metodologia quantitativa. Resultados: 212 pacientes estão em DP no Brasil (agosto, 2021). 80% têm menos de 12 anos de idade. A maioria realiza DP automatizada e 74% são dependentes do Sistema Único de Saúde. Em 25% dos centros faltou material de DP e em 51% os pacientes pediátricos foram convertidos de DP para HD. Conclusão: A maioria dos pacientes tinha menos de 12 anos e era dependente do SUS. A escassez de insumos aconteceu em 25% dos centros. Esses dados apontam para o problema da sustentabilidade de DP, única alternativa de TRS em crianças muito pequenas.

Gene Expression and Immunochemistry Analysis of ADAMTS-1 and Versican in Ameloblastoma.

Background: Ameloblastoma is a benign but locally invasive odontogenic epithelial tumor, associated with a high recurrence rate after treatment. The action of enzymes of the metalloproteinase family is important to the degraded extracellular matrix, contributing to invasion. Thus, this study aimed to investigate the gene and protein expression of ADAMTS-1 and versican in ameloblastoma. Materials and Methods: Twenty cases of ameloblastoma (n = 20) and ten dental follicles (DF) (n = 10) were used as a source for immunochemistry and quantitative RT-PCR for determining the protein and mRNA expressions of the concerned genes, respectively. Moreover, western blot and indirect immunofluorescence analysis were performed in AME cells. Results: ADAMTS-1 and versican were overexpressed in DF than ameloblastoma by RT-PCR. However, in the immunolocalization analysis, ADAMTS-1 was expressed in ameloblastoma more than in DF and versican immunostaining obtained a similar pattern between ameloblastoma and DF. Indirect immunofluorescence detected the ADAMTS-1 and versican expression in cell lines derived from ameloblastoma. Western blot from cell lysate and conditioned medium detected ADAMTS-1 bands representing full-length and different processed forms. Monensin treatment confined ADAMTS-1 in the cell cytoplasm. Versican fragments also were detected in different compartments, intracellular and conditioned medium, allowing the versican process by ADAMTS-1. Conclusion: This study showed a distinct expression of ADAMTS-1 and versican in ameloblastoma and DF, with ADAMTS-1 protein higher expression observed in ameloblastoma and possibly cleaved versican. These findings suggested that ADAMTS-1 may participate in tumor invasion, especially for the degradation of substrates (versican) in the ECM.

Distinct mRNA and protein interactomes highlight functional differentiation of major eIF4F-like complexes from Trypanosoma brucei.

Gene expression in pathogenic protozoans of the family Trypanosomatidae has several novel features, including multiple eIF4F-like complexes involved in protein synthesis. The eukaryotic eIF4F complex, formed mainly by eIF4E and eIF4G subunits, is responsible for the canonical selection of mRNAs required for the initiation of mRNA translation. The best-known complexes implicated in translation in trypanosomatids are based on two related pairs of eIF4E and eIF4G subunits (EIF4E3/EIF4G4 and EIF4E4/EIF4G3), whose functional distinctions remain to be fully described. Here, to define interactomes associated with both complexes in Trypanosoma brucei procyclic forms, we performed parallel immunoprecipitation experiments followed by identification of proteins co-precipitated with the four tagged eIF4E and eIF4G subunits. A number of different protein partners, including RNA binding proteins and helicases, specifically co-precipitate with each complex. Highlights with the EIF4E4/EIF4G3 pair include RBP23, PABP1, EIF4AI and the CRK1 kinase. Co-precipitated partners with the EIF4E3/EIF4G4 pair are more diverse and include DRBD2, PABP2 and different zinc-finger proteins and RNA helicases. EIF4E3/EIF4G4 are essential for viability and to better define their role, we further investigated their phenotypes after knockdown. Depletion of either EIF4E3/EIF4G4 mRNAs lead to aberrant morphology with a more direct impact on events associated with cytokinesis. We also sought to identify those mRNAs differentially associated with each complex through CLIP-seq with the two eIF4E subunits. Predominant among EIF4E4-bound transcripts are those encoding ribosomal proteins, absent from those found with EIF4E3, which are generally more diverse. RNAi mediated depletion of EIF4E4, which does not affect proliferation, does not lead to changes in mRNAs or proteins associated with EIF4E3, confirming a lack of redundancy and distinct roles for the two complexes.

Effect of Salinity and Silicon Doses on Onion Post-Harvest Quality and Shelf Life.

Salt stress during pre-harvest limits the shelf life and post-harvest quality of produce; however, silicon nutrition can mitigate salt stress in plants. Thus, we evaluated the effects of salinity and fertilization with Si, in pre-harvest, on the morpho-physiological characteristics of onion bulbs during shelf life. The experiment was set up in randomized complete blocks, with treatments arranged in split-split plots. The plots had four levels of electrical conductivity of irrigation water (0.65, 1.7, 2.8, and 4.1 dS m-1). The subplots had five fertilization levels with Si (0, 41.6, 83.2, 124.8, and 166.4 kg ha-1). The sub-sub plots had four shelf times (0, 20, 40, and 60 days after harvest). Irrigation water salinity and shelf time reduced firmness and increased the mass loss of onion bulbs during shelf life. Salt stress reduced the contents of sugars and total soluble solids of onion bulbs during storage; however, Si supply improved the contents of these variables. Salinity, Si supply, and shelf time increased the concentrations of pyruvic and ascorbic acids in onion bulbs during shelf life. Si doses between 121.8 and 127.0 kg ha-1 attenuated the impacts caused by moderate salinity, increasing the synthesis of metabolites and prolonging the onion bulbs' shelf life.

Brazilian Dialysis Survey 2020 / Censo Brasileiro de Diálise 2020

Abstract Introduction: National data on chronic dialysis treatment are essential to support the development of health policies aimed at improving the treatment for thousands of people. Objective: To report epidemiological data from the 2020 Brazilian Dialysis Survey, sponsored by the Brazilian Society of Nephrology. Methods: A survey was carried out in Brazilian chronic dialysis centers using an online questionnaire for the year, covering clinical and epidemiological aspects of patients in a chronic dialysis program, data on dialysis therapy, characteristics of dialysis units and the impact of the COVID-19 pandemic. Results: 235 (28%) of the centers responded to the questionnaire. In July 2020, the estimated total number of patients on dialysis was 144,779. The estimated prevalence and incidence rates of patients per million population (pmp) were 684 and 209, respectively. Of the prevalent patients, 92.6% were on hemodialysis (HD) and 7.4% were on peritoneal dialysis (PD); 23% were on the transplant waiting list. A central venous catheter was used by a quarter of patients on HD. The incidence rate of confirmed COVID-19 between February and July 2020 was 684/10,000 dialysis patients, and the lethality rate was 25.7%. The estimated overall mortality and COVID-19 crude annual mortality rates were 24.5 and 4.2%, respectively. Conclusion: The absolute number of patients on chronic dialysis and prevalence rate continued to increase. The low use of PD as dialysis therapy was maintained and the use of long-term catheters for HD increased. The COVID-19 pandemic contributed to the increase in the overall mortality rate.

Resumo Introdução: Dados nacionais sobre tratamento dialítico crônico são essenciais para apoiar o desenvolvimento de políticas de saúde destinadas a melhorar o tratamento de milhares de pessoas. Objetivo: Relatar dados epidemiológicos do Censo Brasileiro de Diálise 2020, patrocinado pela Sociedade Brasileira de Nefrologia. Métodos: Realizou-se pesquisa em centros brasileiros de diálise crônica utilizando questionário online relativo ao ano, abrangendo aspectos clínicos e epidemiológicos de pacientes em programa de diálise crônica, dados sobre terapia dialítica, características das unidades de diálise e impacto da pandemia COVID-19. Resultados: 235 (28%) centros responderam ao questionário. Em julho de 2020, o número total estimado de pacientes em diálise foi 144.779. As taxas estimadas de prevalência e incidência de pacientes por milhão da população (pmp) foram 684 e 209, respectivamente. Dos pacientes prevalentes, 92,6% estavam em hemodiálise (HD) e 7,4% em diálise peritoneal (DP); 23% estavam na lista de espera para transplante. Cateter venoso central foi utilizado por um quarto dos pacientes em HD. A taxa de incidência de COVID-19 confirmada entre fevereiro e julho de 2020 foi 684/10.000 pacientes em diálise, a taxa de letalidade foi 25,7%. As taxas estimadas de mortalidade geral e mortalidade bruta anual por COVID-19 foram 24,5 e 4,2%, respectivamente. Conclusão: O número absoluto de pacientes em diálise crônica e a taxa de prevalência continuaram a aumentar. O baixo uso de DP como terapia de diálise foi mantido e o uso de cateteres de longa permanência para HD aumentou. A pandemia COVID-19 contribuiu para o aumento da taxa de mortalidade geral.

Baseline characteristics and evolution of Brazilian patients with atypical hemolytic uremic syndrome: first report of the Brazilian aHUS Registry.

Background: Atypical hemolytic uremic syndrome (aHUS) is an ultra-rare disease. Therefore, studies involving large samples are scarce, making registries powerful tools to evaluate cases. We present herein the first analysis of the Brazilian aHUS Registry (BRaHUS). Methods: Analysis of clinical, laboratory, genetic and treatment data from patients inserted in the BRaHUS, from 2017 to 2020, as an initiative of the Rare Diseases Committee of the Brazilian Society of Nephrology. Results: The cohort consisted of 75 patients (40 adults and 35 pediatric). There was a predominance of women (56%), median age at diagnosis of 20.7 years and a positive family history in 8% of cases. Renal involvement was observed in all cases and 37% had low C3 levels. In the <2 years of age group, males were predominant. Children presented lower levels of hemoglobin (P = .01) and platelets (P = .003), and higher levels of lactate dehydrogenase (LDH) (P = .004) than adults. Genetic analysis performed in 44% of patients revealed pathogenic variants in 66.6% of them, mainly in CFH and the CFHR1-3 deletion. Plasmapheresis was performed more often in adults (P = .005) and 97.3% of patients were treated with eculizumab and its earlier administration was associated with dialysis-free after 3 months (P = .08). Conclusions: The cohort of BRaHUS was predominantly composed of female young adults, with renal involvement in all cases. Pediatric patients had lower hemoglobin and platelet levels and higher LDH levels than adults, and the most common genetic variants were identified in CFH and the CFHR1-3 deletion with no preference of age, a peculiar pattern of Brazilian patients.

Challenges of Conducting Clinical Trials during the SARS-CoV-2 Pandemic: The ASCEND Global Program Experience.

The coronavirus disease 2019 pandemic has had an unprecedented effect on health and health care and posed challenges to the conduct of clinical trials.Targeted mitigating strategies, on the basis of early and continued data collection from site surveys, limited disruption to the ASCEND trials.Flexibly allowing hemoglobin assessment at local laboratories to inform randomized treatment dosing was key to limiting the discontinuation of treatment.

Performance assessment of a new indirect rapid diagnostic test for plague detection in humans and other mammalian hosts.

Plague is a flea-borne zoonosis that affects a wide range of mammals and still causes outbreaks in human populations yearly across several countries. While crucial for proper treatment, early diagnosis is still a major challenge in low- and middle-income countries due to poor access to laboratory infrastructure in rural areas. To tackle this issue, we developed and evaluated a new Fraction 1 capsular antigen (F1)-based rapid diagnostic test (RDT) as an alternative method for plague serological diagnosis and surveillance in humans and other mammals. In this study, 187 serum samples from humans, dogs, rodents and rabbits were retrospectively assessed using the plague RDT method. To calculate its performance, results were compared to those obtained by traditional hemagglutination (HA) and ELISA, which are well-established methods in the plague routine serodiagnosis. Remarkably, the results from RDT were in full agreement with those from the ELISA and HA assays, resulting in 100% (CI 95% = 95.5-100%) of sensitivity and 100% (CI 95% = 96.6-100%) of specificity. Accordingly, the Cohen's Kappa test coefficient was 1.0 (almost perfect agreement). Moreover, the RDT showed no cross-reaction when tested with sera from individuals positive to other pathogens, such as Y. pseudotuberculosis, Yersinia enterocolitica, Anaplasma platys, Ehrlichia canis and Leishmania infantum. Although preliminary, this study brings consistent proof-of-concept results with high performance of the Plague RDT when compared to HA and ELISA. Although further human and animal population-based studies will be necessary to validate these findings, the data presented here show that the plague RDT is highly sensitive and specific, polyvalent to several mammal species and simple to use in field surveillance or point-of-care situations with instant results.

Pediatric peritoneal dialysis in Brazil: a discussion about sustainability. A document by the Brazilian Society of Nephrology, the Brazilian Society of Pediatrics, the Brazilian Association of Organ Transplantation, and the Brazilian Association of Dialysis and Transplant Centers.

INTRODUçÃO: A diálise peritoneal (DP) é importante para a pediatria. Este estudo mostrou dados de centros brasileiros que utilizam DP pediátrica. MÉTODO: Estudo transversal, observacional, descritivo com questionário eletrônico. Incluiu-se pacientes de 0-18 anos em DP cadastrados nos bancos de dados dos diversos centros. Questionário preenchido anonimamente, sem dados de identificação. Foi adotada metodologia quantitativa. RESULTADOS: 212 pacientes estão em DP no Brasil (agosto, 2021). 80% têm menos de 12 anos de idade. A maioria realiza DP automatizada e 74% são dependentes do Sistema Único de Saúde. Em 25% dos centros faltou material de DP e em 51% os pacientes pediátricos foram convertidos de DP para HD. CONCLUSÃO: A maioria dos pacientes tinha menos de 12 anos e era dependente do SUS. A escassez de insumos aconteceu em 25% dos centros. Esses dados apontam para o problema da sustentabilidade de DP, única alternativa de TRS em crianças muito pequenas.

Brazilian registry for the elimination of hepatitis C in dialysis units: a call to action for Nephrology / Registro brasileiro para eliminação da hepatite C nas unidades de diálise: um chamado para a Nefrologia

Abstract Infection by the hepatitis C virus is more prevalent in patients on dialysis than in the general population in Brazil, and has been associated with worse outcomes. Current therapy for hepatitis C is highly effective, safe, and widely available in Brazil, with coverage provided to dialysis patients with chronic kidney disease, which makes the elimination of hepatitis C a viable target. The Brazilian Society of Nephrology, the Brazilian Society of Hepatology, and the Brazilian Liver Institute developed the "Brazilian Registry for the Elimination of Hepatitis C in Dialysis Units". This project aims to identify, treat, and monitor the response to treatment of patients on chronic dialysis infected with the hepatitis C virus in Brazil. This article presents the issue and invites Brazilian nephrologists to rally around the achievement of a significant goal.

Resumo A infecção pelo vírus da hepatite C é mais prevalente em pacientes em diálise do que na população geral no Brasil e implica um pior prognóstico. O tratamento atual para hepatite C é altamente eficaz, seguro e disponível no país, inclusive para a população de pacientes crônicos em diálise, o que torna a eliminação do vírus da hepatite C uma meta viável. A Sociedade Brasileira de Nefrologia, a Sociedade Brasileira de Hepatologia e o Instituto Brasileiro do Fígado desenvolveram o "Registro Brasileiro para Eliminação da Hepatite C nas Unidades de Diálise". O projeto visa identificar pacientes em diálise crônica com vírus da hepatite C no Brasil, além de tratar e monitorar a resposta virológica após o tratamento. Este breve artigo apresenta o problema e convida os nefrologistas brasileiros a unirem forças nesse objetivo comum.

Brazilian Dialysis Survey 2020.

INTRODUCTION: National data on chronic dialysis treatment are essential to support the development of health policies aimed at improving the treatment for thousands of people. OBJECTIVE: To report epidemiological data from the 2020 Brazilian Dialysis Survey, sponsored by the Brazilian Society of Nephrology. METHODS: A survey was carried out in Brazilian chronic dialysis centers using an online questionnaire for the year, covering clinical and epidemiological aspects of patients in a chronic dialysis program, data on dialysis therapy, characteristics of dialysis units and the impact of the COVID-19 pandemic. RESULTS: 235 (28%) of the centers responded to the questionnaire. In July 2020, the estimated total number of patients on dialysis was 144,779. The estimated prevalence and incidence rates of patients per million population (pmp) were 684 and 209, respectively. Of the prevalent patients, 92.6% were on hemodialysis (HD) and 7.4% were on peritoneal dialysis (PD); 23% were on the transplant waiting list. A central venous catheter was used by a quarter of patients on HD. The incidence rate of confirmed COVID-19 between February and July 2020 was 684/10,000 dialysis patients, and the lethality rate was 25.7%. The estimated overall mortality and COVID-19 crude annual mortality rates were 24.5 and 4.2%, respectively. CONCLUSION: The absolute number of patients on chronic dialysis and prevalence rate continued to increase. The low use of PD as dialysis therapy was maintained and the use of long-term catheters for HD increased. The COVID-19 pandemic contributed to the increase in the overall mortality rate.

Brazilian registry for the elimination of hepatitis C in dialysis units: a call to action for Nephrology.

Infection by the hepatitis C virus is more prevalent in patients on dialysis than in the general population in Brazil, and has been associated with worse outcomes. Current therapy for hepatitis C is highly effective, safe, and widely available in Brazil, with coverage provided to dialysis patients with chronic kidney disease, which makes the elimination of hepatitis C a viable target. The Brazilian Society of Nephrology, the Brazilian Society of Hepatology, and the Brazilian Liver Institute developed the "Brazilian Registry for the Elimination of Hepatitis C in Dialysis Units". This project aims to identify, treat, and monitor the response to treatment of patients on chronic dialysis infected with the hepatitis C virus in Brazil. This article presents the issue and invites Brazilian nephrologists to rally around the achievement of a significant goal.