Medical and nutritional implications in chronic heart failure: strengths and limitations.

Heart failure (HF) is one of the most important global public health problems, as there is an increase in its prevalence and an estimated 23 million of the world's population live with this problem. HF is defined by the presence of structural and functional abnormalities of the cardiac muscle leading to an impairment of ventricular filling and ejection. Multiple comorbidities have been associated with an increased risk of developing cardiovascular diseases. Hypertension has been recognized as one of the most important factors, however, obesity, metabolic syndrome, as well as diabetes also play an important role in the onset of the disease. It is common to find in decompensated heart failure hospitalized patients an impaired nutritional status characterized mainly by the presence of nutritional deficiencies and sarcopenia, which can sometimes progress to cachexia. Therefore, an adequate evaluation through the correct use of nutritional risk tools should be the cornerstone to the prevention of risks. Multiple anthropometric and biochemical parameters are available to establish the nutritional status of hospitalized patients, however, alterations in blood volume presented in patients with HF may alter the result of such assessment. The effectiveness of dietary modifications in the prevention and treatment of different cardiovascular diseases enhanced by appropriate adherence to eating patterns such as the DASH and Mediterranean diet have been inversely associated with the incidence of HF.

La insuficiencia cardiaca (IC) representa uno de los problemas mundiales de salud pública más importantes, ya que existe un aumento en su prevalencia y se estima que 23 millones de la población mundial viven con este problema. Esta entidad se define por la presencia de anormalidades estructurales y funcionales del músculo cardiaco que conducen a un deterioro en la capacidad del llenado y eyección ventricular. Múltiples comorbilidades se han asociado a un incremento en el riesgo de desarrollo de enfermedades cardiovasculares. La hipertensión se ha reconocido como uno de los factores más importantes, sin embargo, la obesidad, el síndrome metabólico, así como la diabetes, también juegan un papel importante en la aparición de dicha enfermedad. Es frecuente encontrar en pacientes hospitalizados con IC deterioro en el estado nutricional caracterizado principalmente por la presencia de deficiencias nutricionales y sarcopenia, que, en ocasiones, puede progresar y manifestarse como caquexia. Por lo anterior, una evaluación adecuada mediante el uso correcto de herramientas para detección de riesgo nutricional es imperativa, se hace necesaria para prevenir los riesgos que esto implica. Existen múltiples parámetros antropométricos y bioquímicos para definir el estado nutricional de los pacientes hospitalizados, sin embargo, las alteraciones en el volumen sanguíneo presentes en pacientes con IC pueden alterar el resultado de dicha evaluación. Las modificaciones dietéticas en la prevención y tratamiento de diversas enfermedades cardiovasculares mediante un buen apego a patrones de alimentación tales como la dieta DASH (enfoques dietéticos para detener la hipertensión, por sus siglas en inglés) y la dieta mediterránea se han asociado inversamente con la incidencia de IC.

Consensus on hemophilia in Mexico.

Hemophilia is a hemorrhagic disorder with a sex-linked inherited pattern, characterized by an inability to amplify coagulation due to a deficiency in coagulation factor VIII (hemophilia A or classic) or factor IX (hemophilia B). Sequencing of the genes involved in hemophilia has provided a description and record of the main mutations, as well as a correlation with the various degrees of severity. Hemorrhagic manifestations are related to levels of circulating factor, mainly affecting the musculoskeletal system and specifically the large joints (knees, ankles, and elbows). This document is a review and consensus of the main genetic aspects of hemophilia, from the inheritance pattern to the concept of women carriers, physiopathology and classification of the disorder, the basic and confirmation studies when hemophilia is suspected, the various treatment regimens based on infusion of the deficient coagulation factor as well as innovative factor-free therapies and recommendations for the management of complications associated with treatment (development of inhibitors and/or transfusion-transmitted infections), or secondary to articular hemorrhagic events (hemophilic arthropathy). Finally, relevant reviews of clinical and treatment aspects of hemorrhagic pathology characterized by acquired deficiency of FVIII secondary to neutralized antibodies named acquired hemophilia.

La hemofilia es un trastorno hemorrágico con patrón de herencia ligado al sexo, caracterizado por una incapacidad en la amplificación de la coagulación ocasionada por la deficiencia del factor VIII (hemofilia A o clásica) o del factor IX (hemofilia B). La secuenciación de los genes involucrados en la hemofilia ha permitido la descripción y registro de las principales mutaciones, así como la correlación con los diversos grados de severidad. Las manifestaciones hemorrágicas se relacionan con los niveles de factor deficiente circulante, afectando principalmente al sistema musculoesquelético y en particular a las grandes articulaciones (rodillas, tobillos y codos). El presente documento hace una revisión y consenso de los principales aspectos genéticos de la hemofilia, desde el patrón de herencia y el concepto de mujeres portadoras, la fisiopatología y clasificación de la enfermedad, los estudios básicos y de confirmación ante la sospecha de hemofilia, y de los diversos esquemas de tratamiento basados en la infusión del factor de coagulación deficiente hasta las terapias innovadoras libres de factor, así como de las recomendaciones para el manejo de las complicaciones asociadas al tratamiento (desarrollo de inhibidores y/o infecciones transmitidas por transfusión) o secundarias a los eventos hemorrágicos a nivel articular (artropatía hemofílica). La parte final del documento revisa los aspectos clínicos y de tratamiento relevantes de una patología hemorragica caracterizada por la deficiencia adquirida del FVIII mediada por anticuerpos neutralizantes denominada hemofilia adquirida.

Impacto de la pandemia de COVID-19 en una cohorte de pacientes con ELA en Cataluña / Impact of the COVID-19 pandemic on a cohort of ALS patients in Catalonia

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Nueva variante patogénica en el gen SPAST en una familia española afecta de paraplejía espástica hereditaria / A novel pathogenic variant of the SPAST gene in a Spanish family with hereditary spastic paraplegia

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Función ejecutiva, lenguaje pragmático y perfiles psicopatológicos según la CBCL en niños con trastornos del neurodesarrollo y antecedentes familiares de esquizofrenia / Executive function, pragmatic language and CBCL psychopathological profiles in children with neurodevelopmental disorders and family history of schizophrenia

INTRODUCCIÓN: La escala CBCL de Achenbach completada por padres evalúa un amplio rango de problemas conductuales y emocionales de inicio en la infancia. Sus subescalas "retraimiento-depresión" y principalmente "problemas de pensamiento" se han propuesto como medida de detección de riesgo de psicosis en adolescentes. Dentro de los posibles endofenotipos de la esquizofrenia se plantean la disfunción ejecutiva y la alteración en el lenguaje pragmático. OBJETIVOS: Identificar mediante ambas subescalas de la CBCL un subgrupo de niños y adolescentes con puntuaciones elevadas entre los pacientes que consultan en psiquiatría infantil por trastornos del neurodesarrollo y que tienen antecedentes familiares de esquizofrenia. MATERIAL Y MÉTODOS: Los padres completan la escala CBCL de Achenbach, CCC-Childrens Communication Checklist- (evaluación del lenguaje pragmático) y BRIEF-2 (evaluación conductual de la función ejecutiva). RESULTADOS: Se incluyeron 21 niños (16 niños: 5 niñas). Edad media 11,4 años. Los diagnósticos principales fueron TDAH (66,7%), trastorno de aprendizaje (9,5%) y TEA (9,5%). Las dos subescalas de la CBCL "retraimiento-depresión" y "problemas de pensamiento" discriminan dos grupos, uno con afectación (n=11) con puntuaciones por encima del Pc70 y otro sin afectación (n=10) con puntuaciones inferiores al Pc70. Los casos con afectación mostraron más dificultades en el lenguaje pragmático y función ejecutiva que los del grupo sin afectación. CONCLUSIONES: Realizar una evaluación dimensional más completa de la psicopatología, como la que ofrece la CBCL, en niños con trastornos del neurodesarrollo y antecedentes familiares de esquizofrenia puede ayudar a describir mejor las dificultades premórbidas e identificar casos susceptibles de seguimiento longitudinal e intervención precoz

INTRODUCTION: The CBCL is a standardized form that parents fill out to describe their children ́s behavioral and emotional problems. Previous studies have suggested that two subscales, "withdrawal-depressed" and mainly "thought problems" may have utility as a psychosis risk screening measure in youth. Executive function and higher-order language dysfunctions have been postulated as potential endophenotypes for schizophrenia. OBJECTIVES: To identify by means of the two CBCL subscales mentioned above, a group of children and adolescents with higher ratings amongst those patients attending an outpatient psychiatric clinic, who present a neurodevelopmental disorder and a family history of schizophrenia MATERIAL AND METHODS: Parents filled out CBCL, CCC-Childrens Communication Checklist- (evaluates pragmatic language) and BRIEF-2 (Behavior Rating Inventory of Executive Function). RESULTS: Twenty-one children were included (16 males; 5 females). Mean age 11,4 y/o. Main diagnoses were ADHD (66,7%), Learning Disorder (9,5%) and ASD (9,5%). CBCL subscales "withdrawn-depressed" and "thought problems" discriminated two groups. One with higher ratings (above Pc70) showing the presence of symptoms (n=11) and the other with lower ratings (below Pc70) indicating symptom absence (n=10). The first group showed more pragmatic language difficulties as well as poorer executive function. CONCLUSIONS: A more comprehensive dimensional evaluation of the psychopathology of children with neurodevelopmental disorders and family history of schizophrenia, by means of CBCL, may provide a better description of premorbid difficulties, helping to identify more vulnerable cases for long term follow up and early intervention

Poly(adenosine diphosphate ribose) polymerase inhibitors induce autophagy-mediated drug resistance in ovarian cancer cells, xenografts, and patient-derived xenograft models.

BACKGROUND: Poly(adenosine diphosphate ribose) polymerase (PARP) inhibitors exhibit promising activity against ovarian cancers, but their efficacy can be limited by acquired drug resistance. This study explores the role of autophagy in regulating the sensitivity of ovarian cancer cells to PARP inhibitors. METHODS: Induction of autophagy was detected by punctate LC3 fluorescence staining, LC3I to LC3II conversion on Western blot analysis, and electron microscopy. Enhanced growth inhibition and apoptosis were observed when PARP inhibitors were used with hydroxychloroquine, chloroquine (CQ), or LYS05 to block the hydrolysis of proteins and lipids in autophagosomes or with small interfering RNA against ATG5 or ATG7 to prevent the formation of autophagosomes. The preclinical efficacy of the combination of CQ and olaparib was evaluated with a patient-derived xenograft (PDX) and the OVCAR8 human ovarian cancer cell line. RESULTS: Four PARP inhibitors (olaparib, niraparib, rucaparib, and talazoparib) induced autophagy in a panel of ovarian cancer cells. Inhibition of autophagy with CQ enhanced the sensitivity of ovarian cancer cells to PARP inhibitors. In vivo, olaparib and CQ produced additive growth inhibition in OVCAR8 xenografts and a PDX. Olaparib inhibited PARP activity, and this led to increased reactive oxygen species (ROS) and an accumulation of γ-H2AX. Inhibition of autophagy also increased ROS and γ-H2AX and enhanced the effect of olaparib on both entities. Treatment with olaparib increased phosphorylation of ATM and PTEN while decreasing the phosphorylation of AKT and mTOR and inducing autophagy. CONCLUSIONS: PARP inhibitor-induced autophagy provides an adaptive mechanism of resistance to PARP inhibitors in cancer cells with wild-type BRCA, and a combination of PARP inhibitors with CQ or other autophagy inhibitors could improve outcomes for patients with ovarian cancer.

Relevancia del síndrome piramidal en la esclerosis lateral amiotrófica / Relevance of the pyramidal syndrome in amyotrophic lateral sclerosis

Introducción: Los signos piramidales (hiperreflexia, espasticidad, signo de Babinski) son fundamentales para el diagnóstico de esclerosis lateral amiotrófica (ELA). Sin embargo, no siempre están presentes al comienzo, pueden variar con el tiempo y es controvertido su papel en la evolución. El objetivo del estudio es describir qué signos piramidales están presentes inicialmente y cómo evolucionan en una cohorte de pacientes con ELA, así como su papel pronóstico. Métodos: Análisis retrospectivo de pacientes recogidos de manera prospectiva, diagnosticados de ELA en nuestro centro, desde 1990 hasta 2015. Resultados: Del total de 130 pacientes con ELA, 34 (26,1%) no presentaron inicialmente ningún signo piramidal, mientras que 15 (11,5%) presentaban un síndrome piramidal completo. De aquellos pacientes sin piramidalismo inicial, la mediana de aparición de los primeros signos fue de 4,5 meses. El signo de Babinski estaba presente en 64 (49,2%), la hiperreflexia en 90 (69,2%) y en 22 (16,9%) pacientes existía espasticidad. Los signos piramidales tendían a mantenerse inalterados en el tiempo, aunque existe un porcentaje de pacientes en el que aparecen tardíamente o desaparecen con el tiempo. No se encontró asociación entre supervivencia y la presencia o modificación de signos piramidales, aunque la disminución de la espasticidad se asociaba a mayor deterioro clínico (escala ALSFR) (p < 0,001). Conclusión: Una cuarta parte de pacientes con ELA no presentaron inicialmente ningún signo piramidal y, en algunos casos, estos desaparecen con el tiempo. Esto resalta la necesidad de la inclusión de herramientas para la valoración de la vía piramidal (AU)

Introduction: Pyramidal signs (hyperreflexia, spasticity, Babinski sign) are essential for the diagnosis of amyotrophic lateral sclerosis (ALS). However, these signs are not always present at onset and may vary over time, besides which their role in disease evolution is controversial. Our goal was to describe which pyramidal signs were present and how they evolved in a cohort of patients with ALS, as well as their role in prognosis. Methods: Retrospective analysis of prospectively collected patients diagnosed with ALS in our centre from 1990 to 2015. Results: Of a total of 130 patients with ALS, 34 (26.1%) patients showed no pyramidal signs at the first visit while 15 (11.5%) had a complete pyramidal syndrome. Of those patients without initial pyramidal signs, mean time of appearance of the first signs was 4.5 months. Babinski sign was positive in 64 (49.2%) patients, hyperreflexia in 90 (69.2%) and 22 (16.9%) patients had spasticity. Pyramidal signs tended to remain unchanged over time, although they seem to appear at later stages or even disappear with time in some patients. We found no association between survival and the presence of changes to pyramidal signs, although decreased spasticity was associated with greater clinical deterioration (ALSFR scale) (P < .001). Conclusion: A quarter of patients with ALS initially showed no pyramidal signs and in some cases they even disappear over time. These data support the need for tools that assess the pyramidal tract (AU)

Leucoencefalopatía multifocal progresiva en un paciente inmunocompetente / Progressive multifocal leukoencephalopathy in an immunocompetent patient

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Tuberculosis genital: diagnóstico e implicaciones en fertilidad. A propósito de un caso / Genital tuberculosis infection: diagnosis and fertility impact. A case report

Resumen CASO CLÍNICO: Paciente de 18 años de edad, sin embarazos previos, que acudió a consulta por dolor y distensión abdominal. La exploración física solo mostró signos de ascitis. La ecografía abdominal reportó líquido libre intraabdominal perihepático, periesplénico y, en ambos flancos. La radiografía de tórax mostró infiltrado intersticial bilateral, de predominio en los campos medios; granuloma calcificado en el lóbulo superior izquierdo. La tomografía toraco-abdomino-pélvica evidenció adenopatías axilares, mediastínicas y cardiofrénicas; útero de tamaño normal y estructuras tubulares pélvicas de 1 cm, bilaterales, compatibles con salpingitis. Ante la sospecha clínica de tuberculosis, se realizó la prueba de Mantoux, que resultó positiva. El estudio ginecológico reportó anejos aumentados de tamaño, duros y de consistencia sólida. La ecografía mostró las trompas de Falopio engrosadas, de morfología arrosariada y vascularización aumentada (53 x 23 mm la derecha y 53 x 14 la izquierda). En la biopsia de endometrio se identificó el bacilo ácido-alcohol resistente. Con estos hallazgos se estableció el diagnóstico de tuberculosis diseminada, con afectación pulmonar y peritoneal. Se prescribió tratamiento con isoniacida, rifampicina, pirazinamida y etambutol, con lo que se observó reacción satisfactoria. La paciente fue dada de alta por disminución de los síntomas, con posterior seguimiento en la consulta de Enfermedades Infecciosas y Ginecología. CONCLUSIÓN: La tuberculosis genital es una alteración poco frecuente en España. El diagnóstico se establece con alta sospecha clínica o durante el estudio de otras enfermedades, pues para su confirmación se requieren medios de cultivo específicos. La importancia del diagnóstico radica en las consecuencias de la fertilidad a futuro, ya que la funcionalidad del aparato reproductor se ve afectada.

Abstract CLINICAL CASE: 18-year-old female patient, who came to the hospital for pain and abdominal distension. Physical examination showed only signs of ascites. Abdominal ultrasound reported perihepatic, perisplenic, and intraabdominal free fluid on both flanks. The radiography showed bilateral interstitial infiltrate, predominantly in the middle fields; Calcified granuloma in the left upper lobe. Thoraco-abdomino-pelvic tomography evidenced axillary, mediastinal and cardiophrenic adenopathies; Uterus of normal size and tubular structures of 1 cm, bilateral, compatible with salpingitis. Before the clinical suspicion of tuberculosis, the Mantoux test was performed, which was positive. The gynecological study reported enlarged aids, hard, solid consistency. Ultrasound showed enlarged fallopian tubes with augmented morphology and increased vascularization (53 x 23 mm on the right and 53 x 14 on the left). Endometrium biopsy identified the resistant acid-bacillus bacillus. With these findings the diagnosis of disseminated tuberculosis with pulmonary and peritoneal involvement was established. Treatment with isoniazid, rifampicin, pyrazinamide and ethambutol was prescribed, with which a satisfactory reaction was observed. The patient was discharged due to decreased symptoms, with subsequent follow-up in the Infectious Diseases and Gynecology service. CONCLUSION: Genital tuberculosis is a rare disorder in Spain. The diagnosis is established with high clinical suspicion or during the study of other diseases, because for its confirmation specific culture media are required. The importance of diagnosis lies in the consequences of future fertility, since the functionality of the reproductive system is affected.

Contribución de los estudios neurofisiológicos seriados en el síndrome de Guillain-Barré atípico / Contribution of serial neurophysiological studies in atypical Guillain-Barré syndrome

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Evaluation of water quality at the source of streams of the Sinos River Basin, southern Brazil / Avaliacão da qualidade da água das nascentes de arroios da Bacia do Rio dos Sinos, região sul do Brasil

The Sinos River Basin (SRB) is located in the northeastern region of the state of Rio Grande do Sul (29º20' to 30º10'S and 50º15' to 51º20'W), southern Brazil, and covers two geomorphologic provinces: the southern plateau and the central depression. It is part of the Guaíba basin, has an area of approximately 800 km² and contains 32 counties. The basin provides drinking water for 1.6 million inhabitants in one of the most important industrial centres in Brazil. This study describes different water quality indices (WQI) used for the sub-basins of three important streams in the SRB: Pampa, Estância Velha/Portão and Schmidt streams. Physical, chemical and microbiological parameters assessed bimonthly using samples collected at each stream source were used to calculate the Horton Index (HI), the Dinius Index (DI) and the water quality index adopted by the US National Sanitation Foundation (NSF WQI) in the additive and multiplicative forms. These indices describe mean water quality levels at the streams sources. The results obtained for these 3 indexes showed a worrying scenario in which water quality has already been negatively affected at the sites where three important sub-basins in the Sinos River Basin begin to form.

A Bacia Hidrográfica do Rio dos Sinos (BHRS) está localizada na região Nordeste do Estado do Rio Grande do Sul (29º20' to 30º10'S and 50º15' to 51º20'W), na região Sul do Brasil, envolvendo duas regiões geomorfológicas, o planalto Sul e a depressão central. Esta bacia faz parte da Bacia do Guaíba e tem uma área de aproximadamente 800 km², atingindo 32 municípios. A BHRS fornece água de abastecimento para cerca de 1.6 milhões de habitantes e para um dos mais importantes centros industriais do Brasil. Este artigo apresenta a determinação de diferentes índices de qualidade de água (IQA) para as regiões de nascente de três importantes sub-bacias pertencentes à BHRS: arroios Pampa, Estância Velha/Portão e Schmidt. Utilizando parâmetros físicos, químicos e microbiológicos, analisados em amostras coletadas bimestralmente em cada ponto próximo à nascente, foram calculados os índices de Horton (IH), de Dinius (ID) e o índice de qualidade de água da National Sanitation Foundation, EUA (IQANSF) usando os métodos somatório e produtório. Os resultados foram analisados para verificação da qualidade da água nos pontos amostrais a fim de comparar e classificar a água na região das nascentes das três sub-bacias. Uma avaliação conjunta dos índices calculados indicou que a água nos três pontos amostrais apresenta qualidade média. Os resultados dos três índices convergem a um cenário preocupante que indica que, desde os pontos iniciais de formação de três importantes sub-bacias do rio dos Sinos, já ocorrem problemas de qualidade de água.

Integrated Environmental Assessment of streams in the Sinos River basin in the state of Rio Grande do Sul, Brazil / Avaliação Ambiental Integrada de arroios da bacia do Rio dos Sinos no Estado do Rio Grande do Sul, Brasil

The deterioration of environmental quality in the Sinos River basin is directly associated with the impacts of intense industrialization and urbanization. An integrated environmental assessment (IEA) was conducted in July and September of 2012, in areas along the sources of the EstânciaVelha/Portão, Pampa and Schmidt streams using physical, chemical and biological methods. The water in the three sampling sites was not proper for human consumption, presented a low toxic contamination index (TCI) and mesotrophic characteristics. One site was included in Class 4, and two, in Class 3, according to current legislation. The rapid assessment protocol (RAP) indicated a natural environmental condition for habitat diversity and environmental impact in the three sites. The Tradescantia pallida (Rose) D.R. Hunt var. purpurea Boom biomarker showed water genotoxicity in two of the sites. The integrated diagnosis of water quality in these streams is fundamentally important to ensure the sustainable management of water resources and their multiple uses, as well to estimate their contribution to pollution in this river basin.

A deterioração da qualidade ambiental da bacia do Rio dos Sinos está diretamente associada a impactos oriundos da intensa industrialização e urbanização. A avaliação ambiental integrada (AAI) foi realizada nos meses de julho e setembro de 2012, em áreas junto às nascentes dos arroios Estância Velha/Portão, Pampa e Schmidt por meio de metodologias que utilizam parâmetros físicos, químicos e biológicos. Os três sítios amostrais apresentaram águas impróprias para o consumo humano, baixo índice de contaminação por tóxicos (ICT) e características mesotróficas. Um sítio foi enquadrado na Classe 4 e dois na Classe 3, segundo a legislação vigente. Os resultados da aplicação do protocolo de avaliação rápida (PAR) indicaram uma situação ambiental natural, quanto à diversidade de habitats e aos impactos ambientais, nos três sítios amostrados. O biondicador Tradescantia pallida (Rose) D.R. Hunt var. purpurea Boom evidenciou genotoxicidade da água em dois sítios amostrados. O diagnóstico integrado da qualidade das águas destes arroios é de fundamental importância para assegurar o gerenciamento sustentado dos recursos hídricos e seus múltiplos usos, além de estimar sua contribuição à poluição desta bacia hidrográfica.

Evaluation of water quality at the source of streams of the Sinos River Basin, southern Brazil

p>The Sinos River Basin (SRB) is located in the northeastern region of the state of Rio Grande do Sul (29º20' to 30º10'S and 50º15' to 51º20'W), southern Brazil, and covers two geomorphologic provinces: the southern plateau and the central depression. It is part of the Guaíba basin, has an area of approximately 800 km sup>2 /sup> and contains 32 counties. The basin provides drinking water for 1.6 million inhabitants in one of the most important industrial centres in Brazil. This study describes different water quality indices (WQI) used for the sub-basins of three important streams in the SRB: Pampa, Estância Velha/Portão and Schmidt streams. Physical, chemical and microbiological parameters assessed bimonthly using samples collected at each stream source were used to calculate the Horton Index (HI), the Dinius Index (DI) and the water quality index adopted by the US National Sanitation Foundation (NSF WQI) in the additive and multiplicative forms. These indices describe mean water quality levels at the streams sources. The results obtained for these 3 indexes showed a worrying scenario in which water quality has already been negatively affected at the sites where three important sub-basins in the Sinos River Basin begin to form. /p>

p>A Bacia Hidrográfica do Rio dos Sinos (BHRS) está localizada na região Nordeste do Estado do Rio Grande do Sul (29º20' to 30º10'S and 50º15' to 51º20'W), na região Sul do Brasil, envolvendo duas regiões geomorfológicas, o planalto Sul e a depressão central. Esta bacia faz parte da Bacia do Guaíba e tem uma área de aproximadamente 800 km sup>2 /sup>, atingindo 32 municípios. A BHRS fornece água de abastecimento para cerca de 1.6 milhões de habitantes e para um dos mais importantes centros industriais do Brasil. Este artigo apresenta a determinação de diferentes índices de qualidade de água (IQA) para as regiões de nascente de três importantes sub-bacias pertencentes à BHRS: arroios Pampa, Estância Velha/Portão e Schmidt. Utilizando parâmetros físicos, químicos e microbiológicos, analisados em amostras coletadas bimestralmente em cada ponto próximo à nascente, foram calculados os índices de Horton (IH), de Dinius (ID) e o índice de qualidade de água da National Sanitation Foundation, EUA (IQANSF) usando os métodos somatório e produtório. Os resultados foram analisados para verificação da qualidade da água nos pontos amostrais a fim de comparar e classificar a água na região das nascentes das três sub-bacias. Uma avaliação conjunta dos índices calculados indicou que a água nos três pontos amostrais apresenta qualidade média. Os resultados dos três índices convergem a um cenário preocupante que indica que, desde os pontos iniciais de formação de três importantes sub-bacias do rio dos Sinos, já ocorrem problemas de qualidade de água. /p>

Integrated Environmental Assessment of streams in the Sinos River basin in the state of Rio Grande do Sul, Brazil

p>The deterioration of environmental quality in the Sinos River basin is directly associated with the impacts of intense industrialization and urbanization. An integrated environmental assessment (IEA) was conducted in July and September of 2012, in areas along the sources of the EstânciaVelha/Portão, Pampa and Schmidt streams using physical, chemical and biological methods. The water in the three sampling sites was not proper for human consumption, presented a low toxic contamination index (TCI) and mesotrophic characteristics. One site was included in Class 4, and two, in Class 3, according to current legislation. The rapid assessment protocol (RAP) indicated a natural environmental condition for habitat diversity and environmental impact in the three sites. The italic>Tradescantia pallida /italic> (Rose) D.R. Hunt var. italic>purpurea /italic> Boom biomarker showed water genotoxicity in two of the sites. The integrated diagnosis of water quality in these streams is fundamentally important to ensure the sustainable management of water resources and their multiple uses, as well to estimate their contribution to pollution in this river basin. /p>

p>A deterioração da qualidade ambiental da bacia do Rio dos Sinos está diretamente associada a impactos oriundos da intensa industrialização e urbanização. A avaliação ambiental integrada (AAI) foi realizada nos meses de julho e setembro de 2012, em áreas junto às nascentes dos arroios Estância Velha/Portão, Pampa e Schmidt por meio de metodologias que utilizam parâmetros físicos, químicos e biológicos. Os três sítios amostrais apresentaram águas impróprias para o consumo humano, baixo índice de contaminação por tóxicos (ICT) e características mesotróficas. Um sítio foi enquadrado na Classe 4 e dois na Classe 3, segundo a legislação vigente. Os resultados da aplicação do protocolo de avaliação rápida (PAR) indicaram uma situação ambiental natural, quanto à diversidade de habitats e aos impactos ambientais, nos três sítios amostrados. O biondicador italic>Tradescantia pallida /italic> (Rose) D.R. Hunt var. italic>purpurea /italic> Boom evidenciou genotoxicidade da água em dois sítios amostrados. O diagnóstico integrado da qualidade das águas destes arroios é de fundamental importância para assegurar o gerenciamento sustentado dos recursos hídricos e seus múltiplos usos, além de estimar sua contribuição à poluição desta bacia hidrográfica. /p>

Effects of nickel on the fern Regnellidium diphyllum Lindm. (Marsileaceae) / Efeitos do níquel sobre a filicínea Regnellidium diphyllum Lindm. (Marsileaceae)

The heterosporous fern Regnellidium diphyllum occurs in southern Brazil and some adjoining localities in Uruguay and Argentina. Currently it is on the list of threatened species in the state of Rio Grande do Sul. Anthropic alterations such as the conversion of wetlands into agricultural areas or water and soil contamination by pollutants may compromise the establishment and survival of this species. Nickel (Ni) is an essential nutrient for plants but increasing levels of this metal due to pollution can cause deleterious effects especially in aquatic macrophytes. Megaspore germination tests were performed using Meyer's solution, at concentrations of 0 (control), 0.05, 0.5, 1, 5, 10, 20, 30, 50 and 100 mg L-1 of Ni. The initial development of apomictic sporophytes was studied using solutions containing 0 (control) to 4.8 mg L-1 of Ni. A significant negative relation was observed between the different Ni concentrations and the megaspore germination/sporophyte formation rates. Primary roots, primary leaves and secondary leaves were significantly shorter at 3.2 and 4.8 mg L-1 of Ni, when compared with the treatment without this metal. At 4.8 mg L-1, leaves also presented chlorosis and necrosis. The introduction of pollutants with Ni in the natural habitat of Regnellidium diphyllum may inhibit the establishment of plants in the initial stage of development, a problem to be considered in relation to the conservation of this species.

A samambaia heterosporada Regnellidium diphyllum Lindm. ocorre no Sul do Brasil e em algumas localidades vizinhas no Uruguai e na Argentina. Atualmente, consta da lista de espécies ameaçadas do Estado do Rio Grande do Sul. Alterações antrópicas - tais como a conversão de áreas úmidas em áreas de agricultura ou a contaminação de água e solo por poluentes - podem comprometer o estabelecimento e a sobrevivência da espécie. Níquel (Ni) é um nutriente essencial às plantas, mas níveis aumentados desse metal, em razão da poluição, podem causar efeitos deletérios, especialmente em macrófitas aquáticas. Testes de germinação de megásporos foram realizados usando-se solução de Meyer, em concentrações de 0 (controle); 0,05; 0,5; 1; 5; 10; 20; 30; 50; 100 mg L-1 de Ni. O desenvolvimento inicial de esporófitos apomíticos foi estudado usando-se soluções contendo 0 (controle) a 4,8 mg L-1 de Ni. Relação negativa significante foi observada entre diferentes concentrações de Ni e as taxas de germinação de megásporos/formação de esporófitos. Raízes primárias e folhas primárias e secundárias foram significantemente mais curtas a 3,2 e 4,8 mg L-1 de Ni, quando comparadas ao tratamento sem esse metal. Em 4,8 mg L-1, folhas também apresentaram clorose e necrose. A introdução de poluentes com Ni no habitat natural de Regnellidium diphyllum pode inibir o estabelecimento de plantas em estádio inicial de desenvolvimento, um problemaa a ser considerado em relação à conservação dessa espécie.

Comunicación pleuro–peritoneal en pacientes en diálisis peritoneal. Experiencia en un centro y revisión de la literatura / Pleuroperitoneal communication in patients on peritoneal dialysis. One hospital's experience and a review of the literature

La diálisis peritoneal es una alternativa de tratamiento en los pacientes con enfermedad renal crónica avanzada. La infusión de líquido en la cavidad peritoneal conlleva un aumento de presión intraabdominal que, en algunas ocasiones, puede producir la fuga del mismo hacia el tórax dando lugar a una comunicación pleuro–peritoneal. Es una complicación poco frecuente, pero supone una alta tasa de abandono de la técnica. El diagnóstico es sencillo y se debe sospechar ante la existencia de disnea súbita con baja ultrafiltración y derrame pleural en la radiografía de tórax. El descanso peritoneal, con transferencia temporal a hemodiálisis, y la pleurodesis pueden ser estrategias eficaces para su tratamiento (AU)

Peritoneal dialysis is a treatment alternative in patients with advanced chronic kidney disease. The infusion of liquid into the peritoneal cavity leads to an increase in intra–abdominal pressure, which can sometimes produce leaks to the chest, giving rise to pleuroperitoneal communication. This is not a common complication, but it brings about high drop–out rates among patients using the technique. Diagnosis is easy and must be suspected in patients with sudden dyspnoea with low ultrafiltration and pleural effusion in the chest x–ray. Peritoneal rest and a temporary transfer to haemodialysis, and pleurodesis can be effective treatment strategies (AU)

Germination and sporophytic development of Regnellidium diphyllum Lindman (Marsileaceae) in the presence of hexavalent chromium

Regnellidium diphyllum Lindman is a heterosporous fern, growing in aquatic environments and surrounding wetlands, which is assumed to be threatened by increasing water pollution and disappearance of its natural habitats. Among contaminants, hexavalent chromium - Cr(VI) - is known to be present in effluents from some leather tanning factories. Megaspore germination tests were performed using Meyer's solution, at concentrations 0 (control), 0.1, 0.5, 1, 5, 10, 15, 20, 30, 50, and 80 mg.L-1, from a standard solution of Titrisol® 1000 mg.L-1. The primary development of apomictic sporophytes was studied using solutions containing 0.025 to 4.8 mg.L-1 of Cr(VI). The experiments were conducted in a growth chamber at 24 ± 1 ºC and for a 12-hour photoperiod under fluorescent lights, providing a nominal irradiance of 77 µmol.m-2/s. Significant differences in megaspore germination, with subsequent sporophytic development, were verified from 0.5 mg.L-1 Cr(VI) concentration onwards. Growth of primary root and primary and secondary leaves was significantly reduced at 3.2 mg.L-1 Cr(VI) concentration or higher. Considering the pollution from Cr(VI) in some areas of R. diphyllum natural occurrence, these data indicate that low reproductive rates and disappearance of populations are likely to occur in these situations.

Regnellidium diphyllum Lindman é uma filicínea heterosporada que se desenvolve em ambientes aquáticos e áreas úmidas circundantes, sendo considerada ameaçada pelo aumento da poluição e desaparecimento dos seus hábitats naturais. Entre os contaminantes, o cromo hexavalente - Cr(VI) - é conhecido por estar presente nos efluentes de algumas indústrias de curtimento de couro. Testes de germinação foram realizados em meio líquido de Meyer, com concentrações de 0(controle); 0,1; 0,5; 1; 5; 10; 15; 20; 30; 50; e 80 mg.L-1 de Cr(VI), a partir de uma solução padrão de Titrisol® a 1000 mg.L-1. O desenvolvimento primário dos esporófitos apomíticos foi analisado em meios contendo de 0,025 a 4,8 mg.L-1 de Cr(VI). Os experimentos foram conduzidos em câmara de crescimento a 24 ± 1 ºC, fotoperíodo de 12 horas com lâmpadas fluorescentes fornecendo irradiância nominal de 77 µmol.m-2/s. Diferenças significativas na germinação dos megásporos e seu subsequente desenvolvimento foram verificadas a partir da concentração 0,5 mg.L-1 de Cr(VI). O crescimento da raiz primária e das folhas primárias e secundárias foi significativamente reduzido na concentração 3,2mg.L-1 de Cr(VI) ou superior. Considerando a poluição proveniente por Cr(VI) em algumas áreas de ocorrência natural de R. diphyllum, esses dados indicam que as baixas taxas de reprodução e mesmo o desaparecimento das populações podem ser esperadas nessas situações.

Rosuvastatin added to standard heart failure therapy improves cardiac remodelling in heart failure rats with preserved ejection fraction.

AIMS: Although statins may provide potential therapeutic pathways for patients with heart failure with preserved ejection fraction (HFpEF), no studies have evaluated statins in combination with standard HF therapy, which would reflect clinical practice more closely. To address this question, we evaluated whether rosuvastatin added to a standard HF therapy provides additional improvement in cardiac structure and function in rats with hypertensive heart failure (SHHF). METHODS AND RESULTS: Two-month-old SHHF rats were randomly assigned to four groups: (i) non-treated SHHF rats; (ii) rosuvastatin-treated SHHF rats; (iii) SHHF rats treated with quinapril plus torasemide plus carvedilol (considered as standard HF therapy); and (iv) SHHF rats treated with the combination of standard HF therapy and rosuvastatin. The administration of a standard anti-hypertensive HF therapy to SHHF rats for 17 months attenuated left ventricular (LV) chamber dilatation, cardiac hypertrophy, fibrosis, and inflammation compared with non-treated SHHF rats. Rosuvastatin alone prevented LV dilatation and cardiac inflammation similar to standard HF therapy-treated SHHF, despite being unable to normalize blood pressure (BP) or influence cardiac hypertrophy. However, and importantly, the addition of rosuvastatin to the standard HF therapy further prevented LV dilatation, preserved cardiac function, and normalized inflammation. CONCLUSION: These data show that the use of rosuvastatin plus a standard HF therapy results in a significant additional improvement in HF and cardiac remodelling in a rat model of HFpEF. These beneficial effects were independent of BP and plasma lipid changes, and seem to be due, at least in part, to decreased myocardial inflammation.

Las cinéticas con glucosa hipertónica permiten identificar mejor el fallo de ultrafiltración. ¿Qué aporta el cribado de sodio? / Kinetic studies with hypertonic glucose permit better identification of ultrafiltration failure. What is the contribution of sodium sieving?

Introducción: La utilización de soluciones con glucosa al3,86%/4,25% se ha postulado como el método ideal para estudiar la función peritoneal, ya que permite evaluar mejor la capacidad de ultrafiltración (UF). Objetivo: El objetivo del estudio es analizar la UF y sus relaciones con la permeabilidad peritoneal y el cribado de sodio mediante la realización de cinéticas peritoneales con glucosa hipertónica. Pacientes y métodos: Realizamos 184 cinéticas con glucosa hipertónica en pacientes estables en diálisis peritoneal (DP), con un tiempo medio en DP de 16 ± 22 meses. Se midieron el coeficiente de transferencia de masa de creatinina (MTCcr), el cociente dializado/plasma de creatinina (D/Pcr),la UF y el cribado de sodio a los 60 minutos (difNa60). Resultados: Los valores medios fueron: MTC-Cr: 9,1 ± 4,5 ml/min, D/Pcr: 0,71 ± 0,09, UF 759 ± 233 ml/4 h y difNa60: 4,7 ± 2,3.El modelo que mejor explica la UF es el que incluye difNa60,MTCcr, edad y tiempo en DP (r = 0,57; p >0,0001). En los pacientes con UF menor de 600 ml (percentil 25) se pierde la correlación entre la UF y el MTCcr, pero se mantiene condifNa60 (r = 0,48). Los 38 pacientes con antecedentes de peritonitisno presentaron diferencias en UF, MTCcr o D/Pcr, pero tienen menor difNa60 (3,7 ± 2,8 frente a 4,9 ± 2,1; p = 0,002)que el resto de pacientes. Conclusiones: La cinética peritoneal realizada con glucosa hipertónica permite no sólo haceruna medida estandarizada de la UF sino también determinar el cribado de sodio, que es el parámetro más sensible para detectar alteraciones del transporte de agua (AU)

Introduction: The use of solutions containing hypertonic glucose(3.86%/4.25%) has been postulated as the method of choice for study the peritoneal function, and permits a better evaluation of the ultrafiltration (UF) capacity. Objective: The aim of our study was to analyze the UF capacity and its relation with the peritoneal permeability and sieving of sodium, performing the peritoneal kinetic study with hypertonic glucose solutions. Patients and methods: We performed 184 peritoneal kinetic studies with hypertonic glucose solutions in stable patients on peritoneal dialysis (PD), with a meantime on PD of 16 ± 22 months. We measured the mass transfer coefficient of creatinine (CrMTC), dialysate to plasma ratio of creatinine (D/PCr), UF capacity and sieving of sodium at 60 minutes(difNa60). Results: The mean values were: CrMTC: 9.1 ± 4.5 ml/min, D/PCr: 0.71 ± 0.09, UF 759 ± 233 ml/4 h and difNa60: 4.7 ± 2.3. The best multivariate model that predicts the UF capacity included: difNa60,CrMTC, age and time on PD (r = 0.57; p >0.0001). In patients with U Flower than 600 ml/4 h (Percentil 25) the correlation between UF and CrMTC was lost, but remains the correlation with difNa60 (r = 0.48).The patients with previous peritonitis (n = 38) showed no differences in UF, CrMTC or D/Pcr, but the had lower difNa60 (3.7 ± 2.8 vs.4.9 ± 2.1; p = 0.002) than the remaning patients. Conclusions: The peritoneal kinetic study performed with hypertonic glucose allows to standarize the UF capacity and by determination of sieving of sodium, the early detection of water transport alterations, before the UF capacity and small solutes permeability alteration develops (AU)