El cálculo de la creatinina sérica basal sobrestima el diagnóstico de alteración renal aguda en pacientes operados de cirugía cardíaca / The calculation of baseline serum creatinine overestimates the diagnosis of acute kidney injury in patients undergoing cardiac surgery

Introducción y objetivo: La definición y clasificación actual de insuficiencia renal aguda se basa en criterios de consenso (sistemas RIFLE y AKIN). De los parámetros recomendados (creatinina, tasa de filtración glomerular y diuresis), la creatinina es el más empleado. En ausencia de valor basal conocido se recomienda su estimación a partir de la ecuación MDRD simplificada, asumiendo en el cálculo una tasa de filtración de 75 ml/min/1,73 m2. El objetivo del presente trabajo fue evaluar la repercusión diagnóstica del empleo de la creatinina basal estimada frente al valor real medido en pacientes operados de cirugía cardíaca. Métodos: Análisis de pacientes operados de cirugía cardíaca mayor incluidos de forma prospectiva en una base de datos. Para cada paciente se calculó el estadio RIFLE máximo alcanzado usando la creatinina basal medida y la estimada. Se analizó la repercusión sobre el diagnóstico mediante coeficientes de correlación intraclase, análisis de concordancia y gráficas de Bland y Altman. Resultados: La incidencia de insuficiencia renal aguda postoperatoria en 2.103 casos operados entre 2002 y 2007 fue del 29,1% al utilizar la creatinina estimada (14,3% con la medida). Esto supone una sobrestimación del 104%, y la correlación intraclase es de 0,12. Excluyendo a los pacientes con insuficiencia renal crónica conocida (tasa de filtrado glomerular [TFG] <60 ml/min/1,73 m2), tanto la sobrestimación (2,4%) como la correlación (0,57) mejoraron. Conclusiones: El cálculo de la creatinina basal a partir de la ecuación MDRD sobrestima la incidencia de insuficiencia renal aguda tras la cirugía cardíaca, y es un método inadecuado para su detección cuando el valor basal se desconoce (AU)

Introduction and objectives: The current definition and classification of acute kidney injury is based on consensus criteria (RIFLE and AKIN systems). Creatinine is the most commonly used of the recommended parameters (creatinine, glomerular filtration rate and diuresis). If the baseline value is not known, it can be calculated based on the simplified MDRD equation, assuming a filtration rate of 75ml/min/1.73m2 for the calculation. The aim of this study was to evaluate the diagnostic impact of using estimated baseline creatinine compared to the actual value measured in patients undergoing cardiac surgery. Methods: Analysis of patients undergoing major cardiac surgery, who were prospectively included in a database. The maximum RIFLE stage reached was calculated for each patient using the measured and estimated baseline creatinine levels. The impact on the diagnosis was analysed using intraclass correlation coefficients, concordance analysis and Bland-Altman plots. Results: The incidence of postoperative acute kidney injury in 2103 cases between 2002 and 2007 was 29.1%, according to estimated creatinine (14.3% with the measure). This represents an overestimation of 104%, with an intraclass correlation of 0.12. By excluding patients with known chronic kidney disease (glomerular filtration rate [<60ml/min/1.73m2), both the overestimation (2.4%) and the correlation (0.57) improved. Conclusions: The calculation of baseline creatinine using the MDRD equation overestimates the incidence of acute kidney injury after cardiac surgery, and is an inadequate method for detection when the baseline value is unknown (AU)

The calculation of baseline serum creatinine overestimates the diagnosis of acute kidney injury in patients undergoing cardiac surgery.

INTRODUCTION AND OBJECTIVES: The current definition and classification of acute kidney injury is based on consensus criteria (RIFLE and AKIN systems). Creatinine is the most commonly used of the recommended parameters (creatinine, glomerular filtration rate and diuresis). If the baseline value is not known, it can be calculated based on the simplified MDRD equation, assuming a filtration rate of 75 ml/min/1.73 m2 for the calculation. The aim of this study was to evaluate the diagnostic impact of using estimated baseline creatinine compared to the actual value measured in patients undergoing cardiac surgery. METHODS: Analysis of patients undergoing major cardiac surgery, who were prospectively included in a database. The maximum RIFLE stage reached was calculated for each patient using the measured and estimated baseline creatinine levels. The impact on the diagnosis was analysed using intraclass correlation coefficients, concordance analysis and Bland-Altman plots. RESULTS: The incidence of postoperative acute kidney injury in 2103 cases between 2002 and 2007 was 29.1%, according to estimated creatinine (14.3% with the measure). This represents an overestimation of 104%, with an intraclass correlation of 0.12. By excluding patients with known chronic kidney disease (glomerular filtration rate [<60 ml/min/1.73 m2), both the overestimation (2.4%) and the correlation (0.57) improved. CONCLUSIONS: The calculation of baseline creatinine using the MDRD equation overestimates the incidence of acute kidney injury after cardiac surgery, and is an inadequate method for detection when the baseline value is unknown.

Intercorrência entre leucose enzoótica e tuberculose em bovinos leiteiros do estado de Pernambuco / Assessment of intercurrence of enzootic leucosis and bovine tuberculosis in dairy cows in the state of Pernambuco, Brazil

Objetivou-se com este estudo avaliar a intercorrência entre leucose enzoótica e tuberculose em rebanhos bovinos leiteiros em oito municípios do Estado de Pernambuco, pelo estabelecimento da prevalência de bovinos reagentes às provas diagnósticas específicas. Foram analisados sorologicamente 662 animais, pela técnica de imunodifusão dupla em gel de agarose e 612 foram avaliados imunoalergicamente, por meio do teste de tuberculinização. Nos 15 rebanhos examinados, as prevalências de bovinos que apresentaram positividade aos testes IDGA e tuberculina foram 32,2% (213/662) e 14,1% (86/612), respectivamente. Os resultados obtidos nesta pesquisa permitiram concluir que as doenças estudadas encontram-se amplamente disseminadas na população avaliada, com crescimento em níveis significativos da leucose, e as infecções pelo vírus da leucose bovina (VLB) e Mycobacterium bovis encontram-se ativas e em expansão, com risco do comprometimento da saúde dos rebanhos bovinos e, pelo caráter zoonótico da tuberculose bovina, das pessoas que lidam com os bovinos.

We carried out this study to evaluate the intercurrence of tuberculosis and enzootic leukosis in dairy cattle herds in 8 districts of the State of Pernambuco, Brazil, by establishing the prevalence of bovines reagent to specific diagnostic tests, and to also verify the correlation between enzootic leucosis, cattle tuberculosis, the leukocytes count and lymphocytes count among the cattle studied. A total of 662 animals were tested serologically and hematologically, by the techniques of double immunodiffusion in agarose gel and the white blood cell count with the total and differential leukocyte count, respectively, and 612 were evaluated immunoallergically by the tuberculin test. In the 15 herds examined, the prevalence of cattle that were positive to the AGID and tuberculin tests were 32.2% (213/662) and 14.1% (86/612), respectively. Analyzing the correlation between the variables total leukocytes and lymphocytes, we found that total leukocyte is highly related to the variable lymphocytes (72%). The results in this study indicated that the diseases studied are widespread in the population studied, with significant levels of growth in leukemia, and infections of bovine leukosis virus (VLB) and Mycobacterium bovis are active and growing, with risk of impairment of the health of cattle herds, and, due to the zoonotic nature of bovine tuberculosis, of the health of people who work with cattle.

Avaliação da composição e qualidade físico-química do leite pasteurizado padronizado comercializado na cidade de São Luís, MA / Evaluation of the composition and physical and chemical quality of standardized pasteurized milk marketed in the city of São Luís, MA, Brazil

Objetivou-se com este estudo avaliar a composição e a qualidade físico-química do leite pasteurizado padronizado comercializado na Cidade de São Luis, MA, verificar se estavam dentro dos padrões estabelecidos pela Instrução Normativa nº 51 do Ministério da Agricultura, Pecuária e Abastecimento e observar a ocorrência de fraudes econômicas como adição de água, através da densidade e crioscopia. Foram coletadas 20 amostras de leite pasteurizado padronizado durante o mês de maio de 2009, no comércio local da cidade. Foram realizadas análises de acidez, densidade, índice crioscópico, EST, ESD, proteína, gordura, cinzas, prova de peroxidase e fosfatase alcalina. Das 20 amostras analisadas, verificou-se que a densidade variou de 1,020 a 1,027 g/mL; a acidez de 10 a 14ºD; a gordura de 2,5 a 3,8%; o EST de 8,6 a 11,36%; ESD 6,1 a 7,86%; crioscopia 0,414 a 0,505ºC; proteínas de 2,4 a 3,32% e cinzas de 0,49 a 0,95%, a % de água adicionada variou de 1,27 a 17,83%. Todas as amostras apresentaram fosfatase negativa e peroxidase positiva. Com relação aos resultados obtidos, pode-se concluir que se apresentaram de forma geral insatisfatórios, evidenciando, principalmente, fraude do produto. Portanto, torna-se necessária a adoção de medidas de fiscalização por parte das autoridades competentes e maior conscientização das indústrias e consumidores.

The objective of this study to evaluate the composition and physico-chemical quality of standardized pasteurized milk marketed in São Luis, MA, Brazil, verify whether it was within the standards established by Instruction No. 51 of the Ministry of Agriculture, Livestock and Supply, and observe the occurrence of any economic fraud such as adding water, by measuring the density and freezing point. We collected 20 samples of standardized pasteurized milk during the month of May 2009, at a local town market. These were analyzed for acidity, density, cryoscopy, TS, SNF, protein, fat, ash, proof of peroxidase and alkaline phosphatase. Of the 20 samples analyzed, it was found that the density ranged from 1.020 to 1.027 g/mL; acidity from 10 to 14°D; fat from 2.5 to 3.8%; TS 8.6 to 11.36%; SNF 6.1 to 7.86%; freezing point 0.414 to 0.505°C; proteins from 2.4 to 3.32%; ash 0.49 to 0.95%; while the percentage of water added ranged from 1.27 to 17.83%. All samples were phosphatase negative and peroxidase positive. Regarding the results obtained, we can conclude that they were generally poor, showing mainly product fraud. Therefore, it is necessary to adopt measures for control by the relevant authorities and to raise awareness within the industries and among consumers.

Human metapneumovirus bronchiolitis in infancy is an important risk factor for asthma at age 5.

BACKGROUND: Human metapneumovirus (hMPV) infection plays an important role in the pediatric respiratory infections. However, little is known about the relationship between hMPV-bronchiolitis and the development of subsequent wheezing. The aim of this study was to evaluate the outcome at third to fifth year after admission for hMPV-bronchiolitis and to compare it with children admitted for respiratory syncytial virus (RSV)-bronchiolitis and with children without lower respiratory disease in the first 2 years of life. METHODS: We studied 55 children (23 hMPV and 32 RSV acute bronchiolitis) aged 3-5 years and hospitalized during the seasons 2000-2005. Thirty-eight children admitted due to acute rotavirus gastroenteritis in the same seasons, and without bronchiolitis during infancy, were also analyzed. Clinical data were collected through structured clinical interviews at the follow-up visit. Skin prick tests to food and inhaled allergens were performed. RESULTS: Asthma was significantly more frequent in children with hMPV-bronchiolitis (odds ratio (OR) = 5.21), RSV-bronchiolitis (OR = 4.68), allergic rhinitis (OR = 1.7), and siblings with atopy (OR = 1.75). In the multivariate analyses, hMPV was the most important risk factor for asthma in preschool years (OR = 15.9), followed by RSV-bronchiolitis (OR = 10.1) and allergic rhinitis (OR = 4.9). No differences were found with respect to allergic rhinitis, atopic dermatitis, food allergy, proportion of positive prick tests, family history of atopy, and asthma. CONCLUSIONS: hMPV-bronchiolitis in infancy was strongly associated with asthma as well as other forms of bronchial obstructive disease at third and fifth year of life. This association is, at least, as strong as the association observed with RSV infections.