Patterns of kidney function and risk assessment in a nationwide laboratory database: the Brazilian CHECK-CKD study.

BACKGROUND: Chronic kidney disease (CKD) is a global health problem with rising prevalence, morbidity, mortality, and associated costs. Early identification and risk stratification are key to preventing progression to kidney failure. However, there is a paucity of data on practice patterns of kidney function assessment to guide the development of improvement strategies, particularly in lower-income countries. METHODS: A retrospective observational analysis was conducted in a nationwide laboratory database in Brazil. We included all adult patients with at least one serum creatinine assessment between June 2018 and May 2021. Our primary objective was to determine the proportion of patients with estimated glomerular filtration rate (eGFR) evaluations accompanied by predicted levels of urinary albumin-to-creatinine ratio (pACR) assessments within 12 months. RESULTS: Out of 4,5323,332 serum creatinine measurements, 42% lacked pACR measurements within 12 months. Approximately 10.8% of tests suggested CKD, mostly at stage 3a. The proportion of serum creatinine exams paired with pACR assessment varied according to the CKD stage. Internal Medicine, Cardiology, and Obstetrics/Gynecology were the specialties requesting most of the creatinine tests. Nephrology contributed with only 1.1% of serum creatinine requests for testing. CONCLUSION: Our findings reveal that a significant proportion of individuals with a creatinine test lack an accompanying urinary albuminuria measurement in Brazil, contrary to the recommendations of the international guidelines. Non-Nephrologists perform most kidney function evaluations, even among patients with presumable advanced CKD. This highlights the urge to incorporate in clinical practice the early detection of CKD and to encourage more collaborative multidisciplinary care to improve CKD management.

Chronic Kidney Disease in Brazil: Current Status and Recommended Improvements.

Background: Over the last 3 decades, over 700 million individuals worldwide have been diagnosed with chronic kidney disease (CKD). In a 2017 survey in southern Brazil, 11.4% of those surveyed had CKD. Early identification and effective therapy in Brazil may reduce CKD's impact. This panel discusses the early diagnosis and treatment of CKD and the barriers and actions needed to improve the management of CKD in Brazil. A panel of Brazilian nephrologists was provided with relevant questions to address before a multiday conference. During this meeting, each narrative was discussed and edited through several rounds until agreement on the relevant topics and recommendations was achieved. Summary: Panelists highlighted hurdles to early diagnosis and treatment of CKD. These include, but are not limited to, a lack of public and patient education, updated recommendations, multidisciplinary CKD treatment, and a national CKD database. People-centered, physician-centered, and healthcare institution-centered actions can be taken to improve outcomes. Patient empowerment is needed via multiple channels of CKD education and access to health-monitoring wearables and apps. Primary care clinicians and nonspecialists must be trained to screen and manage CKD-causing illnesses, including diabetes and hypertension. The healthcare system may implement a national health data gathering system, more screening tests, automated test result reporting, and telehealth. Key Messages: Increasing access to early diagnosis can provide a path to improving care for patients with CKD. Concerted efforts from all stakeholders are needed to overcome the barriers.

Is race adjustment necessary to estimate glomerular filtration rate in South Brazilians?

BACKGROUND AND AIMS: Race coefficients (RC) in equations to estimate glomerular filtration rate (GFR) have been highly questioned. We aimed to evaluate the performance of three equations, namely 2009 Chronic Kidney Disease Epidemiology Collaboration (2009 CKD-EPI), 2021 CKD-EPI, and European Kidney Function Consortium (EKFC) in self-reported Black and White Brazilians. MATERIALS AND METHODS: Our cross-sectional study compared estimated GFR (eGFR) with 51Cr-EDTA measured GFR (mGFR) in healthy adults, patients with type 2 diabetes mellitus with or without chronic kidney disease (CKD), and in non-diabetic individuals with CKD. The performance of these equations was assessed using Bland-Altman plots, Lin's concordance correlation coefficient (CCC), bias, P30, and P15 accuracy. RESULTS: Three hundred six White adults (aged 53 ± 17 years, 55% women, mean mGFR: 83 ± 32 mL/min/1.73 m2) and 48 Black participants (aged 53 ± 17 years, 58% women, mGFR: 90 ± 34 mL/min/1.73 m2) were included. No equation achieved the desirable P30 accuracy value of 90%, neither in White (2009 CKD-EPI:78%, 2021 CKD-EPI:76% and EKFC:77%, p = 0.368) nor in Black volunteers (respective values of 77%, 75%, and 77%; p = 0.882). The 2009 CKD-EPI showed the best performance in Black participants (bias: 4.04; CCC: 0.848), whereas the 2021 CKD-EPI performed better in Whites, with smaller bias (1.45), and better concordance correlation coefficient (0.790). The EKFC presented the worst performance. All equations underdiagnosed advanced CKD in White participants, but not in Black. CONCLUSIONS: The 2021 CKD-EPI does not outperform the 2009 CKD-EPI. Instead, it underestimated the occurrence of CKD in White participants. Thus, we do not recommend replacing the 2009 with the new 2021 CKD-EPI in the Brazilian population.

Associations among environmental exposure to trace elements and biomarkers of early kidney damage in the pediatric population.

BACKGROUND: In kidney damage, molecular changes can be used as early damage kidney biomarkers, such as Kidney Injury Molecule-1 and Neutrophil gelatinase-associated lipocalin. These biomarkers are associated with toxic metal exposure or disturbed homeostasis of trace elements, which might lead to serious health hazards. This study aimed to evaluate the relationship between exposure to trace elements and early damage kidney biomarkers in a pediatric population. METHODS: In Tlaxcala, a cross-sectional study was conducted on 914 healthy individuals. The participants underwent a medical review and a socio-environmental questionnaire. Five early damage kidney biomarkers were determined in the urine with Luminex, and molybdenum, copper, selenium, nickel, and iodine were measured with ICP-Mass. RESULTS: The eGFR showed a median of 103.75 mL/min/1.73 m2. The median levels for molybdenum, copper, selenium, nickel, and iodine were 24.73 ng/mL, 73.35 ng/mL, 4.78 ng/mL, 83.68 ng/mL, and 361.83 ng/mL, respectively. Except for molybdenum and nickel, the other trace elements had significant associations with the eGFR and the early kidney damage biomarkers. Additionally, we report the association of different exposure scenarios with renal parameters. DISCUSSION: and Conclusions. Among the explored metals, exposure to Cu and iodine impairs renal function. In contrast, Se may manifest as a beneficial metal. Interactions of Mo-Se and Mo-Iodine seem to alter the expression of NGAL; Mo-Cu for CLU; Mo-Cu, Mo-Se, and Mo-iodine for Cys-C and a-1MG; and Mo-Cu and Mo-iodine for KIM-1; were noticed. Our study could suggest that trace element interactions were associated with early kidney damage biomarkers.

Effects of inbreeding on production traits and genetic evaluations in Guzerá beef cattle raised under tropical conditions.

The objectives of this study were to evaluate the influence of inbreeding on growth traits and body measurements, as well as on the estimation of genetic parameters and genetic trends in Guzerá cattle. Phenotypic records of 4,212 animals selected for postweaning weight from Guzerá Breeding Program of Advanced Beef Cattle Research Center were utilized. The pedigree file contained records from 7,213 animals born from 1928 to 2019. The traits analyzed were: birth weight (BW), weights adjusted to 210, 378 and 550 days of age (W210, W378 and W550, respectively), chest girth at 378 and 550 days of age (CG378 and CG550), scrotal circumference (SC), and hip height at 378 and 550 days of age (HH378 and H550). Linear regression was used to evaluate the effects of inbreeding on traits. Genetic parameters were obtained using models including or not the effect of inbreeding as a covariate. Inbreeding had negative effects (P ≤ 0.01) on BW (-0.09 kg), W378 (-2.86 kg), W550 (-2.95 kg), HH378 (-0.10 cm), and H550 (-0.29 cm). The lowest and highest heritability estimates were obtained for W210 (0.21 ± 0.07) and HH550 (0.57 ± 0.06), respectively. The genetic correlations were strong and positive between all traits, ranging from 0.44 ± 0.08 (SC x HH) to 0.99 ± 0.01 (W378 x W550). Spearman correlations between EBVs obtained with or without inbreeding effect ranged from 0.968 to 0.995 (P < 0.01). The results indicate loss of productive performance in inbred animals. However, the inclusion of inbreeding coefficient in genetic evaluation models did not alter the magnitude of genetic parameters or genetic trends for the traits studied.

Association between branched-chain amino acids and renal function in the ELSA-Brasil study.

BACKGROUND & AIMS: Epidemiologic studies show high circulating Branched-chain amino acids (BCAA) are associated with excess body weight, impaired fasting glucose, insulin resistance, high blood pressure, and dyslipidemia. There is scarce data on the association between renal function and circulating levels of BCAA. Therefore, we aim to study this association in a sample of the Brazilian Longitudinal Study of Adults (ELSA-Brasil) METHODS: We analyzed participants who had at the baseline BCAA: valine, isoleucine, and leucine measured through nuclear magnetic resonance. The outcomes evaluated were estimated glomerular function (eGFR - CKD-EPI without race) and 12h-albumin-creatinine ratio (ACR). In addition, we built unadjusted and adjusted multivariable linear regression models to investigate the association between the BCAA (total and individual) and eGFR and ACR. RESULTS: We studied 4912 participants (age 51.7(±9.0) years, 53.4% women, 59.5% White (59.5%), 32.7% hypertension, and 18.2% diabetes). The mean BCAA level was 429.15 ± 87.15. The mean eGFR was 84.95 ± 15 ml/min/1.73 m2, and the median ACR was 6.5 (1.8-4920) mg/g. Descriptive analyses comparing eGFR stratified <60 ml/min/1.73 m2 and ACR≥30 mg/g demonstrate that BCAA levels are higher in patients with eGFR<60 and ACR ≥30. Regarding eGFR, an inverse association was detected with BCAA levels when adjusted for demographic variables, and it is not maintained after adjustments for other confounders. Also, a positive association was found for ACR≥30 mg/g, and BCAA levels, and this association is not confirmed after adjustments. CONCLUSIONS: BCAA levels were inversely associated with eGFR and positively associated with ACR. Further studies are necessary to allow the comprehension of those associations.

100% Orange Juice Consumption is Associated with Socioeconomic Status, Improved Nutrient Adequacy, and Higher Bioactive Compounds Intake: Results from Brazilian National Dietary Survey 2017-2018.

OBJECTIVE: The consumption of 100% orange juice (OJ) has been associated with nutrient adequacy and better diet quality. To date, there are few analyses exploring 100% OJ consumption patterns across populations, with no data from Brazil. We aimed to explore the associations between 100% OJ consumption, sociodemographic factors, and nutrient intake in a representative sample of the Brazilian general population aged 10 years or older. METHODS: Data were obtained from the National Dietary Survey 2017-2018, a cross-sectional study including data on individual food intake of 46,164 subjects aged ≥10 years collected using two 24-h dietary recalls. RESULTS: 100% OJ was consumed by 11% of the population, with a mean intake of 43.0 ml/d. Males were more frequent consumers compared to females, and the percentage of consumers increased with education and income. 100% OJ consumption was associated with higher intakes of energy, vitamin C, folate, calcium, magnesium, potassium, polyphenols, and carotenoids. There is no significant difference in fiber intake between consumers and non-consumers. 100% OJ consumers had a higher percentage of the population meeting the Estimated Average Requirement for vitamin A, vitamin C, vitamin D, folate, calcium, and magnesium. CONCLUSION: Our results suggest that 100% OJ could be a component of a healthy diet, helping individuals to achieve nutrient recommendations.

Human health risk assessment of mercury in highly consumed fish in Salvador, Brazil.

This work reports assessing risks to human health resulting from mercury levels in sardines (Sardinella brasiliensis), which have been highly consumed by the low-income population from Salvador, Brazil. Mercury was determined using the Direct Mercury Analysis (DMA) in fifty-one commercially acquired samples in seventeen neighborhoods. The mercury content on a wet basis ranged from 0.023 to 0.083 µg g-1 for an average value of 0.039 µg g-1. The estimated weekly intake (EWI), target hazard quotient (THQ), and maximum safe consuming quantity (MSCQ) were used in the toxicological assessment, and all these indices denoted that this food does not pose any risks to the human health of the population that consumes it. The development of this work was very significant because most sardines sold in Salvador originate from Todos os Santos Bay, which has a history of mercury contamination.

Impact of heat stress on genetic evaluation of oocyte and embryo production in Gir dairy cattle.

Identifying and selecting genotypes tolerant to heat stress might improve reproductive traits in dairy cattle, including oocyte and embryo production. The temperature-humidity index (THI) was used, via random regression models, to investigate the impact of heat stress on genetic parameters and breeding values of oocyte and embryo production in Gir dairy cattle. We evaluated records of total oocytes (TO), viable oocytes (VO), cleaved embryos (CE), and viable embryos (VE) from dairy Gir donors. Twenty-four models were tested, considering age at ovum pick-up (AOPU) and THI means as a regressor in the genetic evaluation. We computed THI in eight periods, from 0 to 112 days before ovum pick-up, which were adjusted by different orders of Legendre polynomials (second, third, and fourth). The best-fit model according to Akaike's information criterion (AIC) and Model Posterior Probabilities (MPP) considered Legendre polynomials of third order and THI means of 112 days for TO, fourth order and 56 days for VO, second order and 28 days for CE, and second order and 42 days for VE, respectively. The heritability (h2) estimates across AOPU and THI scales ranged from 0.34 to 0.62 for TO, 0.31 to 0.58 for VO, 0.26 to 0.39 for CE, and 0.15 to 0.26 for VE, respectively. The fraction of the phenotypic variance explained by the permanent environment in different AOPU and THI scales ranged from 0.03 to 0.25 for TO, 0.05 to 0.26 for VO, 0.09 to 0.36 for CE, and 0.15 to 0.27 for VE, respectively. Spearman's rank correlation between the estimated breeding values in different AOPU and THI scale from the top 5% sires and females ranged from 0.18 to 0.90 for TO, 0.31 to 0.95 for VO, 0.14 to 0.85 for CE, and 0.47 to 0.94 for VE, respectively. The h2 estimates for all evaluated traits varied from moderate to high magnitude across AOPU and THI scales, indicating that genetic selection can result in rapid genetic progress for the evaluated traits. There was a reranking among the best animals in different AOPU and THI. It is possible to select dairy Gir cattle tolerant to heat stress to improve oocyte and embryo production.

Ridge regression and deep learning models for genome-wide selection of complex traits in New Mexican Chile peppers.

BACKGROUND: Genomewide prediction estimates the genomic breeding values of selection candidates which can be utilized for population improvement and cultivar development. Ridge regression and deep learning-based selection models were implemented for yield and agronomic traits of 204 chile pepper genotypes evaluated in multi-environment trials in New Mexico, USA. RESULTS: Accuracy of prediction differed across different models under ten-fold cross-validations, where high prediction accuracy was observed for highly heritable traits such as plant height and plant width. No model was superior across traits using 14,922 SNP markers for genomewide selection. Bayesian ridge regression had the highest average accuracy for first pod date (0.77) and total yield per plant (0.33). Multilayer perceptron (MLP) was the most superior for flowering time (0.76) and plant height (0.73), whereas the genomic BLUP model had the highest accuracy for plant width (0.62). Using a subset of 7,690 SNP loci resulting from grouping markers based on linkage disequilibrium coefficients resulted in improved accuracy for first pod date, ten pod weight, and total yield per plant, even under a relatively small training population size for MLP and random forest models. Genomic and ridge regression BLUP models were sufficient for optimal prediction accuracies for small training population size. Combining phenotypic selection and genomewide selection resulted in improved selection response for yield-related traits, indicating that integrated approaches can result in improved gains achieved through selection. CONCLUSIONS: Accuracy values for ridge regression and deep learning prediction models demonstrate the potential of implementing genomewide selection for genetic improvement in chile pepper breeding programs. Ultimately, a large training data is relevant for improved genomic selection accuracy for the deep learning models.

Abdominal circumference growth velocity as a predictor of adverse perinatal outcomes in small-for-gestational-age fetuses.

OBJECTIVE: To assess the predictive value of abdominal circumference growth velocity (ACGV) between the second and third trimesters to predict adverse perinatal outcomes in a cohort of small-for-gestational-age fetuses without evidence of placental insufficiency (i.e. fetal growth restriction). MATERIAL AND METHODS: This is a single-center retrospective cohort study of all singleton pregnancies with small-for-gestational-age fetuses diagnosed and delivered at a quaternary institution. Crude and adjusted odds ratios (ORs) and corresponding confidence intervals (CIs) were calculated via logistic regression models to assess the potential association between abnormal ACGV (i.e. ≤10th centile) and adverse perinatal outcomes defined as a composite outcome (i.e. umbilical artery pH <7.1, 5-min Apgar score <7, admission to the neonatal intensive care unit, hypoglycemia, intrapartum fetal distress requiring expedited delivery, and perinatal death). Furthermore, the area under the receiver-operating characteristic curve (AUC) of three logistic regression models based on estimated fetal weight and ACGV for predicting the composite outcome is also reported. RESULTS: A total of 154 pregnancies were included for analysis. The median birthweight for the cohort was 2,437 g (interquartile range [IQR] 2280, 2635). Overall, the primary composite outcome was relatively common (29.2%). In addition, there was a significant association between abnormal ACGV and adverse perinatal outcomes (OR 3.37, 95% CI 1.60, 7.13; adjusted OR 4.30, 95% CI 1.77, 10.49). Likewise, the AUC for the ACGV was marginally higher (0.64) than the estimated fetal weight (0.54) and ACGV + estimated fetal weight (0.54). Still, no significant difference was detected between the curves (p = 0.297). CONCLUSIONS: Our results suggest that an ACGV below the 10th centile is a risk factor for adverse perinatal outcomes among small-for-gestational-age fetuses.

Estimated fetal weight standards of the INTERGROWTH-21st project for the prediction of adverse outcomes: a systematic review with meta-analysis.

OBJECTIVE: To systematically review and assess the risk of bias in the literature evaluating the performance of INTERGROWTH-21st estimated fetal weight (EFW) standards to predict maternal, fetal and neonatal adverse outcomes. METHODS: Searches were performed in seven electronic databases (Scopus, Web of Science, Medline, Embase, Lilacs, Scielo and Google Scholar) using citation tools and keywords (intergrowth AND (standard OR reference OR formula OR model OR curve); all from 2014 to the last search on April 16th, 2021). We included full-text articles investigating the ability of INTERGROWTH-21st EFW standards to predict maternal, fetal or neonatal adverse outcomes in women with a singleton pregnancy who gave birth to infants with no congenital abnormalities. The study was registered on PROSPERO under the number CRD42020115462. Risk of bias was assessed with a customized instrument based on the CHARMS checklist and composed of 9 domains. Meta-analysis was performed using relative risk (RR [95%CI]) and summary ROC curves on outcomes reported by two or more methodologically homogeneous studies. RESULTS: Sixteen studies evaluating fifteen different outcomes were selected. The risk of bias was high (>50% of studies with high risk) for two domains: blindness of assessment (81.3%) and calibration assessment (93.8%). Considering all the outcomes investigated, for 95% of the results, the specificity was above 73.0%, but the sensitivity was below 64.1%. Pooled results demonstrated a higher RR of neonatal small for gestational age (6.71 [5.51-8.17]), Apgar <7 at 5 min (2.17 [1.48-3.18]), and neonatal intensive care unit admission (2.22 [1.76-2.79]) for fetuses classified <10th percentile when compared to those classified above this limit. The limitation of the study is the absence of heterogeneity exploration or publication bias investigation, whereas no outcomes were evaluated by more than five studies. CONCLUSIONS: The IG-21 EFW standard has low sensitivity and high specificity for adverse events of pregnancy. Classification <10th percentile identifies a high-risk group for developing maternal, fetal and neonatal adverse outcomes, especially neonatal small for gestational age, Apgar <7 at 5 min, and neonatal intensive care unit admission. Future studies should include blind assessment of outcomes, perform calibration analysis with continuous data, and evaluate alternative cutoff points.

Estimated glomerular filtration rate in Brazilian adults with sickle cell disease: results from the REDS-III multicenter cohort study.

Chronic kidney disease (CKD) has a significant impact on sickle cell disease (SCD) morbidity and mortality. Early identification of individuals at highest risk of developing CKD may allow therapeutic intervention to prevent worse outcomes. This study aimed to evaluate the prevalence and risk factors for reduced estimated glomerular filtration rate (eGFR) among adults with SCD in Brazil. Participants in the REDS-III multicenter SCD cohort with more severe genotypes aged ≥ 18 years with at least two serum creatinine values were analyzed. The eGFR was calculated using the Jamaica Sickle Cell Cohort Study GFR equation. The eGFR categories were defined according to the K/DOQI. Participants with eGFR ≥ 90 were compared to those with those with eGFR < 90. Among the 870 participants, 647 (74.4%) had eGFR ≥ 90, 211 (24.3%) had eGFR 60 to 89, six (0.7%) had eGFR 30 to 59, and six (0.7%) had ESRD. Male sex (OR: 37.3; 95%CI: 22.4-65.1), higher age (OR: 1.04; 95%CI: 1.02-1.06), higher diastolic blood pressure (OR: 1.03; 95%CI: 1.009-1.06), lower Hb (OR: 0.80; 95%CI: 0.68-0.93), and lower reticulocytes (OR: 0.94; 95%CI: 0.89-0.99) levels were independently associated with eGFR < 90. There was a trend towards higher odds of death in participants with eGFR < 90 (OR: 1.8; 95%CI: 0.95-3.32; p = 0.065). In turn, participants with eGFR < 60 had a 12.2 (95%CI: 2.1-96.9) times higher odds for death when compared to those with eGFR ≥ 60. In this study, eGFR < 90 was observed in one-quarter of adults. Older age, male sex, higher diastolic blood pressure, lower hemoglobin, and lower reticulocyte levels were associated with occurrence of eGFR < 90. Estimated GFR < 60 increased the risk of mortality.

Primeras recomendaciones de consenso SLANH - COLABIOCLI / Primeiras Recomendações de Consenso SLANH - COLABIOCLI / (Sociedad Latinoamericana de Nefrología e Hipertensión - Confederación Latinoamericana de Bioquímica Clínica) / Informe de la tasa de filtración glomerular estimada junto a la determinación de la creatininemia en población adulta / First SLANH-COLABIOCLI Consensus Recommendations

Resumen La enfermedad renal crónica (ERC) es de alta prevalencia en América Latina y en todo el mundo. Se estima que entre 10 y 20% de la población adulta es portadora de ERC y su prevalencia va en aumento. La ERC progresa en forma silenciosa. Su diagnóstico temprano y oportuno permite iniciar un tratamiento efectivo, en la mayoría de los casos, para detener la enfermedad. Desde hace mucho tiempo, el análisis de la creatininemia es la principal prueba utilizada para valorar la función renal, pero su confiabilidad es limitada. De acuerdo con las recomendaciones de las GUIAS KDOQI del año 2002 la tasa de filtración glomerular estimada (TFGe) obtenida a través de fórmulas, se estableció como una de las herramientas principales para detectar la enfermedad renal de manera precoz, ya que alerta de forma precisa al médico y al equipo de salud sobre el nivel de función renal del paciente. La detección de una TFGe disminuida (menor de 60 mL/min/1,73 m2) es clínicamente relevante, ya que permite establecer el diagnóstico de enfermedad renal en adultos. En el año 2022, en una encuesta realizada por SLANH y COLABIOCLI dirigida a los laboratorios de análisis clínicos de América Latina (n: 237), el 49% de los mismos no informaban la TFGe rutinariamente. En base a esta realidad SLANH y COLABIOCLI elaboraron estas recomendaciones de consenso en referencia al uso de la TFGe.

Abstract Chronic kidney disease (CKD) has a high prevalence worldwide and in Latin America (10 to 20% of the adult population) and is increasing. CKD progresses silently. Opportune diagnosis and treatment are effective in most cases to improve outcomes. Serum creatinine was the main test to assess kidney function, but its reliability is limited. Through the KDOQI Guidelines 2002, the estimated glomerular filtration rate (eGFR) obtained from equations was established as one of the main tools for the early detection of kidney disease in clinical practice. The detection of a decreased eGFR (less than 60 mL/min/1.73 m2) is clinically relevant. This cut-off level establishes the diagnosis of kidney disease in adults. In 2022 SLANH and COLABIOCLI conducted a survey among the clinical laboratories from Latin America. The survey included 237 laboratories, 49% of which did not routinely report the eGFR. Based on this situation, SLANH and COLABIOCLI have elaborated the following consensus recommendations regarding the use of eGFR.

Resumo A doença renal crônica (DRC) é altamente prevalente na América Latina e em todo o mundo. Estima-se que entre 10 e 20% da população adulta seja portadora de DRC e sua prevalência esteja aumentando. A DRC progride silenciosamente. Seu diagnóstico precoce e oportuno permite iniciar um tratamento eficaz, na maioria dos casos, para estancar a doença. Faz muito tempo, a análise da creatinina tem sido o principal teste usado para avaliar a função renal mas sua confiabilidade é limitada. De acordo com as recomendações dos GUIAS KDOQI do ano de 2002, a estimativa da taxa de filtração glomerular (eGFR), obtida por meio de fórmulas, consolidou-se como uma das principais ferramentas para a detecção precoce da doença renal, visto que alerta com precisão ao médico e ao equipe de saúde sobre o nível de função renal do paciente. A detecção de uma eGFR diminuída (inferior a 60 mL/min/1,73 m2) é clinicamente relevante, pois permite estabelecer o diagnóstico de doença renal em adultos. No ano de 2022, em pesquisa realizada pela SLANH e COLABIOCLI dirigida a laboratórios de análises clínicas da América Latina (n: 237), 49% deles não relataram rotineiramente eGFR. Com base nessa realidade, SLANH e COLABIOCLI prepararam essas recomendações de consenso sobre o uso de eGFR.

Inorganic Contaminants in Plant-Based Yogurts Commercialized in Brazil.

This study aimed to evaluate the content of 11 inorganic elements (Al, Cr, Co, Ni, As, Mo, Cd, Sb, Ba, Hg, and Pb) in commercial plant-based and animal-based yogurts for comparison purposes. The samples were mineralized using a simple and fast ultrasound-assisted acid digestion method at 80 °C for 35 min, and the determination of inorganic elements was performed by ICP-MS. The method was validated according to the INMETRO guide, obtaining recoveries from 80 to 110%, precision from 6 to 15%, and a limit of quantification (LOQ) ranging from 200 µg/kg (Al) to 4 µg/kg (other elements). The element concentrations in the plant-based yogurts were Al(

SNP- and haplotype-based single-step genomic predictions for body weight, wool, and reproductive traits in North American Rambouillet sheep.

Rambouillet sheep are commonly raised in extensive grazing systems in the US, mainly for wool and meat production. Genomic evaluations in US sheep breeds, including Rambouillet, are still incipient. Therefore, we aimed to evaluate the feasibility of performing genomic prediction of breeding values for various traits in Rambouillet sheep based on single nucleotide polymorphisms (SNP) or haplotypes (fitted as pseudo-SNP) under a single-step GBLUP approach. A total of 28,834 records for birth weight (BWT), 23,306 for postweaning weight (PWT), 5,832 for yearling weight (YWT), 9,880 for yearling fibre diameter (YFD), 11,872 for yearling greasy fleece weight (YGFW), and 15,984 for number of lambs born (NLB) were used in this study. Seven hundred forty-one individuals were genotyped using a moderate (50 K; n = 677) or high (600 K; n = 64) density SNP panel, in which 32 K SNP in common between the two SNP panels (after genotypic quality control) were used for further analyses. Single-step genomic predictions using SNP (H-BLUP) or haplotypes (HAP-BLUP) from blocks with different linkage disequilibrium (LD) thresholds (0.15, 0.35, 0.50, 0.65, and 0.80) were evaluated. We also considered different blending parameters when constructing the genomic relationship matrix used to predict the genomic-enhanced estimated breeding values (GEBV), with alpha equal to 0.95 or 0.50. The GEBV were compared to the estimated breeding values (EBV) obtained from traditional pedigree-based evaluations (A-BLUP). The mean theoretical accuracy ranged from 0.499 (A-BLUP for PWT) to 0.795 (HAP-BLUP using haplotypes from blocks with LD threshold of 0.35 and alpha equal to 0.95 for YFD). The prediction accuracies ranged from 0.143 (A-BLUP for PWT) to 0.330 (A-BLUP for YGFW) while the prediction bias ranged from -0.104 (H-BLUP for PWT) to 0.087 (HAP-BLUP using haplotypes from blocks with LD threshold of 0.15 and alpha equal to 0.95 for YGFW). The GEBV dispersion ranged from 0.428 (A-BLUP for PWT) to 1.035 (A-BLUP for YGFW). Similar results were observed for H-BLUP or HAP-BLUP, independently of the LD threshold to create the haplotypes, alpha value, or trait analysed. Using genomic information (fitting individual SNP or haplotypes) provided similar or higher prediction and theoretical accuracies and reduced the dispersion of the GEBV for body weight, wool, and reproductive traits in Rambouillet sheep. However, there were no clear improvements in the prediction bias when compared to pedigree-based predictions. The next step will be to enlarge the training populations for this breed to increase the benefits of genomic predictions.

Metal bioaccumulation in fish from the Araguari River (Amazon biome) and human health risks from fish consumption.

Recently, high concentrations of metals have been found in the waters from sampling sites located in the Araguari River lower section. These metals can be bioaccumulated by fish, but also biomagnified, representing a potential risk through human consumption. Here, we aimed to (1) determine the metal concentrations in muscle samples from fish; (2) evaluate bioaccumulation of metals in muscle tissue of fish species with different feeding behaviors; and (3) investigate the risks of single metals, as well as mixture of metals, to human fish consumption. Eleven fish species were sampled (3 carnivorous, 5 omnivorous, and 3 detritivorous). In four fish species, Cd and Pb concentrations exceeded the Brazilian maximum limits (MLs) for human consumption. Individually, Pb and Cd concentrations in the muscle of these fish indicate risks to human health. When considering the mixture of metals, the consumption of all fish species represents risks. The highest risks implicate detritivorous species. For all fish species evaluated, the estimated daily intake (EDI) of Hg shows values above its reference dose (RfD). Our results suggest the need to establish an environmental monitoring program that aims to preserve environmental quality, biodiversity, and human health. It is also necessary to develop actions that aim to educate Amazonian populations on safe fish preparation and consumption.

Julgamentos metacognitivos e o desempenho de idosos em tarefas de memória / Metacognitive judgments and the performance of the elderly in memory tasks / Juicios metacognitivos y el desempeño de los ancianos en tareas de memoria

O estudo objetivou investigar o monitoramento metacognitivo de idosos por meio da análise de relações entre o desempenho estimado por eles e seus reais desempenhos em tarefas de memória de curto prazo. Participaram 30 idosos não acamados, sem sinais relatados de demência ou indicados por meio do Miniexame do Estado Mental, de ambos os sexos, com idade entre 65 e 90 anos, além de uma pessoa próxima a cada um deles, totalizando 60 participantes. O contato com a amostra foi realizado por meio da estratégia de Snowball Sampling Aproach. Os materiais apresentados aos participantes idosos foram o Miniexame do Estado Mental, os subtestes Aritmética, Dígitos e Sequência de Números e Letras do WAIS III, e o Registro de Julgamentos Metacognitivos. Para os participantes que eram figuras próximas de cada idoso foi apresentado o Questionário para Informantes Múltiplos sobre o Desempenho de Idosos em Tarefas de Memória. Os resultados dos subtestes Aritmética, Dígitos e Sequência de Números e Letras do WAIS III foram correlacionados aos julgamentos dos idosos e das pessoas próximas quanto ao desempenho dos idosos nos subtestes. Foram encontradas correlações fortes e significativas entre os julgamentos e o desempenho real para os três subtestes e correlações moderadas e significativas entre julgamentos de pessoas próximas e o desempenho real dos idosos nos subtestes. Os resultados indicaram que idosos sem sinais de prejuízo cognitivo e seus cuidadores/familiares podem julgar adequadamente os desempenhos em tarefas de memória

The study aimed to investigate the metacognitive monitoring of elderly people by analyzing the relationships between their estimated performance and their actual performance in short-term memory tasks. Thirty elderly individuals who were not bedridden, with no reported signs of dementia or indicated through the Mini Mental State Examination, of both genders, aged between 65 and 90 years, in addition to a person close to each of them participated, totaling 60 participants. Contact with the sample was performed using the Snowball Sam-pling Aproach strategy. The materials presented to the elderly participants were the Mini Mental State Examination, the WAIS III Arithmetic, Digits and Sequence of Numbers and Letters subtests, the Metacognitive Judgments Registry. For participants who were figures close to each elderly person, the Questionnaire for Multiple Informers on the Performance of Elderly Persons in Memory Tasks was presented. The results of the WAIS III Arithmetic, Digits and Sequence of Numbers and Letters subtests were correlated to the judgments of the elderly and those close to them regarding the performance of the elderly in the subtests. Strong and significant correlations were found between judgments and actual performance for the three subtests and moderate and significant correlations were found between judgments of close people and the actual performance of the elderly in the subtests. The results indicated that the elderly, caregivers/family members can properly judge performance in memory tasks

El estudio tuvo como objetivo investigar el seguimiento metacognitivo de las personas mayores mediante el análisis de las relaciones entre su rendimiento estimado y su rendimiento real en tareas de memória a corto plazo. Participaron 30 ancianos que nos se encontraban postrados en cama, sin signos reportados de demencia o índicados a través del Mini Examen del Estado Mental, de ambos sexos, con edades entre 65 y 90 años, además de una persona cercana a cada uno de ellos, totalizando 60 participantes. El contacto con la muestra se realizó mediante la estrategia Snowball Sampling Aproach. Los materiales presentados a los participantes mayores fueron el Mini Examen del Estado Mental, las subpruebas de Aritmética, Dígitos y Secuencia de Números y Letras WAIS III, el Registro de Juicios Metacognitivos. Para los participantes que eran figuras cercanas a cada anciano, se presentó el Cuestionario para Informantes Múltiples sobre el Desempeño de las Personas Mayores en Tareas de Memória. Los resultados de las subpruebas de Aritmética, Dígitos y Secuencia de Números y Letras WAIS III se correlacionaron con los juicios de los ancianos y sus allegados sobre el desempeño de los ancianos en las subpruebas. Se encontraron correlaciones fuertes y significativas entre los juicios y el desempeño real para las tres subpruebas y se encontraron correlaciones moderadas y significativas entre los juicios de personas cercanas y el desempeño real de los ancianos en las subpruebas. Los resultados indicaron que los ancianos, los cuidadores / miembros de la familia pueden juzgar adecuadamente el desempeño en las tareas de memória

A retrospective analysis to estimate trough concentrations of teicoplanin in patients with suspected or documented Gram-positive infections

Abstract Teicoplanin is a glycopeptide antibiotic commonly used to treat Gram-positive bacterial infections in the clinic. The aim of this study was to provide a therapeutic reference for the clinical application and dosage regimen adjustment of teicoplanin by identifying factors associated with its plasma trough concentration (Ctrough). A retrospective study was performed on patients with suspected or documented Gram-positive infections who were hospitalized from November 2017 to January 2020 and treated with teicoplanin while undergoing routine therapeutic drug monitoring (TDM). A total of 112 Ctrough trough measurements were obtained from 72 patients were included in this study. SPSS software was used for correlation analysis and receiver operator characteristic curve (ROC) analysis. The Ctrough for teicoplanin showed statistically significant relationships (P<0.05) with PLT, Scr, CLcr, eGFR, BUN and Cys-C. ROC curve analysis revealed that CLcr and eGFR were more sensitive and specific for Ctrough compared to the other factors. These findings should be considered in the clinical application of teicoplanin and for its dosage adjustment.

Selección contra displasia de cadera canina en el ovejero alemán / Breeding against canine hip dysplasia in the german shepherd dog

RESUMEN La displasia de cadera canina o displasia coxo-femoral (DCF) es un desorden progresivo e incapacitante en perros de razas grandes, como el Ovejero Alemán. La selección de reproductores libres de displasia es la única forma de reducir su incidencia. Se han desarrollado varios métodos de diagnóstico basados en el examen radiográfico, en base a los cuales se seleccionan los reproductores para la cría. La DCF tiene una base hereditaria poligénica e influencia ambiental, con una heredabilidad media a baja (alrededor de 0,20 a 0,40), por lo que el progreso de la selección fenotípica ha sido lento. En Argentina la prevalencia de la displasia en la raza sigue siendo alta (>25%) y es imposible prever su incidencia en la progenie del plantel de cría. Algunos países han implementado la selección basada en el valor estimado de cría, obteniendo un importante avance. Los estudios de asociación del genoma completo han revelado numerosos marcadores asociados a la DCF y se han encontrado varios genes candidatos que señalan la posibilidad de implementar una selección genómica en un futuro cercano.

ABSTRACT Canine hip dysplasia (CHD) is a progressive and disabling disorder in large dog breeds, such as the German Shepherd dog. Breeding sires and dams free of dysplasia is the only way to reduce its incidence. Several diagnostic methods have been developed based on radiographic examination, on the basis of which dogs are selected for breeding. CHD has a polygenic hereditary basis and environmental influence, with a median to low heritability (ca. 0,20 to 0,40), so the progress in phenotypic selection has been slow. In Argentina, the prevalence of dysplasia in German Shepherd dogs remains high (> 25%) and it is impossible to predict its incidence in the offspring of the breeding stock. Some countries have implemented a selection based on the estimated breeding value, obtaining an important advance. Genomewide association studies have revealed numerous CHD-associated markers and several candidate genes have been found that point to the possibility of implementing genomic selection in the near future.