Acute kidney injury in an intensive care unit of a general hospital with emergency room specializing in trauma: an observational prospective study.

BACKGROUND: Acute kidney injury (AKI) is common among intensive care unit (ICU) patients and is associated with high mortality. Type of ICU, category of admission diagnosis, and socioeconomic characteristics of the region can impact AKI outcomes. We aimed to determine incidence, associated factors and mortality of AKI among trauma and non-trauma patients in a general ICU from a low-income area. METHODS: We studied 279 consecutive patients in an ICU during a follow-up of one year. Patients with less than 24-hour stay in the ICU and with chronic kidney disease were excluded. AKI was classified according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria in three stages. Comparisons were performed by the Student-t and Mann-Whitney tests for continuous variables, respectively with and without normal distribution. Comparisons of frequencies were carried out by the Fisher test. Multivariate logistic regression was used to test variables as predictors for AKI and death. RESULTS: Admission categories were proportionally divided into 51.6% of non-trauma diagnosis and 48.4% of trauma cases. Most trauma cases involved brain injury (79.5%). The overall incidence of AKI was 32.9%, distributed among the three stages: 33.7% stage 1, 29.4% stage 2 and 36.9% stage-3. Patients who developed AKI were older, had more diabetes, stayed longer in the ICU, presented higher APACHE II and more often needed mechanical ventilation and use of vasopressors. In comparison with non-trauma cases, trauma patients had a greater prevalence of males, higher APACHE II score, higher urine output, and younger age. There was no difference concerning development of AKI and crude mortality between trauma and non-trauma patients. Age, presence of diabetes, APACHE score and use of vasopressors were independent predictors for AKI, and AKI increased the risk of death ten-fold (OR = 14.51; CI 95% = 7.94-26.61; p < 0.001). CONCLUSIONS: There was a high incidence of AKI in this study. AKI was strongly associated with mortality both among trauma and non-trauma patients. Trauma cases, especially brain injury due to traffic accidents involving motorized two-wheeled vehicles, should be seen as an important preventable cause of AKI.

Volaemic status and dyspepsia in end-stage renal disease patients.

AIM: Studies in animals show a relationship between extracellular volume and gastrointestinal motility. End-stage renal disease (ESRD) patients present fluid overload and frequent dyspeptic symptoms. We looked for an association between volaemic status and dyspepsia among ESRD patients undergoing haemodialysis (HD). METHODS: We studied 155 ESRD patients on HD. Their volaemic status was evaluated using bioimpedance analysis. Fluid overload (FO) in litres and relative fluid overload (rFO) in percentage were calculated. rFO > 15% was classified as hypervolaemia. Dyspepsia was assessed through the Porto Alegre Dyspeptic Symptoms Questionnaire (PADYQ). PADYQ scores equal to or greater than 6 classified patients as dyspeptic. Characteristics of patients with and without dyspepsia were compared. Pearson's test was used to test the correlation between continuous variables. Multivariate linear and logistic regressions were performed to test FO as predictor of dyspepsia score and the presence of dyspepsia. RESULTS: There were 64 (41.2%) patients with dyspepsia. Dyspeptics presented higher FO (2.5 ± 1.8 L vs 1.0 ± 1.8 L; P < 0.001) and higher rFO (16 ± 9.9% vs 4.8 ± 12.0%; P < 0.001). Dyspepsia score was positively correlated with FO (r = 0.300; P < 0.001) and with rFO (r = 0.256; P = 0.001). There were more patients with hypervolaemia among dyspeptics compared to non-dyspeptics (65.6% vs 17.6%; P < 0.001). FO was an independent predictor of dyspepsia score (b = 1.036; P < 0.001) and the presence of dyspepsia (OR = 2.00, 95% CI = 1.55-2.50; P < 0.001). CONCLUSION: Hypervolaemia is associated with dyspepsia among ESRD patients on HD.

Report of four cases of Bardet-Biedl syndrome.

Bardet-Biedl syndrome is rare. Although its diagnosis depends on cardinal clinical manifestations which appear in childhood, we report four cases of Bardet-Biedl syndrome lately diagnosed in a dialysis center. Three cases were diagnosed in end-stage renal disease patients when they started maintenance hemodialysis, and one case was diagnosed through screening among hemodialysis patients' relatives. Although pediatricians have more opportunity to diagnose the syndrome, nephrologists are important during the treatment, since renal failure is the main cause of death among Bardet-Biedl syndrome patients. Moreover, late diagnosis of the syndrome among patients with end-stage renal disease can help to detect new cases through the screening among hemodialysis patients' relatives.

Report of four cases of Bardet-Biedl syndrome / Relato de quatro casos da síndrome de Bardet-Biedl

Bardet-Biedl syndrome is rare. Although its diagnosis depends on cardinal clinical manifestations which appear in childhood, we report four cases of Bardet-Biedl syndrome lately diagnosed in a dialysis center. Three cases were diagnosed in end-stage renal disease patients when they started maintenance hemodialysis, and one case was diagnosed through screening among hemodialysis patients' relatives. Although pediatricians have more opportunity to diagnose the syndrome, nephrologists are important during the treatment, since renal failure is the main cause of death among Bardet-Biedl syndrome patients. Moreover, late diagnosis of the syndrome among patients with end-stage renal disease can help to detect new cases through the screening among hemodialysis patients' relatives.

A síndrome de Bardet-Biedl é rara. Embora seu diagnóstico seja baseado em manifestações cardinais que aparecem na infância, relatamos quatro casos de síndrome de Bardet-Biedl diagnosticados tardiamente em uma unidade de diálise. Três casos foram diagnosticados em pacientes com doença renal crônica terminal quando iniciaram hemodiálise de manutenção, e um caso diagnosticado por meio de rastreamento dos parentes dos casos em diálise. Embora pediatras tenham mais oportunidade para diagnosticar a síndrome, nefrologistas são importantes durante o tratamento, já que a insuficiência renal é a principal causa de óbito entre os pacientes com síndrome de Bardet-Biedl. Além disso, o diagnóstico tardio da síndrome entre pacientes com doença renal crônica terminal pode ajudar a detecção de casos novos por meio do rastreamento de parentes dos pacientes em hemodiálise.

Effect of a crude sulfated polysaccharide from Halymenia floresia (Rhodophyta) on gastrointestinal smooth muscle contractility

The aim of this work was to study the effect of Halymenia floresia (Hf) on duodenum contractility, and on experimental protocols of gastric compliance (GC) in rats. Fraction Hf2s exhibited a concentration-dependent myocontractile effect (EC50 12.48 µg/ml), and an inhibitory effect after consecutive washing. The contractile response promoted by Hf2s in the duodenum strips was completely inhibited by verapamil, and the effects were prevented in the presence of Ca2+-free medium. The pretreatment with atropine prevented the Hf2s myocontractile effect. Hf2s was also capable to decrease the GC (from 3.8±0.06 to 3.4±0.13 ml, P<0.05), which did not return to basal levels after more 50 min of observation. These results indicated that the algal polysaccharide possessed in vitro and in vivo gastrointestinal effects.

Effect of a combination of medium chain triglycerides, linoleic acid, soy lecithin and vitamins A and E on wound healing in rats.

PURPOSE: The aim of the study was to determine the effect of a combination of medium chain triglycerides (caprylic, capric, caproic and lauric acids), linoleic acid (essential fatty acid), vitamins A and E and soy lecithin, through a morphometric study, on the wound healing kinetics of experimental cutaneous ulcers. METHODS: A total of 45 male Wistar rats were used, in which a skin flap of total thickness with an area of 4 cm2 was removed. The animals were divided randomly into 3 groups of 15 rats each, Control, Reference and Test groups, which were treated topically with 0.9% NaCl, a preparation of clostebol combined with neomycin sulfate and the test formulation, respectively. The wound areas were measured by digital planimetry at days zero, 3, 7 and 12 postoperative. Based on the wound area, we determined the degree of tissue repair and mean rate of repair at different time intervals. RESULTS: At day 3, an expansion of the wound area was observed in the Reference group and slight contraction in the Control and Test groups. On the subsequent days, the healing process, according to the degree of repair, proceeded in a linear manner, such that, at day 12, the healed area reached 77.95% of the initial ulcerated region in the Control group, 78.40% in the Reference group and 83.49% in the Test group, showing no significant differences. The overall mean rate of repair was equally similar at 12 days of treatment: 25.79 mm2/dia in the Control group, 25.42 mm2/dia in the Reference group and 27.38 mm2/dia in the Test group. CONCLUSION: The test preparation, applied topically on the experimentally induced cutaneous ulcers in rats, did not accelerate the process of tissue repair by secondary union.

Effect of a combination of medium chain triglycerides, linoleic acid, soy lecithin and vitamins A and E on wound healing in rats / Efeito da combinação de triglicerídeos de cadeia média, ácido linoléico, lecitina de soja e vitaminas A e E na cicatrização de ferida em ratos

PURPOSE: The aim of the study was to determine the effect of a combination of medium chain triglycerides (caprylic, capric, caproic and lauric acids), linoleic acid (essential fatty acid), vitamins A and E and soy lecithin, through a morphometric study, on the wound healing kinetics of experimental cutaneous ulcers. METHODS: A total of 45 male Wistar rats were used, in which a skin flap of total thickness with an area of 4 cm² was removed. The animals were divided randomly into 3 groups of 15 rats each, Control, Reference and Test groups, which were treated topically with 0.9 percent NaCl, a preparation of clostebol combined with neomycin sulfate and the test formulation, respectively. The wound areas were measured by digital planimetry at days zero, 3, 7 and 12 postoperative. Based on the wound area, we determined the degree of tissue repair and mean rate of repair at different time intervals. RESULTS: At day 3, an expansion of the wound area was observed in the Reference group and slight contraction in the Control and Test groups. On the subsequent days, the healing process, according to the degree of repair, proceeded in a linear manner, such that, at day 12, the healed area reached 77.95 percent of the initial ulcerated region in the Control group, 78.40 percent in the Reference group and 83.49 percent in the Test group, showing no significant differences. The overall mean rate of repair was equally similar at 12 days of treatment: 25.79 mm²/dia in the Control group, 25.42 mm²/dia in the Reference group and 27.38 mm²/dia in the Test group. CONCLUSION: The test preparation, applied topically on the experimentally induced cutaneous ulcers in rats, did not accelerate the process of tissue repair by secondary union.

OBJETIVO: Avaliar o efeito da associação de triglicerídeos de cadeia média (ácidos caprílico, cáprico, capróico e láurico), ácido linoléico (ácido graxo essencial), vitaminas A e E e lecitina de soja, através de estudo morfométrico, na cinética de reparação de úlceras cutâneas experimentais. MÉTODOS: Utilizaram-se 45 ratos, machos, da linhagem Wistar, nos quais foi removido um retalho cutâneo de espessura total com 4 cm² de área. Os animais foram divididos aleatoriamente em 3 grupos constituídos de 15 ratos, Controle, Referência e Teste, que foram tratados por via tópica respectivamente, com solução salina 0,9 por cento, composto de clostebol associado a sulfato de neomicina e a formulação em teste. As áreas das feridas foram mensuradas por planimetria digital nos dias zero, 3, 7 e 12 de pós-operatório. A partir da área da ferida, calcularam-se ainda o grau de reparação e a taxa média de reparação em intervalo de tempo. RESULTADOS: No 3o dia observou-se uma expansão da área da ferida no grupo referência e uma leve contração nos grupos controle e teste. Nos dias subseqüentes o processo de reparação, medido pela variável grau de reparação, evoluiu de forma linear, de modo que, no 12º dia, a área reparada alcançou 77,95 por cento da região ulcerada inicial no grupo Controle, 78,40 por cento no grupo Referência e 83,49 por cento no grupo Teste, não sendo constatadas diferenças estatisticamente significante. Igualmente semelhantes foram os valores da taxa média de reparação referente aos 12 dias de tratamento: 25,79 mm²/dia no grupo Controle, 25,42 mm²/dia no grupo Referência e 27,38 mm²/dia no grupo Teste CONCLUSÃO: O composto em Teste, aplicado por via tópica em úlceras cutâneas experimentalmente induzidas em ratos, não acelerou o processo de reparação recidual por segunda intenção.