Critically ill patients with COVID-19-associated acute kidney injury treated with kidney replacement therapy: Comparison between the first and second pandemic waves in São Paulo, Brazil

INTRODUCTION: This study aimed to compare the characteristics and outcomes of critically ill patients with COVID-19-associated acute kidney injury (AKI) who were treated with kidney replacement therapy (KRT) in the first and second waves of the pandemic in the megalopolis of Sao Paulo, Brazil. METHODS: A multicenter retrospective study was conducted in 10 intensive care units (ICUs). Patients aged ≥18 years, and treated with KRT due to COVID-19-associated AKI were included. We compared demographic, laboratory and clinical data, KRT parameters and patient outcomes in the first and second COVID-19 waves. RESULTS: We assessed 656 patients (327 in the first wave and 329 in the second one). Second-wave patients were admitted later (7.1±5.0 vs. 5.6±3.9 days after the onset of symptoms, p<0.001), were younger (61.4±13.7 vs. 63.8±13.6 years, p = 0.023), had a lower frequency of diabetes (37.1% vs. 47.1%, p = 0.009) and obesity (29.5% vs. 40.0%, p = 0.007), had a greater need for vasopressors (93.3% vs. 84.6%, p<0.001) and mechanical ventilation (95.7% vs. 87.8%, p<0.001), and had higher lethality (84.8% vs. 72.7%, p<0.001) than first-wave patients. KRT quality markers were independently associated with a reduction in the OR for death in both pandemic waves. CONCLUSIONS: In the Sao Paulo megalopolis, the lethality of critically ill patients with COVID-19-associated AKI treated with KRT was higher in the second wave of the pandemic, despite these patients being younger and having fewer comorbidities. Potential factors related to this poor outcome were difficulties in health care access, lack of intra-hospital resources, delay vaccination and virus variants.

CORRELAÇÕES ENTRE FADIGA, DEPRESSÃO E QUALIDADE DE VIDA RELACIONADA À SAÚDE DE MULHERES EM QUIMIOTERAPIA / CORRELATIONS BETWEEN FATIGUE, DEPRESSION AND HEALTH RELATED QUALITY OF LIFE IN WOMEN IN CHEMOTHERAPY

Objetivo: Avaliar a presença e possíveis correlações entre fadiga, depressão e qualidade de vida relacionada à saúde em mulheres com câncer de mama e ginecológico durante quimioterapia. Metodologia: Estudo exploratório e transversal, realizado com 54 mulheres na Central de Quimioterapia de um hospital universitário, no período de setembro/2017 a dezembro/2019. Instrumentos utilizados: questionário sociodemográfico e clínico-terapêutico, Escala de Fadiga de Piper, Inventário de Depressão de Beck e Quality of Life Questionnaire-Core30. Resultados: Predominaram mulheres com câncer de mama, com fadiga de leve intensidade e sem depressão, contudo destaca-se que nove apresentaram fadiga clinicamente significante e 12 relataram sinais e sintomas indicativos de depressão. Os escores de estado geral de saúde, das funções cognitivas, social, física e desempenho de papel foram considerados satisfatórios, os sintomas prevalentes foram insônia, fadiga, dor e perda de apetite. Houve correlações moderadas entre os itens dos instrumentos, sendo que quanto maiores os escores de fadiga e depressão, maiores foram os sintomas e menores as escalas funcionais de qualidade de vida. Conclusões: A presença de fadiga e depressão correlacionou-se moderadamente com outros sintomas e podem influenciar a qualidade de vida relacionada à saúde destas mulheres.

Objective: To evaluate the presence and possible correlations between fatigue, depression and health-related quality of life in women with breast and gynecological cancer during chemotherapy. Methodology: Exploratory and cross-sectional study, carried out with 54 women at the Chemotherapy Center of a university hospital, from September/2017 to December/ 2019. Instruments used: sociodemographic and clinical-therapeutic questionnaire, Piper's Fatigue Sacale, Beck Depression Inventory, and Quality of Life Questionnaire-Core30. Results: There was a predominance of women with breast cancer, with mild fatigue and without depression, however it is noteworthy that nine had clinically significant fatigue and 12 reported signs and symptoms indicative of depression. The scores of general health status, cognitive, social, physical functions and role performance were considered satisfactory, the prevalent symptoms were insomnia, fatigue, pain and loss of appetite. There were moderate correlations between the instrument items, and the higher the fatigue and depression scores, the greater the symptoms and the lower the quality of life functional scales. Conclusion: The presence of fatigue and depression was moderately correlated with other symptoms and may influence the health-related quality of life of these women.

Limb immobilization alters functional electrophysiological parameters of sciatic nerve

Immobilization, used in clinical practice to treat traumatologic problems, causes changes in muscle, but it is not known whether changes also occur in nerves. We investigated the effects of immobilization on excitability and compound action potential (CAP) and the ultrastructure of the rat sciatic nerve. Fourteen days after immobilization of the right leg of adult male Wistar rats (n=34), animals were killed and the right sciatic nerve was dissected and mounted in a moist chamber. Nerves were stimulated at a baseline frequency of 0.2 Hz and tested for 2 min at 20, 50, and 100 Hz. Immobilization altered nerve excitability. Rheobase and chronaxy changed from 3.13±0.05 V and 52.31±1.95 µs (control group, n=13) to 2.84±0.06 V and 59.71±2.79 µs (immobilized group, n=15), respectively. Immobilization altered the amplitude of CAP waves and decreased the conduction velocity of the first CAP wave (from 93.63±7.49 to 79.14±5.59 m/s) but not of the second wave. Transmission electron microscopy showed fragmentation of the myelin sheath of the sciatic nerve of immobilized limbs and degeneration of the axon. In conclusion, we demonstrated that long-lasting leg immobilization can induce alterations in nerve function.

Surface roughness of glass ionomer cements indicated for atraumatic restorative treatment (ART)

O objetivo deste estudo foi avaliar a rugosidade superficial de quatro cimentos de ionômero de vidro convencionais quimicamente ativados (Fuji IX, Ketac Molar, Vidrion R e Vitromolar) comumente utilizados no tratamento restaurador atraumático (TRA), imediatamente após a manipulação do material. Vinte espécimes de cada material foram preparados e, após sua estabilização, foi realizada a leitura de sua rugosidade superficial. Os espécimes foram posteriormente examinados em microscopia eletrônica de varredura. Os dados foram submetidos à análise estatística por meio dos testes de Kruskal-Wallis e Mann-Whitney com nível de significância de 5%. A comparação dos materiais aos pares mostrou diferença estatisticamente significante entre todos os materiais (p<0.05), exceto entre o Ketac Molar e o Vidrion R que apresentaram resultados estatisticamente semelhante entre si (p>0.05). Com relação à rugosidade superficial, os materiais podem ser classificados em ordem crescente de rugosidade da seguinte maneira: Ketac Molar < Vidrion R < Fuji IX < Vitromolar. Conclui-se que, dentre os cimentos de ionômero de vidro avaliados, Fuji IX, Ketac Molar e Vidrion R apresentaram rugosidade superficial aceitável, enquanto o Vitromolar apresentou rugosidade superficial consideravelmente maior que os demais materiais.(AU)

Memory of inhibitory avoidance in the rat is regulated by glutamate metabotropic receptors in the hippocampus.

This experiment investigated the effect on memory, in rats, of the bilateral intrahippocampal post-training infusion of the glutamate metabotropic receptor (mGLUR) agonist, ACPD (1S, 2R-aminocyclopentane dicarboxylate) and of the mGLUR antagonist, MCPG ([RS]-alpha-methyl-4-carboxyphenyl glycine). Male Wistar rats were implanted bilaterally with cannulae in the CA1 region of the dorsal hippocampus. After recovery from surgery they were trained in a step-down inhibitory avoidance task and tested for retention 24h later. Immediately or 180min after training they received a bilateral intrahippocampal infusion of saline (0.5µl), ACPD (1.0 or 2.5µg/side), MCPG (2.5µg/side) or ACPD plus MCPG, in 0.5µl saline. Upon immediate post-training infusion, ACPD caused a dose-dependent enhancement of memory and MCPG was amnestic. The effect of MCPG was antagonized by the simultaneous administration of ACPD. When given 180min after training, the drugs had no effect on memory. The results indicate that the early phase of memory is regulated by mGLURs in the hippocampus, and support the suggestion that memory involves long-term potentiation initiated at the time of training in the hippocampus.

NMDA-receptor-dependent, muscimol-sensitive role of the entorhinal cortex in post-training memory processing.

The bilateral infusion into the entorhinal cortex of the NMDA receptor antagonist, AP5 (5.0µg) or of the GABA(A) agonist, muscimol (0.03µg) 90min after training but not 30min before training, 0min after training or 10min before testing, hindered retention test performance 24h after inhibitory avoidance in rats. Glutamate (5.0µg) or picrotoxin (0.08µg) infused 90min after training had no effect. In animals trained with a low level footshock a second training session, 120min after the first, was needed in order to obtain a good retention test performance. This was taken to reflect summation of the consecutive memory traces left by the two training sessions. In these animals, the infusion of AP5 or muscimol into the entorhinal cortex between the two training sessions impeded their summation. The present results suggest that the entorhinal cortex plays a late role in memory processing, that this role does not need a hyperactivation of the entorhinal cortex, and that it is important for the interaction between consecutive memory traces.

Treatment of chronic experimental Trypanosoma cruzi infections in mice with MK-436, a 2-substituted 5-nitroimidazole

The antiprotozoal drug 3-(1-methyl-5-nitroimidazol-2-yl)3a, 4,5,6,7,7a-hexahydro-1,2-benzisoxazole (MK-436) is highly efficacious for treating mice chronically infected with different strains of Trypanosoma cruzi. The compound was administered by gavage in two daily doses of 250 mg per kg body weight to 130 mice that had been infected for 90 to 400 days with either type II or III strains of T. cruzi. The following parasitological cure tests were carried out: xenodiagnosis, haemoculture, and inoculation of blood into newborn mice. Indirect immunofluorescence tests and histopathological studies were also performed

The results indicate that the drug is highly efficacious against chronic infection caused by both type II (cure rate, 90 percent) and type III strains (cure rate, 95.7 percent). Histopathological examinations showed complete clearance of the cardiac and muscular lesions in 36 percent of the mice infected with type II strains and a decrease in the intensity and extension of the lesions in mice infected with type III strains. Indirect immunofluorescence tests were persistently positive for all the mice 3-6 months after the treatment(AU)