A successful peritoneal dialysis program depends on knowledge of the current recommendations and on evidence-based practice guidelines. In this second article, we review the dialysis prescription and the nutritional and cardiovascular management of peritoneal dialysis patients in the light of the existing guidelines advocated by different international societies.

Resumo Objetivos: analisar a relação entre o estado de nutrição materno e o de crianças dos 0 aos 60 meses em São Tomé e Príncipe (STP). Métodos: caracterizou-se o estado de nutrição de 1.169 crianças pelo Índice Peso/Comprimento (P/C) (≤24meses) e Índice de Massa Corporal (IMC) para a idade (>24meses) e o estado de nutrição das mães (IMC) A associação entre o estado de nutrição materno e o das crianças foi testada pelo teste do qui-quadrado ou exato de Fisher, conforme apropriado. Resultados: do total da amostra analisada, a maior parte é representada por crianças do sexo feminino (55%). Observa-se média de idade de 25,2±18 meses (mediana 21 meses). Observou-se uma elevada percentagem de desnutrição aguda global nas crianças de 0≤24meses (30,2%) e de 24 ≤60 meses (22,0%), bem como de desnutrição crônica global (32,0% e 41,1% respetivamente). Entre as mães, observou-se elevado percentual de sobrepeso/obesidade (31,6%) e de baixa estatura (16,5%). Das crianças estudadas, 47,5% têm desnutrição aguda global, comparativamente à prevalência em crianças de mães eutróficas (27,9%) ou de mães com sobrepeso/obesidade (22%) (p<0,001). Conclusões: Observou-se elevada prevalência de desnutrição global aguda e crônica nas crianças estudadas e elevada prevalência de sobrepeso/obesidade maternas. A desnutrição global aguda dos filhos esteve associada à desnutrição materna.

Abstract Objectives: analyse the relation between the nutritional status of children with 0 to 60 months in São Tome and Principe (STP) and their mothers. Methods: characterization of the nutritional status of 1,169 children for the weight / length ratio (W/L) (≤24months) and Body Mass Index (BMI) for age (>24months) and their mothers. The Chi Square or Fisher tests were used for the study on the relation between the nutritional status of the mother and children, as appropriate. Results: fifty-five percent (55%) of the children are female (median = 21 months). There was a high percentage of global acute malnutrition in the children aged0≤24months (30.2%) and 24≤60months (22%) as well as global chronic malnutrition (32% and 41.1% respectively). We observed a high percentage of overweight /obese mothers (31.6%), with 16.5% of them being of a low height. We observed a significantly higher percentage of children with global acute malnutrition 47.5%) when compared with that which was reported for children of normal mothers (27.9%) or overweight /obese (22%) (p<0,001) mothers. Conclusions: It was observed a high prevalence of acute and chronic global malnutrition in the children studied and a high prevalence of overweight /obese mothers. We observed a statistically significant association between maternal and acute global malnutrition of the children.

Background: Peritoneal dialysis (PD) is an established renal replacement therapy, mainly performed at home. There is a general perception that the use of PD is declining worldwide. As countries look to develop dialysis programmes to manage the growing burden of end-stage renal disease (ESRD), it is important to place patterns of PD use in the global context. Although there has been an improvement in PD patient and technique survival over the last years, this modality still remains underutilized in Portugal. Objectives: The primary aim was to evaluate patient and technique survival in a single centre in Portugal over a 20-year period, comparing the last decade with the prior decade, and to identify clinically important factors that predict patient mortality and technique failure. The secondary aim was to determine the main reasons for patient dropout from PD. Methods: Historical cohort study including patients initiating PD between January 1992 and December 2012. Multivariate Cox regression models were developed using baseline candidate variables to predict all-cause mortality and technique survival. Results: A total of 184 patients were included (59.2% male, mean age 48.7 ± 16.9 years), on PD for 24.7 ± 21.2 months. There was an increase in PD use between the first and last decades (79 vs. 105 patients), especially in automated PD (48.1% vs. 60.0%). The main causes of PD drop out were death (34.2%), renal transplant (29.3%) and switch to HD (18.5%) due to inadequate ultrafiltration (38.2%), and peritonitis and access-related infections (29.4%). Patient survival at 5 years was 51.9% in the first decade, and 78.1% in the last decade (p < 0.001). The PD technique survival did not change from the first to the last decade. The presence of prior haemodialysis and diabetes mellitus were predictors of mortality. Conclusion: Over the last two decades, there has been an increase in PD use, and an improvement in patient survival in our Unit

Background: Cardiovascular (CV) disease is the major cause of mortality in patients undergoing renal replacement therapy. The primary aim of the study was to evaluate the CV risk profile and prevalence of CV disease in patients on peritoneal dialysis (PD) in Portugal. The secondary goal was to establish parameters most associated with CV disease. Methods: Retrospective, multicenter study of the prevalent adult population on PD. Six hundred patients were included (56.7% male; mean age 53.5±15.3 years), on PD for 25.6±21.9 months. Patients were divided into two groups: group 1 (n=166) with CV disease and group 2 (n=434) without CV disease. Comparisons were made regarding traditional CV risk factors and those associated with uremia and PD itself, and a multivariate analysis was performed to determine variables independently associated with CV disease. Results: At the end of the study, the prevalence of CV disease was 28%. At univariate analysis, group 1 presented a higher frequency of males (p<.01), older patients (p<.01), diabetics (p<.01), occurrence of left ventricular hypertrophy (LVH) (p<.01), mean C-reactive protein (CRP) (p=.04), lower mean parathormone level (p=.014), lower serum phosphorus (p=.02), lower daily urine output (p=.04), lower weekly Kt/V (p=.008), increased use of icodextrin and hypertonic glucose-based PD solutions (p<.001 and p=.006, respectively) and more were under continuous ambulatory PD (CAPD) (p=.014) and had a high peritoneal transport status (p=.02). Multivariate analysis provided a significant discriminatory influence pertaining to age >50 years, CRP>0.6mg/dl, male gender, diabetes, LVH, CAPD and anuria, when comparing group 1 and group 2. Conclusions: Risk factors most related to the development of CV disease in PD in Portugal are age >50 years, CRP>0.6mg/dL, male gender, diabetes, LVH, CAPD and anuria.

Antecedentes: La enfermedad cardiovascular (CV) es la principal causa de mortalidad en pacientes en terapéutica de reemplazo renal. El principal objetivo del estudio fue evaluar el perfil de riesgo CV y prevalencia de enfermedad CV en pacientes en diálisis peritoneal (DP) en Portugal. El segundo fue determinar los parámetros más relacionados con enfermedad CV. Métodos: Estudio retrospectivo, multicéntrico, de los adultos en DP. Se incluyeron seiscientos pacientes (56,7 % varones, edad media 53,5 ± 15,3 años), en DP por 25,6 ± 21,9 meses. Los pacientes se dividieron: grupo 1 (n = 166) con enfermedad CV y grupo 2 (n = 434) sin enfermedad CV. Las comparaciones se hicieron con los factores tradicionales de riesgo CV y los asociados a uremia y a propia DP; en el análisis multivariante se determinaron las variables asociadas de forma independiente a enfermedad CV. Resultados: Al final del estudio, la prevalencia de enfermedad CV fue del 28 %. En el análisis univariante, el grupo 1 presentó mayor frecuencia de varones (p< 0,01), pacientes de más edad (p< 0,01), diabéticos (p < 0,01), presencia de hipertrofia ventricular izquierda (HVI) (p< 0,01), mayor proteína C-reactiva (PCR) (p= 0,04), menor nivel medio de parathormona (p= 0,014), menor fósforo sérico (p = 0,02), menor diuresis diaria (p= 0,04), menor Kt/V semanal (p = 0,008), un mayor uso de icodextrina y soluciones a base de glucosa hipertónica (p < 0,001 y p = 0,006, respectivamente), con más enfermos sometidos a DP continua ambulatoria (DPCA) (p= 0,014) y tenían un transporte peritoneal alto (p = 0,02). El análisis multivariante demostró la influencia independiente de edad > 50 años, PCR > 0,6 mg/dl, sexo masculino, diabetes, HVI, DPCA y anuria. Conclusiones: Los factores de riesgo más relacionados con el desarrollo de enfermedad cardiovascular en la DP en Portugal son edad > 50 años, PCR > 0,6 mg/dl, sexo masculino, diabetes, HVI, DPCA y anuria.

In Hymenoptera, homozygosity at the sex locus results in the production of diploid males. In social species, these pose a double burden by having low fitness and drawing resources normally spent for increasing the work force of a colony. Yet, diploid males are of academic interest as they can elucidate effects of ploidy (normal males are haploid, whereas the female castes, the queens and workers, are diploid) on morphology and life history. Herein we investigated expression levels of ten caste-related genes in the stingless bee Melipona quadrifasciata, comparing newly emerged and 5-day-old diploid males with haploid males, queens and workers. In diploid males, transcript levels for dunce and paramyosin were increased during the first five days of adult life, while those for diacylglycerol kinase and the transcriptional co-repressor groucho diminished. Two general trends were apparent, (i) gene expression patterns in diploid males were overall more similar to haploid ones and workers than to queens, and (ii) in queens and workers, more genes were up-regulated after emergence until day five, whereas in diploid and especially so in haploid males more genes were down-regulated. This difference between the sexes may be related to longevity, which is much longer in females than in males.

Partamona is a Neotropical genus of stingless bees that comprises 33 species distributed from Mexico to southern Brazil. These bees are well-adapted to anthropic environments and build their nests in several substrates. In this study, 66 colonies of Partamona helleri from five localities in the Brazilian state of Minas Gerais (São Miguel do Anta, Teixeiras, Porto Firme, Viçosa and Rio Vermelho) were analyzed using nine microsatellite loci in order to assess their genetic variability. Low levels of observed (Ho = 0.099-0.137) and expected (He = 0.128-0.145) heterozygosity were encountered and revealed discrete genetic differentiation among the populations (F ST =0.025). AMOVA further showed that most of the total genetic variation (94.24%) in P. helleri was explained by the variability within local populations.