ABSTRACT Introduction: Peritoneal dialysis patients are at increased risk of developing abdominal wall complications, including hernias. This study aimed to determine the incidence of hernias in peritoneal dialysis patients, identify risk factors, and evaluate their impact on technique survival. Methods: A retrospective cohort study was conducted, including prevalent peritoneal dialysis patients in a single center, from January 2010 to October 2020. Data on baseline characteristics, previous abdominal surgeries, and hernia history were collected. Patients with diagnosed hernias during peritoneal dialysis were compared to a control group. Results: Among 155 peritoneal dialysis patients, hernias occurred in 29% (n=45) of the population, with an incidence rate of 0.09 hernias/patient/year. Umbilical hernias were the most common subtype. Autosomal dominant polycystic kidney disease (OR (odds ratio) 3.925; 95% confidence interval (CI), 1.208 - 12.75) history of surgical repaired hernias (OR 5.586; 95% CI 1.540 - 20.255) and a higher number of previous abdominal surgeries (OR 1.680; 95% CI 1.025 - 2.752) were independent predictors of hernia development. Surgical treatment was performed in 59.3% of cases, with a 18.8% recurrence rate. Higher daytime infusion volumes were associated with hernia recurrence (p=0.045). Peritoneal dialysis technique survival did not differ significantly between the hernia and control groups (p=0.700). Conclusion: Hernias are frequent in peritoneal dialysis patients, with autosomal dominant polycystic kidney disease, previous abdominal surgeries, and history of surgically repaired hernias as identified risk factors. Hernias do not significantly interfere with peritoneal dialysis technique survival, but comprehensive management strategies, including early surgical repair and peritoneal dialysis prescription adaptations, can optimize outcomes.

Abstract The Helminthological Collection of the Oswaldo Cruz Institute is the biggest in Latin America and it is among the largest collections at worldwide reference level, with around 40,000 sets of specimens and approximately one million individual specimens. It contains helminths parasites of vertebrate and invertebrate animals that form part of the fauna of Brazil and other countries. The samples comprise holotypes, paratypes and representative specimens of Platyhelminthes, Acanthocephala, Nematoda and other non-helminth phyla, such as Annelida and Arthropoda. Some of the samples preserved in liquid media were found to have dried out. This made it impossible to analyze these samples morphologically for taxonomic purposes. The aim of this study was to test techniques used for rehydration of the tegument of specimens that had been found to have dried out and present protocols for such techniques. A total of 528 specimens that either no longer were immersed in preservatives or had already dried out were analyzed: 96 digenetic trematodes, 45 cestodes, 22 acanthocephalans, 357 nematodes, four hirudineans and four pentastomid crustaceans. The technique of rehydration using only distilled water on the specimens proved to be efficient for recovering tegument malleability, for all samples analyzed in this present study.

Resumo A Coleção Helmintológica do Instituto Oswaldo Cruz é a maior da América Latina e está entre as maiores coleções de referência mundial, com cerca de 40.000 lotes e, aproximadamente, um milhão de espécimes. Seu acervo reúne helmintos parasitos de animais vertebrados e invertebrados da fauna brasileira e de outros países. Seus exemplares são holótipos, parátipos e espécimes representativos de parasitos, pertencentes aos filos Platyhelminthes, Acanthocephala, Nematoda e, ainda alguns espécimes não-helmintos, pertencentes aos filos Annelida e Arthropoda. Parte das amostras preservadas como material líquido foram encontradas dessecadas. Esta condição torna as amostras inviáveis para análise morfológica para propósitos taxonômicos. Portanto, o objetivo deste trabalho foi testar técnicas usadas na reidratação do tegumento dos espécimes que se encontram dessecados e apresentar seus protocolos. Foram analisados 528 lotes, cujos espécimes encontravam-se sem conservantes ou já dessecados: 96 trematodeos digenéticos, 45 cestoides, 22 acantocéfalos, 357 nematoides, quatro hirudíneos e quatro crustáceos pentastomídeos. A técnica de reidratação dos espécimes, utilizando-se apenas água destilada, mostrou-se eficiente na recuperação da maleabilidade tegumentar de todas as amostras trabalhadas no presente estudo.

Abstract Encapsulating peritoneal sclerosis is an uncommon but serious complication of peritoneal dialysis. In most cases, the symptoms appear after peritoneal dialysis withdrawal, which hampers its diagnosis. We present the case of a 44-years-old Caucasian male who had been on peritoneal dialysis for 6 years and 3 months and was switched to hemodialysis due to ultrafiltration failure. During his last months on peritoneal dialysis, he developed anorexia and asthenia, which were initially attributed to dialysis inadequacy. After hemodialysis induction, the patient developed abdominal pain, increased abdominal volume, obstipation alternating with diarrhea, and weight loss. Computed tomography showed de novo ascites. A diagnosis of early encapsulating peritoneal sclerosis was considered, and treatment was promptly initiated with nutritional support, oral prednisolone, and tamoxifen for one year. The patient progressed with resolution of the symptoms. One month after the end of the treatment, he underwent a successful kidney transplant and remain without any major intercurrences. A high level of clinical suspicion is crucial for the early diagnosis of encapsulating peritoneal sclerosis as the disease can be fatal in advanced stages. This case highlights that with early treatment, kidney transplantation can be successfully performed after an episode of encapsulating peritoneal sclerosis.

Resumo A esclerose peritoneal encapsulante é uma complicação incomum, mas grave, da diálise peritoneal. Na maioria dos casos, os sintomas aparecem após a suspensão da diálise peritoneal, o que dificulta seu diagnóstico. Apresentamos o caso de um homem caucasiano de 44 anos de idade que esteve em diálise peritoneal por 6 anos e 3 meses e foi transferido para hemodiálise devido a falha de ultrafiltração. Durante seus últimos meses em diálise peritoneal, ele desenvolveu anorexia e astenia, que foram inicialmente atribuídas à inadequação da diálise. Após a indução de hemodiálise, o paciente desenvolveu dor abdominal, aumento do volume abdominal, obstipação alternada com diarreia, e perda de peso. A tomografia computadorizada mostrou ascite de novo. Foi considerado um diagnóstico de esclerose peritoneal encapsulante precoce, e o tratamento foi prontamente iniciado com suporte nutricional, prednisolona oral e tamoxifeno por um ano. O paciente progrediu com resolução dos sintomas. Um mês após o término do tratamento, ele foi submetido a um transplante renal bem-sucedido e permanece sem maiores intercorrências. Um alto nível de suspeita clínica é crucial para o diagnóstico precoce da esclerose peritoneal encapsulante, uma vez que a doença pode ser fatal em estágios avançados. Este caso destaca que, com tratamento precoce, o transplante renal pode ser realizado com sucesso após um episódio de esclerose peritoneal encapsulante.

In this study, for the first time, histamine-functionalized magnetic nanoparticles (HIS-MNP) were used as sorbent phase combined with bar adsorptive microextraction (BAµE) for the determination of methylparaben (MP), ethylparaben (EP), propylparaben (PP), and butylparaben (BP) in water samples by high performance liquid chromatography coupled with diode array detection (HPLC-DAD). Extraction and desorption conditions, including desorption time and solvent, ionic strength effect and extraction time, were investigated. The extractions were performed for 90 min, 30% of NaCl and sample pH 5. Desorption was carried out using 250 μL of acetonitrile:methanol (25:75 v/v) for 30 min. The limits of detection (LODs) were of 1.5 μg L-1 and limits of quantification (LOQs) were 5.0 μg L-1 for all analytes. The intra-day precision ranged from 1% for EP, PP and BP to 3% for MP, EP, PP and BP. The inter-day precision ranged from 3% for EP to 18% for BP. The relative recoveries varied from 81 to 125%, and relative standard deviations (RSD) ranged between 1 and 16%.

Resumo A síndrome das pernas inquietas é uma patologia com um impacto negativo na qualidade de vida dos doentes, nomeadamente por estar associada a uma disrupção do sono. Felizmente, após o diagnóstico, a maior parte dos doentes apresenta uma boa resposta à terapêutica. O objetivo deste artigo é sistematizar o diagnóstico e a terapêutica desta patologia, focando-se particularmente na sua abordagem nos cuidados de saúde primários. A terapêutica da síndrome das pernas inquietas passa pela implementação de medidas comportamentais e pela correção da ferropénia, se existente. Em alguns casos é necessária a utilização contínua ou intermitente de fármacos, consoante a gravidade dos sintomas. O correto acompanhamento destes doentes, nos quais muitas vezes coexistem alterações do padrão do sono, ansiedade e depressão, é de extrema importância.

Abstract Restless leg syndrome is a pathology with a negative impact on people’s quality of life, particularly because of its association with sleep disturbances. Fortunately, once the diagnosis is made most patients have a good response to treatment. The aim of this article is to systematize the diagnosis and the treatment of this disease, focusing on its management in primary care. The treatment of restless leg syndrome includes the implementation of behavioral changes and the correction of iron deficiency if it is present. In some cases the use of specific drugs is required, daily or as needed according to the severity of symptoms. It is crucial that these patients, who often suffer from anxiety, depression and other sleep disorders, are followed correctly.

ABSTRACT Coronavirus disease 2019 (COVID-19) has affected millions worldwide, and in particular the care of patients on maintenance hemodialysis. These patients are thought to be at high risk of severe SARS-CoV-2 infection due to their older age and multiple comorbidities. The aim of this study was to compare hemodialysis and non-dialysis COVID-19 patients and find possible risk factors for mortality in hemodialysis patients. We developed a single-center retrospective cohort study, from March 1st to December 31st, 2020, that included maintenance hemodialysis patients hospitalized with laboratory confirmed SARS-CoV-2 infection, and age and sex propensity matched non-dialysis patients also hospitalized with a laboratory confirmed SARS-CoV-2 infection (1:1). A total of 34 hemodialysis patients were included, 70.6% male, mean age 76.5 years and on maintenance hemodialysis for 3.0 [0.5-23] years. At admission, 50.0% needed oxygen supply. Median hospital stay duration was 11.0 [5.8-17.0] days, and 38.2% developed bacterial superinfection. Maintenance hemodialysis patient mortality rate was 32.4%. When matched to the non-dialysis group, the hemodialysis group developed more often respiratory insufficiency (50.0% vs 8.8%, p<0.001) and had higher ferritin (1658.0 vs 623.5, p=0.004) and troponin T (130.0 vs 31.0, p<0.001) levels, whereas the non-dialysis group had higher transaminases levels. There was no statistical difference regarding hospitalization time, bacterial superinfection, or mortality between groups. When the logistic regression was performed, only bacterial superinfection was a predictor for mortality in hemodialysis COVID-19 patients (0.01 [0.00-0.26]). There was no difference in hospital stay nor in death rate between hemodialysis and non-dialysis COVID-19 patients. Despite these results, we must emphasize that mortality in the dialysis group was particularly high, with up to 32% of in-hospital mortality, and that bacterial superinfection has been shown to be an independent predictor of mortality. These results highlight the importance of interventions, such as full vaccination coverage, to mitigate the burden of COVID-19 in hemodialysis patients.

Antineutrophil cytoplasmic antibody (ANCA) associated vasculitis commonly involves kidney, lung, upper respiratory tract, skin, gastrointestinal and occasionally peripheral nervous system. Central nervous system is less commonly affected and is generally part of a multi-organ scenario. We present a case of a 21-year-old female with chronic kidney disease secondary to myeloperoxidase ANCA associated vasculitis, diagnosed at age 19. She then presented with pulmonary-renal syndrome with stage 5 CKD. Three months’ cyclophosphamide and prednisone were instituted, followed by azathioprine, but she remained dialysis dependent. After 2 years, while on maintenance treatment, she was admitted to the emergency department with tonic-clonic seizures. She had started oral ciprofloxacin 2 days before for acute gastroenteritis. No illicit drugs were noticed. Blood tests showed an increased myoglobin but were otherwise unremarkable. No anomalies were reported on cerebral computed tomography or cerebrospinal fluid analysis. Magnetic resonance imaging showed diffuse cortico-subcortical lesions with T2 and proton density hypersignal suggesting recent ischemia, and segmental irregularities of various cerebral and vertebral arteries, consistent with small and medium size vessel vasculitis. Intravenous methylprednisolone and oral cyclophosphamide were started. Anti-myeloperoxidase ANCA levels were increased (>200 RU/mL), reinforcing our diagnostic hypothesis of central nervous system (CNS) recurrence of ANCA vasculitis. The patient had a favorable clinical course, with no neurological sequelae. Conclusions: This is a case of ANCA associated vasculitis that presented with kidney and lung but no CNS involvement and recurred with primarily cerebral disease. Favorable outcome was seen with standard immunosuppression. Awareness of this rare but severe complication is critical for timely recognition and prompt treatment.

Resumo O conhecimento das características de aerossóis atmosféricos nas escalas local e regional, suas modificações temporais e inter-relações com as variáveis meteorológicas são de grande importância, pois podem modificar o balanço de energia radiativa global. Esse estudo foi realizado para avaliar a influência de aerossóis na evapotranspiração de uma região semiárida no Nordeste do Brasil. Profundidade ótica de aerossol, radiação solar global, temperatura, umidade e velocidade do ar foram medidas na Embrapa Semiárido, localizada em Petrolina, PE, durante dois anos consecutivos. Um modelo multivariado foi calibrado e validado para estimar a radiação solar global (Rglobal) com base em profundidades óticas de aerossóis (AOD) e radiação solar extraterrestre (R0). Estimativas da evapotranspiração de referência (ET0) foram obtidas pelo método de Penman-Monteith FAO. Os resultados confirmaram que maiores profundidades óticas de aerossóis tendem a diminuir a Rglobal e ET0. Ao contrário, menores profundidades óticas de aerossóis tendem a absorver menos radiação, aumentando a ET0. Para a região semiárida no Nordeste, a maioria dos desvios de ET0 foi menor que ±4%. Entretanto, maiores desvios foram também observados, contribuindo em torno de 30%, o que pode resultar em consequências relevantes no manejo de irrigação, balanço hídrico, zoneamento agroclimático, dentre outras atividades baseadas em estimativas de ET0.

Abstract The knowledge of atmospheric aerosol characteristics at regional and local scales, their temporal changes and interrelations with meteorological variables are of great importance because can modify the global radiative energy balance. This study was carried out to evaluate the influence of aerosols on evapotranspiration over a semiarid region in Northeast Brazil. Aerosol optical depth, global solar radiation, air temperature, air relative humidity, and wind speed were measured in the Research National Center of Semiarid, located at Petrolina, Pernambuco State, Brazil, along two consecutive years. A multivariate model was calibrated and validated for estimating the global solar radiation (Rglobal) based on the aerosol optical depths (AOD) and extraterrestrial solar radiation (R0). Estimates of the reference evapotranspiration (ET0) were obtained by using the FAO standard Penman-Monteith method. Results confirmed that larger aerosol optical depth tends to decrease both Rglobal and ET0. Otherwise, ticker aerosol optical depth tends to absorb less radiation, increasing the ET0. For the semiarid region in Northeast Brazil, most of ET0 deviations were smaller than ±4%. However, higher deviations were also observed, contributing jointly to around 30%, which may result in relevant consequences on the irrigation management, water balance, agroclimatic zoning, among other activities based on the ET0 estimates.

Introduction: The benefits of dialysis in the elderly are dubious. A shared decision-making process, helped by adequate prognostic tools, is essential to determine which patients are better candidates for conservative care. Based on a recent USRDS validated score, this study aimed to identify risk factors associated with early mortality (first 90 days) in a Portuguese cohort of patients. Methods: A total of 197 patients who initiated hemodialysis treatments in a Portuguese facility between 2005 and 2015 were included. Clinical and laboratory data were collected at time of admission to center. Multiple regression models were performed and fitted to identify potential predictors of early mortality. Findings: Total of 93 (47.2%) deaths with 23 (11.7%) deaths occurring in first year. In the first three months, there were 15 (7.6%) deaths. Of those who died in first three months, most were men (n=10; 5.1%), mean age 73.5 ± 6.82 years. Almost half (n=7; 3.6%) were dependent and the majority (n=12; 6.1%) had history of hospitalizations in previous year before admission. They had a higher prevalence of hypoalbuminemia and cardiovascular risk factors. Mortality associated factors were albumin level low (<3.5 g/dL) or unknown (OR 5.73; p<0.05), ischemic cardiomyopathy (OR 4; p<0.05) and history of hospitalizations in previous year before admission (OR 4.3; p<0.05). Absence of history hypertension was associated with a reduction of risk (OR 0, 18, p<0.05). Discussion: Some elements of USRDS score were associated with greater risk for early mortality in this Portuguese cohort of patients. Further investigations are needed in order to validate a specific prognostic tool in Europeans

Introduction: Survival rates of haemodialysis patients have increased worldwide over the last decade. The purposes of this study were to analyze the 10-year survival rate and to identify mortality risk factors in a Portuguese cohort. Subjects and Methods: Data was collected from 273 incident patients on facility haemodialysis treatments between 2005 and 2015. Sociodemographic data, medical history, clinical and analytic parameters were collected. A statistical analysis using Kaplan-Meier survival analysis and Cox regression were performed. Results: Median age was 71 ± 15.5 [22; 91] years, 56.8% were male. Fistula was the first access in 68.5%. Median survival rate was 89 ± 8.8 months. There were 93 deaths (34%). Of the 23 deaths occurring in the first year, 65% (n=15) were during the first 90 days. Mortality risk factors were residence in a nursing home (OR 2.8; p<0.05), coronary heart disease (OR 2.3; p<0.05), central venous catheter use (OR 2.1; p<0.05), history of hospitalizations in year prior to dialysis admission (OR 1.9; p<0.05) and advanced age (OR 1.5; p<0.05). Conclusions: Patients starting haemodialysis in the last decade are mainly elderly and have a prolonged lifespan, reflecting good levels of care. Functional status and dependence, extremes of age, central venous catheter use and high cardiovascular burden are related with greater mortality and should prompt consideration for a more conservative approach

Atypical haemolytic uraemic syndrome (aHUS) is a rare, life-threatening, genetic disease, due to uncontrolled alternative pathway complement activation. Although the renal microvasculature appears to be the predominantly affected target, other organ pathology compatible with local thrombotic microangiopathy has been reported. Eculizumab is a humanized antibody therapy that has been associated with significant inhibition of complement-mediated thrombotic microangiopathy events in aHUS. In this report, we describe the rare case of a patient with relapsing atypical haemolytic uraemic syndrome, cutaneous manifestations of the thrombotic microangiopathy and we discuss the treatment with plasma exchange and eculizumab

RESUMO: A gastrite eosinofílica esquirrosa (GEE) é caracterizada por infiltrado inflamatório difuso de eosinófilos e concomitante proliferação de tecido fibrovascular no estômago. A condição apresenta ocorrência rara e causa desconhecida. Dois cães foram examinados com histórico de emagrecimento progressivo, êmese, melena e anorexia. O hemograma de ambos os casos revelou anemia e eosinofilia, enquanto o exame ultrassonográfico evidenciou espessamento da parede do estômago. Diante de suspeita de neoplasia gástrica e devido ao prognóstico desfavorável, foi realizada a eutanásia dos cães. Na necropsia, ambos apresentavam estômago acentuadamente aumentado, com parede difusamente espessada e firme. O baço dos dois cães apresentava-se aumentado e com superfície nodular. O exame histopatológico revelou infiltrado difuso de eosinófilos, proliferação de tecido fibrovascular e degeneração fibrinoide na parede de vasos sanguíneos no estômago e baço. A GEE é uma condição patológica rara que deve ser considerada no diagnóstico em cães que apresentem sinais gastrointestinais e eosinofilia.

ABSTRACT: Scirrhous eosinophilic gastritis (SEG) is characterized by diffuse infiltration of eosinophils and concomitant fibrovascular tissue proliferation in the stomach wall. The condition is a rare occurrence with an unknown cause. Two dogs were examined with a history of progressive weight loss, emesis, melena and anorexia. Complete blood cell counts of both cases revealed anemia and eosinophilia, while ultrasonography examination revealed thickening of the stomach wall. Due to suspected gastric neoplasia and a poor clinical prognosis, the dogs were euthanized. At necropsy, both had markedly distended stomachs with a diffusely thickened and firm wall. The spleens of both dogs were enlarged with a nodular surface. Histological evaluation revealed diffuse infiltrate of eosinophils, fibrovascular tissue proliferation and fibrinoid degeneration in blood vessel walls of stomach and spleen. SEG is a rare pathological condition that must be considered as a possible diagnosis in dogs presenting gastrointestinal signs and eosinophilia.

O padrão histológico de glomeruloesclerose nodular é típico da nefropatia diabética, mas pode ser encontrado noutras patologias como na glomerulonefrite membranoproliferativa crónica, na amiloidose, nas glomerulopatias associadas a deposição de imunoglobulinas e nas glomerulopatias fibrilar e imunotactóide. Adicionalmente, há alguns casos descritos de glomeruloesclerose nodular idiopática, um diagnóstico de exclusão, que tem sido associado ao tabagismo. Apresentamos o caso de um doente de sexo de masculino, 45 anos de idade, não diabético, com antecedentes de hipertensão arterial diagnosticada há 5 anos e fumador pesado, que foi referenciado à nossa consulta de Nefrologia por hematoproteinúria. Estudo revelou função renal normal e estudo imunológico e imunoelectroforese foram negativas. Biópsia renal revelou um padrão de glomeruloesclerose nodular na microscopia de luz e a imunofluorescência e microscopia electrónica excluíram as outras causas previamente referidas para este padrão. Por exclusão, foi estabelecido o diagnóstico de glomeruloesclerose nodular idiopática, provavelmente em associação com o tabagismo e hipertensão. Glomeruloesclerose nodular idiopática é uma entidade clinicopatológica distinta que deve ser considerada em doentes fumadores activos, particularmente na presença concomitante de hipertensão. Alguns autores sugerem mesmo a designação de “glomeruloesclerose nodular associada ao tabagismo” a esta glomerulopatia “pseudodiabética”.

The histological pattern of nodular glomerulosclerosis is typical of diabetic nephropathy, but it can be found in other diseases, such as chronic membranoproliferative glomerulonephritis, amyloidosis, monoclonal immunoglobulin deposition and fibrillary/immunotactoid glomerulopathies. Additionally, there are few reports of idiopathic nodular glomerulosclerosis, an exclusion diagnosis, which has been associated with smoking. Herein we present a case of a non-diabetic 45-year-old man, with a background history of hypertension known for 5 years and heavy smoking, who was referred to our Nephrology clinic for evaluation of haematoproteinuria. Renal function was normal and serologies and immunoelectrophoresis studies were negative. Renal biopsy revealed a nodular glomerulosclerosis pattern on light microscopy, and immunofluorescence and electronic microscopy excluded other previously referred causes for this pattern. By exclusion, a diagnosis of idiopathicnodular glomerulosclerosis was established, probably in association with smoking and hypertension. Idiopathic nodular glomerulosclerosis is a distinct clinicopathologic entity that should be considered in patients with active smoking, especially if there is concomitant hypertension. Some authors actually suggest the designation of “smoking -related nodular glomerulosclerosis” to this “pseudodiabetic” glomerulopathy.

Reference evapotranspiration (ET0) is critical for agricultural and urban planning, irrigation scheduling, regional water balance studies, and agroclimatological zoning. The objective of this study was to estimate ET0 based on methods with minimum meteorological variable requirements and on empirical models to predict solar radiation. These alternative methods were compared to the FAO Penman-Monteith method by using more than 80 yr of historical weather data. Alternative methods were adapted from the standard FAO Penman-Monteith or Priestley-Taylor methods, which allow estimating ET0 when fewer meteorological variables are available. The Hargreaves-Samani method was also analyzed. The mean absolute error, index of agreement, correlation coefficient, and confidence index were used to compare the alternative methods. Results showed that alternative methods based on the maximum and minimum temperatures, sunshine hours, and/ or wind speed are appropriate for estimating ET0 in the region under study.