Abstract Introduction: Oropharyngeal cancer is a neoplasm with a high incidence in the head and neck region. Despite its location being easily visible during physical examination and advances in its diagnosis, oropharyngeal cancer is often detected at advanced stages. As primary therapeutic strategies, in the context of advanced disease, surgery and/or radiotherapy may be considered as treatments. Methodology: The aim of this study was to analyze the survival of patients with advanced oropharyngeal cancer (stages III and IV of the TNM) who received intended curative treatment with radiotherapy. Thirty-one patients from the Dr. Manuel Quintela Clinics Hospital, who were evaluated in the radiotherapy and otolaryngology clinics between 2013 and 2022, were studied. Results: The patients were mostly smokers, alcoholics, male, with an average age of 60 years. A 5-year overall survival rate of 67,7% (95% CI 47,6 – 84,9) was observed. The mean overall survival at 5 years was 66,3 months (95% CI 47,6 – 84,9). The median overall survival was not reached in the study. Disease persistence after radiotherapy treatment was the only factor that significantly influenced survival. Univariate analysis using Log-Rank showed a mean of 92,3 months (95% CI 77,9 - 106,7) for patients without disease persistence vs. 7,5 months (95% CI 4,9 - 10) with a median of 8 months (95% CI 3 - 12,9) for patients with disease persistence (p< 0,001). Conclusions: The observed survival may be due to the small number of patients included in the study. Incomplete tumor response to treatment proved to be the most relevant factor in survival. The follow-up of these patients is of utmost importance since all deaths were recorded within the first 24 months after diagnosis.

Resumo Introdução: O câncer de orofaringe é uma neoplasia com alta incidência em cabeça e pescoço. Apesar de ocorrer em uma região de fácil visibilidade no exame físico e dos avanços no diagnóstico, o câncer de orofaringe geralmente é detectado em estágios avançados. Como principais estratégias terapêuticas no contexto da doença avançada, podem ser considerados tratamentos como cirurgia e/ou radioterapia. Metodologia: O objetivo deste estudo foi analisar a sobrevida de pacientes com câncer de orofaringe em estágio avançado (estágios III e IV do TNM) que receberam tratamento com intenção curativa por meio de radioterapia. Foram analisados 31 pacientes do Hospital de Clínicas Dr. Manuel Quintela, avaliados nas policlínicas de radioterapia e otorrinolaringologia entre 2013 e 2022. Resultados: A maioria dos pacientes era tabagista, alcoólatra, do sexo masculino, com idade média de 60 anos. Foi observada uma taxa de sobrevida global em 5 anos de 67,7% (47,6 – 84,9 IC 95%). A média de sobrevida global em 5 anos foi de 66,3 meses (47,6 – 84,9 IC 95%). A mediana de sobrevida global não foi atingida no estudo. A persistência da doença após o tratamento com radioterapia foi o único fator que teve influência significativa na sobrevida. A análise univariada por meio do Log-Rank evidenciou uma média de 92,3 meses (77,9 – 106,7 IC 95%) para pacientes sem persistência da doença vs. 7,5 meses (4,9 - 10 IC 95%) com uma mediana de 8 meses (3 – 12,9 IC 95%) para pacientes com persistência da doença (p< 0,001). Conclusões: A sobrevida observada pode ser explicada pelo número reduzido de pacientes incluídos no estudo. A resposta incompleta do tumor ao tratamento demonstrou ser o fator de maior relevância na sobrevida. O acompanhamento desses pacientes é de extrema importância, considerando que todos os óbitos foram registrados nos primeiros 24 meses após o diagnóstico.

Resumen Introducción: El cáncer de orofaringe es una neoplasia con alta incidencia en cabeza y cuello. A pesar de presentarse en un sitio de fácil visibilidad al examen físico y a los avances en su diagnóstico, el cáncer de orofaringe suele detectarse en etapas avanzadas. Como principales estrategias terapéuticas, en el contexto de la enfermedad avanzada, se pueden plantear como tratamientos la cirugía y/o la radioterapia. Metodología: El objetivo de este estudio fue analizar la sobrevida de pacientes con cáncer de orofaringe en estado avanzado (estadios III y IV del TNM) que recibieron tratamiento pretendidamente curativo con radioterapia. Se estudiaron 31 pacientes pertenecientes al Hospital de Clínicas Dr. Manuel Quintela, que fueron valorados en las policlínicas de radioterapia y otorrinolaringología entre 2013 y 2022. Resultados: Los pacientes fueron en su mayoría tabaquistas, alcoholistas, de sexo masculino, con un promedio de edad de 60 años. Fue observada una tasa de sobrevida global a los 5 años del 67,7% (47,6 – 84,9 IC 95%). La media de sobrevida global a los 5 años fue de 66,3 meses (47,6 – 84,9 IC 95%). La mediana de sobrevida global no fue alcanzada en el estudio. La persistencia de la enfermedad después del tratamiento con radioterapia fue el único factor que tuvo una influencia significativa en la sobrevida. El análisis univariado mediante Log-Rank evidenció una media de 92,3 meses (77,9 – 106,7 IC 95%) para pacientes sin persistencia de la enfermedad vs. 7,5 meses (4,9 - 10 IC 95%) con una mediana de 8 meses (3 – 12,9 IC 95%) para pacientes con persistencia de la enfermedad (p< 0,001). Conclusiones: La sobrevida observada puede ser debido al número reducido de pacientes incluidos en el estudio. La respuesta incompleta del tumor al tratamiento demostró ser el factor de mayor relevancia en la sobrevida. El seguimiento de estos pacientes es de suma importancia dado que todos los fallecimientos fueron registrados dentro de los primeros 24 meses luego del diagnóstico.

Resumen Introducción. La enfermedad de la necrosis aguda del hepatopáncreas (AHPND, por sus siglas en inglés) es producida por bacterias Vibrio parahaemolyticus que poseen un plásmido con genes que codifican las toxinas pirA y pirB. La enfermedad se caracteriza por descamación masiva de las células epiteliales del hepatopáncreas, así como la atrofia y decoloración de ese órgano. Los camarones enfermos presentan anorexia y muestran un intestino vacío, debilidad, decoloración del cuerpo y altas mortalidades. Objetivo. Determinar la prevalencia de Vibrio parahaemolyticus causante de AHPND en fincas de camarones en la zona del Pacífico de Costa Rica. Materiales y métodos. Durante los años 2019 y 2020, se recolectaron camarones (Penaeus vannamei) y agua de estanques de 32 fincas localizadas en la costa occidental del golfo de Nicoya (noroeste del país) y la costa del Pacífico Central (Puntarenas-Parrita). Los camarones recolectados en los muestreos tenían un peso de entre 7 y 15 g. El diagnóstico de la presencia de la enfermedad se analizó a nivel molecular con la reacción en cadena de la polimerasa (PCR) punto final, y diferentes protocolos e iniciadores para detectar los genes de las toxinas pirA y pirB. Además, se hizo una correlación lineal entre la presencia de AHPND y la calidad del agua con el programa estadístico R. Resultados. La presencia de Vibrio parahaemolyticus causante de AHPND ocurrió en 93,75 % (30/32) de los estanques muestreados en ambas zonas de cultivo. Conclusiones. Este trabajo confirma la presencia y amplia distribución de AHPND en agua y camarones en treinta fincas camaroneras en el Pacífico de Costa Rica.

Abstract Introduction. The acute hepatopancreas necrosis disease (AHPND) is caused by bacteria Vibrio parahaemolyticus containing a plasmid encoding the toxin genes pirA and pirB. The disease is characterized by massive sloughing of epithelial cells in the hepatopancreas, also showing atrophy and discoloration of that organ. Diseased shrimp display anorexia with empty guts, weakness, body discoloration and high mortality. Objective. To determine the prevalence of Vibrio parahaemolyticus causing AHPND in farms that grow shrimp in the Pacific zone of Costa Rica. Materials and methods. During the years 2019 and 2020, water and shrimp (Penaeus vannamei) samples were obtained from 32 farms located on the western coast of the Nicoya Gulf (Northwest Costa Rica) and the Central Pacific coast (Puntarenas-Parrita). The samples were analyzed by endpoint polymerase chain reaction (PCR) using different protocols and primers to detect the toxins pirA and pirB. Further, a linear correlation between the presence of AHPND and water quality was done using the R statistical program. Results. The presence of Vibrio parahaemolyticus causing AHPND occurred in 93.75 % (30/32) of sampled ponds in both farming areas. Conclusion. This work confirms the presence and wide distribution of AHPND in water and shrimp from thirty shrimp farms in the Costa Rican Pacific.

Abstract:Disease detection and classification in crops is crucial for the development and growth of the agricultural sector. Traditional techniques and the low technical level applied to crop control generate significant losses for farmers. Computer vision offers solutions in this field; however, current research focuses on using convolutional neural networks (CNNs), which cannot accurately locate the most relevant features in an image. To overcome these limitations, this study proposes a deep learning model based on the Vision Transformers (ViT) architecture to detect and classify early and late blight diseases in potato leaves. This research demonstrates how data augmentation, fine-tuning, and transfer learning techniques can improve the model's performance. The dataset for training and testing was taken from the PlantVillage platform. The report of the proposed model's evaluation metrics reaches an accuracy of 99.18% and an F1 score of 98.7%. The results demonstrate a high level of prediction in potato foliar diseases and evidence of the efficiency of attention mechanisms. It is concluded that the model is an innovative and functional tool for farmers.

Resumen:La detección y clasificación de enfermedades en cultivos es crucial para el desarrollo y crecimiento del sector agrícola. El uso de técnicas tradicionales y el bajo nivel técnico aplicado al control de los sembríos generan grandes pérdidas para los agricultores. La visión por computadora aporta soluciones en este campo, no obstante, las investigaciones actuales se centran en el uso de redes neuronales convolucionales (Convolutional Neural Networks, CNNs), las cuales tienen una limitada capacidad para ubicar de forma precisa las características de mayor relevancia en una imagen. Para superar estas limitaciones, nuestro estudio propone un modelo de aprendizaje profundo basado en la arquitectura de Transformadores de Visión (Vision Transformers, ViT) para detectar y clasificar las enfermedades tizón temprano y tizón tardío en las hojas de papa. En esta investigación se evidencia cómo las técnicas de aumento de datos, ajuste fino y aprendizaje por transferencia permiten mejorar el rendimiento del modelo. El conjunto de datos para entrenamiento y prueba fue tomado de la plataforma PlantVillage. El reporte de métricas de evaluación del modelo propuesto alcanza una exactitud de 99.18% y un puntaje F1 de 98.7%. Los resultados demuestran un alto nivel de predicción en las enfermedades foliares de papa y evidencian la eficiencia de los mecanismos de atención. Se concluye que el modelo se consolida como una herramienta innovadora y funcional para los agricultores.

Resumo Introdução: No noroeste de Portugal, a amiloidose AA foi relatada como a nefropatia amiloide mais frequente, embora não esteja claro se a incidência e desfechos da doença mudaram. Os autores analisaram alterações na epidemiologia, etiologias e desfechos de pacientes com amiloidose renal AA nos últimos 40 anos. Métodos: Estudo de coorte retrospectivo de centro único, envolvendo pacientes com diagnóstico de amiloidose AA comprovada por biópsia renal, realizado no noroeste de Portugal entre 1978 e 2019. Os pacientes foram agrupados em coortes de 14 anos baseadas no ano do diagnóstico (CA 1978–1991; CB 1992–2005; CC 2006–2019), com análises de evolução clínica e desfechos. Resultados: Incluímos 69 pacientes com amiloidose AA. A incidência da doença permaneceu estável em CA (64%) e CB (62,7%), em oposição à redução significativa na coorte mais recente (44%, p = 0,027). A idade média na apresentação aumentou em dez anos de CA para CC. No geral, infecções foram a principal causa de óbito, com aumento significativo ao longo do tempo (9,1% na CA para 76,9% na CC; p = 0,002). Não houve diferenças significativas de sobrevida global e renal entre as três coortes. Entretanto, pacientes na CC faleceram com idade mais avançada (61,4 anos) do que na CA (52,3 anos). Conclusão: A incidência de amiloidose AA tem diminuído nos últimos 40 anos. Em contrapartida, a idade de apresentação da nefropatia amiloide tem aumentado. Desfechos globais e renais não melhoraram, mas a expectativa de vida média aumentou, sugerindo progresso no manejo geral e no tratamento de suporte da patologia renal e subjacente.

Abstract Introduction: In the northwest of Portugal, AA amyloidosis was reported as the most frequent amyloid nephropathy, but it is unclear if the disease’s incidence and outcomes have changed. The authors studied the changing epidemiology, aetiologies, and outcomes of patients with renal AA amyloidosis over the last 40 years. Methods: This is a retrospective single-center cohort study involving patients with renal biopsy-proven AA amyloidosis diagnosed in the northwest of Portugal between 1978 and 2019. The patients were grouped into 14-year cohorts based on the year of diagnosis (CA 1978–1991; CB 1992–2005; CC 2006–2019), and clinical course and outcomes were analyzed. Results: Sixty-nine AA amyloidosis patients were included. The incidence of the disease remained stable in CA (64%) and CB (62.7%) as opposed to the significant decrease in the most recent cohort (44%, p = 0.027). The mean age at presentation increased by ten years from CA to CC. Overall, infections were the leading cause of death, with a significant rise over time (9.1% in CA to 76.9% at CC, p = 0.002). There were no significant global and renal survival differences between the three cohorts. However, the CC patients died at an older age (61.4 years) than the CA (52.3 years). Conclusion: The incidence of AA amyloidosis has been declining over the last 40 years. In contrast, the age at presentation of amyloid nephropathy has been increasing. Global and renal outcomes did not improve, but the average life expectancy increased, suggesting progress in general management and supportive care of renal and underlying pathology.

ABSTRACT Sisal (Agave sisalana Perrine), a crucial natural fiber source, exhibits varying yields in China’s Guangdong and Guangxi regions. This groundbreaking study sampled soil and sisal leaves from these production hubs to explore the interplay among soil pH, enzyme activity, microorganisms, and sisal nutrition. Using PCR and high-throughput sequencing, results indicate Guangdong’s soil is mildly acidic, contrasting with Guangxi’s neutral to slightly alkaline soil. Both regions show a robust correlation between soil pH and nutrient availability (organic matter, P, K). Enhanced soil enzyme activity is observed at higher pH levels (6.09, 7.39). Dominant bacterial phyla Acidobacteria, Proteobacteria, and Actinobacteria peak at pH 7.39, 6.09, and 5.41, respectively. Fungal phyla Ascomycota, Basidiomycota, and Mortierellomycota thrive at pH 4.23, 7.39, and 6.48. Sisal leaves display optimal nutrient levels at specific pHs: N, P, and K at pH 6.09; Ca at pH 7.39; Mg at pH 6.48. Functional predictions reveal fungal abundance varies with pH, while bacterial functions like metabolism, disease resistance, and environmental adaptation are bolstered in Guangxi’s alkaline soils compared to Guangdong’s acidic ones. These findings provide a scientific basis for optimizing sisal cultivation management.

ABSTRACT Tidal swamp lands offer potential for expanding rice cultivation, but developing hybrid rice (Oryza sativa L.) in these areas faces significant challenges. Key obstacles include seed availability, fertilizer requirements, water management infrastructure, capital constraints, farmers’ technical skills, pest and disease pressures, consumer preferences, and institutional complexities. Addressing these challenges requires technological interventions and institutional support. Proposed technological solutions cover variety selection, water management, land preparation, seedling practices, amelioration techniques, transplanting methods, fertilization strategies, and pest and disease control measures. These solutions aim to overcome limited seed availability, nutrient deficiencies, suboptimal water management, and pest infestations, maximizing hybrid rice productivity in tidal swamp areas. Institutional strengthening is crucial to tackle systemic barriers like ineffective farmer associations, inadequate extension services, and limited market access. Collaborative efforts involving government agencies, research institutions, farmer groups, and market stakeholders are essential to unlock the full potential of hybrid rice cultivation in tidal swamp lands. By addressing these challenges and implementing targeted interventions, Indonesia can enhance its production sustainably, contributing to national food security and agricultural development goals in line with its vision to become a global food granary by 2045. The development of hybrid rice in swamp areas requires in-depth, on-site research to identify suitable varieties, taking into account soil fertility, hydrological conditions, and seasonal variations. By utilizing local or well-adapted genetic resources, it is possible to ensure the timely and cost-effective production of seeds in large quantities.

ABSTRACT In Mexico, chickpea (Cicer arietinum L.) crop production is extensively limited and reduced by a disease known as wilt, caused by a complex of soil-borne plant pathogenic fungi. The objective of this study was to evaluate the antagonistic capacity of 31 isolates of Trichoderma spp. against the fungi Macrophomina phaseolina, Agroathelia rolfsii, Rhizoctonia solani, Neocosmospora falciformis, Fusarium languescens, F. nirenbergiae, and F. verticillioides. Trichoderma spp. isolates were obtained from rhizospheric soil and chickpea roots collected in the municipalities of Angostura and Salvador Alvarado, in Sinaloa, Mexico. Dual confrontations between the pathogen isolates and antagonistic agents were evaluated on PDA culture medium, using a completely randomized two-factor experimental design with three replicates. The recorded variable was the percentage of inhibition of radial mycelial growth. Of the 31 Trichoderma isolates evaluated, 22 induced > 55% inhibition of the plant pathogens; meanwhile, 7 Trichoderma isolates showed the highest antagonistic effect on each of the plant pathogens, causing > 59% inhibition. These 7 Trichoderma isolates were identified through multilocus phylogenetic analysis using internal transcribed spacer (ITS), EF-1ɑ, and rpb2 sequences, distinguishing 5 isolates as T. afroharzianum and 2 isolates as T. afarasin. These Trichoderma spp. isolates represent a biological control alternative against the complex of fungi causing chickpea wilt in Sinaloa.

Resumo Introdução: Quelantes de fosfato (P) estão entre os medicamentos mais comumente prescritos para controlar níveis de P em pacientes com DRC em diálise. Ainda há escassez de dados sobre adesão aos quelantes de P, sem comparações entre modalidades dialíticas. Métodos: Acessamos fatores associados à adesão ao quelante de P entre pacientes em diálise em um hospital universitário. A adesão foi calculada como a razão entre número de comprimidos tomados por dia, conforme relatado, e número de comprimidos prescritos. Pacientes foram considerados não aderentes se a adesão fosse ao menos 20% menor ou 30% maior do que o prescrito. Resultados: Os pacientes (N = 137) eram jovens, predominantemente mulheres, em diálise por um período mediano de 53 meses. Sevelamer e carbonato de cálcio foram prescritos como quelantes de P para 70,8% e 10,2% dos pacientes, respectivamente, sem diferença entre modalidades dialíticas (p = 0,839). P correlacionou-se com número de comprimidos prescritos (r = 0,368; p = 0,001) e número de comprimidos tomados por dia (r = 0,275; p = 0,001). Encontramos hiperfosfatemia em 52 pacientes (36,4%). A adesão ao carbonato de Ca e sevelamer foi de 100% e 68,4%, respectivamente. Pacientes não aderentes eram mulheres, mais jovens, com albumina e ureia séricas mais elevadas e menor cálcio sérico. A regressão logística mostrou que sexo feminino (HR 3,30; IC 95%: 1,39–7,84; p = 0,007) e hemodiálise vs. diálise peritoneal (HR 4,55; IC 95%: 1,26–16,39; p = 0,021) permaneceram independentemente associados ao comportamento de não adesão. Conclusão: O presente estudo sugere que estratégias para aumentar a adesão devem ser implementadas. A relação entre adesão ao quelante de fosfato e melhores desfechos merece investigação mais aprofundada.

Abstract Introduction: Phosphate (P) binders are among the most common medications prescribed to control P levels in patients with chronic kidney disease on dialysis. There is still a paucity of data on adherence to P binders with no comparison between dialysis modalities. Methods: We accessed factors associated with P binder adherence among patients on dialysis in an academic hospital. Adherence was calculated as the ratio between the number of pills taken per day as reported and the prescribed number of pills. Patients were considered non-adherent if adherence was at least 20% less or 30% more than prescribed. Results: Patients (N = 137) were young, mostly women, and on dialysis for a median time of 53 months. Sevelamer and calcium carbonate were prescribed as P binders to 70.8% and 10.2% of patients, respectively, with no difference across dialysis modalities (p = 0.839). P correlated with the number of pills prescribed (r = 0.368, p = 0.001) and the number of pills taken per day (r = 0.275, p = 0.001). Hyperphosphatemia was found in 52 patients (36.4%). Adherence to Ca carbonate and sevelamer was 100% and 68.4%, respectively. Non-adherent patients were women, younger, with higher serum albumin and urea, and lower serum calcium. Logistic regression showed that female sex (HR 3.30, 95% CI: 1.39–7.84, p = 0.007) and hemodialysis vs. peritoneal dialysis (HR 4.55, 95%, CI: 1.26–16.39, p = 0.021) remained independently associated with a non-adherence behavior. Conclusions: The current study suggests that strategies to increase adherence should be implemented. Whether phosphate binder adherence is associated with better outcomes deserves further investigation.

Resumo A glomerulopatia colapsante (GC) apresenta um curso grave, tipicamente associado a infecções virais, especialmente HIV e parvovírus B19, lúpus eritematoso sistêmico (LES), entre outras etiologias. Uma mulher de 35 anos, com uso recente de um inibidor de JAK devido à artrite reumatoide, apresentou histórico de duas semanas de febre, adenopatia cervical e eritema facial. Após a admissão, observou-se anemia, hipoalbuminemia, proteinúria e injúria renal aguda grave. Foi diagnosticado LES e o DNA do parvovírus B19 foi detectado em amostras de soro. A biópsia renal revelou GC sem quaisquer características típicas de nefrite lúpica. A paciente foi tratada com prednisona e apresentou melhora acentuada da anemia e da função renal após algumas semanas. Neste caso, a paciente com LES apresentou GC possivelmente causada por infecção por parvovírus B19 associada ao genótipo homozigoto G1 da apolipoproteína 1 (APOL1), que tem sido descrito como um fator de risco determinante para essa glomerulopatia. Não está claro se o LES teve uma relação causal com a doença glomerular ou se foi uma causa concomitante. O tratamento pode ser desafiador nesse contexto, uma vez que nenhum medicamento antiviral é eficaz e a imunossupressão não apresenta benefícios perceptíveis, embora o uso de esteroides tenha sido eficaz no tratamento das manifestações renais nesse caso.

Abstract Collapsing glomerulopathy (CG) has a severe course typically associated with viral infections, especially HIV and parvovirus B19, systemic lupus erythematosus (SLE), among other etiologies. A 35-year-old woman with recent use of a JAK inhibitor due to rheumatoid arthritis presented with a 2-week history of fever, cervical adenopathy, and facial erythema. After admission, anemia, hypoalbuminemia, proteinuria, and severe acute kidney injury were noted. SLE was diagnosed and parvovirus B19 DNA was detected in serum samples. Kidney biopsy showed CG without any typical features of lupus nephritis. The patient was treated with prednisone and presented marked improvement of anemia and kidney function after a few weeks. In this case, the patient with SLE presented CG possibly caused by parvovirus B19 infection associated with homozygous apolipoprotein 1 (APOL1) G1 genotype, which has been described as a determinant risk factor for this glomerulopathy. It is not clear whether SLE had a causal relationship with glomerular disease or was a concurrent cause. Treatment can be challenging in such a context, as no antiviral drug is efficient and immunosuppression has no discernable benefit, although steroid use was efficient in treating renal manifestations in this case.

Resumo Introdução: O início da terapia renal substitutiva (TRS) de modo não planejado em portadores de doença renal crônica (DRC) é situação frequente mundialmente. Nesse cenário, a diálise peritoneal (DP) tem se evidenciado como opção terapêutica em comparação à hemodiálise (HD). Na TRS planejada, os custos da DP são inferiores aos da HD, porém a literatura carece dessas análises quando o início é urgente. Objetivo: Avaliar clínica e economicamente, na perspectiva do Sistema Único de Saúde (SUS), a estratégia de iniciar TRS não planejada por HD e DP em pacientes durante seu primeiro ano de terapia. Metodologia: Estudo quase experimental com análise de custo-efetividade a partir de dados primários de pacientes incidentes em TRS, em horizonte temporal de doze meses, por intenção de tratamento. A coleta de dados ocorreu de maneira prospectiva, diretamente dos prontuários médicos, computando dados de utilização de terapia dialítica, medicações de alto custo, procedimentos em acessos dialíticos e eventos ocorridos, com estimativa de custos pelos valores repassados pelo SUS. Na análise econômica, foi proposta a aplicação de método de bootstrapping e construção de gráficos. Resultados: No fim de um ano, não houve diferenças entre custos e efetividade ao iniciar a TRS de maneira não planejada por DP e HD. Conclusão: Iniciar TRS por DP é opção semelhante a iniciar por HD em pacientes com necessidade de métodos não planejados. A mínima necessidade de investimento inicial para criação de vagas de DP é fator que a fortalece como política de saúde pública para expansão da TRS em países em desenvolvimento.

Abstract Introduction: Unplanned initiation of renal replacement therapy (RRT) in chronic kidney disease (CKD) patients is a common situation worldwide. In this scenario, peritoneal dialysis (PD) has emerged as a therapeutic option compared to hemodialysis (HD). In planned RRT, the costs of PD are lower than those of HD; however, the literature lacks such analyses when initiation is urgent. Objective: To clinically and economically evaluate, from the perspective of the Unified Health System (SUS, Sistema Único de Saúde), the strategy of initiating unplanned RRT using HD or PD in patients during their first year of therapy. Methodology: Quasi-experimental study with cost-effectiveness analysis based on primary data from incident patients on RRT, over a twelve-month follow-up period, using the intention-to-treat approach. Data collection occurred prospectively, directly from medical records, computing data on the use of dialysis therapy, high-cost medications, procedures in dialysis accesses and recorded events. Costs were estimated using the amounts reimbursed by the SUS. In the economic analysis, the application of the bootstrap method and the construction of graphical representations were proposed. Results: At the end of one year, there were no differences between costs and effectiveness when initiating unplanned RRT using either PD or HD. Conclusion: Starting RRT with PD is a similar option to starting with HD in patients requiring unplanned methods. The minimal initial investment required to establish PD slots makes it a strong option as a public health policy for expanding RRT in developing countries.

Resumo Introdução: Doenças glomerulares podem estar associadas a malignidades sólidas ou hematopoiéticas. A prevalência dessas associações varia conforme a doença glomerular estudada. O objetivo deste estudo foi avaliar frequência e tipo de neoplasias em pacientes com doenças glomerulares, bem como suas características clínicas, laboratoriais e histopatológicas e a relação com a terapia imunossupressora. Métodos: Estudo retrospectivo, descritivo, observacional e longitudinal que analisou 4.820 prontuários e incluiu 95 pacientes com doença glomerular e neoplasias. Foram coletados dados demográficos, clínicos, laboratoriais e histológicos. Resultados: A prevalência de neoplasias foi 1,97% (95 pacientes; 81 [85,3%] malignas, 14 [14,7%] benignas). As malignidades hematológicas (35,8%) apresentaram maior prevalência, seguidas por tumores de cólon, reto e ginecológicos. A glomerulopatia com maior frequência foi a glomerulopatia membranosa (GM, 25 pacientes, 35,7%). A dose dos agentes imunossupressores entre pacientes com neoplasias, antes ou após a imunossupressão, não foi estatisticamente diferente. A neoplasia foi diagnosticada antes da glomerulopatia em 53% dos pacientes. Entre os casos em que as neoplasias foram diagnosticadas após a glomerulopatia, 43% foram detectadas no primeiro ano de acompanhamento da doença renal. A síndrome predominante na apresentação foi a síndrome nefrótica. A progressão para doença renal crônica estágio 5 ao final do acompanhamento ocorreu em 8,4% dos casos. Conclusões: Neoplasias se manifestaram antes ou, menos frequentemente, após o diagnóstico de doenças glomerulares. Como as neoplasias diagnosticadas após a apresentação da glomerulopatia frequentemente surgem logo após esse diagnóstico, é necessário atenção às neoplasias durante o primeiro ano de acompanhamento das glomerulopatias, especialmente em pacientes com síndrome nefrótica e GM.

Abstract Introduction: Glomerular diseases can be associated with solid or hematopoietic malignancies. The prevalence of these associations varies according to the studied glomerular disease. This study aimed to evaluate the frequency and type of neoplasms in patients with glomerular diseases as well as their clinical, laboratory, and histopathological features and the relationship with immunosuppressive therapy. Methods: This was a retrospective, descriptive, observational, longitudinal study that reviewed 4,820 medical records and included 95 patients with glomerular disease and neoplasms. Demographic, clinical, laboratory, and histologic data were collected. Results: The prevalence of neoplasms was 1.97% (95 patients; 81 [85.3%] malignant, 14 [14.7%] benign). Hematologic malignancies (35.8%) showed the highest prevalence, followed by colon, rectal, and gynecologic tumors. The glomerulopathy with the highest frequency was membranous glomerulopathy (MGN, 25 patients, 35.7%). The dose of the immunosuppressive agents among patients with neoplasms before or after immunosuppression was not statistically different. Neoplasm was diagnosed before glomerulopathy in 53% of patients. Among cases in which neoplasms were diagnosed after glomerulopathy, 43% were diagnosed in the first year of follow-up of the renal disease. The predominant syndrome at presentation was nephrotic syndrome. Progression to chronic kidney disease stage 5 at the end of follow-up occurred in 8.4% of the cases. Conclusions: Neoplasms manifested before or, less frequently, after the diagnosis of glomerular diseases. As neoplasms diagnosed after presentation of glomerulopathy often appeared early after this diagnosis, it is necessary to be aware of neoplasms during the first year of follow-up of glomerulopathies, especially in patients with nephrotic syndrome, and MGN.

ABSTRACT: Introduction: autoimmune diseases are diseases in which an immune response against self antigens develops, affecting some organs or mucous membranes. Some of these diseases include mucous membrane pemphigoid, pemphigus vulgaris, foliaceous, and paraneoplastic. Objective: to analyze the similarities and differences between mucous membrane pemphigoid and pemphigus vulgaris from a clinical and histological point of view in order to determine an adequate diagnosis and treatment. Materials and methods: This is a retrospective and descriptive study based on a series of clinical cases of pemphigus and pemphigoid. Demographic data, clinical characteristics were collected and different diagnostic methods were used to corroborate it, treatments and clinical response were recorded, follow-up evaluations were carried out to document the evolution of the disease and adverse events. Results: The established treatment was effective for each case, it eliminated the lesions, improving the quality of life of the patients. Medications and a comprehensive approach were used to prevent recurrences. Physical and emotional well-being improved with treatment. Conclusions: The diagnosis of autoimmune blistering diseases is based on clinical, histopathological and immunological findings, in addition to immunofluorescence tests. Treatment involves the use of corticosteroids and immunosuppressants. Knowing these diagnostic tools is crucial for proper case management.

RESUMEN: Las enfermedades autoinmunes son enfermedades en las que se desarrolla una respuesta inmune contra antígenos propios, afectando algunos órganos o mucosas. Algunas de estas enfermedades incluyen el penfigoide de las membranas mucosas, el pénfigo vulgar, el foliáceo y el paraneoplásico. El objetivo del estudio fue analizar las similitudes y diferencias entre el penfigoide de membranas mucosas y el pénfigo vulgar desde un punto de vista clínico e histológico para así determinar un diagnóstico y tratamiento adecuado. El estudio es retrospectivo y descriptivo basado en una serie de casos clínicos de pénfigo y penfigoide. Se recopilaron datos demográficos, características clínicas y se utilizaron diferentes métodos diagnósticos para corroborarlo, se registraron los tratamientos y la respuesta clínica, se realizaron evaluaciones de seguimiento para documentar la evolución de la enfermedad y los eventos adversos. El tratamiento instaurado fue efectivo para cada caso, eliminó las lesiones, mejorando la calidad de vida de los pacientes. Se utilizaron medicamentos y un enfoque integral para prevenir recurrencias. El bienestar físico y emocional mejoró con el tratamiento. El diagnóstico de las enfermedades ampollosas autoinmunes se basa en hallazgos clínicos, histopatológicos e inmunológicos, además de las pruebas de inmunofluorescencia. El tratamiento involucra el uso de corticosteroides e inmunosupresores. Conocer estas herramientas diagnósticas es crucial para un manejo adecuado de los casos.

Abstract Patients with diabetic kidney disease (DKD) face an elevated risk of experiencing acute kidney injury (AKI), exacerbating the progression of DKD. This article offers a comprehensive review of the literature and knowledge of the primary pathophysiologic mechanisms underlying kidney damage, as well as the biological implications of maladaptive kidney repair in the context of DKD complicated by AKI. Additionally, we examine in detail the findings of clinical trials evaluating the efficacy and safety of intensive insulin treatment for hyperglycemic patients in intensive care units, alongside the potential risks of hypoglycemia and mortality. Furthermore, through critical analysis of clinical trial results, opportunities for personalized safety-based approaches to mitigate side effects are identified. It is imperative to conduct randomized-controlled studies to assess the impact of intensive insulin treatment on diabetic patients with DKD, and to validate AKI biomarkers in this patient population. Such studies will help to tailor treatment strategies to improve patient outcomes and preserve kidney function. (DKD AKI, , (AKI) damage Additionally units mortality Furthermore results safetybased based identified randomizedcontrolled randomized controlled population function (AKI

Resumo Pacientes com doença renal diabética (DRD) enfrentam um risco elevado de apresentar injúria renal aguda (IRA), o que agrava a progressão da DRD. Este artigo oferece uma revisão abrangente da literatura e do conhecimento dos principais mecanismos fisiopatológicos relacionados ao dano renal, bem como das implicações biológicas do reparo renal mal adaptativo no contexto da DRD complicada por IRA. Além disso, examinamos detalhadamente os achados de ensaios clínicos que avaliam a eficácia e a segurança do tratamento intensivo com insulina para pacientes hiperglicêmicos em unidades de terapia intensiva, juntamente com os riscos potenciais de hipoglicemia e mortalidade. Ainda, por meio da análise crítica dos resultados de ensaios clínicos, são identificadas oportunidades para abordagens personalizadas baseadas na segurança, a fim de mitigar efeitos colaterais. É imperativo realizar estudos randomizados e controlados para avaliar o impacto do tratamento intensivo com insulina em pacientes diabéticos com DRD e validar os biomarcadores de IRA nessa população de pacientes. Tais estudos ajudarão a adaptar as estratégias de tratamento para melhorar os desfechos dos pacientes e preservar a função renal. (DRD IRA, , (IRA) disso intensiva mortalidade Ainda colaterais (IRA

BACKGROUND. Primary immune thrombocytopenia (ITP) is an acquired autoimmune disease characterised by an isolated thrombocytopenia of <100 × 10(9)/L in the absence of identifiable secondary causes. Treatment is indicated when the platelet count is <20 - 30 × 10(9)/L, but may be commenced at higher platelet counts when the risk of bleeding is high. Corticosteroids are the backbone of initial treatment of ITP. There is a paucity of data in South Africa (SA) on the outcomes of newly diagnosed ITP patients treated with corticosteroids. OBJECTIVES. To describe the response, remission and clinical outcomes of newly diagnosed primary ITP patients on first-line corticosteroids. METHODS. This was a retrospective cohort study of 68 patients with a new diagnosis of ITP, seen at the Clinical Haematology Unit at Groote Schuur Hospital, Cape Town, SA, over a 5-year period (2016 - 2020). Demographic and clinical data were obtained from paper and electronic record systems. All participants with secondary causes were excluded. The initial platelet responses to corticosteroids and the final outcomes at last follow-up were determined. Initial platelet responses were classified into no response (NR), partial response (PR) and complete response (CR) in accordance with consensus definitions. Remission was defined as maintenance of a CR after being off corticosteroids for <6 months. Categorical variables were described by frequencies and percentages, while numerical variables were described by medians and interquartile ranges (IQRs) as data were non-parametric. RESULTS. The majority of patients were female (88.2%) and the median (IQR) age at diagnosis was 36 (23.0 - 55.5) years. The female to male ratio was 7.5:1. Most (92.4%) patients responded to corticosteroids, with 74.2% achieving a CR and 18.2% achieving a PR. Only five patients failed to respond (7.6%). The median (IQR) time to achieve CR was 15 (8 - 25) days, and the median (IQR) time to achieve PR was 10.5 (8 - 22) days. Half of the patients went into remission. Following remission, two patients (6.1%) subsequently relapsed at day 344 and day 777, respectively. Hypertension and/or diabetes mellitus were newly diagnosed in 10.6% of patients. CONCLUSION. Corticosteroids are effective first-line therapy for ITP, but are not remission-inducing in all patients. For those patients progressing to chronic ITP, there is a need to investigate cost-effective treatment. Some patients are at high risk of developing new hypertension and diabetes mellitus on corticosteroids, and should be monitored.

BACKGROUND: The personal health behaviours and lifestyle habits of health professionals influence their counselling practices related to non-communicable diseases (NCDs). There is limited evidence on the prevalence of modifiable NCD risk factors among medical students in South Africa (SA OBJECTIVES: To determine the prevalence of modifiable behavioural and metabolic NCD risk factors in first-year medical students at a SA university METHODS: This cross-sectional observational study included 256 first-year students. Participants completed five online questionnaires regarding lifestyle behaviours (physical activity, dietary habits, smoking, alcohol consumption and sleep quality). NCD-related metabolic markers including body composition, blood pressure, total cholesterol and random glucose concentrations, were measured. The prevalence of risk factors was calculated using internationally accepted criteria, and sex differences were reported using one-way ANOVA or χ² test (p<0.05 RESULTS: The prevalence of poor sleep quality was 79.7%, followed by low-to-moderate diet quality (66.8%), low levels of physical activity (64.1%), overweight/ obesity (26.2%), current/past smoking (13.3%) and harmful use of alcohol (12.5%). Most (88.3%) participants had two or more NCD-related risk factors. The prevalence of multiple NCD risk factors differed significantly between male and female participants, with more male participants having >2 CONCLUSIONS: This study found that first-year medical students at a South African university have a high prevalence of lifestyle-related risk factors, specifically poor sleep quality, low levels of physical activity and low-to-moderate diet quality. Sleep hygiene, regular activity and good nutrition should be promoted, and interventions focusing on nutrition, smoking cessation and alcohol consumption could be targeted by sex