The National Policy for Comprehensive Men's Health Care has shown itself to be incapable of meeting the specific needs of trans men, especially when it comes to reproductive health and parenting. This qualitative study investigated the limitations of the current policy, problematizing gender, masculinity and parenting. We highlight three core themes based on the participants’ comments and observations: Gender, sex and sexuality – fusions that circumvent the parenting construct; Constructing parenting and parental recognition; and Stigmatization and exclusion. It is concluded that there is an urgent need for continuous health education and awareness raising regarding parenting policies and the National Policy for Comprehensive Men's Health Care, and among health professionals. It is crucial to recognize and support a variety of family structures and parenting experiences, including those of trans parents. Mens Men s men policy gender participants observations Gender construct recognition exclusion professionals experiences parents

La Política Nacional de Atención Integral a la Salud del Hombre no se muestra capaz de atender las necesidades específicas de los hombres trans, especialmente en salud reproductiva y parentalidad. Por lo tanto, este estudio cualitativo discute las limitaciones de la política actual, problematizando género, masculinidad y paternidad. Como resultado, se destacan tres ejes con base en las declaraciones de los participantes: Género, sexo y sexualidad –fusiones que contornan la construcción parental–; Construcción de la paternidad y del reconocimiento parental y Estigmatización y exclusión. Se concluye que existe la necesidad urgente de educación continua en salud y sensibilización en las políticas de parentalidad, en la Política Nacional de Atención integral a la Salud del Hombre y en los profesionales de salud, siendo crucial el reconocimiento y el apoyo de diversas estructuras familiares y experiencias parentales, incluyendo las de padres trans. trans parentalidad tanto actual género resultado participantes Género fusiones parental– exclusión parentales

A Política Nacional de Atenção Integral à Saúde do Homem não se mostra capaz de atender às necessidades específicas dos homens trans, especialmente em saúde reprodutiva e parentalidade. Assim, este estudo qualitativo, discute as limitações da política atual, problematizando gênero, masculinidade e paternidade. Como resultado, foram destacados três eixos baseados nas falas dos participantes: Gênero, sexo e sexualidade – fusões que contornam a construção parental, Construção da paternidade e do reconhecimento parental e Estigmatização e exclusão. Conclui-se que há necessidade urgente de educação contínua em saúde e sensibilização nas políticas de parentalidade, na Política Nacional de Atenção Integral à Saúde do Homem e nos profissionais de saúde, sendo crucial reconhecer e apoiar diversas estruturas familiares e experiências parentais, incluindo as de pais trans. trans parentalidade Assim qualitativo atual gênero resultado participantes Gênero exclusão Concluise Conclui parentais

Resumo Buscou-se compreender os sentidos e significados do exercício parental entre homens trans que engravidaram antes da transição de gênero por meio de uma pesquisa qualitativa, na qual participaram cinco interlocutores, cuja análise foi realizada à luz das teorias sociais de gênero. Os resultados demonstraram uma experiência parental sujeitada a um campo de tensão e negociações, além de uma produção subjetiva que oscilava entre a transgressão e a acomodação da perspectiva cultural da sua própria vivência. Identificou-se práticas de violências que reiteraram as vulnerabilidades sociais, deflagraram as fragilidades dos serviços de saúde e provocaram efeitos deletérios em homens trans que engravidam antes da transição de gênero.

Abstract This qualitative study, with five participating interlocutors, sought to understand the senses and meanings of parenting among trans men who became pregnant before gender transition. Analysis was conducted in light of social theories of gender. The results demonstrated an experience of parenthood subject to a field of tensions and negotiations, as well as subjective production that oscillated between transgression and accommodation of the cultural perspective of their own experience. The forms of violence found to be practiced reiterated social vulnerabilities, exposed healthcare service weaknesses and produced harmful effects on transgender men who become pregnant before gender transition.

Resumo Buscou-se compreender os sentidos e significados do exercício parental entre homens trans que engravidaram antes da transição de gênero por meio de uma pesquisa qualitativa, na qual participaram cinco interlocutores, cuja análise foi realizada à luz das teorias sociais de gênero. Os resultados demonstraram uma experiência parental sujeitada a um campo de tensão e negociações, além de uma produção subjetiva que oscilava entre a transgressão e a acomodação da perspectiva cultural da sua própria vivência. Identificou-se práticas de violências que reiteraram as vulnerabilidades sociais, deflagraram as fragilidades dos serviços de saúde e provocaram efeitos deletérios em homens trans que engravidam antes da transição de gênero. Buscouse Buscou se qualitativa interlocutores negociações vivência Identificouse Identificou

Abstract This qualitative study, with five participating interlocutors, sought to understand the senses and meanings of parenting among trans men who became pregnant before gender transition. Analysis was conducted in light of social theories of gender. The results demonstrated an experience of parenthood subject to a field of tensions and negotiations, as well as subjective production that oscillated between transgression and accommodation of the cultural perspective of their own experience. The forms of violence found to be practiced reiterated social vulnerabilities, exposed healthcare service weaknesses and produced harmful effects on transgender men who become pregnant before gender transition. study interlocutors transition negotiations vulnerabilities

ABSTRACT Objective: This study aimed to evaluate the incidence of acute kidney injury in hospitalized Brazilian patients with COVID-19 and identify the risk factors associated with its development and prognosis during the two waves of the disease. Methods: We performed a prospective cohort study of hospitalized patients with COVID-19 at a public university hospital in São Paulo from March 2020 to May 2021. Results: Of 887 patients hospitalized with COVID-19, 54.6% were admitted to the intensive care unit. The incidence of acute kidney injury was 48.1%, and the overall mortality rate was 38.9%. Acute kidney replacement therapy was indicated for 58.8% of the patients. The factors associated with acute kidney injury were diuretic use (odds ratio [OR] 2.2, 95%CI= 1.2-4.1, p=0.01), mechanical ventilation (OR= 12.9, 95%CI= 4.3-38.2, p<0.0001), hematuria(OR= 2.02, 95%CI= 1.1-3.5, p<0.0001), chronic kidney disease (OR= 2.6, 95%CI= 1.2-5.5, p=0.009), age (OR= 1.03, 95%CI= 1.01-1.07, p=0.02), and elevated creatine phosphokinase (OR= 1.02, 95%CI= 1.01-1.07, p=0.02) and D-dimer levels (OR= 1.01, 95%CI= 1.01-1.09, p<0.0001). Mortality was higher among those with acute kidney injury (OR= 1.12, 95%CI= 1.02-2.05, p=0.01), elevated Sequential Organ Failure Assessment Scores (OR= 1.35, 95%CI= 1.1-1.6, p=0.007), elevated Acute Tubular Necrosis-Injury Severity Score (ATN-ISS; (OR= 96.4, 95%CI= 4.8-203.1, p<0.0001), and who received mechanical ventilation (OR= 12.9, 95%CI= 4.3-38.2, p<0.0001). During the second wave, the number of cases requiring mechanical ventilation (OR= 1.57, 95%CI= 1.01-2.3, p=0.026), with proteinuria (OR= 1.44, 95%CI= 1.01-2.1, p=0.04), and with higher ATN-ISS Scores (OR= 40.9, 95%CI= 1.7-48.1, p=0.04) was higher than that during the first wave. Conclusion: Acute kidney injury was frequent in hospitalized patients with COVID-19, and the second wave was associated with greater severity. However, mortality rates were similar between the two periods, which may reflect both the effectiveness of vaccines and the constant learning that frontline professionals gained throughout the pandemic to provide greater support to their patients. Registry of Clinical Trials: RBR-62y3h7 Objective COVID19 COVID 19 COVID-1 Methods 202 2021 Results 88 COVID19, 19, 546 54 6 54.6 unit 481 48 1 48.1% 389 38 9 38.9% 588 58 8 58.8 odds OR [OR 22 2 2.2 95CI CI 95 95%CI 1.24.1, 1241 1.2 4.1, 4 1.2-4.1 p=0.01, p001 p p=0.01 , 0 01 p=0.01) OR= (OR 129 12 12.9 4.338.2, 43382 4.3 38.2, 3 4.3-38.2 p<0.0001, p00001 p<0.0001 0001 p<0.0001) hematuriaOR= hematuriaOR hematuria hematuria(OR 02 2.02 1.13.5, 1135 1.1 3.5, 5 1.1-3.5 26 2.6 1.25.5, 1255 5.5, 1.2-5.5 p=0.009, p0009 p=0.009 009 p=0.009) 103 03 1.03 1.011.07, 101107 1.01 1.07, 07 1.01-1.07 p=0.02, p002 p=0.02 102 1.02 Ddimer D dimer 101 1.011.09, 101109 1.09, 09 1.01-1.09 p<0.0001. . 112 1.12 1.022.05, 102205 2.05, 05 1.02-2.05 135 35 1.35 1.11.6, 1116 1.6, 1.1-1.6 p=0.007, p0007 p=0.007 007 p=0.007) NecrosisInjury Necrosis Injury ATNISS ATN ISS (ATN-ISS 964 96 96.4 4.8203.1, 482031 4.8 203.1, 203 4.8-203.1 157 57 1.57 1.012.3, 10123 2.3, 1.01-2.3 p=0.026, p0026 p=0.026 026 p=0.026) 144 44 1.44 1.012.1, 10121 2.1, 1.01-2.1 p=0.04, p004 p=0.04 04 409 40 40.9 1.748.1, 17481 1.7 48.1, 7 1.7-48.1 Conclusion severity However periods Trials RBR62y3h7 RBRyh RBR 62y3h7 y h RBR-62y3h COVID1 COVID- 20 54. 48.1 38.9 58. 2. 24 1.24.1 124 1. 41 4.1 1.2-4. p00 p=0.0 12. 338 4.338.2 4338 43 4. 382 38.2 4.3-38. p0000 p<0.000 000 2.0 13 1.13.5 113 11 3.5 1.1-3. 25 1.25.5 125 55 5.5 1.2-5. p000 p=0.00 00 10 1.0 011 1.011.07 10110 107 1.07 1.01-1.0 1.011.09 109 1.09 022 1.022.05 10220 205 2.05 1.02-2.0 1.3 1.11.6 111 16 1.6 1.1-1. 96. 8203 4.8203.1 48203 2031 203.1 4.8-203. 15 1.5 012 1.012.3 1012 23 2.3 1.01-2. 14 1.4 1.012.1 21 2.1 40. 748 1.748.1 1748 17 1.7-48. RBR62y3h yh 62y3h 48. 38. 1.24. 1.2-4 p0 p=0. 33 4.338. 433 4.3-38 p<0.00 1.13. 3. 1.1-3 1.25. 5. 1.2-5 1.011.0 1011 1.01-1. 1.022.0 1022 1.02-2. 1.11. 1.1-1 820 4.8203. 4820 203. 4.8-203 1.012. 1.01-2 74 1.748. 174 1.7-48 1.24 1.2- p=0 4.338 4.3-3 p<0.0 1.13 1.1- 1.25 1.011. 1.01-1 1.022. 1.02-2 1.11 82 4.8203 482 4.8-20 1.012 1.01- 1.748 1.7-4 p= 4.33 4.3- p<0. 1.011 1.022 1.02- 4.820 4.8-2 1.74 1.7- p<0 4.82 4.8- p<

RESUMO Introdução: Após o transplante cardíaco (TxC), alguns pacientes continuam a apresentar mortalidade desproporcionalmente alta. Objetivos: Investigar quais variáveis clínicas estão associadas à sobrevida após o TxC. Métodos: Estudo do tipo coorte retrospectivo, unicêntrico, com 55 pacientes submetidos a TxC no período de maio de 2019 a abril de 2023. Resultados: A regressão logística identificou, como variáveis associadas ao óbito, o aumento da creatinina no pós-operatório imediato (POI) (p = 0,0067), a resistência vascular pulmonar (RVP) (p = 0,0185) e a pressão sistólica da artéria pulmonar (PSAP) prévios ao TxC (p = 0,0415). Ao construir a curva ROC (receiver operating characteristic curve) com o delta do aumento da creatinina nas primeiras 24 horas do pós-operatório, o ponto de corte foi de 0.35 mg/dL, a sensibilidade de 0,76 e a especificidade de 0,90. Na curva ROC para a RVP, o ponto de corte foi de 2,23 unidades Woods (WU), com sensibilidade de 0,79 e especificidade de 0,72. Na curva ROC para a PSAP, o ponto de corte foi de 40,50 mmHg, com sensibilidade de 0,89 e especificidade de 0,86. Conclusão: Aumento da creatinina para valor maior ou igual a 0,35 mg/dL nas primeiras 24 horas, PSAP com valores superiores a 40,5 mmHg e aumento da RVP para valor acima de 2,23 WU estão associados ao aumento das taxas de mortalidade hospitalar após o TxC. Introdução TxC, , (TxC) alta Objetivos Métodos retrospectivo unicêntrico 5 201 2023 Resultados identificou óbito pósoperatório pós operatório POI (POI p 0,0067, 00067 0,0067 0 0067 0,0067) (RVP 0,0185 00185 0185 (PSAP 0,0415. 00415 0,0415 . 0415 0,0415) receiver curve 2 pósoperatório, operatório, 035 35 0.3 mgdL mg dL 076 76 0,7 090 90 0,90 223 23 2,2 WU, (WU) 079 79 072 72 0,72 4050 40 50 089 89 0,8 086 86 0,86 Conclusão 0,3 405 40, (TxC 20 202 0006 0,006 006 0,018 0018 018 0041 0,041 041 03 3 0. 07 7 0, 09 9 0,9 22 2, (WU 4 08 8 000 0,00 00 0,01 001 01 004 0,04 04 0,0

ABSTRACT Introduction: After heart transplantation (HTx), some patients continue to experience disproportionately high mortality. Objectives: To investigate which clinical variables are associated with survival after HTx. Methods: Retrospective, single-center cohort study with 55 patients undergoing HTx from May 2019 to April 2023. Results: Logistic regression identified, as variables associated with death, the increase in creatinine in the immediate postoperative period (POI) (p = 0.0067), pulmonary vascular resistance (RVP) (p = 0.0185) and pulmonary artery systolic pressure (PSAP) before HTx (p = 0.0415). When constructing the ROC curve (receiver operating characteristic curve) with the delta of the increase in creatinine in the first 24 postoperative hours, the cutoff point was 0.35 mg/dL, the sensitivity was 0.76, and the specificity was 0. 90. In the ROC curve for PVR, the cutoff point was 2.23 Woods units (WU), with sensitivity of 0.79 and specificity of 0.72. In the ROC curve for PSAP, the cutoff point was 40.50 mmHg, with a sensitivity of 0.89 and a specificity of 0.86. Conclusion: An increase in creatinine to a value greater than or equal to 0.35 mg/dL in the first 24 hours, PSAP with values greater than 40.5 mmHg and an increase in RVP to a value above 2.23 WU are associated with increased rates of hospital mortality after HTx. Introduction HTx, , (HTx) Objectives Methods Retrospective singlecenter single center 5 201 2023 Results identified death POI (POI p 0.0067, 00067 0.0067 0 0067 0.0067) (RVP 0.0185 00185 0185 (PSAP 0.0415. 00415 0.0415 . 0415 0.0415) receiver 2 hours 035 35 0.3 mgdL mg dL 076 76 0.76 90 PVR 223 23 2.2 WU, (WU) 079 79 0.7 072 72 0.72 4050 40 50 089 89 0.8 086 86 0.86 Conclusion 405 40. (HTx 20 202 0006 0.006 006 0.018 0018 018 0041 0.041 041 03 3 07 7 9 22 2. (WU 4 08 8 000 0.00 00 0.01 001 01 004 0.04 04 0.0

ABSTRACT Objective: The efficacy of icodextrin versus glucose patients undergoing peritoneal dialysis remains unclear. The study was designed to compare the effects of once-daily long-dwell icodextrin versus glucose on markers of hypervolemia and survival among patients with kidney failure undergoing an unplanned initiation of automated peritoneal dialysis. Methods: This was a randomized, non-blinded, and prospective controlled study. Prevalent and stable patients undergoing automated peritoneal dialysis with a recent peritoneal equilibration test showing a dialysate/plasma creatinine of >0.50 were randomized to receive either 7.5% icodextrin or 2.5% glucose solution. Patients were evaluated at baseline (one month after the start of peritoneal dialysis), 3 months, and 6 months after inclusion. The peritoneal dialysis solution was used for at least 3 months, with a follow-up period of 24 months. Results: Thirty patients were enrolled. There were no baseline differences between the groups. During the study period, patients in the Icodextrin Group showed improvements in the phase angle and ultrafiltration, whereas there were no changes in the Glucose Group. Additionally, extracellular water was significantly lower in the Icodextrin Group at the end of the study than at baseline. No statistical differences between the two groups were observed in urine volume, ultrafiltration, extracellular water, phase angle, renal creatinine clearance, use of diuretics and antihypertensives, or blood pressure. During the 24-month follow-up, the number of events related to overall mortality was seven (Icodextrin Group, n=4; Glucose Group, n=3), with no difference between the groups for this outcome or technique survival. Conclusion: Icodextrin significantly improved ultrafiltration, extracellular water, and phase angle at the end of the study compared to baseline in patients on the urgent start of automated peritoneal dialysis. Registry of Clinical Trials: (www.ctri.nic.in) under the number RBR-97z4wh6. Objective unclear oncedaily once daily longdwell long dwell Methods nonblinded, nonblinded non blinded, blinded non-blinded dialysateplasma dialysate plasma 050 0 50 >0.5 75 7 5 7.5 25 2 2.5 one dialysis, , dialysis) inclusion followup follow up Results enrolled ultrafiltration Additionally volume clearance antihypertensives pressure 24month followup, up, n=4 n4 n 4 n=3, n3 n=3 n=3) Conclusion Trials www.ctri.nic.in wwwctrinicin www ctri nic (www.ctri.nic.in RBR97z4wh6. RBR97z4wh6 RBRzwh RBR 97z4wh6. 97z4wh6 z wh RBR-97z4wh6 05 >0. 7. 2. n= RBR97z4wh zwh 97z4wh RBR-97z4wh >0 >

RESUMO Introdução: Para a redução dos níveis do paratormônio (PTH) estão disponíveis no mercado brasileiro duas classes de medicamentos: ativadores do receptor da vitamina D (não seletivos e seletivos) e calcimiméticos. Dentre os medicamentos supracitados, o SUS disponibiliza calcitriol oral, paricalcitol e cinacalcete. Objetivos: Desenvolver análise de custo-efetividade (CE) e de impacto orçamentário (IO) do cinacalcete versus paricalcitol para pacientes em diálise com HPTS, na perspectiva do SUS. Metodologia: Foi construído um modelo de árvore de decisão para a análise de CE, que considerou o desfecho paratireoidectomia evitada e um horizonte temporal de 1 ano. Quanto à análise de IO, foram considerados dois cenários, um de demanda aferida e outro de abordagem epidemiológica, baseado nos dados da Sociedade Brasileira de Nefrologia (SBN). Resultados: A análise de CE mostrou que o uso de cinacalcete resulta em economia de R$ 1.394,64 ao ano e efetividade incremental de 0,08, em relação a paratireoidectomia evitada. A razão de CE incremental (RCEI) foi de - R$ 17.653,67 por paratireoidectomia evitada para o cinacalcete, já que se mostrou mais efetivo e mais barato comparado ao paricalcitol. Estimou-se que o IO incremental com a ampliação do uso do cinacalcete no SUS estará entre - R$ 1.640.864,62 e R$ 166.368,50 no primeiro ano, considerando os cenários principal e epidemiológico baseado nos dados da SBN. Já ao final de 5 anos após a ampliação do uso, estimou-se um impacto incremental entre - R$ 10.740.743,86 e - R$ 1.191.339,37; considerando os mesmos cenários. Conclusão: Cinacalcete foi dominante para evitar paratireoidectomias, sendo custo-efetivo. Introdução PTH (PTH não calcimiméticos supracitados oral Objetivos custoefetividade custo (CE (IO HPTS Metodologia epidemiológica SBN . (SBN) Resultados R 139464 394 64 1.394,6 008 0 08 0,08 RCEI (RCEI 1765367 17 653 67 17.653,6 Estimouse Estimou 164086462 640 864 62 1.640.864,6 16636850 166 368 50 166.368,5 estimouse estimou 1074074386 10 740 743 86 10.740.743,8 1.191.339,37 119133937 191 339 37 Conclusão paratireoidectomias custoefetivo. custoefetivo efetivo. custo-efetivo (SBN 13946 39 6 1.394, 00 0,0 176536 65 17.653, 16408646 1.640.864, 1663685 16 36 166.368, 107407438 74 8 10.740.743, 1.191.339,3 11913393 19 33 3 1394 1.394 0, 17653 17.653 1640864 1.640.864 166368 166.368 10740743 7 10.740.743 1.191.339, 1191339 139 1.39 1765 17.65 164086 1.640.86 16636 166.36 1074074 10.740.74 1.191.339 119133 13 1.3 176 17.6 16408 1.640.8 1663 166.3 107407 10.740.7 1.191.33 11913 1. 17. 1640 1.640. 166. 10740 10.740. 1.191.3 1191 164 1.640 1074 10.740 1.191. 119 1.64 107 10.74 1.191 11 1.6 10.7 1.19 10. 1.1

ABSTRACT Introduction For the reduction of PTH levels, two classes of drugs are available in the Brazilian market: non-selective and selective vitamin D receptor activators and calcimimetics. Among the mentioned drugs, the SUS provides oral calcitriol, paricalcitol and cinacalcet. Objectives: Develop cost-effectiveness (CE) and budgetary impact (BI) analysis of cinacalcet versus paricalcitol for patients on dialysis with SHPT, from the perspective of SUS. Methodology: A decision tree model was constructed for CE analysis, which considered the outcome of avoided parathyroidectomy and a time horizon of 1 year. As for the BI analysis, two scenarios were considered, one of which was measured demand and other epidemiological, based on data from the Brazilian Society of Nephrology (BSN). Results: The CE analysis showed that the use of cinacalcet results in one-off savings of R$1,394.64 per year and an incremental effectiveness of 0.08, in relation to avoided parathyroidectomy. The incremental CE ratio (ICER) was - R$ 17,653.67 per avoided parathyroidectomy for cinacalcet, as it was more effective and cheaper compared to paricalcitol. As for the BI analysis, it was estimated that the incremental BI with the expansion of the use of cinacalcet in the SUS will be between - R$ 1,640,864.62 and R$ 166,368.50 in the first year, considering the main and the epidemiological scenarios. At the end of 5 years after the expansion of use, an BI was estimated between - R$ 10,740,743.86 and - R$ 1,191,339.37; considering the same scenarios. Conclusion: Cinacalcet was dominant to avoid parathyroidectomies, being cost-effective. levels market nonselective non calcimimetics calcitriol Objectives costeffectiveness cost (CE (BI SHPT Methodology BSN. BSN . (BSN) Results oneoff off R139464 R 394 64 R$1,394.6 008 0 08 0.08 ICER (ICER 1765367 17 653 67 17,653.6 164086462 640 864 62 1,640,864.6 16636850 166 368 50 166,368.5 1074074386 10 740 743 86 10,740,743.8 1,191,339.37 119133937 191 339 37 Conclusion parathyroidectomies costeffective. costeffective effective. cost-effective (BSN R13946 39 6 R$1,394. 00 0.0 176536 65 17,653. 16408646 1,640,864. 1663685 16 36 166,368. 107407438 74 8 10,740,743. 1,191,339.3 11913393 19 33 3 R1394 R$1,394 0. 17653 17,653 1640864 1,640,864 166368 166,368 10740743 7 10,740,743 1,191,339. 1191339 R139 R$1,39 1765 17,65 164086 1,640,86 16636 166,36 1074074 10,740,74 1,191,339 119133 R13 R$1,3 176 17,6 16408 1,640,8 1663 166,3 107407 10,740,7 1,191,33 11913 R1 R$1, 17, 1640 1,640, 166, 10740 10,740, 1,191,3 1191 R$1 164 1,640 1074 10,740 1,191, 119 1,64 107 10,74 1,191 11 1,6 10,7 1,19 1, 10, 1,1

Resumo Introdução: O hiperparatireoidismo secundário (HPTS) à doença crônica renal (DRC) é caracterizado por elevados níveis de paratormônio (PTH), hiperplasia das glândulas paratireoides e doença cardiovascular. Para a redução dos níveis do PTH, estão disponíveis no mercado brasileiro os ativadores não seletivos e seletivos do receptor da vitamina D e os calcimiméticos. Objetivos: Desenvolver análise de custo-efetividade (C/E) e de impacto orçamentário (IO) do paricalcitol intravenoso vs. calcitriol oral para pacientes em diálise com HPTS, na perspectiva do Sistema Único de Saúde. Metodologia: Foi construído um modelo de árvore de decisão para a análise de C/E, que considerou o desfecho morte evitada e um horizonte temporal de 1 ano. Quanto à análise de IO, foram considerados dois cenários, sendo um de demanda aferida e um de abordagem epidemiológica, baseado nos dados da Sociedade Brasileira de Nefrologia. Resultados: A análise mostrou que a relação de C/E foi de R$ 1.213,68 ao ano, e uma efetividade incremental de 0,032, referente à morte evitada. A razão de C/E incremental foi de R$ 37.927,50 por morte evitada para o paricalcitol. Estimou-se que o IO incremental com a ampliação do uso do paricalcitol estará entre R$ 1.600.202,28 e R$ 4.128.565,65 no primeiro ano, considerando os cenários principal e o epidemiológico. Já no fim de 5 anos após a ampliação do uso, estimou-se IO incremental entre R$ 48.596.855,50 e R$ 62.90.555,73. Conclusão: O paricalcitol intravenoso tem eficácia superior e segurança semelhante ao comparador calcitriol oral, diminuindo a mortalidade geral dos pacientes em diálise, embora implique maior custo. Introdução HPTS (HPTS DRC (DRC PTH , (PTH) cardiovascular calcimiméticos Objetivos custoefetividade custo CE C E (C/E (IO vs Saúde Metodologia ano epidemiológica Nefrologia Resultados R 121368 213 68 1.213,6 0032 0 032 0,032 3792750 37 927 50 37.927,5 Estimouse Estimou se 160020228 600 202 28 1.600.202,2 412856565 4 128 565 65 4.128.565,6 epidemiológico estimouse estimou 4859685550 48 596 855 48.596.855,5 629055573 62 90 555 73 62.90.555,73 Conclusão (PTH 12136 21 6 1.213, 003 03 0,03 379275 3 92 37.927, 16002022 60 20 2 1.600.202, 41285656 12 56 4.128.565, 485968555 59 85 48.596.855, 62905557 9 55 7 62.90.555,7 1213 1.213 00 0,0 37927 37.927 1600202 1.600.202 4128565 4.128.565 48596855 8 48.596.855 6290555 62.90.555, 121 1.21 0, 3792 37.92 160020 1.600.20 412856 4.128.56 4859685 48.596.85 629055 62.90.555 1.2 379 37.9 16002 1.600.2 41285 4.128.5 485968 48.596.8 62905 62.90.55 1. 37. 1600 1.600. 4128 4.128. 48596 48.596. 6290 62.90.5 160 1.600 412 4.128 4859 48.596 629 62.90. 16 1.60 41 4.12 485 48.59 62.90 1.6 4.1 48.5 62.9 4. 48. 62.

Abstract Introduction: Hyperparathyroidism (SHPT) secondary to chronic kidney disease (CKD) is characterized by high levels of parathyroid hormone (PTH), hyperplasia of the parathyroid glands and cardiovascular disease. Selective and non-selective and selective vitamin D-receptor activators, calcimimetics, are available in the Brazilian market to reduce PTH levels. Objectives: To develop a cost-effectiveness (C/E) and budgetary impact (BI) analysis of intravenous paricalcitol vs. oral calcitriol for patients on dialysis with SHPT, from the perspective of the Brazilian Public Health Care System (SUS). Methodology: We built a decision-tree model to analyze C/E, which considered the outcome of avoided death and a time horizon of 1 year. As for the BI analysis, two scenarios were considered, one of demand and one of epidemiological approach, based on data from the Brazilian Society of Nephrology. Results: The analysis showed that the C/E ratio was R$ 1,213.68 per year, and an incremental effectiveness of 0.032, referring to avoided death. The incremental C/E ratio was R$37,927.50 per death averted by paricalcitol. It was estimated that the incremental BI with the expansion of paricalcitol use will be between R$1,600,202.28 and R$4,128,565.65 in the first year, considering the main and epidemiological scenarios. At the end of 5 years after the expansion of its use, an incremental BI was estimated between R$ 48,596,855.50 and R$ 62,90,555.73. Conclusion: Intravenous paricalcitol has superior efficacy and similar safety to oral calcitriol, reducing the overall mortality of dialysis patients, although it implies a higher cost. Introduction SHPT (SHPT CKD (CKD PTH, , (PTH) nonselective non Dreceptor D receptor activators calcimimetics Objectives costeffectiveness cost CE C E (C/E (BI vs SUS. SUS . (SUS) Methodology decisiontree decision tree year approach Nephrology Results R 121368 213 68 1,213.6 0032 0 032 0.032 R3792750 37 927 50 R$37,927.5 R160020228 600 202 28 R$1,600,202.2 R412856565 4 128 565 65 R$4,128,565.6 4859685550 48 596 855 48,596,855.5 629055573 62 90 555 73 62,90,555.73 Conclusion (PTH (SUS 12136 21 6 1,213. 003 03 0.03 R379275 3 92 R$37,927. R16002022 60 20 2 R$1,600,202. R41285656 12 56 R$4,128,565. 485968555 59 85 48,596,855. 62905557 9 55 7 62,90,555.7 1213 1,213 00 0.0 R37927 R$37,927 R1600202 R$1,600,202 R4128565 R$4,128,565 48596855 8 48,596,855 6290555 62,90,555. 121 1,21 0. R3792 R$37,92 R160020 R$1,600,20 R412856 R$4,128,56 4859685 48,596,85 629055 62,90,555 1,2 R379 R$37,9 R16002 R$1,600,2 R41285 R$4,128,5 485968 48,596,8 62905 62,90,55 1, R37 R$37, R1600 R$1,600, R4128 R$4,128, 48596 48,596, 6290 62,90,5 R3 R$37 R160 R$1,600 R412 R$4,128 4859 48,596 629 62,90, R$3 R16 R$1,60 R41 R$4,12 485 48,59 62,90 R1 R$1,6 R4 R$4,1 48,5 62,9 R$1, R$4, 48, 62, R$1 R$4

Resumo Introdução: Há vários estudos que comparam os desfechos de pacientes tratados por diálise peritoneal (DP) e hemodiálise (HD), e a maioria é divergente. Métodos: Estudo de coorte que acompanhou pacientes incidentes em DP e HD de modo planejado e não planejado em unidade de diálise do HCFMB de 01/2014 a 01/2019, até o desfecho. Foram coletados dados clínicos e laboratoriais. Comparou-se os grupos DP e HD, óbito e não óbito, por meio do teste qui-quadrado para variáveis categóricas e teste t ou Mann-Whitney para as contínuas. Curva de Kaplan Meier e log-rank test foram utilizados para a sobrevida. A análise multivariada foi realizada por Regressão de Cox. A diferença significante foi de p < 0,05. Resultados: Foram estudados 592 pacientes, 290 tratados por HD e 302 por DP. A média de idade foi de 59,9 ± 16,8, com predomínio de sexo masculino (56,3%), principal doença de base, diabetes (45%). Óbito ocorreu em 29% dos pacientes. Não houve diferença na sobrevida de pacientes tratados por HD e DP. A maior idade (1,018 (IC 95% 1,000-1,037; p=0,046)) foi identificada como fator de risco para o óbito, enquanto a maior quantidade de dias livres de infecção (0,999 (IC 95% 0,999-1,000; p=0,003)), como fator de proteção. Conclusão: A análise reforçou que a sobrevida dos pacientes em HD e DP é semelhante. Foram associados ao óbito a maior idade e o menor tempo livre de infecção. Introdução (DP , (HD) divergente Métodos 012014 01 2014 01/201 012019 2019 01/2019 desfecho laboratoriais Comparouse Comparou se quiquadrado qui quadrado MannWhitney Mann Whitney contínuas logrank log rank Cox 005 0 05 0,05 Resultados 59 29 30 599 9 59, 168 16 8 16,8 56,3%, 563 56,3% 56 3 (56,3%) base 45%. 45 45% . (45%) 1,018 1018 1 018 (1,01 IC 95 1,0001,037 10001037 1,000 1,037 000 037 1,000-1,037 p=0,046 p0046 046 p=0,046) 0,999 0999 999 (0,99 0,9991,000 09991000 0,999-1,000 p=0,003, p0003 p=0,003 003 p=0,003)) proteção Conclusão semelhante (HD 01201 201 01/20 00 0,0 5 2 16, 56,3 (56,3% 4 (45% 1,01 101 (1,0 0001 1,0001,03 1000103 1000 1,00 1037 1,03 03 1,000-1,03 p=0,04 p004 04 0,99 099 99 (0,9 9991 0,9991,00 0999100 0,999-1,00 p000 p=0,00 p=0,003) 0120 20 01/2 0, 56, (56,3 (45 1,0 10 (1, 1,0001,0 100010 100 103 1,000-1,0 p=0,0 p00 0,9 09 (0, 0,9991,0 099910 0,999-1,0 012 01/ (56, (4 1, (1 1,0001, 10001 1,000-1, p=0, p0 (0 0,9991, 09991 0,999-1, (56 ( 1,0001 1,000-1 p=0 0,9991 0,999-1 (5 1,000- p= 0,999-

Abstract Introduction: There are several studies comparing the outcomes of patients treated with peritoneal dialysis (PD) and hemodialysis (HD), and most are divergent. Methods: This is a cohort study that followed patients with incident PD and HD in a planned and unplanned way, in a dialysis unit of the HCFMB from 01/2014 to 01/2019, until the outcome. We collected clinical and laboratory data. The PD and HD groups, death and non-death outcomes, were compared using the chi-square test for categorical variables and t-test, or Mann-Whitney test for continuous variables. Kaplan Meier curve and log-rank test were used for survival. Multivariate analysis was performed using the Cox regression. The significant difference was p < 0.05. Results: We had 592 patients, 290 treated by HD and 302 by PD. The mean age was 59.9 ± 16.8, with a predominance of males (56.3%), the main underlying disease was diabetes (45%); 29% of the patients died. There was no difference in the survival of patients treated by HD and PD. The oldest age (1.018 (95% CI 1.000-1.037; p=0.046)) was identified as a risk factor for death, while the highest number of infection-free days (0.999 (95% CI 0.999-1.000; p=0.003 )) as a protective factor. Conclusion: The analysis reinforced that the survival of patients on HD and PD was similar. Higher age and shorter infection-free time were associated with death. Introduction (PD HD, , (HD) divergent Methods way 012014 01 2014 01/201 012019 2019 01/2019 outcome data groups nondeath non chisquare chi square ttest, ttest t test, t-test MannWhitney Mann Whitney logrank log rank regression 005 0 05 0.05 Results 59 29 30 599 9 59. 168 16 8 16.8 56.3%, 563 56.3% 56 3 (56.3%) 45% 45 (45%) died 1.018 1018 1 018 (1.01 95% 95 (95 1.0001.037 10001037 1.000 1.037 000 037 1.000-1.037 p=0.046 p0046 046 p=0.046) infectionfree infection free 0.999 0999 999 (0.99 0.9991.000 09991000 0.999-1.000 p0003 003 p=0.00 ) Conclusion similar (HD 01201 201 01/20 00 0.0 5 2 16. 56.3 (56.3% 4 (45% 1.01 101 (1.0 (9 0001 1.0001.03 1000103 1000 1.00 1037 1.03 03 1.000-1.03 p=0.04 p004 04 0.99 099 99 (0.9 9991 0.9991.00 0999100 0.999-1.00 p000 p=0.0 0120 20 01/2 0. 56. (56.3 (45 1.0 10 (1. ( 1.0001.0 100010 100 103 1.000-1.0 p00 0.9 09 (0. 0.9991.0 099910 0.999-1.0 p=0. 012 01/ (56. (4 1. (1 1.0001. 10001 1.000-1. p0 (0 0.9991. 09991 0.999-1. p=0 (56 1.0001 1.000-1 0.9991 0.999-1 p= (5 1.000- 0.999-

Resumo Antecedentes: Poucos estudos compararam as complicações infecciosas e mecânicas relacionadas à diálise peritoneal (DP) de início planejado e não planejado. Objetivos: Comparar a incidência e etiologia das complicações mecânicas e infecciosas associadas à DP tanto de início planejado quanto não planejado e avaliar comparativamente a sobrevida da técnica e dos pacientes. Métodos: Estudo de coorte retrospectivo que avaliou pacientes com doença renal crônica em DP não planejada e planejada de 2014 a 2020 quanto às complicações mecânicas e infecciosas e desfechos clínicos óbito ou mudança para hemodiálise. Resultados: Foram avaliados 99 pacientes em DP planejada e 206 em DP não planejada. Foram semelhantes quanto à incidência de Infecção do Orifício de Saída (18,9x17,17%, p=0,71), peritonite (24,27x27,27%, p=0,57) e diferentes quanto aos agentes etiológicos das peritonites, sendo os bacilos Gram-negativos não fermentadores mais frequentes no grupo planejado. Diferiram quanto à complicação mecânica extravasamento e internação, ambas mais frequentes no grupo não planejado (10,68 x 2,02%, p=0,0085 e 35,44 x 17,17%, p=0,0011, respectivamente). Semelhantes quanto à sobrevida dos pacientes e da técnica. À regressão de Cox, associou ao óbito a idade (HR=1,051, IC 95% 1,026-1,07, p=0,0001) e a albumina (HR=0,66, IC 95% 0,501-0,893, p=0,0064), e à peritonite a presença de diabetes (HR=2,016, IC 95% 1,25-3,25, p=0,004). Conclusão: A sobrevida da técnica e dos pacientes foi semelhante nos grupos DP planejada e não planejada, enquanto o extravasamento foi mais frequente no grupo de início não planejado. Associaram-se ao óbito menores valores de albumina e maior idade, e à peritonite, o diabetes. Antecedentes (DP Objetivos Métodos 201 202 hemodiálise Resultados 9 20 18,9x17,17%, 189x1717 18 9x17 17 (18,9x17,17% p=0,71, p071 p p=0,71 , 0 71 p=0,71) 24,27x27,27%, 2427x2727 24 27x27 27 (24,27x27,27% p=0,57 p057 57 peritonites Gramnegativos Gram negativos internação 10,68 1068 10 68 (10,6 2 02 2,02% p00085 0085 p=0,008 3544 35 44 35,4 1717 17,17% p00011 0011 p=0,0011 respectivamente. respectivamente . respectivamente) Cox HR=1,051, HR1051 HR 1 051 (HR=1,051 95 1,0261,07, 1026107 1,026 1,07, 026 07 1,026-1,07 p=0,0001 p00001 0001 HR=0,66, HR066 66 (HR=0,66 0,5010,893, 05010893 0,501 0,893, 501 893 0,501-0,893 p=0,0064, p00064 p=0,0064 0064 p=0,0064) HR=2,016, HR2016 016 (HR=2,016 1,253,25, 125325 1,25 3,25, 25 3 1,25-3,25 p=0,004. p0004 p=0,004 004 p=0,004) Conclusão Associaramse Associaram se 18,9x17,17% 189x171 9x1 (18,9x17,17 p07 p=0,7 7 24,27x27,27% 2427x272 27x2 (24,27x27,27 p=0,5 p05 5 10,6 106 6 (10, 2,02 p0008 008 p=0,00 354 4 35, 171 17,17 p0001 001 p=0,001 HR=1,051 HR105 05 (HR=1,05 0261 1,0261,07 102610 1026 1,02 107 1,07 1,026-1,0 p=0,000 p0000 000 HR=0,66 HR06 (HR=0,6 5010 0,5010,893 0501089 0501 0,50 0893 0,893 50 89 0,501-0,89 p0006 p=0,006 006 HR=2,016 HR201 01 (HR=2,01 253 1,253,25 12532 125 1,2 325 3,25 1,25-3,2 p000 00 18,9x17,17 189x17 9x (18,9x17,1 p0 p=0, 24,27x27,27 2427x27 27x (24,27x27,2 10, (10 2,0 p=0,0 17,1 HR=1,05 HR10 (HR=1,0 1,0261,0 10261 102 1,0 1,026-1, HR=0,6 HR0 (HR=0, 0,5010,89 050108 050 0,5 089 0,89 8 0,501-0,8 HR=2,01 HR20 (HR=2,0 1,253,2 1253 12 1, 32 3,2 1,25-3, p00 18,9x17,1 189x1 (18,9x17, p=0 24,27x27,2 2427x2 (24,27x27, (1 2, 17, HR=1,0 HR1 (HR=1, 1,0261, 1,026-1 HR=0, (HR=0 0,5010,8 05010 0, 08 0,8 0,501-0, HR=2,0 HR2 (HR=2, 1,253, 3, 1,25-3 18,9x17, 189x (18,9x17 p= 24,27x27, 2427x (24,27x27 ( HR=1, (HR=1 1,0261 1,026- HR=0 (HR= 0,5010, 0,501-0 HR=2, (HR=2 1,253 1,25- 18,9x17 (18,9x1 24,27x27 (24,27x2 HR=1 HR= (HR 0,5010 0,501- HR=2 18,9x1 (18,9x 24,27x2 (24,27x 18,9x 24,27x

Abstract Background: Few studies have compared the infectious and mechanical complications seen in planned-start and urgent-start peritoneal dialysis (PD) patients. Objectives: To compare the incidence and etiology of mechanical and infectious complications in patients offered planned- and urgent-start PD and assess potential differences in patient survival and time on PD. Methods: This retrospective cohort study included patients with chronic kidney disease on planned- and urgent-start PD seen from 2014 to 2020 and compared them for mechanical and infectious complications, clinical outcome, death rates, and need to switch to hemodialysis. Results: Ninety-nine patients on planned-start PD and 206 on urgent-start PD were included. Incidence of exit-site infection (18.9 vs. 17.17%, p=0.71) and peritonitis (24.27 vs. 27.27%, p=0.57) were similar between patients, while pathogens causing peritonitis were different, although non-fermenting Gram-negative bacilli were more commonly seen in the planned-start PD group. Leakage as a mechanical complication and hospitalization were more common among patients needing urgent-start PD (10.68 vs. 2.02%, p=0.0085 and 35.44 vs. 17.17%, p=0.0011, respectively). Patient survival was similar between groups. Cox regression found an association between death and age (HR=1.051, 95% CI 1.026-1.07, p=0.0001) and albumin (HR=0.66, 95% CI 0.501-0.893, p=0.0064), and between peritonitis and a diagnosis of diabetes (HR=2.016, 95% CI 1.25-3.25, p=0.004). Conclusion: Patient survival and time on PD were similar between the planned- and urgent-start PD groups, while leakage was more frequently seen in the urgent-start PD group. Death was associated with lower albumin levels and older age, while peritonitis was associated with diabetes. Background plannedstart planned start urgentstart urgent (PD Objectives Methods 201 202 outcome rates hemodialysis Results Ninetynine Ninety nine 20 exitsite exit site 18.9 189 18 9 (18. vs 1717 17 17.17% p=0.71 p071 p 0 71 24.27 2427 24 27 (24.2 2727 27.27% p=0.57 p057 57 different nonfermenting non fermenting Gramnegative Gram negative group 10.68 1068 10 68 (10.6 2 02 2.02% p00085 0085 p=0.008 3544 35 44 35.4 p00011 0011 p=0.0011 respectively. respectively . respectively) groups HR=1.051, HR1051 HR 1 051 (HR=1.051 95 1.0261.07, 1026107 1.026 1.07, 026 07 1.026-1.07 p=0.0001 p00001 0001 HR=0.66, HR066 66 (HR=0.66 0.5010.893, 05010893 0.501 0.893, 501 893 0.501-0.893 p=0.0064, p00064 p=0.0064 , 0064 p=0.0064) HR=2.016, HR2016 016 (HR=2.016 1.253.25, 125325 1.25 3.25, 25 3 1.25-3.25 p=0.004. p0004 p=0.004 004 p=0.004) Conclusion 18. (18 171 17.17 p=0.7 p07 7 24.2 242 (24. 272 27.27 p=0.5 p05 5 10.6 106 6 (10. 2.02 p0008 008 p=0.00 354 4 35. p0001 001 p=0.001 HR=1.051 HR105 05 (HR=1.05 0261 1.0261.07 102610 1026 1.02 107 1.07 1.026-1.0 p=0.000 p0000 000 HR=0.66 HR06 (HR=0.6 5010 0.5010.893 0501089 0501 0.50 0893 0.893 50 89 0.501-0.89 p0006 p=0.006 006 HR=2.016 HR201 01 (HR=2.01 253 1.253.25 12532 125 1.2 325 3.25 1.25-3.2 p000 00 (1 17.1 p=0. p0 24. (24 27.2 10. (10 2.0 p=0.0 HR=1.05 HR10 (HR=1.0 1.0261.0 10261 102 1.0 1.026-1. HR=0.6 HR0 (HR=0. 0.5010.89 050108 050 0.5 089 0.89 8 0.501-0.8 HR=2.01 HR20 (HR=2.0 1.253.2 1253 12 1. 32 3.2 1.25-3. p00 ( 17. p=0 (2 27. 2. HR=1.0 HR1 (HR=1. 1.0261. 1.026-1 HR=0. (HR=0 0.5010.8 05010 0. 08 0.8 0.501-0. HR=2.0 HR2 (HR=2. 1.253. 3. 1.25-3 p= HR=1. (HR=1 1.0261 1.026- HR=0 (HR= 0.5010. 0.501-0 HR=2. (HR=2 1.253 1.25- HR=1 HR= (HR 0.5010 0.501- HR=2

Resumo Fundamento As complicações cardiovasculares da COVID-19 são aspectos importantes da patogênese e do prognóstico da doença. Evidências do papel prognóstico da troponina e da lesão miocárdica em pacientes hospitalizados com COVID-19 na América Latina são ainda escassos. Objetivos Avaliar a lesão miocárdica como preditor independente de mortalidade hospitalar e suporte ventilatório mecânico em pacientes hospitalizados, do registro brasileiro de COVID-19. Métodos Este estudo coorte é um subestudo do registro brasileiro de COVID-19, conduzido em 31 hospitais brasileiros de 17 cidades, de março a setembro de 2020. Os desfechos primários incluíram mortalidade hospitalar e suporte ventilatório mecânico invasivo. Os modelos para os desfechos primários foram estimados por regressão de Poisson com variância robusta, com significância estatística de p<0,05. Resultados Dos 2925 pacientes [idade mediana de 60 anos (48-71), 57,1%], 27,3% apresentaram lesão miocárdica. A proporção de pacientes com comorbidades foi maior nos pacientes com lesão miocárdica [mediana 2 (1-2) vs. 1 (0-20)]. Os pacientes com lesão miocárdica apresentaram maiores valores medianos de peptídeo natriurético cerebral, lactato desidrogenase, creatina fosfoquinase, N-terminal do pró-peptídeo natriurético tipo B e proteína C reativa em comparação a pacientes sem lesão miocárdica. Como fatores independentes, proteína C reativa e contagem de plaquetas foram relacionados com o risco de morte, e neutrófilos e contagem de plaquetas foram relacionados ao risco de suporte ventilatório mecânico invasivo. Os pacientes com níveis elevados de troponina apresentaram um maior risco de morte (RR 2,03, IC95% 1,60-2,58) e suporte ventilatório mecânico (RR 1,87;IC95% 1,57-2,23), em comparação àqueles com níveis de troponina normais. Conclusão Lesão cardíaca foi um preditor independente de mortalidade hospitalar e necessidade de suporte ventilatório mecânico em pacientes hospitalizados com COVID-19. COVID19 COVID 19 COVID-1 doença escassos COVID19. 19. COVID19, 19, 3 cidades 2020 invasivo robusta p005 p 0 05 p<0,05 292 idade 6 4871, 4871 48 71 , (48-71) 57,1%, 571 57,1% 57 57,1%] 273 27 27,3 12 (1-2 vs 020. 020 20 . (0-20)] cerebral desidrogenase fosfoquinase Nterminal N terminal própeptídeo pró independentes RR 203 03 2,03 IC95 IC 1,602,58 160258 1,60 2,58 58 1,60-2,58 1,87IC95% 187IC95 1,87 87 1,87;IC95 1,572,23, 157223 1,57 2,23 23 1,57-2,23) normais COVID1 COVID- 202 p00 p<0,0 29 487 4 7 (48-71 57,1 5 27, (1- 02 (0-20) 2,0 IC9 602 1,602,5 16025 160 1,6 258 2,5 1,60-2,5 87IC95 1,87IC95 187IC9 187 1,8 8 1,87;IC9 572 1,572,23 15722 157 1,5 223 2,2 1,57-2,23 p0 p<0, (48-7 57, (1 (0-20 2, 1,602, 1602 16 1, 25 1,60-2, 87IC9 1,87IC9 187IC 18 1,87;IC 1,572,2 1572 15 22 1,57-2,2 p<0 (48- ( (0-2 1,602 1,60-2 87IC 1,87IC 1,572, 1,57-2, p< (48 (0- 1,60- 1,572 1,57-2 (4 (0 1,57-

Abstract Background Cardiovascular complications of COVID-19 are important aspects of the disease’s pathogenesis and prognosis. Evidence on the prognostic role of troponin and myocardial injury in Latin American hospitalized COVID-19 patients is still scarce. Objectives To evaluate myocardial injury as independent predictor of in-hospital mortality and invasive mechanical ventilation support in hospitalized patients, from the Brazilian COVID-19 Registry. Methods This cohort study is a substudy of the Brazilian COVID-19 Registry, conducted in 31 Brazilian hospitals of 17 cities, March-September 2020. Primary outcomes included in-hospital mortality and invasive mechanical ventilation support. Models for the primary outcomes were estimated by Poisson regression with robust variance, with statistical significance of p<0.05. Results Of 2,925 patients (median age of 60 years [48-71], 57.1% men), 27.3% presented myocardial injury. The proportion of patients with comorbidities was higher among patients with cardiac injury (median 2 [1-2] vs. 1 [0-2]). Patients with myocardial injury had higher median levels of brain natriuretic peptide, lactate dehydrogenase, creatine phosphokinase, N-terminal pro-brain natriuretic peptide, and C-reactive protein than patients without myocardial injury. As independent predictors, C-reactive protein and platelet counts were related to the risk of death, and neutrophils and platelet counts were related to the risk of invasive mechanical ventilation support. Patients with high troponin levels presented a higher risk of death (RR 2.03, 95% CI 1.60-2.58) and invasive mechanical ventilation support (RR 1.87, 95% CI 1.57-2.23), when compared to those with normal troponin levels. Conclusion Cardiac injury was an independent predictor of in-hospital mortality and the need for invasive mechanical ventilation support in hospitalized COVID-19 patients. COVID19 COVID 19 COVID-1 diseases disease s prognosis scarce inhospital hospital Registry 3 cities MarchSeptember March September 2020 variance p005 p 0 05 p<0.05 2925 925 2,92 6 4871, 4871 48 71 , [48-71] 571 57 57.1 men, men men) 273 27 27.3 12 [1-2 vs 02. 02 . [0-2]) peptide dehydrogenase phosphokinase Nterminal N terminal probrain pro Creactive C reactive predictors RR 203 03 2.03 95 1.602.58 160258 1.60 2.58 58 1.60-2.58 187 87 1.87 1.572.23, 157223 1.57 2.23 23 1.57-2.23) COVID1 COVID- 202 p00 p<0.0 292 92 2,9 487 4 7 [48-71 5 57. 27. [1- [0-2] 20 2.0 9 602 1.602.5 16025 160 1.6 258 2.5 1.60-2.5 18 8 1.8 572 1.572.23 15722 157 1.5 223 2.2 1.57-2.23 p0 p<0. 29 2, [48-7 [1 [0-2 2. 1.602. 1602 16 1. 25 1.60-2. 1.572.2 1572 15 22 1.57-2.2 p<0 [48- [ [0- 1.602 1.60-2 1.572. 1.57-2. p< [48 [0 1.60- 1.572 1.57-2 [4 1.57-

RESUMEN: Se presenta el caso de un hombre de 58 años de edad, sin antecedentes de importancia para la presencia de hepatopatía, quien presentó distensión abdominal progresiva que no respondió al manejo a base de diuréticos, diagnosticado incidentalmente a través de estudios de imagen con un quiste mesentérico gigante, el cual constituye un tumor raro, con pocos reportes de caso en la literatura, según lo referido es más frecuente en el sexo femenino, su etiología aun es desconocida, su diagnóstico generalmente se realiza a través de estudios de imagen y el tratamiento consiste en la escisión quirúrgica completa ya que su drenaje constituye un medio ineficaz por el alto riesgo de recurrencia.

ABSTRACT: We present the case of a 58-year-old man, with no history of significant hepatopathy, who presented progressive abdominal distension that did not respond to diuretics, diagnosed incidentally through imaging studies with a giant mesenteric cyst, which is a rare tumor, Its etiology is still unknown, its diagnosis is generally made through imaging studies and the treatment consists of complete surgical excision since its drainage is an ineffective means due to the high risk of recurrence.

RESUMO: Apresentamos o caso de um homem de 58 anos, sem historial de hepatopatia significativa, que apresentava uma distensão abdominal progressiva que não respondia a uma gestão baseada em diuréticos, diagnosticada incidentalmente através de estudos de imagem com um cisto mesentérico gigante, que é um tumor raro, A sua etiologia é ainda desconhecida, o seu diagnóstico é geralmente feito através de estudos de imagem e o tratamento consiste na excisão cirúrgica completa, uma vez que a drenagem é um meio ineficaz devido ao elevado risco de recidiva.

Abstract Background Hydroxyethyl starches are colloids used in fluid therapy that may reduce volume infusion compared with crystalloids, but they can affect renal function in critical care patients. This study aims to assess renal effects of starches using renal biomarkers in the perioperative setting. Methods This prospective, controlled, randomized study compared Hydroxyethyl starch 6% (HES) with Ringer's lactate (RL) in hysterectomy. Each episode of mean arterial pressure (MAP) below 60 mmHg guided the fluid replacement protocol. The RL group received 300 mL bolus of RL solution while the HES group received 150 mL of HES solution. All patients received RL (2 mL.kg−1.h−1) intraoperatively to replace insensible losses. Blood and urine samples were collected at three time points (preoperatively, 24 hours, and 40 days postoperatively) to assess urinary NGAL and KIM-1, as primary outcome, and other markers of renal function. Results Seventy patients were randomized and 60 completed the study. The RL group received a higher crystalloid volume (1,277 ± 812.7 mL vs. 630.4 ± 310.2 mL; p= 0.0002) with a higher fluid balance (780 ± 720 mL vs. 430 ± 440 mL; p= 0.03) and fluid overload (11.7% ± 10.4% vs. 7.0% ± 6.3%; p= 0.04) compared to the HES group. NGAL and KIM-1 did not differ between groups at each time point, however both biomarkers increased 24 hours postoperatively and returned to preoperative levels after 40 days in both groups. Conclusion HES did not increase renal biomarkers following open hysterectomy compared to RL. Moreover, HES provided better hemodynamic parameters using less volume, and reduced postoperative fluid balance and fluid overload.

ABSTRACT. The sewage contains toxic chemical compounds that secondary treatment plants do not eliminate, and chlorine is usually added for disinfection before discharge. Chlorine reacts with sewage compounds forming other toxic compounds. The objective of this study was to evaluate the toxicity of treated sewage from a secondary treatment plant using Danio rerio embryos. Three types of treated sewage were tested, one disinfected with chlorine gas (dCl2), another with sodium hypochlorite (dClO), and the plant discharge, which is a mixture of the two sewage disinfection methods (mCl) with a proportion of 70% of dCl2 and 30% of dClO. To estimate the median lethal dilution treated sewage was diluted with dechlorinated tap water at 20, 40, 60, and 80%. Two additional points were made with pure treated sewage and pure dechlorinated tap water. Embryos were exposed 1 h after fertilization (hpf) to 144 hpf. The dCl2 and the mCl were lethal at 60 and 72 hpf, respectively, while the dClO did not show lethality. The embryos exposed to the mCl showed heart failure and slower blood circulation. Those exposed to dCl2 showed teratogenic effects such as pericardial edema and spinal curvature, while those exposed to dClO presented malformations such as incomplete eye development and otolith formation absence.

Resumo O Departamento de Injúria Renal Aguda (IRA) da Sociedade Brasileira de Nefrologia elaborou o presente documento para fins de padronização da terminologia em IRA e modalidades dialíticas na língua portuguesa para o Brasil. Diversos termos com significados semelhantes têm sido empregados em IRA e suas modalidades dialíticas, causando confusão e disparidades entre pacientes, nefrologistas, instituições de saúde, empresas privadas de assistência, seguradoras e entidades governamentais. Essas disparidades podem impactar a assistência médica, a organização e o atendimento hospitalares, assim como o financiamento e reembolso dos procedimentos relacionados com a IRA. Assim, nomenclatura e definições consensuais foram elaboradas, incluindo-se as definições de IRA, doença renal aguda (DRA) e doença renal crônica (DRC). Adicionalmente, todas as modalidades dialíticas e os procedimentos extracorpóreos relacionados a IRA, atualmente aprovados e disponíveis no país, foram abordados. A Sociedade Brasileira de Nefrologia espera que este Consenso possa padronizar a nomenclatura e prover suporte técnico para todos os atores envolvidos na assistência à IRA no Brasil.

Abstract The Department of Acute Kidney Injury (IRA) of the Brazilian Society of Nephrology prepared this document for the purpose of standardizing AKI terminology and dialysis modalities in the Portuguese language for Brazil. Several terms with similar meanings have been used in AKI and its dialysis modalities, causing confusion and disparities among patients, nephrologists, health institutions, private care companies, insurance companies and government entities. These disparities can impact medical care, hospital organization and care, as well as the funding and reimbursement of AKI-related procedures. Thus, consensual nomenclature and definitions were developed, including the definitions of AKI, acute kidney disease (AKD) and chronic kidney disease (CKD). Additionally, we addressed all dialysis modalities and extracorporeal procedures related to AKI, currently approved and available in the country. The Brazilian Society of Nephrology hopes that this Consensus can standardize the terminology and provide technical support to all involved in AKI care in Brazil.