ABSTRACT. To diagnose and monitor the nutritional status of commercial crops, reference standards must be established based on chemical analyses of soils and leaf tissues. Therefore, the objective of this study was to establish sufficiency ranges, DRIS standards and leaf nutritional diagnoses for palisade grass pastures in the rainy and dry seasons. Of a total of 105 sampled pastures, the 20 highest-yielding areas were used to establish reference standards. In the other, low-productivity pastures, the nutritional status was diagnosed in both the rainy and dry seasons for nitrogen (N), phosphorus (P), potassium (K), calcium (Ca), magnesium (Mg), sulfur (S), boron (B), copper (Cu), iron (Fe), nickel (Ni), molybdenum (Mo), and zinc (Zn). A productivity of 15 tons ha-1 year-1 was determined as the threshold to separate high-yielding (> 15 tons ha-1 year-1) pastures from low-productivity pastures (< 15 tons ha-1 year-1). Sufficiency ranges and foliar DRIS standards were established for palisade grass pastures in the rainy and dry seasons, which resulted in the recommendation of region- and season-specific sufficiency ranges and DRIS leaf standards. In the rainy season, in more than 50% of the evaluated pastures, nutritional deficiencies in all nutrients except K, B and Zn were observed, while in the dry season, only N, P, Cu, and Mn were deficient.

RESUMO CONTEXTO: A lesão renal aguda (LRA) é uma complicação comum e grave na cirrose. OBJETIVO: Avaliar o impacto dos estágios da LRA na mortalidade em 30 dias de pacientes com cirrose. MÉTODOS: Realizou-se um estudo de coorte retrospectivo com pacientes com cirrose hospitalizados. LRA foi diagnosticada de acordo com as recomendações do International Club of Ascites e o estadiamento foi feito de acordo com as recomendações da European Association for the Study of the Liver. Comparações entre os grupos foram feitas por análise de variância unidirecional e teste de Tukey. O teste do qui-quadrado foi calculado para variáveis categóricas. Comparações quanto à lesão renal entre os pacientes foram realizadas com estatísticas de Kaplan-Meier, e diferenças entre os grupos foram analisadas pelo teste de log-rank. Um P-valor <0,05 foi considerado estatisticamente significativo. RESULTADOS: Duzentos e trinta e dois pacientes foram incluídos no estudo. O diagnóstico de LRA foi realizado em 98 (42,2%) deles. A mortalidade geral em 30 dias foi de 19,8% (46/232). A mortalidade aumentou de acordo com a progressão dos estágios de LRA. Entre pacientes sem LRA, a mortalidade foi de 5,2% (7/134). Quando comparados aos pacientes sem LRA, pacientes diagnosticados com LRA estágio 1a tiveram mortalidade de 12,1% (4/33, P=0,152); pacientes com LRA estágio 1b tiveram mortalidade de 45% (18/40, P<0,001); e pacientes com LRA estágios 2 ou 3 tiveram mortalidade de 68% (17/25, P<0,001). Além disso, é importante ressaltar que a resposta completa ao tratamento associou-se à menor mortalidade quando comparada à ausência de recuperação completa da função renal (14,3% vs 57,9%, P<0,001). CONCLUSÃO: LRA estágios 1b ou superior, mas não estágio 1a, estão associadas à maior mortalidade em 30 dias de pacientes com cirrose.

ABSTRACT BACKGROUND: Acute kidney injury (AKI) is a common and severe complication of cirrhosis. OBJECTIVE: To evaluate the impact of AKI staging on 30-day mortality of patients with cirrhosis. METHODS: We performed a retrospective cohort study of hospitalized patients with cirrhosis. Acute kidney injury (AKI) was diagnosed according to the International Club of Ascites recommendations and staged according to the European Association for the Study of the Liver guidelines. Comparisons between groups were made by one-way analysis of variance and Tukey test. Chi-square was calculated for dichotomous variables. Comparisons of renal impairment status among patients were performed using Kaplan-Meier statistics and differences between groups were analyzed using the log-rank test. A P-value <0.05 was considered to be statistically significant. RESULTS: Two hundred and thirty-two patients were included in the study. The diagnosis of AKI was performed in 98 (42.2%) of them. The overall 30-day mortality was 19.8% (46/232). Mortality increased as the degree of AKI progressed. Among patients who did not have AKI, mortality was 5.2% (7/134). When compared to patients without AKI, patients diagnosed with AKI stage 1a had mortality of 12.1% (4/33, P=0.152); patients with AKI stage 1b had mortality of 45% (18/40, P<0.001); and patients with AKI stages 2 or 3 had mortality of 68% (17/25, P<0.001). Moreover, it is noteworthy that full response to treatment was associated to a decreased mortality when compared to patients who did not show complete recovery of renal function (14.3% vs 57.9%, P<0.001). CONCLUSION: AKI stages 1b or greater, but not AKI stage 1a, are associated to higher 30-day mortality of patients with cirrhosis.

ABSTRACT INTRODUCTION Cuba’s HIV epidemic is characterized by high genetic diversity, with circulation of several subtypes and recombinant forms. Earlier studies described a predominance of subtype B in the HIV-positive population, but these studies did not take into account patients’ epidemiologic history. OBJECTIVE Clarify the origin and phylodynamics of HIV-1 subtype B in the Cuban epidemic. METHODS We analysed phylogenetic relationships among 120 sequences (from different geographic origins) of the pol gene in HIV-1 subtype B isolates from Cuban patients diagnosed from 1987 through 2012. Time of HIV-1 subtype B introduction and viral evolutionary rate were determined using a Bayesian coalescent method. RESULTS Based on phylogenetic relationships, subtype B was introduced into Cuba multiple times. Subtype B spread in Cuba through dissemination of strains that probably came from the USA, Canada and Europe. The time of the most recent common ancestor of Cuban subtype B was close to 1977 (95% CI 1974–1982), and the evolutionary rate was 2.7 × 10-3 nucleotide substitutions per site per year. CONCLUSIONS Our results suggest multiple introductions of HIV-1B into Cuba in the late 1970s, predominantly strains from North America and Europe. The results reflect the importance of maintaining, reviewing and updating molecular epidemiology of HIV-1 in Cuba, due to its rapid evolution and possible implications for the National STI/HIV/AIDS Program of Cuba’s Ministry of Public Health.

SUMMARY Neisseria meningitidis is a cause of several life-threatening diseases and can be a normal commensal in the upper respiratory tract of healthy carriers. The carrier rate is not well established especially because there is no standard method for the isolation of N. meningitidis. Therefore, the aim of this study was to compare identification methods for the carrier state. Two swabs were collected from 190 volunteers: one was cultured and the other had DNA extracted directly from the sample. The Polymerase Chain Reaction (PCR) was performed to determine species and serogroups and compared the results between the methods. PCR for species determination used two pairs of primers and when there was only one amplicon, it was sequenced. The culture technique was positive in 23 (12.1%) subjects while the direct extraction method was positive in 132 (69.5%), p < 0.001. Among the 135 subjects with positive N. meningitides tests, 88 (65.2%) were serogroup C; 3 (2.2%) serogroup B; 5 (3.7%) were positive for both serogroup B and C, and 39 (28.9%) did not belong to any of the tested serogroups. In this study, PCR from DNA extracted directly from swabs identified more N. meningitidis asymptomatic carriers than the culture technique.

RESUMO OBJETIVO: Estudar o efeito de dois fluidos de manutenção intravenosos sobre o sódio (Na) plasmático e o equilíbrio ácido-base em pacientes de terapia intensiva pediátrica durante as primeiras 24 horas de internação. MÉTODOS: Foi feito um estudo controlado randomizado prospectivo. Alocamos aleatoriamente 233 pacientes para os grupos: (A) NaCl a 0,9% e (B) NaCl a 0,45%. Os pacientes com um dia a 18 anos apresentavam concentrações normais de eletrólitos e sofriam de insulto agudo (médico/cirúrgico). Principal resultado: variação no sódio plasmático. Testes paramétricos: teste t, Anova, qui-quadrado. O nível de relevância estatística foi estabelecido em a = 0,05. RESULTADOS: Grupo A (n = 130): o Na sérico aumentou 2,91 (± 3,9) mmol L-1 em 24 h (p < 0,01); 2% dos pacientes apresentaram Na acima de 150 mmol L-1. Concentração média de Na na urina: 106,6 (± 56,8) mmol L-1. Sem alteração no pH em 0 e 24 horas. Grupo B (n = 103): o Na sérico não apresentou alterações estatisticamente significativas; 15% dos pacientes apresentaram Na < 135 mmol L-1 em 24 h. Os dois fluidos tiveram efeitos diferentes sobre as situações respiratória e pós-operatória. CONCLUSÃO: O uso de solução fisiológica a 0,9% foi associado à menor incidência de distúrbios eletrolíticos.

ABSTRACT OBJECTIVES: To study the effect of two intravenous maintenance fluids on plasma sodium (Na), and acid-base balance in pediatric intensive care patients during the first 24 h of hospitalization. METHODS: A prospective randomized controlled study was performed, which allocated 233 patients to groups: (A) NaCl 0.9% or (B) NaCl 0.45%. Patients were aged 1 day to 18 years, had normal electrolyte concentrations, and suffered an acute insult (medical/surgical). Main outcome measured: change in plasma sodium. Parametric tests: t-tests, ANOVA, X 2 statistical significance level was set at a = 0.05. RESULTS: Group A (n = 130): serum Na increased by 2.91 (±3.9) mmol/L at 24 h (p < 0.01); 2% patients had Na higher than 150 mmol/L. Mean urinary Na: 106.6 (±56.8) mmol/L. No change in pH at 0 and 24 h. Group B (n = 103): serum Na did not display statistically significant changes. Fifteen percent of the patients had Na < 135 mmol/L at 24 h. The two fluids had different effects on respiratory and post-operative situations. CONCLUSIONS: The use of saline 0.9% was associated with a lower incidence of electrolyte disturbances.

Introduction: the use of antiretroviral therapy has facilitated the slow and partial recovery of the immune system, allowing to reduce opportunistic complications, to increase survival and to improve quality of life in patients infected with human immunodeficiency virus type 1. Objective: to determine rapid evolving viral variants with resistance to antiretroviral drugs in HIV-1 positive patients. Methods: two HIV-1 positive patients were studied. They were appointed by the letters A and B, respectively, and antiretroviral drug resistance were determined at two different times: Moment of diagnosis and 2012. Results were related to clinical variables. Results: at the time of diagnosis Patient A had subtype BG virus with low levels of resistance to zidovudine and stavudine. Patient B had subtype B virus with low levels of resistance to zidovudine. In 2012, the patient A showed FRC18-cpx viral variant with high levels of resistance to lamivudine, emtricitabine, and nevirapine. Patient B remained infected with subtype B virus, but resistant to the reverse transcriptase inhibitors. Conclusions: these results show the dynamic and rapidly evolving variants of HIV-1 infected patients.

Introducción: el empleo de la terapia antirretroviral ha facilitado la recuperación lenta y parcial del sistema inmune, lo que permite reducir las complicaciones oportunistas, incrementar la supervivencia y mejorar la calidad de vida en pacientes infectados por el virus de inmunodeficiencia humana tipo 1. Objetivo: determinar las variantes virales de evolución rápida a la resistencia a drogas antirretrovirales en pacientes positivos a VIH-1. Métodos: se estudiaron 2 pacientes positivos a VIH-1; se nombraron con las letras A y B, respectivamente, y se les determinó la resistencia a drogas antirretrovirales en 2 tiempos diferentes: momento del diagnóstico y 2012. Los resultados se relacionaron con variables clínicas. Resultados: el paciente A, en el momento del diagnóstico, presentó un virus subtipo BG con niveles bajos de resistencia a zidovudina y estavudina y el B, virus subtipo B, con bajos niveles de resistencia a zidovudina. En el año 2012, el paciente A mostró una variante viral FRC18_cpx con altos niveles de resistencia a lamivudina, emtricitabina y nevirapina. El paciente B se mantuvo infectado con un virus subtipo B, pero resistente a los inhibidores de la transcriptasa inversa. Conclusiones: estos resultados muestran la dinámica y rápida evolución de las variantes de VIH-1 en pacientes infectados.

Development of immunity to hepatitis B virus in cirrhotic patients waiting for liver transplantation is highly desirable. Though a double-dose regimen is available, little is know about its effectiveness. We examined the efficacy of double-dose hepatitis B virus vaccination in cirrhotic patients waiting for liver transplantation. We studied 43 patients who were waiting for liver transplantation. They were vaccinated with three doses of 40 mg hepatitis B vaccine at 0, 1 and 6 months; the normal dose is 20 mg. Efficacy was measured based on seroconversion of anti-HBs. Global response to the primary vaccination scheme was 67.5% (29 patients). Forty-one per cent of responders had anti-HBs titers above 1,000 IU/mL. No factors were associated with response, based on multivariate analysis. The vaccination scheme of 40 mg at 0, 1 and 6 months was superior to conventional vaccination doses (20 mg) for cirrhotic patients on a waiting list for liver transplantation.

O objetivo deste trabalho foi avaliar a associação dos polimorfismos dos genes bGH, IGF-1 e PIT-1 com características de peso e ganho de peso numa população F2 de bovinos (Gir x Holandês), pela técnica de PCR-RFLP. As freqüências alélicas A e B, do gene PIT-1, e dos genótipos AA, AB e BB, nas populações parentais foram semelhantes entre si, mas diferentes das freqüências nas populações cruzadas F1 e F2, para esse gene. Quanto ao gene bGH, os animais da raça Holandesa apresentaram freqüência de 100% para o alelo E e os animais da raça Gir, 92% para o alelo F, resultando em alta freqüência de indivíduos heterozigotos nas populações F1 e F2. Quanto ao gene IGF-1, todos os animais da raça Holandesa eram heterozigotos (AB) e, nos animais Gir, a maioria dos indivíduos foi de homozigotos (AA), o que resultou em alta freqüência do alelo A nas populações F1 e F2. Foram encontradas associações significativas do alelo A do gene PIT-1 com as características de peso aos 60, 205, 365 dias e ganho de peso do nascimento aos 60 dias. Em bGH, observou-se efeito significativo do alelo E para peso aos 365 dias e ganho de peso do nascimento aos 60 dias, enquanto o efeito do alelo A do IGF-1 foi significativo somente para peso ao nascimento. Os alelos identificados podem ser usados como marcadores no melhoramento animal.

The objective of this work was to evaluate the association between polymorphisms of bGH, IGF-1 and PIT-1 genes with weight and weight gain traits in a bovine F2 population derived from Holstein x Gyr crosses, using the PCR-RFLP technique. Allelic frequencies A and B of PIT-1 gene and AA, AB, and BB genotypes were similar between parental populations but different from F1 and F2 crossed populations. For the bGH gene, Holstein animals showed allelic frequency of 100% for E allele, while Gyr animals showed allelic frequency of 92% for F allele, resulting in high frequency of heterozygous animals in F1 and F2 populations. For the IGF-1 gene, all Holstein were heterozygous (AB) and most Gyr were homozygous (AA), resulting in a high frequency of A allele in F1 and F2 populations. Significant associations were found between PIT-1 allele A with traits weight at 60, 205 and 365 days and weight gain from birth to 60 days. For IGF-1, significant association was found between A allele and birth weight. For bGH gene, significant associations were found between E allele and 365 days weight and weight gain from birth to 60 days. The selected alleles could be used as markers in animal breeding for these traits.