Low serum potassium levels increase the infectious-caused mortality in peritoneal dialysis patients: a propensity-matched score study

Background and ObjectivesHypokalemia has been consistently associated with high mortality rate in peritoneal dialysis. However, studies investigating if hypokalemia is acting as a surrogate marker of comorbidities or has a direct effect in the risk for mortality have not been studied. Thus, the aim of this study was to analyze the effect of hypokalemia on overall and cause-specific mortality.Design, Setting, Participants and MeasurementsThis is an analysis of BRAZPD II, a nationwide prospective cohort study. All patients on PD for longer than 90 days with measured serum potassium levels were used to verify the association of hypokalemia with overall and cause-specific mortality using a propensity match score to reduce selection bias. In addition, competing risks were also taken into account for the analysis of cause-specific mortality.ResultsThere was a U-shaped relationship between time-averaged serum potassium and all-cause mortality of PD patients. Cardiovascular disease was the main cause of death in the normokalemic group with 133 events (41.8%) followed by PD-non related infections, n=105 (33.0%). Hypokalemia was associated with a 49% increased risk for CV mortality after adjustments for covariates and the presence of competing risks (SHR 1.49; CI95% 1.01-2.21). In contrast, in the group of patients with K < 3.5mEq/L, PD-non related infections were the main cause of death with 43 events (44.3%) followed by cardiovascular disease (n=36; 37.1%). For PD-non related infections the SHR was 2.19 (CI95% 1.52-3.14) while for peritonitis was SHR 1.09 (CI95% 0.47-2.49).ConclusionsHypokalemia had a significant impact on overall, cardiovascular and infectious mortality even after adjustments for competing risks. The causative nature of this association suggested by our study raises the need for intervention studies looking at the effect of potassium supplementation on clinical outcomes of PD patients.

Are metabolic syndrome and its components associated with 5-year mortality in chronic obstructive pupmonary disease patients?

The aim of this study was to evaluate the risk of mortality according to the presence of metabolic syndrome in chronic obstructive pulmonary disease (COPD) patients who were followed for 5 years. We did not establish the influence of metabolic syndrome on mortality rate. However, an increase of 100 mg of triglycerides was associated with a 39% increase in the probability of death in the period of the study (hazard ratio 1.39, 95% confidence interval 1.06-1.83).

Mortality dynamics of spodoptera frugiperda (lepidoptera: noctuidae) immatures in maize

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Associations of vitamin D deficiency with postoperative gait and mortality among patients with fractures of the proximal femur

To assess whether serum vitamin D concentration is associated with gait status and mortality among patients with fractures of the proximal femur, six months after suffering the fracture. Consecutive patients aged ≥65 years with fractures of the proximal femur, who were admitted to the orthopedics and traumatology ward of our service between January and December 2011, were prospectively evaluated. Clinical, radiological, epidemiological and laboratory analyses were performed, including vitamin D. The patients underwent surgery and were followed up as outpatients, with return visits 15, 30, 60 and 180 days after discharge, at which the outcomes of gait and mortality were evaluated. Eighty-eight patients were evaluated. Two of them were excluded because they presented oncological fractures. Thus, 86 patients of mean age 80.2 ± 7.3 years were studied. In relation to serum vitamin D, the mean was 27.8 ± 14.5 ng/mL, and 33.7% of the patients presented deficiency of this vitamin. In relation to gait, univariate and multivariate logistic regression showed that vitamin D deficiency was not associated with gait recovery, even after adjustment for gender, age and type of fracture (OR: 1.463; 95% CI: 0.524-4.088; p = 0.469). Regarding mortality, Cox regression analysis showed that vitamin D deficiency was not related to its occurrence within six months, even in multivariate analysis (HR: 0.627; 95% CI: 0.180-2.191; p = 0.465). Serum vitamin D concentration was not related to gait status and/or mortality among patients with fractures of the proximal femur, six months after suffering the fracture.

Intrauterine growth restricted rats exercised before and during pregnancy: maternal and perinatal repercussions

This study aimed at evaluating the effect of swimming before and during pregnancy on rats born with intrauterine growth restriction (IUGR) and their offspring. For this, nondiabetic and streptozotocin-induced severely diabetic (SD) pregnant rats were mated and generated offspring with appropriate (control, C) and small (IUGR) for pregnancy age, respectively. Following that, C and IUGR groups were further distributed into nonexercised control (C), exercised control (Cex), nonexercised IUGR (IUGR), and exercised IUGR (IUGRex). IUGR rats presented lower mating rate than control rats. Regardless of physical exercise IUGR rats presented decreased body weight from birth to lactation. At 90 days of life, IUGR rats presented glucose intolerance. Maternal organ weights were increased and relative adiposity of IUGRex rats was lower than Cex. IUGR and IUGRex offspring presented reduced body weight than C and Cex, respectively. IUGRex dams presented an increased rate of appropriate for pregnancy age newborns. IUGEex male and female offspring relative brain weight was increased compared with Cex. Therefore, swimming before and during pregnancy prevented glucose intolerance, reduced general adiposity, and increased maternal and offspring organ weight in rats, showing the benefit of physical exercise for IUGR rats.

Perinatal exposure to androgen excess and the effects on the rat uterine estradiol responsiveness

Androgen exposure during sexual development induces alterations in steroidal target tissues. The objective of this study was to evaluate the uterine responsiveness to estradiol after perinatal androgenization. Pregnant Wistar rats were exposed to corn oil or testosterone propionate at 0.05, 0.1, or 0.2 mg/kg from gestational day 12 until postnatal day 21. Female offspring was challenged with estradiol (E2 ) after weaning (0.4 mg/kg) and at adulthood (10 or 100 µg/day), when the pituitary response was also evaluated. At adulthood, control and 0.05 mg/kg groups presented a uterine weight increment when exposed to 100 µg/day of E2 , 0.1 mg/kg group only responded to 10 µg/day of E2 , and the 0.2 mg/kg group showed increased uterine weight at both doses. The pituitary weight was similarly increased after estradiol stimulation in all experimental groups. In conclusion, testosterone propionate exposure induced an abnormal stimulation of uterine tissue growth by estrogen stimulus without affecting pituitary response. More studies are needed to clarify whether these alterations are capable of impairing the reproductive capacity of the female tract. © 2015 Wiley Periodicals, Inc. Environ Toxicol, 2015.

Fatores maternos associados à realização de cesárea eletiva e resultado perinatal segundo tipo de parto: estudo populacional desenvolvido em município de médio porte do interior paulista

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Maturidade pulmonar e fetal de bezerros da raça holandesa preta e branca tecém-nascidos, a termo e hígidos: análise do líquido amniótico

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

A sífilis na gestação e sua influência na morbimortalidade materno-infantil

Syphilis in pregnancy is a public health problem, responsible for the high intrauterine mortality rates. This article aims to present a review of historical and epidemiological aspects, clinical manifestations, diagnosis, the treatment of maternal and congenital syphilis, and its perinatal repercussions. The manuscript also describes the Brazilian main policies in public health care for pregnant women with syphilis and for congenital syphilis eradication. The set of words used were “congenital syphilis”, “syphilis in pregnancy” and “syphilis prenatal care”. The databases searched were PubMed (National Library of Medicine - USA), SciELO (Scientific Electronic Library Online), LILACS (Latin American and Caribbean Health Sciences), PAHO (Pan American Health Organization), IBECS, and WHOLIS Cochrane Library, from 1980 to 2011. Fifty-six articles were included in this review, 18 institutional technical manuals, two textbooks and 36 articles relating to maternal and congenital syphilis. The present review showed that there is a gap between intention and action needed to control and eradicate the disease especially with regard to the expansion of access, not only in relation to the number of visits recommended male gender, it is important to assess the quality of their content as well as the actions to be carried out between appointments.

Fatores de risco relacionados à pré-eclâmpsia

Introduction: Preeclampsia is a major cause of maternal and perinatal morbidity and mortality in Brazil and worldwide. It is a heterogeneous disorder, multifactorial, with no clear etiology and pathophysiology. The identification of risk factors for its development can assist in prevention and early diagnosis of the clinical onset of the disease Objective: To identify risk factors related to the development of preeclampsia aimed at identifying pregnant women at risk for early disease and to offer specialized treatment to them Methodology: A bibliographic survey of scientific articles indexed in the following databases: CAPES (Ovid external Link), Scientific Eletronic Library Online (SciELO), Latin American and Caribbean Health Sciences Literature (LILACS), and Medical Literature Analysis and Retrieval System Online (Medline) of the National Library of Medicine over the last tem years (2001-2011) was carried out with the addition of certain classic and priority references.

Growth and mortality parameters of Paranchurus brasiliensis (Scianidae) captured as bycatch in southeastern of Brazil

The present work provides preliminary informations on the growth and mortality of Paralonchurus brasiliensis captured as a bycatch in the inner shelf of São Paulo Southeastern Brazil. The samplings were carried out using a shrimp fishery trawl. After trawling, the specimens were separated from the other organisms and the fish size and numbers of individuals captured were recorded. A total of 5,943 specimens ranging from 3.6 to 19.9 cm in standard length were sampled.

Doppervelocimetria da artéria oftálmica em gestantes pré-eclâmpticas com recém-nascidos portadores de restrição de crescimento

Pós-graduação em Ginecologia, Obstetrícia e Mastologia - FMB