Dyadic Relationship and Quality of Life Patients with Chronic Kidney Disease

AbstractIintroduction:Chronic Renal insufficiency (CRI) and dialysis treatment lead to a succession of situations for kidney chronic patient, which compromises his aspect, not only physically, and psychologically, with personal, family and social repercussions.Objective:(1) to verify the existence of differences of dyadic adjustment (DA) according to renal replacement treatment (RRT) and (2) verify the existence of differences quality of life (QOL) in accordance with the RRT.Methods:This is a cross-sectional study of a descriptive nature through surveys, exploratory and correlational. The sample consisted of 125 participants. Of these, 31 were to be made RRT by automated peritoneal dialysis (APD) and 94 hemodialysis (HD). Participants were selected from three renal centers: (1) Centro Renal da Prelada (Porto, Portugal), (2) Centrodial (S. João da Madeira, Portugal) and Centro Renal da Misericórdia de Paredes (Paredes, Portugal). The study was carried out for 6 months. The following instruments were applied: Socio-demographic and clinical questionnaire (SDCQ), Dyadic Adjustment Scale (DAS), World Health Organization Quality of Life (WHOQOL-Bref).Results:The results demonstrate the existence of statistically significant differences between the type of RRT and most areas of QOL, as well as the existence of statistically significant differences between the subscales of the DAS evaluated and the type of RRT.Conclusion:The present study demonstrates a greater commitment in terms of QOL of individuals undergoing treatment for HD when compared with those subjected to APD. It turns out, also, that DA is most strongly perceived by patients in APD than with HD.

Dialysis, time and death: comparisons of two consecutive decades among patients treated at the same Brazilian dialysis center

The survival of hemodialysis patients is likely to be influenced not only by well-known risk factors like age and comorbidity, but also by changes in dialysis technology and practices accumulated along time. We compared the survival curves, dialysis routines and some risk factors of two groups of patients admitted to a Brazilian maintenance hemodialysis program during two consecutive decades: March 1977 to December 1986 (group 1, N = 162) and January 1987 to June 1997 (group 2, N = 237). The median treatment time was 22 months (range 1-198). Survival curves were constructed using the Kaplan-Meier method and compared using the log-rank method. The Cox proportional hazard regression model was used to investigate the more important variables associated with outcome. The most important changes in dialysis routine and in patient care during the total period of observation were the progressive increase in the dose of dialysis delivered, the prohibition of potassium-free dialysate, the use of bicarbonate as a buffer and the upgrading of the dialysis equipment. There were no significant differences between the survival curves of the two groups. Survival rates at 1, 5 and 10 years were 84, 53 and 29%, respectively, for group 1 and 77, 42 and 21% for group 2. Patients in group 1 were younger (45.5 ± 15.2 vs 55.2 ± 15.9 years, P<0.001) and had a lower prevalence of diabetes (11.1 vs 27.4%, P<0.001) and of cardiovascular disease (9.3 vs 20.7%, P<0.001). According to the Cox multivariate model, only age (hazard ratio (HR) 1.04, confidence interval (CI) 1.03-1.05, P<0.001) and diabetes (HR 2.55, CI 1.82-3.58, P<0.001) were independent predictors of mortality for the whole group. Patients of group 2 had a lower prevalence of sudden death (19.1 vs 9.7%, P<0.001). After adjusting for age, diabetes and other mortality risk factors, the risk of death was 17% lower in group 2, although this difference was not statistically significant. We conclude that the negative effects of advanced age and of higher frequency of comorbidity on the survival of group 2 patients were probably offset by improvements in patient care and in the quality and dose of dialysis delivered, so that the survival curves did not undergo significant changes along time.

Applications of artificial intelligence to condition-based maintenance

In this paper we discuss interesting developments of expert systems for machine diagnosis and condition-based maintenance. We review some elements of condition-based maintenance and its applications, expert systems for machine diagnosis, and an example of machine diagnosis. In the last section we note some problems to be resolved so that expert systems for machine diagnosis may gain wider acceptance in the future.

Schistosoma mansoni: implante de vermes na cavidade peritoneal visando imunoproteção

Tentou-se obter imunoproteção contra infecção cercariana pela inoculação de vermes vivos na cavidade peritoneal de camundongos. Embora os vermes sobrevivessem bem nestas condições e não ocorresse postura de ovos, não foi possível obter imunoproteção, Também a inoculação de ovos viáveis por via sangüínea e peritoneal não propiciou o aparecimento de imunoproteção nos camundongos com vermes na cavidade peritoneal.

Isolamento do Toxoplasma gondii de exsudato peritoneal e órgãos de camundongos com infecção experimental

Foram examinados exsudatos peritoneais e órgãos (cérebro, coração, pulmão e músculo estriado) de 53 camundongos infectados experimentalmente pelo Toxoplasma gondii, sendo 21 na fase aguda e 32 na crônica. Camundongos albinos, machos, de cerca de 25 g e 2 meses de idade foram inoculados, por via intraperitoneal, com 0,5 ml de exsudato peritoneal (taquizoitas) ou macerado de cérebro (cistos) de camundongos previamente infectados. O exame a fresco foi feito no exsudato peritoneal, entre 3 e 12 dias após inoculação e no cérebro, após 10 dias. Foram realizadas inoculações de macerados de órgãos em novos camundongos (repiques) para a recuperação do parasita no exsudato ou no cérebro. Na infecção aguda as positividades foram, ao exame a fresco: exsudato peritoneal 19/19, pulmão 12/14, músculo 6/9, coração 4/9 e cérebro 1/3. Após inoculação: exsudato peritoneal 5/5, cérebro 2/2, coração 19/19, pulmão 13/13 e músculo 14/17. Após estes últimos resultados foram registrados 9 novos órgãos positivos. A positividade final (igual à recuperação do parasita) foi: exsudato peritoneal 19/19 (100%), coração 15/17 (88,5%), músculo 12/14 (85,7%), pulmão 14/14 (100%) e cérebro 2/3 (66,6%). Na infecção crônica, que transcorreu entre 10 e 495 dias, as positividades foram, ao exame a fresco: cérebro 28/32, coração 0/4 e músculo 0/4. Após repique: cérebro 6/6, coração 14/29 e músculo 16/26. Neste exame foi revelado um novo camundongo positivo elevando para 29 o total de camundongos positivos ou 90,6%. O resultado final foi: cérebro 28/32 (87,5%), músculo 16/28 (57,15%) e coração 14/31 (45,1%). No fim da pesquisa, aos 495 dias, o cérebro apresentava grandes cistos ao exame a fresco e coração e músculo mostravam-se positivos através da inoculação. Conclusões: 1º) nos camundongos o toxoplasma persistiu por 495 dias no cérebro, coração e músculo estriado; 2º) o exame a fresco do pulmão pode substituir ou confirmar o do exsudato peritoneal; 3º) a inoculação de órgãos é necessária pois pode revelar novos casos positivos; 4º) a atividade dos cistos foi demonstrada pelo aumento gradual do seu tamanho e pela recuperação do toxoplasma no cérebro, coração e músculo, após o longo tempo de infecção.

Host cell adhesion to Schistosoma mansoni larvae in the peritoneal cavity of naive mice: histological and scanning electron microscopic studies

Cercariae of Schistosoma mansoni inoculated into the peritoneal cavity of naive mice induced host cell adhesion to their surface, but after 90 minutes the number of adherent cells sharply decreased. The cell detachment is progressive and simultaneous to the cercaria-schistosomule transformation. The histological study showed mainly neutrophils in close contact with the larvae. Mononuclear cells and some eosinophils were occasionally seen surrounding the adherent neutrophils. The scanning electron microscopy showed cells displaying twisted microvilli and several microplicae contacting or spreading over the larval surface, and larvae completely surrounded by clusters of cells. These results suggest that the neutrophils recognize molecules on the cercarial surface which induce their spreading

Effect of oxamniquine on cell adhesion to Schistosoma mansoni larvae in the peritoneal cavity of naive mice

The treatment of naive mice with high closes of oxamniquine, 1 hour before the intraperitoneal inoculation of Schistosoma mansoni cercariae, induces a delay in the transformation process resulting in a longer host cell adhesion.

Desenvolvimento do Schistosoma mansoni na cavidade peritoneal de camundongos da linhagem AKR/J

Cercárias de Schistosoma mansoni, inoculadas na cavidade peritoneal de camundongos da linhagem AKR/J, conseguiram sobreviver in situ e chegar à maturidade sexual. Ao contrário da linhagem convencional (SWISS), onde as fêmeas que se desenvolveram no peritônio não produziram ovos, 7,7% das fêmeas retiradas da cavidade peritoneal de camundongos AKR/J apresentavam ovo normal no útero. Os parasitos recuperados da cavidade peritoneal de ambas as linhagens não apresentaram pigmento hemoglobínico, indicando que os mesmos sobrevivem na cavidade peritoneal de camundongos sem a necessidade de ingestão de hemácias. O desenvolvimento do parasito na cavidade peritoneal de camundongos AKR/J, com produção de ovos normais, reforça os dados, já existentes na literatura, que mostram que o ciclo evolutivo do parasito pode ser completado sem a necessidade da fase pulmonar.

COLONIZATION AND LABORATORY MAINTENANCE OFAnopheles albimanus WIEDEMANN IN VENEZUELA

Anopheles albimanus is one of the main vectors of malaria in Central America and the Caribbean, based on its importance, there are previous reports of the successful colonization of this species in Latin America countries. Mosquitoes were collected in the Aragua State of Venezuela colonized in the laboratory, using a simple and efficient maintenance method. Based on life table calculations under well established laboratory conditions, the Survival Rate Probability was constant and always close to 1 in immature stages, the Reproductive Net Rate (Ro) was 3.83, the generation time (Tc) was 24.5 days and the Intrinsic Growth Rate (rm) was 0.0558. This is the first report of the colonization of A. albimanus in Venezuela.

Schistosoma mansoni: inflammatory foci around larvae in the peritoneal cavity of naive mice is radiosensitive

Innate attack to Schistosoma mansoni cercariae was evaluated in irradiated mice. It was observed that 70% of the larvae from mice sacrificed one day after whole body irradiation with 400 or 800 rads were surrounded by cluster reactivities, without difference from controls. Differences were apparent on day 5 after irradiation with sub lethal (400 rads) or lethal doses (800 rads) suggesting that innate defence to infection take at least 5 days to be affected by low dose whole-body radiation.

Presence of Leishmania amastigotes in peritoneal fluid of a dog with leishmaniasis from Alagoas, Northeast Brazil

The goal of this short communication is to report the uncommon presence of intracellular amastigotes of Leishmania in peritoneal fluid of a dog with leishmaniasis from Alagoas State, Brazil. Physical examination of an adult male rottweiler suspected to be suffering of leishmaniasis revealed severe loss of weight, ascitis, splenomegaly, moderately enlarged lymph nodes, onychogryphosis, generalized alopecia, skin ulcers on the posterior limbs, and conjunctivitis. Samples of bone marrow, popliteal lymph node, skin ulcer, and peritoneal fluid were collected and smears of each sample were prepared and stained with hematoxylin and eosin. Numerous amastigotes were detected in bone marrow, popliteal lymph node, and skin ulcer smears. Smears of peritoneal fluid revealed the unusual presence of several free and intracellular amastigotes of Leishmania. Future studies are needed to determine whether the cytology of ascitic fluid represents a useful tool for diagnosis Leishmania infection in ascitic dogs, particularly in those living in areas where canine leishmaniasis is enzootic.

Withdrawal of maintenance therapy for cytomegalovirus retinitis in AIDS patients exhibiting immunological response to HAART

BACKGROUND: Before the introduction of highly active antiretroviral therapy (HAART), CMV retinitis was a common complication in patients with advanced HIV disease and the therapy was well established; it consisted of an induction phase to control the infection with ganciclovir, followed by a lifelong maintenance phase to avoid or delay relapses. METHODS: To determine the safety of CMV maintenance therapy withdrawal in patients with immune recovery after HAART, 35 patients with treated CMV retinitis, on maintenance therapy, with CD4+ cell count greater than 100 cells/mm³ for at least three months, but almost all patients presented these values for more than six months and viral load < 30000 copies/mL, were prospectively evaluated for the recurrence of CMV disease. Maintenance therapy was withdrawal at inclusion, and patients were monitored for at least 48 weeks by clinical and ophthalmologic evaluations, and by determination of CMV viremia markers (antigenemia-pp65), CD4+/CD8+ counts and plasma HIV RNA levels. Lymphoproliferative assays were performed on 26/35 patients. RESULTS: From 35 patients included, only one had confirmed reactivation of CMV retinitis, at day 120 of follow-up. No patient returned positive antigenemia tests. No correlation between lymphoproliferative assays and CD4+ counts was observed. CONCLUSION: CMV retinitis maintenance therapy discontinuation is safe for those patients with quantitative immune recovery after HAART.

Susceptibility of peritoneal macrophage from different species of neotropical primates to Ex vivo Leishmania (L.) infantum chagasi-infection

This study examined the susceptibility of peritoneal macrophage (PM) from the Neotropical primates: Callithrix jacchus, Callithrix penicillata, Saimiri sciureus, Aotus azarae infulatus and Callimico goeldii to ex vivo Leishmania (L.) infantum chagasi-infection, the etiological agent of American visceral leishmaniasis (AVL), as a screening assay for evaluating the potential of these non-human primates as experimental models for studying AVL. The PM-susceptibility to infection was accessed by the PM-infection index (PMI) at 24, 72 h and by the mean of these rates (FPMI), as well as by the TNF-α, IL-12 (Capture ELISA) and Nitric oxide (NO) responses (Griess method). At 24h, the PMI of A. azarae infulatus (128) was higher than those of C. penicillata (83), C. goeldii (78), S. sciureus (77) and C. jacchus (55). At 72h, there was a significant PMI decrease in four monkeys: A. azarae infulatus (128/37), C. penicillata (83/38), S. sciureus (77/38) and C. jacchus (55/12), with exception of C. goeldii (78/54). The FPMI of A. azarae infulatus (82.5) and C. goeldii (66) were higher than C. jacchus (33.5), but not higher than those of C. penicillata (60.5) and S. sciureus (57.5). The TNF-a response was more regular in those four primates which decreased their PMI at 24/72 h: C. jacchus (145/122 pg/mL), C. penicillata (154/130 pg/mL), S. sciureus (164/104 pg/mL) and A. azarae infulatus (154/104 pg/mL), with exception of C. goeldii (38/83 pg/mL). The IL-12 response was mainly prominent in A. infulatus and C. goeldii which presented the highest FPMI and, the NO response was higher in C. goeldii, mainly at 72 h. These findings strongly suggest that these New World primates have developed a resistant innate immune response mechanism capable of controlling the macrophage intracellular growth of L. (L.) i. chagasi-infection, which do not encourage their use as animal model for studying AVL.

In vitro maintenance of Angiostrongylus costaricensis does not provide physiological conditions for egg laying

Fifteen pairs (male/female) of Angiostrongylus costaricensis were kept in vitro in Waymouth medium for three days to evaluate the amount and duration of egg laying. At 24, 48 and 72 hours, the mean egg counts were 321, 24 and 4 eggs/10 microliters, respectively. Most of the eggs were eliminated within the first 24 hours, suggesting they are expelled under non-physiological conditions. These results indicate that in vitro conditions are not appropriate for drug trials of egg-laying inhibitors for treatment of abdominal angiostrongylosis.