Associação da variabilidade da precipitação pluvial em Santa Maria com a Oscilação Decadal do Pacífico

O objetivo deste trabalho foi verificar a associação da variabilidade interdecadal da chuva em Santa Maria, RS, com a Oscilação Decadal do Pacífico. Parte da variabilidade interanual da precipitação pluvial é explicada pelo fenômeno El Niño Oscilação Sul (ENOS), que acontece no Oceano Pacífico. Na segunda metade da década de 1990, foi relatada outra oscilação na temperatura do Oceano Pacífico, de duração maior que o ENOS, denominada Oscilação Decadal do Pacífico (ODP). Foram usados os dados mensais acumulados de precipitação do período 1912-2008, da Estação Climatológica principal de Santa Maria, e os valores mensais do índice ODP do mesmo período. A análise foi realizada em nível anual, semestral (primeiro e segundo semestre), sazonal (verão, outono, inverno e primavera) e mensal. Existe associação entre a chuva e a ODP, de modo que décadas com chuvas acima da normal são associadas à fase quente da ODP, intercaladas com décadas com chuva abaixo da normal associadas à fase fria da ODP, o que indica oscilações periódicas de médio e longo prazo na precipitação pluvial em Santa Maria, RS.

Effect of intradialytic resistance band exercise on physical function in patients on maintenance hemodialysis: a pilot study.

Although physical activity is recommended in patients on maintenance hemodialysis (MHD), randomized controlled trials testing the effects of exercise in this population have given conflicting results. In general, aerobic exercises mostly failed to produce improvements in physical function, whereas resistance exercises, although less studied, appeared to be more promising. The use of sophisticated materials such as leg press and free weights may preclude widespread application of resistance training in patients on MHD. Simple and cheap elastic bands may thus be an attractive alternative. We tested the feasibility of a supervised intradialytic resistance band exercise training program, and its effects on physical function, in patients on MHD. A total of 11 unselected adult patients on MHD from our center, aged 70 ± 10.7 (mean ± standard deviation) years, including 8 men and 3 women, accepted to follow the program under the supervision of qualified physiotherapists. Thirty-six exercise sessions of moderate intensity (twice a week, mean duration 40 minutes each, during 4.5 to 6 months), mainly involving leg muscles against an elastic resistance, were performed. The exercise program was well tolerated and all patients completed it. Statistically significant improvements were observed in the following tests: Tinetti test, 23.9 ± 3.9 points before versus 25.7 ± 3.5 points after the program (P = .022); the Timed Up and Go test, 12.1 ± 6.6 versus 10 ± 5.8 seconds (P = .0156). Improvements in the 6-minute walk distance and in the one-leg balance tests just failed to reach statistical significance. In this single-center pilot study, an intradialytic resistance band exercise program was feasible, well tolerated, and showed encouraging results on physical function.

Variabilidade interdecadal na série secular de temperatura do ar em Santa Maria, RS

O objetivo deste trabalho foi verificar possíveis associações entre a variabilidade interdecadal das temperaturas mínima (Tmín) e máxima (Tmáx) diárias do ar e da amplitude térmica diária (ATD) em Santa Maria, RS, com a Oscilação Decadal do Pacífico (ODP). Foram usados os valores diários de Tmín e Tmáx de janeiro de 1912 a dezembro de 2009, e os valores mensais do índice da ODP do mesmo período. Há associação entre a variabilidade interdecadal da Tmín e Tmáx e da ATD com a ODP nesse local. Na fase fria da ODP, de 1947-1976, houve decréscimo nas Tmín e Tmáx. Nas duas fases quentes da ODP, 1925-1946 e de 1977-1998, houve aumento na Tmín no primeiro período e na Tmáx no segundo período. Durante a fase fria da ODP, de 1947-1976, houve redução da ATD, pela diminuição da Tmáx média e máxima. Houve aumento na ATD, no primeiro semestre na fase fria atual (1999-2009), em razão da diminuição na média da Tmín. Esses ciclos de aquecimento e resfriamento, na escala decadal, podem nortear estratégias de adaptação e mitigação na agricultura, por meio do melhoramento genético e desenvolvimento de cultivares tolerantes a tais oscilações de temperatura.

Les conséquences rénales de l'anorexie [Anorexia nervosa and the kidney].

Anorexia nervosa (AN) is a severe and potentially lethal disease of the young woman. It is defined as an anxious disorder not to gain weight, and an obsessive behavior regarding body weight and physical appearance. Different and variable patterns of behaviour are observed. This article focuses on the renal problems observed in anorexic patients. Anorexia is often associated with severe electrolyte disturbances, such as hypokalemia and hypophosphatemia, and alterations of water metabolism with hyponatremia and edema. Hypokalemia and chronic dehydration may contribute to the development of renal failure. Even end stage renal disease can be observed in these patients. A better understanding of the pathophysiology might improve treatment of patients suffering from AN.

Traitement et prophylaxie de la Maladie ThromboEmbolique Veineuse (MTEV)

Ont contibué: Mazzolai L., Angellilo A., Bervini D, Borens O, Buclin T, Bulaz C., Burnier M, Calandra T, Cornuz J, Corpataux J,M., Daniel R., Desmartines N., Duchosal M., Eeckhout E., Farron A., Frackowiak R., Hirschi B., Hohlfeld P., Hugli O., Jichlinski P., Jolliet P., Kern C., Levivier M., Leyvraz S., Meuli R., Michel P., Moradpour D., Nicod L., Pannatier A., Prior J., Qanadli S., Ris H.B., Ruchat P., So A., Teta D., Vial Y., Vogt P., Voirol P., Von Segesser L., Waeber G., Yersin B.

A young man with a renal colic

We report the case of a 35-year-old man with no cardiovascular morbidity, presenting with acute flank pain, microscopic haematuria and normal blood pressure. Initially diagnosed as a ureteral colic, the patient was recovered 6 weeks later with severe hypertensive crisis. Further investigations revealed a massive renal infarction secondary to medial fibromuscular dysplasia (FMD). Several aspects of this presentation are intriguing. Renal infarcts are usually seen in older patients having cardiac problems and/or major atheromatous plaques. In addition, FMD is mainly observed in young females and rarely progresses to renal artery occlusion. Furthermore, in this case, FMD remained silent until the acute renal infarction occurred, despite a significant kidney size reduction at the time of diagnosis. Finally, the observation of a delayed hypertensive response to a major renovascular insult provides incentives to discuss possible pathophysiological mechanisms involved in renovascular hypertension.

La néphropathie ischémique par athérosclérose aortorénale : acquisitions thérapeutiques [Atherosclerotic renal artery disease management update]

In the case of atherosclerotic renal artery disease, the best conclusive results lie principally not in the degree of the stenosis but rather in the degree the renal parenchymal disease beyond the stenosis itself. These determining factors involve the controlling of the patients blood pressure, the improvement in the renal function and the beneficial results to the cardiovascular system. Besides the indispensable medical treatment, a revascularisation by angioplasty may be indicated. This procedure with or without vascular stent often allows satisfactory angiographic results. A treatment by surgical revascularisation is only recommended in the case of extensive atherosclerotic lesions of the aorta, complex lesions of the latter or an abdominal aortic aneurism. Although the frequency of restenosis of angioplasty with stent remains extremely low, the risk of cholesterol emboli due to the diffuse atherosclerotic lesions of the abdominal aorta, must be considered at the time of each aortic catheterization. The therapeutic approach of atherosclerotic renal artery disease must be dictated by the whole cardiovascular risk factors and by the threat of target organs. The control of the blood pressure and the maintenance of the renal function must be integrated in the decisional algorithm as well as the possible risks in carrying out an eventual revascularisation procedure. Finally, the renal angioplasty should in numerous situations be integrated in the overall assumption of responsibility of the atherosclerotic vascular diseases, and should be part of the medical treatment. Several questions still do exist; at what moment an atherosclerotic renal artery stenosis should and e considered critical, and which procedure should be considered for which patient? The purpose of this review is to propose a decisional tool for individualized treatments in the light of results from randomized and controlled studies.

Problèmes dus aux fistules d'hémodialyse: un réseau régional de prise en charge [Problems related to haemodialysis vascular accesses: a regional network of care]

The number of patients treated by haemodialysis (HD) is continuously increasing. The complications associated with vascular accesses represent the first cause of hospitalisation in these patients. Since 2001 nephrologists, surgeons, angiologists and radiologists at the CHUV are working to develop a multidisciplinary model that includes planning and monitoring of HD accesses. In this setting the echo-Doppler represents an important tool of investigation. Every patient is discussed and decisions are taken during a weekly multidisciplinary meeting. A network has been created with nephrologists of peripheral centres and other specialists. This model allows to centralize investigational information and coordinate patient care while keeping and even developing some investigational activities and treatment in peripheral centres.

Dinâmica da dormência de gemas de dois anos de macieira 'Imperial Gala' em região de baixa ocorrência de frio

O objetivo deste trabalho foi determinar a dinâmica da dormência de gemas em ramos de dois anos de macieira 'Imperial Gala' com ou sem frio suplementar durante o outono e inverno, cultivadas em Porto Amazonas - PR, região de baixa ocorrência de frio. Os ramos foram coletados em intervalos de 21 dias, de abril a agosto (19-04, 10-05, 31-05, 21-06, 12-07, 02-08 e 23-08) e receberam ou não tratamento com frio suplementar de 1.440 horas, à temperatura de 4 a 7° C. A avaliação da dormência foi realizada pelo teste biológico de estacas de nós isolados (temperatura de 25° C e fotoperíodo de 16 horas) por meio dos parâmetros: tempo médio para brotação (TMB), velocidade de brotação (VB), taxa final de brotação (TF), taxa de brotações vigorosas (TBV) e tempo médio para aparecimento de folhas abertas (TMFA). A dormência mais intensa de gemas de dois anos ocorre no final de maio, com oscilações até o início de agosto. A aplicação de 1.440 horas de frio suplementar de 4 a 7° C altera a dinâmica da dormência das gemas de dois anos, reduzindo o seu tempo médio de brotação. Uma vez propiciada a brotação de gemas não-dormentes de dois anos, as mesmas possuem boa capacidade para se desenvolver.

Balanço de carboidratos em gemas florais de dois genótipos de pereira sob condição de inverno ameno

As pereiras européias e asiáticas, cultivadas sob condições de inverno ameno, como na região Sul do Brasil, apresentam problemas de adaptação. Durante o inverno, as oscilações térmicas e o baixo acúmulo de frio têm sido referidos por alguns autores como causas do abortamento de gemas florais. O objetivo deste trabalho foi determinar o balanço de carboidratos em tecidos de gemas florais de duas cultivares de pereiras: Kieffer (P. communis x P. pyrifolia) e Housui (P. pyrifolia). Os tecidos de gemas florais e da base de gemas foram coletados mensalmente, de fevereiro a setembro de 2002, de plantas de pomar da Embrapa Clima Temperado, Pelotas-RS, coordenadas 32°51' S e 52°21'O, localizado a 230 metros de altitude. O material vegetal foi analisado separadamente quanto às concentrações de açúcares solúveis (por cromatografia gasosa) e porcentagens de amido (por espectrofotometria). Em ambas as cultivares, observou-se que a base da gema é um importante local de reserva. Ocorreram significativos aumentos de açúcares solúveis nas gemas das duas cultivares na fase que antecede a brotação. Em setembro, os açúcares solúveis totais na matéria seca (MS), nas gemas florais da cv. Housui (38,33 mg g-1), foram menores do que os observados nos tecidos da cv. Kieffer (50,39 mg g-1), cultivar melhor adaptada às condições climáticas. O açúcar-álcool sorbitol, seguido da sacarose, foi o açúcar solúvel mais abundante nos tecidos das duas cultivares.

L'hémodiayse intermittente, irremplaçable dans certains cas d'intoxications sévères [Intermittent hemodialysis, irreplaceable in specific cases of severe poisoning].

Le médecin praticien est souvent bien sensibilisé aux indications à l'hémodialyse au cours de l'insuffisance rénale sévère, que celle-ci soit aiguë ou chronique. En dehors des indications traditionnelles à une épuration extrarénale, il existe certaines situations comme des intoxications (metformine, éthylène glycol ou lithium) et d'autres conditions (hypercalcémie, lyse tumorale), dans lesquelles l'hémodialyse intermittente représente le traitement le plus efficace, voire le seul. Bien que ces situations demeurent peu fréquentes, il est décisif de les reconnaître rapidement The medical practitioner is in general well aware of the indications for hemodialysis in severe, acute or chronic renal insufficiency. Apart from the traditional indications for renal replacement therapy, there are some cases such as metfomin and ethylene glycol poisoning, lithium intoxication severe hypercalcemia and tumor lysis syndrome, in which intermittent hemodialysis is the most effective treatment, or sometimes the only effective one. Although these situations remain infrequent, it is crucial to recognize them as quickly as possible.

Vitamin D: a review on its effects on muscle strength, the risk of fall, and frailty.

Vitamin D is the main hormone of bone metabolism. However, the ubiquitary nature of vitamin D receptor (VDR) suggests potential for widespread effects, which has led to new research exploring the effects of vitamin D on a variety of tissues, especially in the skeletal muscle. In vitro studies have shown that the active form of vitamin D, calcitriol, acts in myocytes through genomic effects involving VDR activation in the cell nucleus to drive cellular differentiation and proliferation. A putative transmembrane receptor may be responsible for nongenomic effects leading to rapid influx of calcium within muscle cells. Hypovitaminosis D is consistently associated with decrease in muscle function and performance and increase in disability. On the contrary, vitamin D supplementation has been shown to improve muscle strength and gait in different settings, especially in elderly patients. Despite some controversies in the interpretation of meta-analysis, a reduced risk of falls has been attributed to vitamin D supplementation due to direct effects on muscle cells. Finally, a low vitamin D status is consistently associated with the frail phenotype. This is why many authorities recommend vitamin D supplementation in the frail patient.

L'insuffisance rénale chronique: quelle est la diète optimale

The optimal diet for chronic kidney disease (CKD) is an issue frequently brought up by patients and/or their relatives during outpatient visits. For patients without malnutrition who are motivated and supported by an experienced multidisciplinary team, the optimal protein intake of 0,6 g/kg of ideal body weight/day is recommended to halt the progression of CKD. A calorie intake of 30 to 35 kcal/kg of ideal body weight/day is necessary to reduce the risk of malnutrition from a low protein diet and to maintain a neutral nitrogen balance. A low-salt diet, namely 5 to 6 g/d, is useful to optimize the treatment of hypertension associated with CKD and to limit fluid overload. At the advanced stage of CKD, it is also necessary to restrict the intake of phosphorus and sometimes potassium. Given the complexity of optimal renal diet, coordination between general practitioners, nephrologists and dietitians is essential to foster optimal care.