Use of small doses of furosemide in chronic kidney disease patients with residual renal function undergoing hemodialysis

Background  

The objective of the present study was to verify whether chronic renal patients on hemodialysis (HD) with residual diuresis who were using small doses of furosemide present different levels of urinary volume and sodium excretion compared to patients with residual diuresis who do not use this drug.     

Contraception and reproductive planning during the COVID-19 pandemic

ABSTRACT

Introduction

The coronavirus disease (COVID-19) is a global health emergency. Major disruption to healthcare services during the current COVID-19 pandemic will last even after its peak. Sexual and reproductive health (SRH), specially contraception, needs to be understood as an essential service.     

Quality of life in patients with inflammatory bowel diseases: translation to Portuguese language and validation of the "Inflammatory Bowel Disease Questionnaire" (IBDQ)

BACKGROUND: Crohn's disease comprises, together with ulcerative colitis, the inflammatory bowel diseases, which because their morbidity and chronic evolution have a considerable impact on the patient's quality of life. The measurement of quality of life requires the determination of the degree of subjective well-being attributed to the lack of symptoms, to psychological state and daily activity, and is useful as an instrument of evaluation, both in clinical trials and health programs. Inflammatory Bowel Disease Questionnaire is an instrument developed by North-American investigators of McMaster University which reproducibility and validity has been determined in several countries studies, and has shown its use in the measurement of the quality of life of patients with inflammatory bowel diseases. AIMS: Our purpose was to translate that instrument into Portuguese language, its adaptation to Brazilian culture and verify its psychometric properties (validity and reproducibility). METHODS: It was applied to a population of 50 inflammatory bowel diseases patients (24 with Crohn's disease, 26 with ulcerative colitis). To test the criteria and construction validity of the instrument's, it was compared with SF-36, a general questionnaire for establishing quality of life, and the Crohn's Disease Activity Index and Lichtiger's Index. RESULTS: The correlations obtained were mostly moderate. About the intestinal diseases activity index, Lichtiger's index showed better correlations than Crohn's Disease Activity Index. To evaluate its reproducibility, the instrument was applied on three occasions, twice by the same observer (12 days average between applications) and once by a second observer, resulting in a high degree of intra- and interobserver correlation. CONCLUSIONS: Portuguese version of Inflammatory Bowel Disease Questionnaire is a valid and reproducible instrument which can be used to evaluate the quality of life of Brazilian inflammatory bowel diseases patients.     

ELectrical impedance of isolated retina and its changes during spreading depression

The electrical impedance of isolated chick and toad retinas were measured in the absence of, and during, spreading depression, using sinusoidal measuring currents ranging from 10 to 50,000 Hz. Data obtained in the absence of the reaction indicate an electric heterogeneity of the tissue and suggest that at least two groups of cells are responsible for the observed frequency distribution. Spreading depression is accompanied by impedance changes that depend on the frequency of the measuring current and composition of the Ringer's solution. In chick retinas immersed in standard solution, impedance magnitude (Z) as well as phase angle (θ) change in phase, displaying an initial increase followed by a longer decrease; in the toad, these changes depend on the measuring frequency: at 10 Hz they are similar to the ones observed in chick retinas, whereas at intermediate and high frequencies they are out of phase. In low Cl^? + sucrose Ringer's solution a decrease of impedance is observed in both chick and toad retinas. In low Cl^? + Na₂SO₄ + sucrose Ringer's solution a decrease of impedance also predominates but the Z and θ curves are biphasic and complex, having time courses which are frequency-dependent. In addition, these changes are different in chick and toad preparations.The experiments show that the impedance changes during the retinal reaction might be related both to extracellular as well as cellular currents. The extracellular current changes could be due to decrease of ionic content and volume of extracellular space, the latter variations being drastically reduced when retinas are immersed in low Cl^? solutions. The results also suggest changes of current flow through cellular components which are frequency-dependent: at low frequencies the preferential path being probably through neuronal, and at high frequencies, through glial cells.     

Corporeal weight gain and metabolic syndrome in living kidney donors after nephrectomy

The number of healthy individuals undergoing unilateral nephrectomy for kidney donation is increasing world-wide. Obesity and nephron reduction could promote a decline in the glomerular filtration rate (GFR) and an increase in urinary protein excretion in these individuals. Metabolic Syndrome (MS) is also a risk factor for these patients. This study evaluated GFR, urinary protein excretion, and the possibility of one or more components of MS in this group. METHODS: Twenty live kidney donors were evaluated at an average of 10 years after nephrectomy. We obtained measurements of systolic blood pressure, diastolic blood pressure, and waist circumference. We estimated renal function, urinary protein excretion, triglycerides, high-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and fasting plasma glucose levels. The GFR was calculated through the estimated creatinine clearance using the Cokcroft-Gault equation (eGFR). RESULTS: Of the 20 participants, four developed MS. The patients with a greater number of MS components showed a greater eGFR. Only seven donors (35%) showed a normal blood pressure. Serum creatinine level changes were observed in three patients, and in five there was increased urinary protein excretion. CONCLUSION: This study showed the possibility that corporeal weight gain and MS may be additional overburdens on the GFR of the remaining kidney.     

Systemic Hemodynamic Changes in Elderly Hypertensive Patients After Ingesting Foods With Lipid, Protein, and Carbohydrate Contents

Aging is associated with changes in cardiovascular structure and function, which predisposes elderly people to reduced blood pressure levels after meals. The authors studied cardiac systolic function in elderly hypertensive patients after eating meals with different contents of lipids, proteins, and carbohydrates. Ten elderly male hypertensive patients were studied (mean age, 69 years; range 60–80 years). No patients had a previous history of orthostatic or postprandial hypotension. Patients ate 1 of 3 pre-prepared meals: lipid meal (LM), protein meal (PM), or carbohydrate meal (CM), on different days. Mean arterial pressure, total peripheral resistance index (TPRi), cardiac index (CI), and stroke index were recorded at the end of the fasting period and then at 5, 15, 30, 45, and 60 minutes after food ingestion. After ingestion of a CM, the CI increased from 2.30±0.21 L/min/m² to 2.61±0.24 L/min/m² and the TPRi decreased from 3212±226 dynes/sec² to 2793±255 dynes/sec² at 45 minutes (P<.05). After the LM, the CI increased from 2.15±0.15 to 2.84±0.27 L/min/m² and the TPRi decreased from 3630±274 L/min/m² to 2666±282 dynes/sec² at 45 minutes (P<.05). After the PM, no systemic hemodynamic changes were observed. When all 3 meals were compared, the highest values of CI and the lowest values of TPRi were observed for the LM and CM. The authors' results show that fat- and carbohydrate-rich foods cause changes in the systemic hemodynamic of the elderly hypertensive patients.     

HER-2/neu evaluation by immunohistochemistry and fluorescence in situ hybridization in breast cancer: implications for daily laboratory practice

BACKGROUND: HER-2/neu status was determined by immunohistochemistry (IHC) and fluorescence in situ hybridisation (FISH) methods in more than 300 paraffin-embedded primary breast cancer samples. MATERIALS AND METHODS: HER-2/neu status was determined by FISH using the PathVysion kit (Vysis) and by IHC using either a monoclonal antibody CB11 or a cocktail of antibodies: the monoclonal TAB250 and the polyclonal pAb1. RESULTS: Of the 324 cases evaluable by IHC, 65 out of 318 (20%) and 24 out of 324 (7%) were scored as positive when using the antibody cocktail and the CB11, respectively. HER-2/neu gene amplification occured in 64 out of 324 cases (20%). Concordance of FISH and IHC was found in 285 out of 318 cases (90%) and 278 out of 324 cases (86%) using the cocktail and the CB11, respectively. CONCLUSION: The cost-effectiveness analysis revealed that the use of a sensitive IHC method followed by confirmation of positive results by FISH considerably decreased the FISH costs and may become standard practice for HER-2/neu evaluation.     

Phase II trial of paclitaxel and ifosfamide as a salvage treatment in metastatic breast cancer

Purpose. Treatment results in patients failing first-line chemotherapy inmetastatic breast cancer (MBC) are still unsatisfactory, with patientsexhibiting poor responses to salvage therapy and a short overall survival.Both paclitaxel and ifosfamide are able to produce objective tumor responsesin the disease. Therefore, the antitumor effects and toxicity of theircombined use could be worthwhile studying in patients progressing afterdoxorubicin-containing combinations. Patients and methods: This Phase IItrial of paclitaxel/ifosfamide included patients with bi-dimensionallymeasurable metastatic breast cancer in second or third relapse, followinganthracycline-containing regimens: ECOG PS <2, and adequate hepatic,cardiac renal and hematological functions. Paclitaxel 175 mg/m2 was given onday 1, in a 3-hour infusion with appropriate antiallergic pre-medication;while ifosfamide 1.8 g/m2 was given on days 2, 3, 4 with mesna 360 mg/m2i.v., 15 minutes before and 4 hours after ifosfamide administration, and 720mg/m2 P.O. 8 hours later at home, also on days 2, 3, 4. The cycles wererepeated every 21 days, on an outpatient basis. Results. Twenty-fourpatients were accrued for the study and 23 were considered eligible for theevaluation of toxicity ans response. Previous chemotherapy included: CMF/FAC(16 cases); CMF plus mitoxantrone/FAC/cisplatin, vinblastine, mitomycin C (2cases); and FAC/mitomycin C, vinblastine, and etoposide (5 cases). Therewere 11 (48%) objective responses (95% C.I.: 27-69%),including 2 (9%) CR and 9 (39%) PR (95%) C.I.:0-21% and 19-61%, respectively). Five (22%) patientsattained disease stabilization. Median response duration was 7+ months(range 4 to 20+), and the median overall survival was 12 months (range4-23+). The regimen was well tolerated. WHO nausea/vomiting grades 1-2,alopecia grade 3, and neutropenia grades 1-2 were seen in most patients.Four patients experienced mild neuropathy, while it was grade 3 in 1 case.Seven patients had grade 3 neutropenia. In addition, grade 4 neutropeniaassociated with fever was documented in other 4 cases. No hypersensitivityreactions were seen. One case of reversible tachycardia after drugadministration was seen. Myalgia grades 1-2 was also reported in somepatients. Conclusion. These results suggest that the present regimen hassignificant activity in heavily pretreated patients with a MBC, with amanageable toxicity profile. Further trials exploiting the above mentioneddrug combination are warranted.