Severe hyponatremia induced by the association of fluoxetine, hydrochlorothiazide andcaptopril in a young patient

Descrevemos um caso de hiponatremia grave, com um dos níveis séricos de sódio mais baixos da literatura, secundário ao uso de fluoxetina, captopril e hidroclorotiazida. Paciente do sexo feminino, 45 anos, portadora de hipertensão arterial, vinha assintomática em uso de hidroclorotiazida e captopril, quando, a um mês da internação, iniciou-se fluoxetina devido sintomas de depressão. Paciente foi internada por rebaixamento de nível de consciência, com tomografia computadorizada de crânio evidenciando edema cerebral. Análise bioquímica revelou sódio sérico de 97 meq/L. Paciente evoluiu bem após interrupção das medicações e após administração de solução salina a 3%. O mecanismo pelo qual as drogas citadas desencadeiam hiponatremia é variável e não totalmente compreendido. No caso dos diuréticos tiazídicos, alteração na homeostase do sódio e água nos túbulos renais são os principais fatores relacionados a esse distúrbio eletrolítico. Com relação aos antidepressivos, o aumento da produção do hormônio antidiurético é, mais provavelmente, o fator associado à hiponatremia.. Os inibidores da ECA também são relacionados à hiponatremia, pois bradicinina e angiotensina seriam estimulantes da liberação do Hormônio Antidiurético. Sendo assim, a equipe médica deve fazer o rastreamento, através de uma avaliação clínica atenta e das pesquisas regulares, das concentrações séricas de sódio nesses pacientes, a fim de detectar precocemente distúrbios eletrolíticos potencialmente fatais.We describe a case of severe hyponatremia, with some of the lowest levels of sodium in the literature, secondary to the use of fluoxetine, captopril and hydrochlorothiazide. A 45-year-old female patient suffering from arterial hypertension who was being treated with hydrochlorothiazide and captopril was asymptomatic until one month prior to hospitalization when treatment with fluoxetine was initiated due to depressive symptoms. The patient was hospitalized due to a lower level of consciousness. A CT scan of the skull revealed cerebral edema and the biochemical analysis showed serum levels of sodium of 97 mEq/L. The patient presented favorable evolution after the discontinuation of the medication and with the use of 3% hypertonic saline. The mechanism through which drugs promote hyponatremia varies and is not fully understood. In the case of thiazide diuretics the alteration in sodium homeostasis and water in the renal tubes is the principal relation with this electrolyte disturbance. With antidepressants, however, the increased production of antidiuretic hormone is the most probable. ACE inhibitors are also related to hyponatremia, since bradykinin and angiotensin would stimulate the antidiuretic hormone. Therefore, the medical staff should perform the screening through a careful clinical assessment and tests of concentrations of serum levels of sodium in these patients in the early detection of potentially fatal electrolyte disturbances

Proteinuria predicts relapse in adolescent and adult minimal change disease

OBJECTIVE: This study sought to outline the clinical and laboratory characteristics of minimal change disease in adolescents and adults and establish the clinical and laboratory characteristics of relapsing and non-relapsing patients. METHODS: We retrospectively evaluated patients with confirmed diagnoses of minimal change disease by renal biopsy from 1979 to 2009; the patients were aged >;13 years and had minimum 1-year follow-ups. RESULTS: Sixty-three patients with a median age (at diagnosis) of 34 (23-49) years were studied, including 23 males and 40 females. At diagnosis, eight (12.7%) patients presented with microscopic hematuria, 17 (27%) with hypertension and 17 (27%) with acute kidney injury. After the initial treatment, 55 (87.3%) patients showed complete remission, six (9.5%) showed partial remission and two (3.1%) were nonresponders. Disease relapse was observed in 34 (54%) patients who were initial responders (n = 61). In a comparison between the relapsing patients (n = 34) and the non-relapsing patients (n = 27), only proteinuria at diagnosis showed any significant difference (8.8 (7.1-12.0) vs. 6.0 (3.6-7.3) g/day, respectively, p = 0.001). Proteinuria greater than 7 g/day at the initial screening was associated with relapsing disease. CONCLUSIONS: In conclusion, minimal change disease in adults may sometimes present concurrently with hematuria, hypertension, and acute kidney injury. The relapsing pattern in our patients was associated with basal proteinuria over 7 g/day

Ações de Vigilância Sanitária em laboratórios clínicos em relação ao cumprimento da RDC nº 302/2005/Anvisa no âmbito da SRS/Patos de Minas

Introduction: This study focused on the effectiveness of municipal Sanitary Surveillance actions carried out in the context of clinical laboratories under the jurisdiction of the Regional Health Superintendence of Patos de Minas, state of Minas Gerais, Brazil. Objective: To verify if the Sanitary Surveillance followed eleven regulations set forth by Resolution No. 302/2015 of the Collegiate Board of Directors of the Brazilian Health Surveillance Agency when issuing sanitary permits to such laboratories. Methods: Data were collected from 181 annual health inspection reports from 2006 to 2013. Simple frequency and cross-checking analyses were carried out to treat data. Results: Sanitary Surveillance actions were still incipient in years 2006 and 2007. From 2008 on, however, there has been a significant increase in such actions, although they have shown to be less effective when it comes to compliance with items that are closely related to accuracy of laboratory tests and to the safety of patients and staff. Conclusion: the lack of effectiveness concerning Sanitary Surveillance actions is serious and brings out problems experienced by its team. Such problems ought to be investigated and resolved in order to improve the quality of the services provided by clinical laboratories.Introdução: Este estudo trata da efetividade das ações de Vigilância Sanitária (VISA) municipal em relação ao cumprimento da Resolução da Diretoria Colegiada (RDC) nº 302/2005 no contexto de laboratórios clínicos (LC) jurisdicionados à Superintendência Regional de Saúde de Patos de Minas, Minas Gerais (SRS/PM/MG). Objetivos: Buscou-se verificar se a VISA, ao liberar o alvará sanitário, tem cumprido as exigências de onze itens da referida RDC. Método: Os dados foram obtidos de 181 relatórios anuais de inspeção sanitária realizados de 2006 a 2013. A análise se deu por meio de frequências simples e por cruzamento de dados. Resultados: As ações de VISA mostraram-se incipientes nos anos de 2006 e 2007. A partir do ano de 2008, constatou-se um aumento significativo dessas ações, que foram menos efetivas em relação ao cumprimento de itens que estão sobremaneira ligados à acurácia dos exames laboratoriais e à segurança dos funcionários e dos pacientes. Conclusão: Essa falta de efetividade das ações de VISA pode ser considerada grave e revela problemas vivenciados pela equipe de VISA que devem ser investigados a fim de que essa situação seja solucionada oferecendo, assim, mais qualidade na prestação de serviços dos LC à população

ATLANTIC EPIPHYTES: a data set of vascular and non-vascular epiphyte plants and lichens from the Atlantic Forest

Epiphytes are hyper-diverse and one of the frequently undervalued life forms in plant surveys and biodiversity inventories. Epiphytes of the Atlantic Forest, one of the most endangered ecosystems in the world, have high endemism and radiated recently in the Pliocene. We aimed to (1) compile an extensive Atlantic Forest data set on vascular, non-vascular plants (including hemiepiphytes), and lichen epiphyte species occurrence and abundance; (2) describe the epiphyte distribution in the Atlantic Forest, in order to indicate future sampling efforts. Our work presents the first epiphyte data set with information on abundance and occurrence of epiphyte phorophyte species. All data compiled here come from three main sources provided by the authors: published sources (comprising peer-reviewed articles, books, and theses), unpublished data, and herbarium data. We compiled a data set composed of 2,095 species, from 89,270 holo/hemiepiphyte records, in the Atlantic Forest of Brazil, Argentina, Paraguay, and Uruguay, recorded from 1824 to early 2018. Most of the records were from qualitative data (occurrence only, 88%), well distributed throughout the Atlantic Forest. For quantitative records, the most common sampling method was individual trees (71%), followed by plot sampling (19%), and transect sampling (10%). Angiosperms (81%) were the most frequently registered group, and Bromeliaceae and Orchidaceae were the families with the greatest number of records (27,272 and 21,945, respectively). Ferns and Lycophytes presented fewer records than Angiosperms, and Polypodiaceae were the most recorded family, and more concentrated in the Southern and Southeastern regions. Data on non-vascular plants and lichens were scarce, with a few disjunct records concentrated in the Northeastern region of the Atlantic Forest. For all non-vascular plant records, Lejeuneaceae, a family of liverworts, was the most recorded family. We hope that our effort to organize scattered epiphyte data help advance the knowledge of epiphyte ecology, as well as our understanding of macroecological and biogeographical patterns in the Atlantic Forest. No copyright restrictions are associated with the data set. Please cite this Ecology Data Paper if the data are used in publication and teaching events. © 2019 The Authors. Ecology © 2019 The Ecological Society of Americ

Bone disease in primary glomerulophaty

O objetivo deste estudo foi analisar o metabolismo ósseo de pacientes com proteinúria glomerular sem uso prévio de drogas que afetassem esse metabolismo. Dezessete pacientes foram estudados com biópsia óssea para análise histomorfométrica e fragmentos ósseos foram obtidos para cultura de célula (n=13) na qual nós avaliamos proliferação de osteoblasto. A comparação dos achados histomorfométricos a controles de literatura demonstrou uma diminuição da remodelação óssea e comprometimento de sua microarquitetura. Corroborando com esse resultado houve diminuição da proliferação dos osteoblastos dos pacientes quando comparados a controles (n=5) doadores de órgãos. Análise bioquímica revelou correlação negativa da 25(OH)D3 com a proteinúria e positiva com a proliferação dos osteoblastos em culturaThe objective of this study was to analyze bone metabolism in proteinuria glomerular patients not having previously used drugs affecting bone metabolism. Seventeen patients were studied with histomorphometric analysis of bone biopsies and bone fragments were obtained for cell culture (n = 13), in which we evaluated osteoblastic proliferation. Comparing patients to controls of literature indicate reduced bone remodeling and altered bone microarchitecture. In corroboration, mean osteoblast proliferation was lower in patient samples when compared with those for normal osteoblasts obtained from age-matched, gender-matched donor organs (n = 5). Concentrations of 25-hydroxyvitamin-D3 correlated negatively with proteinuria and positively with osteoblast proliferation in cultur

Microalbuminúria em população não diabética como marcador precoce de nefropatia

Resumo Introdução: Anos antes da evolução para diabetes mellitus tipo II, o paciente pode conviver com um período chamado pré-diabetes. A patogênese envolvida no pré-diabetes é a resistência à insulina. Objetivo: Discutir a frequência de microalbuminúria em população não diabética, porém com risco metabólico aumentado, e avaliar a existência de correlação da microalbuminúria com dados do metabolismo glicídico. Métodos: Foram incluídos no estudo 132 pacientes não diabéticos que apresentassem um ou mais fatores de risco para alteração do metabolismo glicídico: hipertensão arterial; obesidade; parentes em primeiro grau com diabetes; indivíduos das etnias hispano-americanas, asiáticas e afro-americanas; mães de recém-nascidos grandes para a idade gestacional (GIG) ou que apresentaram diabetes gestacional; dosagens séricas em jejum de HDL colesterol 250 mg/dL. Resultados: A frequência de microalbuminúria anormal para o método ocorreu em 16%, havendo presença de menores valores de HDL-colesterol e clearance de creatinina nessa mesma população. Considerando a amostra como um todo houve correlação positiva da microalbuminúria com a creatinina sérica e com o ácido úrico. Conclusão: Nosso estudo sugere que a microalbuminúria seja avaliada como marcador de nefropatia incipiente em população não diabética com risco metabólico aumentado

Acute Kidney Injury after Cardiac Surgery in Patients Without Chronic Kidney Disease

Abstract Introduction: Among patients undergoing cardiac surgery, the occurrence of acute renal injury appears to be associated with worse prognosis and increased mortality. The objective of this study was to evaluate risk factors and the impact this complication on mortality and survival after cardiac surgery among patients without chronic kidney disease. Methods: In this retrospective study, we reviewed the medical records of 142 patients who underwent elective coronary artery bypass grafting, valve replacement (single or multiple), or both (simultaneously) at a tertiary care hospital. Results: Among the 142 patients evaluated, the mean age was 58.28±13.87 years and 80 (56.33%) were female. The postoperative incidence of acute renal injury was 43.66%. Univariate analysis between the groups with and without acute renal injury revealed no significant differences, whereas multivariate analysis showed that risk factors for acute renal injury included valve replacement (OR=4.7, P=0.002, 95% CI=1.76-12.62, age (OR=1.044, P=0.012, 95% CI=1.01-1.07), previous cardiac surgery (OR=36.1, P=0.015, 95% CI=1.99-653.85), postoperative use of the vasoactive drug norepinephrine (OR=3.32, P=0.013, 95% CI=1.29-8.58) and dobutamine (OR=5.3, P=0.019, 95% CI=1.32-21.64). In our sample, there were 30 deaths, of which 25 had acute kidney injury. Survival was also lower among the patients with this complication, especially those who had required hemodialysis (OR=2.60, P<0.001, 95% CI=1.01-6.70) or had previously undergone cardiac surgery (OR=3.68, P<0.001, 95% CI=1.09-12.37). Conclusion: Our findings underscore the importance of identifying risk factors for developing acute renal injury after cardiac surgery, which can further the development of effective renoprotective strategies

Correlation of anthropometric indicators for identifying insulin sensitivity and resistance

CONTEXT AND OBJECTIVES: Early detection of reduced insulin sensitivity (IS) and insulin resistance (IR) is desirable. The aim here was to evaluate correlations of anthropometric indicators for identifying IR or IS and determine the cutoff points of the most effective indicators. DESIGN AND SETTING: Cross-sectional study in the city of São Paulo. METHODS: Sixty-one individuals with normal fasting plasma glucose (NFPG) and 43 overweight women were analyzed. Body mass index (BMI), waist circumference (WC), waist-to-hip ratio, waist-to-height ratio (WHtR), conicity index and the HOMA-IS and HOMA-IR indices were determined. The correlations between the anthropometric indices and IS and IR were determined. ROC analysis was used to determine the areas under the curve (AUC) and cutoff points. RESULTS: Among the NFPG individuals, BMI (r = -0.50; P = 0.002) and WHtR (r = -0.45; P = 0.007) showed correlations with HOMA-IS (homeostasis model assessment of insulin sensitivity). The ROC curve demonstrated statistical significance for BMI (AUC = 0.769; P = 0.005), WHtR (AUC = 0.764; P = 0.01) and WC (AUC = 0.702; P = 0.04), and the best cutoff points were 33.3 kg/m², 0.67 and 100 cm, respectively. Among the overweight women, the best correlation with HOMA-IR was demonstrated by WHtR (r = 0.37; P = 0.01), and the best cutoff point was 0.70 (AUC = 0.61; P = 0.25). CONCLUSION: The most promising indicators for showing IS among the NFPG individuals were BMI, WHtR and WC. Among the overweight women, WHtR demonstrated greater correlation with I