Positive fluid balance as an early biomarker for acute kidney injury: a prospective study in critically ill adult patients

OBJECTIVES: Positive fluid balance is frequent in critically ill patients and has been considered a potential biomarker for acute kidney injury (AKI). This study aimed to evaluate positive fluid balance as a biomarker for the early detection of AKI in critically ill patients. METHODS: This was a prospective cohort study. The sample was composed of patients X18 years old who stayed X3 days in an intensive care unit. Fluid balance, urinary output and serum creatinine were assessed daily. AKI was diagnosed by the Kidney Disease Improving Global Outcome criteria. RESULTS: The final cohort was composed of 233 patients. AKI occurred in 92 patients (40%) after a median of 3 (2-6) days following ICU admission. When fluid balance was assessed as a continuous variable, a 100-ml increase in fluid balance was independently associated with a 4% increase in the odds of AKI (OR 1.04; 95% CI 1.01-1.08). Positive fluid balance categorized using different thresholds was always significantly associated with subsequent detection of AKI. The mixed effects model showed that increased fluid balance preceded AKI by 4 to 6 days. CONCLUSION: These results suggest that a positive fluid balance might be an early biomarker for AKI development in critically ill patients

Aging and decreased glomerular filtration rate: An elderly population-based study

<div><p>Background</p><p>Although a reduced glomerular filtration rate (GFR) in old people has been attributed to physiologic aging, it may be associated with kidney disease or superimposed comorbidities. This study aims to assess the prevalence of decreased GFR in a geriatric population in a developing country and its prevalence in the absence of simultaneous diseases.</p><p>Study design and methods</p><p>This is a cross-sectional study of data from the Saúde, Bem-Estar e Envelhecimento cohort study (SABE study[Health, Well-Being and Aging]), a multiple cohorts study. A multistage cluster sample composed of 1,253 individuals representative of 1,249,388 inhabitants of São Paulo city aged ≥60 years in 2010 was analyzed. The participants answered a survey on socio-demographic factors and health, had blood pressure measured and urine and blood samples collected. GFR was estimated and defined as decreased when <60 mL/min/1.73m². Kidney damage was defined as dipstick-positive hematuria or urinary protein:creatinine > 0.20 g/g.</p><p>Results</p><p>The prevalence of GFR <60 mL/min/1.73m² was 19.3%. Individuals with GFR <60 mL/min/1.73m² were older (75±1 versus 69±1 years, p<0.001), had lower schooling (18 versus 30% with complete 8-year basic cycle, p = 0.010), and higher prevalence of hypertension (82 versus 63%, p<0.001), diabetes (34 versus 26%, p = 0.021), cardiovascular disease (43 versus 24%, p<0.001) and kidney damage (35% versus 15%, p<0.001). Only 0.7% of the entire studied population had GFR <60 mL/min/1.73m² without simultaneous diseases or kidney damage. Among the individuals with GFR <60 mL/min/1.73m², 3.5% had neither renal damage nor associated comorbidities, whereas among those with GFR ≥60 mL/min/1.73m², 11.0% had none of these conditions. Logistic regression showed that older age, cardiovascular disease and hypertension were associated with GFR<60 mL/min/1.73m².</p><p>Conclusions</p><p>Decreased GFR was highly prevalent among the geriatric population in a megalopolis of a developing country. It was rarely present without simultaneous chronic comorbidities or kidney damage.</p></div

Characteristics of the total population and those with GFR < 60 mL/min/1.73 m² and with GFR ≥ 60 mL/min/1.73 m².

<p>Characteristics of the total population and those with GFR < 60 mL/min/1.73 m² and with GFR ≥ 60 mL/min/1.73 m².</p

Association of age and presence of comorbidities with the finding of a decreased GFR.

<p>Association of age and presence of comorbidities with the finding of a decreased GFR.</p

The prevalence of hypertension, diabetes, metabolic syndrome, cardiovascular disease and decreased GFR according to the following age groups: 60–69, 70–79 and ≥80 years.

<p>Data were weighted to be representative of the elderly population of São Paulo based on the 2010 Census in Brazil. Data are presented as weighed percentages. Hypertension: self-reported or the mean of three measurements of arterial blood pressure >140/90 mmHg. Diabetes mellitus: self-reported or a fasting plasma glucose ≥126 mg/dL or a glycohemoglobin ≥6.5%. Metabolic syndrome: presence of at least three of the following criteria: a waist circumference ≥90 cm for men or ≥80 cm for women, triglycerides ≥150 mg/dL, an HDL cholesterol ≤40 mg/dL for males or ≤50 mg/dL for females, a systolic blood pressure ≥130 mm Hg or a diastolic blood pressure ≥85 mmHg and a fasting plasma glucose ≥100 mg/dL. Cardiovascular disease: self-reported. None: absence of hypertension, diabetes, metabolic syndrome or cardiovascular disease. Decreased GFR defined as GFR <60 mL/min/1.73 m².</p

Violência doméstica contra crianças e adolescentes: estudo de um programa de intervenção Domestic violence against children and adolescents: a supporting program study

Este estudo apresenta características gerais de famílias nas quais houve a ocorrência de violência doméstica contra crianças, e avalia os resultados de seu acompanhamento pelo Centro Regional de Atenção aos Maus-Tratos na Infância (CRAMI-Rio Preto). Foram entrevistadas cinqüenta e cinco famílias, que responderam um questionário estruturado. A forma de violência mais prevalente foi a física, presente em 58% dos casos. Sessenta por cento das vítimas são do sexo feminino, e a mãe é agressora em 49% das situações analisadas. Os principais fatores desencadeantes da violência, identificados pelas famílias, são conflitos do casal (58%), características próprias da criança (51%) e histórico de vida dos pais (49%). A maioria das famílias (80%) acredita que a intervenção proporcionou interrupção ou diminuição na intensidade da violência e a forma de acompanhamento que mais houve adesão dos pais foi por meio das visitas domiciliares. Observa-se que a intervenção junto dessas famílias pode ter resultados satisfatórios, desde que a violência possa ser compreendida em seus vários aspectos, ou seja, um sintoma presente no grupo familiar modelado por dificuldades de diferentes naturezas: cultural, social, econômica e das relações interpessoais.<br>This study presents general characteristcs of families in which there was the occurrence of violence against the child as well as to evaluate the results of a supporting program made by the Centro Regional de Atenção aos Maus-Tratos na Infância (CRAMI) for these families. Fifty-five families were interviewed, and a structured questionnaire was used. Among the families, the most prevalent type of violence was physical (58%). Sixty percent of the victims were females, and the mother was the main batterer (49%). Some factors to start committing the violence included: conflicts between the couple (58%); the child's own characteristics (51%) and the parent's life history (49%). The majority of families (80%) believes that this supporting program has provided them decreasing the intensity even interruption of the violence. At-home visits was the most useful way for the parent's compliance to the program. This supporting programs can provide these families better results as long as violence is understood in its different aspects; that is, a present symptom in the family group shaped by several difficulties such as cultural, social, economic, and of relationship among the members

Hepatite C em profissionais da saúde: prevalência e associação com fatores de risco Hepatitis C in health care professionals: prevalence and association with risk factors

OBJETIVO: Avaliar a prevalência do vírus da hepatite entre profissionais da área da saúde e analisar fatores de risco. MÉTODOS: O estudo foi realizado em hospital universitário no município de São José do Rio Preto, SP, de janeiro 1994 a dezembro 1999. Participaram do estudo 1.433 profissionais da área da saúde, 872 funcionários da área administrativa e 2.583 candidatos a doador de sangue. Os dados foram coletados durante exames admissionais, periódicos e após acidentes de trabalho. Informações ocupacionais e não-ocupacionais foram obtidas por meio de questionário. Foram utilizados os testes qui-quadrado, Kruskal-Wallis e análise por regressão logística. RESULTADOS: A prevalência do vírus da hepatite entre os profissionais da saúde (1,7%) foi significativamente maior que nos funcionários administrativos (0,5%; p=0,007) e em candidatos a doadores (0,2%; p=0,001). Entre fatores ocupacionais, o tempo de serviço dos profissionais da saúde com sorologia positiva foi significativamente maior (p=0,016) que naqueles com sorologia negativa. A análise de regressão múltipla revelou que a cada cinco anos na idade, o risco aumenta em 50%. Houve associação significativa entre transfusão de sangue e profissionais de saúde com sorologia positiva. CONCLUSÕES: Profissionais da saúde apresentaram maior prevalência de vírus da hepatite que os profissionais administrativos e candidatos a doador. Naqueles com sorologia positiva, fatores ocupacionais e não-ocupacionais de maior risco foram idade, tempo de serviço e transfusão de sangue.<br>OBJECTIVE: To evaluate the prevalence and risk factors for hepatitis C virus infection among health care professionals. METHODS: The study was carried out at a university hospital in the municipality of São José do Rio Preto, Southeastern Brazil, between January 1994 and December 1999. There were included 1,433 health care professionals, 872 administrative workers, and 2,583 blood donor candidates. Data were collected during admission examinations, periodic screenings, and after occupational accidents. Occupational and non-occupational information was obtained by means of a questionnaire. Data were analyzed using Chi-square and Kruskal-Wallis tests and logistic regression analysis. RESULTS: Prevalence of hepatitis C infection among health care professionals (1.7%) was significantly higher than among administrative workers (0.5%; p=0.007) and blood donor candidates (0.2%; p=0.001). Regarding occupational factors, time in the job was significantly longer (p=0.016) among health care professionals with positive serology than among those with negative serology. Multiple regression analysis showed a 50% increase in risk for every five years of age. There was a significant association between blood transfusion and positive serology among health care workers. CONCLUSIONS: Health care professionals show greater prevalence of hepatitis C than administrative workers and blood donation candidates. Among those with positive serology, occupational and non-occupational factors of greatest risk were age, time in the job, and blood transfusion

Urban prevalence of epilepsy: populational study in São José do Rio Preto, a medium-sized city in Brazil Prevalência urbana da epilepsia: estudo populacional em São José do Rio Preto - cidade de médio porte do Brasil

The aim of this study was to determine the prevalence of epilepsy in the urban population of São José do Rio Preto. This is a medium-sized city of 336000 inhabitants, located in the northwest of the state of São Paulo, Brazil. METHOD: A crosssectional epidemiological investigation with a randomized sample was performed in two phases, a screening phase and a confirmation of the diagnosis phase. The gold standard was a clinical investigation and neurological examination. The chi-square test was used in analysis of the results and p-value value < 0.05 was considered significant. Prevalence was calculated with 95% confidence interval. RESULTS: The study sample size was 17293 individuals, with distributions of gender, age, and race similar to the general population. The prevalence per 1000 inhabitants of epilepsy was 18.6, of these 8.2 were active, defined as at least one seizure within the last two years. The prevalence per 1000 inhabitants for the age groups (years) was 4.9 (04), 11.7 (514), 20.3 (1564) and 32.8 (65 or over). CONCLUSION: Prevalence of both accumulated and active epilepsy was elevated, comparable to other developing nations, in particular those of Latin America. However, the prevalence of epilepsy in childhood was low, whilst in aged individuals it was high similar to industrialized nations.<br>ANTECEDENTES: O objetivo deste estudo foi determinar a prevalência da epilepsia na população urbana de São José do Rio Preto, com 336000 habitantes, localizada no noroeste do Estado de São Paulo/ Brasil. MÉTODO: O estudo populacional, tipo corte transversal, em amostra aleatória, constituiuse de uma fase de rastreamento, mediante um questionário. O padrão ouro para confirmação diagnóstica foi a história clínica e o exame neurológico. Os testes do c² e intervalo de confiança de 95% (IC95%) foram usados para análise dos resultados, tendo sido considerados significantes os de valor p< 0,05. RESULTADOS: A amostra estudada foi de 17293 pessoas, cuja distribuição quanto ao sexo, à faixa etária e à raça foram semelhantes à da população em geral. A prevalência de epilepsia por 1000 hab. foi 18,6, sendo 8,2 para ativa considerandose, pelo menos, uma crise no período dos últimos 2 anos. A prevalência na faixa etária de 0 a 4 anos foi 4,9, de 5 a 14, 11,7; de 15 a 64, 20,3; e acima dos 65 anos foi 32,8. CONCLUSÃO: As prevalências de epilepsia acumulada e ativa foram elevadas, semelhantes às dos países em desenvolvimento, em particular, aos da América Latina. A prevalência de epilepsia na infância foi baixa, enquanto que nos idosos foi elevada, semelhantes às observadas em países desenvolvidos. Estes resultados são relevantes no planejamento de medidas sanitárias, adequação ao tratamento da população, considerando a alta prevalência encontrada, para minimizar o impacto da epilepsia na população