Kidney involvement in malaria: an update

Malaria is an infectious disease of great importance for Public Health, as it is the most prevalent endemic disease in the world, affecting millions of people living in tropical areas of the globe. Kidney involvement is relatively frequent in infections by P. falciparum and P. malariae, but has also been described in the infection by P. vivax. Kidney complications in malaria mainly occur due to hemodynamic dysfunction and immune response. Liver complications leading to hepatomegaly, jaundice and hepatic dysfunction can also contribute to the occurrence of acute kidney injury. Histologic studies in malaria also evidence glomerulonephritis, acute tubular necrosis and acute interstitial nephritis. It is also possible to find chronic kidney disease associated with malaria, mainly in those patients suffering from repeated episodes of infection. Plasmodium antigens have already been detected in the glomeruli, suggesting a direct effect of the parasite in the kidney, which can trigger an inflammatory process leading to different types of glomerulonephritis. Clinical manifestations of kidney involvement in malaria include proteinuria, microalbuminuria and urinary casts, reported in 20 to 50% of cases. Nephrotic syndrome has also been described in the infection by P. falciparum, but it is rare. This paper highlights the main aspects of kidney involvement in malaria and important findings of the most recent research addressing this issue

Is early HIV infection diagnosis at a reference center a reality in the state of Ceara?

Abstract INTRODUCTION: Early diagnosis of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) can decrease transmission and significantly affect morbidity and mortality; however, Brazil still confronts the reality of late HIV diagnosis. METHODS: Medical records of 284 HIV-positive patients were reviewed in this cross-sectional study. RESULTS: Of all patients, 28% were diagnosed in the context of health assessments, whereas 27% were symptomatic at diagnosis. Early HIV infection (Group 1) was diagnosed in 60.2% of participants. They were younger than those with late diagnosis (Group 2) (p = 0.002). CONCLUSIONS: These findings highlight the need for strategies to increase HIV testing in asymptomatic individuals and older patients

Kyrle's disease associated with HIV infection, diabetes, and chronic kidney disease

Kyrle's disease (KD) is a rare skin pathology characterized by transepidermal elimination of abnormal keratin. The aim of this article is to report a rare case of KD associated with diabetes mellitus, chronic kidney disease, and HIV. A 51-year-old male patient complained of diarrhea for 8 months. He was submitted to HIV testing, which showed a positive result. He started antiretroviral therapy with zidovudine, lamivudine, and lopinavir. The diagnostic investigation was negative for opportunistic diseases. After 2 months, skin lesions started appearing, characterized by hyperchromic, pruritic macules and papules distributed in the trunk, back, and upper limbs. He also developed erythematous, scaly lesions in the facial region. A biopsy of the skin was performed, of which histopathological report consisted of perforating disorder, favoring a diagnosis of KD. Treatment with keratolytic soap (Actine) was started, with skin lesion improvement. In this reported case, it is possible that, in addition to diabetes and renal failure, HIV infection played an important role in the genesis of the lesions

Apoio familiar na compreensão do diagnóstico e empoderamento de homens com diabetes mellitus

Objetivo: Identificar como ocorre o empoderamento dos homens com diabetes mellitus para autogestão de sua condição crônica, além de compreender suas motivações e barreiras para realizar o autocuidado. Métodos: Estudo descritivo com referencial qualitativo realizado em 2017, tendo como cenário da pesquisa uma unidade de referência secundária para o atendimento interprofissional da população masculina com diabetes mellitus, situada em Fortaleza, Ceará, Brasil, através de entrevista aberta. Resultados: A análise dos dados empíricos ocorreu por categorização temática e possibilitou a construção de dois temas: motivações para busca de assistência profissional e apoio familiar como suporte para o empoderamento do autocuidado. Evidenciou-se a procura por ajuda profissional ao inicio dos sinais e sintomas da doença e apoio familiar como suporte e envolvimento para o controle metabólico e bem-estar, ajudando-os no tratamento. Identificou-se dificuldade e restrição em expressar sentimentos em relação a doença, para esconder sua vulnerabilidade. Conclusão: Pode-se inferir que os entrevistados procuram ajuda profissional, mas resistem participar de grupo de autoajuda e destacou-se o envolvimento e o apoio da família como fundamentais para o progresso do tratamento e empoderamento do autocuidado

Acute kidney injury in leptospirosis: Overview and perspectives

Leptospirosis is a bacterial disease disseminated through the centuries in the whole world which causes symptoms that go from self-limited diseases to hemorrhagic manifestations and organ failure, including acute kidney injury (AKI), composing the severe disease known as the Weil's syndrome. Mortality rates varies according to the clinical presentation and usually increases when kidney injury is present, and is even higher in the setting of pulmonary hemorrhage. There are recent advances in the search for novel biomarkers of renal involvement and early detection of AKI in leptospirosis, as well as in its pathophysiology. We review in this article the clinical aspects of leptospirosis-associated AKI and the perspectives for future research

Implementation of a Brazilian Cardioprotective Nutritional (BALANCE) Program for improvement on quality of diet and secondary prevention of cardiovascular events: A randomized, multicenter trial

Background: Appropriate dietary recommendations represent a key part of secondary prevention in cardiovascular disease (CVD). We evaluated the effectiveness of the implementation of a nutritional program on quality of diet, cardiovascular events, and death in patients with established CVD. Methods: In this open-label, multicenter trial conducted in 35 sites in Brazil, we randomly assigned (1:1) patients aged 45 years or older to receive either the BALANCE Program (experimental group) or conventional nutrition advice (control group). The BALANCE Program included a unique nutritional education strategy to implement recommendations from guidelines, adapted to the use of affordable and regional foods. Adherence to diet was evaluated by the modified Alternative Healthy Eating Index. The primary end point was a composite of all-cause mortality, cardiovascular death, cardiac arrest, myocardial infarction, stroke, myocardial revascularization, amputation, or hospitalization for unstable angina. Secondary end points included biochemical and anthropometric data, and blood pressure levels. Results: From March 5, 2013, to Abril 7, 2015, a total of 2534 eligible patients were randomly assigned to either the BALANCE Program group (n = 1,266) or the control group (n = 1,268) and were followed up for a median of 3.5 years. In total, 235 (9.3%) participants had been lost to follow-up. After 3 years of follow-up, mean modified Alternative Healthy Eating Index (scale 0-70) was only slightly higher in the BALANCE group versus the control group (26.2 ± 8.4 vs 24.7 ± 8.6, P <.01), mainly due to a 0.5-serving/d greater intake of fruits and of vegetables in the BALANCE group. Primary end point events occurred in 236 participants (18.8%) in the BALANCE group and in 207 participants (16.4%) in the control group (hazard ratio, 1.15; 95% CI 0.95-1.38; P =.15). Secondary end points did not differ between groups after follow-up. Conclusions: The BALANCE Program only slightly improved adherence to a healthy diet in patients with established CVD and had no significant effect on the incidence of cardiovascular events or death. © 2019 The Author