Prevalence and Risk Factors Associated to Chronic Kidney Disease in HIV-Infected Patients on HAART and Undetectable Viral Load in Brazil

BACKGROUND: To determine the prevalence and associated factors with chronic kidney disease (CKD) in a cohort of HIV-positive individuals with undetectable viral load on HAART. METHODS: From March, 2009 to September 2009, 213 individuals between 18-70 years, period on HAART ≥12 months, viral load < 50 copies/mm(3), and CD4 ≥ 200 cells/mm(3), were consecutively enrolled at the outpatient clinic of Hospital de Clínicas, Porto Alegre, Brazil. Exclusion criteria were obesity, malnourishment, amputee, paraplegic, previous history of renal disease, pregnancy and hepatic insufficiency. Renal function was determined by estimated glomerular filtration rate (eGFR) assessed by the modification of diet in renal disease. CKD was defined as an eGFR less or equal than 60 ml/min/1.73 m(2), for a period of at least 3 months. Poisson regression was used to determine factors associated with CKD. RESULTS: CKD was diagnosed in 8.4% of the population, and after adjustment, the risk factors were hypertension (RR = 3.88, 95%CI, 1.84-8.16), time on HAART (RR = 1.15, 95%CI,1.03-1.27) and tenofovir exposure (RR = 2.25, 95%CI, 1.04-4.95). Higher weight (RR = 0.88 95%CI, 0.82-0.96) was associated to normal function. CONCLUSIONS: CKD was a common finding in this cohort of patients and was related to hypertension, time on HAART and tenofovir exposure. We suggest a more frequent monitoring of renal function, especially for those with risk factors to early identify renal impairment

Uso endodontico do formocresol em permanentes jovens. Revisão bibliográfica

A presente revisão bibliográfica visa trazer um pouco de luz às controvérsias que existem quanto ao emprego do FORMOCRESOL em dentes permanentes jovens. Vale salientar que o referido medicamento é o mesmo que se tem usado com alguma freqüência em pulpotomias em dentes temporários. Este trabalho tem também por objetivo esclarecer a confusão existente entre o uso do FORMOCRESOL (Tri cresol formalina) de Buckley e o FORMOCRESOL de Berge

Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42\ub74% vs 44\ub72%; absolute difference \u20131\ub769 [\u20139\ub758 to 6\ub711] p=0\ub767; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5\u20138] vs 6 [5\u20138] cm H2O; p=0\ub70011). ICU mortality was higher in MICs than in HICs (30\ub75% vs 19\ub79%; p=0\ub70004; adjusted effect 16\ub741% [95% CI 9\ub752\u201323\ub752]; p&lt;0\ub70001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0\ub780 [95% CI 0\ub775\u20130\ub786]; p&lt;0\ub70001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status. Funding: No funding

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine

[This corrects the article DOI: 10.1186/s13054-016-1208-6.]

Bland-Altman graph comparing MDRD and CKD-epi in individuals with chronic kidney disease.

<p>There was a concordance in eGFR between the MDRD and CKD-epi equations in individuals with chronic kidney disease (the mean difference was 0.41±1.90 ml). eGFR  =  estimated glomerular filtration rate; MDRD  =  modified diet in renal disease; CKD-epi  =  chronic kidney disease epidemiology.</p

Tailoring the properties of quantum dot-micropillars by ultrafast optical injection of free charge carriers

We review recent studies of cavity switching induced by the optical injection of free carriers in micropillar cavities containing quantum dots. Using the quantum dots as a broadband internal light source and a streak camera as detector, we track the resonance frequencies for a large set of modes with picosecond time resolution. We report a record-fast switch-on time constant (1.5 ps) and observe major transient modifications of the modal structure of the micropillar on the 10 ps time scale: mode crossings are induced by a focused symmetric injection of free carriers, while a lifting of several mode degeneracies is observed when off-axis injection breaks the rotational symmetry of the micropillar. We show theoretically and experimentally that cavity switching can be used to tailor the dynamic properties of the coupled QD–cavity system. We report the generation of ultrashort spontaneous emission pulses (as short as 6 ps duration) by a collection of frequency-selected QDs in a switched pillar microcavity. These pulses display a very small coherence length, attractive for ultrafast speckle-free imaging. Moreover, the control of QD-mode coupling on the 10 ps time scale establishes cavity switching as an appealing resource for quantum photonics

Main demographic characteristics (data are presented as mean ± standard deviation or percentage).

a<p>Estimated glomerular filtration rate,</p>b<p>Antiretroviral therapy</p

Risk factors associated to alteration in the renal function (eGFR < 60 ml/min per 1.73 m² by MDRD); univariate and multivariate analysis.

<p>CKD defined as confirmed (persisting for ≤ 3 months) decrease in eGFR to 60 ml/min per 1.73m² by MDRD or the presence of proteinuria independent of eGFR. CI, confidence interval; RR, risk ratio; eGFR, estimated glomerular filtration rate. All variables significant in univariate analyses (P<0.05) were included in multivariate model. All variables with P<0.1 in the multivariate analysis (data not shown) were included in the final model</p