Estudo morfológico e das classificaçoes das glomerulonefrites no Lupus eritematoso sistemico em nefrite lúpica subclínica

Orientador : José Ederaldo Queiroz TellesDissertaçao (mestrado) - Universidade Federal do Paraná, Setor de Ciencias Biológicas, Programa de Pós-Graduaçao em Ciencias Biológicas (Microbiologia, Parasitologia e Patologia Básica). Defesa: Curitiba, 2005Inclui bibliografiaResumo: O lupus eritematoso sistêmico (LES) é doença autoimune e multissistêmica de apresentação variável. O envolvimento renal clinicamente aparente pelo lupus eritematoso sistêmico (LES) ocorre em 40 a 75% dos pacientes. Entretanto, alterações histológicas renais são observadas em até 90-100% dos pacientes. Define- se como nefrite lúpica subclínica o encontro de anormalidades histológicas renais em pacientes livres de comprometimento clínico-laboratorial. Nesses pacientes, a descrição dos achados anatomopatológicos e a correlação clínico-laboratorial são pobres e inconsistentes. A fim de caracterizar as lesões renais nesse grupo de pacientes, e avaliar o papel da biópsia renal e das técnicas histológicas atualmente disponíveis, foram avaliados 25 indivíduos portadores de LES sem evidências de comprometimento renal clínico ou laboratorial, em acompanhamento no Hospital de Clínicas da Universidade Federal do Paraná. Observou-se anormalidades histológicas à microscopia óptica em 68% dos casos, à microscopia de imunofluorescência em 88% dos casos e à microscopia eletrônica em 40% dos casos. A maior parte dos pacientes apresentou lesões categorizáveis nas classes II e V da classificação da OMS modificada, nas classes Ib, II e V da classificação da OMS, 1995 e nas classes I, II e V da classificação proposta pela Sociedade Internacional de Nefrologia e Sociedade de Patologia Renal (ISN/RPS), 2003. A combinação das técnicas de microscopia óptica, eletrônica e de imunofluorescência resultou em 100% de sensibilidade e valor preditivo negativo. Contudo, os achados anatomopatológicos isoladamente não são capazes de prever o curso da doença, sendo a indicação de biópsia discutível e devendo ser orientada por estudos funcionais, avaliação laboratorial e acompanhamento clínico cuidadosoAbstract: Systemic lupus erithematosus (SLE) is a multisystem autoimmune disease of variable presentation. Overt renal disease occurs in 40 a 75% of the patients. However renal histological abnormalities may be observed in up to 90-100% of the patients. Subclinical lupus nephritis is defined as the finding of renal histological abnormalities in patients free from clinical and laboratorial evidence of renal involvement. In this group of patients the description of the pathological abnormalities and their correlation with the clinical and laboratorial findings are inconsistent and poor. Twenty five renal biopsies of patients with subclinical lupus nephritis were analised in order to characterize the renal lesions and assess the role of the renal biopsy and the available histological techniques. Light microscopy (LM) revealed abnormalities in 68% of the cases; immunofluorescence microscopy (IF) revealed immunocomplex deposits in 88% of the cases and ultrastructural abnormalities were present in 40% of the cases. Most patients had lesions classifiable as classes II e V of WHO, modified classification scheme, classes Ib, II e V of WHO, 1995 classification scheme and classes I, II e V of the proposed ISN/RPS, 2003 classification scheme. The combination of the findings of LM,EM and IF yielded 100% sensitiviy and negative predictive value. Nevertheless pathological findings cannot isolatedly predict the course of the disease. Thus the indication of biopsy in this group of patients remains questionable and must rely on laboratory and functional studies and on careful follow up

Renal transplant pathology: main morphological findings and how to sign out biopsies

Renal transplant has reached remarkable and growing rates of success since its introduction; nowadays it is a widely used replacement therapy. Renal allograft biopsies are increasingly more frequent in the routine of pathology laboratories, whose histological findings are varied. This paper results from the expertise of the members of the Kidney Club of Sociedade Brasileira de Patologia, and presents a general overview of renal allograft pathology, focusing on the current Banff classification, its main categories and cases of difficult diagnosis.O transplante renal alcançou expressivos e crescentes índices de sucesso desde sua implantação, constituindo atualmente uma terapia substitutiva de larga escala. É cada vez mais freqüente o encontro de biópsias de enxerto renal na rotina dos laboratórios de patologia, cujos achados são os mais variados. Este artigo resulta da experiência dos membros do Clube do Rim (da Sociedade Brasileira de Patologia) e apresenta um panorama geral da patologia do transplante renal, enfatizando a atual classificação de Banff, com suas principais categorias e entidades de diagnóstico problemático.Universidade Metropolitana de SantosCentro Universitário LusíadasUniversidade de São PauloUniversidade Federal de São Paulo (UNIFESP) Departamento de PatologiaIrmandade da Santa Casa de Misericórdia de Porto AlegreSalomão & Zoppi Medicina DiagnósticaUniversidade Federal do Rio Grande do Sul Faculdade de Medicina Departamento de PatologiaUniversidade Federal Fluminense Faculdade de Medicina Centro de Ciências MédicasUNIFESP, Depto. de PatologiaSciEL

Electroacupuncture and Moxibustion Decrease Renal Sympathetic Nerve Activity and Retard Progression of Renal Disease in Rats

Background/Aim: Chronic kidney disease (CKD) is an increasing major public health problem worldwide. the sympathetic nervous system and nitric oxide play an important role in the pathogenesis of CKD. Traditional Chinese medicine has accumulated thousands of years of therapeutic experiences. Electroacupuncture (EA) and moxibustion (MO) are two such therapeutic strategies. the aim of this study was to investigate the renal and hemodynamic effects of EA-MO in an experimental model of a CKD. Methods: Male Wistar rats submitted to 5/6th nephrectomy (5/6 NX) were studied for 8 weeks. There were four groups: (1) control, normal rats; (2) NX, 5/6 NX only; (3) NX-AS, 5/6 NX and EA-MO session using sham points, and (4) NX-AM, 5/6 NX and EA-MO session using real acupoints. Biochemical and blood pressure studies, renal sympathetic nerve activity measurements, nitric oxide levels and the histopathological indices were assessed. Results:The EA- and MO-treated group presented significant improvement in all measured functional and histopathological parameters. Conclusion: These findings suggest that EA-MO had beneficial effects on CKD. This effect was probably achieved by the modulation of the renal sympathetic nerve activity and nitric oxide levels, leading to decreased blood pressure, which is associated with less proteinuria. Copyright (c) 2012 S. Karger AG, BaselConselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Fed Univ São Paulo UNIFESP, Dept Med, Div Nephrol, São Paulo, BrazilFed Univ São Paulo UNIFESP, Dept Physiol, Cardiovasc Physiol Div, São Paulo, BrazilFed Univ São Paulo UNIFESP, Dept Pathol, São Paulo, BrazilFed Univ São Paulo UNIFESP, Chinese Med & Acupuncture Div, Dept Orthoped & Traumatol, São Paulo, BrazilFed Univ São Paulo UNIFESP, Dept Med, Div Nephrol, São Paulo, BrazilFed Univ São Paulo UNIFESP, Dept Physiol, Cardiovasc Physiol Div, São Paulo, BrazilFed Univ São Paulo UNIFESP, Dept Pathol, São Paulo, BrazilFed Univ São Paulo UNIFESP, Chinese Med & Acupuncture Div, Dept Orthoped & Traumatol, São Paulo, BrazilWeb of Scienc

PROFESSORS' VIEW ON THE LEARNING POSSIBILITIES OF NURSING AND MEDICINE STUDENTS FROM THE EXPERIENCE IN PROFESSIONAL PRACTICE AND ENCOUNTERED CHALLENGES

O desafio da formação dos profissionais da saúde no Brasil aponta para o compromisso político tanto com a educação quanto com a sociedade, já que requer, além das habilidades técnicas, aperfeiçoamento no processo intra e interpessoal, como apontam as Diretrizes Curriculares Nacionais. O objetivo deste artigo é compreender a percepção docente sobre a aprendizagem dos estudantes dos cursos de enfermagem e medicina inseridos na Estratégia da Saúde de Família e identificar os fatores relacionados ao processo de trabalho docente na metodologia ativa de aprendizagem. A metodologia se deu por pesquisa fundamentada nos pressupostos da Hermenêutica-Dialética. Participaram 10 docentes dos cursos de enfermagem e medicina que acompanham estudantes no cenário de prática profissional. Os dados foram obtidos por meio de entrevistas gravadas. Das análises, emergiram três núcleos de sentido: aprendizagem significativa e relevante; insegurança para o desenvolvimento da metodologia ativa e dificuldades no trabalho docente. Os docentes apontaram a importância do cenário real para aprendizagem e as incertezas e dificuldades do processo. Nesse sentido, esses resultados podem subsidiar mudanças requeridas no processo educacional.The challenge of training health professionals in Brazil points to the political commitment both to education and to society, as it requires, in addition to technical skills, improvement in the intra and interpersonal process as pointed out in the National Curricular Guidelines. The purpose of this article is to understand the Professors’ perception about the students’ learning of the Nursing and Medical courses included in the Family Health Strategy, and to identify the factors related to the teaching work process in the active learning methodology. This Research based on the presuppositions of Hermeneutics-Dialectics. Ten professors from the Nursing and Medicine courses that followed up students in the professional practice scenario participated of the research. The data were obtained through recorded interviews. From the analyses emerged three nuclei of meaning: Significant and relevant learning; Insecurity for the development of the active methodology and Difficulties in the teaching work. The teachers pointed out the importance of the real scenario for learning and the uncertainties and difficulties of the process. In this sense, these results can subsidize required changes in the educational process

Interceptions of quarantine and absent non‑regulated pests in imported plant material

O objetivo deste trabalho foi avaliar as informações qualitativas e quantitativas sobre as interceptações de pragas ausentes não regulamentadas e quarentenárias em material vegetal importado. As informações sobre interceptações de pragas pelo serviço de quarentena vegetal da Embrapa, no período de 1977 a 2013, foram obtidas em um banco de dados, atas laboratoriais e listas de interceptação publicadas. As interceptações foram analisadas de acordo com regulamentação das pragas, espécie vegetal, parte vegetal importada e origem. O material foi categorizado em sementes botânicas e material de propagação vegetativa. No período do levantamento, foram interceptadas 75 espécies de pragas em 114 eventos de interceptação. Fungos, vírus e ácaros constituem a maior parte das interceptações, e a maioria delas ocorreu em lírio, oliveira, trigo, uva, arroz, batata e maçã. A taxa média anual de infestação/infecção do material vegetal analisado é de 2% dos processos de importação. O material para propagação vegetativa apresentou maior taxa de infestação/infecção por pragas do que as sementes botânicas. Das espécies‑pragas interceptadas, 63% não são regulamentadas como quarentenárias para o Brasil. Esses resultados indicam a necessidade premente de revisão da atual lista de pragas quarentenárias do País.The objective of this work was to evaluate qualitative and quantitative information on interceptions of quarantine and absent non‑regulated pests in imported plant material. Information concerning pest interceptions by Embrapa’s plant quarantine service during the period of 1977–2013 was obtained from a database, laboratory reports, and published lists of intercepted pests. Data interceptions were evaluated according to pest regulations, plant species, imported plant parts, and origin of importation. The plant material was categorized as botanical seeds and plant material for vegetative propagation. In the survey period, 75 pest species were intercepted in 114 interception events. Fungi, viruses, and mites were the most intercepted ones, and most interceptions occurred in lily, olive, wheat, grapes, rice, potato, and apple. The average annual rate of infestation/infection of the evaluated plant material was 2% of the import processes. The material for vegetative propagation had a higher rate of infestation/infection with pests than botanical seeds. Of the intercepted pests species, 63% are not regulated as quarantine pests for Brazil. These results indicate the urgent need to review the current list of quarantine pests in the country

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to &lt;90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], &gt;300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of &lt;15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P&lt;0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P&lt;0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Estudo morfológico e das classificaçoes das glomerulonefrites no Lupus eritematoso sistemico em nefrite lúpica subclínica

Orientador : José Ederaldo Queiroz TellesDissertaçao (mestrado) - Universidade Federal do Paraná, Setor de Ciencias Biológicas, Programa de Pós-Graduaçao em Ciencias Biológicas (Microbiologia, Parasitologia e Patologia Básica). Defesa: Curitiba, 2005Inclui bibliografiaResumo: O lupus eritematoso sistêmico (LES) é doença autoimune e multissistêmica de apresentação variável. O envolvimento renal clinicamente aparente pelo lupus eritematoso sistêmico (LES) ocorre em 40 a 75% dos pacientes. Entretanto, alterações histológicas renais são observadas em até 90-100% dos pacientes. Define- se como nefrite lúpica subclínica o encontro de anormalidades histológicas renais em pacientes livres de comprometimento clínico-laboratorial. Nesses pacientes, a descrição dos achados anatomopatológicos e a correlação clínico-laboratorial são pobres e inconsistentes. A fim de caracterizar as lesões renais nesse grupo de pacientes, e avaliar o papel da biópsia renal e das técnicas histológicas atualmente disponíveis, foram avaliados 25 indivíduos portadores de LES sem evidências de comprometimento renal clínico ou laboratorial, em acompanhamento no Hospital de Clínicas da Universidade Federal do Paraná. Observou-se anormalidades histológicas à microscopia óptica em 68% dos casos, à microscopia de imunofluorescência em 88% dos casos e à microscopia eletrônica em 40% dos casos. A maior parte dos pacientes apresentou lesões categorizáveis nas classes II e V da classificação da OMS modificada, nas classes Ib, II e V da classificação da OMS, 1995 e nas classes I, II e V da classificação proposta pela Sociedade Internacional de Nefrologia e Sociedade de Patologia Renal (ISN/RPS), 2003. A combinação das técnicas de microscopia óptica, eletrônica e de imunofluorescência resultou em 100% de sensibilidade e valor preditivo negativo. Contudo, os achados anatomopatológicos isoladamente não são capazes de prever o curso da doença, sendo a indicação de biópsia discutível e devendo ser orientada por estudos funcionais, avaliação laboratorial e acompanhamento clínico cuidadosoAbstract: Systemic lupus erithematosus (SLE) is a multisystem autoimmune disease of variable presentation. Overt renal disease occurs in 40 a 75% of the patients. However renal histological abnormalities may be observed in up to 90-100% of the patients. Subclinical lupus nephritis is defined as the finding of renal histological abnormalities in patients free from clinical and laboratorial evidence of renal involvement. In this group of patients the description of the pathological abnormalities and their correlation with the clinical and laboratorial findings are inconsistent and poor. Twenty five renal biopsies of patients with subclinical lupus nephritis were analised in order to characterize the renal lesions and assess the role of the renal biopsy and the available histological techniques. Light microscopy (LM) revealed abnormalities in 68% of the cases; immunofluorescence microscopy (IF) revealed immunocomplex deposits in 88% of the cases and ultrastructural abnormalities were present in 40% of the cases. Most patients had lesions classifiable as classes II e V of WHO, modified classification scheme, classes Ib, II e V of WHO, 1995 classification scheme and classes I, II e V of the proposed ISN/RPS, 2003 classification scheme. The combination of the findings of LM,EM and IF yielded 100% sensitiviy and negative predictive value. Nevertheless pathological findings cannot isolatedly predict the course of the disease. Thus the indication of biopsy in this group of patients remains questionable and must rely on laboratory and functional studies and on careful follow up

Immunoexpression of inflammatory mediators and adhesion molecules in the study of the severe vascular lesions (v3) of renal transplant acute rejection

Objetives: Acute tubulo-interstitial and mild vascular rejection (Banff types I e IIA) are tipically T-cell mediated processes. Acute severe vascular rejection (Banff type III) however may be mediated by receptor antibodies directed to donor cells and is histologically characterized by transmural arteritis and/or fibrinoid necrosis of the vessel wall. It is still object of debate if transmural arteritis and fibrinoid necrosis are pathogenetically distinct entities. This study tries to shed some light over this question by analyzing the immunoexpression of adhesion molecules and the inflammatory cell immunophenotypic profile in renal allografts with type III rejection. Methods: Seventy explanted renal allografts with acute severe vascular rejection were analyzed. Vascular lesions were classified as i) “FN”- fibrinoid necrosis and ii) “TA”- transmural arteritis . Formalin-fixed, paraffin-embeded tissue underwent immunoperoxidase testing for: i) Presence of CD4, CD8, CD20 and CD68 in vessel wall and interstitial inflammatory cells; ii) Positivity for C4d in peritubular capillaries; iii) Presence of ICAM-1 and VCAM-1 in vessel walls. Groups were compared by Fisher Exact Test, chi-square test for independence and one-way ANOVA with Bonferroni correction (p£0.05). Results: TA lesions revealed marked presence of CD4+ and CD8+ T cells and macrophages and positivity of ICAM-1 e VCAM-1 in the tunica media and endothelium. Positivity of C4d in the PTC was detected in 58% of the cases with no statistically significant differences between the groups. Conclusions: The results suggest that T-cell interactions are involved in the increased positivity of vascular adhesion molecules ICAM-1 and VCAM- 1 in type III renal allograft rejection. Peritubular capillary C4d positivity in grafts with TA, FN or both lesions indicate antibody-mediated injury mechanisms in the pathogenesis of both TA and FN.Rejeição aguda (RA) túbulo-intersticial e RA vascular leve (Banff tipos I e IIA) são tipicamente processos mediados por células T. RA vascular grave (Banff tipo III), entretanto, pode ser mediada por anticorpos do receptor dirigidos a antígenos do doador. Essa forma de rejeição é histologicamente caracterizada por arterite transmural e/ou necrose fibrinóide da parede arterial. Ainda é objeto de debate se arterite transmural e necrose fibrinóide são entidades patogeneticamente relacionadas ou distintas. Na tentativa de esclarecer tal questão, este estudo enfoca a imunoexpressão de moléculas de adesão e o perfil imunofenotípico das células inflamatórias em enxertos renais com RA tipo III. Métodos: Foram analisados setenta enxertos renais explantados com RA vascular grave. As lesões vasculares foram classificadas como: i) “AT” – arterite transmural; ii) “NF” – necrose fibrinóide. Tecido fixado em formalina e embebido em parafina foi submetido a imuno-histoquímica por imunoperoxidase para: i) presença de linfócitos CD4, CD8 e CD20-positivos e macrófagos CD68-positivos nas paredes vasculares; ii) pesquisa de C4d nos capilares peritubulares (PTC); iii) pesquisa da imunoexpressão de ICAM-1 e VCAM-1 nas paredes vasculares. Os grupos foram comparados pelo Teste Exato de Fisher, pelo Teste Qui-Quadrado para independência e por análise variância com um fator com correção de Bonferroni (p< 0,05). Resultados: Nas lesões de AT, foi observada a presença de linfócitos T CD4+ e CD8+ e de macrófagos e a imunoexpressão positiva de ICAM-1 e VCAM-1 na tunica media e no endotélio. Positividade para C4d nos PTC, detectada em 58% dos casos, não diferiu entre enxertos contendo qualquer dos padrões de lesão. Conclusões: Interações entre células T e moléculas de adesão vasculares podem estar envolvidas na patogênese das lesões de AT da rejeição aguda tipo III do enxerto renal. Positividade para o C4d em aproximadamente 50% dos casos indica a participação de mecanismos humorais na patogênese dos dois tipos de lesão vascular.TEDEBV UNIFESP: Teses e dissertaçõe