National data on chronic dialysis treatment are essential for the development of health policies that aim to improve patient treatment.
To present data from the Brazilian Society of Nephrology on ...patients with chronic dialysis for kidney disease in July 2018, making a comparative analysis of the past 10 years.
Data collection from dialysis units, with filling in an online questionnaire for 2018. Data from 2009, 2013 and 2018 were compared.
288 (36.6%) centers answered the questionnaire. In July 2018, the estimated total number of patients on dialysis was 133,464. Estimates of the prevalence and incidence rates of patients undergoing dialysis treatment per million of the population (pmp) were 640 and 204, respectively, with average annual increases of 23.5 pmp and 6 pmp for prevalence and incidence, respectively. The annual gross mortality rate was 19.5%. Of the prevalent patients, 92.3% were on hemodialysis and 7.7% on peritoneal dialysis, with 29,545 (22.1%) on the waiting list for transplantation. Median bicarbonate concentration in the hemodialysis bath was 32 mEq/L. Venous catheters were used as access in 23.6% of the hemodialysis patients. The prevalence rate of positive serology for hepatitis C showed a progressive reduction (3.2%).
The absolute number of patients and rates of incidence and prevalence in dialysis in the country increased substantially in the period, although there are considerable differences in rates by state. There has been a persistent increase in the use of venous catheters as an access for dialysis; and reduction in the number of patients with positive serology for hepatitis C.
Patients on hemodialysis (HD) show changes in muscle structure and function reducing their functional capacity. This study was conduted to assess the effects of respiratory muscle training (RMT) and ...peripheral muscle training (PMT) during dialysis on functional parameters, inflammatory state, and quality of life (QoL) in patients on HD. Randomized controlled trial included 39 patients on HD, and they were divided into three groups: RMT (n = 11), PMT (n = 14), and controls (C, n = 14). Training was performed during the HD session for 10 weeks. Maximal inspiratory pressure (PImax), maximal expiratory pressure (PEmax), forced vital capacity (FVC), six-minute walk test (6MWT), Kt/Vsp, biochemical parameters, and inflammatory state (i.e., level of high sensitivity C-reactive protein) were evaluated. Variation from baseline was calculated by Analysis of Covariance (ANCOVA). The ΔPImax was 22.5 ± 3.2, 9.1 ± 2.9, and −4.9 ± 2.8 cmH2O in the RMT, PMT and C, respectively (p < 0.001); ΔPEmax was 10.8 ± 6.6, 3.7 ± 5.9, and −15.6 ± 5.9 cmH2O respectively (p = 0.014). The Δ6MWT was significantly greater in RMT and PMT (65.5 ± 9; 30.8 ± 8 m) than in C (−0.5 ± 8.1 m), p < 0.001. Although biochemical parameters decreased after training, Kt/V remained unchanged. CRP decreased only in the RMT and PMT groups. There was a significant increase in QoL scores in the training groups (vs. C) in energy/fatigue (p = 0.002), sleep (p < 0.001), pain (p < 0.001), and list of symptoms/problems (p = 0.014). A short period of RMT or PMT during HD significantly improved functional capacity, with RMT showing greater effect than PMT. Muscle training improved biochemical and inflammatory markers, but a direct cause and effect relationship could not be established by this study.
Brazilian Dialysis Survey 2020 Nerbass, Fabiana B; Lima, Helbert do Nascimento; Thomé, Fernando Saldanha ...
Jornal Brasileiro de nefrologia,
09/2022, Letnik:
44, Številka:
3
Journal Article
Recenzirano
Odprti dostop
Abstract Introduction: National data on chronic dialysis treatment are essential to support the development of health policies aimed at improving the treatment for thousands of people. Objective: To ...report epidemiological data from the 2020 Brazilian Dialysis Survey, sponsored by the Brazilian Society of Nephrology. Methods: A survey was carried out in Brazilian chronic dialysis centers using an online questionnaire for the year, covering clinical and epidemiological aspects of patients in a chronic dialysis program, data on dialysis therapy, characteristics of dialysis units and the impact of the COVID-19 pandemic. Results: 235 (28%) of the centers responded to the questionnaire. In July 2020, the estimated total number of patients on dialysis was 144,779. The estimated prevalence and incidence rates of patients per million population (pmp) were 684 and 209, respectively. Of the prevalent patients, 92.6% were on hemodialysis (HD) and 7.4% were on peritoneal dialysis (PD); 23% were on the transplant waiting list. A central venous catheter was used by a quarter of patients on HD. The incidence rate of confirmed COVID-19 between February and July 2020 was 684/10,000 dialysis patients, and the lethality rate was 25.7%. The estimated overall mortality and COVID-19 crude annual mortality rates were 24.5 and 4.2%, respectively. Conclusion: The absolute number of patients on chronic dialysis and prevalence rate continued to increase. The low use of PD as dialysis therapy was maintained and the use of long-term catheters for HD increased. The COVID-19 pandemic contributed to the increase in the overall mortality rate.
Resumo Introdução: Dados nacionais sobre tratamento dialítico crônico são essenciais para apoiar o desenvolvimento de políticas de saúde destinadas a melhorar o tratamento de milhares de pessoas. Objetivo: Relatar dados epidemiológicos do Censo Brasileiro de Diálise 2020, patrocinado pela Sociedade Brasileira de Nefrologia. Métodos: Realizou-se pesquisa em centros brasileiros de diálise crônica utilizando questionário online relativo ao ano, abrangendo aspectos clínicos e epidemiológicos de pacientes em programa de diálise crônica, dados sobre terapia dialítica, características das unidades de diálise e impacto da pandemia COVID-19. Resultados: 235 (28%) centros responderam ao questionário. Em julho de 2020, o número total estimado de pacientes em diálise foi 144.779. As taxas estimadas de prevalência e incidência de pacientes por milhão da população (pmp) foram 684 e 209, respectivamente. Dos pacientes prevalentes, 92,6% estavam em hemodiálise (HD) e 7,4% em diálise peritoneal (DP); 23% estavam na lista de espera para transplante. Cateter venoso central foi utilizado por um quarto dos pacientes em HD. A taxa de incidência de COVID-19 confirmada entre fevereiro e julho de 2020 foi 684/10.000 pacientes em diálise, a taxa de letalidade foi 25,7%. As taxas estimadas de mortalidade geral e mortalidade bruta anual por COVID-19 foram 24,5 e 4,2%, respectivamente. Conclusão: O número absoluto de pacientes em diálise crônica e a taxa de prevalência continuaram a aumentar. O baixo uso de DP como terapia de diálise foi mantido e o uso de cateteres de longa permanência para HD aumentou. A pandemia COVID-19 contribuiu para o aumento da taxa de mortalidade geral.
The Intergovernmental Panel on Climate Change (IPCC) indicates that the waste sector is a potential emitter of methane gas (CH4), which has a greenhouse effect up to 28 times greater than that of ...carbon dioxide (CO2). The management of municipal solid waste (MSW) generates greenhouse gases (GHG) directly through emissions from the process itself as well as indirectly through transportation and energy consumption. The objective of this study was to evaluate the GHG emissions contributed by the waste sector in the Recife metropolitan region (RMR) and to define mitigation scenarios to comply with the Brazilian Nationally Determined Contribution (NDC), a result of the Paris Agreement. To achieve this, an exploratory study was carried out, including a literature review, collection of data, estimation of emissions using the IPCC model (2006), and comparison between the values assumed by the country in 2015 and those estimated in the adopted mitigation scenarios. The RMR is composed of 15 municipalities, has an area of 3,216,262 km2 and a population of 4,054,866 inhabitants (2018), generating approximality 1.4 million t-year of MSW. It was estimated that, in the period from 2006 to 2018, 25.4 million tCO2e were emitted. The comparative analysis between the absolute values defined in the Brazilian NDC and the results from the mitigation scenarios showed that approximately 36 million tCO2e could be avoided through the disposal of MSW in the RMR, equivalent to a 52% reduction in emissions estimated for 2030, a percentage greater than the 47% reduction assumed in the Paris Agreement.
Anaerobic digestion of food waste requires the addition of alkalinizer such as sodium bicarbonate (NaHCO3) which acts as a buffer in pH control, preventing accumulation of VFAs, contributing to ...increased methane production. The appropriate concentration of the alkalizer directly influences the methane generation potential of substrate. This research tested different concentrations of bicarbonate in the anaerobic digestion of food waste, using anaerobic inoculants (industrial granular sludge and flocculent sewage). Several ratios of mass percentages of NaHCO3/mass residue (%), 1.5%, 4.5%, 11%, 28%, and 111%, were tested, evaluating their effect on the methane generation potential and methane concentration in biogas in tests of biochemical potential of methane. The best methane generation potential (214 NmL CH4/g VS) and methane concentration in biogas (78%) was obtained, using 11% NaHCO3 mass/mass residue, and industrial sludge as inoculum. NaHCO3 functioned satisfactorily as a buffering agent for anaerobic digestion. The excess or the scarcity of alkalizer is harmful to anaerobic digestion, regardless of the quality of the inoculum used.
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•NaHCO3 acts efficiently as an alkalizing and buffering agent for FW AD.•NaHCO3, 11% (m/m), provided a methane potential of 214 NmL CH4/g VS for FW AD.•NaHCO3 (11%, m/m) favored the generation of biogas with 78% methane for FW AD.•Absence or excess NaHCO3 interferes with the methane potential obtained for FW AD.
Objective
The aim of this cross‐sectional study was to evaluate the association between periodontitis and different severities of chronic kidney disease (CKD) in predialytic patients.
Materials and ...Methods
Demographic, socioeconomic, and medical data of 139 patients from the nephrology service of one university hospital in Porto Alegre, Brazil, were obtained through interview and clinical records. Full‐mouth six‐sites per tooth periodontal examinations were performed. Associations between periodontitis, stages of CKD, and estimated glomerular filtration rate (eGFR) were estimated by multivariable models adjusted for sex, smoking, vitamin D supplementation, physical activity, and renal treatment duration. CKD was classified based on eGFR (<60 ml/min/1.73 m2) estimated by the Chronic Kidney Disease Epidemiology Collaboration equation.
Results
Patients with severe periodontitis, compared to those without severe periodontitis, had 2.8 (95% CI: 1.25–6.62) and 3.4 (95% CI: 1.27–9.09) times higher risk of being in stages 4 and 5 of CKD, respectively. Having ≥ 2 teeth with clinical attachment loss (CAL) ≥6 mm increased 3.9 times the risk of being in stage 5 of CKD. Patients with severe periodontitis and ≥2 teeth with CAL ≥ 6 mm had 4.4 ml/min/1.732 and 5.2 ml/min/1.732 lower eGFR (p‐values < .05), respectively.
Conclusion
Severe periodontitis was associated with poor renal conditions in predialytic CKD patients, strengthening the importance of periodontal evaluation in such patient population.
The current study investigated the methane generation potential from the anaerobic bio-digestion of fruits and vegetables wastes (FVW) generated in a food supply center in Brazil. This study used the ...ensiling process as a pre-treatment for this lignocellulosic biomass aiming to improve the methane yield. FVW were mixed in the same proportion (0.2 g on a volatile solid basis per residue) and ensiled at room temperature (≈25 °C) for 30 and 55 days (samples Ensil-30 and Ensil-55). The ensiled and untreated waste samples were inoculated with industrial granular sludge and incubated at 37 °C (mesophilic conditions) until there was no more significant biogas generation. The experimental data were fitted to the First-order, Cone, and Modified Gompertz kinetic models. The methane yield of the ensiled samples was ≈21% higher than the methane yield of the untreated sample. Considering the ensiled samples, the methane generation was statistically the same (52.0 and 51.3 NmL/gvs for samples Ensil-30 and Ensil-55, respectively), that is, duplication of the storage period failed to increase the methane volume. Although the results indicated that the ensiling of FVW could be a viable strategy to improve the biodegradability of the lignocellulosic biomass and promote its valorization as an energy source, a preselection of the agricultural residues that will feed the biodigesters is suggested. Considering the process conditions and the residues used, the substrate characteristics were shown to carry out a key role in the bio-digestion processes and consequently in methane generation.
► Laboratory and field tests to investigate gas generation in and CH4 emission. ► The study performed on an Experimental Cell with a 36,659-ton capacity in Brazil. ► The results showed waste ...decomposes 4–5 times faster in a tropical wet climate. ► Capillary and methanotrophic final cover layers presented lower CH4 emissions. ► These facts must be considered in projects developed in tropical climate countries.
Landfill gas (LFG) emissions from municipal solid waste (MSW) landfills are an important environmental concern in Brazil due to the existence of several uncontrolled disposal sites. A program of laboratory and field tests was conducted to investigate gas generation in and emission from an Experimental Cell with a 36,659-ton capacity in Recife/PE – Brazil. This investigation involved waste characterisation, gas production and emission monitoring, and geotechnical and biological evaluations and was performed using three types of final cover layers. The results obtained in this study showed that waste decomposes 4–5 times faster in a tropical wet climate than predicted by traditional first-order models using default parameters. This fact must be included when considering the techniques and economics of projects developed in tropical climate countries. The design of the final cover layer and its geotechnical and biological behaviour proved to have an important role in minimising gas emissions to the atmosphere. Capillary and methanotrophic final cover layers presented lower CH
4 flux rates than the conventional layer.
Lissencephaly in Shih Tzu dogs Rodríguez-Sánchez, Diego Noé; Pinto, Giovana Boff Araujo; Thomé, Edval Fernando ...
Acta veterinaria scandinavica,
06/2020, Letnik:
62, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Abstract
Background
Lissencephaly is a brain malformation characterized by smooth and thickened cerebral surface, which may result in structural epilepsy. Lissencephaly is not common in veterinary ...medicine. Here, we characterize the first cases of lissencephaly in four Shih Tzu dogs, including clinical presentations and findings of magnetic resonance imaging of lissencephaly and several concomitant brain malformations.
Case presentation
Early-onset acute signs of forebrain abnormalities were observed in all dogs, which were mainly cluster seizures and behavioral alterations. Based on neurological examination, the findings were consistent with symmetrical and bilateral forebrain lesions. Metabolic disorders and inflammatory diseases were excluded. Magnetic resonance imaging for three dogs showed diffuse neocortical agyria and thickened gray matter while one dog had mixed agyria and pachygyria. Other features, such as internal hydrocephalus, supracollicular fluid accumulation, and corpus callosum hypoplasia, were detected concomitantly. Antiepileptic drugs effectively controlled cluster seizures, however, sporadic isolated seizures and signs of forebrain abnormalities, such as behavioral alterations, central blindness, and strabismus persisted.
Conclusions
Lissencephaly should be considered an important differential diagnosis in Shih Tzu dogs presenting with early-onset signs of forebrain abnormalities, including cluster seizures and behavioral alterations. Magnetic resonance imaging was appropriate for
ante
-
mortem
diagnosis of lissencephaly and associated cerebral anomalies.
The green coconut’s shell is considered to be waste while it represents most of its volume and weight. The objective of this research was to analyze the influence of the addition of 1% (by weight) of ...green coconut’s (Cocos nucifera) fibers in the unsaturated behavior of compacted mixtures of clayey soil, with fibers randomly distributed in the soil matrix. Both the pure soil and the mixture were submitted to filter paper tests according to Chandler and Gutierrez (1986) and Marinho (1994), in order to obtain their characteristic curves and verify their differences, using the relation suction-humidity proposed by Chandler, Crilly and Montgomery-Smith (1992) and van Genuchten’s (1980) adjustment method, which was also used to estimate the unsaturated hydraulic conductivity and relative permeability to air and water as functions of the degree of saturation. The results revealed that the addition of fibers provided greater water percolation in the drying path, and greater air flow during wetting. This behavior is a reflection of the greater retention capacity provided by the fibers, which promotes a more gradual change in the degree of saturation, in relation to the ‘pure soil’, which is a very interesting characteristic for applications subject to large variations in humidity.
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