Prevalence and predictors of nonadherence to hemodialysis

BACKGROUND

The prevalence of nonadherence to dialysis (NAD) presents a wide variation, depending on the parameters used and demographic regions studied. This study aimed to assess the prevalence and predictors of NAD of patients with chronic kidney disease undergoing hemodialysis (HD).

MATERIALS AND METHODS

This was a cross-sectional study with 255 adult patients receiving HD for >3 months. Skipping a session per month, shortening a session for at least 10 min, phosphorus >7.5 mg/dl, potassium >6.0 mmol/l and interdialytic weight gain (IDWG) >5.7% of body weight were indicative of NAD. The association of sociodemographic and clinical variables with NAD was assessed using logistic regression.

RESULTS

Mean age was 50 ± 13.1 years, 62.7% were male, 85.5% were of African descent and 62% were married. The prevalence rates of NAD were: 49% of shortening sessions, 18% of hyperkalemia, 12% of hyperphosphatemia, 9% of IDWG >5.7% of dry weight and 8% of skipping HD. Independent predictors of NAD were: age ≤50 years, not being married, living alone, living in Salvador, attending dialysis without a companion, ethnic African descent, Kt/V <1.3 and residual diuresis <100 ml/day.

CONCLUSION

NAD is frequent and distinct sociodemographic and clinical variables predict different parameters.

16 STRATEGIES OF FOLLICULAR WAVE SYNCHRONIZATION WITH ESTRADIOL BENZOATE IN GYR (BOS TAURUS INDICUS) CATTLE

Physiological and behavioral differences between Bos taurus and Bos indicus can influence the response to a fixed AI protocol. The objective of this study was to examine the reduction of the usual dose of 2 mg of estradiol benzoate (EB) to 1 mg at the beginning of a fixed-time AI protocol, aiming at follicular regression. In a second step, we evaluated the effect of EB on follicle development during follicular pre-deviation and dominance. The experiment was performed at Monte Verde Farm (Uberaba, MG, Brazil). Twenty-two cows (n = 10 heifers and n = 12 nonlactating cows) underwent an estrous synchronization protocol with a progesterone-releasing intravaginal device (P4; Sincrogest®, Ouro Fino Animal Health, São Paulo, Brazil) and received 1 (G1mg, n = 11) or 2 mg (G2mg, n = 11) of EB (Sincrodiol®, Ouro Fino Animal Health), on a random day (designated Day 0). Follicular dynamics was monitored once per day by ultrasonography from Day 0 to 4 with blood sample collections. In a second step, females received 2 mg of EB on Day 3 (GD3, pre-deviation, n = 4) or Day 5 (GD5, dominance, n = 4) of the estrous cycle (Day 0 was the ovulation). Following these treatments, follicular development was monitored daily for 6 days with blood sample collections. The statistical analysis was conducted using the SAS System for Windows 2 (2003; SAS Institute Inc., Cary, NC, USA). The explanatory variables included in the statistical model were the dose of EB, animal category (cows and heifers), and their interaction. The mean test was used to compare intervals from EB treatment to follicular atresia and follicular wave emergence using ANOVA. Progesterone concentrations between groups were compared using the Wilcoxon test. Independently of animal category or stage of the estrous cycle, both EB doses (1 or 2 mg) induced follicular atresia in 2.2 ± 0.9 and 2.1 ± 1.2 days (P > 0.05), respectively. Emergence of a new follicular wave was observed, from Day 0 to 4, in 64% (7/11) of females from G1mg and in 45% (5/11) from G2mg, and the interval between treatment and follicular emergence was 3.4 ± 0.8 and 3.0 ± 1.0 days (P > 0.05), respectively. Plasma progesterone concentrations of the 22 animals increased from 2.1 ± 2.0 ng mL–1 to 7.6 ± 3.0 ng mL–1 by 24 h after the device insertion (P < 0.05), reaching peak concentration (8.0 ± 3.0 ng mL–1) by 48 h after treatment beginning, decreasing to 6.4 ± 2.5 ng mL–1 by 72 h, and remaining constant up to 96 h. Estradiol benzoate injection at follicle pre-deviation (GD3) caused follicular atresia (2.0 ± 1.4 days) and emergence of a new follicular wave in 3.7 ± 0.1 days in all animals (4/4). However, EB injection during follicle dominance (GD5) did not synchronize a new follicular wave and follicles persisted during the time of monitoring. Furthermore, EB applied at dominance hastened luteolysis in 50% (2/4) of the treated animals. In conclusion, a reduced dose of EB (1 mg) at the beginning of the protocol with P4 effectively induces follicular atresia. To synchronize a wave emergence at any stage of the estrous cycle, EB must be associated with an exogenous source of progesterone.

An analysis of the 1978 African swine fever outbreak in Brazil and its eradication

The aim of this paper is to evaluate the African swine fever (ASF) outbreak that began in 1978 in Paracambi municipality, Rio de Janeiro State, Brazil, and the steps taken by the Brazilian authorities to eradicate the disease. The presence of ASF in the country was confirmed by isolating the virus, and its pathogenicity was certified by the laboratory of the Plum Island Disease Center, New York, United States. Even before the laboratory results became available, the Brazilian Agriculture Ministry declared an Animal Health Emergency, in which the official Veterinary Services adopted rapid control measures to restrain and eradicate the disease. These control measures contributed to the reorganisation of the national swine industry and stimulated the use of high-technology production techniques, as well as an improvement in herd health consciousness. All this contributed to Brazil becoming the largest meat exporter in the world.

Estrógenos em água: otimização da extração em fase sólida utilizando ferramentas quimiométricas

Muitos métodos analíticos estão sendo desenvolvidos visando à determinação de contaminantes orgânicos, especialmente alteradores endócrinos. Tais métodos baseiam-se geralmente na extração em fase sólida (SPE) seguida por determinação cromatográfica (CG ou HPLC). No presente trabalho utilizou-se ferramentas quimiométricas no processo de SPE para avaliar os principais fatores que influenciam tal processo e as interações entre os mesmos. Foram analisadas matrizes de água subterrânea fortificada com hormônios (17 b estradiol, estrona e 17 b etinilestradiol) e a determinação analítica foi feita por HPLC/Fluorescência. Um planejamento fatorial completo foi utilizado. Os fatores escolhidos incluíram: condicionamento da fase sólida, concentração dos analitos, volume da amostra e solvente de eluição. As melhores condições obtidas foram: 500 mL da amostra, condicionamento da fase sólida (C18) com acetona (4mL), metanol (6 mL) e água pH 3(10 mL), e eluição dos analitos com 4 mL de acetona.

[Combating foot and mouth disease in Brazil: private sector participation]

The fact that cattle herds in Brazil are in such good health and that the meat on the domestic and international markets is safe and of high quality is largely due to the campaign to combat foot and mouth disease and to the improvements that this campaign has made in the organisation of the Brazilian bovine production industry. Launched in 1965, the campaign set itself ambitious objectives, but thanks to the direct participation of producer organisations it received the necessary support and funding. The results are reflected in the growing number of states--fifteen to date--that are internationally recognised as free from foot and mouth disease with vaccination. Thanks to the active participation of producers and of the entire production chain in foot and mouth disease eradication efforts, Brazil has risen to become a leading player in the international beef trade.

[Relations between official and private veterinary services in epidemiology and the control of contagious diseases]

Growing budget restrictions in many countries have meant that official Veterinary Services cannot assume responsibility for any new activities. The natural reaction is to turn to private veterinary services to provide the support needed to strengthen the control and surveillance of priority diseases and thereby support the development of the livestock sector and the establishment of safe international trade. In this context, official Veterinary Services must work together with private veterinarians, delegating various technical animal health activities, so that they may focus their efforts on those tasks that cannot be delegated: standardisation, control, auditing, general system co-ordination, epidemiological surveillance, etc., as well as organising veterinary policy in order to make best use of budget resources. For these relations to be efficient, a dynamic, two-way epidemiological information mechanism must be created, whereby private veterinarians periodically keep governments informed, on the basis of an agreed methodology. Moreover, the official Veterinary Services must systematically transmit information on List A and B diseases of the OIE (World organisation for animal health), and perform detailed analyses of epidemiologically significant events. The article proposes the establishment of relations between public and private veterinary services as a way in which to provide the livestock sector with the health and hygiene conditions that are necessary for effective disease control, which in turn provides greater security for international trade and increased consumer protection.

Six-month isoniazid-rifampin treatment for pulmonary tuberculosis in children

One hundred and seventeen children with pulmonary tuberculosis underwent treatment with a 6-month daily regimen of rifampin (15 mg/kg/day) and isoniazid (10 mg/kg/day). The criteria for the diagnosis of pulmonary tuberculosis were (1) clinical symptoms and signs in 93 children (79%), (2) history of direct contact with an adult with tuberculosis in 106 children (91%), (3) tuberculin reaction of 5 mm or more, without previous bacillus Calmette-Guérin (BCG), in 45 children (38%), (4) suggestive radiologic alterations in all patients, and (5) positive bacteriology or histology in four patients (3%). The treatment was completed by 97 children (83%). The mean weight gain during therapy was 2,145 g. There was an excellent clinicoradiologic response to the treatment, and improvement in chest roentgenograms was observed in all patients at the end of therapy. No relapses occurred among the patients followed for an average of 21.4 months. This study indicates that the treatment of primary pulmonary tuberculosis in children with a combination of rifampin and isoniazid daily for 6 months is efficacious and does not result in any relapse.