Recognition and management of community-acquired acute kidney injury in low-resource settings in the ISN 0by25 trial: A multi-country feasibility study

BackgroundAcute kidney injury (AKI) is increasingly encountered in community settings and contributes to morbidity, mortality, and increased resource utilization worldwide. In low-resource settings, lack of awareness of and limited access to diagnostic and therapeutic interventions likely influence patient management. We evaluated the feasibility of the use of point-of-care (POC) serum creatinine and urine dipstick testing with an education and training program to optimize the identification and management of AKI in the community in 3 low-resource countries.Methods and findingsPatients presenting to healthcare centers (HCCs) from 1 October 2016 to 29 September 2017 in the cities Cochabamba, Bolivia; Dharan, Nepal; and Blantyre, Malawi, were assessed utilizing a symptom-based risk score to identify patients at moderate to high AKI risk. POC testing for serum creatinine and urine dipstick at enrollment were utilized to classify these patients as having chronic kidney disease (CKD), acute kidney disease (AKD), or no kidney disease (NKD). Patients were followed for a maximum of 6 months with repeat POC testing. AKI development was assessed at 7 days, kidney recovery at 1 month, and progression to CKD and mortality at 3 and 6 months. Following an observation phase to establish baseline data, care providers and physicians in the HCCs were trained with a standardized protocol utilizing POC tests to evaluate and manage patients, guided by physicians in referral hospitals connected via mobile digital technology. We evaluated 3,577 patients, and 2,101 were enrolled: 978 in the observation phase and 1,123 in the intervention phase. Due to the high number of patients attending the centers daily, it was not feasible to screen all patients to assess the actual incidence of AKI. Of enrolled patients, 1,825/2,101 (87%) were adults, 1,117/2,101 (53%) were females, 399/2,101 (19%) were from Bolivia, 813/2,101 (39%) were from Malawi, and 889/2,101 (42%) were from Nepal. The age of enrolled patients ranged from 1 month to 96 years, with a mean of 43 years (SD 21) and a median of 43 years (IQR 27–62). Hypertension was the most common comorbidity (418/2,101; 20%). At enrollment, 197/2,101 (9.4%) had CKD, and 1,199/2,101 (57%) had AKD. AKI developed in 30% within 7 days. By 1 month, 268/978 (27%) patients in the observation phase and 203/1,123 (18%) in the intervention phase were lost to follow-up. In the intervention phase, more patients received fluids (observation 714/978 [73%] versus intervention 874/1,123 [78%]; 95% CI 0.63, 0.94; p = 0.012), hospitalization was reduced (observation 578/978 [59%] versus intervention 548/1,123 [49%]; 95% CI 0.55, 0.79; p < 0.001), and admitted patients with severe AKI did not show a significantly lower mortality during follow-up (observation 27/135 [20%] versus intervention 21/178 [11.8%]; 95% CI 0.98, 3.52; p = 0.057). Of 504 patients with kidney function assessed during the 6-month follow-up, de novo CKD arose in 79/484 (16.3%), with no difference between the observation and intervention phase (95% CI 0.91, 2.47; p = 0.101). Overall mortality was 273/2,101 (13%) and was highest in those who had CKD (24/106; 23%), followed by those with AKD (128/760; 17%), AKI (85/628; 14%), and NKD (36/607; 6%). The main limitation of our study was the inability to determine the actual incidence of kidney dysfunction in the health centers as it was not feasible to screen all the patients due to the high numbers seen daily.ConclusionsThis multicenter, non-randomized feasibility study in low-resource settings demonstrates that it is feasible to implement a comprehensive program utilizing POC testing and protocol-based management to improve the recognition and management of AKI and AKD in high-risk patients in primary care.

Etienne Macedo and colleagues report on a point-of-care testing program for acute kidney injury and disease in high-risk primary care patients.     

Beta diversity of aquatic macroinvertebrate assemblages associated with leaf patches in neotropical montane streams

Over 70% of the total channel length in all river basins is formed by low order streams, many of which originate on mountaintops. Headwater streams play fundamental roles in processing and transporting terrestrial and aquatic organic matter, often harboring high biodiversity in bottom leaf patches deposited from riparian vegetation. The objective of this study was to assess the variation in taxonomic composition (measured by beta diversity of aquatic macroinvertebrates) among stream sites located in the Espinhaço Meridional Mountain Range, part of a UNESCO Biosphere Reserve in eastern Brazil. We tested two hypotheses. (a) Taxa turnover is the main reason for differences in aquatic insect assemblages within stream sites; we predicted that turnover would be higher than nestedness in all stream sites. (b) Stream site altitude and catchment elevation range are the main explanatory variables for the differences in beta diversity; we predicted that local stream site variables would account for only minor amounts of variation. In both dry and wet seasons, we sampled twice in two habitat types (five leaf patches in pools and five in riffles) in each of nine stream sites distributed in three different river basins. We computed average pairwise beta diversity among sampling stations and seasons in each stream site by using Jaccard and Bray–Curtis indices, and calculated the percentages of diversity resulting from turnover and nestedness. Finally, we tested the degree that local‐ or catchment‐level predictor variables explained beta diversity. We found that turnover was the main component of beta diversity and that both dissolved oxygen and elevation range best explained Bray–Curtis beta diversity. These results reinforce the importance of leaf patches in montane (sky islands) Neotropical savanna streams as biodiversity hotbeds for macroinvertebrates, and that both local and landscape variables explained beta diversity.     

Fresh-frozen human bone graft for repair of defect after adenomatoid odontogenic tumour removal

The aim of this paper was report the clinical, radiographic, and histological case of adenomatoid odontogenic tumour (AOT) in adolescent woman as well as present the reconstructive treatment of AOT using fresh-frozen human bone graft with guided bone regeneration. AOT is a benign, noninvasive lesion with slow but progressive growth. Biopsy and microscopic examination confirmed the presence of an AOT. Treatment was conservative and the prognosis was excellent. The patient has been followed-up for without recurrence. The use of fresh-frozen human bone graft can be a safe choice for reconstruction of the bone defects to treat AOT.     

Simultaneous extraction and biotransformation process to obtain high bioactivity phenolic compounds from brazilian citrus residues

Recent studies have pointed to a reduction in the incidence of some cancers, diabetes, and neuro‐degenerative diseases as a result of human health benefits from flavanones. Currently, flavanones are obtained by chemical synthesis or extraction from plants, and these processes are only produced in the glycosylated form. An interesting environmentally friendly alternative that deserves attention regarding phenolic compound production is the simultaneous extraction and biotransformation of these molecules. Orange juice consumption has become a worldwide dietary habit and Brazil is the largest producer of orange juice in the world. Approximately half of the citrus fruit is discarded after the juice is processed, thus generating large amounts of residues (peel and pectinolytic material). Hence, finding an environmentally clean technique to extract natural products and bioactive compounds from different plant materials has presented a challenging task over the last decades. The aim of this study was to obtain phenolics from Brazilian citrus residues with high bioactivity, using simultaneous extraction (cellulase and pectinase) and biotransformation (tannase) by enzymatic process. The highest hesperetin, naringenin and ellagic acid production in the experiment were 120, 80, and 11,250 µg g^?1, respectively, at 5.0 U mL^?1 of cellulase and 7.0 U mL^?1 of tannase at 40°C and 200 rpm. Also, the development of this process generated an increase of 77% in the total antioxidant capacity. These results suggest that the bioprocess obtained innovative results where the simultaneous enzymatic and biotransformatic extracted flavanones from agro‐industrial residues was achieved without the use of organic solvents. The methodology can therefore be considered a green technology. © 2015 American Institute of Chemical Engineers Biotechnol. Prog., 31:1273–1279, 2015     

Inhibition of digestive trypsins by plant Kunitz proteins reduces the viability of Spodoptera cosmioides larvae

The acquired resistance by insects and the harmful environmental effects of chemical pesticides have encouraged the search of new tools for proper pest management. Among them, the use of protease inhibitors (PIs) obtained from plants has gained interest because they are a natural system against herbivory, are organic molecules with higher specificity and have the potential to cause less damage to nature. The aim of this work was to characterise the inhibitory potential of the proteins ApTI (Adenanthera pavonina trypsin inhibitor) and ILGA (Inga laurina trypsin inhibitor) on the digestive trypsins of Spodoptera cosmioides through molecular docking, enzymatic kinetics and biological survival analyses. The docking between trypsins and inhibitors was performed using the program CLUSPRO; the inhibitory constant Ki and the inhibition type were determined through chromogenic assays. In order to analyse survival, several concentrations of ApTI and ILTI inhibitors were included in the artificial diet of neonatal larvae. In this study, we determined that ILTI binds to the active site of the trypsins with a specificity similar to its natural substrate, whereas APTI showed that the inhibitor reactive site is not in contact with the trypsins catalytic site. The ILTI and APTI inhibitors were characterized as competitive and uncompetitive tight‐binding inhibitors, respectively. The survival curves obtained using Kaplan–Meier estimators indicated that the lowest percentage survival (20%) for all inhibitors tested was obtained using 1.0% doses at a development time of less than 20 days. We concluded that ILTI and APTI present biotechnological potential as agents against phytophagous Lepidoptera insects, inhibiting trypsins through tight‐binding inhibition, with competitive and non‐competitive mechanisms, respectively. The effect of ApTI and ILTI on the development of S. cosmioides larvae is shown to be toxic.     

Morphological and anatomical changes in soybean roots subjected to indole-3-acetic acid and tryptophol: indole compounds present in plant auxin metabolism

The auxin metabolism is practically elucidated, and the compounds that are part of the biosynthesis are well characterized, but the indole-3-ethanol or tryptophol, a molecule that has a regulatory position in the indole-3-acetic acid biosynthesis, still represents a gap in the understanding of this pathway. We examined the hypothesis that tryptophol present the function of plant growth regulation on soybean root development. We evaluated two doses of auxin and two doses of tryptophol (100 e 200 mg L^??1), respectively, beside a control treatment (water), via leaf application, in soybean plants under V1–V2 phonological stages. After 18 days of application, the roots were collected for their volume and area measurement, thereafter small segments (0.5 cm of length), were collected at 1 cm below the root-collar, for anatomical analysis. We observed that the control showed greater area and root volume, but using 200 mg L^??1 auxin and 100 mg L^??1 tryptophol led to a radial increase of roots with significant increases in width radius vascular and cortical parenchyma. These results suggest that the application of both compounds had a potential of modify the vascular and ground tissues in soybean roots, which may be beneficial for the development of plants.     

Lignin peroxidase isoforms from Streptomyces viridosporus T7A: are they a monomer based structure?

Five fractions with lignin peroxidase activity were isolated by FPLC-Mono Q from a Streptomyces viridosporus culture. F4 and F5 showed the highest specific activity and degree of protein homogeneity by chromatofocusing, IEF- and gradient-PAGE. The individual analysis of F4 and F5 by FPLC-Superdex 75, showed MW that were multiples to each other (68,000; 23,000; 12,000), although by SDS PAGE a sole MW of 13,500 was obtained, indicating a monomer based structure. The amino-acid composition of F5 showed absence of sulfur amino acids.     

Characterization of recombinant Desulfovibrio gigas ferredoxin.

Dg ferredoxin gene was cloned using the polymerase chain reaction (PCR), inserted into vector pT7-7, and overexpressed in Escherichia coli (E. coli) grown in aerobic media. The recombinant protein is a dimer and contains a [3Fe-4S] cluster per monomer. EPR and (1)H NMR data of recombinant and wild-type protein are compared.