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Abstract Kidney disease is a common complication of multiple myeloma (MM) and a risk factor for increased morbimortality. In this retrospective cohort study based on medical records, we analyzed the kidney function of patients with renal disease related to MM during the first year of treatment. All patients included were consecutively admitted to the outpatient services of two hospitals between January 2009 and January 2019 and met the diagnostic criteria for MM regardless of the reason for seeking medical help. We excluded patients who had kidney disease or who were on dialysis before MM diagnosis. We investigated the factors associated with renal function recovery using multivariate analysis. We evaluated 167 patients (median age of 66 ± 11.49 years). Almost half of the patients had arterial hypertension (76; 45.5%). The majority had International Staging System (ISS) grades 3 (73; 43.7%) or 2 (60; 35.9%). Seventy-four (44%) patients had an estimated glomerular filtration rate (eGFR) 1.0 g, and extramedullary plasmacytoma. However, only baseline renal function (eGFR > 60 ml/min/1.73 m2) and HSCT were associated with greater recovery of renal function at 12 months of follow-up.

Abstract Collapsing glomerulopathy (CG) has a severe course typically associated with viral infections, especially HIV and parvovirus B19, systemic lupus erythematosus (SLE), among other etiologies. A 35-year-old woman with recent use of a JAK inhibitor due to rheumatoid arthritis presented with a 2-week history of fever, cervical adenopathy, and facial erythema. After admission, anemia, hypoalbuminemia, proteinuria, and severe acute kidney injury were noted. SLE was diagnosed and parvovirus B19 DNA was detected in serum samples. Kidney biopsy showed CG without any typical features of lupus nephritis. The patient was treated with prednisone and presented marked improvement of anemia and kidney function after a few weeks. In this case, the patient with SLE presented CG possibly caused by parvovirus B19 infection associated with homozygous apolipoprotein 1 (APOL1) G1 genotype, which has been described as a determinant risk factor for this glomerulopathy. It is not clear whether SLE had a causal relationship with glomerular disease or was a concurrent cause. Treatment can be challenging in such a context, as no antiviral drug is efficient and immunosuppression has no discernable benefit, although steroid use was efficient in treating renal manifestations in this case.

Abstract The use of regional citrate anticoagulation (RCA) in liver failure (LF) patients can lead to citrate accumulation. We aimed to evaluate serum levels of citrate and correlate them with liver function markers and with the Cat/Cai in patients under intensive care and undergoing continuous venovenous hemodiafiltration with regional citrate anticoagulation (CVVHDF-RCA). A prospective cohort study in an intensive care unit was conducted. We compared survival, clinical, laboratorial and dialysis data between patients with and without LF. Citrate was measured daily. We evaluated 200 patients, 62 (31%) with LF. Citrate was significantly higher in the LF group. Dialysis dose, filter lifespan, systemic ionized calcium and Cat/Cai were similar between groups. There were weak to moderate positive correlations between Citrate and indicators of liver function and Cat/Cai. The LF group had higher mortality (70.5% vs. 51.8%, p = 0.014). Citrate was an independent risk factor for death, OR 11.3 (95% CI 2.74–46.8). In conclusion, hypercitratemia was an independent risk factor for death in individuals undergoing CVVHDF-ARC. The increase in citrate was limited in the LF group, without clinical significance. The correlation between citrate and liver function indicators was weak to moderate.

This study analyzes Environmentally Sustainable Practices (ESPs) in the Organic Food Tourist Route (OFTR) in South Brazil. Data collection included interviews with open and closed questions about ESPs and the Barometer of Tourism Sustainability (BTS) tool. Eight owners or managers of OFTR's enterprises answered questions online or personally. Content analysis and descriptive statistics were used. Results indicated that tourism enterprises adopt ESPs according to each reality since some are dedicated to producing and commercializing organic products, while others are dedicated to lodging and guided tours. Managers realize the importance of adopting ESPs, enabling a decrease in expenses and the supply of organic products. Since tourists are concerned and careful with the environment nowadays, sustainability must be considered, becoming a differential. The enterprises develop ESPs, which makes the route potentially sustainable, following the standards established by the BTS. In order to achieve the “sustainable” level, the enterprises on the route need to improve their performance in many items whose results were less sustainable. From a theoretical perspective, this study contributed to understanding how ESPs were developed in enterprises and how they contribute to tourism development. The understanding of tourist routes expanded with an emphasis on sustainability, the environmental dimension, the ESPs, and organic agriculture. The BTS enabled the assessment of the sustainability of OFTR's enterprises.

As cooperativas agrícolas são estruturas econômicas intermediárias que apresentam direitos de propriedade difusos acarretando problemas de governança e ineficiência econômica. Este estudo propôs-se a analisar a existência dos problemas do horizonte e do carona em cooperativas de produtores de leite familiares do Rio Grande do Sul. Para tal, utilizou-se uma amostra intencional não probabilística onde foram pesquisadas duas cooperativas. Foram aplicados 31 roteiros de entrevistas semiestruturadas aos cooperados, funcionários e presidentes das organizações. Os resultados revelaram que os cooperados possuem visão de curto prazo (restrita à sua propriedade agrícola). Quanto à visão dos cooperados sobre o seu papel nas organizações este é pouco claro gerando espaço para ações oportunistas nas mesmas. Conclui-se que os problemas oriundos dos direitos de propriedade difusos se manifestaram nas organizações analisadas e geram ineficiências nas suas governanças.

Los senderos de la naturaleza están configurados en una modalidad de turismo rural en la que se propone que las comunidades rurales organicen circuitos para la venta de productos. El objetivo de este artículo fue analizar las redes de relaciones sociales formadas entre los participantes de esta modalidad de turismo rural en el territorio Vale do Ivaí, estado de Paraná, Brasil. Por medio de un muestreo intencional no probabilístico, se realizaron 42 entrevistas semiestructuradas en 2015. Las redes de relaciones sociales que se formaron en los paseos por la naturaleza se basan en lazos fuertes y débiles. Se concluye que existen lazos fuertes en las subredes y que los lazos débiles se encuentran entre las subredes, lo que garantiza la fluidez y dinámica de la red.

This paper aims at analysing the way institutions, under the approach of New Institutional Economics, incentivize or restrict the development of a wine tourism destination. This is a case study conducted in Vale dos Vinhedos, Rio Grande do Sul, Brazil, which is the main wine tourism destination in the country. A documental analysis was held along with interviews with 13 representative organizations (public and private) of wine and tourism sectors in the region. In the study, it was observed that wine tourism in Vale dos Vinhedos, lacks formal institutions, being solidly based on informal institutions, in other words, cultural region’s patterns. Additionally, the entry of new tourism players, with a different mindset, creates conflicts and institutional pressure, especially related to land usage. It can be observed that leadership structures connected to these sectors have put effort to promote the destination. However, there is little formal institutional incentive. Thus, to solve these bottlenecks, it is recommended that the formulation of incentive policies be coherent with the informal institutional structure of the region, that they support local entrepreneurship, aiming at wine tourism dynamization in small properties, the definition of a shared destiny view and the roles of different segments of governance.

ABSTRACT Introduction: The clinical impact of vascular calcification is well established in the context of cardiovascular morbidity and mortality, but other clinical syndromes, such as calciphylaxis, although less frequent, have a significant impact on chronic kidney disease. Methods: Case report of a 27-year-old woman, who had complained of bilateral pain in her toes for 3 days, with the presence of small necrotic areas in the referred sites. She had a history of type 1 diabetes (25 years ago), with chronic kidney disease, on peritoneal dialysis, in addition to rheumatoid arthritis. She was admitted to the hospital, which preceded the current condition, due to exacerbation of rheumatoid arthritis, evolving with intracardiac thrombus due to venous catheter complications, when she started using warfarin. Ischemia progressed to her feet, causing the need for bilateral amputations. Her chirodactyls were also affected. Thrombophilia, vasculitis, endocarditis or other embolic sources were investigated and discarded. Her pathology report evidenced skin necrosis and superficial soft parts with recent arterial thrombosis, and Monckeberg's medial calcification. We started treatment with bisphosphonate and sodium thiosulfate, conversion to hemodialysis and replacement of warfarin with unfractionated heparin. Despite all the therapy, the patient died after four months of evolution. Discussion: Calciphylaxis is a rare microvasculature calcification syndrome that results in severe ischemic injuries. It has pathogenesis related to the mineral and bone disorder of chronic kidney disease combined with the imbalance between promoters and inhibitors of vascular calcification, with particular importance to vitamin K antagonism. Conclusion: The preventive strategy is fundamental, since the therapy is complex with poorly validated effectiveness.

Abstract Introduction: Infectious complications are common in systemic lupus erythematosus. Although uncommon, central nervous system infections do occur and have significant lethality, with several etiological agents. Methods: We report on the case of a 29-year-old woman recently diagnosed with systemic lupus erythematosus with hematological, cutaneous, serous and renal manifestations (class IV lupus nephritis), who underwent corticosteroid pulse therapy and mycophenolate induction therapy. After 3 months of evolution, she developed headache and altered mental status. Computed tomography showed an area of hypoattenuation in the left frontal white matter and her cerebrospinal fluid examination showed pleocytosis and hyperproteinorrhachia. Peripheral blood and CSF culture identified Listeria monocytogenes. The patient presented deterioration of her neurological status, requiring invasive mechanical ventilation, monitoring of intracranial pressure and, despite all the intensive support, persisted in a comatose state and developed multiple organ failure, evolving to death due to nosocomial bloodstream infection. Discussion: Infection from L. monocytogenes usually occurs after eating contaminated food, manifesting itself with diarrhea and, occasionally, invasively, such as neurolisteriosis. Further investigation with CSF analysis and MRI is necessary, and the diagnosis consists of isolating the bacteria in sterile body fluid. Conclusion: The case presents a patient whose diagnosis of meningoencephalitis became an important differential with neuropsychiatric disorder. The poor outcome reinforces the need to remember this infectious condition as a serious complication in the natural history of SLE.

ABSTRACT Objective The objective of the present study is to evaluate the association of red blood cell distribution width with acute kidney injury in sepsis. Methods This is a retrospective study of 849 critically ill patients with sepsis in intensive care unit. Demographic data, renal function, inflammation, complete blood count, and acid-base parameters were compared between acute kidney injury and non-acute kidney injury groups. Therefore, a multivariate analysis was performed to observe independent predictive factors. Results Comparatively, higher levels of C-reactive protein, lactate, red blood cell distribution width, and Simplified Acute Physiology Score 3 were found in the acute kidney injury group. The study showed a higher frequency of women, hemoglobin (Hgb) concentration, platelets, bicarbonate and PaO2/FiO2 ratio in the non-acute kidney injury group. In addition, there was an independent association of comorbidity-chronic kidney disease [OR 3.549, 95%CI: 1.627-7.743; p

Introduction Multicenter studies involving patients with acute kidney injury (AKI) associated with the disease caused by the new coronavirus (COVID-19) and treated with renal replacement therapy (RRT) in developing countries are scarce. The objectives of this study were to evaluate the demographic profile, clinical picture, risk factors for mortality, and outcomes of critically ill patients with AKI requiring dialysis (AKI-RRT) and with COVID-19 in the megalopolis of São Paulo, Brazil. Methods This multicenter, retrospective, observational study was conducted in the intensive care units of 13 public and private hospitals in the metropolitan region of the municipality of São Paulo. Patients hospitalized in an intensive care unit, aged ≥ 18 years, and treated with RRT due to COVID-19-associated AKI were included. Results The study group consisted of 375 patients (age 64.1 years, 68.8% male). Most (62.1%) had two or more comorbidities: 68.8%, arterial hypertension; 45.3%, diabetes; 36.3%, anemia; 30.9%, obesity; 18.7%, chronic kidney disease; 15.7%, coronary artery disease; 10.4%, heart failure; and 8.5%, chronic obstructive pulmonary disease. Death occurred in 72.5% of the study population (272 patients). Among the 103 survivors, 22.3% (23 patients) were discharged on RRT. In a multiple regression analysis, the independent factors associated with death were the number of organ dysfunctions at admission and RRT efficiency. Conclusion AKI-RRT associated with COVID-19 occurred in patients with an elevated burden of comorbidities and was associated with high mortality (72.5%). The number of organ dysfunctions during hospitalization and RRT efficiency were independent factors associated with mortality. A meaningful portion of survivors was discharged while dependent on RRT (22.3%).

El turismo en las zonas rurales ha demostrado ser un catalizador importante para el desarrollo económico, ya que en todo el mundo las propiedades rurales diversifican sus actividades. El objetivo del artículo fue analizar la estrategia de diversificar los medios de subsistencia (Ellis, 2000; Padilha, 2009; Padilha et al., 2020) en las propiedades rurales de la ruta de turismo rural Vale del Paraíso (Brasil). Como procedimiento metodológico, se llevó a cabo una investigación cualitativa de casos múltiples en seis empresas, con la aplicación de un cuestionario, registrando y analizando las respuestas utilizando la técnica de análisis de contenido. Como resultado, es evidente que entre las razones para explorar el turismo rural, se centraron en la diversidad de los recursos naturales, la receptividad y la generación de ingresos, con aspectos que facilitan y obstaculizan, así como elementos que modifican el acceso al capital y el desempeño del turismo. En las zonas rurales, el desarrollo de habilidades de comunicación, el intercambio de conocimientos con los turistas, la autoestima, el valor agregado del producto y el aumento de los ingresos familiares son evidentes.

Abstract Background Performing a kidney biopsy is necessary to accurately diagnose diseases such as glomerulonephritis and tubulointerstitial nephritis, among other such conditions. These conditions predispose patients to chronic kidney disease, as well as acute kidney injury (AKI). Notably, most epidemiological studies describing AKI have not investigated this patient population. Methods Included patients admitted to the nephrology ward of a tertiary hospital who underwent percutaneous kidney biopsy. AKI was diagnosed based on the Kidney Disease: Improving Global Outcomes criteria. Results Of the 223 patients investigated, 140 (62.8%) showed AKI. Of these, 91 (65%), 19 (13.6%), and 30 (21.4%) presented with AKI classified as stages 1, 2, and 3, respectively. The primary indication for performing biopsy was nephrotic syndrome or nephrotic proteinuria (73 [52.1%] in the AKI vs. 51 [61.4%] in the non-AKI group, p = 0.048). Focal segmental glomerulosclerosis was the most prevalent primary disease (24 [17.1%] in the AKI vs. 15 [18.0%] in the non-AKI group, p = 0.150). Multivariate analysis of risk factors associated with AKI showed hemoglobin levels (odds ratio [OR] 0.805, 95% confidence interval [CI] 0.681–0.951, p = 0.011), serum high-density lipoprotein cholesterol levels (HDL-c, OR 0.970, 95% CI 0.949–0.992, p = 0.008), and baseline serum creatinine levels (OR 2.703, 95% CI 1.471–4.968, p = 0.001) were significantly associated with AKI. Conclusions We observed a high prevalence of AKI in hospitalized patients who underwent kidney biopsy to investigate their renal disease, particularly glomerulonephritis. Higher levels of hemoglobin and serum HDL-c were associated with a lower risk of AKI.

This article analyzes changes in Mexico’s rural labor market by identifying the main sources of employment and income of rural households for the 2002-2007 period. Quantitative analysis is based on panel data from the Mexico National Rural Household Survey; the results confirm that industry, trade and services are the most important source of income for the rural sector. These findings confirm projections made in literature concerning the loss of relevance of agricultural sector as an income generator, encouraging development of Mexican rural communities. Households were no grouped by income level, which was a constraint for examining in more detail the weight of non-agricultural activities for each group.

Este artigo teve como objetivo caracterizar os agricultores familiares que atuam com produção orgânica na região da Serra Gaúcha, conhecendo as motivações e os fatores que influenciam no acesso a diferentes canais de comercialização. Através da constituição de uma amostra intencional não probabilística utilizando alguns critérios, foram entrevistados 49 produtores vinculados à comercialização em supermercados e em uma feira de agricultores. Os resultados revelaram que a agricultura orgânica é uma atividade recente e está vinculada a formação de associações. A principal motivação para adesão à atividade está relacionada à preocupação com a saúde. Os supermercados e as feiras são os principais canais de comercialização, sendo que as feiras estão relacionadas ao início do cultivo orgânico e os supermercados apresentam-se como uma forma de comercialização mais recente. Conclui-se que a cooperação foi fundamental no acesso a canais de comercialização de um mercado em construção e com potencial determinado por uma crescente demanda de produtos.

Abstract Background Many controversies exist regarding the management of dialysis-requiring acute kidney injury (D-AKI). No clear evidence has shown that the choice of dialysis modality can change the survival rate or kidney function recovery of critically ill patients with D-AKI. Methods We conducted a retrospective study investigating patients (≥16 years old) admitted to an intensive care unit with D-AKI from 1999 to 2012. We analyzed D-AKI incidence, and outcomes, as well as the most commonly used dialysis modality over time. Outcomes were based on hospital mortality, renal function recovery (estimated glomerular filtration rate-eGFR), and the need for dialysis treatment at hospital discharge. Results In 1,493 patients with D-AKI, sepsis was the main cause of kidney injury (56.2%). The comparison between the three study periods, (1999–2003, 2004–2008, and 2009–2012) showed an increased in incidence of D-AKI (from 2.56 to 5.17%; p = 0.001), in the APACHE II score (from 20 to 26; p

Abstract This work has as its theme the common natural resources and the management models that allow new governance systems in the rural areas in the surrounding of protected areas. In this sense, this paper aims to discuss the collective action of social actors in the management of common natural resources in the surroundings of the National Park of Serra da Bodoquena (PNSB). Based on institutional approach for the study of the self-organisation and self-governance in common-pool resources situations developed by Elinor Ostrom, the investigation sought the theoretical explanation of phenomena. The conclusions point out that the expected mobilisation of groups of individuals in the pursuit of common goals is twofold. In this case, the participants of the action arena create different goals and different collective actions according to their interests.

As Caminhadas na Natureza configuram-se numa modalidade de turismo rural e propõem que comunidades rurais organizem circuitos de caminhada e vendam produtos e serviços a caminhantes oriundos de centros urbanos. O estudo pretende analisar a origem do projeto Caminhadas na Natureza, adotando o recorte geográfico do Território Vale do Ivaí, Estado do Paraná. Nesta análise foram observados o processo de desenvolvimento do projeto e as motivações que conduziram 42 atores a se envolver nas caminhadas, entre eles, agricultores, caminhantes e organizadores. Por meio de entrevistas semiestruturadas, observou-se que o projeto surgiu de uma organização social independente, mas foi fortemente impulsionado por diversas ações de políticas públicas, principalmente do Ministério do Desenvolvimento Agrário - MDA e da Empresa de Assistência Técnica e Extensão Rural - EMATER Paraná. As motivações que levaram os atores a se engajarem no projeto pertencem principalmente à dimensão social, seguida pela dimensão de prestígio e econômica.

The quality of the host ‑guest ratio (hospitality) plays an important role in the tourist experience. This research aimed to describe and analyze the hospitality practices and their actions in the development of various fields of hospitality in tourism. The mountainous region of Rio de Janeiro State was elected to the research. We used primary data collection at 9 rural families working with tourist activities in 2012, through in ‑depth interviews, in addition to the field diary and photographic recording technique. The results revealed that the basis for the construction of commercial hospitality is the domestic hospitality, and this does not disintegrate for the construction of that because families providing such services do not cease to receive feed, host and entertain your friends and family. We conclude that there is the hybridization of domestic hospitality commercial.

A dinâmica rural no novo século, baseada na multifuncionalidade da agricultura, assim como a busca da valorização do rural, da reconexão entre cidade e campo e da conscientização de crianças e jovens sobre a produção de alimentos, trouxeram à tona a emergência de novas atividades não agrícolas, como o Turismo Rural Pedagógico (TRP), uma nova modalidade de turismo rural e agroturismo voltada à prática pedagógica. Desta forma, o presente artigo apresenta alguns resultados da dissertação intitulada A prática do turismo rural pedagógico: aspectos motivacionais e impressões dos benefícios para as famílias e comunidades rurais, cujo principal objetivo foi investigar e identificar as motivações e os benefícios socioeconômicos do turismo rural pedagógico para as famílias e a comunidade no entorno do projeto Viva Ciranda e do roteiro Caminhos Rurais. Para tanto, foram realizadas entrevistas semiestruturadas com os empreendedores e a comunidade local. A análise dos dados foi realizada por meio da categorização das respostas, tabulação dos dados e dos softwares Web-QDA e Excel. Os resultados revelaram que o TRP consolida-se como uma interessante opção de investimento e de estratégia de desenvolvimento local, atraindo diferentes perfis de empreendedores. Observou-se que, embora represente uma oportunidade de diversificação econômica, as principais motivações para iniciar e permanecer no TRP, bem como os principais benefícios reconhecidos pelos empreendedores, estão vinculados aos aspectos sociais, como a valorização do meio rural, a satisfação pessoal e a conexão entre rural e urbano. Além disso, a pesquisa verificou o reconhecimento e a valorização dessa prática pela comunidade do entorno das propriedades pedagógicas. Palavras-chave: Turismo rural pedagógico. Turismo rural. Motivações. Desenvolvimento rural.

Este trabalho tem como objetivo estudar as relações de trabalho na atividade turística no meio rural de São José dos Ausentes. As mudanças produtivas ocorridas no meio rural por meio da diversificação das culturas agrícolas e da inserção de atividades não agrícolas no espaço rural têm permitido um novo debate sobre o desenvolvimento rural. Novas formas de uso do espaço rural estão postas e com elas novas formas de organização da vida familiar, cuja divisão do trabalho é uma das esferas mais afetadas. A proximidade entre as tarefas realizadas no ambiente doméstico com a atividade produtiva turismo rural permite que homens e mulheres desenvolvam e reestruturem suas funções dentro da unidade familiar. Porém, não se sabe se estas mudanças permitem transformações na divisão sexual do trabalho e se isto possibilita repensar as estruturas de gênero no meio rural. Para compreender essa teia de relações, foi preciso refletir sobre as relações internas à família, como a organização das tarefas diárias, o sistema produtivo e a participação de cada membro nas decisões que envolvem o grupo familiar. Para isso pesquisaram-se sete famílias pluriativas e seis famílias agrícolas no meio rural do município de São José dos Ausentes, RS. De forma geral, pode-se sinalizar para uma reprodução da forma tradicional da divisão sexual do trabalho nas famílias rurais pesquisadas, sobretudo no que diz respeito ao trabalho feminino no momento em que velhas práticas são reafirmadas pelo turismo. Palavras-Chave: Turismo rural. Trabalho. Gênero.

Este trabalho examina as ocupações e fontes de renda de mulheres e homens das famí­lias das áreas rurais na região Nordeste do Brasil, 2002 a 2009. Foram feitas estatí­sticas descritivas dos microdados da Pesquisa Nacional por Amostra de Domicí­lios. Os resultados mostraram que o número de famí­lias dessas áreas cresceu, mas de agricultura familiar reduziu. Verificou-se a intensa redução das ocupações agrí­colas e o aumento da proletarização das famí­lias rurais. A ocupação não agrí­cola foi um importante lócus para as mulheres gerarem renda. A maior fonte de renda das famí­lias é oriunda das ocupações agrí­colas dos homens; e as transferências sociais são as maiores fontes para as mulheres.

This paper aims to present some results of scientific research, whose main objective consisted in analyzing the activities of pedagogical rural tourism as educational practice to be developed in addition to schooling, based on two empirical experiences developed in southern Brazil: the Tourism Route “Caminhos Rurais” of Porto Alegre (RS) and the Tourism Project “Viva Ciranda” in Joinville (SC). Methodologically, we used a literature review, the observation of the proposed activities and semi‑structured interviews conducted with 11 farmers, owners of farm properties and 22 teachers who visited these properties. We conclude that pedagogical rural tourism plays an important socio‑educational function, as contributing to children’s learning and setting into value of the farmers knowledge and practices.

Several factors influence the outcomes in acute kidney injury (AKI), especially in intensive care unit (ICU) patients. In this scenario, continuous renal replacement therapies (CRRT) are used to control metabolic derangements and blood volume. Knowing this fact, it may be possible to change the course of the disease and decrease the high mortality rate observed. Thus, we aimed to evaluate the main risk factors for death in AKI patients needing CRRT.This was a prospective, observational cohort study of ICU patients (N = 183) with AKI who underwent continuous venovenous hemodiafiltration (CVVHDF) as their initial dialysis modality choice. The patients were predominantly male (62.8%) and their median age was 65 (55-76) years. The most frequent comorbidities were cardiovascular disease (39.3%), hypertension (32.8%), diabetes (24%), and cirrhosis (20.7%). The main cause of AKI was sepsis (52.5%). At beginning of CVVHDF, 152 patients (83%) were using vasopressors. The median SAPS 3 and SOFA score at ICU admission was 61 (50-74) and 10 (7-12), respectively. The dialysis dose delivered was 33.2 (28.9-38.7) ml/kg/h. The median time between ICU admission and CVVHDF initiation was 2 (1-4) days. The median cumulative fluid balance during the CVVHDF period was -1838 (-5735 +2993) ml. The mortality rate up to90 days was 58%. The independent mortality risk factors in propensity score model were: chronic obstructive pulmonary disease (OR = 3.44[1.14-10.4; p = 0.028]), hematologic malignancy (OR = 5.14[1.66-15.95; p = 0.005]), oliguria (OR = 2.36[1.15-4.9; p = 0.02]), positive daily fluid balance during CVVHDF (OR = 4.55[2.75-13.1; p

Esta investigación tuvo como objetivo describir y analizar las prácticas de hospitalidad, así como sus acciones en el desarrollo de los diferentes dominios de la hospitalidad en las actividades turísticas. La región Serrana del Estado de Río de Janeiro fue elegida para llevar a cabo la investigación. La encuesta de datos primarios se utilizó con 9 familias rurales que trabajan con actividades turísticas, en 2012, mediante entrevistas en profundidad, además de la técnica de diario de campo y registro fotográfico. Los resultados revelaron que la base de la construcción de la hospitalidad comercial es la hospitalidad doméstica, que no se desintegra en la construcción de la misma porque las familias que ofrecen dichos servicios no dejan de recibir, alimentar, hospedar y entretener a sus amigos y familiares. Se puede concluir que existe una hibridación de la hospitalidad rural con la urbana, así como de la hospitalidad doméstica con la hospitalidad comercial.

Objective: To compare three different regimens of thymoglobulin induction. Methods: One hundred seventy two patients submitted to renal transplantation from a dead donor were divided into three groups according to the total number of thymoglobulin doses used in the post-transplantation surgery: Group 1, until 14 doses – May 2002 to June 2004 (n = 48); Group 2, until 7 doses – July 2004 to December 2006 (n = 57); Group 3, until 4 doses – January 2007 to July 2009 (n = 67). The three groups were compared according to the main outcomes. Results: The main demographic differences among the groups were: greater dialysis time in Group 3 (p < 0.001 for Group 1; and p = 0.04 for Group 2); donor age, greater in Groups 2 and 3 (p = 0.02; p = 0.01, respectively); and cold ischemia time progressively greater from Group 1 to 3: 19.5 ± 5.1 to 24.6 ± 5.7 hours (p < 0.001). In relation to the inhibitor of calcineurin, the relationTac/Csa was 14.6/66.7% in Group 1, 78.9/12.3% in Group 2 and 100/0% in Group 3. Reflecting the increase in cold ischemia time, the incidence of delayed graft function was 64.6%, 68.4% e 82.1% in Groups 1, 2 and 3, respectively (p = ns). The incidence of acute rejection was similar in the three groups: 16.7% (1); 16.3% (2) and 16.4 (3) – p = ns. The prevalence of viremia for cytomegalovirus was 61.7% in Group 1, 66.1% in Group 2 and 83.3% in Group 3 (p = ns). There were no difference related to the number of infected cells with cytomegalovirus in antigenemia, according to the groups, however, patients in Group 3 had an earlier diagnosis: from 64.3 ± 28.5 days in Grup 2, to 47.1 ± 22.5 days, in Group 3, p < 0.001. Survival of the graft in one year was 89.6%, 92.9% and 91.0%, in Groups 1, 2 and 3, respectively (p = ns). The graft function was much better with the lower doses of thymoglobulin: Group 1: 57.0 ± 20.0 mL/min; Group 2: 67.0 ± 18.4 mL/min (p = 0.008); Group 3: 71.2 ± 18.4 mL/min (p < 0.001, Group 1 versus Group 3; p = 0.06, Group 1 versus Group 2). There was a significant reduction in the costs of induction protocol from U$ 7,567.02 to U$ 3,485.56 (p < 0.001). Conclusions: The total number of thymoglobulin doses for immunologic induction could be reduced in a safe and effective way, without a negative impactin graft rejection or survival, preserving renal function and being significantly cheaper.

This article aims, from the theoretical origins, a conceptual understanding of the term "meios de vida" by Antonio Candido, to what or whom it refers and which is its real meaning and applicability in current understandings of rural livelihoods, verifying its correlation with the "livelihoods perspective". For this purpose, it´s applied the latest version of "The partners of Rio Bonito", searching into the livelihoods perspective, such comparative parameter to elucidate the pioneering studies by social scientist Antonio Candido in the understanding of rural livelihoods transformations in the middle of the XX century. Based on the data and information applied in the assay, the “meios de vida” proposed by Candido, weren´t and aren´t the same “livelihoods” proposed by Chambers, Conway, Ellis and Scoones, although attending another proposal, applied in diferent contexts, from others perspectives, but with the same goals, which however does not exclude the concept from the livelihoods perspective genealogy, unlike, inserting it in one of its branches and arms as located and successful experiences.

Objective: To evaluate the incidence of antibody-mediated rejection after the C4d and donor specific antibody detection was provided by Luminex in renal transplantation biopsies; to compare acute antibody-mediated rejection characteristics as related to acute cellular rejection; to evaluate the impact on the incidence of acute antibody mediated rejection after the utilization of cross match test by flux cytometry and the detection of pre-transplantation donor specific antibody in patients with previous history of exposition to alloantigens. Methods: One hundred twenty-four renal transplanted patients were evaluated through the detection of C4d in early biopsies of those presenting graft dysfunction and the detection of antibody against donor when C4d was positive. The acute antibody mediated rejection was treated by plasmapheresis and intravenous immunoglobulin. Rresults: The incidence of acute rejection was 18.8%, being the acute cellular rejection 14.9% and acute antibody mediated rejection 6.6%. When both were compared, the acute antibody-mediated rejection were earlier than the acute cellular rejection (12.5 versus 59.9 days, p = NS), being more frequent in female patients (75 versus 29%, p = 0.05), with deceased donors (75 versus 33%, p = 0.09), with higher dialysis time (87.7 versus 47.4, p = 0.03), greater number of transfusion episodes (4.6 versus 1.4, p = 0.02), greater panel reaction activity (28.0 versus 4.8, p = 0.03) and more frequently in re-transplanted patients (50 versus 5.6%, p = 0.02). Delayed graft function was more frequent in antibody mediated rejection (100 versus 50%, p = 0.02). All patients with acute cellular rejection reversed graft function after treatment, with 100% graft survival after one year. Among patients with acute antibody-mediated rejection, the treatment with plasmapheresis and immunoglobulin was efficient in reducing the titers of donor specific antibody (2605 versus 202 mfi, p < 0.001), but 3/8 of patients evolved to graft loss, making graft survival of 62.5% (p < 0.001). Cconclusions: The routine use of detecting C4d and donor specific antibody increased the incidence of acute rejection. Acute antibody-mediated rejection presented clinical profile and therapeutic response different from acute cellular rejection, identifying a worse prognosis as well as therapeutic success.

Objective: The aim of this study was to perform a direct analysis ofKATP mRNA expression by RT-PCR in kidney and isolated aorta fromrats with cirrhosis (induced by carbon tetrachloride) and controls.The present study also analyses the relation between induced cirrhosisand urinary excretion of sodium and sympathetic activity in cirrhoticrats. Methods: Rats were placed in metabolic cages and allowedfree access to food and water. Cirrhosis was induced by repeateddoses of carbon tetrachloride by gastric gavage. After some weeks,the kidney and aorta were dissected and utilized for RNA extraction.Blood and urine were analyzed for electrolytes. Renal function wasestimated by creatinine clearance and sodium urinary excretion.Serum catecholamines were measured by HPLC analysis. Results:First, RT-PCR analysis showed that KATP mRNA is expressed in liverwith cirrhosis and intense fibrosis, but not with moderate fibrosis.Second, RT-PCR analysis revealed that KATP mRNA was detectedonly in aorta dissected from rats with cirrhosis. Finally, an enhancedreabsorption of sodium without renal failure suggests a potentialmediator would increase the activity of the sympathetic system.Conclusion: These results suggest that KATP mRNA is expressed incirrhotic rats with sympathetic activation and renal dysfunction. Thischannel might be involved in another route where the vascular tonecan be modulated in cirrhosis.

In Plastic Surgery, cell culture represents the perspective of studying cellular mechanisms that guide the healing process of several tissues. Some steps of the healing process depend on physical factors as the tissular partial pressure of O2. In cell culture, it is possible to submit cells to hypoxic enviroment. The present study reports an alternative method at low cost for the establishment of hypoxic environment in cell culture flasks.A cultura de células, na Cirurgia Plástica, representa uma perspective para o estudo dos mecanismos celulares que norteiam o processo cicatricial de diversos tecidos. Algumas etapas do processo de cicatrização dependem de fatores físicos como a pressão parcial de O2. Em uma cultura de células, é possível submeter células a um ambiente hipóxico. O presente estudo relata um método alternativo de baixo custo para o estabelecimento de um ambiente hipóxico em frascos de cultura de células.

El desafío actual del desarrollo rural es de crear oportunidades de empleo y renta, con la participación de la población local, teniendo en cuenta que la producción agropecuaria tradicional no garantiza más lo indispensable a una actividad económica rentable. De esta manera, el objetivo de este artículo es de argumentar, apoyándose en estudios hechos en dos municipios del Estado de Santa Catarina (Lages y San Martiño ), Región Sur del Brasil, que el turismo rural puede constituirse en una estrategia de desarrollo sostenible que genera ideas, instrumentos y métodos para enfrentar las dificultades existentes. El turismo, aunque tardío, apalanca las regiones rurales que se encuentran en crisis para generar nuevas formas de empleos, ocupación de la mano de obra y renta, como también permite la combinación y el encadenamiento de actividades complementarias, parcerías entre los propietarios de las fincas, empresarios, administradores y asociaciones de manera que facilitan la comercialización de los productos y servicios locales. The challenge faced by rural development programmes is to create employment opportunities and income, with the involvement of local population, taking into account that the traditional agricultural production does not offer the guarantee of an efficient economic activity. Thus, the aim of this article is to argue, based on data collected in two counties of the State of Santa Catarina (Lages and Sao Martinho ), Southern Region of Brazil, that rural tourism can be a useful strategy of sustainable development in the sense that it generates ideas, tools and methods to face current difficulties. Rural tourism helps to maintain the existing jobs, to generate new occupations and to aggregate new incomes as well as to stimulate the emergence of new economic activities, new forms of partnership among farmers, industrialists, administrators and associations in view of facilitating the sale of local products and services.

The incidence and outcomes of acute kidney injury (AKI) in kidney transplantation are poorly known. Retrospective cohort analysis was performed on the data of all patients (≥3 months after transplantation and ≥16 years of age) admitted to the hospital due to medical or surgical complications from 2007 to 2010. We analyzed 458 kidney transplant recipients, 55.2% men, median age 49 (IQR, 36-58) years, median of 12.5 (IQR, 3-35) months after kidney transplantation; admitted to the hospital due to medical or surgical complications. Most of the patients received a kidney from a deceased donor (62.2%), the primary cause for hospital admission was infection (60.7%) and 57 (12.4%) individuals were diagnosed with acute rejection (AR). The incidence of AKI was 82.3%: 31.9% stage 1, 29.3% stage 2 and 21.2% stage 3. Intensive care unit (ICU) admission (OR 8.90, 95% CI: 1.77-44.56 p = 0.008), infection (OR 5.73, 95% CI: 2.61-12.56, p

Neste artigo, analisaram-se as tabulações especiais dos microdados das PNADs relativas às ocupações das famílias no Estado do Paraná entre 1992 e 1999. Os dados evidenciaram um crescimento das famílias ocupadas em atividades não-agrícolas, a redução das famílias ocupadas em atividades exclusivamente agrícolas e o aumento do número de famílias de aposentados e pensionistas. Pode-se, assim, afirmar que o meio rural paranaense sofre tanto de uma espécie de "urbanização" como também de uma transformação crescente em local de moradia. Informações complementares conduzem a inferir-se que ocorre redução importante no universo denominado agricultura familiar.This article analyses the special processes of the National Home Research Sample’s (PNAD) micro data relative to the occupations of rural families in the state of Paraná between 1992 and 1999. The data show growth in the number of families working in non-agricultural activities, a reduction of the number of families working in exclusively agricultural activities, and growth in the number families headed by pensioners and/or retired people. It is possible to assume that the Paranaense rural environment is experiencing a type of "urbanization" and increasing transformation in the housing area. Further information leads us to conclude that an important reduction in the universe of Brazilian family agriculture is occurring.

Este artigo tem como objetivo apresentar alguns resultados de uma investigação científica, cujo principal objetivo consistiu em analisar as atividades de turismo rural pedagógico como prática educativa a ser desenvolvida em complemento ao ensino escolar, com base em duas experiências empíricas desenvolvidas no sul do Brasil: O Roteiro "Caminhos Rurais" de Porto Alegre (RS) e o Projeto de Turismo "Viva Ciranda", em Joinville (SC). Metodologicamente, utilizou-se a revisão da literatura, a observação das atividades propostas e entrevistas semiestruturadas, realizadas com 11 agricultores, donos das propriedades e 22 professores, que visitaram essas propriedades. Conclui-se que o turismo rural pedagógico desempenha importante função socioeducativa, contribuindo para a aprendizagem das crianças e a valorização dos saberes e fazeres dos agricultores.

The epidemiological characteristics of myiases are not well defined.It has been described in persons having close contact with animalsthat usually atract flies, or in individuals of low socioeconomic level,in a poor health condition. In Brazil myasis have also been describedwith similar epidemiological characteristics. The authors describe acase of myiasis in a previously healthy patient of good socioeconomicstanding and to discuss its treatment.

Muito embora o fenômeno de residências secundárias não se constitua num evento recente, o mesmo tem se destacado em virtude dos novos contornos que denota aos espaços em que se manifesta, sobretudo quando situado em espaços rurais. Diante desta perspectiva, o presente trabalho visa estudar as mobilidades espaciais em residências secundárias no meio rural, nos seus fluxos de finais de semana e de veraneio, de forma a analisar as ações, interações e dinâmicas estabelecidas com os espaços enfocados. A pesquisa foi realizada nos municípios de Itaara e Restinga Seca, Rio Grande do Sul - Brasil. Metodologicamente, a pesquisa contou com: revisão bibliográfica; coleta de dados quali-quantitativos, onde utilizaram-se questionários aplicados a 86 visitantes e 25 entrevistas com os gestores públicos municipais, iniciativa privada e comunidade local. Os resultados demonstram que o fenômeno de residências secundárias afeta em várias dimensões os espaços nos quais manifesta-se, bem como apresenta distinções na relevância das periodicidades dos fluxos, uma vez que divergem em intensidade e heterogeneidade na forma em que atuam no espaço e relacionam-se com o seu entorno.

Para qualificar a gestão e o controle social do Programa Nacional de Alimentação e Nutrição do Escolar (PNAE), foram criados os Centros Colaboradores em Alimentação e Nutrição do Escolar (CECANEs), parcerias do Fundo Nacional de Desenvolvimento da Educação do Ministério da Educação (FNDE- MEC) com Universidades Federais. Os CECANEs desenvolvem pesquisas, projetos de extensão e capacitações com os atores do Programa, com o objetivo de atuar regionalmente, prestando apoio técnico aos envolvidos nos diversos municípios. Assim sendo, este trabalho visa descrever as atividades desenvolvidas pelo CECANE UFRGS as quais têm colaborado para torná-lo referência regional no âmbito da Alimentação Escolar. Foram realizadas pesquisas para avaliar o perfil nutricional de pré-escolares, de adolescentes e dos escolares indígenas kaingangs matriculados em escolas no Rio Grande do Sul (RS). Somando-se a estas, desenvolveram-se um estudo descrevendo o perfil profissional dos nutricionistas que atuam no Programa e pesquisas na área de manipulação de alimentos. Além destas ações foram realizadas assessorias in loco aos municípios da Região Sul, capacitações com 1580 agentes do PNAE, em municípios de Santa Catarina (SC) e do RS, bem como formações com agricultores e demais envolvidos com as compras da agricultura familiar para a alimentação escolar no RS. Conclui-se que os objetivos do Centro Colaborador estão sendo atingidos, na medida que têm produzido informações relevantes para nortear ações futuras dos CECANEs e do FNDE, bem como oportunizado a diversos envolvidos com o PNAE qualificação para suas atividades. Sendo assim, as ações desenvolvidas fortalecem o papel social da Universidade e possibilitam a interação do ensino-pesquisa-extensão com as políticas públicas.

No contexto da nova relação do rural e urbano, a agricultura urbana ganha importância em função de aspectos a ela ligados, tais como a crescente urbanização, a pobreza, problemas de abastecimento e valores fora de mercado. Todavia, os estudos existentes no Brasil sobre a temática ainda são escassos. O objetivo principal deste trabalho é apresentar os resultados de uma investigação sobre a contribuição da agricultura urbana na melhoria da renda e da alimentação de famílias pobres. Para tal, foram entrevistadas, inicialmente, 38 e, posteriormente, 20 famílias, em cinco bairros do município de Santa Maria-RS. Os resultados revelam que a atividade não cumpre necessariamente o papel de provedora de renda adicional, mas conduz a uma economia expressiva, pois certos alimentos deixam de ser comprados. A produção obtida oferece nutrientes importantes, ficando ausentes os alimentos mais ricos em minerais, os quais não são produzidos pelas famílias. A atividade pode ser considerada um modo de produção fora de mercado ou uma economia de subsistência e cumpre papel relevante na complementação da alimentação, fornecendo produtos frescos e relativamente livres de contaminantes industriais, o que contribui para a segurança alimentar e nutricional das famílias.

Ischemia and reperfusion injury is an inevitable event in renal transplantation. The most important consequences are delayed graft function, longer length of stay, higher hospital costs, high risk of acute rejection, and negative impact of long-term follow-up. Currently, many factors are involved in their pathophysiology and could be classified into two different paradigms for education purposes: hemodynamic and immune. The hemodynamic paradigm is described as the reduction of oxygen delivery due to blood flow interruption, involving many hormone systems, and oxygen-free radicals produced after reperfusion. The immune paradigm has been recently described and involves immune system cells, especially T cells, with a central role in this injury. According to these concepts, new strategies to prevent ischemia and reperfusion injury have been studied, particularly the more physiological forms of storing the kidney, such as the pump machine and the use of antilymphocyte antibody therapy before reperfusion. Pump machine perfusion reduces delayed graft function prevalence and length of stay at hospital, and increases long-term graft survival. The use of antilymphocyte antibody therapy before reperfusion, such as Thymoglobulin™, can reduce the prevalence of delayed graft function and chronic graft dysfunction.

OBJETIVO: Investigar a relação entre a transfusão de hemácias e os níveis séricos de Fas solúvel, eritropoietina e citocinas inflamatórias em pacientes gravemente enfermos, com e sem insuficiência renal aguda. MÉTODOS: Os seguintes grupos foram estudados: pacientes gravemente enfermos com insuficiência renal aguda (n=30) e sem insuficiência renal aguda (n=13), pacientes portadores de doença renal crônica terminal em hemodiálise (n=25) e indivíduos saudáveis (n=21). Os níveis séricos de Fas solúvel, eritropoietina, interleucina 6, interleucina 10 e ferro, além da concentração de hemoglobina e de hematócrito, foram analisados em todos os grupos. A associação entre tais variáveis foram estudadas nos pacientes gravemente enfermos. RESULTADOS: Os níveis séricos de eritropoietina mostraram-se mais elevados nos pacientes gravemente enfermos do que nos dos demais grupos. Concentrações mais baixas de hemoglobina foram documentadas nos pacientes com insuficiência renal aguda em relação aos demais. Níveis séricos mais elevados de Fas solúvel foram observados nos pacientes com insuficiência renal aguda e doença renal crônica terminal. Pacientes gravemente enfermos transfundidos apresentaram níveis séricos mais elevados de Fas solúvel (5.906±2.047 e 1.920±1.060; p

ABSTRACT Given the shortage of organs transplantation, some strategies have been adopted by the transplant community to increase the supply of organs. One strategy is the use of expanded criteria for donors, that is, donors aged >60 years or 50 and 59 years, and meeting two or more of the following criteria: history of hypertension, terminal serum creatinine >1.5mg/dL, and stroke as the donor´s cause of death. In this review, emphasis was placed on the use of donors with acute renal failure, a condition considered by many as a contraindication for organ acceptance and therefore one of the main causes for kidney discard. Since these are well-selected donors and with no chronic diseases, such as hypertension, renal disease, or diabetes, many studies showed that the use of donors with acute renal failure should be encouraged, because, in general, acute renal dysfunction is reversible. Although most studies demonstrated these grafts have more delayed function, the results of graft and patient survival after transplant are very similar to those with the use of standard donors. Clinical and morphological findings of donors, the use of machine perfusion, and analysis of its parameters, especially intrarenal resistance, are important tools to support decision-making when considering the supply of organs with renal dysfunction.

Kidney disease is a common complication of multiple myeloma (MM) and a risk factor for increased morbimortality. In this retrospective cohort study based on medical records, we analyzed the kidney function of patients with renal disease related to MM during the first year of treatment. All patients included were consecutively admitted to the outpatient services of two hospitals between January 2009 and January 2019 and met the diagnostic criteria for MM regardless of the reason for seeking medical help. We excluded patients who had kidney disease or who were on dialysis before MM diagnosis. We investigated the factors associated with renal function recovery using multivariate analysis. We evaluated 167 patients (median age of 66 ± 11.49 years). Almost half of the patients had arterial hypertension (76; 45.5%). The majority had International Staging System (ISS) grades 3 (73; 43.7%) or 2 (60; 35.9%). Seventy-four (44%) patients had an estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m² at the time of MM diagnosis. Fifty-two patients (31%) underwent hematopoietic stem cell transplantation (HSCT). After 12 months, 4 (2.3%) patients needed dialysis, and 18 (10.7%) died. The factors associated with an eGFR < 60 ml/min/1.73 m² were anemia, hyperuricemia, 24-hour proteinuria > 1.0 g, and extramedullary plasmacytoma. However, only baseline renal function (eGFR > 60 ml/min/1.73 m2) and HSCT were associated with greater recovery of renal function at 12 months of follow-up. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective: To determine whether pre-hospital statin use is associated with lower renal replacement therapy requirement and/or death during intensive care unit stay. Methods: Prospective cohort analysis. We analyzed 670 patients consecutively admitted to the intensive care unit of an academic tertiary-care hospital. Patients with ages ranging from 18 to 80 years admitted to the intensive care unit within the last 48 hours were included in the study. Results: Mean age was 66±16.1 years old, mean body mass index 26.6±4/9kg/m2 and mean abdominal circumference was of 97±22cm. The statin group comprised 18.2% of patients and had lower renal replacement therapy requirement and/or mortality (OR: 0.41; 95%CI: 0.18-0.93; p=0.03). The statin group also had lower risk of developing sepsis during intensive care unit stay (OR: 0.42; 95%CI: 0.22-0.77; p=0.006) and had a reduction in hospital length-of-stay (14.7±17.5 days versus 22.3±48 days; p=0.006). Statin therapy was associated with a protective role in critical care setting independently of confounding variables, such as gender, age, C-reactive protein, need of mechanical ventilation, use of pressor agents and presence of diabetes and/or coronary disease. Conclusion: Statin therapy prior to hospital admission was associated with lower mortality, lower renal replacement therapy requirement and sepsis rates.

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