ObjectivesDetermine the prevalence and identify predictors of hypovitaminosis D in patients with type 2 diabetes mellitus (T2DM); 2) correlate vitamin D levels with variables indicative of glycemic control and cardiovascular risk.Research design and methodsWe conducted a cross-sectional study with consecutive patients treated at a University Hospital’s Endocrinology outpatient clinic located at 12°58′S latitude, between October 2012 and November 2013. Hypovitaminosis D was defined as 25-hydroxyvitamin D < 30 ng/mL (chemiluminescence).ResultsWe evaluated 108 patients with mean duration of T2DM of 14.34 ± 8.05 years and HbA1c of 9.2 ± 2.1%. Mean age was 58.29 ± 10.34 years. Most were women (72.2%), non-white (89.8%) and had hypertension (75.9%) and dyslipidemia (76.8%). Mean BMI was 28.01 ± 4.64 kg/m2; 75.9% were overweight. The prevalence of hypovitaminosis D was 62%. In multiple logistic regression, independent predictors of hypovitaminosis D were female gender (OR 3.10, p = 0.02), dyslipidemia (OR 6.50, p < 0.01) and obesity (OR 2.55, p = 0.07). In multiple linear regression, only total cholesterol (β = −0.36, p < 0.01) and BMI (β = −0.21, p = 0.04) remained associated with levels of 25-hydroxyvitamin D.ConclusionsUsing currently recommended cutoffs, the prevalence of hypovitaminosis D in Brazilians with T2DM was as high as that of non-tropical regions. Female gender, dyslipidemia and obesity were predictors of hypovitaminosis D. Low levels of 25-hydroxyvitamin D were correlated with high cholesterol and BMI values. Future studies are needed to evaluate whether vitamin D replacement would improve these parameters and reduce hard cardiovascular outcomes.

bStudies on amphotericin B (AmB) nephrotoxicity use diverse definitions of acute kidney injury (AKI). Here, we used the new Kidney Disease Improving Global Outcome (KDIGO) system to describe the incidence, predictors, and impact of AmB-induced AKI on hospital mortality in 162 patients treated with AmB (120 with deoxycholate preparation and 42 with liposomal preparation). KDIGO stage 1 requires an absolute increase of >0.3 mg/dl or >1.5؋ over baseline serum creatinine (SCr), while stage 2 requires >2؋, and stage 3 requires >3؋. A binary KDIGO definition (KDIGObin) corresponds to stage >1. For comparison, we included two definitions of AKI traditionally utilized in nephrotoxicity studies: >0.5 mg/dl (NT0.5) and >2؋ (NT2؋) increase in baseline SCr. The overall incidence of AmB-induced AKI by KDIGObin was 58.6% (stage 1, 30.9%; stage 2, 18.5%; stage 3, 9.3%). Predictors of AKI by KDIGObin were older age and use of furosemide and angiotensin-converting enzyme inhibitor (ACE-I). Traditional criteria detected lower incidences of AKI, at 45.1% (NT0.5) and 27.8% (NT2؋). Predictors of AKI by traditional criteria were older age and use of vancomycin (NT0.5) and use of vancomycin and vasopressors (NT2؋). KDIGObin detected AKI 2 days earlier than the most sensitive traditional criterion. However, only traditional criteria were associated with intensive care unit (ICU) admission, mechanical ventilation, and mortality. In conclusion, the increase in sensitivity of KDIGObin is accompanied by a loss of specificity and ability to predict outcomes. Prospective studies are required to weigh the potential gain from early AKI detection against the potential loss from undue changes in management in patients with subtle elevations in SCr.A mphotericin B (AmB) is a powerful antifungal and antiparasitic agent that binds to the ergosterol component of microbial membranes, creating pores that result in cation leakage and cell death (1). AmB is the drug of choice for the treatment of severe forms of leishmaniasis and remains a lifesaving option for certain invasive fungal infections. Nevertheless, its use is limited by toxicity, including acute kidney injury (AKI).AmB administration leads to direct renal vasoconstriction and causes a profound reduction in renal blood flow (2-4). In addition, AmB alters renal tubular cell membrane permeability (5, 6), allowing back diffusion of hydrogen ions and thereby impairing acid excretion. Recent data suggest that sodium entry through membrane pores activates mitogen-activated protein (MAP) kinases and increases intracellular calcium concentration, culminating in renal tubular cell injury (7). Therefore, AmB-induced AKI appears to result from a combination of ischemic and toxic insults (8). Phenotypically, AmB-induced AKI manifests itself through elevated serum creatinine (SCr) levels that may be accompanied by renal tubular acidosis, characterized by hyperchloremic metabolic acidosis, hypokalemia, and hypomagnesemia.Mistro and coworkers (9) systematically reviewed the literature on AmB-induced AKI and...

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Introduction With the progressive technological development, that we can observe all over the world, and with the increasing rates of paediatric cancer patient survivals, there are every day more “cured” children, but those sequels whom remained will interfere in these children’s quality of life and others [ 1 ]. It’s becoming important to evaluate these paediatric cancer patients in order to evaluate the results of the treatments in their perspective, giving nursing a prestige and preponderant roll in the treatments clinical evaluation, on children’s health surveillance and monitoring, in order to increase health gains [ 2 ]. The aim of this study is to identify the paediatric cancer patients and their families needed nursing cares in order to increase their quality of life. Materials and methods An Integrative literature review by the PI[C]OD method [ 3 ]. To answer the investigation question: “Which nursing cares should we adopt with the children and his family, with the purpose of increasing their quality of life facing a oncologic pediatric disease?”. Available articles were searched in knowledge library online (B-on), EBSCOhost database and the Scientific Electronic Library Online (SciELO). Published between 2013 to 2019. The inclusion criteria were Paediatric cancer patients and families, Nursing care and quality of life. From a total of 43 articles, 7 were included in the study. Results There are three key thematics, namely: (1) Psycho-oncology. This one has a decisive role in the therapeutic adherence of the medical treatment, as well as in the family support [ 4 ]. (2) Family nursing. The family nurse is represented as the reference link between the Healthcare Service and the user/family, assuming the responsibility in the assurance of global health care assistance for several families, at many cases of crisis and in all the processes of health-disease [ 5 ]. (3) Needs of children and families. These children and their family have different specific needs, various and changing, that include a physical psychologic and spiritual dimension [ 6 ]. Discussion and conclusions The studies underline the importance of nursing interventions in order to improve the childs with cancer disease and their family’s quality of life. At the level of clinical practice in nursing, it is important to discuss the results of this study within the team, ensuring patient safety and the quality of nursing care based on scientific evidence.