In order to assess the prevalence of and risk factors for aminoglycoside-associated nephrotoxicity in intensive care units (ICUs), we evaluated 360 consecutive patients starting aminoglycoside therapy in an ICU. The patients had a baseline calculated glomerular filtration rate (cGFR) of >30 ml/min/1.73 m 2 . Among these patients, 209 (58%) developed aminoglycoside-associated nephrotoxicity (the acute kidney injury [AKI] group, which consisted of individuals with a decrease in cGFR of >20% from the baseline cGFR), while 151 did not (non-AKI group). Both groups had similar baseline cGFRs. The AKI group developed a lower cGFR nadir (45 ؎ 27 versus 79 ؎ 39 ml/min/1.73 m 2 for the non-AKI group; P < 0.001); was older (56 ؎ 18 years versus 52 ؎ 19 years for the non-AKI group; P ‫؍‬ 0.033); had a higher prevalence of diabetes (19.6% versus 9.3% for the non-AKI group; P ‫؍‬ 0.007); was more frequently treated with other nephrotoxic drugs (51% versus 38% for the non-AKI group; P ‫؍‬ 0.024); used iodinated contrast more frequently (18% versus 8% for the non-AKI group; P ‫؍‬ 0.0054); and showed a higher prevalence of hypotension (63% versus 44% for the non-AKI group; P ‫؍‬ 0.0003), shock (56% versus 31% for the non-AKI group; P < 0.0001), and jaundice (19% versus 8% for the non-AKI group; P ‫؍‬ 0.0036). The mortality rate was 44.5% for the AKI group and 29.1% for the non-AKI group (P ‫؍‬ 0.0031). A logistic regression model identified as significant (P < 0.05) the following independent factors that affected aminoglycoside-associated nephrotoxicity: a baseline cGFR of <60 ml/min/1.73 m 2 (odds ratio [OR], 0.42), diabetes (OR, 2.13), treatment with other nephrotoxins (OR, 1.61) or iodinated contrast (OR, 2.13), and hypotension (OR, 1.83). In conclusion, AKI was frequent among ICU patients receiving an aminoglycoside, and it was associated with a high rate of mortality. The presence of diabetes or hypotension and the use of other nephrotoxic drugs and iodinated contrast were independent risk factors for the development of aminoglycoside-associated nephrotoxicity.

Dengue is presently the most relevant viral infection transmitted by a mosquito bite that represents a major threat to public health worldwide. Acute kidney injury (AKI) is a serious and potentially lethal complication of this disease, and the actual incidence is unknown. In this review, we will assess the most relevant epidemiological and clinical data regarding dengue and the available evidence on the frequency, etiopathogenesis, outcomes and treatment of dengue-associated AKI.

Aminoglycoside are frequently used due to its high efficacy against gram-negative bacteria and positive synergism with other antibiotics against gram-positive organisms. They are commonly used for prevention and treatment of infection complications after cardiothoracic surgery. The principal side effect of this class of antibiotics is nephrotoxicity, which may occur in up to 20% of the exposed patients. Although usually reversible, aminoglycosideinduced renal injury prolongs hospitalization time and increase patients cost. Even more important, the occurrence of nephrotoxicity is associated with higher patient mortality. There are some known risk factors for nephrotoxicity development and some measures that may prevent it. This review will cover the most relevant aspects of this important side effect of aminoglycoside therapy. Descriptors 445OLIVEIRA, JFP ET AL -Aminoglycoside nephrotoxicity Braz J Cardiovasc Surg 2006; 21(4): 444-452

IntroductionThere is an increasing demand for multi-organ donors for organ transplantation programmes. This study protocol describes the Donation Network to Optimise Organ Recovery Study, a planned cluster randomised controlled trial that aims to evaluate the effectiveness of the implementation of an evidence-based, goal-directed checklist for brain-dead potential organ donor management in intensive care units (ICUs) in reducing the loss of potential donors due to cardiac arrest.Methods and analysisThe study will include ICUs of at least 60 Brazilian sites with an average of ≥10 annual notifications of valid potential organ donors. Hospitals will be randomly assigned (with a 1:1 allocation ratio) to the intervention group, which will involve the implementation of an evidence-based, goal-directed checklist for potential organ donor maintenance, or the control group, which will maintain the usual care practices of the ICU. Team members from all participating ICUs will receive training on how to conduct family interviews for organ donation. The primary outcome will be loss of potential donors due to cardiac arrest. Secondary outcomes will include the number of actual organ donors and the number of organs recovered per actual donor.Ethics and disseminationThe institutional review board (IRB) of the coordinating centre and of each participating site individually approved the study. We requested a waiver of informed consent for the IRB of each site. Study results will be disseminated to the general medical community through publications in peer-reviewed medical journals.Trial registration numberNCT03179020; Pre-results.

No abstract

A pandemia de Covid-19 apresentou impactos severos em diversos setores da sociedade, principalmente na área da medicina. Nesta, uma área de atuação muito impactada foi a de transplantes, que no começo teve de ser paralisada em inúmeros centros, por variadas razões. O objetivo deste artigo foi analisar, de forma comparativa entre os anos de 2019 e 2020, o impacto da pandemia de Covid-19 nos números de transplante do Hospital de Base (HB), referência nacional em transplantes, e no estado de São Paulo, bem como no número de doações dessas localidades.Ométodo utilizado neste trabalho foi a análise comparativa por meio de dados obtidos pelo Registro Brasileiro de Transplantes, pela Associação Brasileira de Transplante de Órgãos e pelo Sistema Estadual de Transplantes. Foram analisados os seguintes órgãos no HB e no estado de São Paulo: coração, fígado, pulmão e rim. Pâncreas foi analisado apenas no estado. Por meio das análises, observou-se que no HB houve queda nos números de transplante de todos os órgãos analisados, e no estado de São Paulo, nos números de transplante de pulmão e rim, mantendo-se o número de transplante de pâncreas e aumentando os números de transplante de coração e fígado. Com relação aos doadores, observou-se queda nas notificações de potenciais doadores, mas aumento do número de doadores efetivos, por causa da diminuição da taxa de recusa familiar.

Resumen: La pandemia de Covid-19 presentó impactos severos en varios sectores de la sociedad, principalmente en el área de la medicina. Dentro de esta, un área de actuación muy impactada fue la de los trasplantes, que al comienzo debió ser paralizada en numerosos centros, por distintas razones. El objetivo de este artículo fue analizar, de forma comparativa entre los años 2019 y 2020, el impacto de la pandemia de Covid-19 en los números de trasplante del Hospital de Base (HB), referencia nacional en trasplantes, y en el estado de São Paulo, así como también en el número de donaciones en esas localidades. El método utilizado en este trabajo fue el análisis comparativo por medio de datos obtenidos por el Registro Brasileño de Trasplantes, por la Asociación Brasileña de Trasplante de Órganos y por el Sistema Estadual de Trasplantes. En el HB y en el estado de São Paulo fueron analizados los siguientes órganos: corazón, hígado, pulmón y riñón. El páncreas fue analizado solo en el estado. Por medio de los análisis, se observó que en el HB hubo caída en los números de trasplante de todos los órganos analizados, y en el estado de São Paulo, en los números de trasplante de pulmón y riñón, manteniéndose el número de trasplante de páncreas y aumentando los números de trasplante de corazón e hígado. Con relación a los donantes, se observó una caída en las notificaciones de potenciales donantes, pero un aumento del número de donantes efectivos, a causa de la disminución de la tasa de rechazo familiar

The Covid-19 pandemic had severe impacts on various sectors of society, especially in the area of medicine. In this area, one segment of activity that was greatly impacted was transplantation, which at first had to be halted in numerous centers, for various reasons. The objective of this article was to analyze, in a comparative way between the years 2019 and 2020, the impact of the Covid-19 pandemic in the numbers of transplantations in a district hospital (DH), a national reference in transplantations, and in the state of São Paulo, as well as in the number of donations from these locations. The method used in this work was the comparative analysis using data obtained from the Brazilian Transplant Registry, the Brazilian Association of Organ Transplantation and the State Transplant System. The following organs were analyzed in the DH and in the state of São Paulo: heart, liver, lung and kidney. Pancreas was analyzed only in the state. Through the analyses, it was observed that in the DH there was a decrease in the numbers of transplantations for all organs analyzed, and in the state of São Paulo, in the numbers of lung and kidney transplantations, maintaining the number of pancreas transplantations and increasing the numbers of heart and liver transplantations. Regarding donors, there was a decrease in the number of potential donors, but an increase in the number of actual donors, due to a decrease in the family refusal rate.