Acometimento pancreático em casos fatais de leptospirose humana: aspectos clínicos e histopatológicos

Hyperamylasemia has been reported in more than 65% of patients with severe leptospirosis, and the true diagnosis of acute pancreatitis is complicated by the fact that renal failure can increase serum amylase levels. Based on these data we retrospectively analyzed the clinical and histopathological features of pancreas involvement in 13 cases of fatal human leptospirosis. The most common signs and symptoms presented at admission were fever, chills, vomiting, myalgia, dehydratation, abdominal pain and diarrhea. Trombocytopenia was evident in 11 patients. Mild increased of AST and ALT levels was seen in 9 patients. Hyperamylasemia was recorded in every patient in whom it was measured, with values above 180 IU/L (3 cases). All patients presented acute renal failure and five have been submitted to dialytic treatment. The main cause of death was acute respiratory failure due to pulmonary hemorrhage. Pancreas fragments were collected for histological study and fat necrosis was the criterion used to classify acute pancreatitis. Histological pancreatic findings were edema, mild inflammatory infiltrate of lymphocytes, hemorrhage, congestion, fat necrosis and calcification. All the patients infected with severe form of leptospirosis who develop abdominal pain should raise the suspect of pancreatic involvement.Hiperamilasemia tem sido documentada em mais de 65% dos pacientes com leptospirose severa, e o diagnóstico de pancreatite aguda torna-se difícil pelo fato de que a insuficiência renal pode aumentar os níveis séricos de amilase. Assim, foram analisadas, retrospectivamente, as características clínicas e histopatológicas do acometimento pancreático em 13 casos fatais de leptospirose humana. Os sinais e sintomas mais comuns foram febre, calafrios, vômitos, mialgia, desidratação, dor abdominal e diarréia. Trombocitopenia foi encontrada em 11 pacientes. Elevação dos níveis de AST e ALT foi observada em nove casos. Hiperamilasemia foi detectada em todos os pacientes em que foi dosada, com valores acima de 180 UI/L (três casos). Todos os pacientes desenvolveram insuficiência renal aguda e cinco necessitaram de tratamento dialítico. A principal causa de morte foi insuficiência respiratória devido à hemorragia pulmonar. Fragmentos do pâncreas foram obtidos para estudo histológico, e necrose gordurosa foi o critério utilizado para classificar pancreatite. Os achados histológicos foram edema pancreático, infiltrado inflamatório discreto de linfócitos, hemorragia, congestão, necrose gordurosa e calcificação. Deve-se suspeitar de acometimento pancreático em todo paciente com a forma grave de leptospirose que desenvolve dor abdominal

Effect of non-abrupt doping and interfacial profiles on the carrier sheet density in one-side modulation-doped GaN/AlGaN quantum wells

The results of an accurate theoretical study on the effects of non-abrupt doping and interfacial profiles on the electron sheet density in one-side modulation-doped wurtzite GaN/AlGaN single quantum wells at low temperatures are presented. We solve coupled Schr¨odinger and Poisson equations self-consistently via the finite difference method. By employing a proper discretization on a nonuniform grid and taking into account the strong piezoelectric and spontaneous polarization fields exhibited by the wurtzite III-nitride heterostructures, a substantial increase in the 2DEG density is predicted with the increase of the donor diffusion length and the reduction of the spacer thickness

Estimulaçao ventricular mínima associada à estimulaçao na via de saída do ventrículo direito: análise do remodelamento atrial elétrico e mecânico atrial e da qualidade de vida

Introduçao: O algoritmo de estimulaçao ventricular mínima (EVM) do marcapasso (MP) de dupla-câmara permite uma estimulaçao cardíaca fisiológica. Questiona-se se a associaçao a um sítio alternativo de estimulaçao ventricular pode reduzir a incidência de arritmias supraventriculares em longo prazo, sobretudo a fibrilaçao atrial (FA) crônica. Objetivo: Comparar a densidade de arritmia atrial, a dimensao do átrio esquerdo e a qualidade de vida quando do sinergismo entre a EVM (por meio d

Estimulaçao ventricular mínima associada à estimulaçao na via de saída do ventrículo direito: análise do remodelamento atrial elétrico e mecânico atrial e da qualidade de vida

Introduçao: O algoritmo de estimulaçao ventricular mínima (EVM) do marcapasso (MP) de dupla-câmara permite uma estimulaçao cardíaca fisiológica. Questiona-se se a associaçao a um sítio alternativo de estimulaçao ventricular pode reduzir a incidência de arritmias supraventriculares em longo prazo, sobretudo a fibrilaçao atrial (FA) crônica. Objetivo: Comparar a densidade de arritmia atrial, a dimensao do átrio esquerdo e a qualidade de vida quando do sinergismo entre a EVM (por meio d

Benign fasciculations and corticosteroid use: possible association? An update

Fasciculations are characterized by visible subtle and fast contractions of muscle, even wormlike in movement, by the contraction of a fascicle of muscle fibers. The authors present the case study of a 28-year-old patient with the appearance of migratory and diffuse fasciculations with an onset after partial tapering off of oral corticosteroides (60 mg total dose) indicated for treatment of Minimal change Glomerulopathy. Clinical Neurological physical exam allied with an ENMG, besides other complementary laboratory exams were used for screening the above-mentioned patient. Afterwards, current research relating to the topic at hand was made in order to update the data available in the Bireme, Scielo and PubMed Data Banks using the following key words: Fasciculation's, motor neuron disease, and benign fasciculations in the Portuguese, English as well as Spanish language. Although fasciculation's are most commonly associated with Motor neuron disease as well as with certain metabolic disorders, they may also be present in individuals with absolutely no underlying pathological disorders. In our case, fasciculation potentials that have been present for six months, with no other signs of a neurogenic disorder as well as absence of laboratory findings, the patient received a diagnosis of Benign Fasciculation Syndrome (BFS).We believe that the use of corticosteroides in high doses with subsequent tapering contributed to the fasciculation's, especially due to the changes that this causes on the ionic channels. Fasciculation's are symptoms seen in a large range of conditions, and also being the main symptom of the so-called Benign Fasciculation Syndrome. We have presented an example of this clinical syndrome in a patient whose complaint was fasciculation's, with complete clinical remission of symptoms following complete tapering off of corticosteroid six months previously

Seroprevalence and Seroconversion of Dengue and Implications for Clinical Diagnosis in Amazonian Children

This study aimed to evaluate the prevalence of serum IgG dengue in children in an Amazonian population, to assess the seroconversion rate in 12 months, and to estimate how many seropositive children had a prior clinical diagnosis of dengue. We conducted a population-based study between 2010 and 2011, with children aged 6 months to 12 years that were living in the urban area of a small town in the Brazilian Amazon. The prevalence of IgG antibodies against dengue antigens was determined by indirect ELISA technique, and seronegative children were reexamined after 12 months to determine seroconversion rates. Results showed seroprevalence of IgG antibodies against dengue type of 2.9%, with no significant association between age, race, and sex. In seropositive children, only 8.4% had received a clinical diagnosis of dengue, and the ratio of clinically diagnosed cases and subclinical cases was 1 : 11. The seroconversion rate between 2010 and 2011 was 1.4% (CI 3.8% to 35.1%). The seroprevalence of dengue in this pediatric population was low, and the vast majority of cases were not clinically detected, suggesting a difficulty in making the clinical diagnosis in children and a high frequency of asymptomatic infections

Neurobehavioral and Antioxidant Effects of Ethanolic Extract of Yellow Propolis

Propolis is a resin produced by bees from raw material collected from plants, salivary secretions, and beeswax. New therapeutic properties for the Central Nervous System have emerged. We explored the neurobehavioral and antioxidant effects of an ethanolic extract of yellow propolis (EEYP) rich in triterpenoids, primarily lupeol and β-amyrin. Male Wistar rats, 3 months old, were intraperitoneally treated with Tween 5% (control), EEYP (1, 3, 10, and 30 mg/kg), or diazepam, fluoxetine, and caffeine (positive controls) 30 min before the assays. Animals were submitted to open field, elevated plus maze, forced swimming, and inhibitory avoidance tests. After behavioral tasks, blood samples were collected through intracardiac pathway, to evaluate the oxidative balance. The results obtained in the open field and in the elevated plus maze assay showed spontaneous locomotion preserved and anxiolytic-like activity. In the forced swimming test, EEYP demonstrated antidepressant-like activity. In the inhibitory avoidance test, EEYP showed mnemonic activity at 30 mg/kg. In the evaluation of oxidative biochemistry, the extract reduced the production of nitric oxide and malondialdehyde without changing level of total antioxidant, catalase, and superoxide dismutase, induced by behavioral stress. Our results highlight that EEYP emerges as a promising anxiolytic, antidepressant, mnemonic, and antioxidant natural product

A FISIOTERAPIA AQUÁTICA NO PÓS-OPERATÓRIO DE LIGAMENTO CRUZADO ANTERIOR

INTRODUÇÃO: A lesão no joelho é a segunda lesão esportiva mais comum após a entorse de tornozelo, no que causa instabilidade e afeta o desempenho atlético. Dentre os tratamentos para lesões pós-cirúrgicas do ligamento cruzado anterior, destaca-se a fisioterapia aquática como recurso fisioterapêutico que proporciona benefícios terapêuticos ao paciente através das propriedades físicas e aquecimento da água, promovendo ganhos rápidos de amplitude de movimento e redução do edema. OBJETIVO: analisar a atuação da fisioterapia aquática no tratamento do pós- operatório de LCA. METODOLOGIA: trata-se de uma revisão integrativa de literatura, consistindo em uma pesquisa do tipo descritiva. Os descritores controlados utilizados na estratégia de busca foram selecionados no Descritores em Ciências da Saúde utilizado os operadores booleanos “AND” e “OR” para combinar os termos. Para iniciar a busca de referências, acessou-se as bases de dados BVS e PubMED, tendo um quantitativo final de 8 estudos a serem analisados. RESULTADOS: os estudos demonstraram a efetividade da fisioterapia aquática na reabilitação pós cirurgia de lesão de LCA, sendo um recurso terapêutico que proporciona melhora do quadro álgico, ganho de força muscular, melhora da marcha, capacidade funcional e qualidade de vida aos pacientes, além de ser um treinamento inovador com resultados favoráveis em relação à reabilitação convencional, pois em questão de amplitude de movimento do membro lesionado foi melhor em condições subaquáticas em relação de terra firme. CONSIDERAÇÕES FINAIS: A fisioterapia atua no tratamento de pós- operatório de LCA trazendo benefícios como ganhos na marcha, níveis de flexão do joelho, recuperação funcional, restauração da força muscular do joelho e estruturas envolvidas no movimento, treinamento neuromuscular e melhorias na eficiência da propriocepção.https://revistaft.com.br/a-fisioterapia-aquatica-no-pos-operatorio-de-ligamento-cruzado-anterior

COVID-19 outcomes in people living with HIV: Peering through the waves

Objective: To evaluate clinical characteristics and outcomes of COVID-19 patients infected with HIV, and to compare with a paired sample without HIV infection. Methods: This is a substudy of a Brazilian multicentric cohort that comprised two periods (2020 and 2021). Data was obtained through the retrospective review of medical records. Primary outcomes were admission to the intensive care unit, invasive mechanical ventilation, and death. Patients with HIV and controls were matched for age, sex, number of comorbidities, and hospital of origin using the technique of propensity score matching (up to 4:1). They were compared using the Chi-Square or Fisher's Exact tests for categorical variables and the Wilcoxon for numerical variables. Results: Throughout the study, 17,101 COVID-19 patients were hospitalized, and 130 (0.76%) of those were infected with HIV. The median age was 54 (IQR: 43.0;64.0) years in 2020 and 53 (IQR: 46.0;63.5) years in 2021, with a predominance of females in both periods. People Living with HIV (PLHIV) and their controls showed similar prevalence for admission to the ICU and invasive mechanical ventilation requirement in the two periods, with no significant differences. In 2020, in-hospital mortality was higher in the PLHIV compared to the controls (27.9% vs. 17.7%; p = 0.049), but there was no difference in mortality between groups in 2021 (25.0% vs. 25.1%; p > 0.999). Conclusions: Our results reiterate that PLHIV were at higher risk of COVID-19 mortality in the early stages of the pandemic, however, this finding did not sustain in 2021, when the mortality rate is similar to the control group