Liver transplantation for acute liver failure due to antitubercular drugs – a single-center experience

OBJECTIVES: Patients receiving treatment for tuberculosis are at risk of developing acute liver failure due to the hepatotoxicity of antitubercular drugs. We aimed to describe our experience with liver transplantation from deceased donors in this situation. METHODS: We identified patients undergoing transplantation for acute liver failure due to antitubercular drugs in our prospectively maintained database. RESULTS: Of 81 patients undergoing transplantation for acute liver failure, 8 cases were attributed to antitubercular drugs during the period of 2006-2016. Regarding the time of tuberculosis treatment until the onset of jaundice, patients were on antitubercular drugs for a mean of 64.7 days (21-155 days). The model for end-stage liver disease (MELD) score of patients ranged from 32 to 47 (median 38), and seven patients underwent transplantation under vasopressors. The 1-year survival was 50%. Three patients died during the week following transplantation due to septic shock (including a patient with acute liver failure due to hepatic/ disseminated tuberculosis), and the remaining patient died 2 months after transplantation due to pulmonary infection. There were 2 cases of mild rejection and 1 case of moderate rejection. Of the surviving patients, all were considered cured of tuberculosis after alternative drugs were given. CONCLUSION: Patients arrived very sick and displayed poor survival after deceased donor transplantation

Continuous Catalyst-Free Esterification of Oleic Acid in Compressed Ethanol

The esterification of oleic acid in a continuous catalyst-free process using compressed ethanol was investigated in the present study. Experiments were performed in a tubular reactor and variables investigated were temperature, pressure, and oleic acid to ethanol molar ratio for different residence time. Results demonstrated that temperature, in the range of 473 K to 573 K, and pressure had a positive effect on fatty acid ethyl esters (FAEE) production. In the experimental range investigated, high conversions can be obtained at low ethanol concentrations in the reaction medium and it was observed that oleic acid to ethanol molar ratios greater than 1 : 6 show no significant increase in conversion. Nonnegligible reaction conversions (>90%) were achieved at 573 K, 20 MPa, oleic acid to ethanol molar ratio of 1 : 6, and 20 minutes of residence time

Comparative study of etiological diagnosis of nosocomial pneumonia

Nosocomial pneumonia is a common complication in patients on mechanical ventilation and results in significant mortality. Diagnosis of pneumonia in patients who are intubated and under mechanical ventilation is difficult, even with the aid of clinical, laboratorial, and endoscopic tests. The objective of this study was to compare three methods of tracheal sputum collection in patients with a clinical and radiological diagnosis of pneumonia. Twenty-two patients with a clinical diagnosis of liver disease were enrolled, 18 years of age or older, 13 males and nine females, who had been mechanically ventilated over an intubation period of 5.86 ± 4.62 days. These patients were being treated in intensive care unit (ICU) of the Liver Transplantdepartment. Secretion collection was carried out according to a protocol with three distinct methods: endotracheal aspiration with a closed aspiration system, Bal cath and bronchoalveolar lavage. Of the 22 patients analyzed, 21 (95.4%) showed one or more infectious agent when the closed aspiration system was used. With the Bal cathâ collection, 19 patients (86.3%) had one or more infectious agents; in the collection by bronchoalveolar lavage, 10 patients (45.4%) presented one or more infectious agent. According to the laboratorial analysis, 14 different microorganisms were isolated, the most frequent of which were Staphylococcus aureus, Pseudomonas aeruginosa, and Klebsiella pneumoniae. We concluded that aspiration with the closed system produced the most effective results in comparison with those of bronchoalveolar lavage and the Bal cathâ, and may be an acceptable method for diagnosing hospital-acquired pneumonia when no fiberoptic technique is available

Urinary infection or radiation cystitis? A prospective evaluation of urinary symptoms in patients submitted to pelvic radiotherapy

OBJECTIVES: The purpose of this study was to evaluate the incidence of urinary tract infection (UTI) in patients with cystitis symptoms who underwent pelvic radiation therapy and identify correlated predictive factors. METHODS: A prospective cohort study was conducted of patients who met the following: primary pelvic cancer treated with curative intent, older than 18 years old, and good performance status. The exclusion criteria were patients being treated for a UTI, using a urinary catheter, in dialysis or with cystostomy or nephrostomy, and using antibiotics during treatment. Urinalysis and urine culture were collected before the beginning of radiation therapy. Weekly evaluations of urinary symptoms were subsequently performed. In cases of new or worsening symptoms, a questionnaire was applied, and new urine exams were collected. The UTI diagnosis was defined by uroculture as bacterial growth greater than 104 CFU/mL. RESULTS: From September 2014 to November 2015, 112 patients were sequentially recruited, and 72 (64%) fulfilled the inclusion criteria. During follow-up, 24 (33%) patients had new urinary symptoms or worse preexisting symptoms. A UTI was confirmed in the second urinary culture in only one (1.4%) patient. CONCLUSIONS: The incidence of UTI was much lower than expected, suggesting that asymptomatic bacteriuria develops symptoms due to radiotherapy. Due to the low rate of UTI, no predictive factor was identified

Infecção por Vírus Monkeypox: Avaliação do Doador e do Candidato ao Transplante de Órgãos Sólidos

Contextualização: Desde maio de 2022, casos de monkeypox (varíola dos macacos ou mpox) foram relatados em vários países, com evidências de transmissão comunitária. No cenário atual, temos transmissão identificada em diferentes continentes, relacionada com disseminação local do vírus por contato íntimo inter-humano. Objetivo: O objetivo desse artigo é informar a comunidade transplantadora sobre as eventuais implicações da doença para a população de receptores de transplantes e seus doadores. Método: Nesse artigo apresenta-se as orientações para adequar a avaliação de doadores e de candidatos a transplantes de órgãos, tendo em vista os riscos potenciais decorrentes da emergência de mpox em nosso meio. É importante considerar que este documento reflete a opinião de especialistas diante das escassas evidências atualmente disponíveis. Resultados e Conclusões: As recomendações de manejo e avaliação do doador baseiam-se no risco potencial da transmissão do vírux MPXV. Estima-se que o risco de transmissão pelo transplante seja baixo, levando-se em conta a incerteza sobre a duração da viremia em pacientes com mpox e a presença de vírusviável em células e tecidos. Recomenda-se, no entanto, que os médicos responsáveis pelo paciente estejam alerta para as evidências de infecção e que acionem ou notifiquem as instituições caso haja indícios de transmissão pelo transplante

Plasmid-mediated mcr-1 in carbapenem-susceptible Escherichia coli ST156 causing a blood infection: an unnoticeable spread of colistin resistance in Brazil?

OBJECTIVE: We describe an IncX4 pHC891/16mcr plasmid carrying mcr-1 in a colistin-resistant and carbapenem-susceptible E. coli isolate (HC891/16), ST156, which caused a blood infection in a Brazilian patient with gallbladder adenocarcinoma. METHODS: Strain HC891/16 was subjected to whole genome sequencing using the MiSeq Platform (Illumina, Inc., USA). Assembly was performed using Mira and ABACAS. RESULTS: The isolates showed resistance only to ciprofloxacin, ampicillin and cefoxitin, and whole-genome sequencing revealed the presence of aac(6’)Ib-cr and blaTEM1. CONCLUSION: Our findings warn of the possible silent dissemination of colistin resistance by carbapenem-susceptible mcr-1 producers, as colistin susceptibility is commonly tested only among carbapenem-resistant isolates

Evaluation of bacterial infections in organ transplantation

Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao PauloHospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paul