Características da morte súbita tida como não esperada na doença de Chagas

Trinta e cinco indivíduos falecidos subitamente e de modo inesperado foram necropsiados em Serviços Médico-Legais em Uberaba e Uberlândia. A sorologia do líquido pericárdico e os achados anatomopatológicos estabeleceram o diagnóstico de doença de Chagas. Todos, exceto dois, eram do sexo masculino e tinham idade média de 38 anos. Resolvemos fazer uma investigação retrospectiva procurando obter de familiares e amigos e nos registros médicos informações sobre as circunstâncias do óbito e manifestações que pudessem constituir possíveis indícios de doença cardíaca e de comprometimento de outros órgãos. Em 31,2% não havia quaisquer sintomas ou suspeita de cardiopatia. Contudo, em 57,1% dos casos conseguimos detectar história de tonturas (42,8%), dispnéia de esforço (48%), perda de consciência (34,2%) e palpitações (31,4%). A disfagia e ou a obstipação estavam presentes em 38%. Não houve correlação entre a sintomatologia e a intensidade da miocardite. Em 56% o êxito letal surgiu enquanto desenvolviam esforço físico ou tinham emoção. Pelo modo como ocorreu o óbito pode-se concluir que a iminência deste não foi pressentida pelo paciente ou circunstantes em 43,8% dos casos; no restante, o óbito súbito foi precedido de indícios, tais como gestos, pedidos de ajuda, etc. Somente em 5 dos 35 casos o eletrocardiograma havia sido realizado meses ou anos antes do óbito: todos apresentavam alterações.Thirty five individuals who died suddenly and unexpectedly were autopsied at Medico-Legal Services in Uberaba and Uberlandia (State of Minas Gerais-Brazil). Serology of the pericardial fluid and histopathological findings established a diagnosis of Chagas' disease. All, with two exceptions were males and their mean age was 38 years. We decided to conduct a retrospective investigation regarding the manner of death of chagasic patients who died suddenly from information obtained from family members and friends. The questionaire explored possible cardiac and systemic factors related to the risk of such an event. In 31.2% there were no symptoms norsuspicion of cardiopathy. However, in 57,1% it was possible to detect a history of dizziness (42,8%), dyspnoea on exertion(48%), loss of conciousness (34,2%) andpalpitations (31,4%). Dysphagia and or constipation was present in 38%. There was no correlation between symptomatology and the intensity of myocarditis on histopathological examination. In 56% the death occurred during physical exercise oran emotionalepisode. From the mannerof death we can conclude that there was no indication that such an event would occur in 43.8% of patients. In the rest the death waspreceeded by signs on thepart of the patient that he was in difficulty. Electrocardiograms were available from only fivepatients: all were abnormal

Liver enzymes serum levels in patients with chronic kidney disease on hemodialysis: a comprehensive review

We reviewed the literature regarding the serum levels of the enzymes aspartate aminotransferase, alanine aminotransferase, and gamma-glutamyl transferase in patients with chronic kidney disease on hemodialysis with and without viral hepatitis. Original articles published up to January 2013 on adult patients with chronic kidney disease on hemodialysis were selected. These articles contained the words “transaminases” “aspartate aminotransferase” “alanine aminotransferase” “gamma glutamyl transferase,” “liver enzymes”, AND “dialysis” OR “hemodialysis”. A total of 823 articles were retrieved. After applying the inclusion and exclusion criteria, 49 articles were selected. The patients with chronic kidney disease on hemodialysis had reduced serum levels of aminotransferases due to hemodilution, lower pyridoxine levels, or elevated homocysteine levels. The chronic kidney disease patients on hemodialysis infected with the hepatitis C virus also had lower aminotransferase levels compared with the infected patients without chronic kidney disease. This reduction is in part due to decreased viremia caused by the dialysis method, the production of a hepatocyte growth factor and endogenous interferon-α, and lymphocyte activation, which decreases viral action on hepatocytes. Few studies were retrieved on gamma-glutamyl transferase serum levels; those found reported that there were no differences between the patients with or without chronic kidney disease. The serum aminotransferase levels were lower in the patients with chronic kidney disease on hemodialysis (with or without viral hepatitis) than in the patients with normal renal function; this reduction has a multifactorial origin

The reduction of serum aminotransferase levels is proportional to the decline of the glomerular filtration rate in patients with chronic kidney disease

OBJECTIVE: This study sought to determine the serum aminotransferase levels of patients with predialysis chronic kidney disease and establish their relationships with serum creatinine levels and glomerular filtration rate. METHODS: Patients with chronic kidney disease were evaluated between September 2011 and May 2012. Aminotransferase and creatinine serum levels were measured using an automated kinetic method, and glomerular filtration rates were estimated using the Cockroft-Gault and Modification of Diet in Renal Disease formulas to classify patients into chronic kidney disease stages. RESULTS: Exactly 142 patients were evaluated (mean age: 64±16 years). The mean creatinine serum level and glomerular filtration rate were 3.3±1.2 mg/dL and 29.1±13 mL/min/1.73 m2, respectively. Patients were distributed according to their chronic kidney disease stages as follows: 3 (2.1%) patients were Stage 2; 54 (38%) were Stage 3; 70 (49.3%) were Stage 4; and 15 (10.5%) were Stage 5. The mean aspartate aminotransferase and alanine aminotransferase serum levels showed a reduction in proportion to the increase in creatinine levels (p=0.001 and p=0.05, respectively) and the decrease in glomerular filtration rate (p=0.007 and p=0.028, respectively). Alanine aminotransferase and aspartate aminotransferase serum levels tended to be higher among patients classified as stage 2 or 3 compared with those classified as stage 4 or 5 (p=0.08 and p=0.06, respectively). CONCLUSIONS: The aspartate aminotransferase and alanine aminotransferase serum levels of patients with predialysis chronic kidney disease decreased in proportion to the progression of the disease; they were negatively correlated with creatinine levels and directly correlated with glomerular filtration rate

Contribuição ao conhecimento do quadro anatomopatológico do coração na doença de Chagas

Os conhecimentos anatomopatológicos da fase aguda humana da doença de Chagas são baseados, quase que em sua totalidade, em trabalhos realizados há várias décadas. Nos últimos anos, mesmo os patologistas de áreas endêmicas da tripanossomíase cruzi não têm tido oportunidade de necropsiar chagásicos falecidos nessa fase da moléstia. Isto parece importante, visto que é necessário interpretar os achados morfológicos, tendo como base os novos conhecimentos adquiridos pela patologia, bem como, especificamente, colocá-los no contexto das novas idéias que se tem sobre a doença de Chagas. Por estas razões, pareceu-nos de interesse relatar os achados de necropsia por nós realizada, recentemente, em chagásico falecido na fase aguda e chamar a atenção para dados morfológicos cardíacos, que podem contribuir para melhor conhecimento da forma em questão da doença

Hepatitis E virus seroprevalence among schistosomiasis patients in Northeastern Brazil

Background: Hepatitis E virus (HEV) can cause chronic infection with rapid progression to liver cirrhosis in immunocompromised patients. HEV seroprevalence in patients with Schistosoma mansoni in Brazil is unknown. We evaluated the prevalence of past or present HEV infection in schistosomiasis patients in Recife, Pernambuco, Brazil. A total of 80 patients with Schistosoma mansoni were consecutively enrolled in a cross-sectional study. Serum samples were tested for the presence of anti-HEV IgG antibodies by enzyme immunoassay (Wan tai anti-HEV IgG, Beijing, China) and for the presence of HEV RNA using real time reverse transcriptase-polymerase chain reaction with primers targeting the HEV ORF2 and ORF3. Clinical and laboratory tests as well as abdominal ultrasound were performed at the same day of blood collection. Results: Anti-HEV IgG was positive in 18.8% (15/80) of patients with SM. None of the samples tested positive for anti-HEV IgM or HEV-RNA. Patients with anti-HEV IgG positive presented higher levels of alanine aminotranferase (p = 0.048) and gama-glutamil transferase (p = 0.022) when compared to patients without anti-HEV IgG antibodies. Conclusion: This study demonstrates that the seroprevalence of HEV is high in patients with Schistosoma mansoni in Northeastern of Brazil. Past HEV infection is associated with higher frequency of liver enzymes abnormalities. HEV infection and its role on the severity of liver disease should be further investigated among patients with Schistosoma mansoni. (C) 2016 Elsevier Editora Ltda.Fundacao de Amparo a Pesquisa do Estado de Sao PauloUniv Fed Sao Paulo Unifesp, Div Infect Dis, Sao Paulo, SP, BrazilFleury SA Grp, Sao Paulo, BrazilUniv Fed Sao Paulo Unifesp, Div Gastroenterol, Sao Paulo, BrazilUniv Fed Pernambuco UFPE, Div Gastroenterol, Recife, PE, BrazilUniv Fed Sao Paulo Unifesp, Div Infect Dis, Sao Paulo, SP, BrazilUniv Fed Sao Paulo Unifesp, Div Gastroenterol, Sao Paulo, BrazilFAPESP: 2012/22925-3FAPESP: 2013/03701-0Web of Scienc