Avaliação de risco cardiovascular perioperatório em pacientes submetidos a transplante renal no Hospital de Clínicas de Porto Alegre

O transplante renal é o tratamento padrão ouro para pacientes com doença renal crônica terminal. Doença cardiovascular é a principal causa de morte nesses pacientes. A avaliação de risco cardiovascular perioperatório visa identificar e tratar esses pacientes de maior risco. Entretanto, as diretrizes atuais divergem quanto às recomendações. Realizamos uma revisão não sistemática abordando as evidências atuais sobre o impacto da doença cardiovascular nessa população. Realizamos também estudo de coorte retrospectiva com 325 pacientes submetidos a transplante renal no Hospital de Clínicas de Porto Alegre avaliando a acurácia do Índice Cardíaco Revisado de Lee (RCRI). A incidência de eventos cardiovasculares maiores (MACE) foi de 5,8% em 30 dias. O RCRI apresentou área sob a curva (AUC = 0,64; IC 95% 0,49 - 0,78) e nenhuma de suas categorias apresentou capacidade de predizer MACE em 30 dias ou 1 ano após o transplante renal.Kidney transplantation is the gold standard treatment to end-stage kidney disease. Cardiovascular disease is the leading cause of death in these patients. Perioperative cardiovascular evaluation is critical to risk stratify these patients. However, current guidelines differ on recommendations. We did a non-systematic review addressing the current evidence of the impact of cardiovascular disease on this population. Also, we performed a retrospective cohort with 325 deceased-donor kidney transplantation patients at the Hospital de Clínicas de Porto Alegre. The incidence of MACE was 5.8% at first 30 days after transplantation. The RCRI presented AUC = 0.64 (CI 95% 0.49 - 0.78) and none of the categories were able to predict MACE at 30 days after surgery

Pyogenic liver abscess in children: two cases report and literature review

Description of two cases of pyogenic liver abscess. The first case: a 3-years-old immunocompetent girl with fever, abdominal pain, vomiting, and diarrhea. Abdominal ultrasound: multiloculated heterogeneous collection in the right hepatic lobe (Figure 1A). The second case, a 1-year-old girl with congenital neutropenia, showed fever, malaise, anorexia, sweating and pallor. Abdominal computed tomography showed hypodense lesion with heterogeneous impregnation by contrast in the left hepatic lobe (Figure 1B). Different clinical presentations, images and treatment are of special interest in pediatrics and are reviewed in this text

Characterization of advanced glycation end products and their receptor (RAGE) in an animal model of myocardial infarction

Circulating advanced glycation end products (AGE) and their receptor, RAGE, are increased after a myocardial infarction (MI) episode and seem to be associated with worse prognosis in patients. Despite the increasing importance of these molecules in the course of cardiac diseases, they have never been characterized in an animal model of MI. Thus, the aim of this study was to characterize AGE formation and RAGE expression in plasma and cardiac tissue during cardiac remodeling after MI in rats. Adult male Wistar rats were randomized to receive sham surgery (n = 15) or MI induction (n = 14) by left anterior descending coronary artery ligation. The MI group was stratified into two subgroups based on postoperative left ventricular ejection fraction: low (MIlowEF) and intermediate (MIintermEF). Echocardiography findings and plasma levels of AGEs, protein carbonyl, and free amines were assessed at baseline and 2, 30, and 120 days postoperatively. At the end of follow-up, the heart was harvested for AGE and RAGE evaluation. No differences were observed in AGE formation in plasma, except for a decrease in absorbance in MIlowEF at the end of follow-up. A decrease in yellowish-brown AGEs in heart homogenate was found, which was confirmed by immunodetection of N-ε-carboxymethyl-lysine. No differences could be seen in plasma RAGE levels among the groups, despite an increase in MI groups over the time. However, MI animals presented an increase of 50% in heart RAGE at the end of the follow-up. Despite the inflammatory and oxidative profile of experimental MI in rats, there was no increase in plasma AGE or RAGE levels. However, AGE levels in cardiac tissue declined. Thus, we suggest that the rat MI model should be employed with caution when studying the AGERAGE signaling axis or anti-AGE drugs for not reflecting previous clinical findings

Prevalence of pfmdr1, pfcrt, pfdhfr and pfdhps mutations associated with drug resistance, in Luanda, Angola

<p>Abstract</p> <p>Background</p> <p>Malaria is the infectious disease causing the highest morbidity and mortality in Angola and due to widespread chloroquine (CQ) resistance, the country has recently changed its first-line treatment recommendations for uncomplicated malaria, from CQ to artemisinin combination therapies (ACT) in adults, and sulphadoxine/pyrimethamine (S/P) in pregnant women. Loss of SP sensitivity is, however, progressing rapidly in Africa and, in this study, were investigated a number of molecular markers associated to CQ and S/P.</p> <p>Methods</p> <p>Blood samples were collected from 245 children with uncomplicated malaria, admitted at the Pediatric Hospital Dr. David Bernardino (HPDB), Angola, and the occurrence of mutations in <it>Plasmodium falciparum </it>was investigated in the <it>pfmdr1 </it>(N86Y) and <it>pfcrt </it>(K76T) genes, associated with CQ resistance, as well as in <it>pfdhfr </it>(C59R) and <it>pfdhps </it>(K540E), conferring SP resistance.</p> <p>Results</p> <p>The frequencies of <it>pfmdr1 </it>mutations in codon 86 were 28.6% N, 61.3% Y and 10.1% mixed infections (NY). The frequency of <it>pfcrt </it>mutations in codon 76 were 93.9% K, 5.7% T and 0.4% mixed infections (KT). For <it>pfdhfr </it>the results were in codon 59, 60.6% C, 20.6% R and 18.8% mixed infections (CR). Concerning <it>pfdhps</it>, 6.3% of the isolates were bearers of the mutation 540E and 5.4% mixed infections (K540E).</p> <p>Conclusion</p> <p>The results of this epidemiologic study showed high presence of CQ resistance markers while for SP a much lower prevalence was detected for the markers under study.</p