Evaluation of renographic and metabolic parameters in human Kidney transplantation

Background: the aim of this work is to demonstrate that the value of the mean transit time (MTT) obtained from the 99mTc-MAG3 renogram deconvolution is related to the levels of adenine nucleotides determined in cortical biopsies from transplanted kidneys. Methods: the functional state was estimated by means of the MTT and the initial height (H0) of the renal retention function obtained from the 99mTc-MAG3 renogram deconvolution and by the measure of adenine nucleotides obtained from biopsies. We studied 30 kidney graft recipients, 25 normal functioning grafts (NFG) and 5 with acute tubular necrosis (ATN). Results: the MTT is significantly longer for ATN (p < 0.001). The initial uptake values (H0) are significantly lower for ATN (p < 0.001). The sum of adenine nucleotides (SAN) is significantly greater for NFG than for ATN (p < 0.001). The values of the MTT seem to reflect the energy state of the cells in transplanted kidney. Conclusion: the analysis of MTT may be indicative of the functional metabolic recovery and thus it may be predictive of the renal graft function at least in the same extent than the biochemical analysis of a cortical renal biopsy immediately after blood reperfusion of the tissue

Endovascular management of dural fistulas into the cavernous sinus: A systematic review

Background: Dural fistula to the cavernous sinus (DFCS) is an infrequent pathology that consists in the anomalous communication between the meningeal branches of the internal carotid artery (ICA) and/or the external carotid artery (ECA) and the cavernous sinus.Aim: To perform a systematic review to evaluate clinical and imaging findings in DFCS, and current indications for treatment.Methods: A literature search was performed in several medical databases using the keywords “intracranial dural fistula”, “carotid-cavernous fistula”, “endovascular treatment”, associated with “outcome”; resulting articles were assessed by considering factors such as: number of patients treated, type of material used, complications, and type of image technique used for diagnosis.Results: 33 articles were selected, yielding: clinical and imaging: The symptoms are basically related to the type of venous drainage of the fistula. The combination of ocular symptoms and tinnitus is highly suggestive of DFCS. Ocular symptoms are found in 80-97% of patients, while the tinnitus is present in up to 50% of cases. The imaging method for initial assessment of the DFCS is the magnetic resonance imaging. Digital subtraction angiography is the method of choice to determine adequately the precise angioarchitecture of the injury and its drainage. This data is of vital importance in future decision making. Treatment: Currently are considered as indications for the management of DFCS: 1) rapidly progressive deterioration of visual function, 2) angiographic evidence of abnormal cortical venous drainage, 3) the hypoxic consequences in retina and optic nerve, and 4) ischemic keratitis; the most suitable materials for embolization of the DFCS are CA and PAP.Conclusion: DFCS stills being an uncommon cerebrovascular condition, with good outcomes from endovascular treatment

Assistência de enfermagem ao paciente com infarto agudo do miocárdio em uma urgência e emergência: relato de experiência / Nursing care for patients with acute myocardial infarction in an urgency and emergency: experience report

O infarto agudo do miocárdio (IAM), ou ataque cardíaco (AC), é a morte das células de uma região do músculo do coração por conta da formação de um coágulo que interrompe o fluxo sanguíneo de forma súbita e intensa. A principal causa do IAM é a aterosclerose, doença em que placas de gordura se acumulam no interior das artérias coronárias, chegando a obstrui-las. Na maioria dos casos o infarto ocorre quando há o rompimento de uma dessas placas, levando à formação do coágulo e interrupção do fluxo sanguíneo (MINISTÉRIO DA SAÚDE, 2018). Este estudo, é descritivo de natureza relato de experiência, elaborado a partir da vivência da equipe de enfermagem na atuação para com um paciente acometido por IAM em uma urgência e emergência de um hospital público do interior do Pará. Dentro desse contexto, faz parte da assistência de enfermagem ao indivíduo com IAM: instalação de oxigênio terapia, punção de acesso venoso periférico, monitorização de sinais, realização de ECG e administração de fármacos como nitratos.  Com isso, a equipe de enfermagem deve estar preparada para atender casos de IAM em uma unidade de urgência e emergência. Portanto, é fundamental que o enfermeiro tenha competências técnicas e conhecimento sobre a patologia evidenciada, tendo em vista que o tempo nessa situação imprescindíveis para o paciente

MartiTracks: A Geometrical Approach for Identifying Geographical Patterns of Distribution

Panbiogeography represents an evolutionary approach to biogeography, using rational cost-efficient methods to reduce initial complexity to locality data, and depict general distribution patterns. However, few quantitative, and automated panbiogeographic methods exist. In this study, we propose a new algorithm, within a quantitative, geometrical framework, to perform panbiogeographical analyses as an alternative to more traditional methods. The algorithm first calculates a minimum spanning tree, an individual track for each species in a panbiogeographic context. Then the spatial congruence among segments of the minimum spanning trees is calculated using five congruence parameters, producing a general distribution pattern. In addition, the algorithm removes the ambiguity, and subjectivity often present in a manual panbiogeographic analysis. Results from two empirical examples using 61 species of the genus Bomarea (2340 records), and 1031 genera of both plants and animals (100118 records) distributed across the Northern Andes, demonstrated that a geometrical approach to panbiogeography is a feasible quantitative method to determine general distribution patterns for taxa, reducing complexity, and the time needed for managing large data sets

Diverticulite: fisiopatologia e manejo terapêutico : Diverticulitis: pathophysiology and therapeutic management

Diverticulite é retratada como uma doença intestinal marcada pelo processo inflamatório na parede interna do intestino. Tal afecção colônica, a mais comum dentro das não neoplásicas, é considerada uma complicação clínica frequente, normalmente com curso não complicado da doença diverticular, de modo que afeta entre 10% a 25% dos pacientes com essa patologia. Estudos recentes têm evidenciado a relação do aumento da idade com a prevalência de diverticulose, ainda que, na atual conjuntura, também tem-se notado a incidência de diverticulite sintomática em pessoas cada vez mais jovens - entre 18 e 44 anos. A fisiopatologia da doença diverticular não é plenamente compreendida e pesquisas mostram que ela sofre a influência de diferentes fatores causais, tais como genética, obesidade, alterações estruturais, níveis de vitamina D, idade, atividade física, tabagismo, ingestão de fibras e medicamentos. Ainda que comumente se apresente como assintomática, essa doença pode em alguns casos apresentar manifestações inespecíficas, como dor ou constipação. Vale ressaltar que, dentre as manifestações clínicas, a mais frequente é a dor no quadrante inferior esquerdo do abdome. O diagnóstico é essencialmente clínico, ainda que exames laboratoriais, como o PCR, podem ser usados. O manejo terapêutico dessa afecção, principalmente em sua manifestação aguda, é feito em etapas, com auxílio dos critérios de Hinchey, segundo análise da gravidade da apresentação do quadro clínico, atentando-se às comorbidades e complicações que o paciente pode apresentar. Por fim, foi constatado que as complicações da diverticulite, tal qual abscesso, fístula, peritonite ou perfuração, frequentemente transcorrem, com exceção da fístula, no primeiro acontecimento da doença em comparação com episódios seguintes

SÍNDROME DE CROHN E INTERVENÇÕES CIRÚRGICAS: ENFOQUE INTEGRADO EM ANESTESIA E CIRURGIA GERAL

&nbsp;Crohn's Syndrome is a chronic inflammatory disease of the gastrointestinal tract, characterized by periods of activity and remission, which can result in serious complications, such as strictures, fistulas and abscesses. Although initial treatment involves the use of medication, a significant portion of patients with Crohn's Syndrome end up requiring surgical interventions. In this context, the integrated approach between anesthesia and general surgery plays a fundamental role, ensuring not only the effectiveness of the surgical procedure, but also the safety and well-being of the patient. Objective: To discuss the main considerations involved in the anesthetic and surgical management of Crohn's Syndrome, highlighting the importance of an integrated approach to optimize clinical results and patients' quality of life. Methodology: The Cochrane, Scielo and Medline databases were used, with articles published between 2017 and 2023, available in English or Portuguese. Final Considerations: In view of the complexity of Crohn's Syndrome, an integrated approach between anesthesia and general surgery is essential to ensure successful surgical results and a better quality of life for patients. Furthermore, customizing the treatment plan, considering each patient's individual needs, and ongoing education about the disease are crucial to optimizing long-term results.A Síndrome de Crohn é uma doença inflamatória crônica do trato gastrointestinal, caracterizada por períodos de atividade e remissão, que pode resultar em complicações graves, como estenoses, fístulas e abscessos. Embora o tratamento inicial envolva o uso de medicamentos, uma parcela significativa dos pacientes com Síndrome de Crohn acabam necessitando de intervenções cirúrgicas. Nesse contexto, a abordagem integrada entre anestesia e cirurgia geral desempenha um papel fundamental, garantindo não apenas a eficácia do procedimento cirúrgico, mas também a segurança e o bem-estar do paciente. Objetivo: Discutir as principais considerações envolvidas no manejo anestésico e cirúrgico da Síndrome de Crohn, destacando a importância da abordagem integrada para otimizar os resultados clínicos e a qualidade de vida dos pacientes. Metodologia: Foram utilizadas as bases de dados Cochrane, Scielo e Medline, com artigos publicados entre os anos 2017 e 2023, disponíveis em inglês ou português. &nbsp;Considerações Finais: Em vista da complexidade da Síndrome de Crohn, uma abordagem integrada entre anestesia e cirurgia geral é essencial para garantir resultados cirúrgicos bem-sucedidos e melhor qualidade de vida para os pacientes. Além disso, a personalização do plano de tratamento, considerando as necessidades individuais de cada paciente, e a educação contínua sobre a doença são cruciais para otimizar os resultados a longo prazo

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London