RESUMEN
OBJECTIVES: The proportion of older transplant recipients has increased. Cognitive impairment is not rare after kidney transplant, but data on this issue in liver transplant recipients are scarse. MATERIALS AND METHODS: In this cross-sectional study, we evaluated all liver transplant recipients from a single center in Brazil from July 2018 to June 2020 in terms of cognitive performance to determine the prevalence of neurocognitive disorder. We compared liver transplant recipients with neurocognitive disorder with liver transplant recipients without neurocognitive disorder. We also compared those with an alcoholic cause of liver transplant with other patients. The presence of depressive symptoms was assessed. We performed correlations of clinical data with cognitive scores. RESULTS: In a sample of 100 recipients with median age of 62 years (interquartile range, 56.2-69 y), neurocognitive disorder was present in 21% of the group. Patients with cognitive impairment were older (68 y [61-72] vs 61 y [52-68]; P = .019) and had a trend to higher proportion of persistent kidney injury (33.3% vs 13.9%; P = .055) versus patients without cognitive impairment. Recipients with alcoholic cause of liver transplant exhibited worse cognitive performance in the Mini-Mental State Examination (score of 26 [23.7-28.2] vs 28 [26-29]; P = .024) and the Alzheimer Disease Assessment Scale-cognitive (score of 10.4 [8.6-14.2] vs 8 [6.3-10]; P = .008) than other patients. Weak negative correlations were shown in cognitive performance scores versus recipient age (Semantic Verbal Fluency test, r = -0.334 [P = .001]; Clock Drawing test, r = -0.209 [P = .037]; Alzheimer Disease Assessment Scale-cognitive, r = -0.323 [P = .001]). CONCLUSIONS: Neurocognitive disorder was common in liver transplant recipients, in part due to increased age. This study also suggested a role for alcoholic cause of liver transplant and persistent kidney injury in the development of cognitive impairment.
Asunto(s)
Cognición , Disfunción Cognitiva , Trasplante de Hígado , Humanos , Estudios Transversales , Trasplante de Hígado/efectos adversos , Persona de Mediana Edad , Masculino , Femenino , Brasil/epidemiología , Factores de Riesgo , Anciano , Prevalencia , Disfunción Cognitiva/diagnóstico , Disfunción Cognitiva/epidemiología , Disfunción Cognitiva/etiología , Disfunción Cognitiva/psicología , Resultado del Tratamiento , Factores de Edad , Medición de Riesgo , Hepatopatías Alcohólicas/cirugía , Hepatopatías Alcohólicas/psicología , Hepatopatías Alcohólicas/epidemiología , Hepatopatías Alcohólicas/diagnósticoRESUMEN
O infarto da artéria de Percheron é uma apresentação rara de acidente vascular cerebral, caracterizado principalmente por isquemia talâmica bilateral. A apresentação clinica desse infarto se apresenta de maneira inesperada e variável. Relata-se um caso de um paciente masculino, idoso, acometido por diversas comorbidades, admitido na emergência em coma e hemiplégico a direita, demonstrando acometimento neurológico. A condição clínica do paciente variou durante a hospitalização, apresentando melhora do quadro neurológico focal e midríase fixa à direita, levando a um diagnóstico tardio. Paciente evoluiu ao óbito devido a causas não neurológicas.
The artery of Percheron infarct is a rare presentation of stroke, featured mainly by thalamic bilateral ischemia. The clinical presentation of this infarct is unexpected and variable. It's reported a case of a male patient, elderly, affected with several comorbidities, admitted to the emergency in comatose state and right hemiplegic, proving neurological involvement. The patient's clinical condition has fluctuated throughout the hospitalization presenting improvement of the focal neurologic implication and right mydriasis, culminating in a lagged diagnosis. Patient's death due to non neurologic causes.
Asunto(s)
Humanos , Masculino , Anciano , Infarto Cerebral/diagnóstico por imagen , Tálamo/irrigación sanguínea , Tálamo/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Comorbilidad , Factores de Riesgo , Resultado FatalRESUMEN
INTRODUÇÃO: O monitoramento da glicose pelo portador de diabetes melito é importante na prevenção de complicações clínicas. OBJETIVO: Comparar a intensidade de dor nas punções em lóbulo da orelha e polpa digital e a interferência do local de punção sobre os valores do exame de glicemia capilar. MÉTODO: Estudo exploratório, descritivo e quantitativo. Participaram 70 portadores de diabetes melito. A monitorização foi realizada ao acaso, com glicosímetro G-TECH Free 1®. Para avaliação da intensidade da dor, utilizou-se uma escala numérica graduada em 0 (ausente), 1 (muito leve), 2 (leve), 3 (moderada) e 4 (intensa). RESULTADOS: Para os portadores de diabetes melito Tipo 1, a glicemia média foi de 274,38±22,64 mg/dL para lóbulo da orelha e de 298,33±4,58 mg/dL para polpa digital. Para DM Tipo 2, os valores foram 187,19±9,85 mg/dL para lóbulo da orelha e 195,41±10,47 mg/dL para polpa digital. Houve correlação entre as glicemias encontradas nos dois locais de punção. Para os portadores de diabetes melito Tipo 1, observou-se ausência de dor (0) em lóbulo da orelha e polpa digital com 1,86±0,12. Para portadores de diabetes melito Tipo 2, obteve-se que a média de intensidade de dor para lóbulo da orelha foi de 0,06±0,03 e para polpa digital, 1,75±0,09. CONCLUSÃO: Houve diferença estatística quanto ao índice glicêmico gerado pelos diferentes locais. Menor intensidade de dor foi observada quando o teste é realizado no lóbulo da orelha, sendo uma boa opção para o local de exame.
INTRODUCTION: Glucose self-monitoring by diabetes mellitus patients is important for the prevention of clinical complications. OBJECTIVE: To compare the pain intensity in punctures at earlobe and fingertip and to evaluate the interference of the puncture site on the values of capillary blood glucose test. METHOD: Descriptive and exploratory quantitative study. We evaluated 70 diabetes mellitus patients. The monitoring was randomly carried out, with G-TECH Free glucometer 1®. To assess pain intensity, it was used a numerical scale graded in 0 (absent), 1 (mild), 2 (mild), 3 (moderate), and 4(severe). RESULTS: For patients with Type 1 diabetes mellitus, the average blood glucose was 274.38±22.64 mg/dL for earlobe and 298.33±4.58 mg/dL for fingertip. For Type 2 diabetes mellitus, results were 187.19±9.85 mg/dL for earlobe and 195.41±10.47 mg/dL for fingertip. There was correlationbetween blood glucoses measured in both puncture sites. For patients with Type 1 diabetes mellitus, there was no pain (0) in earlobe, and fingertip was 1.86±0.12. For patients with Type 2 diabetes mellitus, it was found that the average pain intensity for earlobe was 0.06±0.03 and for fingertip, 1.75±0.09. CONCLUSION: There was a statistical difference regarding the glycemic index generated by different sites. Lower pain intensity was observed when the test was done on the earlobe, as a good choice for test site.