RESUMEN

Patients with end-stage renal disease and iliocaval venous obstruction are normally nonviable recipients of kidney transplantation. We report a case of a 34-year-old male patient who has been receiving hemodialysis as renal replacement therapy for 6 years due to immunoglobulin A nephropathy. Past medical history included multiple central venous catheter infections and catheter-associated thrombosis. Iliac confluence and inferior vena cava occlusion previously excluded the patient from the renal transplantation list. The exhaustion of venous access sites was already documented. After multidisciplinary discussion, the patient was proposed for endovascular iliocaval reconstruction aiming for a future kidney transplant. Iliocaval recanalization was achieved through bilateral femoral access. Inferior vena cava and iliac angioplasty were performed. A dedicated venous stent was deployed in the inferior vena cava, followed by a double-barrel reconstruction of the iliac confluence. Successful iliocaval recanalization was accomplished. Five months after kidney transplantation was performed with a deceased donor graft in the right iliac fossa. The postoperative period was uneventful. After 12 months, the patient remained free from kidney replacement therapies with a serum creatinine level of 1.3 mg/dL. To the best of our knowledge, this is the first clinical description of a successful kidney transplant in a patient with a previous iliocaval reconstruction.

RESUMEN

INTRODUCTION: The femoropopliteal sector endovascular treatment is particularly challenging due to its high tortuosity and torsional forces. Better results are still needed to ensure the long-term patency of stenting in this area. The Supera stent appears to change this paradigm. METHODS: This single-center retrospective cohort study aims to evaluate the efficacy and safety of femoropopliteal stenting with Supera in a real-world population. Seventy-nine patients were treated between January 2015 and December 2020, and the results are reported with a median follow-up of 28 months. RESULTS: Indications for revascularization were chronic limb-threatening ischemia with tissue loss (73.6%) or ischemic rest pain (17.7%) and claudication (7.6%). Thirty-six patients (45.6%) were classified as GLASS stage III according to the Global Limb Anatomic Staging System, with 65.8% and 30.4% in grades 3 and 4 of femoropopliteal and infrapopliteal sectors, respectively. The 36-month primary, primary-assisted, and secondary patency rates were 68.6%, 72.0%, and 79.0%, respectively, with an amputation-free survival rate of 86.6%. There was no significant difference between primary patency rates in GLASS stages I-II compared with GLASS stage III (36-month primary patency rates of 72% vs 63% respectively, p = 0.342) nor in amputation-free survival (88% vs 84%, p = 0.877). After adjusting for potential confounders, only the stent conformation significantly affected the primary patency rates, with a higher hazard of reintervention for the elongated (HR = 3.179; p = 0.36; CI 1.081-9.347) and the compressed (HR = 3.014; p = 0.42; CI 1.039-8.746) forms. CONCLUSIONS: The 36-month patency of the Supera stents in our real-world cohort was similar to other reported series. The GLASS stage did not interfere with the stent patency, proving it is a good choice even in the most adverse anatomy patients. Only the non-nominal stent conformation affected the primary patency rates in our patients.

RESUMEN

Physical activity levels are typically undesirably low in chronic kidney disease patients, especially in those undergoing haemodialysis, and particularly on dialysis days. Intradialytic exercise programmes could be a solution to this issue and have been reported to be safe and relatively easily implemented in dialysis clinics. Nevertheless, such implementation has been failing in part due to barriers such as the lack of funding, qualified personnel, equipment, and patient motivation. Intradialytic aerobic exercise has been the most used type of intervention in dialysis clinics. However, resistance exercise may be superior in eliciting potential benefits on indicators of muscle strength and mass. Yet, few intradialytic exercise programmes have focused on this type of intervention, and the ones which have report inconsistent benefits, diverging on prescribed exercise intensity, absent or subjective load progression, equipment availability, or exercise supervision. Commonly, intradialytic resistance exercise interventions use free weights, ankle cuffs, or elastic bands which hinder load progression and exercise intensity monitoring. Here, we introduce a recently developed intradialytic resistance exercise device and propose an accompanying innovative resistance exercise training protocol which aims to improve the quality of resistance exercise interventions within dialysis treatment sessions.

Asunto(s)

Fallo Renal Crónico , Insuficiencia Renal Crónica , Entrenamiento de Fuerza , Humanos , Entrenamiento de Fuerza/métodos , Diálisis Renal , Fallo Renal Crónico/terapia , Ejercicio Físico/fisiología , Calidad de Vida

RESUMEN

Current vascular access (VA) practice adopts arteriovenous fistulas (AVF) as first option for haemodialysis, relegating arteriovenous grafts (AVG) for patients with exhausted upper limb venous patrimony. The Hemodialysis Reliable Outflow graft (HeRO®) is a device assuring direct venous outflow to the right atrium, thus avoiding central venous obstructive disease. Its use together with early access grafts avoids the need for central venous catheters (CVC) bridging periods. We report the deployment of the HeRO device using a previous stentgraft as pathway for the placement of the outflow component, in a patient with no-option for further autogenous upper limb access. This technique spared the usual central vein's exit point for the HeRO graft and, using an early-access dialysis graft, allowed for next-day successful haemodialysis.

Asunto(s)

Várices , Humanos , Várices/terapia , Vena Safena

RESUMEN

Peripheral arterial disease (PAD), abdominal aortic aneurysm (AAA) and chronic mesenteric ischaemia (CMI) are vascular diseases uncommonly observed in the same patient, especially when treatment is required. This case report illustrates a patient requiring mesenteric revascularization due to CMI. A long flush occlusion of the superior mesenteric artery (SMA) precluded endovascular revascularization. Therefore, we performed a retrograde bypass from the right common iliac artery (CIA) to the SMA. On the 6-month follow-up, the patient developed right limb ischemia despite the absence of intestinal angina. CT angiography revealed CIA occlusion, bypass patency through hypogastric retrograde filling and modest growth of a AAA. Due to the presence of contralateral CIA lesions and to achieve durable revascularization, we opted to perform a AAA repair with an aorto-uni-iliac endograft followed by a femorofemoral crossover bypass. This achieved AAA's repair, lower limb revascularization, and a suitable and durable inflow to the mesenteric bypass.

Asunto(s)

Implantación de Prótesis Vascular , Isquemia Mesentérica , Humanos , Isquemia Mesentérica/diagnóstico por imagen , Arteria Ilíaca/diagnóstico por imagen , Aorta Abdominal/cirugía , Isquemia/etiología

RESUMEN

Progressive familial intrahepatic cholestasis type 2 (PFIC2) is a rare autosomal recessive disorder caused by mutations in the ABCB11 gene. Clinical manifestations include cholestasis with low γ-glutamyltransferase (GGT), hepatosplenomegaly, and severe pruritus. Liver transplantation is required for individuals with progressive liver disease or failure of the bypass procedure and has been considered curative. However, in the case of PFIC2, although bile salt excretory pump (BSEP) deficiency is a liver-specific condition rather than a systemic disease, evidence of recurrent BSEP disease has been shown in a small proportion of allografts. We describe an unusual case of a 21-year-old individual with PFIC2 and evidence of recurrent BSEP disease after liver transplantation, with clinical and laboratory improvement after pulse therapy with methylprednisolone for 3 days and adjustment of oral immunosuppression. This case report highlights the recurrence of PFIC2 in patients post liver transplant. It also emphasizes the importance of clinical suspicion, which should be considered in cases of posttransplant cholestasis in PFIC2 patients, especially those with low γ-glutamyltransferase (GGT) and without signs of acute graft rejection. Having knowledge of the condition favors a targeted diagnostic approach and contributes to early therapeutic management and a higher success rate.

Asunto(s)

Colestasis Intrahepática , Colestasis , Trasplante de Hígado , Miembro 11 de la Subfamilia B de Transportador de Casetes de Unión al ATP/genética , Transportadoras de Casetes de Unión a ATP , Adulto , Colestasis Intrahepática/etiología , Colestasis Intrahepática/genética , Humanos , Trasplante de Hígado/efectos adversos , Mutación , Adulto Joven , gamma-Glutamiltransferasa

RESUMEN

BACKGROUND: The association between ulcerative colitis (UC) and primary sclerosing cholangitis has been described for several years and can be classified as having a distinct disease phenotype from inflammatory bowel diseases (IBD). The simultaneous occurrence of decompensated liver disease requiring liver transplant and active IBD is a management challenge, considering that these patients may be at increased risk of infections, thromboembolic events, bleeding, and drug hepatotoxicity. CASE PRESENTATION: We describe a case of a 37-year-old patient with UC and sclerosing cholangitis presenting with severe decompensated rectocolitis complicated with thromboembolic phenomena and severe liver dysfunction who underwent liver transplant while using biological therapy to control bowel disease. CONCLUSIONS: This case highlights the evolution of sclerosing cholangitis to liver transplant in patients with decompensated UC. Despite the risk of recurrence, primary sclerosing cholangitis has excellent results after liver transplant. Despite the use of immunosuppression after liver transplant, biological therapy may be necessary to control IBD.

Asunto(s)

Colangitis Esclerosante , Colitis Ulcerosa , Enfermedades Inflamatorias del Intestino , Hepatopatías , Trasplante de Hígado , Colangitis Esclerosante/complicaciones , Colangitis Esclerosante/cirugía , Colitis Ulcerosa/complicaciones , Colitis Ulcerosa/cirugía , Humanos , Enfermedades Inflamatorias del Intestino/complicaciones , Hepatopatías/complicaciones , Trasplante de Hígado/efectos adversos

RESUMEN

BACKGROUND: Portal vein thrombosis is a relatively frequent complication in patients with liver cirrhosis. Its detection and management are essential to avoid worsening portal hypertension or liver function complications. This complication can also negatively impact or even preclude liver transplant. CASE PRESENTATION: We report the case of a patient who presented with acute portal vein thrombosis, which allowed the diagnosis of liver cirrhosis and hepatocarcinoma within the Milan criteria. Chemical thrombolysis was performed with a mechanical aspiration of the thrombus, and in a second moment, the patient was submitted to a liver transplant. CONCLUSIONS: Advances in the therapeutic approach to portal vein thrombosis and surgical techniques have allowed the condition to no longer be an absolute contraindication to liver transplantation. Diagnosis in the acute phase is associated with greater therapeutic success, aiming to avoid the extension of thrombosis and achieve portal vein recanalization.

Asunto(s)

Hipertensión Portal , Neoplasias Hepáticas , Trasplante de Hígado , Trombosis , Trombosis de la Vena , Humanos , Hipertensión Portal/complicaciones , Cirrosis Hepática/complicaciones , Cirrosis Hepática/cirugía , Neoplasias Hepáticas/complicaciones , Neoplasias Hepáticas/cirugía , Trasplante de Hígado/efectos adversos , Trasplante de Hígado/métodos , Vena Porta/diagnóstico por imagen , Trombosis/complicaciones , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/etiología , Trombosis de la Vena/cirugía

RESUMEN

Background and aims: Inflammatory bowel diseases (IBD) are chronic conditions that may be accompanied by autoimmune liver disease (AILD), most commonly primary sclerosing cholangitis (PSC). The objective of this study was to evaluate the behaviour of patients with IBD associated with AILD and compare a PSC group with a non-PSC group.Methods: Medical records of patients with IBD associated with PSC, autoimmune cholangitis, primary biliary cholangitis, small-duct PSC, autoimmune hepatitis (AIH) and overlapping syndromes were assessed.Results: Fifty-four patients were included: 48 (88.9%) had ulcerative colitis and six (11.1%) had Crohn's disease; 35 (64.8%) had PSC and 19 (35.2%) did not have PSC. There was no difference in outcomes (surgical treatment for IBD, liver transplantation or death) between the groups. Time since the diagnosis of IBD was associated with surgical treatment of IBD (p=0.041; OR: 1.139, 95% CI: 1.006–1.255). Time since the diagnosis of AILD (p=0.003; OR: 1.259, 95% CI: 1.1–1.396), as well as portal hypertension at diagnosis (p=0.014; OR: 18.22, 95% CI: 1.815–182.96), were associated with liver transplantation. In addition, previous diagnosis of AIH was associated with de novo IBD (p=0.012; OR: 7.1, 95% CI: 1.215–42.43).Conclusion: Both groups had similar disease behaviour. A longer time since the diagnosis of IBD increased the risk for surgical treatment (13.9%/year). A 25.9%/year increase in liver transplantation was observed after the diagnosis of AILD, which was increased 18.22 times by the presence of portal hypertension. In addition, the diagnosis of AIH was associated with an increase in the number of diagnoses of de novo IBD (7.1).

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Antecedentes y objetivos: Las enfermedades inflamatorias intestinales (EII) son afecciones crónicas que pueden ir acompañadas de enfermedad hepática autoinmune (EHA) o colangitis esclerosante primaria (CEP). El objetivo del estudio fue evaluar el comportamiento de pacientes con EII asociada a EHA y comparar un grupo con CEP con un grupo sin CEP.Métodos: Se evaluaron las historias clínicas de pacientes con EII asociadas con CEP, colangitis autoinmune, colangitis biliar primaria, CEP de conductos pequeños, hepatitis autoinmune (HAI) y síndromes superpuestos.Resultados: Se incluyeron 54 pacientes. De ellos, 48 (88,9%) tenían colitis ulcerosa y seis (11,1%) tenían enfermedad de Crohn; 35 (64,8%) tenían CEP y 19 (35,2%) no tenían CEP. No hubo diferencias en los resultados (tratamiento quirúrgico para la EII, trasplante de hígado o muerte) entre los grupos. El tiempo transcurrido desde el diagnóstico de EII se asoció con el tratamiento quirúrgico de la EII (p=0,041). El tiempo desde el diagnóstico de EHA (p=0,003), así como la hipertensión portal en el momento del diagnóstico (p=0,014), fueron asociado con el trasplante de hígado. Además, el diagnóstico previo de HAI se asoció con EII de novo (p=0,012).Conclusión: Ambos grupos tuvieron un comportamiento de enfermedad similar. Un mayor tiempo desde el diagnóstico de EII aumentó el riesgo de tratamiento quirúrgico (13,9%/año). Se observó un aumento del 25,9%/año en el trasplante de hígado después de diagnóstico de EIA, que se incrementó 18,22 veces por la presencia de hipertensión portal. Además, el diagnóstico de HAI se asoció con un aumento en el número de diagnósticos de EII de novo (7,1).

Asunto(s)

Humanos , Enfermedades Inflamatorias del Intestino , Hepatopatías , Enfermedades Autoinmunes , Colangitis Esclerosante , Registros Médicos , Cirrosis Hepática Biliar , Gastroenterología , Estudios Retrospectivos , Colitis Ulcerosa , Enfermedad de Crohn , Terapéutica , Quimioterapia

RESUMEN

BACKGROUND AND AIMS: Inflammatory bowel diseases (IBD) are chronic conditions that may be accompanied by autoimmune liver disease (AILD), most commonly primary sclerosing cholangitis (PSC). The objective of this study was to evaluate the behaviour of patients with IBD associated with AILD and compare a PSC group with a non-PSC group. METHODS: Medical records of patients with IBD associated with PSC, autoimmune cholangitis, primary biliary cholangitis, small-duct PSC, autoimmune hepatitis (AIH) and overlapping syndromes were assessed. RESULTS: Fifty-four patients were included: 48 (88.9%) had ulcerative colitis and six (11.1%) had Crohn's disease; 35 (64.8%) had PSC and 19 (35.2%) did not have PSC. There was no difference in outcomes (surgical treatment for IBD, liver transplantation or death) between the groups. Time since the diagnosis of IBD was associated with surgical treatment of IBD (p=0.041; OR: 1.139, 95% CI: 1.006-1.255). Time since the diagnosis of AILD (p=0.003; OR: 1.259, 95% CI: 1.1-1.396), as well as portal hypertension at diagnosis (p=0.014; OR: 18.22, 95% CI: 1.815-182.96), were associated with liver transplantation. In addition, previous diagnosis of AIH was associated with de novo IBD (p=0.012; OR: 7.1, 95% CI: 1.215-42.43). CONCLUSION: Both groups had similar disease behaviour. A longer time since the diagnosis of IBD increased the risk for surgical treatment (13.9%/year). A 25.9%/year increase in liver transplantation was observed after the diagnosis of AILD, which was increased 18.22 times by the presence of portal hypertension. In addition, the diagnosis of AIH was associated with an increase in the number of diagnoses of de novo IBD (7.1).

Asunto(s)

Colangitis Esclerosante , Colitis Ulcerosa , Enfermedad de Crohn , Hepatitis Autoinmune , Hepatopatías , Adolescente , Adulto , Anciano , Colangitis/complicaciones , Colangitis/epidemiología , Colangitis Esclerosante/complicaciones , Colangitis Esclerosante/epidemiología , Colitis Ulcerosa/complicaciones , Colitis Ulcerosa/diagnóstico , Colitis Ulcerosa/epidemiología , Colitis Ulcerosa/cirugía , Enfermedad de Crohn/complicaciones , Enfermedad de Crohn/diagnóstico , Enfermedad de Crohn/epidemiología , Enfermedad de Crohn/cirugía , Progresión de la Enfermedad , Femenino , Hepatitis Autoinmune/complicaciones , Hepatitis Autoinmune/epidemiología , Humanos , Hipertensión Portal/complicaciones , Cirrosis Hepática Biliar/complicaciones , Hepatopatías/complicaciones , Hepatopatías/epidemiología , Trasplante de Hígado/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Factores de Tiempo , Adulto Joven

RESUMEN

Variceal bleeding is a serious complication in cirrhotic patients and is related to increased expression of inflammatory mediators that accentuate circulatory dysfunction. The study aims to evaluate the performance of high mobility protein group 1 (HMG1) and interleukin-6 (IL-6) as predictors of acute kidney injury (AKI), infection and death in these patients. Fifty patients who were diagnosed with advanced chronic liver disease with variceal bleeding were included. The mean age was 52.8 ± 10.8 years, and 33 (66%) were male. Twenty-one (42%) patients were classified as Child-Pugh C, 21 (42%) Child-Pugh B and 8 (16%) Child-Pugh A. The mean HMG1 serum level was 2872.36 pg/mL ± 2491.94, and the median IL-6 serum level was 47.26 pg/mL (0-1102.4). In AKI, the serum level of HMG1 that performed best on the ROC curve was 3317.9 pg/mL. The IL-6 serum level was not associated with AKI. HMG1 and IL-6 cut-off values that better predicted infection were 3317.9 pg/mL and 72.9 pg/mL, and for mortality, the values were 2668 pg/mL and 84.5 pg/mL, respectively. In multivariate analysis, the variables that were associated with AKI and infection outcomes were model for end-stage liver disease and HMG1. Infections were related to the risk of death. Clinical and laboratory variables related to the outcomes were identified. Serum levels of HMG1 were associated with AKI and infection and had good performance in the ROC curve. IL-6 levels were not maintained in logistic regression outcomes but had good performance in infection and death outcomes. Such data will be useful for comparisons and possible future validations.

Asunto(s)

Enfermedad Hepática en Estado Terminal , Várices Esofágicas y Gástricas , Hepatopatías , Adulto , Enfermedad Hepática en Estado Terminal/complicaciones , Várices Esofágicas y Gástricas/complicaciones , Várices Esofágicas y Gástricas/diagnóstico , Femenino , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiología , Humanos , Interleucina-6 , Cirrosis Hepática/complicaciones , Hepatopatías/complicaciones , Masculino , Persona de Mediana Edad , Pronóstico , Índice de Severidad de la Enfermedad

RESUMEN

We present a study of the IR behavior of a three-dimensional superrenormalizable quantum field theory consisting of a scalar field in the adjoint of SU(N) with a φ^{4} interaction. A bare mass is required for the theory to be massless at the quantum level. In perturbation theory, the critical mass is ambiguous due to IR divergences, and we indeed find that at two loops in lattice perturbation theory the critical mass diverges logarithmically. It was conjectured long ago in [R. Jackiw et al., Phys. Rev. D 23, 2291 (1981)PRVDAQ0556-282110.1103/PhysRevD.23.2291, T. Appelquist et al., Phys. Rev. D 23, 2305 (1981)PRVDAQ0556-282110.1103/PhysRevD.23.2305] that superrenormalizable theories are nonperturbatively IR finite, with the coupling constant playing the role of an IR regulator. Using a combination of Markov Chain Monte Carlo simulations of the lattice-regularized theory, frequentist and Bayesian data analysis, and considerations of a corresponding effective theory, we gather evidence that this is indeed the case.

RESUMEN

Coping with the COVID-19 pandemic has required measures to contain the contagion, including social isolation. However, this and other factors have caused mental health problems, both in patients and health professionals and in family members or asymptomatic population. Religious support can be an ally for this type of confrontation. In the case of the COVID-19 pandemic, spiritual/religious care has been restricted and insufficient. When accessible to patients and frontline professionals, they are offered by virtual means, almost always by recorded media and made available in bulk. This essay argues, based on references in the areas of psychology, psychoneuroimmunology, biosafety, and military, that the face-to-face and personalized relationship between religious leaders, patients, health professionals, family members, and faith communities is as essential as possible for the dignified treatment victims, referral to spiritual needs and resilience of society, in addition to contributing to the improvement of the immune response of all. Practical examples are cited in the areas of military chaplaincy and hospital civilian chaplaincy. The essay also proposes the adoption of protocols already published by WHO and other safety measures such as the use of robotics and the recruitment/training of mass chaplains. In addition to contributing to the improvement of COVID-19 pandemic coping processes, the study also contributes to improving the delivery of spiritual/religious care as an ally to physical and mental, individual, and collective health.

Asunto(s)

COVID-19 , Trastornos Mentales , Religión y Psicología , Aislamiento Social , COVID-19/psicología , Humanos , Trastornos Mentales/prevención & control , Aislamiento Social/psicología

RESUMEN

BACKGROUND: Inflammatory bowel diseases (IBD) are chronic inflammatory affections of recurrent nature whose incidence and prevalence rates have increased, including in Brazil. In long term, they are responsible for structural damage that impacts quality of life, morbidity and mortality of patients. OBJECTIVE: To describe the profile of physicians who treat IBD patients as well as the characteristics of IBD care, unmet demands and difficulties. METHODS: A questionnaire containing 17 items was prepared and sent to 286 physicians from 101 Brazilian cities across 21 states and the Federal District, selected from the register of the State Commission of the "Study Group of Inflammatory Bowel Disease of Brazil" (GEDIIB). RESULTS: The majority of the physicians who answered the questionnaire were gastroenterologists and colorectal surgeons. More than 60% had up to 20 years of experience in the specialty and 53.14% worked at three or more locations. Difficulties in accessing or releasing medicines were evident in this questionnaire, as was referrals to allied healthy professionals working in IBD-related fields. More than 75% of physicians reported difficulties in performing double-balloon enteroscopy and capsule endoscopy, and 67.8% reported difficulties in measuring calprotectin. With regard to the number of patients seen by each physician, it was shown that patients do not concentrate under the responsibility of few doctors. Infliximab and adalimumab were the most commonly used biological medicines and there was a higher prescription of 5-ASA derivatives for ulcerative colitis than for Crohn's disease. Steroids were prescribed to a smaller proportion of patients in both diseases. The topics "biological therapy failure" and "new drugs" were reported as those with higher priority for discussion in medical congresses. In relation to possible differences among the country's regions, physicians from the North region reported greater difficulty in accessing complementary exams while those from the Northeast region indicated greater difficulty in accessing or releasing medicines. CONCLUSION: The data obtained through this study demonstrate the profile of specialized medical care in IBD and are a useful tool for the implementation of government policies and for the Brazilian society as a whole.

Asunto(s)

Colitis Ulcerosa , Enfermedades Inflamatorias del Intestino , Médicos , Brasil/epidemiología , Colitis Ulcerosa/tratamiento farmacológico , Humanos , Enfermedades Inflamatorias del Intestino/terapia , Infliximab , Calidad de Vida

RESUMEN

ABSTRACT BACKGROUND: Inflammatory bowel diseases (IBD) are chronic inflammatory affections of recurrent nature whose incidence and prevalence rates have increased, including in Brazil. In long term, they are responsible for structural damage that impacts quality of life, morbidity and mortality of patients. OBJECTIVE: To describe the profile of physicians who treat IBD patients as well as the characteristics of IBD care, unmet demands and difficulties. METHODS: A questionnaire containing 17 items was prepared and sent to 286 physicians from 101 Brazilian cities across 21 states and the Federal District, selected from the register of the State Commission of the "Study Group of Inflammatory Bowel Disease of Brazil" (GEDIIB). RESULTS: The majority of the physicians who answered the questionnaire were gastroenterologists and colorectal surgeons. More than 60% had up to 20 years of experience in the specialty and 53.14% worked at three or more locations. Difficulties in accessing or releasing medicines were evident in this questionnaire, as was referrals to allied healthy professionals working in IBD-related fields. More than 75% of physicians reported difficulties in performing double-balloon enteroscopy and capsule endoscopy, and 67.8% reported difficulties in measuring calprotectin. With regard to the number of patients seen by each physician, it was shown that patients do not concentrate under the responsibility of few doctors. Infliximab and adalimumab were the most commonly used biological medicines and there was a higher prescription of 5-ASA derivatives for ulcerative colitis than for Crohn's disease. Steroids were prescribed to a smaller proportion of patients in both diseases. The topics "biological therapy failure" and "new drugs" were reported as those with higher priority for discussion in medical congresses. In relation to possible differences among the country's regions, physicians from the North region reported greater difficulty in accessing complementary exams while those from the Northeast region indicated greater difficulty in accessing or releasing medicines. CONCLUSION: The data obtained through this study demonstrate the profile of specialized medical care in IBD and are a useful tool for the implementation of government policies and for the Brazilian society as a whole.

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RESUMO CONTEXTO: As doenças inflamatórias intestinais (DII) são afecções inflamatórias crônicas de caráter recorrente, cujas taxas de incidência e prevalência têm aumentado, inclusive no Brasil. A longo prazo, são responsáveis por danos estruturais que impactam na qualidade de vida, morbidade e mortalidade dos pacientes. OBJETIVO: Avaliar o perfil dos médicos que atendem pacientes com DII, assim como as características deste atendimento, demandas não atendidas e dificuldades. MÉTODOS: Um questionário contendo 17 variáveis foi elaborado e enviado para médicos, selecionados a partir do cadastro da Comissão das Estaduais do Grupo de Estudos da Doença Inflamatória Intestinal do Brasil (GEDIIB), totalizando 286 médicos de 101 cidades brasileiras distribuídas por 21 estados e Distrito Federal. RESULTADOS: A maioria dos médicos que respondeu o questionário foram Gastroenterologistas e Coloproctologistas. Mais de 60% tinham até 20 anos de atuação na especialidade e 53,14% trabalhavam em três locais ou mais. A dificuldade no acesso ou liberação de medicamentos ficou evidenciada neste questionário, assim como a dificuldade no encaminhamento para profissionais não médicos que atuam em DII. Mais de 75% dos médicos relataram dificuldades para realização de enteroscopia por duplo balão e cápsula endoscópica, e 67,8% para realização da calprotectina. Em relação ao número de pacientes atendidos por cada médico, foi evidenciado que não há uma concentração de pacientes sob a responsabilidade de poucos médicos. O infliximabe e o adalimumabe foram os biológicos mais utilizados e ficou evidenciada prescrição maior de derivados de 5-ASA para retocolite ulcerativa quando comparada à doença de Crohn. Os corticoides foram prescritos para uma parcela menor de pacientes em ambas doenças. Os temas "falha a terapia biológica" e "novas drogas" foram referidos como aqueles com maior prioridade para discussão em eventos científicos. Em relação às possíveis diferenças entre cada região e o restante do país, os médicos da região Norte relataram maior dificuldade no acesso a exames complementares e os médicos da região Nordeste, maior dificuldade no acesso ou liberação de medicamentos. CONCLUSÃO: Os dados obtidos por meio deste estudo mostram o perfil do atendimento médico especializado em DII e podem se constituir em ferramenta útil para para elaboração de políticas governamentais e para sociedade brasileira como um todo.

Asunto(s)

Humanos , Médicos , Enfermedades Inflamatorias del Intestino/terapia , Colitis Ulcerosa/tratamiento farmacológico , Calidad de Vida , Brasil/epidemiología , Infliximab

RESUMEN

BACKGROUND: Acute kidney injury (AKI) affects from 20% to 50% of cirrhotic patients, and the one-month mortality rate is 60%. The main cause of AKI is bacterial infection, which worsens circulatory dysfunction through the release of HMGB1 and IL-6. OBJECTIVES: To evaluate HMGB1 and IL-6 as biomarkers of morbidity/mortality. METHODS: Prospective, observational study of 25 hospitalised cirrhotic patients with AKI. Clinical and laboratory data were collected at the time of diagnosis of AKI, including serum HMGB1 and IL-6. RESULTS: The mean age was 55 years; 70% were male. Infections accounted for 13 cases. The 30-day and three-month mortality rates were 17.4% and 30.4%, respectively. HMGB1 levels were lower in survivors than in nonsurvivors at 30 days (1174.2 pg/mL versus 3338.5 pg/mL, p = 0.035), but not at three months (1540 pg/mL versus 2352 pg/mL, p = 0.243). Serum IL-6 levels were 43.3 pg/mL versus 153.3 pg/mL (p = 0.061) at 30 days and 35.8 pg/mL versus 87.9 pg/mL (p = 0.071) at three months, respectively. The area under the ROC curve for HMGB1 was 0.842 and 0.657, and that for IL-6 was 0.803 and 0.743 for discriminating nonsurvivors at 30 days and three months, respectively. In multivariate analysis, no biomarker was independently associated with mortality. CONCLUSION: HMGB1 levels were associated with decreased survival in cirrhotics. Larger studies are needed to confirm our results.

Asunto(s)

Lesión Renal Aguda/sangre , Biomarcadores/sangre , Proteína HMGB1/sangre , Interleucina-6/sangre , Cirrosis Hepática/sangre , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante

RESUMEN

Resumo A pandemia da COVID-19, por demandar isolamento social, impõe aproximação e coordenação de esforços de entes públicos e privados por intermédio da Internet e dos serviços digitais. O artigo analisa o uso e a operacionalização do ciberespaço pela Administração Pública no combate ao SARS-CoV-2 e apresenta um diagnóstico das vulnerabilidades e desafios referentes a essa crescente operacionalização. A administração pública passou a operacionalizar o ciberespaço com mais afinco a partir da década de 1990, com o e-government. Estratégias de coordenação (inter)governamental impostas pela atual conjuntura seriam impossíveis sem a intensificação da operacionalização do ciberespaço pelo aparato administrativo público, que transpõe para o domínio digital práticas e ações pouco usuais ou mesmo inéditas. Dada sua artificialidade, o ciberespaço só pode ser operacionalizado por detentores de meios para tal. A "democratização" cibernética esbarra na exclusão digital. O atual isolamento social evidencia desafios técnicos e socioeconômicos decorrentes da transposição do aparato de administração pública para o ciberespaço.

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Resumen Por exigir aislamiento social, la pandemia de COVID-19 impone la aproximación y coordinación de esfuerzos de las entidades públicas y privadas por medio de Internet y de los servicios digitales. El artículo analiza el uso y operacional actual del ciberespacio por parte de la Administración Pública en la lucha contra el virus SARS-CoV-2 y presenta un diagnóstico de las vulnerabilidades y desafíos relacionados con esta creciente utilización operacional. La administración pública comenzó a usar el ciberespacio con mayor ahínco desde la década de 1990, momento en que surgió el e-government. Las estrategias de coordinación (inter)gubernamental impuestas por la situación actual serían imposibles sin la intensificación de la utilización operacional del ciberespacio por parte del aparato administrativo público, que transpone al dominio digital prácticas y acciones poco usuales o inéditas. Dada su artificialidad, el ciberespacio solo puede ser operado por quienes tienen los medios para hacerlo. La "democratización" cibernética choca con la exclusión digital. El aislamiento social actual destaca los desafíos técnicos y socioeconómicos derivados de la transposición del aparato de la administración pública al ciberespacio.

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Abstract The COVID-19 pandemic, while demanding social distancing, imposes approximation and coordination of efforts by public and private entities through the Internet and digital services. This article analyzes the use and operationalization of cyberspace by the public administration in the fight against SARS-CoV-2. It presents a diagnosis of the vulnerabilities and challenges related to this growing operationalization. The public administration began to operationalize cyberspace more vigorously from the 1990s, with e-government. Inter-governmental and governmental coordination strategies imposed by the current situation would be impossible without the intensification of the operationalization of cyberspace by the public administration apparatus, which transposes unusual and even unprecedented practices and actions to the digital domain. Given its artificiality, cyberspace can only be operated by those with the means to do so. Cyber-democratization comes up against the digital divide. The current need for social distancing highlights technical and socio-economic challenges arising from the transposition of the public administration apparatus into cyberspace.

Asunto(s)

Humanos , Masculino , Femenino , Administración Pública , Infecciones por Coronavirus , Internet , Brecha Digital , Gobierno Electrónico

RESUMEN

Background: Acute kidney injury occurs in approximately 20% of hospitalized cirrhotic patients. Mortality is estimated at 60% within a month and 65% within a year. Aims: To evaluate survival in 30 days and in 3 months of cirrhotic patients hospitalized with acute kidney injury, identifying factors associated with mortality. Methods: 52 patients with cirrhosis admitted to an academic tertiary center who presented acute kidney injury according to the International Club of Ascites criteria were evaluated. Clinical and laboratory data was collected at diagnosis between 2011 and 2015. Results: Average age was 54.6 (±10.7) years and 69.2% were male. The average MELD, MELD-Na, and Child-Pugh scores were 21.9 (±7.0), 24.5 (±6.7), and 10.1 (±2.2), respectively. Thirty patients (57.7%) were in acute kidney injury stage 1, 16 (30.8%) in stage 2, and six (11.6%) in stage 3. Mortality was 28.6% in 30 days and 44.9% in three months. In multivariate analysis, variables that were associated independently to mortality were lack of response to expansion treatment and Child-Pugh score. Mortality was 93.3% in three months among nonresponders compared to 28.6% among those who responded to volume expansion (p<0.0001). Conclusion: Acute kidney injury in cirrhosis has dire prognosis, particularly in patients with advanced cirrhosis and in nonresponders to volume expansion.

Asunto(s)

Lesión Renal Aguda/etiología , Hospitalización , Cirrosis Hepática/complicaciones , Lesión Renal Aguda/epidemiología , Lesión Renal Aguda/mortalidad , Adulto , Anciano , Femenino , Humanos , Cirrosis Hepática/mortalidad , Cirrosis Hepática/terapia , Masculino , Persona de Mediana Edad , Análisis Multivariante , Pronóstico , Estudios Prospectivos , Tasa de Supervivencia , Factores de Tiempo

RESUMEN

This study aimed to identify and characterize genetically species of the genus Hepatozoon detected in Hydrochoerus hydrochaeris (capybaras) and Pecari tajacu (collared peccaries) from two localities from the Eastern Amazon. Blood samples from 196 free-living H. hydrochaeris from Marajó Island and 109 P. tajacu kept in captivity in Belém, Pará, were collected and analyzed for the presence of Hepatozoon spp. Partial sequences of the 18S rRNA gene were obtained and analyzed in comparison to others available in the NCBI database. Our results demonstrated a high prevalence of Hepatozoon canis in both mammals and the existence of four haplotypes of Hepatozoon spp., three of Hepatozoon canis and one of Hepatozoon cuestensis, found only in H. hydrochaeris. In addition, these data increase the genetic diversity of H. canis from the Eastern Amazon, as well as reporting, for the first time, the infection of mammals by H. cuestensis and P. tajacu by H. canis.

Asunto(s)

Artiodáctilos , Coccidiosis/veterinaria , Eucoccidiida/genética , Variación Genética , Roedores , Animales , Brasil/epidemiología , Coccidiosis/epidemiología , Coccidiosis/parasitología , Eucoccidiida/fisiología , Filogenia , Prevalencia , ARN Protozoario/análisis , ARN Ribosómico 18S/análisis