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Clinical Trial Demonstrates Efficacy of Transcranial Direct Current Stimulation (tDCS) in Improving Pain Management from Post-Laminectomy Syndrome

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Pain Studies and Treatment 2023年第4期11卷 27-42页

作者： Marilia Capuço Oliveira Fernanda Menezes de Faria Gerardo Maria de Araújo Filho Ana carolina gonçalves Olmos Demosthenes Santana Silva Junior Camila Souza alves Cosmo Department of Neurological Sciences Psyquiatry and Medical Psychology Faculdade de Medicina de S&#227o José do Rio Preto S&#227o Paulo Brazil

Chronic pain, a multidimensional experience affecting individuals’ sensory, cognitive, and emotional aspects, significantly impacts their quality of life. Post-laminectomy syndrome, a condition characterized by persistent back pain following spinal surgery, often leads to disability and increased healthcare utilization. Methods: This randomized, controlled, blind clinical trial aimed to investigate the efficacy of Transcranial Direct Current Stimulation (tDCS) in managing pain from post-laminectomy syndrome in patients. Twenty-four participants were assigned to three groups: sham stimulation, active stimulation over primary motor cortex (M1), or stimulation over dorsolateral prefrontal cortex (DLPFC). Stimulation was administered for five consecutive days, 20 minutes per session, using a current of 1.5 mA through 25 cm2 electrodes. Pain intensity was assessed using Visual Analog Scale (VAS) before, during, and after intervention. Results: An ANOVA model demonstrates significant reduction in pain intensity compared to baseline in VAS, (F(7, 285) = 12.292;p 0.001;Power = 1.000;η2p = 0.534), in tDCS applied to M1, after five days of intervention. After stimulation, a significant improvement was observed in WHOQoL-Bref Quality of life item 1 (p = 0.04), considering statistical significant difference p 0.05. Correlation between the variables: quality of life, depression, anxiety and pain also demonstrates reduction in depression and anxiety according to Beck’s Depression and Anxiety Inventories (BDI and BAI), p 0.05. This effect was not observed in DLPFC stimulation group. Patients who believed they received active stimulation, in sham group, demonstrated potential for effective blinding. Conclusion: The tDCS applied to primary motor cortex effectively improved pain management and psychiatry symptoms in post-laminectomy syndrome patients. The technique’s low cost, ease of use, and high tolerability make it a promising adjuvant therapy for chronic pain conditio

关键词： Non-Invasive Neuromodulation Transcranial Direct Current Stimulation Post-Laminectomy Syndrome Chronic Pain

Use of the Scar Acceleration Method/Método de Aceleração Cicatricial—MAC®—in the Treatment of Capsular Contracture: Case Report

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Open Journal of Therapy and Rehabilitation 2020年第4期8卷 131-142页

作者： carolina Macedo alves Moreira carolina gonçalves Pinheiro Aline Ronis Sampaio Michele Paula dos Santos Andres Felipe Mantilla Santamaria Miriam Viviane Baron Cristine Brandenburg Nathália Ken Pereira Iketani Mara Alessandra Porto dos Reis Oliveira Alexandre Sancho Esteban Fortuny Felice Picariello Marcus Vinicius de Mello Pinto Dr. Daniel Thomaz Clinic Uberlandia Minas Gerais Brazil Postgraduate Program in Health Sciences of the Faculty of Medicine of ABC (FMABC) The Vale do Salgado Faculty (FVS) Ceará Brazil Celulare Institute Petrópolis Rio de Janeiro Brazil School of Medicine of the Pontifical Catholic University of Rio Grande do Sul (PUC/RS) Porto Alegre Brazil School of Medicine of the Industrial University of Santander (UIS) Bucaramanga Colombia School of Medicine of the Pontifical Catholic University of Rio Grande do Sul (PUC/RS) Porto Alegre Brazil Postgraduate Program in Medicine and Health Sciences of the Pontifical Catholic University of Rio Grande do Sul (PUC/RS) Por-to Alegre Brazil Brazilian Education of the Federal University of Ceará (UFC) Fortaleza Brazil Hospital Beneficiente Portuguesa of Belém Pará Brazil Clínica Instituto de Cirurgia Plástica Vênus Barreiras Bahia Brazil Unigranrio Rio de Janeiro Brazil Universidad Finis Terrae and CEO of Diagnostra Santiago Chile Università degli Studi di Napoli Federico II Napoli Italy Ph.D. and Creator of the MAC® Method CEO and Researcher of the Celulare Institute Petrópolis Rio de Janeiro Brazil

Capsular contracture is a frequent complication in the postoperative period of breast implantation. It usually accompanies the appearance of a firm breast that can progress to pain, distortion, and asymmetry of the breasts, requiring surgical revision. The present study is a case report. A 58-year-old woman with a medical diagnosis of capsular contracture of the right breast evidenced by ultrasound. She was referred to the physiotherapy clinic in October 2019 with an initial complaint of pain on palpation, swelling, and stiffness in her right breast. The patient was evaluated and the MACò method was used to treat capsular contracture. For this, 12 sessions of photodynamic therapy were carried out. The treatment included the use of LED by doping: red (300 s), violet (60 s) and blue (120 s), with the use of 1% methylene blue in target areas, three times a week. The patient had the beginning of symptoms’ remission in the fourth visit and total remission in the 12th visit. It was concluded that the use of photodynamic therapy using the MAC

关键词： Breast Implants Fibroses Methylene Blue Semiconductor Diode Laser Photodynamic Therapy

A Study of Laser Effectiveness in Injured Tissues Regeneration

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Journal of Biosciences and Medicines 2021年第3期9卷 55-63页

作者： Marcus Vinicius de Mello Pinto Aline Ronis Sampaio Miriam Viviane Baron carolina Macedo alves Moreira carolina gonçalves Pinheiro Michele Paula dos Santos Andres Felipe Mantilla Santamaria Cristine Brandenburg Nathália Ken Pereira Iketani Mara Alessandra Porto dos Reis Oliveira Alexandre Sancho Felice Picariello Esteban Fortuny Juliano Tibola Nilton Petrone Vilardi Junior Celulare Institute Petrópolis Rio de Janeiro Brazil School of Medicine Pontifical Catholic University of Rio Grande do Sul (PUC/RS) Porto Alegre Brazil Dr. Daniel Thomaz Clinic Uberlandia Minas Gerais Brazil Faculty of Medicine of ABC (FMABC) Santo André Brazil Vale do Salgado Faculty (FVS) Ceará Brazil School of Medicine Industrial University of Santander (UIS) Bucaramanga Colombia Federal University of Ceará (UFC) Fortaleza Brazil Hospital Beneficiente Portuguesa of Belém Pará Brazil Clínica Instituto de Cirurgia Plástica Vênus Barreiras Bahia Brazil Unigranrio Rio de Janeiro Brazil da Universita Federico II di Napoli Italia e Pesquisador do Internacional Research Group Rio Grande do Norte Brazil Universidad Finis Terrae Santiago Chile UDESC Florianopolis SC Brazil Fluminense Football Club Rio de Janeiro RJ Brazil

This study aimed to understand the use of low level laser in the regeneration of injured tissues. Also to design our own opinion on the subject, as chemists. Laser is nothing more than a light with very special characteristics that grant it therapeutic properties. We can observe the existence of three different types of laser, being one of them the therapeutic laser, which is used in substitution for medications or along with them. Another type of laser is the surgical one and, in addition to these, there is a diagnostic type. A great advantage is that, instead of taking the medicine, the patient’s own body can be activated by the laser to produce certain substances that can often replace the drugs. This is a literature review emphasizing the use of low level laser. Thus, the reflections from this study can contribute to the amplification of the production of knowledge that aims at the resignification of the use of laser in therapy. Greater attention was given to two types of laser radiation: He-Ne and As-Ga, both presenting a high therapeutic potential in superficial and deep injures. However, the He-Ne laser excels in superficial lesions, whereas the As-Ga laser does so in deep injures, such as articular, muscular, etc.

关键词： Laser Injury Regeneration

Suicide Attempts in a General Hospital: A Case-Control

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Open Journal of Psychiatry 2023年第S2期13卷 518-531页

作者： Fernanda Menezes de Faria Marília Capuço Oliveira Gerardo Maria de Araújo Filho Celina Dias Santos Lazzaro Ellen Thaís França dos Santos Gouveia Maria Fernanda Birolli Pedro Bueno da Silveira Agrelli Yoichi Takaki Konno Ana carolina gonçalves Olmos Department of Neurological Sciences Psyquiatry and Medical Psychology Faculdade de Medicina de S&#227o José do Rio Preto S&#227o Paulo Brazil

Objective: This study aims is to conduct a comparative analysis of the clinical and sociodemographic profiles of individuals referred to Consultation-Liaison Psychiatry (CLP) at a tertiary general hospital, specifically focusing on those seeking assistance due to suicide attempts (TS) versus CLP requests for other reasons (non-TS) between the years 2010 and 2020. Additionally, we aim to assess factors associated with suicide attempts. Method: This retrospective controlled study involves a thorough examination of medical records encompassing 3913 patients who received CLP services at the Hospital de Base (HB) and the Children and Maternity Hospital (HCM) of São José do Rio Preto Medical School Foundation (Funfarme) from June 2010 to June 2020. The patient cohort is categorized into two groups: those with requests for SA (n = 677) and those with requests for other reasons. Results: In the SA group, as opposed to the non SA group, statistically significant differences were observed for gender (predominantly female), employment status (employed), marital status (single), and age (younger). Notably, a higher prevalence of psychiatric antecedents (88.7%, n = 555 vs. 73.6% n = 2018) was found in the SA group, indicating a significant association. The frequency of SA requests remained stable over the years. Among the SA group, mood disorders were the most prevalent (39%, n = 372), followed by disorders related to substance use (21.2%, n = 202), and personality disorders (16%, n = 152). A history of previous suicide attempts emerged as a crucial factor for the recurrence of SA (p-value ≤ 0.001). Exogenous intoxication emerged as the most frequently employed method in attempts (79.6%, n = 539), particularly prevalent among patients diagnosed with mood disorders (41%, n = 314). A significant association was observed between the method of attempt and the nosological psychiatric diagnosis (χ2 = 42.277;p ≤ 0.001). Regarding outcomes, the majority of patients were refer

关键词： Consultation-Liaison Psychiatry Exogenous Intoxication General Hospital Mood Disorders Suicide Attempt

Real-world treatment patterns and disease control over one year in patients with inflammatory bowel disease in Brazil

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World Journal of Gastroenterology 2021年第23期27卷 3396-3412页

作者： Ligia Yukie Sassaki Sender J Miszputen Roberto Luiz Kaiser Junior Wilson R Catapani Mauro Bafutto António S Scotton Cyrla Zaltman Julio Pinheiro Baima Hagata S Ramos Mikaell Alexandre Gouvea Faria carolina D gonçalves Isabella Miranda Guimaraes Cristina Flores Heda M B S Amarante Rodrigo Bremer Nones JoséMiguel Luz Parente Murilo Moura Lima Júlio Maria Chebli Maria de Lourdes Abreu Ferrari Julia F Campos Maria G P Sanna Odery Ramos Rogério Serafim Parra Jose J R da Rocha Omar Feres Marley R Feitosa Rosana Fusaro Caratin Juliana Tosta Senra Genoile Oliveira Santana Department of Internal Medicine Botucatu Medical School at Sao Paulo State University(UNESP)Botucatu 18618-687São PauloBrazil Department of Gastroenterology Escola Paulista de MedicinaSao PauloSão Paulo 18618-687São PauloBrazil Department of Proctology Kaiser Day HospitalSão Jose do Rio Preto 15015-110São PauloBrazil Department of Gastroenterology Faculdade de Medicina do ABCSanto Andre 09060-870São PauloBrazil Department of Gastroenterology Faculdade de MedicinaGoiania 74535-170GoiásBrazil Department of Gastroenterology CMIP Centro Mineiro de PesquisaJuiz de Fora 36010-570Minas GeraisBrazil Department of Internal Medicine Federal University of Rio de JaneiroRio de Janeiro 21941-913Rio de JaneiroBrazil Department of Gastroenterology Escola Paulista de MedicinaSão Paulo 04023-900São PauloBrazil Hospital de Clínicas de Porto Alegre Hospital de Clínicas de Porto AlegrePorto Alegre 90035-903Rio Grande do SulBrazil Hospital de Clinicas da Universidade Federal do Paraná Hospital de Clinicas da Universidade Federal do ParanáCuritiba ParanáParanáBrazil Gastroenterology Department Hospital Nossa Senhora das GraçasCuritiba 80810-040ParanáBrazil Department of General Medicine Universidade Federal do PiauíTeresina 64049-550PiauíBrazil Gastroenterology Hospital Universitario da Universidade Federal do PiauiTeresina 64049-550PiauíBrazil Department of Medicine University Hospital of Federal University of Juiz de ForaJuiz de ForaJuiz de Fora 36036-247Minas GeraisBrazil Department of Clinical Medicine Universidade Federal de Minas GeraisBelo Horizonte 30130-100Minas GeraisBrazil Hospital de Clinicas da Universidade Federal do Paraná Hospital de Clinicas da Universidade Federal do ParanáCuritiba 80060-900ParanáBrazil Department of Surgery and Anatomy Ribeirao Preto Medical SchoolUniversity of Sao PauloRibeirão Preto 14048-900São PauloBrazil Scientific Affairs Takeda Pharmaceuticals BrazilSao Paulo 04709-011Brazil Clinical Research Takeda PharmaceuticalsSão Paulo 04709-011Sã

BACKGROUND Crohn’s disease(CD)and ulcerative colitis(UC)are inflammatory bowel diseases(IBDs)with a remission-relapsing presentation and symptomatic exacerbations that have detrimental impacts on patient quality of life and are associated with a high cost burden,especially in patients with moderate-to-severe *** Real-world Data of Moderate-to-Severe Inflammatory Bowel Disease in Brazil(RISE BR)study was a noninterventional study designed to evaluate disease control,treatment patterns,disease burden and health-related quality of life in patients with moderate-to-severe active *** report findings from the prospective follow-up phase of the RISE BR study in patients with active UC or *** To describe the 12-mo disease evolution and treatment patterns among patients with active moderate-to-severe IBD in *** This was a prospective,noninterventional study of adult patients with active Crohn’s disease(CD:Harvey-Bradshaw Index≥8,CD Activity Index≥220),inadequate CD control(i.e.,calprotectin>200μg/g or colonoscopy previous results),or active ulcerative colitis(UC:Partial Mayo score≥5).Enrollment occurred in 14 centers from October 2016 to February *** proportion of active IBD patients after 9-12 mo of follow-up,Kaplan-Meier estimates of the time to mild or no activity and a summary of treatment initiation,discontinuation and dose changes were *** The study included 118 CD and 36 UC patients,with mean±SD ages of 43.3±12.6 and 44.9±16.5 years,*** most frequent drug classes at index were biologics for CD(62.7%)and 5-aminosalicylate derivates for UC patients(91.7%).During follow-up,65.3%of CD and 86.1%of UC patients initiated a new treatment at least ***/dose changes occurred in 68.1%of CD patients[median 2.0(IQR:2-5)]and 94.3%of UC patients[median 4.0(IQR:3-7)].On average,CD and UC patients had 4.4±2.6 and 5.0±3.3 outpatient visits,*** median time to first mild or no activity was 319(IQR:239-3

关键词： Crohn’s disease Ulcerative colitis Inflammatory bowel diseases Prospective study

Non-Hodgkin’s Lymphoma Associated with Metastatic Lung Cancer: Case Report

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Advances in Lung Cancer 2021年第3期10卷 40-47页

作者： Miriam Viviane Baron Gabriela Di Lorenzo Garcia Scherer Célia Regina Martins Korzenieski Julia Braga da Silveira carolina Boeira Soares Carina Marangoni Marcus Vinicius de Mello Pinto Aline Ronis Sampaio Alexandre Gomes Sancho Esteban Fortuny Pacheco Felice Picariello Joice Nedel Ott Isabel Cristina Reinheimer carolina gonçalves Pinheiro Nathália Ken Pereira Iketani Cristine Brandenburg Danielle de Mello Florentino Patrícia Froes Meyer Bartira Ercília Pinheiro da Costa Postgraduate Program in Medicine and Health Sciences of the Pontifical Catholic University of Rio Grande do Sul (PUC/RS) Porto Alegre Brazil School of Medicine of the Pontifical Catholic University of Rio Grande do Sul (PUC/RS) Porto Alegre Brazil School of Health and Life Sciences of the Pontifical Catholic University of Rio Grande do Sul (PUC/RS) Porto Alegre Brazil Celulare Institute Rio de Janeiro Brazil Unigranrio Rio de Janeiro Brazil Universidad Finis Terrae Santiago Chile Università degli Studi di Napoli Federico II Napoli Italy Postgraduate Program in Health Sciences of the Faculty of Medicine of ABC (FMABC) S&#227 o Paulo Brazil Hospital Beneficiente Portuguesa of Belém Pará Brazil Federal University of Ceará (UFC) Fortaleza Brazil Uniredentor University Rio de Janeiro Brazil Centro Universitário do Rio Grande do Norte Natal RN Brazil

Lymphomas are neoplastic transformations that affect lymphoid cells. Diffuse large B-cell non-Hodgkin’s lymphoma has a high degree of cell proliferation, accounting for 30% of all lymphomas. Lung cancer is the leading cause of death worldwide and the recommended treatment is chemotherapy. Among the main complications resulting from non-Hodgkin’s lymphoma, lung cancer and chemotherapy used in their treatment, we can mention sepsis, acute kidney injury and febrile neutropenia. Febrile neutropenia can occur by suppressing the production of neutrophils. Sepsis, a widespread infection, is the main cause of acute kidney injury, which can also be caused by hydroelectrolytic complications or by nephrotoxicity. This is a report of a smoking patient with metastatic lung cancer who sought care due to progressive dysphagia, cough with chest pain, fever, and lower airways critical obstruction due to mediastinal lymphadenopathy, being diagnosed with diffuse large B-cell non-Hodgkin’s lymphoma. The patient evolved to death because of a significant worsening of the ventilatory pattern of multifactorial cause, mainly due to sepsis, acute kidney injury, and febrile neutropenia. The patient had mostly classic characteristics of her comorbidities, however, the overlapping of interrelated comorbidities led to the outcome of death. What is unusual about the present case report is that the patient’s characteristics, such as age, sex, and ethnicity, are opposite to those described as risk factors for diffuse large B-cell non-Hodgkin’s lymphoma.

关键词： Acute Kidney Injury Febrile Neutropenia Sepsis Chemotherapy

Real-world disease activity and sociodemographic,clinical and treatment characteristics of moderate-to-severe inflammatory bowel disease in Brazil

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World Journal of Gastroenterology 2021年第2期27卷 208-223页

作者： Cyrla Zaltman Rogério Serafim Parra Ligia Yukie Sassaki Genoile Oliveira Santana Maria de Lourdes Abreu Ferrari Sender J Miszputen Heda M B S Amarante Roberto Luiz Kaiser Junior Cristina Flores Wilson R Catapani JoséMiguel Luz Parente Mauro Bafutto Odery Ramos carolina D gonçalves Isabella Miranda Guimaraes Jose J R da Rocha Marley R Feitosa Omar Feres Rogerio Saad-Hossne Francisco Guilherme Cancela Penna Pedro Ferrari Sales Cunha Tarcia NF Gomes Rodrigo Bremer Nones Mikaell Alexandre Gouvea Faria Mírian Perpétua Palha Dias Parente António S Scotton Rosana Fusaro Caratin Juliana Senra Júlio Maria Chebli Department of Internal Medicine Federal University of Rio de JaneiroRio de Janeiro 21941-913Brazil Department of Surgery and Anatomy Ribeirão Preto Medical SchoolUniversity of São PauloRibeirao Preto 14049-900São PauloBrazil Department of Internal Medicine São Paulo State University(UNESP)Medical SchoolBotucatu 18618-687São PauloBrazil IBD Unit Federal University of BahiaSalvador 41150-000BahiaBrazil Department of Clinical Medicine Medical SchoolUniversidade Federal de Minas GeraisBelo Horizonte 30130-100Minas GeraisBrazil Department of Gastroenterology Escola Paulista de MedicinaSão Paulo 04023-900Brazil Hospital de Clinicas Universidade Federal do ParanaCuritiba 80060-900ParanaBrazil Department of Proctology Beneficencia Portuguesa Hospital/Kaiser Day HospitalSao Jose do Rio Preto 15015110São PauloBrazil Department of Gastroenterology and Hepatology Sciences Hospital de ClínicasUniversidade Federal do Rio Grande do SulPorto Alegre 90560002Rio Grande do SulBrazil Department of Gastroenterology Faculdade de Medicina do ABCSanto Andre 09060-870São PauloBrazil Department of General Medicine Gastroenterology UnitUniversity HospitalFederal University of PiauiTeresina 64049-550PiauíBrazil Department of Gastroenterology Faculdade de MedicinaUniversidade Federal de GoiásGoiania 74535-170GoiasBrazil Department of Surgery Botucatu Medical School at São Paulo State University(UNESP)Botucatu 18618687São PauloBrazil Department of Gastroenterology UNIFESPSão Paulo 04040-002Brazil IBD unit Gastroenterology DepartmentHospital Nossa Senhora das GraçasCuritiba 80810-040ParanaBrazil Department of Proctology Kaiser Hospital DiaSao Jose do Rio Preto 15015-110São PauloBrazil Health Sciences Center Epidemiology UnitState University of PiauiTeresina 64001-280PiauíBrazil Department of Gastroenterology CMIP Centro Mineiro de PesquisaJuiz de Fora 36010-570Minas GeraisBrazil Scientific Affairs Takeda Pharmaceuticals BrazilSão Paulo 04709-011Brazil Clinical Research Takeda Pharma

BACKGROUND Understanding the treatment landscape of inflammatory bowel diseases(IBD)is essential for improving disease management and patient *** is the largest Latin American country,and it presents socioeconomic and health care differences across its geographical *** country has the highest increase in IBD incidence and prevalence in Latin America,but information about the clinical and treatment characteristics of IBD is *** To describe the sociodemographic,clinical,and treatment characteristics of IBD outpatients in Brazil overall and in the Southeast,South and Northeast/Midwest *** Multicenter,cross-sectional study with a 3-year retrospective chart review *** with moderate-to-severe Crohn’s disease(CD)or ulcerative colitis(UC)were consecutively enrolled between October 2016 and February *** CD at enrollment was defined as a Harvey Bradshaw Index≥8 or a CD Activity Index≥220 or a calprotectin level>200μg/g or an active result based on colonoscopy suggestive of inadequate control during the previous year;active UC was defined as a partial Mayo score≥*** statistics were used to analyze all *** In a total of 407 included patients,CD was more frequent than UC,both overall(264 CD/143 UC patients)and by region(CD:UC ratios of 2.1 in the Southeast,1.6 in the South and 1.2 in the Northeast/Midwest).The majority of patients were female(54.2%of CD;56.6%of UC),and the mean ages were 45.9±13.8 years(CD)and 42.9±13.0 years(UC).The median disease duration was 10.0(range:0.5-45)years for both IBD *** enrollment,44.7%[95%confidence interval(CI):38.7-50.7]of CD patients and 25.2%(95%CI:18.1-32.3)of UC patients presented with active *** than 95%of IBD patients were receiving treatment at enrollment;CD patients were commonly treated with biologics(71.6%)and immunosuppressors(67.4%),and UC patients were commonly treated with mesalazine[5-Aminosalicylic acid(5-ASA)]derivates(69.9%)and

关键词： Inflammatory bowel disease Crohn's disease Ulcerative colitis Disease activity Epidemiology Treatment

Opportunistic Infections in Late Kidney Transplantation with Death Outcome: Case Report

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Open Journal of Nephrology 2021年第2期11卷 171-182页

作者： Miriam Viviane Baron Carina Marangoni Michele Paula dos Santos Célia Regina Martins Korzenieski Vitória Pereira Itaquy Tais Michele Werle Gabriela Di Lorenzo Garcia Scherer Joice Nedel Ott Marcus Vinicius de Mello Pinto Janine Koepp carolina gonçalves Pinheiro Nathália Ken Pereira Iketani Cristine Brandenburg Aline Ronis Sampaio Alexandre Sancho Danielle de Mello Florentino Bartira Ercília Pinheiro da Costa Postgraduate Program in Medicine and Health Sciences of the Pontifical Catholic University of Rio Grande do Sul (PUC/RS) Porto Alegre Brazil Coordination for the Improvement of Higher Education Personnel Brazilia Brazil School of Medicine of the Pontifical Catholic University of Rio Grande do Sul (PUC/RS) Porto Alegre Brazil Schoolof Health and Life Sciences of the Pontifical Catholic University of Rio Grande do Sul (PUC/RS) Porto Alegre Brazil CelulareInstitute Rio de Janeiro Brazil University of Santa Cruz do Sul (UNISC) Santa Cruz do Sul Brazil Postgraduate Program in Health Sciences of the Faculty of Medicine of ABC (FMABC) S&atilde o Paulo Brazil Hospital Beneficiente Portuguesa of Belém Pará Brazil Dom José Institute of Education and Culture/University of Vale do Acaraú (IDJ/UVA) Ceará Brazil Unigranrio University Rio de Janeiro Brazil Uniredentor University Rio de Janeiro Brazil

Cytomegalovirus (CMV) and Pneumocystis jirovecii fungus are the main opportunistic microorganisms that affect transplanted individuals. Immunosuppressive drugs administered to prevent organ rejection leave the immune system vulnerable to these infections. The present report is about a kidney transplanted patient using immunosuppressants who was diagnosed with cytomegalovirus and pneumocystosis requiring admission to the intensive care unit (ICU). Female patient, 57 years old, a kidney transplanted three years ago, with comorbidities, such as systemic arterial hypertension, hypertriglyceridemia and type 2 diabetes mellitus. She was admitted to the hospital in January 2020 with a history of diarrhea, cough, malaise and weight loss of seven kg in a month. She made continuous use of the immunosuppressants tacrolimus® and mycophenolate sodium (MFS). After five days of hospitalization, she was transferred to the ICU due to refractory diarrhea, worsening renal function and respiratory pattern, requiring mechanical ventilation. Chest tomography showed changes that led to the diagnostic hypothesis of CMV pneumonia or Pneumocystis jirovecii. Treatment with Ganciclovir® and Bactrim® was started. The bronchial lavage polymerase chain reaction test confirmed the infectious condition for CMV and Pneumocystis jirovecii. Despite the drug therapy instituted, there was no improvement in the infectious condition. The patient started to present a general and progressive worsening of the clinical picture with loss of renal graft function, respiratory failure, metabolic acidosis, hemodynamic instability and severe distributive shock, evolving to death. In the present report, it was observed that after late kidney transplantation the fragility of the immune system caused by the use of immunosuppressants contributed to the development of a severe infection with CMV and Pneumocystis jirovecii. Adjusting the doses of immunos

关键词： Renal Transplantation Infections Opportunistic Immunosuppressive Agent Cytomegalovirus Pneumocystis

Early Hepatic Encephalopathy after a Transjugular Intrahepatic Portosystemic Shunt Procedure: Case Report

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Open Journal of Gastroenterology 2021年第6期11卷 81-88页

作者： Miriam Viviane Baron Gabriela Di Lorenzo Garcia Scherer Michele Paula dos Santos Andres Felipe Mantilla Santamaria Cristine Brandenburg Isabel Cristina Reinheimer Marcus Vinicius de Mello Pinto Aline Ronis Sampaio Alexandre Gomes Sancho Alexandre Gomes Sancho Esteban Fortuny Pacheco Felice Picariello Danielle de Mello Florentino Joice Nedel Ott carolina gonçalves Pinheiro Nathália Ken Pereira Iketani Sonia Carvalho Patrícia Froes Meyer Bartira Ercília Pinheiro da Costa Postgraduate Program in Medicine and Health Sciences of the Pontifical Catholic University of Rio Grande do Sul (PUC/RS) Porto Alegre Rio Grande do Sul Brazil School of Medicine of the Pontifical Catholic University of Rio Grande do Sul (PUC/RS) Porto Alegre Rio Grande do Sul Brazil Industrial University of Santander (UIS) Bucaramanga Colombia University of Vale do Acaraú (IDJ/UVA) Ceará Brazil Celulare Institute Rio de Janeiro Brazil Unigranrio Rio de Janeiro Brazil Universidad Finis Terrae Santiago Chile Università degli Studi di Napoli Federico II Napoli Italy Uniredentor University Rio de Janeiro Brazil Postgraduate Program in Health Sciences of the Faculty of Medicine of ABC (FABC) S&#227o Paulo Brazil Hospital Beneficiente Portuguesa of Belém Pará Brazil Rigshospital Copenhagen East K&#248benhavn Denmark Centro Universitário do Rio Grande do Norte Natal Brazil

Patients with decompensated hepatic cirrhosis may present systemic alterations and dysfunction of multiple organs. Ascites, portal hypertension, esophageal varices, and hepatic encephalopathy are common complications arising from cirrhosis. The aim of this paper is to report a case of a patient with liver cirrhosis and the complications of a transjugular intrahepatic portosystemic shunt. Male, elderly, and ex-alcoholic, diagnosed with liver cirrhosis, ascites, and esophageal varices. He underwent transjugular intrahepatic portosystemic shunt due to portal hypertension and returned to the hospital after 24 hours with agitation and mental confusion. He had a bowel movement stop, neurological worsening, loss of renal function, hepatic hydrothorax, hepatic encephalopathy, hypernatremia, hypocalcemia, and hypophosphatemia. He underwent a new procedure to occlude the transjugular intrahepatic portosystemic shunt, showing improvement of the mental status and ascites. However, continued with decompensation and hydro-electrolytic disorders. He evolved with worsening of the ventilatory pattern, and neurological and renal function, with a fatal outcome. Esophageal varices due to portal hypertension can be corrected with the transjugular intrahepatic portosystemic shunt. However, complications such as hypernatremia, hepatic hydrothorax, and hepatic encephalopathy may occur. Therefore, there is a need for reintervention to shunt or reduce its caliber. Thus, for patients with advanced age and decompensated cirrhosis, the potential risks and benefits of this procedure should be carefully evaluated due to the risk of complications and death.

关键词： Ascites Hypernatremia Portasystemic Shunt Transjugular Intrahepatic Hepatic Encephalopathy