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Transmission of cryptococcosis by liver transplantation:A case report and review of literature

World Journal of Hepatology 2020年第5期12卷 253-261页

作者： gustavo de sousa arantes ferreira Andre Luis Conde Watanabe Natalia de Carvalho Trevizoli Fernando Marcus Felippe Jorge Carolina de Fatima Couto Priscila Brizolla de Campos Gabriel Oliveira Nunes Caja department of Liver Transplantation Instituto de Cardiologia do Distrito FederalBrasilia 70673900Brazil

BACKGROUND Cryptococcosis is a fungal infection caused by the yeast-like encapsulated basidiomycetous fungus of the Cryptococcus neoformans(***)species *** fungi are ubiquitous in soil and bird droppings,and infection by them is an important global health concern,particularly in immunosuppressed patients,such as organ transplant recipients and those infected by the human immunodeficiency *** fungus usually enters the body through the respiratory tract,but extremely rare cases of infection acquired by transplantation of solid organs have been *** SUMMARY We report a case of disseminated cryptococcosis in a liver transplant recipient,diagnosed 2 wk after the *** patient initially presented with fever,hyponatremia and elevated transaminase levels,manifesting intense headache after a few *** cultures were positive for *** biopsy showed numerous fungal elements surrounded by gelatinous matrix and sparse granulomatous *** resonance imaging of the brain showed multiple small lesions with low signal in T2,peripheric enhancement and edematous halo,diffuse through the parenchyma but more concentrated in the subcortical *** with amphotericin B for 3 wk,followed by maintenance therapy with fluconazole,led to complete resolution of the *** recipients of both kidneys from the same donor also developed disseminated cryptococcosis,confirming the transplant as the source of *** organ donor lived in a rural area,surrounded by tropical rainforest,and had negative blood cultures prior to organ *** This case highlights the risk of transmission of fungal diseases,specifically of ***,through liver graft during liver transplantation.

关键词： Cryptococcosis Liver transplantation Cryptococcus neoformans Case report Immunosuppression Fungal infection

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Multiple hepatic infarctions secondary to diabetic ketoacidosis:A case report

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World Journal of Hepatology 2022年第11期14卷 1977-1984页

作者： Vitoria Mikaelly da Silva Gomes gustavo de sousa arantes ferreira Luise Cristina Torres Rubim de Barros Barbara Moreira Ribeiro Trindade dos Santos Lorenna Paulinelli Bahia Vieira department of General Surgery Hospital das Clinicas da Universidade Federal de Minas GeraisBelo Horizonte 30130100Minas GeraisBrazil Instituto de Cardiologia do Distrito Federal Brasilia 70673900Distrito FederalBrazil department of General Surgery Hospital Metropolitano Doutor Celio de CastroBelo Horizonte 30620090Minas GeraisBrazil

BACKGROUND Hepatic infarctions(HI)are ischemic events of the liver in which a disruption in the blood flow to the hepatocytes leads to focal ischemia and *** HI are due to occlusive events in the liver’s blood vessels,but non-occlusive HI may *** are associated with disruption of microvasculature,such as in diabetic *** HI usually presents as peripheral lesions with clear borders,irregular nodular lesions may occur,indistinguishable from liver neoplasms and presenting a diagnostic *** SUMMARY We report a case of multiple extensive HI in a patient with poorly controlled diabetes mellitus,who first presented to the emergency room with diabetic *** then developed jaundice,thrombocytopenia,and a marked elevation of serum *** ultrasound of the liver showed the presence of multiple irregular *** investigation with a computerized tomography scan confirmed the presence of multiple hypoattenuating nodules with irregular borders and heterogeneous *** lesions were considered highly suggestive of a primary neoplasm of the *** the patient was clinically stable,his bilirubin levels remained persistently elevated,and he underwent an ultrasound-guided percutaneous biopsy of the largest *** results revealed extensive ischemic necrosis of hepatocytes,with no signs of associated *** months after the symptoms,the patient showed great improvement in all clinical and laboratory parameters and extensive regression of the lesions on imaging *** This case highlights that diabetic ketoacidosis can cause non-occlusive HI,possibly presenting as nodular lesions indistinguishable from neoplasms.

关键词： Hepatic infarction Non-occlusive infarcts Diabetic ketoacidosis Pseudotumor of the liver Liver infarcts Case report

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Leukocytoclastic vasculitis caused by hepatitis C virus in a liver transplant recipient: A case report

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World Journal of Hepatology 2019年第4期11卷 402-408页

作者： gustavo de sousa arantes ferreira Andre Luis Conde Watanabe Natalia de Carvalho Trevizoli Fernando Marcus Felippe Jorge Luiz gustavo Guedes Diaz Milla Carolina Costa Lafeta Araujo Gabriela de Campos Araujo Amanda de Castro Machado department of Liver Transplantation Instituto de Cardiologia do Distrito Federal Curso de Medicina Universidade Catolica de Brasilia

BACKGROUND Infection by the hepatitis C virus(HCV) is currently considered to be a global health issue, with a high worldwide prevalence and causing chronic disease in afflicted individuals. The disease largely involves the liver but it can affect other organs, including the skin. While leukocytoclastic vasculitis has been reported as one of the dermatologic manifestations of HCV infection, there are no reports of this condition as the first symptom of HCV recurrence after liver *** SUMMARY We report here a case of leukocytoclastic vasculitis in a liver transplant recipient on maintenance immunosuppression. The condition presented as a palpable purpura in both lower extremities. Blood and urine cultures were negative and all biochemical tests were normal, excepting evidence of anemia and hypocomplementemia. Imaging examination by computed tomography showed a small volume of ascites, diffuse thickening of bowel walls, and a small bilateral pleural effusion. Skin biopsy showed leukocytoclasia and fibrinoid *** biopsy was suggestive of HCV recurrence in the graft, and HCV polymerase chain reaction yielded 11460 copies/mL and identified the genotype as 1 A. Treatment of the virus with a 12-wk direct-acting antiviral regimen of ribavirin, sofosbuvir and daclatasvir led to regression of the symptoms within the first 10 d and subsequent complete resolution of the *** This case highlights the difficulties of diagnosing skin lesions caused by HCVinfection in immunosuppressed patients.

关键词： Hepatitis C Liver transplantation Leukocytoclastic vasculitis Immunosuppression Direct-acting antivirals Case report

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Superior mesenteric artery syndrome in a patient with esophageal stenosis: A case report

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World Journal of Surgical Procedures 2022年第2期12卷 13-19页

作者： Luise Cristina Torres Rubim de Barros Barbara Moreira Ribeiro Trindade dos Santos gustavo de sousa arantes ferreira Vitoria Mikaelly da Silva Gomes Lorenna Paulinelli Bahia Vieira department of General Surgery Hospital de Clinicas da Universidade Federal de Minas GeraisBelo Horizonte 31710350Minas GeraisBrazil department of Liver Transplantation Instituto de Cardiologia do Distrito FederalBrasilia 70658-700Distrito FederalBrazil department of General Surgery Hospital Metropolitano Doutor Celio de CastroBelo Horizonte 30620090Minas GeraisBrazil

BACKGROUND Superior mesenteric artery syndrome(SMAS)is a rare condition,characterized by duodenal obstruction caused by compression of its third part by the superior mesenteric artery(SMA).Most cases of SMAS are associated with weight loss,and the most frequent clinical manifestations are nausea,vomiting,postprandial fullness,and abdominal *** of SMAS is usually conservative,consisting mainly of adequate nutritional support,but in refractory cases surgery may be necessary,with gastrojejunostomy and duodenojejunostomy being the most commonly performed *** SUMMARY We describe the case of a man in his forties with a pre-existing diagnosis of esophageal stricture due to sodium hydroxide ingestion,who suffered significant weight loss after replacement of his jejunostomy *** was admitted to the hospital due to pain and abdominal distension.A computerized tomography scan showed significant distension of the stomach and duodenum with narrowing of the duodenum at the point at which it is crossed by the superior mesenteric artery,thus establishing the diagnosis of *** to the presence of the esophageal stricture,the patient was incapable of emesis;however,passage of a nasogastric tube for decompression was not *** the risk of gastric perforation due to distention,we opted for surgical treatment in the form of a surgical gastrojejunostomy after which he showed complete resolution of all symptoms and was discharged from the hospital 5 d after the *** Diagnosis of SMAS can be challenging in patients with esophageal stenosis,and risk of gastric perforation may preclude conservative treatment.

关键词： Superior mesenteric artery syndrome Duodenal obstruction Wilkie’s syndrome Esophageal stricture Esophageal stenosis Case report

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Biochar influences the cane fields’microbiota and the development of pre-sprouted sugarcane seedlings

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Waste Disposal and Sustainable Energy 2023年第1期5卷 75-88页

作者： Bruna Cristina Pinto Adriana Barboza Alves Osania Emerenciano ferreira gustavo Henrique Gravatim Costa Magno Andréde Oliveira Augusto Cesar da Silva Bezerra Alan Rodrigues Teixeira Machado Postgraduate Program in Environmental Sciences State University of Minas GeraisFrutal UnityFrutalMinas Gerais38202-436Brazil department of Agricultural and Biological Sciences State University of Minas GeraisFrutal UnityFrutalMinas Gerais38208-436Brazil Postgraduate Program in Geotechnical Engineering Federal University of Ouro PretoOuro PretoMinas Gerais35400-000Brazil department of Transport Engineering Federal Center for Technological Education of Minas GeraisBelo HorizonteMinas Gerais30421-169Brazil department of Exact Sciences State University of Minas GeraisJoão Monlevade UnityJoão MonlevadeMinas Gerais35930-314Brazil

This research investigates the soil conditioning effect of sugar cane fields with biochar produced from sugarcane *** influence on the physicochemical and microbiological conditions of the soil and the agronomic performance of sugarcane seedlings was *** this end,the biochar from sugarcane bagasse was produced by pyrolysis in a double drum oven and mixed with soil at rates of 0,1%,3%,and 5%(in weight).The experiment was installed in a greenhouse with two evaluation periods(30 days and 60 days)and five *** pot received a pre-sprouted cane seedling,and the analysis of colony-forming units(bacteria and fungi),physicochemical characteristics of the soil,and growth and development of sugarcane were performed per *** biochar showed a high fixed carbon content(72%)and a specific surface area estimated by the adsorption of methylene blue of 50 m2 g−***,its structure is porous and contains important nutrients(e.g.,CaO,K2O,and P2O5).In the periods evaluated,the applications of the 3%and 5%(in weight)rates of biochar reduced most of the soil fertility ***,the chemical analyses indicated that the sugarcane field soil collected already possessed high *** microbiota was influenced,but only the application of the 3%(in weight)rate at 60 days after planting showed a significant positive effect on the number of bacteria forming units,with an increase of approximately 385%.On the other hand,no significant positive effect on sugarcane development was ***,biochar application in high-fertility sugarcane plantation soil did not result in gains for sugarcane development in the periods evaluated.

关键词： Soil Biometry Microbiology Double drum oven Biochar

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Implementation of a High-Risk Outpatient Clinic for Children with Complex Congenital Heart Disease in a Reference Service in Brazil

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Congenital Heart Disease 2023年第6期18卷 649-656页

作者： gustavo Foronda Vanessa ferreira Amorim de Melo Claudia Regina Pinheiro de Castro Grau Ingrid Magatti Piva Glaucia Maria Penha Tavares Ana Cristina Sayuri Tanaka Nana Miura department of Pediatric Cardiology and Adult Congenital Heart Diseases Heart Institute of the University of São PauloSão PauloBrazil Foronda Clinic São PauloBrazil Institute of Orthopedics and Traumatology University of São PauloSão PauloBrazil department of Echocardiography Heart Institute of the University of São PauloSão PauloBrazil

Background:Children with congenital heart disease(CHD),even after surgical approaches,and especially those who undergo staged procedures in theﬁrst months of life,remain vulnerable to readmissions and complications,requiring very close monitoring and differentiated intervention ***:descriptive and exploratory study,of the experience report type,which presents the process of building the high-risk outpatient clinic for complex congenital heart diseases(AAR)at the Instituto do Coração(InCor).Results:Report of the path taken to structure the AAR,demonstrating the organization,interface with the multidisciplinary team,admission and discharge criteria,training,and patient proﬁ*** theseﬁve years of care,275 patients were treated,59.65%with biventricular interstage physiology,followed by univentricular interstage physiology(34.55%),residual defects after surgical procedures(3.63%),tumors with risk of mechanical obstruction(1.45%)and patients with an intrauterine approach(0.72%).The signiﬁcant number of critical patients who were successfully discharged from hospital(44.72%),the low mortality rate due to sudden deaths at home and the high adherence to follow-up cor-roborate the impact of this specialized ***:despite the limitations of the study,this experi-ence report showed that with few resources,there is the possibility of organizing an AAR with differentiated care,with the objective of early detection and treatment of residual injuries,identiﬁcation of early interventions,edu-cation of parents for follow-up of their children,resulting in individualized treatment,promoting a better quality of life for this population.

关键词： Congenital heart defects ambulatory care heart defects

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Mesenchymal stem cell secretome and nanotechnology:Combining therapeutic strategies

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BIOCELL 2022年第8期46卷 1807-1813页

作者： ADRIANA L.ferreira gustavo C.PARIS ALINE de A.AZEVEDO ERIKA A.C.CORTEZ SIMONE N.CARVALHO LAIS de CARVALHO ALESSANDRA A.THOLE Laboratory of Stem Cell Research Roberto Alcantara Gomes Biology InstituteRio de Janeiro State UniversityRio de Janeiro20540170Brazil

Mesenchymal stem cells(MSC)have pushed the field of stem cell-based therapies by inducing tissue regeneration,immunosuppression,and angiogenesis mainly through vesicles and soluble factors release(paracrine signaling).MSC-extracellular vesicles(MSC-EV)adaptable secretome and homing to injured sites allowed researchers to unlock a new era of cell-free based *** parallel,nanoparticles(NP)have been explored in contributing to transport and drug delivery systems,giving drugs desired physical-chemical properties to exploit cell ***,NPs can be quickly recognized by immune cells and cleared from *** this viewpoint,we explore how combining both therapeutic strategies can improve efficacy and circumvent limitations of both *** benefit from the potent MSC membrane composition,guiding chemotaxis to tumor sites,a very restricted ***-EV has low immunogenicity,high stability,long half-life and can explore tissue targeting ligands as a precise drug carry,even across biological *** properties promote enhanced targeted drug delivery that can be combined with NP,exploring biological membrane production through:*** cell therapy with NP-infused MSC;***-containing MSC-EV generated by NP-infused MSC;*** coating NP in MSC membrane(“MSC NanoGhosts”),allowing precise cargo definition without losing ***,nanotechnology combined with cell-based therapeutic resources can greatly improve targeted drug delivery,improving efficacy and opening a new venue of therapeutic possibilities.

关键词： Mesenchymal stem cells Nanoparticles Secretome Exosome Targeted drug delivery

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Risk stratification and geographical mapping of Brazilian inflammatory bowel disease patients during the COVID-19 outbreak:Results from a nationwide survey

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World Journal of Gastroenterology 2021年第12期27卷 1226-1239页

作者： Natália sousa Freitas Queiroz Fábio Vieira Teixeira Marina Pamponet Motta Liliana Andrade Chebli Adriano Akira ferreira Hino Camilla de Almeida Martins Abel Botelho Quaresma Alexandre Augusto de Paula da Silva Adérson Omar Mourão Cintra Damião Rogerio Saad-Hossne Paulo gustavo Kotze department of Gastroenterology University of São Paulo School of MedicineSão Paulo 05403-000SPBrazil IBD Unit Gastroenterology DepartmentGastrosaúde ClinicMarilia 17509190SPBrazil School of Medicine Federal University of BahiaSalvador 40020-025BHBrazil IBD Outpatient Clinics Universidade Federal de Juiz de ForaJuiz de Fora 36010-010MGBrazil Health Sciences Postgraduate Program Pontifícia Universidade Católica do Paraná(PUCPR)Curitiba 80440-220PRBrazil departamento de Ciências da Saúde Universidade do Oeste de Santa Catarina(UNOESC)Joaçaba 89600-000SCBrazil Botucatu Medical School Paulista State University(UNESP)Botucatu 18600-050SPBrazil IBD Outpatient Clinics Pontificia Universidade Católica do Paraná(PUCPR)Curitiba 80440-220PRBrazil

BACKGROUND Coronavirus disease 2019(COVID-19)pandemic is still evolving globally,and Brazil is currently one of the most affected *** is still debated whether patients with inflammatory bowel disease(IBD)are at a higher risk for developing COVID-19 or its *** To assess geographical distribution of IBD patients at the highest risk and correlate these data with COVID-19 mortality rates in *** The Brazilian IBD Study Group(Grupo de Estudos da Doença Inflamatória Intestinal do Brasil)developed a web-based survey adapted from the British Society of Gastroenterology *** included categories were demographic data and inquiries related to risk factors for complications from *** were categorized as highest,moderate or lowest individual *** Spearman correlation test was used to identify any association between highest risk and mortality rates for each state of the *** A total of 3568 patients(65.3%females)were *** participants were from the southeastern and southern regions of Brazil,and 84.1%were using immunomodulators and/or *** patients(55.1%)were at moderate risk,23.4%were at highest risk and 21.5%were at lowest risk of COVID-19 *** association between the proportion of IBD patients at highest risk for COVID-19 complications and higher mortality rates was identified in different Brazilian states(r=0.146,P=0.467).CONCLUSION This study indicates a distinct geographical distribution of IBD patients at highest risk for COVID-19 complications in different states of the country,which may reflect contrasting socioeconomic,educational and healthcare *** association between high risk of IBD and COVID-related mortality rates was identified.

关键词： Crohn’s disease Colitis,Ulcerative COVID-19 Inflammatory bowel disease Brazil

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Gravitational and Quantum Effects in Neuron Function

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Journal of Life Sciences 2016年第6期10卷 273-278页

作者： gustavo Rodrigues ferreira Gomes International Center of Condensed Matter Physics University of Brasilia (UnB) Brasilia 70297-400 Distrito Federal Brazil

The relation between microtubules architecture in the cytoskeletal structure inside the dendrites and soma and the emergence of neuron function and firing action potential crosses the tiny line between physics and biology. As decoherence is a fundamental mechanism in some biological process such as photosynthesis and others examples, the gravitational quantum approach may contribute to elucidate if neuron function really emerges from quantum coherence in neuronal microtubules. The Einstein equation correlates the stress-energy tensor Tμv to a specific divergence-free combination Ricci tensor Rμv and the metric. In the semiclassical formulation, we have Gμv = Rμv -1/2gμvR=8πG/C^4〈ψ｜μvψ〉 which describes the quantum field in curved space-time geometry. But for a more precise equation in relation to the stress-energy tensor, we know that in a non-zero temperature, the wave-function is not enough to describe the physical reality. A more precise equation demands a formulation in the density-matrix form but for now there is no Diosi-Penrose model with density-matrix formulation. Such a density-matrix description can be viewed as a probability mixture of different wave-functions. Using some algebra and rules related to the mathematical manipulation of the density-matrix applied to operators, such the stress energy tensor, we found the von Neumann-Einstein equation for the general relativity equation in the density matrix operator form, Gμv = 8πG/C^4Tr[pTμv]. Thus density-matrix operator--instead of just a wave function of pure states--applied to the stress-energy tensor gives the curvature of space time, given by Einstein tensor, Gμv. The quantum fluctuation in the gravitational space-time field might feed back to decohere the quantum density-matrix. As long as decoherence can be viewed as the loss of information from a system to the environment, the density-matrix p is also related to that process and considering the measurement problem, density-matrix /garter is a more

关键词： Semiclassical equation quantum gravity decoherence microtubulin neuron function.

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deep sedation during gastrointestinal endoscopy: Propofol-fentanyl and midazolam-fentanyl regimens

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World Journal of Gastroenterology 2013年第22期19卷 3439-3446页

作者： Marcos Eduardo Lera dos Santos Fauze Maluf-Filho Dalton Marques Chaves Sergio Eiji Matuguma Edson Ide gustavo de Oliveira Luz Thiago ferreira de Souza Fernanda C Simoes Pessorrusso Eduardo Guimares Hourneaux de Moura Paulo Sakai department of Gastroenterology Hospital das Clínicas University of Sao Paulo Medical School Sao Paulo CEP 05403-900 Brazil Cancer Institute of Sao Paulo State Sao Paulo CEP 01246-000 Brazil

AIM: To compare deep sedation with propofol-fentanyl and midazolam-fentanyl regimens during upper gastrointestinal endoscopy. METHODS: After obtaining approval of the research ethics committee and informed consent, 200 patients were evaluated and referred for upper gastrointestinal endoscopy. Patients were randomized to receive propofol-fentanyl or midazolam-fentanyl (n = 100/group).We assessed the level of sedation using the observer's assessment of alertness/sedation (OAA/S) score and bispectral index (BIS). We evaluated patient and physician satisfaction, as well as the recovery time and complication rates. The statistical analysis was performed using SPSS statistical software and included the MannWhitney test, χ 2 test, measurement of analysis of variance, and the κ statistic. RESULTS: The times to induction of sedation, recovery, and discharge were shorter in the propofolfentanyl group than the midazolam-fentanyl group. According to the OAA/S score, deep sedation events occurred in 25% of the propofol-fentanyl group and 11% of the midazolam-fentanyl group (P = 0.014). Additionally, deep sedation events occurred in 19% of the propofol-fentanyl group and 7% of the midazolamfentanyl group according to the BIS scale (P = 0.039). There was good concordance between the OAA/S score and BIS for both groups (κ = 0.71 and κ = 0.63, respectively). Oxygen supplementation was required in 42% of the propofol-fentanyl group and 26% of the midazolam-fentanyl group (P = 0.025). The mean time to recovery was 28.82 and 44.13 min in the propofolfentanyl and midazolam-fentanyl groups, respectively (P deep sedation occurred with propofolfentanyl and midazolam-fentanyl, but was more frequent in the former. Recovery was faster in the propofol-fentanyl group.

关键词： Endoscopy deep sedation Anesthetic administration Anesthetic dose Adverse effects

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