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

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 tacrolimussup>®sup> 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 Ganciclovirsup>®sup> and Bactrimsup>®sup> 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

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儿童健康优先和干预措施

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英国医学杂志中文版 2017年第17期20卷 190-196页

作者： Wilson M Were Zulfiqar A Bhutta Trevor Duke Rajiv Bahl Cynthia Boschi-pinto mark Young Eric starbuck Maharaj K Bhan 熊祎杜忠东 Department of Maternal NewbornChild and Adolescent Health World Health Organization GenevaSwitzerland Center for GlobalChild Health Hospital for Sick Children TorontoON Canada Center of Excellencein Women and Child Health Aga KhanUniversity KarachiPakistan Centre forInternational Child Health Department of PaediatricsUniversity of MelbourneMelbourne VICAustralia Health section United Nations Children Fund(UNICEF) New York NY USA Department of Global Health Save the Children Fairfield CT USA Indian Institute of Technology New Delhi India 首都医科大学附属北京儿童医院

Wilson Were和他的同事解释了为什么全球社会应该继续投资于儿童健康，完成尚未完成的儿童生存议程，解决新出现的影响儿童健康的优先问题。

关键词：儿童健康优先干预措施保健知识

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Pulmonary Tuberculosis Associated with socioeconomic Vulnerability and Ineffective support Network: Case Report

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Journal of Biosciences and Medicines 2023年第5期11卷 151-157页

作者： Michele Paula dos santos Gabriela Di Lorenzo Garcia scherer Carolina Hack Alves Italo Trois Maestri Carolina Boeira soares Carlos Augusto Treviso stella Duarte pinto Ana Paula Wagner steinmetz Laura Gomes Boabaid de Barros maria Eduarda Perobelli Buzetto Gabriel Lorentz Trein Guilherme Boeira soares Aline Porto Brendda Pereira Gomes Fernanda Bercht Merten Luane Pereira Gomes Bárbara Adelmann de Lima Rafaela siviero Caron-Lienert Miriam Viviane Baron school of Medicine Pontifical Catholic University of Rio Grande do Sul (PUCRS) Porto Alegre Brazil Course of Medicine Lutheran University of Brazil (ULBRA) Canoas Brazil school of Health and Life sciences Pontifical Catholic University of Rio Grande do Sul (PUCRS) Porto Alegre Brazil Interdisciplinary Institute of science and Health Education Porto Alegre Brazil

Tuberculosis is one of the 10 leading causes of death in the world. Its symptoms include fever, malaise, weakness, weight loss, chest pain, cough, expectoration, shortness of breath and sepsis, which is its most frequent complication. Due to these symptoms, many patients with tuberculosis require admission to the Intensive Care Unit, where they usually are placed on mechanical ventilation. Tuberculosis is more prevalent in the population in situations of social and economic vulnerability. The main factors that interfere with adherence to treatment and the prognosis of these patients are the patient’s support network and their socioeconomic status. We present the following report of a long-time smoker patient, with chronic kidney disease and previous treatment for tuberculosis, who was brought to the emergency room due to lowering of the sensorium, and was immediately placed on mechanical ventilation. The tests suggested sepsis with a respiratory focus, so a search for Alcohol-Acid-Resistant Bacillus was carried out, with a positive result. The patient was transferred to the Intensive Care Unit due to tachycardia and acute respiratory failure. The patient was a smoker with a high tobacco load, chronic kidney disease, in addition to precarious economic, educational and self-care conditions. This report shows that patients with tuberculosis and its complications can be stabilized through known pharmacological treatment. However, the most effective measure to interrupt the transmission of the disease remains the early diagnosis and the provision of adequate treatment, with guidelines aimed at the cessation of harmful habits, such as smoking.

关键词： smoking Kidney Disease sepsis Respiratory Failure

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Propagation Model of Invasive species:Road systems as Dispersion Facilitators

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Research in Ecology 2020年第1期2卷 12-19页

作者： Nunes,L.J.R. Meireles,C.I.R. pinto Gomes C.J. Almeida Ribeiro N.M.C. ICAAM-Instituto de Ciências Agrárias e Ambientais Mediterrânicas Universidade deÉvoraÉvoraPortugal Departamento da Paisagem Ambiente e OrdenamentoUniversidade deÉvoraÉvoraPortugal Departamento de Fitotecnia Universidade deÉvoraÉvoraPortugal

The globalization of the planet allowed plant species to emerge from their traditional habitats and spread to other *** dispersion,sometimes occasional,sometimes by the influence of man,reaches proportions today that,in some cases,affect the development of natural ecosystems and their ***,becomes imperative to know seeds dispersion occur,since only after can be taken measures to mitigate these *** the same way that natural communication paths,such as rivers,are responsible for the natural dispersal of seeds,man-made communication paths,such as road systems,can allow very rapid *** review article addresses this issue,raising a problem that can be observed in Portugal,but which can easily be transposed to other territories of the Mediterranean basin,given the similarities in these *** dispersion model described here,called Highway Flow Model,intends to show the mechanisms of seed dispersion through road systems,mainly due to the configuration of the road profiles,but also by the processes associated with the cleaning of the *** demonstrates the need to take measures,such as cleaning and inspecting the equipment used to clean roadside berths before moving them to a new service elsewhere.

关键词： Invasive species Highway Flow Model species dispersion Invasive behavior

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在玉米品系的杂种优势群分类中分子标记和正交组合效果的比较

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国外作物育种 2003年第6期22卷 19-19页

作者： R．deM．C．pinto 郭元林

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采用电子病历数据建立危重症患儿早期急性肾损伤预测模型

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中国小儿急救医学 2016年第8期23卷 521-521页

作者： sanche.-pinto LN Khemani RG 方伯梁首都医科大学附属北京儿童医院

目的急性肾损伤(acute kidney injury, AKI)与危重症患儿不良预后独立相关。然而AKI的主要生物标记物血清肌酐却为损伤晚期标记物, 且可造成诊断延迟。本研究旨在采用电子病历(electronic health record, EHR)数据于综合性PICU建立并验... 详细信息

目的急性肾损伤(acute kidney injury, AKI)与危重症患儿不良预后独立相关。然而AKI的主要生物标记物血清肌酐却为损伤晚期标记物, 且可造成诊断延迟。本研究旨在采用电子病历(electronic health record, EHR)数据于综合性PICU建立并验证一项基于数据的AKI多变量临床预测模型。设计采用回顾性数据推导并验证一项预测模型。对象 2003年5月至2015年3月间入院的所有1个月～21岁患者中, 入院时无AKI, 最终存活且住ICU至少24 h者。场所一家多学科三级PICU。干预措施主要预后指标为早期AKI, 定义为入ICU 72 h内发生的AKI。根据入ICU 12 h内的EHR数据, 采用多因素Logistic回归法推导儿童早期AKI风险评分。测量方法和主要结果研究共纳入9 396例患儿, 其中4%发生早期AKI, 此类患儿病死率显著高于未发生早期AKI者(26% vs.3.3%, P<0.001)。共检验候选变量33项, 最终模型包含7项预测因子, 分辨力良好(受试者工作特征曲线下面积=0.84)且标度适当。该模型经两项验证集验证, 分辨力均良好, 受试者工作特征曲线下面积分别为0.81及0.86。结论本研究制定并验证了儿童早期AKI风险评分, 作为一项基于数据的AKI临床预测模型, 对综合性PICU患儿分辨力及标度均良好。它仅采用入ICU 12 h内可随时获得的客观EHR数据, 可推广用于各PICU。将该预测模型设计成自动临床决策支持系统, 可指导制定预防、治疗及研究策略。

关键词：急性肾损伤风险电子病历儿科重症监护

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A New Device for Intermittent Emptying of the Bladder in Children and Adults:A Long-Term Follow-Up

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Open Journal of Urology（泌尿学期刊） 2023年第6期

作者： salvador V.C.Lima Fernanda C.F.s.Calisto Flavia C.M.pinto Daniel C.C.Aragão Eugênio s.Lustosa Heron O.schots Paulo A.A.Alves Fábio O.Vilar

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Impacts of Climate Change in Portugal:Common Perception of Causes and Consequences in Forest Development

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Research in Ecology 2019年第2期1卷 24-30页

作者： L.J.R.Nunes C.I.R.Meireles C.J.pinto Gomes N.M.C.Almeida Ribeiro ICAAM-Instituto de Ciências Agrárias e Ambientais Mediterrânicas Universidade deÉvora7000-083ÉvoraPortugal Departamento da Paisagem Ambiente e OrdenamentoUniversidade deÉvora7000-671ÉvoraPortugal Departamento de Fitotecnia Universidade deÉvora7000-083ÉvoraPortugal

Presently the world faces what most likely will be the greatest challenge humanity has ever *** change is a phenomenon,or rather a set of phenomena,that directly influences the daily lives of human populations all over the ***,this influence normally negative also affects ecosystems,with emphasis on agroforestry systems,of which human populations are directly dependent on food and in a large number of primary raw *** is with this premise as a starting point that this work makes an analysis on the current state of climate change in Portugal,since,being a country of Mediterranean climate influence,it should be one of the territories where changes will be felt with more intensity and *** this work,the current position on energy production in Portugal regarding Green House Gases(GHGs)emissions and the evolution prospects for the near future,namely in the perspective of the impacts caused on forest resources,are discussed.

关键词： Climate change Forest management Renewable energies Green House Gases(GHGs)

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投资决策经济学

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作者： (美)克里斯托弗 D. 派若斯(Christopher D. Piros) (美)杰拉尔德 E. 平托(Jerald E. pinto)

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Advanced stage stuck Gland Adenocarcinoma:Case Report

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Modern Research in Inflammation 2020年第1期9卷 1-7页

作者： Miriam Viviane Baron Michele Paula dos santos Gabriela Di Lorenzo Garcia scherer Luis Manuel Ley Dominguez Vitoria Pereira Itaquy Natalia Cardoso Nascimento Fernanda Nerys Tais Michele Werle Carolina Paz Mohamad Isa Carina marangoni mariana martins Dantas santos marcus Vinicius de Mello pinto Janine Koepp Daiana Klein Weber Carissimi Joice Nedel Ott Carolina Goncalves Pinheiro Nathália Ken Pereira Iketani 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 AlegreBrazil Improvement of Higher Education Personnel Brazil(CAPES)Distrito FederalBrazil school of Medicine of the Pontifical Catholic University of Rio Grande do sul(PUC/Rs) Porto AlegreBrazil school of Health and Life sciences of the Pontifical Catholic University of Rio Grande do sul(PUC/Rs) Porto AlegreBrazil Celulare Institute PetrópolisRio de JaneiroBrazil Undergraduate Nursing Course of the University of santa Cruz do sul(UNIsC) Santa Cruz do SulBrazil Postgraduate Program in Health sciences of the Faculty of Medicine of ABC(FMABC) Sao PauloBrazil Undergraduate Physiotherapy Course of the Vale do salgado Faculty(FVs) CearáBrazil Physiotherapy of the Hospital Beneficiente Portuguesa of Belém ParáBrazil

Parotid gland adenocarcinoma is commonly a tumor of low malignancy and low incidence worldwide. The reported case shows the rapid progression of this tumor in an elderly patient and infrequent effects, such as a presentation of facial edema not commonly described in the medical literature. Patient was admitted to hospital in November 2019 with secretion and partial hearing loss in the right ear and infiltrative and stone lesion with initial skin ulceration in the right cervical region. After 42 days, he returned and was admitted to the intensive care unit with significant swelling of the face, hardened and hyperemic neck, difficulty in speech and inability to open the eye. He presented changes in the mobility of the speech and hearing organs, reduced laryngeal mobility, vocal changes, speech with altered articulation and severe oropharyngeal dysphagia with risk of bronchoaspiration. The patient was diagnosed in september 2019 with a parotid tumor (salivary gland adenocarcinoma T4). The medical team requested computed tomography, computed tomography angiography of the chest and cervical vessels and computed tomography of the neck, in addition to evaluation by the head and neck surgery service and general surgery. After analyzing the results, the medical team suggested a hypothesis of tumor invasion that could result in obstruction of local lymphatic drainage, something unusual in the evolution of this type of tumor. In addition, it was not possible to adhere to radiotherapy treatment due to the extent of the lesion and there was also no confirmation of metastases. The reported case shows us that parotid gland adenocarcinoma, when diagnosed in an advanced stage, can limit the approach to treatment. It was chosen in agreement with the family to proceed with palliative care without invasive measures. Palliative care may be the best option for cases like this, bringing some comfort to the patient and his family.

关键词： Parotid Neoplasms Cancer of the Parotid Palliative Care Critical Care

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