Alteraciones del estado ácido básico en pacientes adultos con insuficiencia renal crónica / Acid-base status alterations in adult patients with chronic renal failure

RESUMEN Introducción: el portador de insuficiencia renal crónica puede presentar diversas alteraciones del estado ácido básico, siendo la acidosis metabólica la más frecuente. Objetivos: describir las características demográficas y clínicas y las alteraciones del estado ácido básico de pacientes adultos que ingresan con insuficiencia renal crónica en dos centros hospitalarios del Paraguay. Metodología: se aplicó un diseño observacional, descriptivo, transversal. Se incluyó a sujetos adultos de ambos sexos, portadores de insuficiencia renal crónica, que acudieron al Hospital Nacional (Itauguá) y Hospital Militar (Asunción) entre abril y noviembre del 2021. Se midieron variables antropométricas, clínicas y laboratoriales al ingreso. Los datos se sometieron a estadística descriptiva con el programa Epi Info 7™. El estudio contó con la aprobación del Comité de Ética de la Universidad Privada del Este, Paraguay. Resultados: se incluyó a 148 sujetos, siendo 78 (52,7 %) varones con edad media 58 ± 16 años y 70 (47,3 %) mujeres con edad media 54 ± 17 años. Las etiologías más frecuentes de la insuficiencia renal crónica fueron la diabetes mellitus e hipertensión arterial (44,5 %). Se detectó 12 sujetos (8,1 %) con gasometría normal. La alteración del estado ácido básico más frecuente fue la acidosis metabólica (87,2 %), predominando en este grupo los casos con brecha aniónica normal. Conclusiones: las alteraciones del estado ácido básico predominantes en pacientes con insuficiencia renal crónica fue la acidosis metabólica con brecha aniónica normal. Se sugiere aplicar los cálculos de los mecanismos compensadores para llegar al diagnóstico certero de estas alteraciones metabólicas.

ABSTRACT Introduction: the carrier of chronic renal failure can present various alterations of the basic acid state, being the metabolic acidosis the most frequent. Objectives: to describe the demographic and clinical characteristics and alterations in the acid-base status of adult patients admitted with chronic renal failure in two hospitals in Paraguay. Methodology: an observational, descriptive, cross-sectional design was applied. Adult subjects of both sexes, carriers of chronic renal failure, who attended the National Hospital (Itauguá) and the Military Hospital (Asunción) between April and November 2021 were included. Anthropometric, clinical and laboratory variables were measured at admission. The data was submitted to descriptive statistics with the Epi Info 7™ program. The study was approved by the Ethics Committee of the Universidad Privada del Este, Paraguay. Results: 148 subjects were included, being 78 (52.7 %) men with a mean age of 58 ± 16 years and 70 (47.3 %) women with a mean age of 54 ± 17 years. The most frequent etiologies of chronic renal failure were diabetes mellitus and arterial hypertension (44.5 %). 12 subjects (8.1 %) with normal blood gases were detected. The most frequent alteration of the acid-base status was metabolic acidosis (87.2 %), with cases with normal anion gap predominating in this group. Conclusions: the predominant acid-base status alterations in patients with chronic renal failure was metabolic acidosis with normal anion gap. It is suggested to apply the calculations of the compensatory mechanisms to arrive at the accurate diagnosis of these metabolic alterations.

Risco de úlcera por pressão na pessoa em situação crítica em unidades de cuidados intensivos: validação da escala CALCULATE / Risk of pressure ulcer in the critically ill patient in intensive care units: validation of the CALCULATE scale

A pessoa em situação crítica apresenta um risco acrescido de desenvolvimento de úlceras por pressão, pela complexidade do seu estado clínico e pelos tratamentos necessários. Torna-se então fundamental perceber quais os fatores que mais contribuem para este risco acrescido e quantificá-lo, de forma a desenvolver estratégias preventivas eficazes e eficientes. Para este efeito, a utilização de escalas de avaliação de risco surge como um apoio à tomada de decisão do enfermeiro, sendo que a utilização da escala de Braden na pessoa internada em Cuidados Intensivos não é consensual, existindo escalas desenvolvidas especificamente para esta população. Este estudo tem como objetivos a tradução e validação para português da escala CALCULATE e a sua comparação com a escala de Braden, no que diz respeito às capacidades preditivas (sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo). Para isso, desenvolveu-se um estudo quantitativo, longitudinal, observacional e metodológico. Numa primeira fase procedeu-se à tradução e adaptação da escala CALCULATE à língua portuguesa. A segunda fase diz respeito à validação da escala e à análise da validade concorrente com a escala de Braden. Para a segunda fase, foi utilizada uma amostra sequencial de 218 admissões em duas unidades de cuidados intensivos polivalentes do norte do país, entre o dia 1 de junho e 31 de agosto de 2019. Foi registada uma incidência de úlceras por pressão de 16,1%, verificando-se uma predominância do sexo masculino (65,7%) e uma média de idade de 57,14±14,476 anos. O tempo médio para o aparecimento foi de 5,00±3,087 dias. Relativamente à classificação das UPP, a grande maioria foi classificada como categoria 2 (82,9%), seguida pelas úlceras não categorizáveis ­ profundidade indeterminada (14,3%), sendo que 54,2% se localizavam na região sacrococcígea e 25,6% na região occipital. A estabilidade temporal da escala CALCULATE foi verificada utilizando a correlação de Pearson entre vários momentos, conseguindo resultados satisfatórios que mostraram correlações moderadas e moderadas-altas. A validade concorrente foi analisada através de correlações com a escala de Braden, que se mostraram moderadas, valores negativos na ordem dos 0,60 indicando que ambas as escalas avaliam o mesmo tópico. A escala CALCULATE apresentou uma sensibilidade de 80,0%, uma especificidade de 71,0%, um valor preditivo positivo de 34,6% e um valor preditivo negativo de 94,9%, com um coeficiente de Matthews de 0,39. Já a escala de Braden apresentou 100,0% de sensibilidade, 13,1% de especificidade, 18,0% de valor preditivo positivo e 100,0% de valor preditivo negativo, com um coeficiente de Matthews de 0,16. Ambas as escalas apresentaram AUC acima de 0,70 (0,794 para a CALCULATE e 0,783 para a Braden), que mostra que ambas tem um poder discriminatório aceitável. Não obstante, conclui-se que a escala CALCULATE é mais indicada para a avaliação do risco de úlcera por pressão na pessoa em situação crítica por apresentar maior equilíbrio entre as propriedades preditivas e considerando que a previsão feita pela escala de Braden é quase aleatória.

The critical care patient has an increased risk of developing a pressure ulcer, due to both complexity of the clinical state and the treatments required. So, it´s imperative to understand what factors contribute the most for this increased risk and how to quantify it, in order to develop effective and efficient preventive strategies. Thus, the use of risk assessment scales supports the nurses' decision, although the Braden scale use is controversial in the person in Intensive Care, there are other scales specifically created for this population. This study aims to translate and validate to Portuguese the CALCULATE scale and to compare it with the Braden scale, considering the predictive properties (sensibility, specificity, positive predictive value and negative predictive value). To do so, it was developed a longitudinal, observational and methodological study, divided in two parts. First, it was necessary to translate and adapt the CALCULATE scale to the Portuguese language. Afterwards, in a second phase, the scale was validated and had the concurrent validity assessed compared to the Braden scale. For the second phase, it was used a sequential sample of 218 admissions in two intensive care units in the north of the country, between the 1st of June and the 31st of August of 2019. There was a pressure ulcer incidence of 16,1%, mostly developed by men (65,7%) and with a mean age of 57,14±14,476 years. The average time for the development of an ulcer was 5,00±3,087 days. Considering the classification, most of them were category 2 ulcers (82,9%) and suspected deep tissue injury (14,3%). They were more frequent in the sacrum area (54,2%) and the occiput (25,6%). The temporal stability of the CALCULATE scale was verified using the Pearson correlation between several moments, with satisfactory results that showed moderate to moderate-high correlations. The concurrent validity was analysed through correlations with the Braden scale, which were moderate, with values around 0,60, indicating that both scales measure the same construct. The CALCULATE scale had a sensibility of 80,0%, a specificity of 71,0%, a positive predictive value of 34,6% and a negative predictive value of 94,9%, with a Matthews coefficient of 0,39. On the other hand, the Braden scale had 100,0% of sensibility, 13,1% of specificity, 18,0% of positive predictive value and 100,0% of negative predictive value, with a Matthews coefficient of 0,16. Both scales had AUC above 0,70 (0,794 for the CALCULATE and 0,783 for the Braden), which shows an acceptable accuracy. Nevertheless, the conclusion is that CALCULATE is more suitable to evaluate the risk of developing a pressure ulcer in the critical care patient because it shows more balance between the predictive properties and considering that the Braden scale is almost random in its predictions.

The effect of gingival aging in diabetic and non-diabetic status: an experimental study / El efecto del envejecimiento gingival en el estado diabetico y no diabetico. Estudio experimental

Major gingivalperiodontal changes according to age have been observed in both diabetic and nondiabetic rats. Male Wistar rats weighing 200220 g were divided into two groups: 1) Nondiabetic (ND) and 2) Diabetic (D) by receiving an intraperitoneal (ip) dose of streptozotocin (STZ) (50 mg /kg). Animals from both groups (ND and D) were euthanized at 4, 8, 12, 17 y 25 weeks after treatment with saline solution or STZ. Glycemia values in ND rats were 5 to 6 mmol/L, while in D, glycemia increased progressively between weeks 4 and 25, with values ranging from 18.3±2.1 to 39.3±2.7 mmol/L. Oxidative stress differed significantly in gums of ND and D rats. ND: lipid peroxidation: Malondialdehyde (MDA): 8.52±1.2 to 15.5±2(nmol/mgP); superoxide dismutase (SOD): 37.1±4.2 to 21.2±1.3 (U/100mgP); D: MDA 13.1±1.6 to 22.9±2.7 (nmol/L); superoxide dismutase (SOD): 17.7±0.8 to 9.±0.2 (U/100mgP). Vascular permeability (VP) and gingival edema (E) showed significant changes between ND and D rats from 4 to 25 weeks. ND: PV: 10±0.2 to 16.1±1.3 (EB ug/g dry t); E: 0.9±0.1 to 4.1±1.3 ml; D: PV: 12±1.2 to 24.4±1.6 (EB ug/g dry t); E: 2.2±0.2 to 8.4±1.3 ml. Aging produced progressive natural changes in oxidative stress, VP and gingival E. In diabetic animals, changes in oxidative stress, VP and gingival E were observed early and were progressively more significant than for ND. According to these results, nondiabetic gingival modifications develop naturally with age, while in aging associated to diabetic disease, hyperglycemia increases progressively and early (AU)

Se han observados importantes cambios gingivoperiodontales en función de la edad tanto en ratas no diabéticas como en ratas diabéticas. Ratas machos Wistar de 200220 g de peso corporal fueron separadas en dos grupos: 1) No diabéticas(ND) ; 2) Diabéticas (D), por haber recibido una dosis intraperitoneal (ip) de estreptozotocina (STZ) (50 mg /kg). Ambos grupos de ratas (ND y D) fueron sacrificados a las 4, 8, 12, 17 y 25 semanas de edad después del tratamiento con solución salina o con STZ. En ratas ND las los valores de glucemia fueron de 5 a 6 mmol/L, en tanto que en las D las glucemias se observaron progresivamente aumentadas entre las 4 y las 25 semanas con valores entre 18.3±2.1 a 39.3±2.7 mmol/L. El estrés oxidativo mostró diferencias significativas entre las encías de animales ND respecto a los D; ND: peroxidacion lipidica: Malondihaldeido (MDA): 8.52±1.2 a 15.5±2(nmol/mgP);superoxido dismutasa (SOD):37.1±4.2 a 21.2±1.3 (U/100mgP); D : MDA 13.1±1.6 a 22.9±2.7 (nmol/L); Superoxidodismutasa :SOD 17.7±0.8 a 9.±0.2 (U/100mgP). La permeabilidad vascular(PV) y el edema(E) gingival mostraron cambios significativos entre las 4 y las 25 semanas de edad entre los animales ND respecto a los D : ND : PV : 10±0.2 a 16.1±1.3 (EB ug/g t seco); E :0.9±0.1 a 4.1±1.3 ml; D: PV :12±1.2 a 24.4±1.6 (EB ug/g t seco); E 2.2_/0.2 a 8.4± 1.3 ml. El envejecimiento produjo cambios progresivos naturales en el estrés oxidativo, PV y E gingival. En tanto que en el estado diabético los cambios del estrés oxidativo, PV y E gingival se observan temprano y fueron progresivamente más significa tivos comparados con los ND. De acuerdo a estos resultados las modificaciones gingivales no diabéticas se desarrollan naturalmente en función de la edad, en cambio en la senectud asociada con enfermedad diabética la hiperglucemia aumenta progresiva y tempranamente (AU)

[Factors associated with delay to reperfusion therapy in patients with ST-Segment Elevation Myocardial Infarction in a hospital in the southeast of Mexico]. / Factores asociados con retraso en la terapia de reperfusión en infarto agudo de miocardio con elevación del segmento ST (IMCEST) en un hospital del sureste mexicano.

UNLABELLED: Introduction and subject: The aim of the study was to determine the factors involved in the delayed medical care of patients with ST-Segment Elevation Myocardial Infarction. METHODS: A prospective observational study was conducted in patients admitted to the coronary care unit at Dr. Juan Graham Casasús hospital with a diagnosis of ST-Segment Elevation Acute Myocardial Infarction. In all patients, clinical data, type and time of reperfusion treatment, and factors associated with delay were identified. RESULTS: Between November 2012 and January 2015 we included 213 patients with ST-Segment Elevation Myocardial Infarction. Age, diabetes, atypical chest angina and patient arrival period (night or weekend), were more frequent in patients presenting after 12 hours of onset of symptoms of myocardial infarction. Of these, hospital admission at night or weekend was the only independent predictor for delay to the emergency room. CONCLUSIONS: This study shows that in a referral hospital in southeast of Mexico, the delay attributable to the patient was the most common factor associated with care in patients with ST-Segment Elevation Myocardial Infarction. Patient arrival period was associated with delay to medical care.

Left Ventricular Dilation and Pulmonary Vasodilatation after Surgical Shunt for Treatment of Pre-Sinusoidal Portal Hypertension.

OBJECTIVE: The aim of this study was to prospectively investigate the long-term cardiovascular and pulmonary hemodynamic effects of surgical shunt for treatment of portal hypertension (PH) due to Schistosomiasis mansoni. LOCATION: The University of São Paulo Medical School, Brazil; Public Practice. METHODS: Hemodynamic evaluation was performed with transesophageal Doppler and contrast-enhanced echocardiography (ECHO) on twenty-eight participants with schistosomal portal hypertension. Participants were divided into two groups according to the surgical procedure used to treat their schistosomal portal hypertension within the last two years: group 1-distal splenorenal shunt (DSRS, n = 13) and group 2-esophagogastric devascularization and splenectomy (EGDS, n = 15). RESULTS: The cardiac output (5.08 ± 0.91 L/min) and systolic volume (60.1 ± 5.6 ml) were increased (p = 0.001) in the DSRS group. DSRS participants had a significant increase (p < 0.0001) in their left ventricular end-systolic and end-diastolic diameters as well as in their left ventricular end-diastolic and end-systolic volumes (p < 0.001) compared with the preoperative period. No statistically significant difference was found in the patients who underwent EGDS. ECHO revealed intrapulmonary vasodilatation (IPV) in 18 participants (64%), 9 DSRS and 9 EGDS (p > 0.05). CONCLUSIONS: The late increase in the cardiac output, stroke volume and left ventricular diameters demonstrated left ventricular dilatation after a distal splenorenal shunt. ECHO revealed a greater prevalence for IPV in patients with schistosomiasis than has previously been described in patients with PH from liver cirrhosis.

Determination of limited histotrophy as the reproductive mode in Mustelus schmitti Springer, 1939 (Chondrichthyes: Triakidae): analysis of intrauterine growth of embryos

This work analyzed length-mass relationship, growth in length, mass variations and dynamic of yolk sac depletion of Mustelus schmitti embryos, extracted from females catched by the artisanal fishery acting off La Paloma (34°39'S, 54°10'W, Uruguay) during 2006 and 2007. Differences in total length and total mass between sexes were not significant. Embryos showed a negative allometric growth for both years with a slope change near the day 170 of the year, likely to be associated with the depletion of the external yolk sac. Gompertz and Von Bertalanffy curves were adjusted for each year. Parturition date was determined around the day 300 of the year. Yolk depletion followed a logistic dynamic Yt=1/(1+e(-13.749 + 0.072*t)) for 2006 and Yt=1/(1+e(-10.472 + 0.054*t)) for 2007. Embryos showed a mean increase in total dry mass of 5.4g in 187 days which, together with yolk depletion dynamics, indicates additional energetic supply, suggesting that M. schmitti presents limited histotrophy.

Este trabajo analizó las relaciones largo-masa, crecimiento en talla, variaciones en masa y dinámica de consumo del saco vitelino de embriones de Mustelus schmitti extraídos de hembras capturadas por la flota pesquera artesanal del puerto de La Paloma (34°39'S, 54°10'W, Uruguay) durante 2006 y 2007. Las diferencias en largo total y masa total entre sexos no fueron significativas. Los embriones mostraron crecimiento alométrico negativo en ambos años, con un cambio de pendiente cercano al día 170, probablemente asociado con el agotamiento del saco vitelino externo. Se ajustaron curvas de crecimiento de Gompertz y VonBertalanffy para cada año. La fecha de parición se determinó cerca del día 300 del año. El consumo de vitelo siguió una dinámica logística Yt=1/(1+e(-13.749 + 0.072*t)) en 2006 y Yt=1/(1+e(-10.472 + 0.054*t)) en 2007. Los embriones mostraron un aumento promedio de masa seca de 5.4g en 187 días, esto, junto con la dinámica de consumo de vitelo, indicó una provisión adicional de energía, sugiriendo que M. schmitti presenta histotrofía limitada.

Padrão hemodinâmico tardio (> 2 anos) e vasodilatação intrapulmonar, antes e após tratamento cirúrgico da hipertensão portal secundária à forma hepatoesplênica da esquistossomose mansônica: análise comparativa entre desconexão ázigo-port / Sistemic hemodynamics (> 2 years) and intrapulmonary vasodilatation before and after surgical treatment of portal hypertension due to hepatoesplenic mansonic shistosomiasis: comparative analysis of esophagogastric devascularization with splenectomy (EGDS) and distal splenorenal shunt (DSRS)

O presente estudo avaliou comparativamente o padrão hemodinâmico e a presença de vasodilatação intrapulmonar antes e após tratamento cirúrgico tardio (> 2 anos) da hipertensão portal através da desconexão ázigo portal com esplenectomia (DAPE) e anastomose esplenorenal distal (AERD) na esquistossomose mansônica forma hepatoesplênica. Foram estudados prospectivamente 37 pacientes portadores de hipertensão portal secundária a esquistossomose mansônica confirmada por biópsia hepática , sendo 21 pacientes do sexo masculino e 16 do sexo feminino, com idade média de 46,6 + 12 anos, no período de janeiro de 2007 a dezembro de 2008. A avaliação do padrão hemodinâmico sistêmico foi realizada através do Doppler transesofágico (Cardio QÒ) e da ecocardiografia bidimensional com Doppler nos pacientes dos grupos AERD (n=13) e DAPE (n=15) . Os resultados obtidos foram comparados com grupo controle constituído por 10 pacientes sem hipertensão portal submetidos à endoscopia digestiva alta para avaliação de dispepsia. A avaliação da presença de síndrome hepatopulmonar foi realizada em todos os pacientes através da ecocardiografia contrastada com infusão salina 0,9% nos grupos DAPE (n=15), AERD (n=13) e pré-operatório (n=9). Os pacientes que apresentavam vasodilatação intrapulmonar no período pré-operatório repetiram o exame após 30 dias do procedimento cirúrgico. Em relação ao padrão hemodinâmico sistêmico observou-se aumento significativo (p =0,001) do débito cardíaco no grupo AERD (5,08 ± 0,91 L/min) em relação ao controle (4,17 ± 0,52 L/min). Ao contrário, os pacientes submetidos à DAPE (4,36 ± 0,59 L/min) não apresentaram diferença estatística significante (p = 0,47) em relação ao controle (4,17 ± 0,52 L/min). Os pacientes do grupo AERD apresentaram aumento estatisticamente significante (p = 0,001) do volume sistólico (60,1 + 5,6 ml) em relação ao controle (53,2 + 5,6 ml), enquanto que não houve diferença significativa (p = 0,41) nos pacientes submetidos à DAPE...

This study is a comparative analysis of the hemodynamic pattern and presence of intrapulmonary vasodilatation in hepatoesplenic mansoni schistosomiasis before and after surgical treatment (> 2 years) of portal hypertension by esophagogastric devascularization with splenectomy (EGDS) and distal splenorenal shunt (DSRS). 37 patients with portal hypertension secondary to hepatosplenic mansoni schistosomiasis confirmed by liver biopsy were prospectively studied between January 2007 to December 2008. 21 patients were male and 16 were female, with an mean age of 46.6 +12 years. The hemodynamic evaluation was performed by transesophageal doppler (Cardio QÒ) and Doppler echocardiography in DSRS (n=13) and EGDS (n=15) patients. The results were compared with a control group of 10 patients without portal hypertension submitted to upper digestive endoscopy for dyspepsia evaluation The presence of pulmonary vasodilatation was evaluated in all patients by contrastenhanced echocardiography with saline solution 0,9% in DSRS (n=15), EGDS (n=13) and preoperative (n=9) groups. Patients with intrapulmonary vasodilation in the preoperative period repeated the exam 30 days after surgical treatment of portal hypertension by a devascularization procedure. Systemic hemodynamic evaluation by transesophageal Doppler revealed a significant increase in cardiac output (p =0.001) in the DSRS (5,08 ± 0,91 L/min) patients in relation to control group (4,17 ± 0,52 L/min). By contrast, patients submitted to EGDS (4,36 ± 0,59 L/min) present no increase in cardiac output (p = 0.47) when compared with control group (4,17 ± 0,52 L/min). The DSRS patients presented a statistically significant increase (p = 0.001) in systolic volume (60,1 + 5,6 ml) in relation to the control (53,2 + 5,6 ml), while no significant difference (p = 0.41) was observed in EGDS group (56 ± 9,4 ml). There was no statistically significant difference between heart rate and mean arterial pressure between groups...

Pre- and postoperative systemic hemodynamic evaluation in patients subjected to esophagogastric devascularization plus splenectomy and distal splenorenal shunt: a comparative study in schistomomal portal hypertension.

AIM: To investigate the systemic hemodynamic effects of two surgical procedures largely employed for treatment of schistosomal portal hypertension. METHODS: Thirty-six patients undergoing elective surgical treatment of portal hypertension due to hepatosplenic mansonic schistosomiasis were prospectively evaluated. All patients were subjected to preoperative pulmonary artery catheterization; 17 were submitted to esophagogastric devascularization and splenectomy (EGDS) and 19 to distal splenorenal shunt (DSRS). The systemic hemodynamic assessment was repeated 4 d after the surgical procedure. RESULTS: Preoperative evaluation revealed (mean +/- SD) an increased cardiac index (4.78 +/- 1.13 L/min per m(2)), associated with a reduction in systemic vascular resistance index (1457 +/- 380.7 dynes.s/cm(5).m(2)). The mean pulmonary artery pressure (18 +/- 5.1 mmHg) as well as the right atrial pressure (7.9 +/- 2.5 mmHg) were increased, while the pulmonary vascular resistance index (133 +/- 62 dynes x s/cm(5) x m(2)) was decreased. Four days after EGDS, a significant reduction in cardiac index (3.80 +/- 0.4 L/min per m(2), P < 0.001) and increase in systemic vascular resistance index (1901.4 +/- 330.2 dynes x s/cm(5) x m(2), P < 0.001) toward normal levels were observed. There was also a significant reduction in pulmonary artery pressure (12.65 +/- 4.7 mmHg, P < 0.001) and no significant changes in the pulmonary vascular resistance index (141.6 +/- 102.9 dynes x s/cm(5) x m(2)). Four days after DSRS, a non-significant increase in cardiac index (5.2 +/- 0.76 L/min per m(2)) and systemic vascular resistance index (1389 +/- 311 dynes x s/cm(5) x m(2)) was observed. There was also a non-significant increase in pulmonary artery pressure (19.84 +/- 5.2 mmHg), right cardiac work index (1.38 +/- 0.4 kg x m/m(2)) and right ventricular systolic work index (16.3 +/- 6.3 g x m/m(2)), without significant changes in the pulmonary vascular resistance index (139.7 +/- 67.8 dynes xs/cm(5) x m(2)). CONCLUSION: The hyperdynamic circulatory state observed in mansonic schistosomiasis was corrected by EGDS, but was maintained in patients who underwent DSRS. Similarly, the elevated mean pulmonary artery pressure was corrected after EGDS and maintained after DSRS. EGDS seems to be the most physiologic surgery for patients with schistosomal portal hypertension.