SGLT2 inhibitors and NLRP3 inflammasome: potential target in diabetic kidney disease.

Diabetic kidney disease (DKD) remains the leading cause of chronic kidney disease (CKD) worldwide. The pathogenesis of DKD is influenced by functional, histopathological, and immune mechanisms, including NLRP3 inflammasome activity and oxidative stress. The sodium-glucose cotransporter 2 inhibitors (SGLT2i) have shown metabolic benefits and the ability to slow the progression of DKD in several clinical studies over the years. Recent studies suggest that the antidiabetic activity also extends to inhibition of the inflammatory response, including modulation of the NLRP3 inflammasome, reduction of pro-inflammatory markers and reduction of oxidative stress. Here we review the efficacy of SGLT2i in the treatment of CKD and discuss the role of the inflammatory response in the development of DKD, including its relationship to the NLRP3 inflammasome and oxidative stress.

Littoral cell angioma of the spleen: case report and literature review.

Littoral cell angioma is an extremely rare splenic vascular tumor originating from the cells lining the splenic red pulp sinuses. Approximately 150 cases of littoral cell angioma have been reported since 1991. Its clinical manifestation is usually asymptomatic and is mostly diagnosed as an incidental finding through abdominal imaging. Herein, we present a case of littoral cell angioma in a 41-year-old woman with no previous comorbidities, which initially presented as a nonspecific splenic lesion diagnosed on imaging in the emergency room. The patient was treated through laparoscopic intervention.

Littoral cell angioma of the spleen: case report and literature review

ABSTRACT Littoral cell angioma is an extremely rare splenic vascular tumor originating from the cells lining the splenic red pulp sinuses. Approximately 150 cases of littoral cell angioma have been reported since 1991. Its clinical manifestation is usually asymptomatic and is mostly diagnosed as an incidental finding through abdominal imaging. Herein, we present a case of littoral cell angioma in a 41-year-old woman with no previous comorbidities, which initially presented as a nonspecific splenic lesion diagnosed on imaging in the emergency room. The patient was treated through laparoscopic intervention.

Handheld Echocardiography in a Clinical Practice Scenario: Concordances Compared to Standard Echocardiographic Reports.

BACKGROUND: The purpose of this study was to assess the utility of a handheld device (HH) used during common daily practice and its agreement with the results of a standard echocardiography study (STD) performed by experienced sonographers and echocardiographer. METHODS: A prospective follow-up was conducted in an adult outpatient echocardiography clinic. Experienced sonographers performed the STD and an experienced echocardiographer performed the HH. STD included 2-dimensional images, Doppler and hemodynamics analysis. Hemodynamic assessment was not performed with the HH device because the HH does not include such technology. The images were interpreted by blinded echocardiographers, and the agreement between the reports was analyzed. RESULTS: A total of 108 patients were included; and the concordance for left ventricle (LV) ejection fraction (EF), wall motion score index, LV and right ventricle (RV) function, RV size, and mitral and aortic stenosis was excellent with κ values greater than 0.80. Wall motion abnormalities had good concordance (κ value 0.78). The agreement for LV hypertrophy, mitral and aortic regurgitation was moderate, and tricuspid and pulmonary regurgitation agreements were low (κ values of 0.26 and 0.25, respectively). CONCLUSIONS: In a daily practice scenario with experienced hands, HH demonstrated good correlation for most echocardiography indications, such as ventricular size and function assessment and stenosis valve lesion analyses.

Bone-Marrow Stem Cells and Acellular Human Amniotic Membrane in a Rat Model of Heart Failure.

Myocardial infarction (MI) remains the leading cause of cardiovascular death worldwide and a major cause of heart failure. Recent studies have suggested that cell-based therapies with bone marrow stem cells (BMSC) and human amniotic membrane (hAM) would recover the ventricular function after MI; however, the mechanisms underlying these effects are still controversial. Herein, we aimed to compare the effects of BMSC and hAM in a rat model of heart failure. MI was induced through coronary occlusion, and animals with an ejection fraction (EF) < 50% were included and randomized into three groups: control, BMSC, and hAM. The BMSC and hAM groups were implanted on the anterior ventricular wall seven days after MI, and a new echocardiographic analysis was performed on the 30th day, followed by euthanasia. The echocardiographic results after 30 days showed significant improvements on EF and left-ventricular end-sistolic and end-diastolic volumes in both BMSC and hAM groups, without significant benefits in the control group. New blood vessels, desmine-positive cells and connexin-43 expression were also elevated in both BMSC and hAM groups. These results suggest a recovery of global cardiac function with the therapeutic use of both BMSC and hAM, associated with angiogenesis and cardiomyocyte regeneration after 30 days.

Pulmonary thromboembolism in conjunction with intracavitary thrombus caused by severe acute respiratory syndrome coronavirus-2 infection in a patient living with human immunodeficiency virus.

Approximately one-third of patients with coronavirus disease 2019 (COVID-19) present with coagulation disorders and hematological changes. However, the clinical manifestations of COVID-19 and prognoses of people living with human immunodeficiency virus (HIV) remain controversial. This study reports the case of a 27-year-old HIV-infected man who regularly used antiretroviral medications, had no other comorbidities and was admitted for acute respiratory distress syndrome caused by COVID-19. Complementary examinations during hospitalization revealed a diagnosis of pulmonary thromboembolism in association with an intracavitary thrombus.

Tissue-engineered amniotic membrane in the treatment of myocardial infarction: a systematic review of experimental studies.

OBJECTIVE: myocardial infarction (MI) remains the leading cause of death worldwide. Cell-based therapies have become potential therapeutic approaches, attempting to recover the contractility of necrotic cardiomyocytes. In the present study, we aimed to systematically evaluate experimental studies on the use of tissue-engineered amniotic membrane (hAMC) in MI treatment. METHODS: a systematic review of literature published in PubMed, Embase and CENTRAL databases was conducted, until March 31, 2020, for experimental studies reporting on hAMC cell-therapy performed on LV function, MI size, paracrine effects, angiogenesis, and cell differentiation. Two reviewers selected the articles that met the inclusion criteria and disagreements were solved through a consensus. RESULTS: a total of 11 studies were included for data extraction. For the acute scenario, therapeutic use of hAMC after MI was capable of improving LV function in rats, mainly due to its paracrine effects (anti-apoptotic and anti-inflammatory) and associated with cardiomyocyte differentiation, MI size reduction and neo-angiogenesis. CONCLUSION: tissue engineered hAMC following MI provided clinically relevant benefits on cardiac function and ventricular remodeling.

Pulmonary thromboembolism in conjunction with intracavitary thrombus caused by severe acute respiratory syndrome coronavirus-2 infection in a patient living with human immunodeficiency virus

Abstract Approximately one-third of patients with coronavirus disease 2019 (COVID-19) present with coagulation disorders and hematological changes. However, the clinical manifestations of COVID-19 and prognoses of people living with human immunodeficiency virus (HIV) remain controversial. This study reports the case of a 27-year-old HIV-infected man who regularly used antiretroviral medications, had no other comorbidities and was admitted for acute respiratory distress syndrome caused by COVID-19. Complementary examinations during hospitalization revealed a diagnosis of pulmonary thromboembolism in association with an intracavitary thrombus.

Linfoma primário do pênis: relato de caso / Primary penile lymphoma: case report

Objetivo: Relatar o caso de um paciente diagnosticado com linfoma peniano primário, um dos subtipos menos comuns de câncer de pênis. Caso clínico: Paciente masculino, 63 anos, hígido, com queixa de ulcerações dolorosas em região balano-prepucial. Sem queixas urinárias, traumatismo peniano ou relação sexual desprotegida. Ao exame inicial, pênis com prepúcio exuberante, sinais de má higiene, tecido necrótico em glande e parafimose. Optou-se por postectomia, desbridamento de glande e cistostomia de proteção, com anatomopatológico demonstrando neoplasia maligna pouco diferenciada e análise imuno-histoquímica sugerindo linfoma de células B. O paciente realizou seis ciclos de quimioterapia, com remissão completa dos sintomas no quarto ciclo. Foi submetido à reconstrução de uretra e glande posteriormente, pela técnica de Mathieu (retalho cutâneo). Comentários: O linfoma peniano primário é ainda pouco relatado e conhecido. Ainda que seu manejo seja controverso, a quimioterapia adjuvante com terapia cirúrgica reconstrutiva se demonstrou uma opção eficiente de tratamento

Objective: To report the case of a patient diagnosed with primary penile lymphoma. Clinical case: A 63-years-old male patient presented with ulcerated lesions on the penis with a 2-week evolution. The patient denied urinary symptoms, penile trauma, or unprotected sex. The initial examination showed a penis with an exuberant foreskin and signs of poor local hygiene, with paraphimosis and necrotic tissue on the gland. A postectomy and debridement of the gland was performed, and the anatomopathological exam showed poorly differentiated malignancy, while the immunohistochemical analysis suggested B-cell lymphoma. The patient was submitted to six cycles of chemotherapy, with complete remission of the symptoms after the fourth cycle. In sequence, a reconstruction of the urethra and glans was performed using the Mathieu's technique. Comments: Primary penile lymphoma is still a poorly reported disease. Although its management remains controversial, adjuvant chemotherapy with reconstructive surgical therapy showed to be an efficient approach

Uso do Stroop EncephalApp para o screening de encefalopatia hepática mínima em pacientes cirróticos no sul do Brasil / Use of the stroop encephalapp for covert hepatic encephalopathy screening in cirrhotic patients in southern brazil

ABSTRACT BACKGROUND: Covert hepatic encephalopathy (CHE) is difficult to detect due to the lack of easily applicable screening tools. The Stroop EncephalApp is a smartphone application already validated for CHE screening. However, its applicability to the Brazilian population is not known. OBJECTIVE: To estimate the prevalence of CHE and evaluate the use of Stroop EncephalApp in a cirrhotic population in Brazil. METHODS: In this cross-sectional study, we evaluated 99 patients previously diagnosed with liver cirrhosis in a Private Hospital in Curitiba/PR. Patients were initially submitted to the mini mental state examination (MMSE) to exclude individuals with dementia. After, the Psychometric Hepatic Encephalopathy Score (PHES) test was performed and lastly, the Stroop EncephalApp test. Results were adjusted for age, sex and education levels to evaluate the accuracy of the app on detecting the disease, comparing its results with the gold standard method (PHES). Patients with one or more of the following were excluded: dementia, inadequate MMSE score, illiteracy, color blindness, history of drugs/alcohol abuse within the past 3 months and previous or actual episodes of encephalopathy. The statistical analysis was performed by SPSS 2.0 and the significance adopted by 5%. RESULTS: We included 82 individuals in the final analysis. Among these patients, 29 were diagnosed with CHE by the PHES test (35.36% prevalence) and 28 of those obtained equal diagnosis by the Stroop EncephalApp (96.6% sensitivity). A total of 53 patients obtained negative results for CHE by PHES, while the Stroop test classified 27 of them as having the disease. In the multivariate analysis, high levels of education were associated with better performance during the tests. No significant relationship was observed between age and sex with the probability of diagnosing CHE through the PHES test.

RESUMO CONTEXTO: A encefalopatia hepática mínima (EHM) é uma complicação neuro-psiquiátrica da cirrose cuja detecção é dificultada pela falta de ferramentas práticas. O Stroop EncephalApp é um aplicativo de smartphones capaz de detectar a doença, entretanto sua aplicabilidade na população brasileira ainda não é conhecida. OBJETIVO: Avaliar o uso do Stroop EncephalApp para diagnóstico e avaliação de EHM em uma população de pacientes cirróticos no Brasil. MÉTODOS: Através de um estudo observacional transversal, 99 indivíduos sabidamente cirróticos foram recrutados do ambulatório de hepatologia de um hospital privado em Curitiba/PR. Primeiramente, foram aplicados o mini exame do estado mental (MEEM) para excluir indivíduos com demência; após, foram aplicados o Escore Psicométrico da Encefalopatia Hepática (PHES), atual padrão-ouro para diagnóstico de EHM, e posteriormente o Stroop EncephalApp, ajustando para idade, sexo e anos de formação acadêmica, buscando avaliar a eficiência do aplicativo em detectar a doença e comparar seus resultados com o atual padrão-ouro. Foram excluídos do estudo indivíduos com demência, pontuação insuficiente no MEEM, analfabetos, daltônicos, e com histórico de abuso de álcool/drogas ilícitas nos últimos 3 meses e paciente com episódios prévios ou atuais de encefalopatia hepática. A análise estatística foi realizada pelo SPSS 2.0 e a significância adotada em 5%. RESULTADOS: Um total de 82 indivíduos foram incluídos na análise final. Destes, 29 foram diagnosticados com EHM (35,36% de prevalência) através do PHES e 28 obtiveram o mesmo resultado após a aplicação do Stroop (96,6% de sensibilidade). Cinquenta e três pacientes obtiveram um resultado negativo para EHM através do PHES, sendo que 27 desses obtiveram um resultado positivo para EHM através do Stroop. Na análise multivariada, níveis elevados de escolaridade estiveram associados com melhor desempenho durante a execução dos testes. Não houve associação significativa entre idade e sexo com a probabilidade de apresentar encefalopatia através do PHES. CONCLUSÃO: O Stroop EncephalApp é uma ferramenta viável e com boa sensibilidade para o screening de EHM, mas possui baixa especificidade na população estudada.

USE OF THE STROOP ENCEPHALAPP FOR COVERT HEPATIC ENCEPHALOPATHY SCREENING IN CIRRHOTIC PATIENTS IN SOUTHERN BRAZIL.

BACKGROUND: Covert hepatic encephalopathy (CHE) is difficult to detect due to the lack of easily applicable screening tools. The Stroop EncephalApp is a smartphone application already validated for CHE screening. However, its applicability to the Brazilian population is not known. OBJECTIVE: To estimate the prevalence of CHE and evaluate the use of Stroop EncephalApp in a cirrhotic population in Brazil. METHODS: In this cross-sectional study, we evaluated 99 patients previously diagnosed with liver cirrhosis in a Private Hospital in Curitiba/PR. Patients were initially submitted to the mini mental state examination (MMSE) to exclude individuals with dementia. After, the Psychometric Hepatic Encephalopathy Score (PHES) test was performed and lastly, the Stroop EncephalApp test. Results were adjusted for age, sex and education levels to evaluate the accuracy of the app on detecting the disease, comparing its results with the gold standard method (PHES). Patients with one or more of the following were excluded: dementia, inadequate MMSE score, illiteracy, color blindness, history of drugs/alcohol abuse within the past 3 months and previous or actual episodes of encephalopathy. The statistical analysis was performed by SPSS 2.0 and the significance adopted by 5%. RESULTS: We included 82 individuals in the final analysis. Among these patients, 29 were diagnosed with CHE by the PHES test (35.36% prevalence) and 28 of those obtained equal diagnosis by the Stroop EncephalApp (96.6% sensitivity). A total of 53 patients obtained negative results for CHE by PHES, while the Stroop test classified 27 of them as having the disease. In the multivariate analysis, high levels of education were associated with better performance during the tests. No significant relationship was observed between age and sex with the probability of diagnosing CHE through the PHES test.

Uso do Princípio de Mitrofanoff com Técnica de Yang-Monti para Derivação Urinária: Relato em Paciente Jovem / Use of the mitrofanoff principle and Yang-Monti Technique for urinary diversion in a young patiente: case report

Objetivo: relatar o caso de uma paciente submetida a cirurgia de derivação urinária utilizando o princípio de Mitrofanoff com a técnica de Yang-Monti. Caso clínico: paciente, feminino, 26 anos, apresentou- -se com queixas de dor para realização de sondagem vesical por sequela de bexiga neurogênica subsequente a ressecção prévia de tumor medular. Após falha medicamentosa, decidiu-se pela urostomia a fim de formar um conduto cateterizável no abdome, seguindo o princípio de Mitrofanoff. Durante o ato cirúrgico, houve aposição do apêndice cecal na cúpula da bexiga objetivando anastomosar sua extremidade distal na cicatriz umbilical. Entretanto, devido à sua falta de comprimento, optou-se por alongar o conduto com um segmento intestinal remodelado pela técnica de Yang-Monti. Comentários: o princípio de Mitrofanoff com a técnica de Yang-Monti, utilizando segmentos intestinais remodelados devido à incompatibilidade do apêndice cecal, demonstrou-se segura e efetiva para o tratamento da incontinência urinária.

Objective: To report the case of a patient submitted to a urinary diversion surgery using the Mitrofanoff principle with the Yang-Monti technique. Clinical case: A 26-years-old patient presented with complaints of pain for bladder catheterization due to a neurogenic bladder sequel after previous spinal tumor resection. After drug-therapy failure, urostomy was decided to form a catheterizable conduit in the abdomen, using the Mitrofanoff principle. During the surgical procedure, the appendix of the cecal was affixed to the dome of the bladder in order to anastomosis its distal part to the umbilical scar. However, due to its lack of length, it was decided to lengthen the conduit with an intestinal segment remodeled by the Yang-Monti technique. Comments: The Mitrofanoff principle associated to the Yang-Monti technique using remodeled intestinal segments, due to the incompatibility of the cecal appendix, proved to be a safe and effective procedure for the treatment of urinary incontinence.