Low Inflammatory Stimulus Increases D2 Activity and Modulates Thyroid Hormone Metabolism during Myogenesis In Vitro.

Thyroid hormone (TH) signaling controls muscle progenitor cells differentiation. However, inflammation can alter muscle TH signaling by modulating the expression of TH transporters (Slc16a2), receptors (Thra1), and deiodinase enzymes (Dio2 and Dio3). Thus, a proinflammatory environment could affect myogenesis. The role of a low-grade inflammatory milieu in TH signaling during myogenesis needs further investigation. Herein, we aimed to study the impact of the bacterial lipopolysaccharide (LPS)-induced inflammatory stimulus on the TH signaling during myogenesis. C2C12 myoblasts differentiation was induced without (CTR) or with 10 ng/mL LPS presence. The myoblasts under LPS stimulus release the proinflammatory cytokines (IL-6 and IL-1ß) and chemokines (CCL2 and CXCL-1). LPS decreases Myod1 expression by 28% during the initial myogenesis, thus reducing the myogenic stimulus. At the same time, LPS reduced the expression of Dio2 by 41% but doubled the D2 enzymatic activity. The late differentiation was not affected by inflammatory milieu, which only increased the Slc16a2 gene expression by 38%. LPS altered the intracellular metabolism of TH and reduced the initial myogenic stimulus. However, it did not affect late differentiation. Increased intracellular TH activation may be the compensatory pathway involved in the recovery of myogenic differentiation under a low-grade inflammatory milieu.

Inhibition of extracellular traps by spores of Trichoderma stromaticum on neutrophils obtained from human peripheral blood.

Although the genus Trichoderma is widely used as a biocontrol agent in crops, little is known about its potential impact on the human immune system. In mice, our group has shown that exposition to T. asperelloides spores lead to reduced neutrophil counts in the peripheral blood and in the peritoneal cavity. In addition, T. stromaticum spores produced an inflammatory infiltrate on mice lungs, reducing the levels of IFN-γ and IL-10 cytokines, reactive oxygen species, and receptors of microbial patterns. Here we demonstrate that the interaction of human peripheral neutrophils with T. stromaticum spores also leads to a reduced release of neutrophil extracellular traps (NETs) after induction with the NET-inducer agent phorbol 12-myristate 13-acetate. This interaction also reduced the expression levels of multiple microRNAs, such as miR-221, miR-222, miR-223 and miR-27a, as well as genes related to NETs, such as ELANE, MPO and PADI4. Furthermore, T. stromaticum spores affected the expression of the genes SOCS3, TLR4, CSNK2A1, GSDMD, and NFFKBIA, related to the activation of inflammatory immune responses in neutrophils. Overall, our results suggest T. stromaticum as a potential NET inhibitor and as an immunomodulatory agent. Since this fungus is used as biocontrol in crops, our findings point to the importance of advancing our knowledge on the effects of this bioagent on the human immune system. Finally, the study of the active compounds produced by the fungus is also important for the prospection of new drugs that could be used to block the exacerbation of inflammatory immune responses present in several human diseases.

Incidência de reações adversas associadas ao uso de inibidores de calcineurina em pacientes submetidos ao transplante pulmonar / Incidence of adverse reactions associated with the use of calcineurin inhibitors in patients undergoing lung transplantation

Introdução: O uso de terapia imunossupressora é de extrema importância no transplante pulmonar, entretanto existem diversas reações adversas (RAMs) associadas ao seu uso. Neste trabalho buscamos descrever a incidência de perda de função renal (FR), diabetes mellitus (DM), hipertensão arterial sistêmica (HAS) e hipercolesterolemia associadas ao uso de ICN na população de transplantados pulmonares do Hospital de Clínicas de Porto Alegre após 1 ano de transplante.Metodologia: Estudo de coorte retrospectivo, conduzido no Hospital de Clínicas de Porto Alegre. Foram incluídos os pacientes transplantados de pulmão no período de 2016 a 2018.Resultados: Após um ano do transplante 56,5% (13/23) tiveram uma perda de FR em comparação ao basal, mas com valores ainda dentro da normalidade e 30,4% (7/23) perderam FR. A diferença de FR antes e após o transplante foi estatisticamente significativa com p < 0,001, no entanto não foi observado diferença entre os ICN (p = 0,499). Entre as variáveis: DM, HAS e Hipercolesterolemia, apenas o desenvolvimento de HAS foi estaticamente significativo quando comparado ao período pré-transplante (p < 0,001).Conclusão: Nossos dados demonstraram importante perda de FR após uso de imunossupressores ICN, corroborando com dados já publicados, no entanto, não foi possível identificar associação com ICN específico, sugerindo que benefícios na intercambialidade de terapias entre os ICN na tentativa de preservação da FR devem ser melhor estudados. Diante da possibilidade de desenvolvimento de RAMs associadas ao uso de imunossupressores, destacamos a importância da inserção do farmacêutico clínico nas equipes de transplante.

Introduction: Immunosuppressive therapy is extremely important in lung transplantation, but there are several adverse drug reactions (ADRs) associated with its use.Objective: To report the incidence of loss of renal function (RF), diabetes mellitus (DM), systemic arterial hypertension (SAH), and hypercholesterolemia associated with the use of calcineurin inhibitors (CNIs) in the population of lung transplant recipients at Hospital de Clínicas de Porto Alegre at 1 year after transplant. Methods: We conducted a retrospective cohort study of patients undergoing a lung transplant at Hospital de Clínicas de Porto Alegre from 2016 to 2018.Results: At 1 year after transplant, 56.5% (13/23) had loss of RF compared with baseline, but the values remained within the normal range, whereas 30.4% (7/23) had complete loss of RF. There was a statistically significant difference in RF before and after transplant (p < 0.001), but not in CNIs (p = 0.499). Among the variables DM, SAH, and hypercholesterolemia, only the development of SAH was statistically significant compared with the pre-transplant period (p < 0.001).Conclusion: Our data demonstrated an important loss of RF after the use of CNI immunosuppressants, which is consistent with published data. However, no association was identified with the type of CNI, suggesting that the benefits of the interchangeability of CNI therapies aimed at preserving RF should be further studied. Given the potential occurrence of ADRs associated with the use of immunosuppressants, we highlight the importance of the presence of a clinical pharmacist in the transplant team.

Sepsis Disrupts Mitochondrial Function and Diaphragm Morphology.

BACKGROUND: The diaphragm is the primary muscle of inspiration, and its dysfunction is frequent during sepsis. However, the mechanisms associated with sepsis and diaphragm dysfunction are not well understood. In this study, we evaluated the morphophysiological changes of the mitochondrial diaphragm 5 days after sepsis induction. METHODS: Male C57Bl/6 mice were divided into two groups, namely, cecal ligation and puncture (CLP, n = 26) and sham-operated (n = 19). Mice received antibiotic treatment 8 h after surgery and then every 24 h until 5 days after surgery when mice were euthanized and the diaphragms were collected. Also, diaphragm function was evaluated in vivo by ultrasound 120 h after CLP. The tissue fiber profile was evaluated by the expression of myosin heavy chain and SERCA gene by qPCR and myosin protein by using Western blot. The Myod1 and Myog expressions were evaluated by using qPCR. Diaphragm ultrastructure was assessed by electron microscopy, and mitochondrial physiology was investigated by high-resolution respirometry, Western blot, and qPCR. RESULTS: Cecal ligation and puncture mice developed moderated sepsis, with a 74% survivor rate at 120 h. The diaphragm mass did not change in CLP mice compared with control, but we observed sarcomeric disorganization and increased muscle thickness (38%) during inspiration and expiration (21%). Septic diaphragm showed a reduction in fiber myosin type I and IIb mRNA expression by 50% but an increase in MyHC I and IIb protein levels compared with the sham mice. Total and healthy mitochondria were reduced by 30% in septic mice, which may be associated with a 50% decrease in Ppargc1a (encoding PGC1a) and Opa1 (mitochondria fusion marker) expressions in the septic diaphragm. The small and non-functional OPA1 isoform also increased 70% in the septic diaphragm. These data suggest an imbalance in mitochondrial function. In fact, we observed downregulation of all respiratory chain complexes mRNA expression, decreased complex III and IV protein levels, and reduced oxygen consumption associated with ADP phosphorylation (36%) in CLP mice. Additionally, the septic diaphragm increased proton leak and downregulated Sod2 by 70%. CONCLUSION: The current model of sepsis induced diaphragm morphological changes, increased mitochondrial damage, and induced functional impairment. Thus, diaphragm damage during sepsis seems to be associated with mitochondrial dysfunction.

Sequential therapies for advanced urothelial cancer: Hope meets new challenges.

A dramatic change in the treatment of advanced urothelial carcinomas (UC) occurred in the last 3 years, initially with the development of several check-point inhibitors, for second and first-line therapy. More recently, the approval of anti-FGFR (Fibroblast Growth Factor Receptor) and anti-nectin-4 inhibitors based on phase 2 studies in refractory disease, and the preliminary results of 3 randomized phase 3 trials combining chemotherapy and immunotherapy in first-line as well as using maintenance immunotherapy after chemotherapy induction, created a new paradigm in the treatment of metastatic disease. In this review, we will explore the new classes of agents and how they could be incorporated in the clinical practice as well as the results of recently presented randomized studies, guiding oncologists on the possible sequences for patients with advanced urothelial carcinoma.

Characterization of a protein with unknown function (LinJ.30.3360) in Leishmania amazonensis and Leishmania infantum.

Leishmaniasis is a disease caused by trypanosomatid protozoa of the genus Leishmania. In the Americas, the species Leishmania amazonensis is predominantly associated with American cutaneous leishmaniasis (ACL) while L. infantum is an agent of visceral leishmaniasis (VL). The genome sequences of Leishmania spp. have shown that each genome can contain about 8000 genes encoding proteins, more than half of which have an unknown function (''hypotheticals") at the time of publication. To understand the biology and genome of the organisms, it is important to discover the function of these "hypothetical" proteins; however, few studies have focused on their characterizations. Previously, LinJ.30.3360 (a protein with unknown function) was identified as immunogenic to canine serum with VL and a good antigen to diagnose the visceral form in dogs. Here, we show that the LinJ.30.3360 protein is conserved in L. infantum, L. tarantolae, L. donovani, L. major, L. mexicana, L. braziliensis, L. panamensis, Leptomonas pyrrhocoris, and Leptomonas seymouri. It has been annotated as a MORN (Membrane Occupation and Recognition Nexus) domain protein. However, since the function of this motif is unknown, functional inferences based on the primary sequence are not possible. The protein has a folded ß-leaf secondary structure, and phosphorylation was the only post-translational modification (PTM) found using prediction approach. Experiments have shown that it is located close to the flagellar pocket and presents similar abundance in both L. amazonensis and L. infantum. Furthermore, because it is a conserved protein in trypanosomatids but not in mammals and also because of its antigenicity, LinJ.30.3360 may constitute a potential drug target and/or vaccine for leishmaniasis.

Hipnose no controle do medo e da ansiedade em odontopediatria: revisão integrativa da literatura / Hypnosis in the control of pain and anxiety in pediatric dentistry: an integrative literature review

Objetivo: Analisar a literatura científica acerca da eficácia da hipnose como técnica de gestão comportamental para reduzir a dor e/ou a ansiedade no tratamento odontopediátrico. Metodologia: A partir da pergunta norteadora "Qual é a efetividade da hipnose no manejo comportamental de crianças durante o tratamento odontológico?", foi realizada uma busca nas bases de dados BVS, Cochrane Library, Google Acadêmico e PubMed, seguindo uma estratégia de combinação das palavras-chave "Odontopediatria" (Pediatric Dentistry), "Hipnose em Odontologia" (Hypnosis, Dental) e "Ansiedade ao tratamento odontológico" (Dental Anxiety). Não houve restrição com relação ao ano de publicação, idioma ou local em que o estudo foi realizado. A seleção dos estudos foi realizada em três etapas: por meio do processo de leitura dos títulos e resumos, exclusão de artigos duplicados e obtenção e leitura dos artigos completos selecionados. Resultados: De um total de 40 artigos encontrados, quatro foram selecionados, sendo incluídos manualmente mais dois numa busca manual nas referências dos artigos identificados e optou-se por acrescentar duas pesquisas. Desta forma, as referências dos artigos selecionados tornaram-se fontes de identificação de novos artigos, após conferência da lista de referências dos artigos incluídos, totalizando seis artigos analisados. Essas pesquisas foram conduzidas em diversos países como México, Índia, França, Turquia e Estados Unidos. Trezentas e quarenta e uma crianças foram analisadas, com idade variando de quatro a 16 anos. A hipnose, na maioria das pesquisas, foi avaliada antes e durante o procedimento odontológico anestésico local. A frequência cardíaca e a saturação de oxigênio foram medidas utilizadas para avaliar a ansiedade dos pacientes e a resistência física, entre outras ferramentas, foi utilizada para avaliar a dor em três pesquisas. Conclusão: A hipnose diminuiu significativamente a frequência cardíaca, a resistência física (principalmente o choro), a ansiedade e a dor em procedimentos de injeção anestésica local, e aumentou significativamente a cooperação dos pacientes Odontopediátricos, no entanto são necessários mais estudos randomizados sobre esse tema, com padronização metodológica, considerando o alto risco de viés encontrado nas pesquisas.

Aim: To analyze the scientific literature about the effectiveness of hypnosis as a behavior-al management technique used to reduce pain and/or anxiety in the pediatric treatment. Methods: Based on the guiding question "What is the effectiveness of hypnosis in the man-agement of children's behavior during dental treatment?", a bibliographic search was car-ried out on the BVS, Cochrane Library, Google Scholar, and PubMed databases by com-bining the keywords "Pediatric Dentistry", "Hypnosis, Dental", and "Dental Anxiety". There was no restriction concerning year of publication, language, or place. The selection of studies was carried out in three stages: through the process of reading the titles and ab-stracts, by excluding duplicate articles, and obtaining and reading the selected full articles. Results: Out of 40 articles found, we selected four. Two articles were then included manu-ally, totaling six articles.The surveys were conducted in several countries, such as Mexico, India, France, Turkey, and the United States. Three hundred and forty-one children, aged from four to 16 years old, were analyzed. Hypnosis, in most studies, was assessed before and during the local anesthetic dental procedure. Heart rate and oxygen saturation were used to assess patients' anxiety, and physical resistance, among other tools, was used to as-sess pain in three studies. Conclusion: Hypnosis significantly reduced heart rate, physical resistance (mainly crying), anxiety, and pain in local anesthetic injection procedures. Also, it significantly increased the cooperation of pediatric patients; however, more randomized studies on this topic, with methodological standardization, are necessary considering the high risk of bias found in the studies.

Sepsis Impairs Thyroid Hormone Signaling and Mitochondrial Function in the Mouse Diaphragm.

Background: Sepsis can cause the nonthyroidal illness syndrome (NTIS), resulting in perturbed thyroid hormone (TH) signaling and reduced thyroxine (T4) levels. TH is a major regulator of muscle function, via its influence on mitochondria. This study aimed at evaluating the relationship between TH signaling, mitochondrial function, and the antioxidant defense system in the diaphragms of septic mice. Methods: Male C57Bl/6 mice were divided into two groups: cecal ligation and puncture (CLP) and sham. Twenty-four hours after surgery, plasma, diaphragms, and livers were collected. TH metabolism and responses were analyzed by measuring messenger RNA (mRNA) expression of Dio1 in the liver, and Thra, Thrb, Dio2, Slc16a10, and Slc16a2 (encodes MCT 10 and 8), in the diaphragm. T4 plasma levels were measured by radioimmunoassay. Damage to diaphragm mitochondria was assessed by electron microscopy and real-time polymerase chain reaction (qPCR), and function with oxygraphy. The diaphragm antioxidative defense system was examined by qPCR, analyzing superoxide dismutase (SOD) 1 (Sod1), mitochondrial superoxide dismutase (SOD 2; Sod2), extracellular superoxide dismutase (SOD 3; Sod3), glutathione peroxidase 1 (Gpx1), and catalase (Cat) expression. The effect of TH replacement was tested by treating the mice with T4 and triiodothyronine (T3) (CLP+TH) after surgery. Results: CLP mice presented reduced total plasma T4 concentrations, downregulated Dio1, and upregulated Il1b mRNA expression in the liver. CLP mice also displayed downregulated Thra, Thrb, Slc16a10, and Slc16a2 expression in the diaphragm, suggesting that TH signaling was compromised. The expression of Ppargc1a (encoding PGC1a) was downregulated, which correlated with the decrease in the number of total mitochondria, increase in the percentage of injured mitochondria, downregulation of respiratory chain complex 2 and 3 mRNA expression, and reduced maximal respiration. In addition, septic animals presented a three-fold increase in Ucp3 and G6pdh expression; downregulated Sod3, Gpx1, and Cat expression; and upregulated Sod2 expression, potentially due to elevated reactive oxygen species levels. The mitochondrial number and the percentage of injured mitochondrial were similar between sham and CLP+TH mice. Conclusions: Sepsis induced responses consistent with NTIS, resulted in mitochondrial damage and functional impairment, and modulated the expression of key antioxidant enzymes in the diaphragm. Thus, impaired diaphragm function during sepsis seems to involve altered local TH signaling, mitochondrial dysfunction, and oxidative stress defense.

Measuring Intracellular Vesicle Density and Dispersion Using Fluorescence Microscopy and ImageJ/FIJI.

Cell signalling, cell secretion, and plasma membrane repair are processes that critically rely on intracellular vesicles, important components of the endocytic and secretory pathways. More specifically, the strategic distribution of intracellular vesicles is important for diverse cellular processes. The method presented here is a simple, affordable, and efficient tool to analyze the distribution of intracellular vesicles such as lysosomes, endosomes, Golgi vesicles or secretory granules under different experimental conditions. The method is an accessible way to analyze the density and dispersion of intracellular vesicles by combining immunofluorescence with pixel-based quantification software (e.g., ImageJ/FIJI). This protocol can be used widely within the scientific community because it utilizes ImageJ/FIJI, an open source software that is free. By tracking fluorescent vesicles based on their position relative to cell nuclei we are able to quantify and analyze their distribution throughout the cell.

Qualidade de vida de familiares/cuidadores de pessoas idosas com alzheimer: contribuição do grupo de apoio / Quality of life of family members/caregivers of elderly people bearing alzheimer's disease: support group contribution / Calidad de vida de familiares/cuidadores de personas idosas con alzheimer: contribución del grupo de apoyo

Analisar a qualidade de vida de familiares/cuidadores de pessoas idosas com doença de Alzheimer e a influência do grupo Assistência Multidisciplinar aos cuidadores de pessoas com a doença de Alzheimer neste processo. Método: Estudo qualitativo, exploratório-descritivo, realizado com seis familiares/cuidadores, participantes do grupo. Os dados coletados, entre abril a maio de 2016, através do grupo focal, questionário semiestruturado e pela avaliação do questionário de qualidade de vida, foram submetidos a análise de conteúdo. Resultados: Emergiram duas categorias: Grupo AMICA: compartilhamento de saberes e vivências em prol da qualidade de vida; Grupo AMICA: (re)pensar no cotidiano, auxiliar na qualidade de vida. Os dados objetivos, foram apresentados em duas tabelas e apontaram como fatores mais prejudicados: Limitações por aspectos físicos, emocionais e vitalidade. Conclusões: O grupo Assistência Multidisciplinar aos cuidadores de pessoas com a doença de Alzheimer tem significativa relevância e influência sobre a qualidade de vida dos familiares/cuidadores participantes

Objective: The study's main purpose has been to analyze the QOL of family members/caregivers of elderly people bearing Alzheimer's disease, as well as to assess during this process the influence of the group named Integrated Multidisciplinary Assistance to Caregivers of people bearing Alzheimer's disease (IMACA). Methods: It is a descriptive-exploratory study with a qualitative approach that was performed with six family members/caregivers, who were participants in the aforementioned group. Data collection took place from April to May 2016, through data sharing between the focus group, semi-structured questionnaire and the assessment of the 36-Item Short Form Health Survey questionnaire (SF-36) for quality of life. Results: The independent data were subjected to content analysis resulting in two categories, as follows: IMACA group: sharing knowledge and experiences in favor of the quality of life; IMACA group: (re)thinking about everyday life, helping with the quality of life. By analyzing the SF-36 evaluation scale, the found objective data pointed out the following factors as the most impaired ones: Limitations due to physical, emotional and vital aspects. Conclusions: It was possible to observe that the Integrated Multidisciplinary Assistance to Caregivers of people bearing Alzheimer's disease has shown significant relevance and influence on the participating family members'/caregivers' quality of life

Objetivo: Analizar la calidad de vida de familiares / cuidadores de personas mayores con enfermedad de Alzheimer y la influencia del grupo Asistencia Multidisciplinar a los cuidadores de personas con la enfermedad de Alzheimer en este proceso. Método: Estudio cualitativo, exploratorio-descriptivo, realizado con seis familiares/cuidadores, participantes del grupo. Los datos fueron recolectados, entre los meses de abril y mayo de 2016, a través de la triangulación de las técnicas de grupo focal, cuestionario semiestructurado y por la evaluación del cuestionario de calidad de vida (SF-36). Resultados: Los datos subjetivos fueron sometidos a análisis de contenido resultando em dos categorías: Grupo AMICA: intercambio de saberes y vivencias en pro de la calidad de vida; Grupo AMICA: (re) pensar en lo cotidiano, auxiliar en la calidad de vida. Los datos objetivos, encontrados a través del análisis de la escala de evaluación SF-36, fueron presentados en dos tablas, y señalaron como factores más perjudicados: Limitaciones por aspectos físicos, emocionales y vitalidad. Conclusiones: Fue posible observar que el grupo Asistencia Multidisciplinar a los cuidadores de personas con la enfermedad de Alzheimer tiene significativa relevancia e influencia sobre la calidad de vida de los familiares/ cuidadores participantes

Leishmania amazonensis hijacks host cell lysosomes involved in plasma membrane repair to induce invasion in fibroblasts.

Intracellular parasites of the genus Leishmania are the causative agents of leishmaniasis. The disease is transmitted by the bite of a sand fly vector, which inoculates the parasite into the skin of mammalian hosts, including humans. During chronic infection the parasite lives and replicates inside phagocytic cells, notably the macrophages. An interesting, but overlooked finding, is that other cell types and even non-phagocytic cells have been found to be infected by Leishmania spp. Nevertheless, the mechanisms by which Leishmania invades such cells had not been previously studied. Here, we show that L. amazonensis can induce their own entry into fibroblasts independently of actin cytoskeleton activity, and, thus, through a mechanism that is distinct from phagocytosis. Invasion involves subversion of host cell functions, such as Ca2+ signaling and recruitment and exocytosis of host cell lysosomes involved in plasma membrane repair.This article has an associated First Person interview with the first author of the paper.

Thyroid Hormones Play Role in Sarcopenia and Myopathies.

Skeletal muscle maintains posture and enables movement by converting chemical energy into mechanical energy, further contributing to basal energy metabolism. Thyroid hormones (thyroxine, or T4, and triiodothyronine, or T3) participate in contractile function, metabolic processes, myogenesis and regeneration of skeletal muscle. T3 classically modulates gene expression after binding to thyroid hormone nuclear receptors. Thyroid hormone effects depend on nuclear receptor occupancy, which is directly related to intracellular T3 levels. Sarcolemmal thyroid hormone levels are regulated by their transport across the plasma membrane by specific transporters, as well as by the action of deiodinases types 2 and 3, which can activate or inactivate T4 and T3. Thyroid hormone level oscillations have been associated with the worsening of many myopathies such as myasthenia gravis, Duchenne muscular dystrophy (DMD) and rhabdomyolysis. During aging skeletal muscle show a decrease in mass and quality, known as sarcopenia. There is increasing evidence that thyroid hormones could have a role in the sarcopenic process. Therefore, in this review, we aim to discuss the main effects of thyroid hormones in skeletal muscular aging processes and myopathy-related pathologies.

Cotidiano de familiares/cuidadores de idosos com alzheimer: contribuições do grupo de apoio / Daily family members/caregiver with alzheimer: support group contributions

Objetivo: compreender a influência da Doença de Alzheimer no cotidiano dos familiares/cuidadores depessoas idosas e a contribuição do grupo Assistência Multidisciplinar Integrada aos Cuidadores de Pessoas coma Doença de Alzheimer. Método: estudo exploratório-descritivo, de abordagem qualitativa, realizado com seisfamiliares/cuidadores, participantes de um projeto de extensão, desenvolvido em uma instituição de ensinosuperior no Rio Grande do Sul, Brasil. Os dados foram coletados pela técnica de grupo focal, submetidos àTécnica de Análise de Conteúdo. Resultados: determinaram-se quatro categorias >; >; >; >.Conclusão: a Doença de Alzheimer é geradora de múltiplos sentimentos, sendo necessário buscar suporte eacolhimento nos grupos de apoio.

Cirrhotic Cardiomyopathy: Another Case of a Successful Approach to Treatment of Hepatorenal Syndrome.

Hepatorenal syndrome (HRS) is defined as a failure of renal function, potentially reversible, in patients with liver cirrhosis and ascites. Recently, a component of cardiomyopathy associated with HRS was described, but the use of positive inotropic medicine as part of the treatment of the acute phase has not been extensively evaluated. We report a second case in our hospital of a patient with HRS type I without previous heart disease, with secondary hemodynamic decompensation due to liver disease, in which the abnormalities in systolic function by speckle-tracking echocardiography were observed and could be reversed by the use of inotropes. After partial response to current therapies, the patient presented a clinical and laboratorial response with improvement of renal function after infusion of dobutamine. Clinical studies are needed for the therapy approach to HRS taking into account myocardial dysfunction as a major contributing factor for renal dysfunction.