[Urinary ascites, uroperitoneum and urinary peritonitis in children: management of nine case reports in Madagascar]. / Ascite urinaire, uropéritoine et péritonite urinaire chez l'enfant : conduite diagnostique et thérapeutique à propos de neuf observations à Madagascar.

OBJECTIVE: To evaluate the frequency of urinary peritonitis in children and to highlight its terms of management in a country with limited resources. PATIENTS AND METHODS: We retrospectively observed nine case reports of urinary peritonitis collected in surgical reanimation service at the CHU of Antananarivo, from 1st January 2009 to 31 December 2012. RESULTS: Urinary peritonitis accounts 0.5% of all pediatric abdominal emergencies and 5% of pediatric urological emergencies collected in our service during study period. Three etiologies were traumatic bladder rupture, one bladder iatrogenic rupture, four secondary to obstructive uropathy and one other after cystolithotomy. We found a new case of posttraumatic transverse rupture of the bladder neck. Among obstructive uropathy observed, there were two cases of posterior urethral valves and two cases of ureteralpelvic junction obstruction. Clinical expression was dominated by fever, with abdominal distention and defense. In majority of cases, etiological diagnosis was made intraoperatively. The surgical treatment by laparotomy was performed under cover of systemic antibiotic therapy. Evolution was complicated with sepsis in three cases and acute renal failure in both cases. Surgical follow-up without complication were observed in four cases. A child has died to septic shock and multivisceral failure. CONCLUSION: Unlike urinary ascites resulting a transperitoneal extravasation of urine, uroperitoneum was a fistula between adominal cavity and content of the urinary tract. Urinary ascites was a rare cause of peritonitis. In contrast, uroperitoneum caused peritonitis quickly. Urinary peritonitis was a rare entity but severe prognosis in children. In majority of cases, etiological diagnosis was made intraoperatively.

[Biliary peritonitis: diagnostic and therapeutic aspects]. / Les péritonites biliaires : aspects diagnostiques et thérapeutiques.

AIMS: The aim was to describe the diagnostic and therapeutic aspects of biliary peritonitis. PATIENTS AND METHODS: This was a descriptive cross-sectional study with retrospective collection over a period of 10 years including patients operated on for biliary peritonitis. RESULTS: We collected 10 cases of biliary peritonitis with an average age of 38 years with a sex ratio of 2.3. Two patients presented with an abdominal contusion following a road traffic accident. Maximum abdominal pain in the right hypochondrium was present in three patients, signs of peritoneal irritation in all patients, positive Widal and Felix serodiagnosis in eight patients. At midline laparotomy, the gallbladder was perforated in three patients, gangrenous in five, phlegmonous in one, sclero-atrophic in one. Cholecystectomy was performed in all patients. Biliary peritonitis was of traumatic origin in two patients, and typhoid in eight. Postoperatively, there were four cases of sepsis and three cases of parietal suppuration. Three patients died. CONCLUSION: Biliary peritonitis discovered during laparotomies for peritonitis, was secondary to typhoid cholecystitis, and had a high morbidity and mortality.

BUTS: Le but était de décrire les aspects diagnostiques et thérapeutiques des péritonites biliaires. PATIENTS ET MÉTHODES: Il s'est agi d'une étude transversale descriptive à collecte rétrospective sur une période de 10 ans incluant les patients opérés pour péritonite biliaire. RÉSULTATS: Nous avons colligé 10 cas de péritonite biliaire d'un 'âge moyen de 38 ans avec un sex-ratio de 2,3. Deux patients présentaient une contusion abdominale par suite d'un accident de la circulation routière. Une douleur abdominale maximale à l'hypochondre droit était présente chez trois patients, des signes d'irritation péritonéale chez tous les patients, un sérodiagnostic de Widal et Félix positif chez huit patients. À la laparotomie médiane la vésicule biliaire était perforée chez trois patients, gangrénée chez cinq, phlegmoneuse chez un, scléro-atrophique chez un. La cholécystectomie a été réalisée chez tous les patients. La péritonite biliaire était d'origine traumatique chez deux patients, et typhique chez huit. En post opératoire on notait quatre cas de sepsis, et trois cas de suppuration pariétale. Trois patients sont décédés. CONCLUSION: les péritonites biliaires découvertes lors de laparotomies pour péritonite, étaient secondaires à des cholécystites typhiques, et avaient une forte morbi-mortalité.

[Negative impact of COVID-19 pandemic on peritonitis rate in peritoneal dialysis patients: Pleading for a continuous educational training]. / Conséquences de la pandémie de COVID-19 sur le taux de péritonites de dialyse péritonéale : plaidoyer pour une formation continue ininterrompue.

BACKGROUND: Peritonitis is a common complication of chronic peritoneal dialysis treatment contributing to both technique failure and/or death. Little is effectively known about the actual benefits of a continuous training program on peritonitis rates. In the present study, we measured the impact of our patients' training protocol on peritonitis rates. We further studied which consequences the COVID-related disruption of our follow-up program had on peritonitis rates. METHODS: We present our yearly peritonitis rates since our patients' training and retraining program was implemented in 2010. We then focused our study on three consecutive years: 2019, 2020 (emergence of COVID-19), and 2021, collecting microbiological data from each peritonitis episode. Statistical analysis were used to corroborate our findings. RESULTS: Since 2010, peritonitis rates declined linearly (R2=0,6556; df=8; P<0.01) until its nadir in 2019 with 4 peritonitis episodes. The majority of infections were then treated in the outpatient Clinic. In 2020, our continuous technique evaluation decreased by 51% and 28 peritonitis episodes occurred, 47% secondary to strict cutaneous bacteria's, and 31% gastro-intestinal, irrespective of patients' experience or peritoneal dialysis modality. The hospitalization rate reached 71%. Having restored our protocol, we decreased peritonitis rates by 50% in 2021. CONCLUSIONS: Risk factors for peritonitis are identifiable and modifiable and require sustained intervention, continuous visual monitoring and training. These interventions significantly reduce peritonitis rates. Any brief interruption to patients' technique evaluation may elevate peritonitis rates significantly.

Mycobacterium fortuitum peritoneal dialysis-related peritonitis in a child: A case report and review of the literature.

BACKGROUND: Non-tuberculous mycobacteria (NTM) are an uncommon but serious cause of peritoneal dialysis (PD)-related infections. NTM peritonitis typically necessitates PD catheter removal, PD withdrawal, and aggressive, prolonged antimicrobial treatment. Few reported cases of NTM peritonitis in the pediatric population exist. METHODS: We describe a case of a 9-year-old boy on PD after kidney allograft failure who developed Mycobacterium fortuitum peritonitis, and we summarize the available literature on M. fortuitum peritonitis in pediatric patients receiving PD. RESULTS AND CONCLUSION: Therapeutic options were limited by adverse medication effects and risk of drug-drug interactions in a patient with complex mental health comorbidities. Clofazimine presented an acceptable oral treatment option for long-term therapy in combination with ciprofloxacin and was well tolerated by this patient. Prompt PD catheter removal followed by 6 months of dual antimicrobial therapy resulted in a full recovery and successful re-transplantation with no infection relapse.

HISTORIQUE: Les mycobactéries non tuberculeuses (MNT) sont une cause courante, mais peu fréquente, d'infections causées par la dialyse péritonéale (DP). En général, la péritonite à MNT nécessite le retrait du cathéter à DP, le retrait de la DP et un traitement antimicrobien prolongé et énergique de la DP. Il y a quelques cas déclarés de péritonite à MNT dans la population pédiatrique. MÉTHODOLOGIE: Les auteurs décrivent le cas d'un garçon de neuf ans sous DP à cause de l'insuffisance d'une allogreffe rénale et qui est atteint d'une péritonite à Mycobacterium fortuitum, et ils résument le contenu des publications scientifiques sur la péritonite à M. fortuitum chez les patients pédiatriques sous DP. RÉSULTATS ET CONCLUSION: Les possibilités thérapeutiques étaient limitées par les effets indésirables des médicaments et le risque d'interactions entre médicaments chez un patient ayant des morbidités complexes en santé mentale. La clofazimine était un traitement par voie orale acceptable pour un traitement à long terme combiné avec de la ciprofloxacine et était bien tolérée. Le retrait rapide du cathéter à DP suivi par six mois de bithérapie antimicrobienne a permis une pleine guérison et une nouvelle transplantation réussie, sans récidive de l'infection.

[Peritoneal dialysis catheter sterilization by urokinase administration in case of relapsing peritonitis: About four observations]. / Stérilisation du cathéter de dialyse péritonéale en cas de péritonite récidivante : intérêt de l'administration d'urokinase. À propos de quatre observations.

The presence of a biofilm within the peritoneal dialysis catheter where bacteria are encapsulated, protected from the action of antibiotics and insidiously liberated within the dialysate, best explains the relapse of the infectious peritonitis, when antibiotics are withdrawn. We here report a serie of four clinical cases in whom the administration of urokinase within the peritoneal catheter in addition to the current antibiotherapy, has cured relapsing peritonitis due to Staphylococcus epidermidis in two cases, Acinetobacterjohnsonii in one case and Staphylococcus haemolyticus in one case, respectively. This approach, safe and easy, allowed the infection eradication and did prevent a catheter removal and a potential transfer of the patients to hemodialysis.

[Surgical removal of an intraperitoneal foreign body in a Swiss Simmental cow with a magnet]. / Chirurgische Entfernung eines intra­peritonealen Fremdkörpers mittels eines Magneten bei einer Kuh der Rasse Swiss Fleckvieh.

INTRODUCTION: This case report describes the surgical removal of a foreign body from the abdominal cavity in a Swiss Simmental cow with a disinfected magnet. The procedure was performed from the right flank a few days after a ruminotomy. An inflamed connective tissue mass was found and prepared. Since manual palpation could not locate the foreign body, a disinfected magnet was inserted into the mass and a crooked, headless nail of 3 cm length was removed. Ten days postsurgical antimicrobial treatment was necessary due to the local peritonitis. The cow recovered well after the second surgery and showed very good eating and ruminating behavior.

INTRODUCTION: Ce rapport de cas décrit l'exérèse chirurgicale de la cavité abdominale d'un corps étranger qui avait traversé la paroi du réticulum à l'aide d'un aimant désinfecté chez une vache Simmental suisse. Cette procédure a été réalisée quelques jours après une ruminotomie et a été effectuée à partir du flanc droit. Pour pouvoir atteindre le corps étranger à éliminer, une masse inflammatoire riche en tissu conjonctif a dû être préparée. Comme la palpation manuelle en vue de trouver le corps étranger n'avait pas réussi, un aimant désinfecté a été inséré dans la masse décrite ci-dessus, ce qui a permis de retirer un clou d'environ 3 cm de long, tordu et sans tête. En postopératoire, l'animal a dû, en raison d'une péritonite locale, être maintenu sous antibiotiques pendant dix jours. La vache s'est bien rétablie après la deuxième opération et a montré un très bon comportement alimentaire et ruminatoire.

[Encapsulant peritonitis]. / Une péritonite encapsulante.

INTRODUCTION: Encapsulating peritonitis is a rare but severe chronic fibrotic condition related to the development of a white fibrous membrane surrounding the digestive tract. Idiopathic forms have been described, however the disease is most often secondary to peritoneal dialysis or more rarely to surgery. Treatment is difficult and not codified. CASE REPORT: We report here the observation of a 36-year-old patient whose diagnosis of encapsulating peritonitis was made after a long sub-occlusive history, eight years after a gastric ulcer perforation. DISCUSSION: We discuss the possible etiologies and we present a focus on this rare and little-known entity.

[Capnocytophaga spp. peritonitis in a peritoneal dialysis: A case report]. / Péritonite à Capnocytophaga spp. en dialyse péritonéale automatisée : à propos d'un cas.

INTRODUCTION: Capnocytophaga spp. is a slow-growing bacterium that forms a part of the normal oral flora of dogs and cats. In peritoneal dialysis, only seven cases have been reported. We report the observation of a case of peritonitis with Capnocytophaga spp. in a patient on peritoneal dialysis who lives with a cat. CASE REPORT: A 64-year-old woman with chronic end stage renal disease due to chronic interstitial nephropathy on automated peritoneal dialysis has been admitted for diffuse abdominal pain. The dialysis fluid was cloudy with 11,250 elements/mm3, of leukocytes. Direct examination was negative. The C-reactive protein was 165mg/L. Intraperitoneal probabilistic antibiotic therapy was initiated 1g of cefazolin and 1g of ceftazidime per day. After eight days, aerobic culture was negative, the anaerobic one was positive to gram negative bacilli, but the identification could not be possible with MALDI-TOF mass spectrometry. Antibiotic therapy was continued by ceftazidime for 21 days. The evolution was marked by the improvement of the clinical and biological state of the patient. The germ was finally identified using the genomic 16S rRNA sequencing technique. This is Capnocytophaga spp. Investigation then revealed that the patient's cat sometimes entered her room at the time of connection of peritoneal dialysis. CONCLUSION: The case of our patient once again reveals the diagnostic difficulties posed by Capnocytophaga spp. Innovative techniques, such as MALDI-TOF-MS or genomic sequencing of ribosomal RNA, should be further used in peritoneal dialysis in the diagnosis of peritonitis.

[Non-traumatic digestive perforation in Koutiala: epidemiological and therapeutic aspects]. / Perforation digestive non traumatique a Koutiala : aspects epidemio-cliniques et therapeutiques.

PURPOSE: the aim of this study was to evaluate the clinical and therapeutic aspects of non-traumatic digestive perforations at the Koutiala Reference Health Center. PATIENTS AND METHODS: This was a prospective and descriptive study from August 1, 2017 to December 31, 2018. Patients admitted and operated on for non-traumatic digestive perforation were included. The parameters studied were age, sex, frequency, clinical aspects, etiologies, treatment and operative follow-up. RESULT: Sixty-one patients were registered. Non-traumatic digestive perforations accounted for 78.2% of cases of acute peritonitis (n = 78). Men were in the majority with 73.8%. The average age was 34.5 years old. The symptomatology was represented by abdominal pain in all patients, vomiting in 56 patients and fever in 42 patients. The mean duration of evolution of the symptomatology was 5.5 days. On physical examination, the most common signs were abdominal contracture with 81.9%, disappearance of prehepatic maturation (52.4%) and pain in rectal examination (95.1%). Radiological pneumoperitoneum was found in 39 patients. The serodiagnosis of Widal was positive in 15 cases. The etiologies were dominated by perforation of infectious origin with 77.0% (46). The perforation was ileal in 28 patients, appendicular in 18 patients and gastroduodenal in 11 patients. Excision-suturing of the perforation was done in 30 patients, resection anastomosis in 8 patients and appendectomy in 18 patients. Morbidity and mortality were respectively 14.7% and 6.5%. CONCLUSION: Non-traumatic digestive perforations are the first cause of peritonitis in our department. The ileal seat is the most common and is most often secondary to typhoid fever. Morbidity and mortality remain high and this result is a reflection of late diagnosis which is the main factor of severity of digestive perforations.

BUT: Evaluer les aspects cliniques et thérapeutiques des perforations digestives non traumatiques au Centre de Santé de Référence de Koutiala. PATIENTS ET MÉTHODES: Il s'agissait d'une étude prospective et descriptive allant du 1erAoût 2017 au 31 décembre 2018. Les patients admis et opérés pour perforation digestive non traumatique étaient inclus. Les paramètres étudiés étaient l'âge, le sexe, la fréquence, les aspects cliniques, les étiologies, le traitement et les suites opératoires. RÉSULTAT: Soixante-un patients ont été enregistrés. Les perforations digestives non traumatiques ont représenté78,2% de causes de péritonite aigue (n=78). Les hommes étaient majoritaires avec 73,8%.L'âge moyen était de 34,5 ans. La symptomatologie était représentée par la douleur abdominale chez tous les patients, les vomissements chez 56 patients etla fièvre chez 42 patients. La durée moyenne d'évolution de la symptomatologie était de 5,5 jours. A l'examen physique, les signes les plus fréquents étaient la contracture abdominale avec 81,9%, la disparition de la matité pré hépatique (52,4%) et la douleur au toucher rectal (95,1%). Un pneumopéritoine radiologique a été trouvé chez 39 patients. Le sérodiagnostic de Widal était positif dans 15 cas. Les étiologies étaient dominées par la perforation d'origine infectieuseavec77,0% (46). La perforation était iléal chez 28 patients, appendiculaire chez 18 patients et gastroduodénale chez 11 patients. L'excision-suture de la perforation a été faite chez 30 patients, la résection anastomose chez 8 patients et l'appendicectomiechez18 patients. La morbidité et la mortalité ont été respectivement de 14,7%de 6,5%. CONCLUSION: Les perforations digestives non traumatiques sont la première cause de péritonite dans notre service. Le siège iléal est le plus fréquent et qui est secondaire le plus souvent à la fièvre typhoïde. La morbi-mortalité reste élever et ce résultat est le reflet du diagnostic tardif qui constitue le principal facteur de gravité des perforations digestives.

Clinical and laboratory findings in 60 cows with type-3 abomasal ulcer.

INTRODUCTION: This study involved 60 cows aged 1.9 to 13 years (mean 4.8 ± 2.3 years) with type-3 abomasal ulcer. The most common clinical signs were, in decreasing order of frequency, partial or complete anorexia (98%), obtunded demeanour (95%), decreased skin surface temperature (78%), congested scleral vessels (73%), abdominal guarding (61%), tachypnoea (58%), fever (58%) and tachycardia (55%). One or more concomitant disorders were diagnosed in 86% of the cows. The most common abnormal laboratory findings were hypokalaemia (75%), shortened glutaraldehyde test time (46%) and hyperfibrinogenaemia (43%). The diagnosis of type-3 abomasal ulcer was made in all cows during laparotomy and/or at postmortem examination. Forty-eight (80%) cows were euthanased immediately after the initial examination, during laparotomy or after unsuccessful treatment. Twelve (20%) cows were treated with a solution of sodium chloride and glucose administered via an indwelling jugular catheter, antibiotics, metamizole or flunixin, and discharged from the clinic. Ten cows were still in production two years later.

INTRODUCTION: Cette étude portait sur 60 vaches âgées de 1,9 à 13 ans (moyenne de 4,8 ± 2,3 ans) atteintes d'un ulcère de la caillette de type 3. Les signes cliniques les plus fréquents étaient, par ordre de fréquence décroissante, une anorexie partielle ou complète (98%), un comportement apathique (95%), une diminution de la température de la peau (78%), des vaisseaux scléraux congestionnés (73%), une défense abdominale (61%) de la tachypnée (58%), de la fièvre (58%) et tachycardie (55%). Un ou plusieurs troubles concomitants ont été diagnostiqués chez 86% des vaches. Les résultats de laboratoire anormaux les plus fréquents étaient une hypokaliémie (75%), une durée réduite du test du glutaraldéhyde (46%) et une hyperfibrinogénémie (43%). Le diagnostic d'ulcère de la caillette de type 3 a été posé chez toutes les vaches au cours d'une laparotomie et/ou lors de l'examen post mortem. Quarante-huit (80%) des vaches ont été euthanasiées immédiatement après l'examen initial, pendant la laparotomie ou après un traitement infructueux. Douze (20%) vaches ont été traitées avec une solution de chlorure de sodium et de glucose administrée via un cathéter jugulaire à demeure, des antibiotiques, du métamizole ou de la flunixine et ont quitté la clinique. Dix de ces vaches étaient encore en production deux ans plus tard.

[Type II Quadratus Lumborum block for a sub-total gastrectomy in a septic patient]. / Bloqueio do quadrado lombar tipo II para uma gastrectomia subtotal em um paciente séptico.

INTRODUCTION AND OBJECTIVES: Quadratus Lumborum block was recently described and has already shown good results as an analgesic technique in abdominal surgeries, having the potential to significantly reduce opioids consumption and be a valid alternative to epidural catheter. We performed a type II Quadratus Lumborum block for analgesia in a septic patient having a sub-total gastrectomy. CASE REPORT: An 80 year-old, ASA III, male patient, weighting 50kg, with a history of arterial hypertension and hypercholesterolemia, diagnosed with sepsis due to purulent peritonitis was submitted to an open laparotomy. Bilateral ultrasound-guided type II Quadratus Lumborum block was performed before surgery, using 10mL of levobupivacaine 0.25% and 5mL of mepivacaine 1%, per side. Pain relief was achieved 5minutes after injection and the patient referred no pain in the immediate postoperative period. DISCUSSION: Type II Quadratus Lumborum block may be considered a valid alternative for postoperative analgesia in a septic patient undergoing major abdominal surgery with some relative contraindications to epidural catheter placement. It allowed us to achieve excellent pain management avoiding opioids usage. However, more reports are still needed to properly access its usefulness.

Infectious and mechanical complications in planned-start vs. urgent-start peritoneal dialysis: a cohort study / Complicações infecciosas e mecânicas relacionadas à diálise peritoneal de início planejado vs. não planejado: um estudo de coorte

Abstract Background: Few studies have compared the infectious and mechanical complications seen in planned-start and urgent-start peritoneal dialysis (PD) patients. Objectives: To compare the incidence and etiology of mechanical and infectious complications in patients offered planned- and urgent-start PD and assess potential differences in patient survival and time on PD. Methods: This retrospective cohort study included patients with chronic kidney disease on planned- and urgent-start PD seen from 2014 to 2020 and compared them for mechanical and infectious complications, clinical outcome, death rates, and need to switch to hemodialysis. Results: Ninety-nine patients on planned-start PD and 206 on urgent-start PD were included. Incidence of exit-site infection (18.9 vs. 17.17%, p=0.71) and peritonitis (24.27 vs. 27.27%, p=0.57) were similar between patients, while pathogens causing peritonitis were different, although non-fermenting Gram-negative bacilli were more commonly seen in the planned-start PD group. Leakage as a mechanical complication and hospitalization were more common among patients needing urgent-start PD (10.68 vs. 2.02%, p=0.0085 and 35.44 vs. 17.17%, p=0.0011, respectively). Patient survival was similar between groups. Cox regression found an association between death and age (HR=1.051, 95% CI 1.026-1.07, p=0.0001) and albumin (HR=0.66, 95% CI 0.501-0.893, p=0.0064), and between peritonitis and a diagnosis of diabetes (HR=2.016, 95% CI 1.25-3.25, p=0.004). Conclusion: Patient survival and time on PD were similar between the planned- and urgent-start PD groups, while leakage was more frequently seen in the urgent-start PD group. Death was associated with lower albumin levels and older age, while peritonitis was associated with diabetes.

Resumo Antecedentes: Poucos estudos compararam as complicações infecciosas e mecânicas relacionadas à diálise peritoneal (DP) de início planejado e não planejado. Objetivos: Comparar a incidência e etiologia das complicações mecânicas e infecciosas associadas à DP tanto de início planejado quanto não planejado e avaliar comparativamente a sobrevida da técnica e dos pacientes. Métodos: Estudo de coorte retrospectivo que avaliou pacientes com doença renal crônica em DP não planejada e planejada de 2014 a 2020 quanto às complicações mecânicas e infecciosas e desfechos clínicos óbito ou mudança para hemodiálise. Resultados: Foram avaliados 99 pacientes em DP planejada e 206 em DP não planejada. Foram semelhantes quanto à incidência de Infecção do Orifício de Saída (18,9x17,17%, p=0,71), peritonite (24,27x27,27%, p=0,57) e diferentes quanto aos agentes etiológicos das peritonites, sendo os bacilos Gram-negativos não fermentadores mais frequentes no grupo planejado. Diferiram quanto à complicação mecânica extravasamento e internação, ambas mais frequentes no grupo não planejado (10,68 x 2,02%, p=0,0085 e 35,44 x 17,17%, p=0,0011, respectivamente). Semelhantes quanto à sobrevida dos pacientes e da técnica. À regressão de Cox, associou ao óbito a idade (HR=1,051, IC 95% 1,026-1,07, p=0,0001) e a albumina (HR=0,66, IC 95% 0,501-0,893, p=0,0064), e à peritonite a presença de diabetes (HR=2,016, IC 95% 1,25-3,25, p=0,004). Conclusão: A sobrevida da técnica e dos pacientes foi semelhante nos grupos DP planejada e não planejada, enquanto o extravasamento foi mais frequente no grupo de início não planejado. Associaram-se ao óbito menores valores de albumina e maior idade, e à peritonite, o diabetes.

Efeitos anti-inflamatórios do extrato alcoólico de folhas de garcinia gardneriana na peritonite induzida por lipopolissacarídeo / Anti-inflammatory effects of garcinia gardneriana leaf extract on lipopolysaccharideinduced peritonitis

Introdução: A Garcinia gardneriana é utilizada na medicina tradicional brasileira para o tratamento de tumores, inflamações e alívio de dores, mas as informações científicas são ainda limitadas. Objetivos: Diante do uso popular e o anseio por efeitos colaterais mínimos, o objetivo geral deste estudo foi avaliar as propriedades anti-inflamatórias da G. gardneriana em modelo de peritonite induzido por lipopolissacarideo (LPS). Métodos: Ratos Wistar foram divididos aleatoriamente em 3 grupos (n= 5/ grupo): controle, induzido à peritonite e não tratado e induzido à peritonite e tratado com extrato de folhas alcoólico de G. gardneriana a 4%. A peritonite foi induzida por única injeção intraperitoneal de LPS (1 mg/kg). O tratamento com o extrato foi realizado por gavagem (1 ml), administrado antes e 12h após a injeção do LPS. Os ratos foram eutanasiados após 24h da indução de peritonite. Amostras de sangue foram coletadas para análise plasmática de histamina, o lavado intraperitoneal para quantificação de neutrófilos e o intestino delgado para processamento histológico, quantificação de mastócitos e imuno-histoquímica da expressão da proteína Anexina A1 (AnxA1). Resultados: As análises quantitativas indicaram os efeitos anti-inflamatórios do extrato, pela redução do recrutamento de neutrófilos para a cavidade peritoneal e a diminuição da quantidade de mastócitos na lâmina própria do intestino delgado, comparadas aos animais não tratados. Não houve diferença estatística dos níveis de histamina. A imuno-histoquímica indicou diminuição acentuada da expressão da AnxA1 na mucosa intestinal dos animais tratados. Conclusão: Nossos dados demonstraram que o extrato alcoólico de G. gardneriana tem forte ação anti-inflamatória e potencial terapêutico para o desenvolvimento de fitoterápicos com propriedades anti-inflamatórias

Introduction: Garcinia gardneriana is used in traditional Brazilian medicine for the treatment of tumors, inflammation and relief of pain, but scientific information is still limited. Objective: In the face of popular use and the desire for minimal side effects, the general objective of this study was to evaluate the anti-inflammatory properties of G. gardneriana in a model of lipopolysaccharide-induced peritonitis (LPS). Methods: Wistar rats were randomly divided into 3 groups (n = 5 / group): control, induced to peritonitis and untreated and induced to peritonitis and treated with 4% alcoholic extract of G. gardneriana leaves. Peritonitis was induced by single intraperitoneal injection of LPS (1 mg/kg). Treatment with the extract was performed by gavage (1 ml), given before and 12h after LPS injection. The rats were euthanized 24h after the peritonitis induction. Blood samples were collected for plasma analysis of histamine, intraperitoneal lavage for quantification of neutrophils and the small intestine for histological processing for quantification of mast cells, and immunohistochemical analysis of the expression of Annexin A1 (AnxA1) protein. Results: Quantification analyses indicated the anti-inflammatory effects of the extract by reducing the recruitment of neutrophils into the peritoneal cavity and reducing the amount of mast cells in the lamina propria of the small intestine compared to the untreated animals. There was no statistical difference in the levels of histamine. Immunohistochemical studies indicated a marked decrease of the AnxA1 expression in the intestinal mucosa of the treated animals. Conclusion: Our data demonstrated that the alcoholic extract of G. gardneriana has a strong anti-inflammatory action and therapeutic potential for the development of herbal products with anti-inflammatory properties

Introducción: Garcinia gardneriana se utiliza en la medicina tradicional brasileña para el tratamiento de tumores, inflamaciones y alivio del dolor, pero la información científica aún es limitada. Objetivo: Frente al uso popular y la búsqueda de efectos secundarios mínimos, lo objetivo general de este estudio fue evaluar las propiedades antiinflamatorias de G. gardneriana en un modelo de peritonitis inducido por lipopolisacárido (LPS). Métodos: Se dividieron aleatoriamente ratas Wistar en 3 grupos (n= 5/grupo): control, inducido a peritonitis y no tratado, e inducido a peritonitis y tratado con extracto alcohólico de hojas de G. gardneriana al 4%. La peritonitis fue inducida por una única inyección intraperitoneal de LPS (1 mg/kg). El tratamiento con el extracto se realizó por gavaje (1 ml), administrado antes y 12 horas después de la inyección de LPS. Las ratas fueron sacrificadas después de 24 horas de la inducción de peritonitis. Se recopilaron muestras de sangre para el análisis plasmático de histamina, el lavado intraperitoneal para la cuantificación de neutrófilos y el intestino delgado para el procesamiento histológico, la cuantificación de mastocitos y la inmunohistoquímica de la expresión de la proteína Anexina A1 (AnxA1). Resultados: Los análisis cuantitativos indicaron los efectos antiinflamatorios del extracto, mediante la reducción del reclutamiento de neutrófilos en la cavidad peritoneal y la disminución de la cantidad de mastocitos en la lámina propia del intestino delgado, en comparación con los animales no tratados. No hubo diferencia estadística en los niveles de histamina. La inmunohistoquímica indicó una disminución pronunciada de la expresión de AnxA1 en la mucosa intestinal de los animales tratados. Conclusión: Nuestros datos demostraron que el extracto alcohólico de G. gardneriana tiene una fuerte acción antiinflamatoria y potencial terapéutico para el desarrollo de fitoterapéuticos con propiedades antiinflamatorias.

Melanoma metastásico en intestino delgado: causa infrecuente de perforación: reporte de caso / Metastatic melanoma in the small intestine: infrequent cause of perforation: case report / Melanoma metastático em intestino delgado: causa rara de perfuração: relato de caso

El intestino delgado es el sitio de asiento más frecuente del melanoma metastásico. Su diagnóstico es un desafío por cursar asintomático o con síntomas inespecíficos. Son pocos los casos que presentan complicaciones, siendo infrecuente la peritonitis por perforación. El objetivo del trabajo es comunicar el caso clínico de una peritonitis por perforación de una metástasis de melanoma en intestino delgado. Caso clínico: Paciente de sexo masculino de 66 años con diagnóstico de melanoma de cuello y secundario óseo, encefálico y pulmonar, fue intervenido de urgencia por peritonitis aguda por perforación de metástasis en intestino delgado. El estudio histológico confirmó secundarismo de melanoma cutáneo. Conclusión: Sabiendo que el yeyuno íleon es el sitio de asiento más frecuente de las metástasis de melanoma, ante la presencia de síntomas digestivos inespecíficos o anemia se debe sospechar su compromiso y evaluar posibles alternativas terapéuticas.

The small intestine is the most frequent site of metastatic melanoma. However, its diagnosis continues to be a challenge since it is usually asymptomatic or with non-specific symptoms. Few cases result in complications, peritonitis due to perforation being infrequent. The objective of the work is to report a clinical case of peritonitis due to perforation of a melanoma metastasis in the small intestine. Clinical case: A 66-year-old male patient diagnosed with melanoma of the neck and secondary bone, brain and lung melanoma, underwent emergency surgery for acute peritonitis due to perforation of metastasis in the small intestine, which was resected and anastomosed. The histology confirmed the secondary nature of the cutaneous melanoma. Conclusion: Knowing that the jejunum-ileum is the most frequent site of melanoma metastases, in the presence of non-specific digestive symptoms or anemia, its involvement should be suspected and possible therapeutic alternatives should be evaluated.

O intestino delgado é o local mais frequente de melanoma metastático. O diagnóstico é um desafio por ser assintomático ou apresentar sintomas inespecíficos. Há poucos casos que apresentam complicações, sendo pouco frequente a peritonite por perfuração. O objetivo deste trabalho é relatar um caso clínico de peritonite por perfuração de metástase de melanoma no intestino delgado. Caso clínico: Paciente do sexo masculino, 66 anos, diagnosticado com melanoma no pescoço com metástase óssea, cefálica e pulmonar. Foi submetido a cirurgia de emergência por peritonite aguda por perfuração de metástases do intestino delgado. O estudo histológico confirmou melanoma cutâneo. Conclusão: Sabendo que o jejuno e o íleo é o local mais frequente de metástase de melanoma, na presença de sintomas digestivos inespecíficos ou anemia deve-se suspeitar de seu acometimento e avaliar possíveis alternativas terapêuticas.

[The reality on peritoneal dialysis in France: 40years after]. / La réalité de la dialyse péritonéale en France : 40 ans après.

The share of peritoneal dialysis (PD) in the spectrum of chronic dialysis has decreased in France over the last ten years. Despite various facilities offered by the health authorities, PD remains confidential in many private units and some public hospitals. The enthusiasm present at the beginning of this technology, forty years ago, is declining, despite a real improvement in new developments, a real increase in patient survival, today at least similar to that on hemodialysis. Then, the aim of this review is first to give a summary of the principles and practice of patient and staff education and to describe the role of the medical contribution in decision-making. The second aim is to review patient and technique survival data of PD patients henceforth prolonged, and the new insights into dialysis adequacy. The presence of residual renal function is a main determinant of patient comfort together with prevention of over-hydratation. Improvement of the peritoneal catheter is underlined. The prevention and management of infections is reviewed, and also the regular assessment of peritoneal function. Free water transport is a predictor of encapsulating peritoneal sclerosis, which should be assessed regularly. The physiopathology and the pathogenesis of this devastating complication allow now the prevention, and a better treatment.

Habilidades procedimentales invariantes para el diagnóstico y el tratamiento de la peritonitis posoperatoria

Introducción: Las habilidades procedimentales invariantes en las peritonitis posoperatorias, les permite a los cirujanos el diagnóstico temprano y la reoperación abdominal urgente. Objetivo: Diseñar las habilidades procedimentales invariantes de atención diagnóstica y terapéutica a la peritonitis posoperatoria dirigida a los cirujanos. Método: Se realizó una investigación cualitativa en el Hospital Clínico Quirúrgico "Ambrosio Grillo" de Santiago de Cuba en el trimestre mayo-julio de 2022. La población de estudio estuvo constituida por 33 profesionales tratantes de la peritonitis posoperatoria: 22 médicos (12 cirujanos y 10 intensivistas) y 11 licenciadas en Enfermería. Se utilizó la sistematización como método teórico y como método empírico la revisión documental con la revisión de las historias clínicas y la observación con la práctica atencional-docente de la autora principal. Resultados: Se diseñaron las habilidades procedimentales invariantes para el diagnóstico temprano y la terapéutica de la peritonitis posoperatoria dirigida a los cirujanos con especial importancia en el método clínico. La autopreparación del tema en cuestión posibilita la complementación de conocimientos y habilidades aprendidas, así como la actualización de saberes que garantiza la atención clínica quirúrgica a este complejo enfermo. Conclusiones: El diseño de las habilidades procedimentales invariantes para el diagnóstico temprano y la terapéutica de la peritonitis posoperatoria en la necesaria superación permanente y continuada de los cirujanos representa una herramienta asistencial-docente que contribuye al mejoramiento del desempeño profesional ante este tipo de enfermo.

Introduction: Invariant procedural skills in postoperative peritonitis allow surgeons an early diagnosis and the performance of urgent abdominal resurgery. Objective: To design invariant procedural skills to be implemented for surgeons on the diagnostic and therapeutic care of postoperative peritonitis. Method: A qualitative research was conducted at the Hospital Clínico Quirúrgico "Ambrosio Grillo" of Santiago de Cuba in the quarter period of May-July 2022. The study population consisted of 33 specialists on postoperative peritonitis: 22 physicians (12 surgeons and 10 intensivists) and 11 graduated bachelor in nursing. Systematization was used as the theoretical method and the empirical methods used were the document analysis supported with the review of clinical histories and the observation with the main author's attentional-teaching practice. Results: It was designed an invariant procedural skills for the early diagnosis and therapy of postoperative peritonitis with special emphasis on the clinical method. The self-preparation on the subject makes possible the complementation of both knowledge and skills learned, as well as an update of knowledge that guarantees the surgical clinical care of these complex patients. Conclusions: The design of invariant procedural skills for the early diagnosis and therapy of postoperative peritonitis in the necessary permanent and continuous knowledge improvement of surgeons represents a care-teaching tool that contributes to improve the professional performance at the time to attend to this type of patient.

Introdução: As habilidades processuais invariantes na peritonite pós-operatória permitem aos cirurgiões o diagnóstico precoce e a reoperação abdominal urgente. Objetivo: Projetar as habilidades processuais invariantes de atenção diagnóstica e terapêutica para peritonite pós-operatória destinadas a cirurgiões. Método: Uma pesquisa qualitativa foi realizada no Hospital Clínico Cirúrgico "Ambrosio Grillo" em Santiago de Cuba no trimestre maio-julho de 2022. A população do estudo consistiu em 33 profissionais que tratam de peritonite pós-operatória: 22 médicos (12 cirurgiões e 10 intensivistas) e 11 graduados em enfermagem. Utilizou-se como método teórico a sistematização e como métodos empíricos a revição documental com revisão de histórias clínicas e a observação com a prática docente-atencional da autora principal. Resultados: Desenharam-se competências processuais invariantes para o diagnóstico precoce e terapêutica da peritonite pós-operatória dirigidas a cirurgiões com especial importância no método clínico. O autopreparo do sujeito em questão possibilita a complementação dos conhecimentos e habilidades aprendidas, bem como a atualização de conhecimentos que garantem o cuidado clínico cirúrgico desta complexa doença. Conclusões: O desenho de habilidades processuais invariantes para o diagnóstico precoce e tratamento da peritonite pós-operatória no necessário aperfeiçoamento permanente e contínuo dos cirurgiões representa uma ferramenta cuidado-ensino que contribui para o aperfeiçoamento da atuação profissional frente a este tipo de paciente.

Mannheim's peritonitis index in the prediction of postoperative outcome of peritonitis / O índice de peritonite de mannheim na predição do desfecho pós-operatório da peritonite

ABSTRACT Objective: evaluate the effectiveness of MPI to predict mortality in patients with peritonitis in Santa Casa de Misericordia de Vitoria Hospital (HSCMV). Methods: a longitudinal observational cohort retrospectively study, with a sample of 75 patients diagnosed with peritonitis between January 2010 to December 2 of 2015, in HSCMV and with all the necessary criteria for the calculation of IPM. Results: we found a profile of the patients, 33 female and 42 male, mean age 42 years, 11 deaths and 14.67% mortality percentage. Comparing the MPI variables into two groups (survivors and deceased) was found that older than 50 years, presence of malignancy and patients with organ dysfunction have statistical significance for mortality, with p<0.05. The MPI ranged between 4-41 points, with average of 21.2 points. However, among the dead, the score ranged from 23 to 41, with a mean of 32.8. Therefore, the cutoff point of 27 points was established by evaluating the best value of Kappa concordance index, and through it were calculated: 90.90% sensitivity and specificity of 78.13% by the ROC curve. Conclusion: based on these results, it was established that the MPI was effective in estimating the risk of death when the index reaches values = 27 points. Categorizing patients into different risk groups helps in determining a better prognosis and defining operative risk, thus contributing to the choice of the surgical procedure nature.

RESUMO Objetivo: avaliar a efetividade do índice de peritonite de Mannheim (IPM) para predizer mortalidade em pacientes com peritonite no Hospital Santa Casa de Misericórdia de Vitória (HSCMV). Método: Coorte longitudinal, observacional retrospectivo, com amostra de 75 pacientes diagnosticados com peritonite entre janeiro de 2010 a 02 de dezembro de 2015 no HSCMV, com todos os critérios necessários para o cálculo do IPM. Resultados: Encontrou-se um perfil dos pacientes, sendo 33 do sexo feminino e 42 do masculino, idade média de 42 anos, 11 óbitos e percentual de mortalidade de 14,67%. Comparando as variáveis do IPM em dois grupos (sobreviventes e falecidos), constatou-se que idade maior do que 50 anos, presença de malignidade e pacientes com disfunção de órgãos tiveram significância estatística para mortalidade, com p<0,05. O IPM variou entre 4 e 41 pontos, com média de 21,2 pontos. No entanto, entre os falecidos o escore variou de 23 a 41 pontos, com média de 32,8. Sendo assim, foi estabelecido o ponto de corte de 27 pontos através da avaliação do melhor valor do Índice Kappa de concordância, e através dele foram calculados: sensibilidade de 90,90% e especificidade de 78,13% através da curva ROC. Conclusão: Com base nesses resultados, foi visto que o IPM foi eficiente em estimar o risco de morte, sendo esse identificado quando o índice atinge valores = 27 pontos.

Impact of telemedicine on metabolic control and hospitalization of peritoneal dialysis patients during the COVID-19 pandemic: a national multicentric cohort study / Impacto da telemedicina no controle metabólico e hospitalização de pacientes em diálise peritoneal durante a pandemia de COVID-19: um estudo de coorte multicêntrico nacional

Abstract Introduction: The coronavirus-19 pandemic threatens the lives of all people, but results in higher mortality rates for patients with end-stage kidney disease (ESKD) including those on peritoneal dialysis (PD). Telemedicine was the main alternative to reduce exposure to the virus, but it was introduced in the Brazil without proper training. Objective: To investigate the impact of telemedicine on metabolic control, peritonitis rates, and hospitalization in PD patients during the pandemic. Methods: This was a retrospective multicenter cohort study. We included all adult patients on chronic PD from 9 clinics selected by convenience during the pandemic. The outcomes of interest were measured and compared between before and after switching to telemedicine using repeated measure analysis and multilevel Poisson regression. Results: The study included 747 patients with a mean age of 59.7±16.6 years, of whom 53.7% were male and 40.8% had diabetes. Biochemical parameters including hemoglobin, potassium, phosphate, calcium, and urea serum levels did not change significantly after transition to telemedicine. There was no association between telemedicine and peritonitis rates. In contrast, hospitalization rates increased significantly in the telemedicine period. The incidence rate ratio (IRR) for hospitalization in the telemedicine period was 1.54 (95%CI 1.10-2.17; p 0.012) and 1.57 (95%CI 1.12-2.21; p 0.009) in the mixed-effects Poisson regression before and after adjustment for the presence of confounders. Admissions for hypervolemia and infections not related to PD doubled after transition to telemedicine. Conclusion: The implementation of telemedicine without proper training may lead to an increase in adverse events in PD patients.

Resumo Introdução: A pandemia do coronavírus-19 ameaça a vida de todas as pessoas, mas resulta em uma alta taxa de mortalidade em pacientes com doença renal em estágio terminal (DRET), incluindo aqueles em diálise peritoneal (DP). A telemedicina foi a principal alternativa para reduzir a exposição ao vírus, mas foi introduzida no Brasil sem treinamento adequado. Objetivo: Investigar o impacto da telemedicina no controle metabólico, taxas de peritonite e hospitalização em pacientes em DP na pandemia. Métodos: Estudo de coorte multicêntrico retrospectivo. Incluímos todos os pacientes adultos em DP crônica de 9 clínicas selecionadas por conveniência durante a pandemia. Desfechos de interesse foram medidos e comparados entre antes e depois da mudança para telemedicina usando análise de medidas repetidas e regressão multinível de Poisson. Resultados: Incluiu-se 747 pacientes com idade média de 59,7±16,6 anos, sendo 53,7% homens e 40,8% diabéticos. Parâmetros bioquímicos, incluindo níveis séricos de hemoglobina, potássio, fosfato, cálcio e ureia não mudaram significativamente após transição para telemedicina. Não houve associação entre telemedicina e taxas de peritonite. Em contraste, taxas de hospitalização aumentaram significativamente no período de telemedicina. A razão de taxas de incidência (RTI) para internação no período de telemedicina foi 1,54 (IC95% 1,10-2,17; p 0,012) e 1,57 (IC95% 1,12-2,21; p 0,009) na regressão multinível de Poisson antes e após ajuste para presença de fatores de confusão. As internações por hipervolemia e infecções não relacionadas à DP dobraram após transição para telemedicina. Conclusão: A implementação da telemedicina sem treinamento adequado pode levar ao aumento de eventos adversos em pacientes em DP.

Does ascitic fluid filtration improve the microbiological diagnosis of spontaneous bacterial peritonitis? An experimental laboratory study / A filtração do líquido ascítico melhora o diagnóstico microbiológico da peritonite bacteriana espontânea? Um estudo experimental laboratoria

ABSTRAC: Background: Spontaneous Bacterial Peritonitis (SBP) is a serious and frequent complication among cirrhotic patients with ascites and can be diagnosed by cytological analysis of the ascitic fluid. The microbiological culture of ascitic fluid, however, is positive in less than 40% of SBP cases, which often results in inappropriate antimicrobial therapy. Empirical therapy may be suboptimal, increasing patient's risk of aggravation, or overestimated, unnecessarily boosting bacterial resistance. Objective: This experimental laboratory study aimed to standardize and verify the technical feasibility of ascitic fluid vacuum filtration, as a way to optimize the etiological diagnosis of SBP, compared to the automated method. Method: The method evaluated and standardized in this study was ascitic fluid vacuum filtration. Its principle is the concentration of bacteria on a filter membrane. Results: This study included 36 cirrhotic patients treated at a public university hospital between 11.13.2017 and 06.30.2019. Among them, 47.2% (17/36) presented cytology test results compatible with SBP. For these patients, culture sensitivity using the automated method was 35.3% (6/17), against 11.8% (2/17) with the vacuum filtration method. Conclusion: In conclusion, vacuum filtration does not improve the microbiological diagnosis of SBP in this population compared to the automated method. (AU)

RESUMO:Contexto: A Peritonite Bacteriana Espontânea (PBE) é uma complicação grave e frequente entre pacientes cirróticos com ascite, diagnosticada por meio da análise citológica do líquido ascítico. A cultura microbiológica do líquido ascítico, por sua vez, é positiva em menos de 40% dos casos de PBE, o que resulta frequentemente na instituição de terapia antimicrobiana inapropriada. A terapia empírica pode ser subótima, aumentando o risco de agravamento do paciente, ou superestimada, impulsionando desnecessariamente a resistência bacteriana. Objetivo: Estudo experimental laboratorial, propôs padronizar e verificar a viabilidade técnica da filtração a vácuo do líquido ascítico, como forma de otimizar o diagnóstico etiológico na PBE, comparativamente ao sistema automatizado de culturas de sangue. Método: O método avaliado e padronizado neste estudo foi a da filtragem a vácuo do líquido ascítico. Esse tem como princípio a concentração da bactéria em uma membrana filtrante. Resultados: Nesse estudo, foram incluídos 36 pacientes cirróticos atendidos em um hospital público universitário, entre 13.11.2017 e 30.06.2019. Entre eles, 47,2% (17/36) apresentaram citologia compatível com PBE. Nesses, a sensibilidade da cultura pelo método semi-automatizado foi de 35,3% (6/17) e da cultura pelo método da filtragem a vácuo foi de 11,8% (2/17). Conclusão: Em conclusão, a filtragem a vácuo não melhora o diagnóstico microbiológico da PBE em relação ao método automatizado. (AU)

Does ascitic fluid filtration improve the microbiological diagnosis of spontaneous bacterial peritonitis? An experimental laboratory study / A filtração do líquido ascítico melhora o diagnóstico microbiológico da peritonite bacteriana espontânea? Um estudo experimental laboratorial

Background: Spontaneous Bacterial Peritonitis (SBP) is a serious and frequent complication among cirrhotic patients with ascites and can be diagnosed by cytological analysis of the ascitic fluid. The microbiological culture of ascitic fluid, however, is positive in less than 40% of SBP cases, which often results in inappropriate antimicrobial therapy. Empirical therapy may be suboptimal, increasing patient's risk of aggravation, or overestimated, unnecessarily boosting bacterial resistance. Objective: This experimental laboratory study aimed to standardize and verify the technical feasibility of ascitic fluid vacuum filtration, as a way to optimize the etiological diagnosis of SBP, compared to the automated method. Method: The method evaluated and standardized in this study was ascitic fluid vacuum filtration. Its principle is the concentration of bacteria on a filter membrane. Results: This study included 36 cirrhotic patients treated at a public university hospital between 11.13.2017 and 06.30.2019. Among them, 47.2% (17/36) presented cytology test results compatible with SBP. For these patients, culture sensitivity using the automated method was 35.3% (6/17), against 11.8% (2/17) with the vacuum filtration method. Conclusion: In conclusion, vacuum filtration does not improve the microbiological diagnosis of SBP in this population compared to the automated method (AU)

Contexto: A Peritonite Bacteriana Espontânea (PBE) é uma complicação grave e frequente entre pacientes cirróticos com ascite, diagnosticada por meio da análise citológica do líquido ascítico. A cultura microbiológica do líquido ascítico, por sua vez, é positiva em menos de 40% dos casos de PBE, o que resulta frequentemente na instituição de terapia antimicrobiana inapropriada. A terapia empírica pode ser subótima, aumentando o risco de agravamento do paciente, ou superestimada, impulsionando desnecessariamente a resistência bacteriana. Objetivo: Estudo experimental laboratorial, propôs padronizar e verificar a viabilidade técnica da filtração a vácuo do líquido ascítico, como forma de otimizar o diagnóstico etiológico na PBE, comparativamente ao sistema automatizado de culturas de sangue. Método: O método avaliado e padronizado neste estudo foi a da filtragem a vácuo do líquido ascítico. Esse tem como princípio a concentração da bactéria em uma membrana filtrante. Resultados: Nesse estudo, foram incluídos 36 pacientes cirróticos atendidos em um hospital público universitário, entre 13.11.2017 e 30.06.2019. Entre eles, 47,2% (17/36) apresentaram citologia compatível com PBE. Nesses, a sensibilidade da cultura pelo método semi-automatizado foi de 35,3% (6/17) e da cultura pelo método da filtragem a vácuo foi de 11,8% (2/17). Conclusão: Em conclusão, a filtragem a vácuo não melhora o diagnóstico microbiológico da PBE em relação ao método automatizado (AU)