Multisystemic Beryllium Disease: An Exceptional Case Revealed by a Urinary Tract Granulomatosis.

Chronic beryllium disease (CBD), or berylliosis, is an interstitial lung disease caused by the chronic inhalation of finely particulate beryllium, frequently mistaken for sarcoidosis. It is rarely associated with skin nodular lesions, asymptomatic granulomatous hepatitis or calcium nephrolithiasis. To date, it has never been reported as a diffused multi-organ granulomatous disease. A 60-year-old Pakistani man, a former excavation worker with ancient history of suspected sarcoidosis, underwent a left nephroureterectomy for suspected papillary kidney carcinoma. The histopathological analysis showed a benign non-necrotic granulomatous infiltration of the renal pelvis and ureter. Six months later, he suffered from two consecutive episodes of acute kidney failure. Bladder biopsies found similar noncaseous granulomatosis and kidney biopsies showed interstitial nephritis. Known for suspected asthma, sleep apnea, and usual interstitial pneumonia, the patient would regularly consult for episodes of pyrexia, chills, nocturnal coughing, and wheezing. As kidney function gradually worsened, he ultimately started hemodialysis and was transferred to our facility. A positive blood beryllium lymphocyte proliferation test confirmed the diagnosis of CBD. This original report is the first description of multi-organ berylliosis with diffused urothelial granulomatosis and pseudo-tumor. The patient's pulmonary disease is minimal compared with renal and urinary tract involvement, eventually responsible for end-stage kidney disease. Berylliosis usually responds to glucocorticoids. This case report highlights the importance of evoking the diagnosis of CBD in the presence of any granulomatosis, even extra-thoracic, especially if associated with pulmonary symptoms, however atypical.

National survey regarding obstetricians' perspective of obstetric emergencies in Brazil

Abstract Introduction The maternal mortality rate in developing countries, such as Brazil, has significantly increased since 2020. Obstetric Emergencies (OE) account for 72.5% of these deaths. A national survey was conducted in Brazil to evaluate how gynecologists and obstetricians deal with OE and identify the main difficulties regarding theoretical/practical knowledge and structural resources. Methods An electronic questionnaire assessing resource availability, health teams, institutional protocols, and provision of OE training courses was completed by Brazilian obstetricians. Results More than 90 % of the questionnaire respondents reported treating a pregnant and/or puerperal patient with severe morbidity and that their health network has human resources, trained professionals, and structural resources required for this type of care. However, few respondents participate in continuing education programs (36 %) or specific training for the medical team (61.41 %). The implementation rates of obstetric risk identification protocols (33.09 %), a rapid response team (46.54 %), and boxes and emergency cart assembly teams (71.68 %) were determined. Conclusion A high Maternal Mortality Ratio (MMR) may be related to disorganized healthcare systems, low implementation of risk classification protocols for the care of severe maternal and fetal conditions, and lack of access to continued/specific training programs. The Brazilian MMR is multifactorial. According to obstetricians, Brazilian health services include care teams, essential medications, obstetric centers, and clinical analysis laboratories, though they lack systematized processes and permanent professional training for qualified care of OE.

How can we reduce maternal mortality due to preeclampsia? The 4P rule

Abstract In low and middle-income countries such as Brazil, most maternal deaths are related to hypertensive complications. Preeclampsia is the leading cause of maternal mortality and morbidity. Significant proportion is associated with the following factors: lack of identification of high-risk women, lack of adequate prevention, difficulty in maintaining a high-risk prenatal follow-up, delayed diagnosis, insecurity and low use of magnesium sulphate, delayed pregnancy interruption and lack of postpartum follow-up of these high-risk cases. Four major actions are proposed to minimize this alarming clinical picture and reduce the mortality rates due to preeclampsia, called the "4 P Rule" (Adequate Prevention - Vigilant Prenatal Care - Timely Delivery (Parturition) - Safe Postpartum). From this simple "rule" we can open a range of important processes and reminders that may help in the guidance of preeclampsia management.

Práticas avançadas de enfermagem em cuidados paliativos na comunidade compassiva de favela: relato de experiência / Advanced practice nursing in palliative care within the compassionate favela community: an experience report

OBJETIVO: descrever a prática avançada do enfermeiro em cuidados paliativos que atua com a equipe Interdisciplinar em um projeto de extensão universitária nas favelas da Rocinha e Vidigal no Rio de Janeiro, Brasil. MÉTODO: Trata-se de um estudo descritivo do tipo relato de experiência, sobre a aplicabilidade de práticas avançadas de enfermagem, no contexto de cuidados paliativos em comunidades vulneráveis, Rocinha e Vidigal, 2019 e 2020. RESULTADOS: Enfermeiros líderes, por meio da micropolítica, buscam o alívio do sofrimento humano, mediante o controle de sinais e sintomas físicos, psicossociais e espirituais, através de raciocínio clínico, habilidade de resolução de problemas por intermédio da consulta de enfermagem e articulação junto a equipe interdisciplinar. CONCLUSÃO: A abordagem de cuidados paliativos sob a ótica do projeto de comunidade compassiva tem mostrado uma forte prática da autonomia do enfermeiro, assim como proporciona visibilidade para a vulnerabilidade social e fortalecimento da prática avançada do enfermeiro no Brasil.

OBJECTIVE: to describe the advanced practice of nurses in palliative care who work with the Interdisciplinary team in a university extension project in the favelas of Rocinha and Vidigal in Rio de Janeiro, Brazil. METHOD: This descriptive research shows an experience report on the applicability of advanced practice nursing in palliative care in vulnerable communities, Rocinha and Vidigal, 2019 and 2020. RESULTS: Through micropolitics, leading nurses seek to relieve human suffering by controlling physical, psychosocial, and spiritual signs and symptoms through clinical reasoning, problem-solving skills in nursing appointments, and articulation with the interdisciplinary team. CONCLUSION: From the perspective of the compassionate community project, the palliative care approach has shown a strong practice of nurse autonomy, provided visibility for social vulnerability, and strengthened the advanced practice of nurses in Brazil.

Terapia ocupacional no contexto da nefrologia: revisão narrativa / Occupational therapy in the nephrology context: narrative review / Terapia ocupacional en el contexto de la nefrología: una revisión narrativa

Introdução: A doença renal crônica apresenta muitas limitações, interferindo diretamente na participação das atividades cotidianas do indivíduo. Objetivo: Revisar de forma narrativa estudos sobre terapia ocupacional no contexto da nefrologia, levantando dados e registros em periódicos de intervenções e ações pontuais de profissionais dessa área. Métodos: revisão narrativa nos principais periódicos da Terapia Ocupacional no Brasil: Cadernos Brasileiros de Terapia Ocupacional, Revista de Terapia Ocupacional da Universidade de São Paulo, Revista Interinstitucional Brasileira de Terapia Ocupacional e Revista Baiana de Terapia Ocupacional. Resultados/Discussão: Amostra final composta por 11 artigos, com intervenções, em sua maioria, na hemodiálise; presença de metodologia quantitativa, com abordagem sobre qualidade de vida e proposta de estruturação do serviço no contexto da nefrologia. Conclusão: Foram observadas as diversas formas de inserção da Terapia Ocupacional no contexto da nefrologia, perpassando espaços da hemodiálise e do transplante renal, sempre acompanhado com o olhar holístico. (AU)

Introduction: Chronic kidney disease presents many limitations, directly interfering in an individual's daily activities. Objective: Narratively review studies on occupational therapy in the context of nephrology, collecting data and records in intervention journals and specific actions by professionals in this area. Methods: narrative review in the main journals of Occupational Therapy in Brazil: Brazilian Notebooks of Occupational Therapy (Cadernos Brasileiros de Terapia Ocupacional), University of São Paulo's Journal of Occupational Therapy (Revista de Terapia Ocupacional da Universidade de São Paulo), Brazilian Interinstitutional Journal of Occupational Therapy (Revista Interinstitucional Brasileira de Terapia Ocupacional), Bahia's Journal of Occupational Therapy (Revista Baiana de Terapia Ocupacional). Results/Discussion: A final sample consisting of 11 articles about interventions, mostly, on hemodialysis; presence of quantitative methodology, addressing quality of life and proposing a service structure in the context of nephrology. Conclusion: It was possible to observe in this study different forms of Occupational Therapy insertion in the context of nephrology, going through hemodialysis and kidney transplant spaces, always accompanied by a holistic view. (AU)

Introducción: la enfermedad renal crónica tiene limitaciones limitadas, que interfieren directamente con las actividades diarias del individuo. Objetivo: Revisar narrativamente estudios sobre terapia ocupacional en el contexto de la nefrología, recopilando datos y registros en intervenciones periódicas y acciones específicas de profesionales en esta área. Métodos: revisión narrativa de las principales revistas de Terapia Ocupacional en Brasil: Cuadernos Brasileños de Terapia Ocupacional, Revista de Terapia Ocupacional de la Universidad de São Paulo, Revista Interinstitucional de Terapia Ocupacional, Revista Baiana de Terapia Ocupacional. Resultados/Discusión: El discurso final consta de 11 artículos, con intervenciones, principalmente en hemodiálisis; presencia de metodología cuantitativa, abordando la calidad de vida y proponiendo una estructura del servicio en el contexto de la nefrología. Conclusión: fue posible observar en este estudio las diferentes formas de inserción de la terapia ocupacional en el contexto de la nefrología, pasando por espacios de hemodiálisis y trasplante de riñón, siempre acompañado de una visión holística. (AU)

Processo de morte e morrer e cuidados paliativos: um pleito necessário para graduação em enfermagem / Death and dying process and palliative care: a necessary claim for nursing undergraduation / Proceso de muerte y el morir y cuidados paliativos: un reclamo necesario para la carrera de enfermería

Objetivo: analisar a percepção dos estudantes de graduação em enfermagem sobre a temática "o processo de morte e morrer" e sua abordagem durante sua formação. Método: estudo descritivo, exploratório, com abordagem qualitativa, desenvolvido com alunos do último ano de graduação em Enfermagem de uma universidade pública do Rio de Janeiro. Resultados: Participaram do estudo 57 estudantes e, após a organização dos dados emergiram as classes: "Sentimentos frente à morte"; "A necessidade da abordagem do conteúdo de morte na graduação"; "A vivência da morte do paciente" e "Atitude de cuidado diante do processo de morte". Considerações finais: uma formação que contemple o estudo da tanatologia e a filosofia dos cuidados paliativos é de suma importância, dado ao fato de que a morte é consequência inexorável da vida. O estudo reafirma a necessidade constante desta discussão durante a formação e o exercício da enfermagem(AU)

Objective: to analyze the perception of undergraduate nursing students about the theme, "the process of death and dying" and its approach during their training. Method: descriptive, exploratory study, with a qualitative approach developed with students of the last year of undergraduate nursing in a public university in Rio de Janeiro. Results: 57 students participated in the study and, after organizing the data, the following classes emerged: "Feelings about death"; "The need to approach the content of death in training education"; "The patient's death experience" and "Care attitude towards the process of death. Final considerations: nursing undergraduation education must have included the study of thanatology and the philosophy of palliative care, due to the importance given that death is an inexorable consequence of life. The study reaffirms the importance of this discussion happening during the nursing education training and over nursing work(AU)

Objetivo: analizar la percepción de los estudiantes de enfermería sobre el tema "El proceso de la muerte y el morir" y su enfoque durante los estudios de formación. Método: Investigación descriptiva, exploratoria, con enfoque cualitativo desarrollado junto a estudiantes del último año de pregrado en enfermería en una universidad pública de Rio de Janeiro. Resultados: En el estudio participaron 57 alumnos y, tras organizar los datos, surgieron las siguientes clases:"Sentimientos ante la muerte"; "La necesidad de abordar el contenido de muerte en el pregrado"; "La experiencia de la muerte del paciente" y "Actitud de cuidado ante el proceso de muerte". Consideraciones finales: una formación que incluya el estudio de la tanatología y la filosofía de los cuidados paliativos es de suma importancia dado que la muerte es una consecuencia inexorable de la vida. El estudio reafirma la necesidad de que esta discusión sea constante durante la formación y el ejercicio de la enfermería(AU)

Multiple Complications of Crohn's Disease and the Need for Early and Continuous Multidisciplinary Undertaking.

Crohn's disease is an inflammatory disease that typically affects the bowels but can also have many different extraintestinal manifestations. One of those complications is immunoglobulin A nephropathy (IgAN), which is one of the most encountered renal lesions in the setting of Crohn's disease. Another point of focus for Crohn's patients is the risk of cancer, with a higher risk of colorectal cancer but also extraintestinal neoplasia such as hepatobiliary, hematological, and urinary tract neoplasia. We present the case of a young patient suffering from long-term Crohn's disease and subsequent IgAN leading to end-stage kidney disease and hemodialysis. The patient was diagnosed young and had undergone multiple surgeries and different treatments in various countries. He then presented in our center already with advanced chronic renal failure from IgAN that was unknown due to poor multidisciplinary follow-up. Shortly after starting hemodialysis, he developed a large abdominal mass, first thought to result from Crohn's-related fistula. This mass turned out to be a urachal adenocarcinoma, a rare type of bladder cancer with an especially poor prognosis. It is not known whether this type of cancer is associated with either Crohn's disease or IgAN, and no such association has been previously described. The treatment of urachal cancer usually relies on surgery, with the addition of chemotherapy in some cases. Unfortunately for our patient, his case was already so advanced at the moment of diagnosis that he was excluded from curative treatment and quickly passed away thereafter. This case illustrates many important aspects of the rigorous follow-up that is needed for Crohn's patients, with regular check-ups, screening investigations, and the need for multidisciplinary evaluation. Furthermore, it describes the development of a rare type of cancer in the setting of Crohn's disease and IgAN, with no prior established link between these different pathologies.

Evaluation of Transplant Suitability in a Patient with Previous Colorectal Cancer and Subsequent Radiation Cystitis: Insights from a Complicated Case.

Assessing transplant suitability can be a meticulous process, involving multiple investigations and various specialties. This process is well described in the latest KDIGO guidelines. We recently asked ourselves if those guidelines are still relevant to current clinical practice given the rapid evolution of modern medicine, especially in the field of oncology. We present the complicated case of a 60-year-old woman with ESKD (end-stage kidney disease) and a prior history of cancer, with secondary urological complications, to illustrate different interesting considerations for KT (kidney transplant). Our patient was diagnosed with rectal cancer at the age of 46, for which she was treated with surgery and radiotherapy before developing chronic radiation cystitis. This was followed by repeated urinary tract infections and secondary nephrolithiasis, ultimately leading to severe bilateral hydronephrosis and obstructive ESKD. We know that the type of cancer and its characteristics should be evaluated in detail, and we should offer patient-tailored recommendations after a multidisciplinary evaluation. In our case, the prior rectal cancer is not to be feared because curative treatment has been achieved and the patient has been cancer-free for 14 years, knowing that this type of cancer is not at high risk of recurrence after transplantation. The frail urological anatomy, however, represents a bigger challenge. Not only does it complicate the technical feasibility of KT but it also increases the risk of complications and graft failure. It is difficult to clearly determine KT possibility when considering it in such patients. What is clear on the other hand is that such a decision should be taken considering the choice of the patient and the involved physicians. We should also consider the potential benefits and risks of KT in order to make an informed decision.

Slum compassionate community: expanding access to palliative care in Brazil.

OBJECTIVE: To describe the implementation of a compassionate community in Rocinha and Vidigal slums, located in the city of Rio de Janeiro. METHOD: Report on the experience of implementing a Compassionate Community based on the World Health Organization conceptual bases, supported by university extension guidelines. RESULTS: Initially, local leaders and residents were recruited and trained in palliative care. Subsequently, health professionals from different specialties engaged in the project through volunteering. Home visits were instituted in the form of interconsultation and "sponsorships" by residents and health professionals to people in palliative care and family members. Finally, the health care network in the territory was integrated in order to recognize the project as a support network. CONCLUSION: We highlight the experience as living work in health, which involves relationships and creative processes, which mobilize structured technical knowledge and relationships between people and soft-hard and soft technologies, making it possible to recognize powers in the territory.

Adansonia digitata L. (Baobab) Bioactive Compounds, Biological Activities, and the Potential Effect on Glycemia: A Narrative Review.

Adansonia digitata L. fruit, also known as baobab, has been used traditionally throughout the world for its medicinal properties. Ethnopharmacological uses of various plant parts have been reported for hydration, antipyretic, antiparasitic, antitussive, and sudorific properties and also in the treatment of diarrhea and dysentery in many African countries. Several studies have revealed that in addition to these applications, baobab has antioxidant, anti-inflammatory, analgesic, and antimicrobial activities. The health benefits of baobab have been attributed to its bioactive compounds, namely phenols, flavonoids, proanthocyanins, tannins, catechins, and carotenoids. Baobab fruit is also an important source of vitamin C and micronutrients, including zinc, potassium, magnesium, iron, calcium, and protein, which may reduce nutritional deficiencies. Despite scientific studies revealing that this fruit has a wide diversity of bioactive compounds with beneficial effects on health, there is a gap in the review of information about their mechanisms of action and critical analysis of clinical trials exploring, in particular, their effect on glycemia regulation. This work aims to present a current overview of the bioactive compounds, biological activities, and effects of A. digitata fruit on blood glucose, highlighting their potential mechanisms of action and effects on glycemia regulation, evaluated in recent animal and human trials.

Jejunal perforation secondary to blind insertion of peritoneal dialysis catheter: a case report and review of literature.

BACKGROUND: Peritoneal dialysis (PD) depends upon a functioning and durable access to the peritoneal cavity. Many techniques exist to insert a peritoneal catheter, showing similar outcomes and benefits. Blind percutaneous insertion represents a bedside intervention predominantly performed by nephrologists requiring only local anesthesia, sedation and minimal transcutaneous access. Although current guidelines recommend insertion techniques allowing visualization of the peritoneal cavity, the blind percutaneous approach is still widely used and has been proven safe and effective to bring durable peritoneal dialysis access. Herein, we described a rare case of jejunal perforation secondary to blind PD catheter placement, and conduct a review of the current medical literature describing early bowel perforations secondary to PD catheter placement, gathering descriptions of symptomatology and outcomes and their relations to the insertion technique. CLINICAL PRESENTATION: We herein describe the case of a 48 year-old patient with a history of appendectomy who suffered from triple jejunal perforation after blind percutaneous insertion and subsequent embedment of his peritoneal catheter. Accurate diagnosis was made 1 month after insertion due to atypical clinical presentation and because physicians had no access to the peritoneal cavity after catheter embedment. After surgical repair and broad-spectrum antibiotics, the patient was switched to HD. CONCLUSION: Early catheter-related visceral injury is a rare, yet threatening condition that is almost always causing a switch to hemodialysis or death. Our review highlights that laparoscopic catheter placement might bring better outcomes if perforation occurs, as it allows immediate diagnosis and treatment. On the contrary, catheter embedment may delay clinical diagnosis and therefore bring worse outcomes.

The Effect of Ginger (Zingiber officinale Roscoe) Aqueous Extract on Postprandial Glycemia in Nondiabetic Adults: A Randomized Controlled Trial.

Ginger has shown beneficial effects on blood glucose control due to its antioxidant and anti-inflammatory properties. The present study investigated the effect of ginger aqueous extract on postprandial glucose levels in nondiabetic adults and characterized its antioxidant activity. Twenty-four nondiabetic participants were randomly assigned into two groups (NCT05152745), the intervention group (n = 12) and the control group (n = 12). Both groups were administered 200 mL of an oral glucose tolerance test (OGTT), after which participants in the intervention group ingested 100 mL of ginger extract (0.2 g/100 mL). Postprandial blood glucose was measured while fasting and after 30, 60, 90, and 120 min. The total phenolic content, flavonoid content, and antioxidant activity of ginger extract were quantified. In the intervention group, the incremental area under the curve for glucose levels decreased significantly (p < 0.001) and the maximum glucose concentration significantly reduced (p < 0.001). The extract possessed a polyphenolic content of 13.85 mg gallic acid equivalent/L, a flavonoid content of 3.35 mg quercetin equivalent/L, and a high superoxide radical inhibitory capacity (45.73%). This study showed that ginger has a beneficial effect on glucose homeostasis under acute conditions and encourages the use of ginger extract as a promising source of natural antioxidants.

Slum compassionate community: expanding access to palliative care in Brazil / Comunidad de favela compasiva: ampliar el acceso a los cuidados paliativos en Brasil / Comunidade compassiva de favela: ampliando o acesso aos cuidados paliativos no Brasil

ABSTRACT Objective: To describe the implementation of a compassionate community in Rocinha and Vidigal slums, located in the city of Rio de Janeiro. Method: Report on the experience of implementing a Compassionate Community based on the World Health Organization conceptual bases, supported by university extension guidelines. Results: Initially, local leaders and residents were recruited and trained in palliative care. Subsequently, health professionals from different specialties engaged in the project through volunteering. Home visits were instituted in the form of interconsultation and "sponsorships" by residents and health professionals to people in palliative care and family members. Finally, the health care network in the territory was integrated in order to recognize the project as a support network. Conclusion: We highlight the experience as living work in health, which involves relationships and creative processes, which mobilize structured technical knowledge and relationships between people and soft-hard and soft technologies, making it possible to recognize powers in the territory.

RESUMEN Objetivo: Describir la implementación de una comunidad compasiva en las favelas de Rocinha y Vidigal, ubicadas en la ciudad de Río de Janeiro. Método: Relato de la experiencia de implementación de una Comunidad Compasiva a partir de las bases conceptuales de la Organización Mundial de la Salud, sustentada en lineamientos de extensión universitaria. Resultados: Inicialmente, se reclutaron y capacitaron a líderes locales y residentes en cuidados paliativos. Posteriormente, profesionales de la salud de diferentes especialidades se involucraron en el proyecto a través del voluntariado. Se instituyeron visitas domiciliarias en la modalidad de interconsulta y "patrocinios" por parte de residentes y profesionales de salud a personas en cuidados paliativos y familiares. Finalmente, se integró la Red de Atención a la Salud del territorio para reconocer el proyecto como una red de apoyo. Conclusión: Destacamos la experiencia como trabajo vivo en salud, que involucra relaciones y procesos creativos, que movilizan saberes técnicos estructurados y relaciones entre personas y tecnologías ligeras-duras y ligeras, posibilitando el reconocimiento de poderes en el territorio.

RESUMO Objetivo: Descrever a implementação de uma comunidade compassiva nas favelas da Rocinha e Vidigal, localizadas na cidade do Rio de Janeiro. Método: Relato da experiência da implementação de uma Comunidade Compassiva a partir das bases conceituais da Organização Mundial da Saúde, amparada pelas diretrizes da extensão universitária. Resultados: Inicialmente, lideranças locais e moradores foram recrutados e receberam treinamento sobre cuidados paliativos. Posteriormente, profissionais de saúde de diferentes especialidades engajaram-se no projeto por meio da prática do voluntariado. Foram instituídas visitas domiciliares na modalidade interconsulta e "apadrinhamentos" por moradores e profissionais de saúde às pessoas em cuidados paliativos e familiares. Por fim, a Rede de Atenção à Saúde do território foi integrada de forma a reconhecer o projeto como rede de apoio. Conclusão: Destacamos a experiência como trabalho vivo em saúde, que envolve relações e processos criativos, os quais mobilizam o saber técnico estruturado e as relações entre as pessoas e as tecnologias leve-duras e leves, tornando factível o reconhecimento de potências no território.

Complicações em cirurgias e procedimentos lipoaspirativos: uma revisão da literatura / Complications in surgeries and lipoaspirative procedures: a review of the literature / Complicaciones en cirugías y procedimientos lipoaspirativos: una revisión de la literatura

O atual estudo objetiva evidenciar as complicações surgidas a partir de uma cirurgia de lipoaspiração no que diz respeito aos seus impactos na saúde dos pacientes. Trata-se de uma revisão integrativa, realizada por meio da pesquisa dos seguintes Descritores em Ciências da Saúde (DeCS): complications and liposuction. Sendo selecionados artigos de 2019 a 2023 que foram publicados até o dia 26/05/2023, selecionando-se 22 artigos, dos quais foram excluídos 15 e restaram apenas 7 artigos revisados. Lipoaspiração se resume em uma técnica cirúrgica que é utilizada para a remoção dos depósitos de gordura, sendo que possui finalidade estética, no entanto este procedimento pode cursar com consequências danosas à saúde dos pacientes como tromboembolismo, sepse e dentre outros. Tendo em vista essas complicações, a melhor opção é o investimento na formação de profissionais de qualidade e uma maior fiscalização aos centros e salas cirúrgicas.

The current study aims to highlight the complications arising from liposuction surgery with regard to its impacts on patients' health. This is an integrative review, carried out through the research of the following Descriptors in Health Sciences (DeCS): complications and liposuction. We selected articles from 2019 to 2023 that were published until 26/05/2023, selecting 22 articles, of which 15 were excluded and only 7 revised articles remained. Liposuction is summarized in a surgical technique that is used for the removal of fat deposits, being that it has aesthetic purpose, however this procedure can occur with harmful consequences to the health of patients such as thromboembolism, sepsis and among others. In view of these complications, the best option is to invest in the training of quality professionals and greater supervision of the operating centers and operating rooms.

El presente estudio tiene como objetivo destacar las complicaciones derivadas de la cirugía de liposucción con respecto a sus impactos en la salud de los pacientes. Se trata de una revisión integradora, realizada a través de una encuesta de los siguientes descriptores en Ciencias de la Salud (DeCS): complicaciones y liposucción. Con los artículos seleccionados de 2019 a 2023 que se publicaron antes del 26/05/2023, se seleccionaron 22 artículos, de los cuales 15 quedaron excluidos y sólo quedaban siete revisados. La lipoaspiración se resume en una técnica quirúrgica que se utiliza para la remoción de depósitos de grasa, y tiene un propósito estético, aunque este procedimiento puede tener consecuencias perjudiciales para la salud de los pacientes como tromboembolismo, sepsis y otros. En vista de estas complicaciones, la mejor opción es invertir en la formación de profesionales de calidad y en una mayor supervisión de los centros y salas quirúrgicos.

An anti-inflammatory and low fermentable oligo, di, and monosaccharides and polyols diet improved patient reported outcomes in fibromyalgia: A randomized controlled trial.

Background: Fibromyalgia (FM) has been associated with dysbiosis and low-grade inflammation. Studies have reported that diet influences clinical features in FM. Objective: To evaluate the effect of an anti-inflammatory and low fermentable oligo, di, and monosaccharides and polyols (FODMAP) diet on clinical outcomes of patients with FM. Methods: This two arms Randomized Controlled Trial (NCT04007705) included 46 female patients with FM. The intervention group (n = 22) adopted an anti-inflammatory diet for 3 months, excluding gluten, dairy, added sugar, and ultra-processed foods, along with a low FODMAPs diet in the first month. The control group (n = 24) followed general healthy eating recommendations. Both diets were applied by a certified dietitian. Before and after the intervention, participants were assessed regarding pain, fatigue, gastrointestinal symptoms, quality of sleep, and quality of life, through the Revised Fibromyalgia Impact Questionnaire (FIQR), Visual Analogue Pain Scale (VAS), Visual Analog Scale from gastrointestinal symptoms (VAS GI), Brief Pain Inventory (BPI), Pittsburg Sleep Quality Index (PSQI), Fatigue Severity Survey (FSS), and The Short Form Health Survey (SF-36). A blood sample was collected and high-sensitive C-Reactive Protein and Erythrocyte Sedimentation Rate were quantified. Paired Samples t-test/Wilcoxon and independent samples t-test/Mann-Whitney were used to compare variables between groups. Results: After intervention, there was an improvement in intervention group scores of FIQR (p = 0.001), VAS (p = 0.002), BPI (p = 0.011), FSS (p = 0.042), VAS_GI (p = 0.002), PSQI (p = 0.048), and SF36 (p = 0.045) compared to control group. Inflammatory biomarkers (hs-CRP, ESR) did not change in both groups. The intervention was beneficial in the intervention group, regardless of age, disease duration, body mass index variation, and body fat change between baseline and post-intervention. Conclusion: An anti-inflammatory and low-FODMAP diet improved clinical features in patients with FM and may be useful as a complement to pharmacological therapy. Clinical Trial Registration: [https://clinicaltrials.gov/ct2/show/NCT04007705], identifier [NCT04007705].

Interações medicamentosas no pós-operatório de cirurgia cardíaca / Interacciones farmacológicas durante el postoperatorio de cirugía cardíaca / Drug interactions in postoperative care after heart surgery

Objetivo: verificar as interações medicamentosas potencialmente teóricas (IMPT) com suas respectivas repercussões clínicas e correlacioná-las ao perfil clínico-medicamentoso a partir de prescrições em pós-operatório de cirurgia cardíaca. Materiais e métodos: estudo descritivo, transversal, retrospectivo, com amostra de 133 prescrições de pacientes internados em um hospital estadual do Rio de Janeiro, Brasil, entre março e agosto de 2018. Para a avaliação das interações, utilizou-se do software Micromedex Solutions®, seguido da estatística descritiva e inferencial dos dados pelo software Epi Info 7®. Resultados: foram prescritas 2.062 doses, identificadas 96 IMPT, das quais 66 foram classificadas como graves e 30, moderadas. A IMPT de maior prevalência foi Bromoprida/Tramal® por via intravenosa (n=26), seguida de AAS/Clopidogrel (n=21) por via oral. Evidenciou-se associação entre as variáveis interação medicamentosa-polifarmácia (χ² = 98.853,p = 0,0000001) e interação medicamentosa-comorbidade (χ²= 4.246, p = 0,23609658). Conclusões: houve alta prevalência de IMPT no pós-operatório de cirurgia cardíaca. A verificação precoce das prescrições possibilita a rastreabilidade e adoção de medidas mitigatórias de erros no uso de medicamento, o que contribui para a segurança do paciente e para a qualidade da assistência.

Objetivo: verificar las interacciones farmacológicas potencialmente teóricas (IFPT), con sus respectivas repercusiones clínicas, y correlacionarlas con el perfil clínico-farmacológico a partir de las prescripciones en el postoperatorio de cirugía cardiaca. Materiales y métodos: estudio descriptivo, transversal y retrospectivo con una muestra de 133 prescripciones de pacientes hospitalizados en un centro de salud estatal de Río de Janeiro, Brasil, entre marzo y agosto de 2018. Para evaluar las interacciones se utilizó el Software Micromedex Solutions®, junto con la aplicación de estadística descriptiva e inferencial para los datos recopilados, empleando el Software Epi Info 7®. Resultados: se prescribieron 2.062 dosis y se identificaron 96 IFPT, de las cuales 66 fueron clasificadas como graves y 30 como moderadas. La IFPT más prevalente fue Bromoprida/Tramal® por vía intravenosa (n = 26), seguida de AAS/Clopidogrel (n = 21) por vía oral. Se identificó una asociación entre las variables interacciones farmacológicas-polifarmacia (χ² = 98,853, p = 0,0000001) e interacciones farmacológicas-comorbilidades (χ² = 4.246, p = 0,23609658). Conclusiones: se registró una alta prevalencia de IFPT en el postoperatorio de cirugía cardíaca. La verificación temprana de prescripciones permite detectar y adoptar medidas de mitigación de errores de medicación, contribuyendo a la seguridad del paciente y la calidad de la atención.

Objective: To verify potentially theoretical drug interactions (PTDI), including their clinical repercussions, and correlate them to the clinical-pharmacological profile of medical prescriptions in the postoperative period of cardiac surgery. Methodology: Prescriptive, cross-sectional, and retrospective study with a sample of 133 drug prescriptions of hospitalized patients in a Rio de Janeiro state hospital in Brazil, between March and August 2018. To assess the interactions, the Micromedex Solutions® Software was used, followed by the descriptive and inferential statistics of the data by the Epi Info 7® Software. Results: A total of 2,062 doses were prescribed, identifying 96 PTDI, of which 66 were classified as severe and 30 as moderate. The most prevalent PTDI was Bromopride/Tramal® intravenously (n = 26), followed by ASA/Clopidogrel (n = 21) orally. There was an association between the variables drug interaction-polypharmacy (χ² = 98,853, p = 0.0000001) and drug interaction-comorbidities (χ² = 4,246, p = 0.23609658). Conclusions: A high prevalence of PTDI during the postoperative period of cardiac surgery was reported. The early verification of prescriptions makes it possible to detect and adopt mitigation measures in response to medication errors, thus contributing to patient safety and higher quality in the care provided.

Clinical management of a granulomatous tubulointerstitial nephritis associated with a bilateral granulomatous anterior uveitis: A challenging case report and review of the literature.

Acute granulomatous tubulointerstitial nephritis (GTIN) is a rare finding in renal biopsy. Differential diagnosis is facilitated when GTIN is associated with granulomatous bilateral anterior uveitis (GBAU). Nevertheless, differentiation between a rare form of granulomatous tubulointerstitial nephritis and uveitis syndrome (TINU) and sarcoidosis can be challenging. We report a case of biopsy-proven GTIN with concomitant GBAU, leading to a dead-end diagnosis. We discuss workup and propose a diagnostic algorithm based on a literature review. We also report a successful treatment of ophthalmologic and renal relapse using mycophenolate mofetil.

Effect of Aqueous Cinnamon Extract on the Postprandial Glycemia Levels in Patients with Type 2 Diabetes Mellitus: A Randomized Controlled Trial.

Cinnamon is a spice used in traditional cuisine that has been investigated due to hypoglycemic properties. The objective of this study was to investigate the effect of aqueous cinnamon extract on postprandial glycemia levels in type 2 diabetes mellitus (DM2) adults. This clinical trial enrolled 36 adults with DM2, randomly allocated in two groups: the control group (n = 18) took only an oral glucose tolerance test (OGTT) and the intervention group (n = 18) took OGTT immediately followed by aqueous cinnamon extract (6 g/100 mL) ingestion. Blood glucose levels were measured on fasting and after 30, 60, 90 and 120 min in both groups. The chemical analysis of the aqueous cinnamon extract included total phenols content determination and antioxidant activity assessment through FRAP and DPPH methods. The data reveal that aqueous cinnamon extract ingestion did not show a significant difference in the incremental area under the curve (p = 0.834), maximum glucose concentration (p = 0.527) and glucose concentration variation (p = 0.873) compared with the control group. Cinnamon extract possess a total phenol content of 1554.9 mg/L gallic acid equivalent and a strong antioxidant capacity, revealed by the DPPH (5125.0 µmol Trolox/L) and FRAP (3658.8 µmol Trolox/L) tests. Aqueous cinnamon extract did not significantly influence postprandial glucose response in diabetic patients during an OGTT.

Adansonia digitata L. (Baobab Fruit) Effect on Postprandial Glycemia in Healthy Adults: A Randomized Controlled Trial.

Baobab fruits have been traditionally used in Africa due to their therapeutic properties attributed to their high polyphenol content. The aim of the study was to investigate the effect of baobab fruit on postprandial glycaemia in healthy adults and to measure its bioactive compounds and antioxidant activity. The study (NCT05140629) was conducted on 31 healthy subjects. The participants were randomly allocated in the control group (oral glucose tolerance test (OGTT); n = 16) and in the intervention group (OGTT, followed by administration of 250 mL baobab aqueous extract (BAE); n = 15). Total phenols, proanthocyanins, hydrolyzable tannins, and antioxidant activity (FRAP, DPPH, ABTS, and inhibition of O2•- and NO• methods) were quantified. Repeated measures ANOVA of mixed type and independent samples t-test were used. Glycemia incremental area under the curve (p = 0.012) and glucose maximum concentration (p = 0.029) was significantly lower in the intervention group compared to the control group. The BAE revealed high total contents of phenols, proanthocyanins, and hydrolyzable tannins, as well as a strong capacity to scavenge superoxide anions and nitric oxide radicals and a high antioxidant activity. In conclusion, this study encourages the use of this food component as a promising source of natural antioxidants and a hypoglycemic agent under glucose load acute conditions.

Rectal ulcer in a hemodialysis patient receiving Kayexalate®.

Kayexalate can cause severe unrecognized GI lesions. Diagnosis of kayexalate crystals in GI biopsy samples is important. Pathologists and clinicians should work hand in hand. New drugs should be available to all patients to treat hyperkalemia.