Wernicke-Korsakoff Syndrome associated with hyperemesis gravidarum and fetal death: Case report and literature review / Síndrome de Wernicke-Korsakoff associado a hiperêmese gravídica e morte fetal: Relato de caso e revisão de literatura

We describe a clinical case of a pregnant patient with hyperemesis gravidarum who progressed to abortion, Wernicke's encephalopathy, and Korsakoff's psychosis, all related to thiamine deficiency. The patient presented symptoms of disorientation, nonspecific limb movements, and fever, initially treated with metronidazole and ceftriaxone for suspected infected abortion. Subsequently, the patient was diagnosed with retained and infected abortion, and thiamine replacement therapy was initiated with an intravenous loading dose of 900 mg/day. During hospitalization, the patient presented with tetraparesis, nystagmus, decreased level of consciousness, anterograde and retrograde amnesia, confabulation, and aphasia. Magnetic resonance imaging showed lesions in the pons, typical of Wernicke's encephalopathy. The patient was empirically treated with acyclovir and ampicillin and showed clinical improvement. The text also provides a brief narrative review of the literature on the topic.

Descrevemos um caso clínico de uma paciente grávida com hiperêmese gravídica que evoluiu para aborto, Encefalopatia de Wernicke e Psicose de Korsakoff, ambas relacionadas à deficiência de tiamina. A paciente apresentou sintomas de desorientação, movimentos inespecíficos dos membros e febre, sendo, inicialmente, tratada com metronidazol e ceftriaxona por suspeita de aborto infectado. Posteriormente, a paciente foi diagnosticada com aborto retido e infectado e iniciou-se a reposição de tiamina com dose endovenosa de ataque de 900 mg/dia. Durante o internamento, a paciente apresentou tetraparesia, nistagmo, rebaixamento do nível de consciência, amnésia anterógrada e retrógrada, confabulação e afasia. A ressonância magnética mostrou lesões na ponte, típicas da Encefalopatia de Wernicke. A paciente foi tratada com aciclovir e ampicilina empiricamente e apresentou melhoras no quadro clínico. O texto também faz uma breve revisão narrativa da literatura sobre o tema.

Miocardiopatia Dilatada após uso de Adalimumabe em paciente com Pioderma Gangrenoso / Dilated myocardiopathy after use of Adalimumab in a patient with pyoderma gangrenosum

Introdução: O pioderma gangrenoso é uma dermatose incomum, crônica e de apresentação clínica variável. Sua etiologia é indefinida, e seu tratamento não é bem estabelecido. O Adalimumabe é um anticorpo monoclonal humano contra o fator de necrose tumoral alfa (anti- TNF) que é raramente associado à disfunção cardíaca. Relato de Caso: Relatamos um caso de uma paciente com pioderma gangrenoso idiopático que, após duas doses de Adalimumabe, desenvolveu insuficiência cardíaca grave com miocardiopatia dilatada. Ela foi tratada com diurético de alça, betabloqueador e antagonista da enzima conversora da angiostensina. Após dois meses, encontrava-se sem queixas cardiorrespiratórias e com melhora da fração de ejeção. Conclusão: A miocardiopatia dilatada, apesar de ser manifestação rara do uso de fármacos anti -TNF deve ser considerada no diagnóstico diferencial de insuficiência respiratória após seu uso.

Introduction: Pyoderma gangrenosum is an unusual chronic dermatosis of mixed clinical presentation. Its etiology is unclear, and its treatment is not well established. Adalimumab is a human monoclonal antibody against the tumor necrosis factor alpha (anti TNF) which is rarely associated with cardiac dysfunction. Case Report: We report a case of a patient with idiopathic Pyoderma gangrenosum who developed severe heart failure with dilated myocardiopathy after two doses of Adalimumab. She was treated with loop diuretic, beta-blocker and angiostensin-converting enzyme antagonist. After two months, she was without cardiorespiratory complaints and with improvement in the ejection fraction. Conclusion: Dilated myocardiopathy, despite being a rare manifestation of the use of anti -TNF drugs should be considered in the differential diagnosis of respiratory failure after its use.

COVID-19 in a Patient with Chronic Lymphocytic Leukaemia with Pseudohypoxemia.

Infection with SARS-CoV-2 causes critical disease in approximately 5% of affected patients, particularly the elderly, hypertensive, obese and immunocompromised. Patients with haematological cancer, including chronic lymphocytic leukaemia (CLL), are particularly at risk of complications. Very rarely, patients with extreme leukocytosis may develop spurious hypoxemia, or pseudohypoxemia, which confuses the diagnosis of complications and can lead to intervention errors. We report the case of a patient with CLL, severe infection with SARS-CoV-2 and pseudohypoxemia. LEARNING POINTS: Patients with haematological neoplasms are susceptible to viral, bacterial and fungal infections, and are thus at risk of COVID-19.Patients with chronic lymphocytic leukaemia may rarely, due to a high lymphocyte count, present with spurious, or in vitro, hypoxemia.The clinician must identify and properly treat such cases to prevent any unnecessary treatments and their complications.

Avaliação da positividade de anticorpos antifosfolipídeo em pacientes com doença hipertensiva específica da gravidez / Evaluation of antiphospholipid antibody positivity in patients with hypertensive disorders during pregnancy

Introdução: a doença Hipertensiva Específica da Gravidez (DHEG), possui alta prevalência, sendo importante causa de morbidade materna e fetal. A síndrome de Anticorpos Antifosfolipídeos (SAAF) é sabidamente fator de risco para DHEG; porém, em doentes sem diagnóstico prévio de SAAF, poucos estudos são feitos em relação à soroprevalência de anticorpos antifosfolipídeos na DHEG. Objetivos: Estimar, a partir da comparação da positividade de anticorpos antifosfolipídeos entre dois grupos de pacientes, uma possível relação causal entre estes e a presença de doença hipertensiva específica da gravidez. Metodologia: realizamos um estudo observacional, com puérperas diagnosticadas com DHEG, sem diagnóstico prévio de doenças autoimunes ou SAAF, dosando-se os títulos de anticorpos anticardiolipina, anti-beta2glicoproteina1 e anticoagulante lúpico em comparação com puérperas sem patologias em um hospital de ensino terciário. Resultados: Foram avaliadas 69 pacientes, sendo 60 pacientes com DHEG em seu espectro de gravidade, 9 pacientes em grupo de controle normal, sendo observada que a incidência de algum AFL foi 31,6% no grupo de casos e 0% no grupo controle (p=0,00). Conclusão: concluímos que um número importante de puérperas possuem, durante a DHEG, níveis elevados de anticorpos antifosfolipídeos. Acreditamos que essas doentes se beneficiarão de novo screening para SAAF após 12 semanas, com o objetivo de, em gravidez futura, evitar novos eventos mórbidos. (AU)

Introduction: Hypertensive Pregnancy disease has a high prevalence and is a major cause of maternal and fetal morbidity. The antiphospholipid antibodies syndrome (APL) is a known risk factor for preeclampsia, however, in patients without prior diagnosis of APL, few studies are made regarding the prevalence of antiphospholipid antibodies in preeclampsia. Objectives: To estimate, from the comparison of the positivity of antiphospholipid antibodies in the two groups of patients, a possible causal relationship between these and the presence of preeclampsia. Methods: We conducted an observational study with mothers diagnosed with preeclampsia without prior diagnosis of auto-immune diseases or APL, dosing up the titles of anticardiolipin, anti-ß2 -glycoprotein I and lupus anticoagulant compared to women with no conditions. Results: 69 patients were evaluated, 60 patients with preeclampsia in their spectrum of severity and 9 patients in the normal control group, being observed incidence of some AFL was 31.6% in the case group and 0% in the control group (p = 0,00). Conclusion: We conclude that a significant number of mothers have presented, during the preeclampsia, high levels of antiphospholipid antibodies, suggesting that antiphospholipid antibodies may play a pathogenic role in some women with preeclampsia. (AU)

Diffuse Gastric Cancer During Pregnancy: Report of a Rare Association.

Gastric cancer during pregnancy is a rare event and difficult to diagnose, as the symptoms can be confused with those of an ordinary pregnancy. We report a case of a 25-year-old patient with a 29-week gestation, with asthenia complaint, vomiting and weight loss. During the investigation of wasting syndrome endoscopy was performed with infiltrative ulcerative lesions in pre-pyloric region with biopsy revealing carcinoma with signet ring, undifferentiated type. It was held on a strict control of fetal vitality, and pregnancy was interrupted via the abdominal delivery at 34 weeks. Soon after the cesarean section was performed, exploratory laparotomy was performed to perform inventory of the abdominal cavity, being observed the presence of carcinomatous implants in the peritoneum. In the face of irresectability clinical conduct was adopted and the patient was sent to chemotherapy, ensuring nutrition via a jejunostomy. The article reviews the gastric carcinoma association with pregnancy, discussing the initiation of treatment and continuity of pregnancy.

Serum levels of interleukin-6 in contacts of active pulmonary tuberculosis / Níveis séricos de interleucina-6 em contatos de tuberculose pulmonar ativa

INTRODUCTION: It is estimated that over two billion individuals are infected by Mycobacterium tuberculosis worldwide. Interleukin-6 (IL-6) is an important cytokine whose serum levels are commonly high in active pulmonary tuberculosis (TB). IL-6 screening in contacts of patients with TB may be useful to monitor the progress of the infectious process and to infer the risk of progression to active disease. OBJECTIVE: To evaluate the serum levels of interleukin-6 in contacts of patients with active pulmonary tuberculosis and to compare them with two other groups: a) patients affected by active pulmonary tuberculosis; b) non-contacts of tuberculosis. METHODS: Cross-sectional study with 15 contacts of patients with active pulmonary tuberculosis, selected according to the protocol recommended by the Ministry of Health. The serum levels of interleukin-6 were measured by Enzyme-linked immunosorbent assay (ELISA). The same test was also applied in the two comparison groups: 38 patients with active pulmonary tuberculosis (confirmed by clinical examination, X-rays of the chest and baciloscopy) and 63 non-contacts (healthy blood donors). RESULTS: In the contact group, the median IL-6 concentration was 1.7 pg/ml (0.96-4.8 pg/ml). For those affected by active pulmonary tuberculosis and non-contact individuals, these values corresponded to 4.3 pg/ml (0.5-24 pg/ml) and 0.5 pg/ml (0-2.8 pg/ml), respectively (p < 0.0001). CONCLUSION: Contacts of patients with active pulmonary tuberculosis had significantly higher IL-6 serum levels (3.4 times higher) in relation to non-contact individuals, but on a lower level (2.5 times lower) when compared to those affected by active disease.

INTRODUÇÃO: Estima-se em mais de dois bilhões o número de infectados pelo Mycobacterium tuberculosis no mundo. A interleucina-6 (IL-6) é uma importante citocina, cujos níveis séricos estão comumente elevados na tuberculose pulmonar ativa. A dosagem dessa citocina em contatos de pacientes com tuberculose pode ser útil para se acompanhar a evolução do processo infeccioso, bem como para inferir o risco de progressão da doença ativa. OBJETIVO: Avaliar os níveis séricos de IL-6 em contatos de pacientes com tuberculose pulmonar ativa e compará-los com os de dois outros grupos: a) pacientes acometidos por tuberculose pulmonar ativa; b) não contatos de tuberculose. MÉTODOS: Estudo transversal com 15 contatos de pacientes com tuberculose pulmonar ativa, selecionados de acordo com protocolo preconizado pelo Ministério da Saúde. Os níveis séricos de IL-6 foram mensurados por meio de ensaio imunoenzimático (ELISA). O mesmo ensaio também foi empregado nos dois grupos de comparação: 38 pacientes com tuberculose pulmonar ativa (confirmada por exame clínico, raios X de tórax e baciloscopia) e 63 não contatos, doadores saudáveis de sangue. RESULTADOS: Para o grupo de contatos, a mediana de concentração de IL-6 foi de 1,7 pg/ml (0,96-4,8 pg/ml); para os acometidos por tuberculose pulmonar ativa e indivíduos não contatos, esses valores foram 4,3 pg/ml (0-12 pg/ml) e 0,5 pg/ml (0-2,8 pg/ml), respectivamente (p < 0,0001). CONCLUSÃO: Contatos de pacientes com tuberculose pulmonar ativa apresentaram níveis séricos de IL-6 significativamente aumentados (3,4 vezes mais), em relação aos indivíduos não contatos, mas em um patamar inferior (2,5 vezes menos), quando comparados com os acometidos pela doença ativa.

Repercussão sistêmica e terapêutica utilizada em pacientes hospitalizados com doença pulmonar obstrutiva crônica / Repercussão sistêmica e terapêutica utilizada em pacientes hospitalizados com doença pulmonar obstrutiva crônica

A Doença Pulmonar Obstrutiva Crônica tem como característica principal a limitação ao fluxo aéreo, não sendo totalmente reversível, mas podendo ser prevenida e tratada. As repercussões sistêmicas da doença podem levar a internação hospitalar por consequências de características próprias da doença e inflamação nas vias aéreas. A pesquisa objetiva conhecer as principais repercussões sistêmicas e a terapêutica utilizada em pacientes, com Doença Pulmonar Obstrutiva Crônica, internados em uma unidade hospitalar. Trata-se de um estudo prospectivo, quantitativo e documental, realizado em um Hospital Público de referência na assistência a patologias cardiopulmonares, composto por pacientes de ambos os sexos internados com diagnóstico de Doença Pulmonar Obstrutiva Crônica confirmado no prontuário. As variáveis analisadas estiveram relacionadas à história clínica (etilismo, tabagismo, doenças associadas), as repercussões sistêmicas (fraqueza muscular, perda de peso e retenção CO2), as complicações clínicas (desconforto e infecção respiratória), a terapêutica clínica (oxigenoterapia, ventilação não invasiva e ventilação mecânica) e terapêutica fisioterápica. Utilizou-se a estatística descritiva. Foram coletados dados de 31 prontuários de pacientes com Doença Pulmonar Obstrutiva Crônica, 21(68%) do sexo feminino e 10(32%) do sexo masculino com média de idade de 66,5 anos. As repercussões sistêmicas mais presentes foram: retenção de CO2 19(61%), fraqueza muscular 13(42%) e perda de peso 12(39%). No que se refere à terapêutica clínica, farmacológica e fisioterápica foram utilizados: oxigenoterapia 30(97%), corticóides 25(81%), broncodilatadores 23(74%), antibióticos 20(65%), e alguns utilizaram VNI 5 (16%) e, 23(74%) tinham indicação de fisioterapia. Constatou-se que as principais repercussões sistêmicas foram a retenção de CO2, fraqueza muscular e perda de peso. As terapêuticas utilizadas foram propostas para melhorar e/ou reverter os sintomas apresentados pelos pacientes a fim de reduzir o tempo de internamento e morbimortalidade.

The chronic obstructive pulmonary disease (COPD) is characterized chiefly by the airflow limitation and is not fully reversible, but can be prevented and treated. The systemic effects of the disease can lead to hospitalization for consequences of characteristics of the disease and airway inflammation. Objective: To know the main effects and systemic therapy used in patients with COPD admitted to a hospital. Methodology: A prospective, quantitative and documentary. Performed in a public hospital reference in assisting cardiopulmonary pathologies. Composed of patients of both sexes admitted with diagnosis of COPD confirmed in the medical record. The variables analyzed were related to clinical history (alcoholism, smoking, associated diseases), the systemic effects (muscle weakness, weight loss and CO2 retention), the clinical complications (discomfort and respiratory infection), clinical therapy (oxygen, ventilation is not and invasive mechanical ventilation) and physiotherapy treatment. We used descriptive statistics. Results: Data were collected from medical records of 31 patients with COPD, 21 (67.7%) females and 10 (32.2%) were male with a mean age of 66.5 years. The systemic effects were more present: CO2 retention 19 (61.2%), muscle weakness 13 (41.9%) and weight loss 12 (38.7%). With regard to medical therapy, physical therapy and drug were used: oxygen 30 (96.7%), corticosteroids, 15 (80.6%), bronchodilators 23 (74.1%), antibiotics 20 (64.5%) and some used NIV 5 (15.1%) and 23 (74.1%) were referred for physiotherapy. Conclusion: It was found that the main effects were systemic CO2 retention, muscle weakness and weight loss. The treatments used were proposals to improve and / or reverse the symptoms of the patients in order to reduce the length of stay and mortality.

Perfil clínico e laboratorial de pacientes com sepse, sepse grave e choque séptico admitidos em uma unidade de terapia intensiva / Clinical and laboratory profile of patients with sepsis, severe sepsis and septic shock admitted in an intensive care unit

A sepse, sepse grave e choque séptico são as principais causas de mortalidade nas Unidades de Terapia Intensiva. Objetivou-se traçar o perfil clínico e laboratorial de pacientes com sepse, sepse grave e choque séptico admitidos em uma unidade de terapia intensiva. Os pacientes com diagnóstico de sepse foram avaliados no 1º, 3º e 5º dias de internação e reavaliados ao final da internação para definição do desfecho clínico. Analisou-se a evolução clínica, alterações hemodinâmicas, disfunções orgânicas (através da Sepsis Related Organ Failure - SOFA), etiologia e tempo de permanência. A amostra constou de 46 pacientes e 17 com sepse, 10 com sepse grave e 19 com choque séptico. A acidose metabólica, plaquetopenia e leucocitose foram as principais alterações laboratoriais detectadas, a disfunção respiratória foi a mais prevalente. Quanto ao desfecho do internamento 25 pacientes evoluíram ao óbito. Recomenda-se aprofundamento sobre o mecanismo de atuação da sepse, além de uma equipe multidisciplinar capacitada para abordar esses pacientes e elaborar protocolos de tratamento cada vez mais efetivos.

Sepsis is a major cause of mortality in intensive care units. The objective was to delineate the clinical profile of patients with sepsis admitted to an intensive care unit. Patients diagnosed with sepsis were evaluated at 1, 3 and 5 days of admission and reassessed at the end of hospitalization for defining the clinical outcome. The variables were: clinical, hemodynamic changes, organ dysfunction (through Related Organ Failure Sepsis - SOFA), etiology and length of stay. The sample consisted of 46 patients and 17 with sepsis, 10 with severe sepsis and 19 with septic shock. Metabolic acidosis, thrombocytopenia and leukocytosis were the main laboratory abnormalities detected, respiratory dysfunction was the most prevalent. Regarding the outcome of admission 25 patients progressed to death. We recommend futher work on the mechanism of sepsis and a multidisciplinary team able to address these patients and develop treatment protocols that make these approaches more effective.

Protein-losing enteropathy in systemic lupus erythematosus: case report.

Protein-losing enteropathy is rarely seen in patients with systemic lupus erythematosus. This clinical condition should be suspected in the presence of persistent hypoalbuminemia despite normal liver function, adequate protein intake, and no significant proteinuria. We report the case of a 48-year-old female with weight loss, cavity effusions (ascites and pleural effusion), and lower extremity edema. The diagnosis of lupus was established based on the presence of lymphopenia, proteinuria, ANA, and positive autoantibodies (anti-Sm, anti-DNA, and anti-Ro). Because hypoalbuminemia persisted even with corticosteroid therapy at the dose of 1 mg/kg, protein-losing enteropathy was diagnosed by use of Tc-99m albumin scintigraphy. After adding azathioprine to the treatment, the symptoms subsided and serum albumin levels improved.

Achalasia and thyroid disease: possible autoimmune connection? / Acalasia e doença tireoidiana: uma conexão autoimune possível?

Many cases have been published showing a co-existence of autoimmune thyroid diseases (AITDs) and other autoimmune diseases. About a quarter of patients with achalasia have a concurrent thyroid disease, most commonly associated with hypothyroidism. Although relatively rare, the association of achalasia and hyperthyroidism requires attention. The physiopathology of Grave's Disease (GD) involves B- and T-mediator lymphocytes, which have an affinity for known thyroid antigens: thyroglobulin, thyroid-peroxidase, and thyrotrophin receptor. Currently, however, the real physiopathogenesis of achalasia continues to be unknown. Some important findings are suggestive of an autoimmune mechanism: significant infiltration of the myoenteric plexus by monocytes, presence of the class II-Human Histocompatibility Complex DQwl antigen and antibodies to myoenteric neurons. The present case reports a patient who, despite testing negative for Chagas' disease, had achalasia, progressed to developing significant wasting and worsening of his quality of life, was later diagnosed with hyperthyroidism. After endoscopic esophageal dilatation and radioiodine ablation of the thyroid gland, there was great improvement in the patient clinical condition. Arq Bras Endocrinol Metab. 2012;56(9):677-82.

Muitos casos têm sido publicados mostrando uma coexistência entre as doenças autoimunes da tireoide (DAIT) e outras doenças autoimunes. Cerca de um quarto dos pacientes com acalasia têm doenças da tireoide concomitantemente, sendo a mais comum a associação com hipotireoidismo. Apesar de ser relativamente rara, a associação da acalasia e hipertireoidismo requer atenção. A fisiopatologia da doença de Graves (DG) envolve os linfócitos B e T-mediados, os quais têm afinidade pelos antígenos da tireoide: tireoglobulina, tireoperoxidase e receptor de tireotrofina. Atualmente, a real fisiopatogenia da acalasia continua desconhecida. No entanto, alguns importantes achados em análise são sugestivos de mecanismo autoimune: infiltração significativa do plexo mioentérico pelos monócitos, presença do antígeno-DQwl do Complexo Humano de Histocompatibilidade classe II e presença de anticorpos contra neurônios mioentéricos. Este presente caso aborda um paciente que, apesar de testes negativos para doença de Chagas, tem acalasia que progrediu para o desenvolvimento de significativa perda ponderal e piora da sua qualidade de vida, posteriormente, diagnosticado com hipertireoidismo. Após dilatação endoscópica esofágica e ablação da glândula tireoide com radioiodo, houve grande melhora na condição clínica do paciente. Arq Bras Endocrinol Metab. 2012;56(9):677-82.

Enteropatia perdedora de proteínas no lúpus eritematoso sistêmico: relato de caso / Protein-losing enteropathy in systemic lupus erythematosus: case report

A enteropatia perdedora de proteínas raramente pode ser observada em pacientes com lúpus eritematoso sistêmico. Essa situação clínica deve ser suspeitada quando houver hipoalbuminemia persistente, na presença de uma função hepática preservada, ingesta proteica adequada e ausência de proteinúria significativa. Descrevemos o caso de uma paciente de 48 anos com perda ponderal, derrames cavitários (ascite e derrame pleural) e edema de membros inferiores. O diagnóstico de lúpus foi firmado a partir da presença de linfopenia, proteinúria, FAN e autoanticorpos positivos (anti-Sm, anti-DNA e anti-Ro). Houve persistência de hipoalbuminemia mesmo com corticoterapia na dose de 1 mg/kg de peso, sendo diagnosticada enteropatia perdedora de proteínas por meio da cintilografia com albumina 99mTc. A melhora clínica e laboratorial da paciente veio após a associação da azatioprina com corticosteroide.

Protein-losing enteropathy is rarely seen in patients with systemic lupus erythematosus. This clinical condition should be suspected in the presence of persistent hypoalbuminemia despite normal liver function, adequate protein intake, and no significant proteinuria. We report the case of a 48-year-old female with weight loss, cavity effusions (ascites and pleural effusion), and lower extremity edema. The diagnosis of lupus was established based on the presence of lymphopenia, proteinuria, ANA, and positive autoantibodies (anti-Sm, anti-DNA, and anti-Ro). Because hypoalbuminemia persisted even with corticosteroid therapy at the dose of 1 mg/kg, protein-losing enteropathy was diagnosed by use of Tc-99m albumin scintigraphy. After adding azathioprine to the treatment, the symptoms subsided and serum albumin levels improved.

Achalasia and thyroid disease: possible autoimmune connection?

Many cases have been published showing a co-existence of autoimmune thyroid diseases (AITDs) and other autoimmune diseases. About a quarter of patients with achalasia have a concurrent thyroid disease, most commonly associated with hypothyroidism. Although relatively rare, the association of achalasia and hyperthyroidism requires attention. The physiopathology of Grave's Disease (GD) involves B- and T-mediator lymphocytes, which have an affinity for known thyroid antigens: thyroglobulin, thyroid-peroxidase, and thyrotrophin receptor. Currently, however, the real physiopathogenesis of achalasia continues to be unknown. Some important findings are suggestive of an autoimmune mechanism: significant infiltration of the myoenteric plexus by monocytes, presence of the class II-Human Histocompatibility Complex DQwl antigen and antibodies to myoenteric neurons. The present case reports a patient who, despite testing negative for Chagas' disease, had achalasia, progressed to developing significant wasting and worsening of his quality of life, was later diagnosed with hyperthyroidism. After endoscopic esophageal dilatation and radioiodine ablation of the thyroid gland, there was great improvement in the patient clinical condition.

Estudo das doenças glomerulares em pacientes internados no Hospital Geral César Cals (Fortaleza-CE) / Study of glomerular diseases in patients admitted to the Hospital Geral César Cals (Fortaleza-CE)

A biópsia renal percutânea constitui o padrão-ouro para o diagnóstico, prognóstico e tratamento das doenças glomerulares. Estudamos 51 pacientes que foram submetidos à biópsia renal no Hospital Geral César Cals, em fortaleza, Ceará Brasil, no período de janeiro de 2000 a dezembro de 2007. Houve predomínio do sexo feminino (57%). A faixa etária mais afetada foi de 20-40 anos. A principal forma de apresentação das glomerulopatias foi a síndrome nefrótica (49%), e o padrão histopatológico mais prevalente nas glomerulopatias secundárias (37%). Tivemos 5,8% de complicações atribuídas à biópsia renal, tendo sido a hematúria macroscópica a principal responsável (3,9%). Estudos mais abrangentes são necessários para traçar o perfil epidemiológico das doenças glomerulares no Estado do Ceará.

A percutaneous renal biopsy is the gold standard for diagnosis, prognosis and treatment of glomerular diseases. We studied 51 patients who underwent renal biopsy at the Hospital Geral César Cals, Fortaleza, Ceara, Brazil, from January 2000 to December 2007. There was predominance of females (57%). The most affected age group was 20-40 years. The main form of presentation was nephrotic syndrome glomerulopathies (49%), and histopathological pattern more prevalent in secondary glomerulopathies (37%). 5.8% had complications attributed to renal biopsy, macroscopic hematuria was the main cause (3.9%). Large studies are needed to delineate the epidemiological profile of glomerular diseases in Ceará.

Acute kidney injury requiring dialysis in obstetric patients: a series of 55 cases in Brazil.

OBJECTIVE: To investigate the risk factors associated with oliguria and death in obstetric patients with acute kidney injury (AKI). METHODS: The study group included all obstetric patients with AKI, under dialytic treatment, in Hospital Geral César Cals, Fortaleza, Brazil, from January 2000 to December 2006. AKI were classified according to the RIFLE criteria. Univariate and multivariate analysis were performed to investigate the factors associated with oliguria and death. RESULTS: A total of 55 patients were included. Their average age was 26.2 +/- 6.7 years. The main etiologies of AKI were pregnancy-related hypertension (41.8%), HELLP syndrome (40%), puerperal sepsis (14.5%), abruption placentae (9.1%), hemolytic uremic syndrome (9.1%) and thrombotic thrombocytopenic purpura (5.5%). Oliguria was observed in 36 cases (65%). Death occurred in 17 cases (30.9%). Factors associated with oliguria were, diagnosis of HELLP syndrome, hyperbilirubinemia and death. Factors associated with death were, presence of puerperal sepsis, hyperbilirubinemia, hypotension, oliguria and low levels of HCO(3). CONCLUSION: AKI is a rare but potential fatal complication in obstetric patients. RIFLE criteria seem to have association with mortality. There are important factors associated with oliguria and death, which must be prompt recognized to the institution of adequate therapeutic measures.

Polimorfismo -174G>C do gene de interleucina-6 na tuberculose pulmonar [manuscrito] / Polymorphism -174G> C interleukin-6 gene in pulmonary tuberculosis [manuscript]

O objetivo do estudo foi investigar o perfil de produção de IL-6 em pacientes com tuberculose pulmonar ativa e avaliar o papel funcional do polimorfismo -174G>C do gene de IL-6 na produção sistêmica deste citocina. Um total de 63 pacientes e 99 controles foi estudado, sendo 38 pacientes [25(65,8%) masculinos] e 63 controles [51 (81%) masculinos] para a dosagem de IL-6, enquanto, 42 pacientes [25 (60%) masculinos] e 79 controles [62 (78,5%) masculinos] para o estudo do polimorfismo. Os pacientes foram selecionados dos centros de referência da rede estadual de saúde: Dona Libânia, Hospital de Messejana, Hospital de Maracanaú e Hospital Geral Dr. César Cals. O grupo controle foi selecionado no HEMOCE. Foi realizado teste de ELISA para a dosagem sérica de IL-6. O DNA genômico foi extraído de sangue periférico e o polimorfismo de IL-6 foi estudado por reação de polimerase em cadeia utilizando iniciadores sequência específicos...