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1.
ANZ J Surg ; 93(12): 2921-2927, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-38041216

RESUMO

PURPOSE: Stoma creation is a common procedure in patients with Crohn's disease (CD), and early prophylaxis with biologics is recommended for high-risk patients. However, the effect of biologic exposure on morbidity after stoma closure remains unknown. Therefore, this study aimed to investigate the impact of biologic use on the occurrence of complications in CD patients following stoma closure. METHODS: Consecutive patients diagnosed with CD who underwent ileostomy reversal at a tertiary care centre between 1 January 2013 and 1 December 2021, were included in the study. The primary outcome was the occurrence of 90-day postoperative complications. RESULTS: The study included 347 eligible patients who underwent ileostomy reversal. There was no significant difference in terms of infectious complications, overall complications or length of postoperative stay between the biologic and non-biologic groups. Multivariate logistic regression analysis identified several predictors of postoperative morbidity, including preoperative haemoglobin levels below 100 g/L, CRP levels above 10 mg/L, anastomotic site, ileostomy-related infectious complications and albumin levels below 35 g/L. CONCLUSIONS: This study demonstrated that the use of biologics is not associated with adverse outcomes. However, such as high CRP levels, ileostomy-related infectious complications, hypoproteinemia, and hemoglobinemia, should be optimized prior to surgery to reduce postoperative morbidities.


Assuntos
Produtos Biológicos , Doença de Crohn , Estomas Cirúrgicos , Humanos , Doença de Crohn/tratamento farmacológico , Doença de Crohn/cirurgia , Doença de Crohn/complicações , Estudos Retrospectivos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/etiologia , Ileostomia/efeitos adversos , Ileostomia/métodos , Produtos Biológicos/uso terapêutico
2.
Hematol Rep ; 15(4): 562-577, 2023 Oct 13.
Artigo em Inglês | MEDLINE | ID: mdl-37873794

RESUMO

COVID-19, caused by SARS-CoV-2, and its variants have spread rapidly across the globe in the past few years, resulting in millions of deaths worldwide. Hematological diseases and complications associated with COVID-19 severely impact the mortality and morbidity rates of patients; therefore, there is a need for oversight on what pharmaceutical therapies are prescribed to hematologically at-risk patients. Thrombocytopenia, hemoglobinemia, leukopenia, and leukocytosis are all seen at increased rates in patients infected with COVID-19 and become more prominent in patients with severe COVID-19. Further, COVID-19 therapeutics may be associated with hematological complications, and this became more important in immunocompromised patients with hematological conditions as they are at higher risk of hematological complications after treatment. Thus, it is important to understand and treat COVID-19 patients with underlying hematological conditions with caution. Hematological changes during COVID-19 infection and treatment are important because they may serve as biomarkers as well as to evaluate the treatment response, which will help in changing treatment strategies. In this literature review, we discuss the hematological complications associated with COVID-19, the mechanisms, treatment groups, and adverse effects of commonly used COVID-19 therapies, followed by the hematological adverse events that could arise due to therapeutic agents used in COVID-19.

3.
Parasitol Int ; 96: 102774, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-37380124

RESUMO

Babesia gibsoni is mainly transmitted by hard ticks of the genus Rhipicephalus (R. sanguineus) and Haemaphysalis (H. longicornis), and causes canine babesiosis. Clinical manifestations of B. gibsoni infection include fever, hemoglobinemia, hemoglobinuria, and progressive anemia. Traditional antibabesial therapy, such as imidocarb dipropionate or diminazene aceturate, can only alleviate severe clinical manifestations and cannot eliminate parasites in the host. Food and Drug Administration (FDA)-approved drugs are a solid starting point for researching novel therapy strategies for canine babesiosis. In this work, we screened 640 FDA-approved drugs against the growth of B. gibsoni in vitro. Among them, 13 compounds (at 10 µM) exhibited high growth inhibition (>60%), and two compounds, namely idarubicin hydrochloride (idamycin) and vorinostat, were chosen for further investigation. The half-maximal inhibitory concentration (IC50) values of idamycin and vorinostat were determined to be 0.044 ± 0.008 µM and 0.591 ± 0.107 µM, respectively. Viability results indicated that a concentration of 4 × IC50 of vorinostat prevented the regrowth of treated B. gibsoni, whereas parasites treated with 4 × IC50 concentration of idamycin remained viable. The B. gibsoni parasites treated with vorinostat exhibited degeneration within erythrocytes and merozoites, in contrast to the oval or signet-ring shape of normal B. gibsoni parasites. In conclusion, FDA-approved drugs offer a valuable platform for drug repositioning in antibabesiosis research. Particularly, vorinostat demonstrated promising inhibitory effects against B. gibsoni in vitro, and further studies on vorinostat are necessary to elucidate its mechanism as a novel treatment in infected animal models.


Assuntos
Babesia , Babesiose , Doenças do Cão , Ixodidae , Estados Unidos , Animais , Cães , Babesiose/parasitologia , Vorinostat/farmacologia , Vorinostat/uso terapêutico , Idarubicina/farmacologia , Idarubicina/uso terapêutico , United States Food and Drug Administration , Doenças do Cão/tratamento farmacológico , Doenças do Cão/parasitologia
4.
Transfus Med ; 33(5): 409-412, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-37379860

RESUMO

OBJECTIVES: Acute hemolytic transfusion reaction (AHTR) due to ABO-incompatible erythrocyte concentrate (EC) is one of the most catastrophic complications of transfusion. Since the hemolysis is intravascular; hemoglobinemia and hemoglobinuria result in disseminated intravascular coagulation (DIC), acute renal failure, shock, and sometimes death. BACKGROUND: Treatment of AHTR is mostly supportive measures. Today there are no clear suggestions about plasma exchange (PE) in these patients. METHODS/MATERIALS: Here we report our experience with six patients diagnosed with AHTR due to ABO-incompatible EC transfusion. RESULTS: We performed PE in 5 of these patients. Although all of our patients were geriatric and most of them had significant comorbidities four out of five patients recovered without an incident. CONCLUSION: Although PE is considered a last-chance treatment when other measures fail in the literature, our experience above indicates that it must be evaluated in every patient with AHTR early in the course. If the patient has cardiac and renal comorbidities, large volume EC is transfused, DAT is negative, plasma color is red and there is macroscopic hemoglobinuria, we suggest performing PE.


Assuntos
Hemólise , Reação Transfusional , Humanos , Idoso , Troca Plasmática , Hemoglobinúria , Transfusão de Plaquetas , Incompatibilidade de Grupos Sanguíneos , Eritrócitos , Sistema ABO de Grupos Sanguíneos
5.
Terminologia | DeCS - Descritores em Ciências da Saúde | ID: 013823

RESUMO

A morbid condition due to the presence of sulfmethemoglobin in the blood. It is marked by persistent cyanosis, but the blood count does not reveal any special abnormality in the blood. It is thought to be caused by the action of hydrogen sulfide absorbed from the intestine. (Stedman, 25th ed)


Estado mórbido debido a la presencia de sulfohemoglobina en la sangre, caracterizado por cianosis persistente, pero con un recuento sanguíneo que no revela ninguna anomalía especial de la sangre; se cree que es debida a la acción de sulfuro de hidrógeno absorbido del intestino. (Stedman, 25a ed)


Estado mórbido que se deve à presença de sulfemoglobina no sangue. Caracteriza-se por cianose persistente, mas o hemograma não revela qualquer anormalidade especial naquele líquido. Acredita-se que seja causada pela ação do sulfeto de hidrogênio absorvido a partir do intestino. (Stedman, 25a ed)

6.
Biochim Biophys Acta Mol Cell Res ; 1870(1): 119378, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-36220452

RESUMO

Sulfhemoglobinemia is an incurable disease caused by an overdose of sulfur-containing drugs with oxidizing properties. Its diagnosis remains hindered due to the similarity of symptoms to other pathological state - methemoglobinemia, as well as contradictory information on the structure and characteristics of sulfhemoglobin. Herein, we present sulfhemoglobinemia model on living functional human erythrocytes, designed to recreate processes which could take place in a patient body in order to complement missing information and highlight distinctiveness of two hemoglobin (Hb) adducts formed after interaction with sulfur donors. Employed techniques, UV-Vis absorption, Raman, Fourier transformed infrared (FT-IR) and electronic circular dichroism (ECD) spectroscopies, allowed to distinguish and characterize Hb adduct with sulfur atom bounded directly to the iron ion (HbFeIII-SH), and irreversibly connected to the porphyrin ring (SHb - sulfhemoglobin). Presented herein results provided also new evidence on formation of both these hemoglobin adducts inside functional erythrocytes under oxidative conditions and during sulfur-containing drug presence, what can be further translated into future physiological studies. Moreover, we found that sulfur attachment to the porphyrin ring altered Hb structure and lead to changes in protein packing inside RBCs, eventually. Interestingly, measurement of blood drop smear by Raman spectroscopy occurred the most accurate method to differentiate HbFeIII-SH and SHb, indicating potential of this technique in sulfhemoglobinemia diagnosis.


Assuntos
Porfirinas , Sulfemoglobinemia , Humanos , Sulfa-Hemoglobina/análise , Sulfemoglobinemia/diagnóstico , Espectroscopia de Infravermelho com Transformada de Fourier , Hemoglobinas , Enxofre
7.
Chemotherapy ; 68(2): 111-114, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36446317

RESUMO

Mistletoe, Viscum album, is a medicinal plant used in complementary medicine in oncology. Patients do not necessarily mention to their oncologist this phytotherapeutic treatment which may be responsible for unsuspected drug interactions. Some patients are adept at taking medicinal plants, a practice often unknown to health professionals who take care of them. This case reports drug interactions leading to bleeding secondary to warfarin overdose. A patient over 75 years of age was treated with nab-paclitaxel and gemcitabine as a first course for metastatic pancreatic adenocarcinoma (day 0). He was also treated with warfarin for atrial fibrillation. At day 3, he reported faintness and melena. At day 5, the biological assessment revealed anemia with hemoglobinemia of 5.1 g/dL and an international normalized ratio of 7.3, indicating vitamin K antagonist (VKA) overdose. Warfarin was discontinued and the patient received vitamin K supplementation and transfusions. The final diagnosis was an anemic syndrome due to gastrointestinal bleeding secondary to VKA overdose. Based on the chronology, a drug interaction between chemotherapy and warfarin was first suspected. Then, the patient interview found out that he self-medicated with subcutaneous injections of mistletoe extracts: 10 mg on day 0 and on day 2. Nab-paclitaxel can displace warfarin from its albumin binding sites and increase the free and active concentration of warfarin. Mistletoe extracts (V. album) are used as complementary medicine in oncology. Warfarin is predominantly metabolized in the liver by 1A2, 2C9, and 3A4 cytochrome P450 (CYP) isoforms. An inhibitor of these cytochromes prevents the degradation of warfarin into inactive metabolites, leading to accumulation or even overdose of this narrow therapeutic index VKA. Nab-paclitaxel and gemcitabine do not act on these cytochromes. V. album is a cytochrome P450 3A4 inhibitor which therefore probably led to an increase in exposure to warfarin. Thus, there are two pharmacokinetic hypotheses that may explain warfarin overdose: the displacement of warfarin from its albumin binding sites or the inhibition of CYP3A4 by mistletoe. This adverse drug event was reported to the Regional Pharmacovigilance Center of Strasbourg on June 30, 2021, and registered under the number ST20212767.


Assuntos
Adenocarcinoma , Neoplasias Pancreáticas , Masculino , Humanos , Neoplasias Pancreáticas/tratamento farmacológico , Neoplasias Pancreáticas/patologia , Varfarina/efeitos adversos , Adenocarcinoma/tratamento farmacológico , Paclitaxel/uso terapêutico , Gencitabina , Extratos Vegetais/efeitos adversos , Sistema Enzimático do Citocromo P-450/metabolismo , Sistema Enzimático do Citocromo P-450/uso terapêutico , Interações Medicamentosas , Albuminas/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Pancreáticas
8.
Artigo em Inglês | MEDLINE | ID: mdl-36473034

RESUMO

Vascular and lung injury are well established complications associated with hemolytic disorders, and hemolysis associated pulmonary hypertension (PH) has emerged as the most serious complication of sickle cell disease. The causal relationship between intravascular hemolysis and the development of PH is still under investigation. Previously we have shown that repetitive administration of hemolyzed autologous blood causes PH in rats. Dimethyl sulfoxide (DMSO), a widely used solvent and anti-inflammatory agent, induces hemolysis in vivo. We hypothesized that repetitive administration of DMSO would induce PH in rats. We also examined hemolysis-induced release of adenosine deaminase (ADA) and arginase from red blood cells, which may amplify hemolysis-mediated vascular injury. Acute administration of DMSO (1.5ml/30 min into the right atrium) induced intravascular hemolysis and pulmonary vasoconstriction. DMSO-induced increase in right ventricular peak systolic pressure (RVPSP) was associated with increased release of ADA. Notably, the acute increase in RVPSP was attenuated by administration of an adenosine A2A receptor agonist or by pretreatment of animals with ADA inhibitor erythro-9-(2-hydroxy-3-nonyl) adenine (EHNA). Repetitive administration of DMSO for 10 days produced anemia, hemoglobinuria, hemoglobinemia, splenomegaly, and development of PH. Histopathological analysis revealed pulmonary vascular remodeling. The presented data describe a new model of hemolysis induced PH, suggesting that hemolysis is mechanistically related to pulmonary hypertension, and pointing to a potential pathogenic role that adenosine deaminase and accelerated adenosine metabolism may play in hemolysis associated pulmonary hypertension.


Assuntos
Dimetil Sulfóxido , Hipertensão Pulmonar , Animais , Humanos , Ratos , Adenosina Desaminase , Dimetil Sulfóxido/farmacologia , Hipertensão Pulmonar/induzido quimicamente
9.
Orthop Rev (Pavia) ; 14(6): 38574, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36267213

RESUMO

Background: Tranexamic acid and fibrin sealant have been shown to be effective in reducing the need for transfusion after hip fracture surgery. Objective: The aim of this study was to evaluate the efficacy of local haemostatic agents to reduce the need of postoperative transfusion in elederly patients after hip hemiarthroplasty. Methods: All patients admitted to our institution with a diagnosis of proximal femur fracture from September 2018 to March 2021 were involved. Inclusion criteria were: diagnosis of femoral neck fracture, classified as AO 31B2-3, surgical treatment with hip hemiarthroplasty, hemoglobinemia on admission > 8 gr/dL. Patients were divided in four groups. Results: EVICEL was used on 25 patients, TRANEX was used on 52 patients, standard hemostatic care was used on 73 patients, while post-surgical drain was used on 21 patients. 3 patients were transfused in the EVICEL group while 26 patients were transfused in the control group (p 0,0404), there was also statistical significant difference in the need of perioperative transfusion between EVICEL group and drain group with 10 patients transfused (p 0,0102). Statistical significant differences was found about haemoglobin variation in the first post-operative day between TRANEX group and control group (p 0,000155) and between TRANEX group and drain group (p 0,013) and also between TRANEX group and control group in the third post-operative day (p 0,0004). Conclusion: This study demonstrates that the use of both fibrin sealant or TXA can reduce total blood loss and the need of transfusions in geriatric population with intracapsular femur fracture.

10.
J Vet Diagn Invest ; 34(6): 968-971, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36184929

RESUMO

A 7-y-old male Labrador Retriever dog was presented because of acute onset of dark-colored urine after a hunting session the day prior. Moderate hemoglobinemia was observed, associated with transient hemoglobinuria and hematuria with no concurrent evidence of underlying urinary tract disease. The patient's clinical signs resolved within 36 h post-exercise without specific treatment. The concurrent occurrence of exertional hemolysis and hematuria in a dog is uncommon; these conditions are commonly reported separately in human athletes.


Assuntos
Doenças do Cão , Hematúria , Cães , Masculino , Humanos , Animais , Hematúria/etiologia , Hematúria/veterinária , Hemólise , Doenças do Cão/diagnóstico , Hemoglobinúria/veterinária , Testes Hematológicos/veterinária
11.
Rev. med. Chile ; 150(10): 1401-1406, oct. 2022. ilus, tab
Artigo em Espanhol | LILACS | ID: biblio-1431842

RESUMO

Sulfhemoglobin (SulfHb) is formed by hemoglobin (Hb) oxidation by sulfur compounds. Sulfhemoglobinemia is mainly associated with drugs or intestinal bacterial overgrowth. Patients present with central cyanosis, an abnormal pulse oximetry and normal arterial oxygen partial pressure. These features are shared with methemoglobinemia (MetHb) whose diagnosis requires an arterial co-oximetry. Depending on the device used, SulfHb may produce interference with this technique. We report two females aged 31 and 43 years, consulting at the emergency room with cyanosis. Both had a history of acute and chronic, high dose zopiclone ingestion. Pulse oximetry showed desaturation but with normal arterial oxygen partial pressure. Cardiac and pulmonary diseases were ruled out. Co-oximetry in two different analyzers showed interference or normal MetHb percentages. No other complications ensued, and cyanosis decreased over days. Since MetHb was discarded among other causes of cyanosis in a compatible clinical context, the diagnosis of sulfhemoglobinemia was made. The confirmatory method is not available in Chile. The presence of SulfHb is difficult to diagnose, confirmatory tests are not readily available, and it frequently interferes with arterial co-oximetry. This is attributed to a similar absorbance peak of both pigments in arterial blood. Venous co-oximetry can be useful in this context. SulfHb is a self-limited condition in most cases, however it must be differentiated from methemoglobinemia to avoid inappropriate treatments like methylene blue.


Assuntos
Humanos , Feminino , Sulfemoglobinemia/complicações , Metemoglobinemia/diagnóstico , Metemoglobinemia/induzido quimicamente , Oxigênio , Oximetria/efeitos adversos , Cianose/complicações
12.
Artigo em Inglês | MEDLINE | ID: mdl-35329082

RESUMO

Hypoalbuminemia in major cancer surgery can lead to postoperative short and long-term complications. Our study was designed to detect albumin variations in three major cancer surgeries: ovarian debulking (DBK), major abdominal gastrointestinal surgery (ABD), and major cervico-facial, or ear, nose and throat cancer surgery (ENT). Single-center prospective study inclusion criteria were non-emergency procedures scheduled to last at least five hours. We performed hourly perioperative monitoring of the patients' albuminemia and hemoglobinemia. Electronic charts were followed for at least five years for survival analysis. Sixty-three patients were analyzed: 30 in the DBK group, 13 in the ABD group, and 20 in the ENT group. There was a significant difference in albumin decrease between the ENT group and the two others (−19% at six hours in the ENT group versus -49% in the debulking group and −31% in the ABD group (p < 0.05). There was no significant difference between the DBK and ABD groups. The decrease in hemoglobin was not significantly different between the groups, and no significant difference was observed in long-term survival. DBK and ABD surgery yielded significant hypoalbuminemia. Therefore, the extent of decrease in serum albumin is probably not the only etiology of the specific postoperative complications of these major surgeries. No significant difference was noticed in five-year mortality, and no correlation was found in relation to the degree of intraoperative albumin kinetics.


Assuntos
Hipoalbuminemia , Neoplasias , Feminino , Humanos , Cinética , Neoplasias/complicações , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco , Albumina Sérica/análise
13.
Rev Med Chil ; 150(10): 1401-1406, 2022 Oct.
Artigo em Espanhol | MEDLINE | ID: mdl-37358100

RESUMO

Sulfhemoglobin (SulfHb) is formed by hemoglobin (Hb) oxidation by sulfur compounds. Sulfhemoglobinemia is mainly associated with drugs or intestinal bacterial overgrowth. Patients present with central cyanosis, an abnormal pulse oximetry and normal arterial oxygen partial pressure. These features are shared with methemoglobinemia (MetHb) whose diagnosis requires an arterial co-oximetry. Depending on the device used, SulfHb may produce interference with this technique. We report two females aged 31 and 43 years, consulting at the emergency room with cyanosis. Both had a history of acute and chronic, high dose zopiclone ingestion. Pulse oximetry showed desaturation but with normal arterial oxygen partial pressure. Cardiac and pulmonary diseases were ruled out. Co-oximetry in two different analyzers showed interference or normal MetHb percentages. No other complications ensued, and cyanosis decreased over days. Since MetHb was discarded among other causes of cyanosis in a compatible clinical context, the diagnosis of sulfhemoglobinemia was made. The confirmatory method is not available in Chile. The presence of SulfHb is difficult to diagnose, confirmatory tests are not readily available, and it frequently interferes with arterial co-oximetry. This is attributed to a similar absorbance peak of both pigments in arterial blood. Venous co-oximetry can be useful in this context. SulfHb is a self-limited condition in most cases, however it must be differentiated from methemoglobinemia to avoid inappropriate treatments like methylene blue.


Assuntos
Metemoglobinemia , Sulfemoglobinemia , Feminino , Humanos , Metemoglobinemia/induzido quimicamente , Metemoglobinemia/diagnóstico , Sulfemoglobinemia/complicações , Oximetria/efeitos adversos , Cianose/complicações , Oxigênio
14.
Int J Lab Hematol ; 43(4): 837-844, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34092029

RESUMO

INTRODUCTION: Methemoglobin (MetHb) and sulfhemoglobin (SHb) measurements are useful in the evaluation of cyanosis. When one or both values are elevated, additional analysis is important to establish the etiology of the disorder. Methemoglobinemia occurs from acquired or hereditary causes with diverse treatment considerations, while true sulfhemoglobinemia is only acquired and treatment is restricted to toxin removal. Some toxic exposures can result in a dual increase in MetHb and SHb. Hereditary conditions, such as M-Hemoglobin variants (M-Hbs), can result in increased MetHb and/or SHb values but are clinically compensated and do not require treatment if they are cyanotic but otherwise clinically well. METHODS: Herein, we report 53 hemoglobin variant cases that have associated MetHb and SHb levels measured by an adapted Evelyn-Malloy laboratory assay method. RESULTS: Our data indicate M-Hbs cause variable patterns of MetHb and SHb elevation in a fairly reproducible pattern for the particular variant. In particular, α globin chain M-Hbs can mimic acquired sulfhemoglobinemia due to an isolated increased SHb value. CONCLUSION: If the patient appears clinically well other than cyanosis, M-Hbs should be considered early in the evaluation process to differentiate from acquired conditions to avoid unnecessary testing and treatment regimens and prompt genetic counseling.


Assuntos
Cianose/sangue , Metemoglobina/análise , Sulfa-Hemoglobina/análise , Adolescente , Adulto , Criança , Pré-Escolar , Cianose/genética , Feminino , Variação Genética , Hemoglobina M/análise , Hemoglobina M/genética , Humanos , Lactente , Masculino , Metemoglobinemia/sangue , Metemoglobinemia/genética , Sulfemoglobinemia/sangue , Sulfemoglobinemia/genética , Adulto Jovem
15.
J Emerg Med ; 61(2): 147-150, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34034895

RESUMO

BACKGROUND: Sulfhemoglobinemia is a rare dyshemoglobinemia that presents similarly to methemoglobinemia. CASE REPORT: An 83-year-old woman with stage IV ovarian cancer presented to the Emergency Department after a near syncopal spell and was found to be cyanotic with a pulse oximetry reading of 71%. Pulse oximetry improved to only the mid-80s range with administration of high-flow oxygen. Her arterial blood gas on supplemental high-flow oxygen demonstrated a PaO2 of 413 mm Hg and methemoglobin of 1.2%, but also noted the interference of the co-oximetry with sulfhemoglobinemia. Further history revealed that the patient had recently been started on phenazopyridine. The phenazopyridine was stopped, an exchange transfusion was offered but declined, and the patient was discharged to home hospice. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The diagnosis of sulfhemoglobinemia can be challenging given that routine co-oximetry does not identify it. The clue to the diagnosis is that the cyanotic-appearing patient has a normal or elevated PaO2 and seems to be less ill than expected, given the degree of cyanosis. Sulfhemoglobinemia does not reverse with the administration of methylene blue.


Assuntos
Metemoglobinemia , Sulfemoglobinemia , Idoso de 80 Anos ou mais , Cianose , Dispneia , Feminino , Humanos , Metemoglobinemia/diagnóstico , Azul de Metileno , Oximetria , Fenazopiridina
16.
Updates Surg ; 73(6): 2375-2380, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33796980

RESUMO

The graft nephrectomy is burdened by immunological and surgical complications. The main surgical complications of graft nephrectomy are hemorrhage, infections, vascular injury and death. The mortality is high, with percentages varying between 1.3 and 38%. Therefore, graft nephrectomy should be recommended only in selected cases. We conducted a retrospective study, comparing the data of 26 patients undergoing an allograft nephrectomy (2009-2013), without embolization of the renal artery (NO EMBO group) with the data of 40 patients undergoing an allograft nephrectomy (2014-2019), with embolization of the renal artery (EMBO group). We included only graft nephrectomies performed at least 6 months after transplantation. The patients included in the study were consecutive because until 2013 we did not perform the embolization of the renal graft artery. Afterwards, from 2014, instead, we routinely carry out embolization to all patients to be subjected to graft nephrectomy. We, therefore, wanted to analyze whether this surgical approach compared to the previous technique can lead to an improvement in morbidity and mortality, reducing the risk of bleeding and operating times. The examination of our data highlights that embolization of renal artery reduces the operating times of the explant, in addition the group subjected to embolization had less changes in hemoglobinemia and less blood loss.


Assuntos
Embolização Terapêutica , Transplante de Rim , Rejeição de Enxerto , Humanos , Nefrectomia , Artéria Renal/cirurgia , Estudos Retrospectivos
17.
Beijing Da Xue Xue Bao Yi Xue Ban ; 53(2): 298-301, 2021 Mar 11.
Artigo em Chinês | MEDLINE | ID: mdl-33879901

RESUMO

OBJECTIVE: To observe the postoperative bleeding after percutaneous renal biopsy (PRB) in Tibet, To analyze and summarize the risk factors associated with bleeding in high altitude patients to improve the safety of surgery. METHODS: A retrospective analysis of 150 cases of PRB in the Department of Nephrology, People's Hospital of Tibet Autonomous Region from May 2016 to May 2018 were carried out, and the correlations between the potential risk factors (gender, age, blood pressure, hemoglobin, platelet, serum creatinine) and postoperative bleeding events were analyzed. RESULTS: During the study period, the 150 patients receiving procedure of PRB were enrolled in our hospital, with an average age of (41.2±15.6) years, of whom 58.7% (88/150) were male, 41.3% (62/150) were female, and major bleeding complications occurred in 12 biopsies (8.0%, 12/150). Six cases for men and women, respectively. The mean age in the bleeding group seemed to be higher than that in the non-bleeding group [(48.3±20.0) years vs. (40.6±15.1) years, P=0.099]. There was no significant difference in the incidence of hypertension, hemoglobinemia, urea nitrogen and prothrombin time between the two groups. The level of serum creatinine in the hemorrhage group seemed to be higher than that in the non-bleeding group (P=0.090), and the time of the hemorrhagic group was longer than that in the non-bleeding group (P=0.069). The platelet count in the bleeding group was significantly lower than that in the non-bleeding group (P < 0.05). Multivariate Logistic regression analysis showed that the prolonged activation of partial prothrombin time and lower platelet count had a relatively high risk of bleeding, which was statistically significant (P=0.079, P=0.082). CONCLUSION: PRB is safe and reliable on the whole in plateau areas; Old age, low platelet count, decreased renal function and prolonged activated partial coagulation time are related to postoperative bleeding of PRB, and hyperhemoglobin is not a risk factor for bleeding. High hemoglobin is not a risk factor for postoperative bleeding of PRB at high altitude.


Assuntos
Hemorragia , Adulto , Idoso , Biópsia , Feminino , Hemorragia/epidemiologia , Hemorragia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Tempo de Tromboplastina Parcial , Estudos Retrospectivos , Fatores de Risco , Tibet
18.
Chronobiol Int ; 38(6): 933-940, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33779457

RESUMO

This study aimed to assess the effects of the lunar cycle on diurnal variation of biological, i.e, hormonal, biochemical, and hematological, profiles of diurnally active healthy men. Blood samples of 20 males were collected on four occasions [full moon (FM) and new moon (NM), in the morning (06:00-07:00 h) and evening (19:00-20:00 h)]. The results showed that melatonin and testosterone levels and neutrophils count were lower during the FM as compared to the NM in the morning (p < .001; d = 4.13, p < .001; d = 3.84, p < .01; d = 0.77, respectively) and evening (p < .001; d = 6.36, p < .001; d = 4.03, p < .05; d = 1.07, respectively) samples. However, cortisol level was higher during the FM compared to the NM, in the morning (p < .001; d = 0.74) and evening (p < .001; d = 3.54). Hemoglobinemia was higher only in the evening during the FM compared to the evening of the NM (p < .01; d = 1.22). In summary, this study confirmed that lunar cycle can affect human biological parameters independently of time of day.


Assuntos
Melatonina , Lua , Ritmo Circadiano , Nível de Saúde , Humanos , Masculino
19.
Saudi J Kidney Dis Transpl ; 32(5): 1388-1396, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-35532709

RESUMO

The elderly population has significantly increased in the world. Nephrotic syndrome (NS) is one manifestation of glomerular nephropathy in the elderly. The objective of our study is to determine NS particularities in the elderly and to identify the factors predicting progression to chronic end-stage renal disease (ESRD). This is a retrospective and descriptive study, carried out between January 1, 1975 and December 31, 2017. It includes participants aged 65 years old or over hospitalized for NS. A multivariate study was carried out and the dependent variable was the evolution to ESRD. We studied 115 patients with an average age of 71 ±5 years (65-83) and a sex ratio (male/female) of 1.7. Twenty-three percent of patients were diabetic. The median proteinuria was 4.7 g/L (3-19.5). NS was impure in 89.5% of patients. Renal biopsy was performed in 45 patients (39.13%). NS was secondary in 65.2% of cases mainly to amyloidosis (35.6%). Idiopathic nephropathy was dominated by membranous nephropathy (9.5%). Treatment was etiopathogenic in only 18 patients (15.6%). At the end of follow-up, 15.8% of patients achieved complete or partial remission and 56.6% progressed to ESRD. The multivariate study found as independent risk factors of progression to ESRD: uremia >17 mmol/L [adjusted odds ratio (aOR) = 33.2 (1.3-837.7); P <0.05],, phosphoremia ≥1.6 mmol/L [aOR = 22.1 (1.8-266.5); P <0.05], serum potassium ≥4.3 mmol/L (aOR = 24.7 (2.4, 251.5); P <0.01], extra-renal signs [aOR = 38.9 (2.4-634.3); P = 0.01], secondary nephropathy [aOR = 74 (3.1-1788.2); P <0.01] and membranoproliferative glomerulonephritis [aOR = 48 (1.4-1675.5); P <0.05]. The protective factors were hemoglobinemia ≥9.3 g/dL [aOR = 0.007 (0-0.2); P <0.01], kidneys well differentiated [0.032 (0.003-0.4); P<0.01] and treatment with two diuretics [aOR = 0.03 (0.00-30.4); P <0.01]. It is important to recognize the spectrum of kidney diseases in the elderly to improve the progression factors to ESRD.


Assuntos
Glomerulonefrite Membranosa , Falência Renal Crônica , Síndrome Nefrótica , Idoso , Feminino , Glomerulonefrite Membranosa/patologia , Humanos , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/etiologia , Masculino , Síndrome Nefrótica/diagnóstico , Síndrome Nefrótica/epidemiologia , Síndrome Nefrótica/etiologia , Prognóstico , Estudos Retrospectivos
20.
Ann Thorac Surg ; 111(2): 623-628, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-32171730

RESUMO

BACKGROUND: Venoarterial extracorporeal membrane oxygenation (VA ECMO) is increasingly being used for circulatory shock. Bleeding is a frequent complication and is associated with increased mortality. The purpose of our study was to identify factors associated with early major bleeding after VA ECMO initiation. METHODS: We performed a retrospective observational study based on our database. In accordance with the Extracorporeal Life Support Organization definition, the population was divided in two groups: major bleeding events (group B) and no major bleeding events (group O). We collected data on all major bleeding events occurring during the first 48 hours after VA ECMO initiation. RESULTS: Of the 243 patients analyzed, 111 patients (46%) had an early major bleeding event. Independent risk factors associated with early major bleeding events were postcardiotomy VA ECMO (odds ratio [OR] 1.98; 95% confidence interval [CI], 1.08 to 3.62; P = .02), body mass index (OR 0.91; 95% CI, 0.85 to 0.98; P = .01), hemoglobinemia (OR 0.8; 95% CI, 0.7 to 0.92; P = .002), fibrinogen (OR 0.67; 95% CI, 0.52 to 0.84; P = .001), and pH (OR 0.15; 95% CI, 0.02 to 1.04; P = .05). By using a receiver-operating characteristics curve analysis, hemoglobin level less than 9 g dL-1, fibrinogen level less than 2 g L-1, pH lower than 7.12, and body mass index below 25 kg/m2 were identified to predict early major bleeding events. Major bleeding events were independently associated with mortality (OR 2.54; CI 95%, 1.38 to 4.66; P = .01). CONCLUSIONS: We found that postcardiotomy VA ECMO, hemoglobin levels less than 9 g dL-1, fibrinogen levels less than 2 g L-1, pH lower than 7.12, and body mass index below 25 kg/m2 were associated with a higher risk for early major bleeding events.


Assuntos
Oxigenação por Membrana Extracorpórea/efeitos adversos , Hemorragia/etiologia , Idoso , Índice de Massa Corporal , Feminino , Hemostasia , Humanos , Concentração de Íons de Hidrogênio , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Trombose/etiologia
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