Veno-venous extracorporeal membrane oxygenation in patients with SARS-CoV-2 pneumonia in Brazil: a case series / Oxigenação por membrana extracorpórea venovenosa em pacientes com pneumonia por SARS-CoV-2 no Brasil: série de casos

ABSTRACT Objective: The world has been suffering from the COVID-19 pandemic. Some COVID-19 patients develop severe viral pneumonia, requiring mechanical ventilation and measures to treat refractory hypoxemia, such as a protective ventilation strategy, prone positioning, and the use of veno-venous extracorporeal membrane oxygenation (VV-ECMO). We describe a case series of 30 COVID-19 patients who needed VV-ECMO at the Hospital Alemão Oswaldo Cruz, located in the city of São Paulo, Brazil. Methods: We included all patients who required VV-ECMO due to COVID-19 pneumonia between March of 2020 and June of 2021. Results: Prior to VV-ECMO, patients presented with the following median scores: SOFA score, 11; APPS score, 7; Respiratory ECMO Survival Prediction score, 2; and Murray score, 3.3. The 60-day-in-hospital mortality was 33.3% (n = 10). Conclusions: Although our patients had a highly severe profile, our results were similar to those of other cohort studies in the literature. This demonstrates that VV-ECMO can be a good tool even in a pandemic situation when it is managed in an experienced center.

RESUMO Objetivo: O mundo vem sofrendo com a pandemia de COVID-19. Alguns pacientes com COVID-19 desenvolvem pneumonia viral grave, necessitando ventilação mecânica e medidas para tratar a hipoxemia refratária, como estratégias de ventilação protetora, posição prona e uso de oxigenação por membrana extracorpórea venovenosa (ECMO-VV). Descrevemos uma série de casos de 30 pacientes com COVID-19 que necessitaram de ECMO-VV no Hospital Alemão Oswaldo Cruz, localizado na cidade de São Paulo, Brasil. Métodos: Foram incluídos todos os pacientes que necessitaram de ECMO-VV devido à pneumonia por COVID-19 entre março de 2020 e junho de 2021. Resultados: Antes da ECMO-VV, os pacientes apresentavam as seguintes medianas: escore SOFA de 11; escore APPS de 7; escore Respiratory ECMO Survival Prediction de 2; e escore de Murray de 3,3. A mortalidade hospitalar em 60 dias foi de 33,3% (n = 10). Conclusões: Apesar de nossos pacientes apresentarem um perfil de alta gravidade, nossos resultados foram semelhantes aos de outros estudos de coorte na literatura. Isso demonstra que a ECMO-VV pode ser uma boa ferramenta mesmo em uma situação de pandemia quando administrada em um centro experiente.

Increasing transplantability in Brazil: time to discuss Kidney Paired Donation / Doação renal pareada no Brasil: tempo para reflexão

Abstract Introduction: Kidney transplantation (KT) is the best treatment for chronic kidney disease. In Brazil, there are currently more than 26 thousand patients on the waitlist. Kidney Paired Donation (KPD) offers an incompatible donor-recipient pair the possibility to exchange with another pair in the same situation, it is a strategy to raise the number of KT. Discussion: KPD ceased being merely an idea over 20 years ago. It currently accounts for 16.2% of living donors KT (LDKT) in the USA and 8% in Europe. The results are similar to other LDKT. It is a promising alternative especially for highly sensitized recipients, who tend to accumulate on the waitlist. KPD is not limited to developed countries, as excellent results were already published in India in 2014. In Guatemala, the first LDKT through KPD was performed in 2011. However, the practice remains limited to isolated cases in Latin America. Conclusion: KPD programs with different dimensions, acceptance rules and allocation criteria are being developed and expanded worldwide to meet the demands of patients. The rise in transplantability brought about by KPD mostly meets the needs of highly sensitized patients. The Brazilian transplant program is mature enough to accept the challenge of starting its KPD program, intended primarily to benefit patients who have a low probability of receiving a transplant from a deceased donor.

Resumo Introdução: O transplante renal (TxR) é sabidamente o melhor tratamento para doença renal crônica. No Brasil, mais de 26 mil pacientes aguardam em lista atualmente. A doação renal pareada (DRP) oferece a um par de doador/receptor incompatível a possibilidade de trocar com outro par na mesma situação, representando uma estratégia para aumentar o número de TxR. Discussão: A DRP deixou de ser apenas uma ideia há mais de 20 anos. Atualmente é responsável por 16,2% dos TxR com doador vivo (TxRDV) nos EUA e 8% na Europa. Os resultados são semelhantes a outros TxRDV. Essa modalidade representa uma alternativa promissora, especialmente para os receptores hipersensibilizados que tendem a se acumular em lista de espera. A DRP não está limitada a países desenvolvidos. Em 2014, a Índia já publicava excelentes resultados. Na Guatemala, o primeiro TxRDV através de DRP aconteceu em 2011. Porém, a prática permanece limitada a casos isolados na América Latina. Conclusão: Programas de DRP com diferentes dimensões, regras para aceitação e critérios para alocação estão sendo desenvolvidos e expandidos mundialmente com o objetivo de atender às demandas dos pacientes. O aumento na capacidade de transplantar trazido pela DRP vem ao encontro especialmente das necessidades dos pacientes hipersensibilizados. O programa de TxR brasileiro tem maturidade para assumir o desafio de iniciar o programa de DRP, com o objetivo de beneficiar principalmente seus pacientes que estão em maior desvantagem por apresentarem baixas chances de transplante com doadores falecidos.

Representaciones sociales de líderes comunitarios sobre el consumo de sustancias psicoactivas en un sector marginal de la comuna 18 de la ciudad de Cali-Colombia en el año 2018 / Social representations of community leaders on the consumption of psychoactive substances in a marginal sector of the ciyi of Cali

el objetivo primordial de este estudio fue Comprender las representaciones sociales de los líderes de organizaciones de base comunitaria sobre el consumo de sustancias psicoactivas en un sector barrial de la comuna 18 en la ciudad de Cali. Método: Se desarrolló un estudio bajo un enfoque investigativo cualitativo y su diseño se asumió como un estudio de representaciones sociales, el cual se suscribe al paradigma interpretativo-constructivista. Resultados: Las representaciones sociales son una especie de conocimiento de sentido común por medio del cual los individuos y las comunidades convierten una realidad física en construcciones perceptibles de aquello que les rodean, convirtiendo lo extraño en familiar. Esta descripción está basada en el proceso de codificación y categorización que se teje alrededor de los componentes de las Representaciones Sociales, a saber; La información, las actitudes y el campo de la representación social.

Introduction: Social representations are a kind of common sense knowledge by means of which individuals and communities convert a physical reality into perceptible constructions of what surrounds them, converting the strange into familiar. The main objective of this study was to understand the social representations of the leaders of community-based organizations on the consumption of psychoactive substances in a neighborhood sector of commune 18 in the city of Cali. Method: A study was developed under a qualitative research approach and its design was assumed as a study of social representations, which subscribes to the interpretive-constructivist paradigm. Results: The community leaders defined the two-dimensional phenomenon, on the one hand; a health problem, evidencing a series of scientific knowledge in the participants, which influences the constitution of the Social Representation of psychoactive substance consumption as a disease, and on the other hand, a social problem given that it is associated with social determinants and of policies that are outside the scope of consumption itself. Conclusion: The Social Representations that leaders and community-based organizations attribute to the use of psychoactive substances in the sector of the commune 18 are characterized by being made up of meanings that are woven between a scientific knowledge about the consumption of substances, an institutional discourse and the moral assessment system established in the context of the community.

El fracaso escolar como un síntoma afectivo en niños y niñas bajo condiciones de orfandad / School failure as a affective symptom in children and girls under conditions of orphanhood

El presente artículo emerge a partir de una revisión crítica acerca de los conceptos de fracaso escolar y la experiencia de orfandad, estableciendo las limitaciones actuales con que se aborda el fenómeno educativo y la conceptualización sobre la infancia huérfana. De esta forma, se cuestionan las dimensiones afectivas y traumáticas que subyacen al fracaso escolar. Al final, se invita a la investigación empírica para abordar el fenómeno preguntando si es posible considerar que la experiencia de abandono en niños y niñas, con todas sus vivencias de maltrato y deprivación, pueda estar relacionada con las dificultades en el aprendizaje y en últimas con el fracaso escolar.

This paper emerges from a critical review of the concepts of school failure and experience orphans, establishing the current limitations with the educational phenomenon and the conceptualization of the orphaned children is addressed. Thus, the emotional and traumatic dimensions underlying question school failure. In the end, they are invited to empirical research to address the phenomenon wondering if you might consider the experience of abandonment in children, with all their experiences of abuse and deprivation, it can be related to learning difficulties and ultimately with school failure.

Acerca de la imposibilidad de la prevención del consumo y abuso de sustancias psicoactivas. ¿una Invitación a la discusión en las ciencias sociales? / The impossibility of prevention and psychoactive substance abuse. An invitation to social sciences to this discussion?

El presente artículo pretende inducir a una discusión crítica acerca de las nociones conceptuales de la prevención aplicados al fenómeno del consumo de sustancias psicoactivas. Se realizó un recorrido teórico sobre las nociones acerca de la enfermedad y como estas preceden el concepto de prevención. De la misma se abordan aproximaciones al término de prevención y algunos de los modelos existentes, los cuales han sido bandera de las ciencias de la salud y finalmente estableciendo puntos de encuentro y desencuentro, lo cual abre un espacio necesario para que las ciencias sociales realicen sus portaciones. Finalmente, se discute sobre la imposibilidad de la prevención bajo el marco conceptual y metodológico existente.

This article aims to induce a critical discussion of the conceptual notions of prevention applied to the phenomenon of psychoactive substances. A theoretical course on notions about the disease was made and how are you precede the concept of prevention. Similarly the term prevention approaches are discussed and some of the existing models, which have been the projects of health sciences and finally establishing points of convergence and divergence, which opens up a space needed for the social sciences to make their contributions. Finally, there is the discussion about the impossibility of prevention under the existing conceptual and methodological framework.

Del vínculo materno y otras relaciones adictivas / Of the maternal bond and other addictive relationships

Este estudio tuvo como objetivo explorar la significación de la figura materna y su posible relación con la dependencia a sustancias psicoactivas en adolescentes institucionalizados en la Fundación Hogares Claret. La investigación asumió una perspectiva psicoanalítica de corte cualitativo, la población la conformaron tres adolescentes.

This study aimed to explore the significance of the maternal figure and its possible relationship with dependence on psychoactive substances in institutionalized adolescents at the Fundación Hogares Claret. The research assumed a qualitative psychoanalytic perspective, the population was made up of three adolescents.

Análise de 10 anos de seguimento de transplantesrenais com doador vivo não aparentado / Ten-year follow-up of kidney transplantation with living unrelated donor

INTRODUÇÃO: No contexto atual da elevada escassez de órgãos para o transplante renal e do reconhecimento cada vez maior da rejeição crônica mediada por anticorpos anti-HLA como uma importante causa de perda do enxerto, uma contínua demonstração da boa evolução a longo prazo de transplantes renais com doadores vivos não aparentados (DVNA) é de suma importância. OBJETIVOS: Analisar a sobrevida do enxerto e dos pacientes transplantados com DVNA, e compará-la com doadores vivos aparentados (DVA). MÉTODOS: Foram analisados 389 primeiros transplantes renais com doador vivo realizados em um único centro, entre janeiro de 1998 e dezembro de 2007, 281 com DVA e 108 com DVNA. RESULTADOS: Não houve diferença significativa na sobrevida dos pacientes (89,1 por cento vs. 84,7 por cento, p = 0,40) e do enxerto (81,1 por cento vs. 68,9 por cento, p = 0,77), em 10 anos de seguimento, entre DVA e DVNA, respectivamente. Na análise multivariada do modelo de regressão proporcional de Cox, a reatividade contra painel (PRA) > 10 por cento e a ocorrência de rejeição aguda no 1º ano após o transplante foram os únicos preditores independentes de perda do enxerto (OR 2,54, IC 95 por cento 1,35 - 4,78; p < 0,05 e OR 4,1, IC 95 por cento 2,04 -4,78; p < 0,05, respectivamente). CONCLUSÃO: Transplantes renais com DVNA representam uma importante fonte de órgãos para suprir uma crescente demanda, com resultados semelhantes aos transplantes com DVA, independente da compatibilidade HLA.

INTRODUCTION: In the current era of scarcity of kidneys available for transplantation, and chronic anti-HLA-mediated rejection as a main cause of graft loss, continuous demonstration of the long-term survival of grafts from living unrelated kidney donors (LURD) is paramount. OBJECTIVE: Analyze long-term kidney graft and patient outcomes using LURD, and compare them with living related donors (LRD). METHODS: We analyzed the 389 first renal transplantations performed with a living donor (281 LRD and 108 LURD), in a single center, from January 1998 through December 2007. RESULTS: There were no significant differences between LRD and LURD as refers to patient survival (89.1 percent vs. 84.7 percent, p = 0.40, respectively) and graft survival (81.1 percent vs. 68.9 percent, p = 0.77, respectively), 10 years post-transplantation. On Cox proportional regression model of multivariate analysis, panel reactive antibodies (PRA) > 10 percent and the occurrence of acute rejection in the first year posttransplantation were the only independent predictors of graft loss (HR 2.54, 95 percent CI 1.35 -4.78; p < 0.05 and HR 4.1, 95 percent CI 2.04 - 4.78; p < 0.05, respectively). CONCLUSION: LURD are an important source of organs for renal transplantation, with results similar to those obtained with LRD, regardless of HLA matching.

Parathyroidectomy after kidney transplantation: short-and long-term impact on renal function

INTRODUCTION: Kidney transplantation corrects endocrine imbalances. Nevertheless, these early favorable events are not always followed by rapid normalization of parathyroid hormone secretion. A possible deleterious effect of parathyroidectomy on kidney transplant function has been reported. This study aimed to compare acute and longterm renal changes after total parathyroidectomy with those occurring after general surgery. MATERIALS AND METHODS: This was a retrospective case-controlled study. Nineteen patients with persistent hyperparathyroidism underwent parathyroidectomy due to hypercalcemia. The control group included 19 patients undergoing various general and urological operations. RESULTS: In the parathyroidectomy group, a significant increase in serum creatinine from 1.58 to 2.29 mg/dl (P < 0.05) was noted within the first 5 days after parathyroidectomy. In the control group, a statistically insignificant increase in serum creatinine from 1.49 to 1.65 mg/dl occurred over the same time period. The long-term mean serum creatinine level was not statistically different from baseline either in the parathyroidectomy group (final follow-up creatinine = 1.91 mg/dL) or in the non-parathyroidectomy group (final follow-up creatinine = 1.72 mg/dL). CONCLUSION: Although renal function deteriorates in the acute period following parathyroidectomy, long-term stabilization occurs, with renal function similar to both preoperative function and to a control group of kidney-transplanted patients who underwent other general surgical operations by the final follow up.

Acute renal failure due to abdominal compartment syndrome: report on four cases and literature review

We report on 4 cases of abdominal compartment syndrome complicated by acute renal failure that were promptly reversed by different abdominal decompression methods. Case 1: A 57-year-old obese woman in the post-operative period after giant incisional hernia correction with an intra-abdominal pressure of 24 mm Hg. She was sedated and curarized, and the intra-abdominal pressure fell to 15 mm Hg. Case 2: A 73-year-old woman with acute inflammatory abdomen was undergoing exploratory laparotomy when a hypertensive pneumoperitoneum was noticed. During the surgery, enhancement of urinary output was observed. Case 3: An 18-year-old man who underwent hepatectomy and developed coagulopathy and hepatic bleeding that required abdominal packing, developed oliguria with a transvesical intra-abdominal pressure of 22 mm Hg. During reoperation, the compresses were removed with a prompt improvement in urinary flow. Case 4: A 46-year-old man with hepatic cirrhosis was admitted after incisional hernia repair with intra-abdominal pressure of 16 mm Hg. After paracentesis, the intra-abdominal pressure fell to 11 mm Hg

Estado nutricional, antropométrico bioquímico y clínico en preescolares de la comunidad rural de Canaguá: estado Mérida / Nutritional status: anthropometric biochemical and clinical evaluations in preeschoolers in the rural community of Canagua Mérida state

Se estudiaron 66 preescolares, seleccionados mediante el muestreo estratificado aleatorio, de los diferentes estratos socioeconómicos de la Parroquia de Canaguá, Estado Mérida. El estado nutricional se evaluó a través de mediciones antropométricas y exámenes clínico-nutricionales, bioquímicos y coproparasitológicos. Según las mediciones antropométricas más del 70 por ciento de los niños están dentro de la norma. Los estudios hematológicos y bioquímicos mostraron que más del 80 por ciento de los niños presentan niveles aceptables de hemoglobina, hematocrito y concentración de hemoglobina corpuscular media, mientras que el porcentaje de niños con niveles séricos de hierro por debajo de 0.50µ/mL era del 30 por ciento. Seis preescolares: 5 desnutridos y 1 con estado nutricional normal, presentaron una anemia nutricional ferropénica. La concentración sérica promedio de las vitaminas A y E fue de 0.300ñ0.15 y 5.87ñ0.53 mg/mL, respectivamente, con un 27 por ciento de los niños en riesgo de presentar una carencia de vitamina A. En el presente estudio se observó hasta un 30 por ciento de los preescolares con cabello seco, palidez conjuntival, hipotoná muscular, hipertrofia de las papilas e irritabilidad. Llamó la atención la alta prevalencia de caries dental en la, población estudiada. El examen coproparasitológico evidenció que el 66,67 por ciento de los niños están infestado, a predominio de áscaris lumbricoides (34,85 por ciento). Los resultados indican que los preescolares estudiados están en condiciones aceptables en la mayoría de los parámetros utilizados en la evaluación clínico nutricional, hematológica y bioquímica.

Hyperhomocyst(e)inemia in chronic stable renal transplant patients

PURPOSE: Hyperhomocyst(e)inaemia is an important risk factor for atherosclerosis, which is currently a major cause of death in renal transplant patients. The aim of this study was to assess the influence of immunosuppressive therapy on homocyst(e)inemia in renal transplant recipients. METHODS: Total serum homocysteine (by high performance liquid chromatography), creatinine, lipid profile, folic acid (by radioimmunoassay-RIA) and vitamin B12 (by RIA) concentrations were measured in 3 groups. Group I patients (n=20) were under treatment with cyclosporine, azathioprine, and prednisone; group II (n=9) were under treatment with azathioprine and prednisone; and group III (n=7) were composed of renal graft donors for groups I and II. Creatinine, estimated creatinine clearance, cyclosporine trough level, lipid profile, folic acid, and vitamin B12 concentrations and clinical characteristics of patients were assessed with the aim of ascertaining determinants of hyperhomocyst(e)inemia. RESULTS: Patient ages were 48.8 ñ 15.1 yr (group I), 43.3 ñ 11.3 yr (group II); and 46.5 ñ 14.8 yr (group III). Mean serum homocyst(e)ine (tHcy) concentrations were 18.07 ñ 8.29 mmol/l in renal transplant recipients; 16.55 ñ 5.6 mmol/l and 21.44 ñ 12.1 mmol/l respectively for group I (with cyclosporine) and group II (without cyclosporine) (NS). In renal donors, tHcy was significantly lower (9.07 ñ 3.06 mmol/l; group I + group II vs. group III, p<0.008). There was an unadjusted correlation (p<0.10) between age (r=0.427; p<0.005) body weight (r=0.412; p<0.05), serum creatinine (r=0.427; p<0.05), estimated creatinine clearance (r=0.316; p<0.10), and tHcy in renal recipients (group I +II). Independent regressors (r2=0.46) identified in the multiple regression model were age (coefficient= 0.253; p=0.009) and serum creatinine (coefficient=8.07; p=0.045). We found no cases of hyperhomocyst(e)inemia in the control group. In contrast, 38 per cent of renal recipients had hyperhomocyst(e)inemia: 7 cases (35 per cent) on cyclosporine and 4 (45 per cent) without cyclosporine, based on serum normal levels. CONCLUSIONS: Renal transplant recipients frequently have hyperhomocyst(e)inemia. Hyperhomocyst(e)inemia in renal transplant patients is independent of the scheme of immunosuppression they are taking. The older the patients are and the higher are their serum creatinine levels, the more susceptible they are to hyperhomocyst(e)inemia following renal transplantation

Peritonite esclerosante e encapsulante secundária à diálise peritoneal ambulatorial contínua / sclerosing encapsulating peritonitis secundary by the continuous ambulatory peritoneal dialysis

A diálise peritoneal ambulatorial contínua (DPAC) é uma modalidade terapêutca eficiente para o tratamento da insuficiência renal crônica. A peritonite esclerosante e encapsulante (PEE) é uma conplicaçäo rara e grave da DPAC, associada com alta taxa de mortalidade e que ocorre, geralmente, após um tempo prolongado em tratamento complicado com episódios graves e recorrentes de peritonites. Relatamos três casos de PEE, entre 222 pacientes sob DPAC no Hospital das Clínicas da Faculdade de Medicina da Universidade de Säo Paulo, no período de 1984 e 1997, diagnosticados nos últimos 3 anos: dois casos do sexo feminino e um, do masculino, com tempo médio em DPAC de 55,3 meses e média de 4,3 episódios de peritonite. Os três pacientes apresentaram quadro clínico de obstruçäo intestinal e dois deles usavam B-bloqueador. Enfocamos a necessidade de prevençäo da PEE, o diagnóstico precoce e as recentes opçöes terapêuticas para reduçäo de sua morbidade e de sua mortalidade.(au)

Hipervitaminosis A aguda y riñón: alteraciones histoquímicas y bioquímicas renales en conejos tratados con dosis elevadas de vitamina A / Hypervitaminosis A acute and kidney: alterative histological, histochemical and biochemical renal changes in rabbits produced by parenteral administration of vitamin A

En el presente trabajo se describen las alteraciones histoquímicas y bioquímicas renales producidas en conejos mediante la inyección intramuscular diaria de 100.000 UI de vitamina A, durante 7 días (hipervitaminosis A aguda). El estudio microscópico mostró hallazgos más frecuentes: hiperemia generalizada, hemorragias córticomedulares discretas y generalizadas, tumefacción de las asas glomerulares, edema de las células tubulares proximales y distales y la presencia de masas celulares multinucleares de forma, aspecto y tamaño variable en la luz tubular. Mediante técnicas histoquímicas y bioquímicas se pudo comprobar, en estos animales, incremento en el contenido renal de grasas neutrales y de fosfolípidos, mientras que los mucopolisacáridos ácidos, las proteínas totales y las nucleoproteínas tienden a disminuir significativamente (p<0.05). Las masas celulares endotubulares muestran una fuerte reacción positiva con la mayoría de las técnicas histoquímicas empleadas. En conclusión, la hipervitaminosis A aguda, confirmada por el incremento tisular de la vitamina A, tiene un efecto tóxico profundo y marcado sobre el riñón

Enzimas en el jugo gastrico: una ayuda para el diagnostico del cancer gastrico / Enzymes in the gastric juice: an aid in the diagnosis of gastric cancer

In the present study we measured the activities of the following enzymes: LDH (lactic dehydrogenase), beta-glucuronidase, acid maltase, phosphohexoseisomerase (PHI) and acid proteases in the gastric juice of patients with gastric cancer (n = 50) (Case Group), in endoscopically normal subjects (n = 50) and in subjects with different non tumor-like digestive pathologies (n = 55) (Control Groups). In the patients with gastric carcinoma we found a significant increase in LDH, beta-glucuronidase, PHI and acid maltase activities and a decreased activity of acid proteases. The results agree with previous findings from other workers. The variations of enzyme activities in gastric juice can help to differentiate between malignant and benign processes of the gastric mucosa.