Poor prognosis indicators of type-2 diabetic COVID-19 patients

Diabetes is associated with a worse prognosis and a high risk of morbidity and mortality in COVID-19 patients. We aimed to evaluate the main factors involved in the poor prognosis in diabetic patients. A total of 984 patients diagnosed with COVID-19 admitted to the hospital were included in this study. Patients were first divided into type-2 diabetic (DM+) and non-diabetic (DM-) groups. The participants were analyzed based on the National Early Warning Score (NEWS) and on the Quick-Sequential Organ Failure Assessment (qSOFA) to find the best prognostic risk score for our study. The DM+ and DM- groups were divided into non-severe and severe groups. Comparative and correlative analyses were used to identify the physiological parameters that could be employed for creating a potential risk indicator for DM+ COVID-19 patients. We found a poorer prognosis for the DM+ COVID-19 patients with a higher ICU admission rate, mechanical ventilation rate, vasopressor use, dialysis, and longer treatment times compared with the DM- group. DM+ COVID-19 patients had increased plasma glucose, lactate, age, urea, NEWS, and D-dimer levels, herein referred to as the GLAUND set, and worse prognosis and outcomes when compared with infected DM- patients. The NEWS score was a better indicator for assessing COVID-19 severity in diabetic patients than the q-SOFA score. In conclusion, diabetic COVID-19 patients should be assessed with the NEWS score and GLAUND set for determining their prognosis COVID-19 prognosis.

Placa bloqueada em fratura tibiotársica de coruja suindara (Tyto furcata): relato de caso / Locking plate in tibiotarsal fracture in a suindara owl: case report

Foi atendida, no Hospital Veterinário da Universidade de Cuiabá, uma coruja suindara (Tyto furcata), resgatada pela Polícia Militar Ambiental, sem histórico, adulta e 400 gramas de peso corporal. A ave apresentava impotência funcional do membro pélvico direito, além de desvio, crepitação e dor na região proximal tibiotársica direita, sem lesão cutânea. Estudo radiográfico revelou fratura diafisária oblíqua curta em tibiotarso direito. A estabilização da fratura foi realizada com placa bloqueada do sistema de 1,5mm, na função de apoio, seis orifícios, com três parafusos monocorticais distais, dois parafusos monocorticais proximais e um parafuso bicortical proximal. Ao 30º dia do pós-operatório, os achados radiográficos de consolidação óssea e o retorno da função do membro permitiram a alta médica. Concluiu-se que o uso de placa bloqueada em função apoio para estabilização de fraturas tibiotársicas simples de coruja suindara oferece resultados satisfatórios.(AU)

An adult suindara owl (Tyto furcata), with no specific history and 400 grams of body weight was treated at the Veterinary Hospital of the University of Cuiabá. The patient presented functional impotence in the right pelvic limb, deviation, crepitation and pain in the proximal region in right tibiotarsal, without cutaneous lesions. Radiographs revealed a short oblique diaphyseal fracture at the right tibiotarsus. Fracture stabilization was performed with a 1.5mm locking plate, buttress, six holes; three distal monocortical screws, two proximal monocortical screws and a proximal bicortical screw. On the 30th postoperative day, radiographic revealed bone healing, and the return of limb function allowed medical discharge. It was concluded that the use of locking plates in buttress function to stabilize simple tibiotarsus fractures in suindara owl offers satisfactory results.(AU)

Differential gene expression profiles of hepatocellular carcinomas associated or not with viral infection

Chronic hepatitis B (HBV) and C (HCV) virus infections are the most important factors associated with hepatocellular carcinoma (HCC), but tumor prognosis remains poor due to the lack of diagnostic biomarkers. In order to identify novel diagnostic markers and therapeutic targets, the gene expression profile associated with viral and non-viral HCC was assessed in 9 tumor samples by oligo-microarrays. The differentially expressed genes were examined using a z-score and KEGG pathway for the search of ontological biological processes. We selected a non-redundant set of 15 genes with the lowest P value for clustering samples into three groups using the non-supervised algorithm k-means. Fisher’s linear discriminant analysis was then applied in an exhaustive search of trios of genes that could be used to build classifiers for class distinction. Different transcriptional levels of genes were identified in HCC of different etiologies and from different HCC samples. When comparing HBV-HCC vs HCV-HCC, HBV-HCC/HCV-HCC vs non-viral (NV)-HCC, HBC-HCC vs NV-HCC, and HCV-HCC vs NV-HCC of the 58 non-redundant differentially expressed genes, only 6 genes (IKBKâ, CREBBP, WNT10B, PRDX6, ITGAV, and IFNAR1) were found to be associated with hepatic carcinogenesis. By combining trios, classifiers could be generated, which correctly classified 100 percent of the samples. This expression profiling may provide a useful tool for research into the pathophysiology of HCC. A detailed understanding of how these distinct genes are involved in molecular pathways is of fundamental importance to the development of effective HCC chemoprevention and treatment.

Low occurrence of occult hepatitis B virus infection and high frequency of hepatitis C virus genotype 3 in hepatocellular carcinoma in Brazil

Occult hepatitis B virus (HBV) infection has been reported among patients with hepatitis C virus (HCV) infection and hepatocellular carcinoma (HCC). Our aim was to evaluate the presence of occult HBV infection in patients with HCV-related liver cirrhosis (LC) with or without HCC in São Paulo, Brazil. Serum and liver tissue samples from 50 hepatitis B surface antigen-negative patients with HCV-related LC who underwent liver transplantation at the University of São Paulo School of Medicine Hospital from 1993 to 2004 were divided into groups with LC only (N = 33) and with LC plus HCC (N = 17). HBV DNA was assayed for serum and paraffin-embedded liver tissue (tumoral and non-tumoral) using real time PCR and only 1 case with HCC had HBV DNA-positive serum. All liver samples were negative. HCV genotype 3 was detected in 17/39 (43.7 percent) cases. In conclusion, using a sensitive real time PCR directed to detect HBV variants circulating in Brazil, occult hepatitis B infection was not found among HCV-positive cirrhotic patients and was rarely found among HCV-positive HCC patients. These results are probably related to the low prevalence of HBV infection in our population. Furthermore, we have also shown that HCV genotype 3 is frequently found in Brazilian cirrhotic patients, particularly when they also have HCC. More studies involving a large number of cases should be carried out to confirm these data and to further characterize Brazilian HCV genotype isolates to elucidate genetic features that might be related to its carcinogenic potential.

Liver mitochondrial dysfunction and oxidative stress in the pathogenesis of experimental nonalcoholic fatty liver disease

Oxidative stress and hepatic mitochondria play a role in the pathogenesis of nonalcoholic fatty liver disease. The aim of the present study was to evaluate the role of hepatic mitochondrial dysfunction and oxidative stress in the pathogenesis of the disease. Fatty liver was induced in Wistar rats with a choline-deficient diet (CD; N = 7) or a high-fat diet enriched with PUFAs-omega-3 (H; N = 7) for 4 weeks. The control group (N = 7) was fed a standard diet. Liver mitochondrial oxidation and phosphorylation were measured polarographically and oxidative stress was estimated on the basis of malondialdehyde and glutathione concentrations. Moderate macrovacuolar liver steatosis was observed in the CD group and mild liver steatosis was observed in the periportal area in the H group. There was an increase in the oxygen consumption rate by liver mitochondria in respiratory state 4 (S4) and a decrease in respiratory control rate (RCR) in the CD group (S4: 32.70 ± 3.35; RCR: 2.55 ± 0.15 ng atoms of O2 min-1 mg protein-1) when compared to the H and control groups (S4: 23.09 ± 1.53, 17.04 ± 2.03, RCR: 3.15 ± 0.15, 3.68 ± 0.15 ng atoms of O2 min-1 mg protein-1, respectively), P < 0.05. Hepatic lipoperoxide concentrations were significantly increased and the concentration of reduced glutathione was significantly reduced in the CD group. A choline-deficient diet causes moderate steatosis with disruption of liver mitochondrial function and increased oxidative stress. These data suggest that lipid peroxidation products can impair the flow of electrons along the respiratory chain, causing overreduction of respiratory chain components and enhanced mitochondrial reactive oxygen species. These findings are important in the pathogenesis of nonalcoholic fatty liver disease.

Tratamento cirúrgico dos insulinomas: estudo de 59 casos / Surgical treatment of insulinoma: study of 59 cases

Após a confirmaçao clínica e laboratorial de hiperinsulinismo, o principal problema consiste na localizaçao precisa da lesao no parênquima pancreático, propiciando tratamento cirúrgico adequado. Objetivo. Analisar os métodos utilizados para o diagnóstico e localizaçao pré e intra-operatório dos insulinomas, bem como as técnicas e os resultados do tratamento cirúrgico. Métodos. Foram estudados 59 casos consecutivos de insulinoma submetidos a intervençao cirúrgica. Cada um dos métodos utilizados para a localizaçao pré-operatória dessas lesoes foi avaliado quanto à sua eficiência em confronto com os achados intra-operatórios. A palpaçao do pâncreas, isoladamente ou associada à ultra-sonografia intra-operatória, como métodos de localizaçao dos insulinomas, foi também estudada. Os tipos de intervençao cirúrgica foram analisados quanto aos seus resultados imediatos e tardios. Resultados. Dos 59 insulinomas, 55 eram benignos e quatro, malignos. Dos métodos utilizados para a localizaçao pré-operatória, a ultra-sonografia foi eficiente em 28,1 por cento dos casos, a tomografia computadorizada em 25 por cento, a ultra-sonografia endoscópica em 27,2 por cento, a arteriografia seletiva em 54,1 por cento e a colheita de amostras de sangue portal para dosagem de insulina em 94,4 por cento dos casos. A palpaçao bidigital, durante a intervençao cirúrgica, localizou as lesoes em 54/55 casos (98,2 por cento). A ultra-sonografia intra-operatória foi decisiva em apenas um caso. Cinco doentes apresentavam neoplasia endócrina múltipla tipo I e em todos as lesoes pancreáticas eram múltiplas. Foram efetuadas 29 enucleaçoes e 32 ressecçoes pancreáticas nos doentes com lesoes benignas. Os doentes com lesoes malignas foram submetidos a ressecçoes pancreáticas e quimioterapia. Nao houve mortalidade, porém observaram-se complicaçoes (fístulas) em 29/59 casos. Os resultados foram bons em 98,1 por cento dos doentes com lesoes benignas. Apenas um dos doentes com lesoes malignas. sobreviveu cinco anos. Três doentes portadores de lesoes benignas e submetidos a ressecçoes pancreáticas evoluíram com diabetes tardiamente. Conclusoes. A localizaçao pré-operatória nao é absolutamente necessária desde que a palpaçao bidigital associada a ultra-sonografia intra-operatória permite a localizaçao de todas as lesoes. As enucleaçoes devem ser utilizadas, quando possível, de preferência às ressecçoes pancreáticas nas lesoes benignas.

Hepatic damage during acute pancreatitis in the rat

We studied the alterations in the metabolism of liver mitochondria in rats with acute pancreatitis. Male Wistar rats were allocated to a control group (group I) and to five other groups corresponding to 2,4, 12,24 and 48 h after the induction of acute pancreatitis by the injection of 5 per cent sodium taurocholate into the pancreatic duct. Sham-operated animals were submitted to the same surgical steps except for the induction of acute pancreatitis. Mitochondrial oxidation and phosphorylation were measured polarographically by determining oxygen consumption without ADP (basal respiration, state 4) and in the presence of ADP (activated respiration, state 3). Serum amylase, transaminases (ALT and AST) and protein were also determined. Ascitic fluid, contents of amylase, trypsin and total protein were also determined and arterial blood pressure was measured in all groups. In ascitic fluid, trypsin and amylase increased reaching a maximum at 2 and 4h, respectively. Serum amylase increased at 2 h reaching a maximum at 4 h. Serum transaminase levels increased at 12 and 24 h. After 2 h (and also 4 h) there was an increase in state 4 respiration (45.65 + 1.79 vs 28.96 + 1.50) and a decrease in respiration control rate (3.53 + 0.09 vs 4.45 + 0.08) and in the ADP/O ratio (1.77 + 0.02 vs 1.91 + 0.01) compared to controls (P<0.05). These results indicate a disruption of mitochondrial function, which recovered after 12 h. In the 48-h groups there was mitochondrial damage similar to that occurring in ischemic lesion. Beat-to-beat analysis (30 min) showed that arterial blood pressure remained normal up to 24 h (111 + 3 mmHg) while a significant decrease occurred in the 48-h group (91 + 4 mmHg). These data suggest biphasic damage in mitochondrial function in acute pancreatitis: an inital uncoupled phase, possibly secondary to enzyme activity, followed by a temporary recovery and then a late and final dysfunction, associated with arterial hypotension, possibly related to ischemic damage.

Reduction of pancreatic enzyme content and mortality in experimental acute pancreatitis in rats

A previous report has shwon that undernutrition reduces the mortality of acute experimental pancreatitis probably by decreasing pancreatic enzyme content of the pancreas without any harmful effect on the organ. The aim of the present study was to assess the effect of acute reduction of pancreatic enzyme content on the outcome of acute pancreatitis. Two groups of males Wistar rats weighing 230-250 g were studied: group I, 12-h fasted animals, and group II, add libitum-fed animals who received cerulein at the inframaximal dose (0.2 µg kg-1h-1) for 2 h. Cerulein adminsitration resulted in the reduction of the pancreatic contents of chymotrypsinogen (71 percent), trypsinogen (55 percent), proelastase (60 percent), amylase (62 percent) and cathepsin B (45 percent) (P<0.05). However, no significant reduction in pancreatic phospholipase content was observed. Acute pancreatitis wass induced in group I after 12-h fasting and in group II at the end of cerulein infusion by retrograde injection of 0.5 ml of 2.5 percent Na+ taurocholate into the pancreatic duct. Ascites volume and the degree of histologically observed lesions were similar in both groups, but 72-h mortality was 56 percent in the control group (10/18) and 23 percent (5/22) in the cerulein group (P<0.05). We speculate that the reduction of pancreatic enzyme content may exert its beneficial effect in acute pancreatitis by decreasing the quantity of pancreatic enzymes reaching the circulation and consequently their pathogenic effects

Mononuclear phagocytic system in acute pancreatitis

1. Functional alterations of the mononuclear phagocytic system (MPS) may be an important factor in the pathogenesis of infection in acute pancreatitis (AP). In the present study, MPS activity was investigated in rats and hepatic blood flow (HBF) was also determined. 2. A total of 122 male Wistar rats were divided into three groups: 1, AP group (N = 51); 2, sham-operated (SO) (N = 49); 3, intact group (IG) (N = 22). AP was induced by retrograde injection of 0.5 ml of 2.5 per cent sodium taurocholate saline into the main biliopancreatic duct under ketamine chloride anesthesia. SO animals were submitted to the same surgical steps as AP animals except for AP induction. 3. Each experimental group was subdivided into two subgroups. The first subgroup was submitted to the study of MPS activity as follows: each group was injected with colloidal 198Au and liver clearance parameters were determined 2 h (N = 11), 12 h (N = 10) and 24 h (N = 10) later in the AP group, and 2 h (N = 9), 12 h (N = 10) and 24 h (N = 11) later in the SO group. In the second subgroup, HBF was assessed using 131I-bromosulphalein at 2 h (N = 10) and 24 h (N = 10) in the AP group and at 2 h (N = 10) and 24 h (N = 10) in the SO group. The IG was submitted to both radioactive tracer studies. Each animal was used for only one experiment.(ABSTRACT TRUNCATED AT 250 WORDS)

Modifications of tissue blood flow in acute pancreatitis

I.Acute pancreatitis (AP) was induced by ductal injection of 2.5% sodium taurocholate saline solution. Plasma and red blood cell (RBC) volume and visceral organ blood flow were evaluated by a radioisotopic method (51Cr tracers) in 45 adult male Wistar rats (22 submitted to AP and 23 controls) 4 h after AP induction. 51Cr-albumin was used to measure plasma volume and 51Cr-RBC was used to measure RBC volume. II.Changes in tissue hematocrit reflect alterations in tissue blood flow, since reduction in blood flow increases microvascular erythrocyte sequestration. To evaluate the tissue blood flow, we introduce a "tissuehematocrit index" calculated relating 51Cr-RBC and 51Cr-albumin specific activities measured in visceral organ biopsies. Application of this index to the control and AP groups showed a decrease in blood flow in all visceral organs of the AP group which was reflected by an increase in tissue hematocrit index (2.5-fold for kidneys, 2-fold for pancreas and lungs, 1.6-fold for liver, and 1.2-fold for spleen). III.As expected there was an increase in blood hematocrit and a decrease in plasma volume in the AP group, but there were no significant alterations in RBC volume. However, an unequal decrease in blood flow in various tissues such as kidneys, lungs, pancreas and liver was detected in the AP group. IV.This approach provides an easy and simple way to evaluate possible therapeutic protocols for the treatment of acute panreatitis by measuring effects on visceral blood flow and plasma and blood volumes

Microbiologic study on stethoscopic eartips

Due to the inadequate use of stethoscopic eartips and the possibility of they being a source of infection of the ear, a microbiologic study has been carried out on 34 stethoscopes. The material from the eartips was cultured, one eartip being "contaminated", and the other disinfected previously with 70 per cent aqueous alcohol. Microorganisms developed in 100 per cent of the contaminated eartips and in 64.71 per cent of the clean ones. Howver ther was no statistically significant difference between the two groups, showing that 70 per cent aqueous alcohol is not an efficient disinfectant

Uso de ansiolítico como terapêutica coadjuvante no manejo nutricional de pacientes com câncer gástrico / The use of an anciolytic agent as coadjuvant therapy in the nutritional management of patients with digestive cancer

A desnutriçäo e a ansiedade säo acompanhantes freqüentes das enfermidades malignas do aparelho digestivo, notadamente no contexto do tratamento pré e pós-operatório. Numa avaliaçäo clínica de enfermos portadores destes transtornos, foram investigados os possíveis benefícios da introduçäo de uma medicaçäo ansiolítica como coadjuvante para a recuperaçäo do estado geral e das condiçöes nutritivas destes pacientes

Caracterizacao da rejeicao em transplante ortotopico de figado em caes.I-Esquemas de imunossupressao, tempo de sobrevida e aspectos clinicos. / Characterization of rejection in orthotopic liver transplantation in dogs. I-Immunosuppression schedule, survival time and clinical aspects

Foram estudados os esquema de imunossupressao, o tempo de sobrevida, os aspectos clinicos e as causas de obito de 14 caes submetidos a transplante ortotopico de figado que receberam ou nao imunossupressao a base de corticoide, 6-mercaptopurina, azatioprina e globulina antilinfocitaria.Entre os achados clinicos destacaram-se: complicacoes infecciosas (85,7%), hemorragia digestiva (64,3%), anorexia (50%), ascite (42,9%), ictericia (35,7%), vomitos (28,6%) e coma (7,1%). O tempo de sobrevida observado nos caes deste trabalho foi de cinco a 27 dias e os achados clinicos nao foram caracteristicos do processo de rejeicao do figado transplantado. Durante as necropsias encontraram-se em 64,3% dos animais deste trabalho foram observados processos infecciosos

Correlacoes entre achados clinicos, bioquimicos e anatomo-patologicos em transplante ortotopico de figado em caes. / Correlations between clinical, biochemical and anatomo-pathological findings in orthotopic liver transplantation in dogs

Foram estudados os apectos clinicos, bioquimicos e anatomo-patologicos de 14 caes submetidos a transplante ortotopico de figado que receberam ou nao imunossupressao a base de corticoide, 6-mercaptopurina, azatioprina e globulina anti-linfocitaria.O tempo de sobrevida observado nos caes deste trabalho foi de 5 a 27 dias. Todos os caes foram submetidos a necropsia, tendo-se colhido frangmentos dos figados transplantados para estudo histopatologico. Foram correlacionados entre si, atraves da aplicacao do teste exato de Fisher, os parametros clinicos, bioquimicos e anatomo-patologicos dos caes submetidos a transplante ortotopico de figado com e sem imunossupressao com o objetivo de melhor estudar a evolucao desses animais

Tomografia computadorizada do abdome no diagnostico e tratamento cirurgico das pacreatites agudas. / Computerized tomography of the abdomen in the diagnosis and surgical treatment of acute pancreatitis

Os autores estudaram 14 doentes portadores de pancreatite aguda grave. Doze desses doentes foram submetidos a intervencoes cirurgicas e os demais foram tratados clinicamente. Em todos os doentes submetidos a intervencao cirurgica foi possivel localizar pancreaticas e peripancreaticas, bem como efetuar o tratamento adequado. Em apenas 1 dos 14 casos o diagnostico foi estabelecido exclusivamente pela tomografia computadorizada, havendo, nos demais casos sinais clinicos e laboratoriais caracteristicos. A localizacao precisa das lesoes necroticas e das colecoes liquidas permitiu tratamento cirurgico eficiente de todos os pacientes, tendo a mortalidade atingido apenas 14,2% dos casos

Dilatacao congenita dos ductos biliares. Analise de 11 pacientes. / Congenital dilatation of the bile ducts.Analysis of 11 patients

As dilatacoes congenitas das vias biliares intra-hepaticas podem representar serio problema diagnostico, principalmente devido a sua raridade. No presente trabalho sao analisados os aspectos clinicos, laboratoriais e radiologicos de 11 doentes portadores dessa afeccao. A presenca de dor febre e periodos de remissao dos sintomas constituiram os aspectos clinicos mais frequentemente observados nesse grupo de pacientes. A elevacao dos niveis de fosfatase alcalina foi o dado laboratorial mais significativo. Dentre os metodos diagnosticos por imagem os mais eficientes foram as colangiografias transepatica, endoscopica e intra-operatoria, essa ultima com 100% de possibilidades diagnosticas.Com base nos dados observados os autores propoem uma rotina diagnostica para a doenca de Caroli e comparam-na com as demais doencas fibropolicisticas dos sistemas hepatobiliar e renal

Caracterizacao da rejeicao em transplante ortotopico de figado em caes.III - Achados anatomo-patologicos. / Characterization of rejection in orthotopic liver transplantation in dogs. III - Anatomopathological findings

Foram estudados os achados anatomo-patologicos de 14 caes submetidos a transplante ortotopico de figado que receberam ou nao imunossupressao a base de corticoide, 6-mercaptopurina; azatioprina e globulina anti-linfocitaria. O tempo de sobrevida observado nos caes deste trabalho foi de 5 a 27 dias. Todos os caes foram submetidos a necropsia, tendo-se colhido fragmentos dos figados transplantados para estudo his topatologico. Durante as necropsias podese fazer diagnostico macroscopico de rejeicao dos figados transplantados em 57,1% dos caes estudados. em 64,3% destes animais encontraram-se sinais de hemorragia digestiva por ulcera gastroduodenal hemorragica e ou por enterite hemorragica. Em 85,7% dos animais deste trabalho foram observados precessos infecciosos tipo: pneumonite, peritonite, abscesos hepaticos, colangite e supuracao de ferida cirurgica.Entre os achados histopatologicos encontraram-se em todos os caes estudados em graus diferentes de intensidade: infiltrado linfoplasmocitario; necrose hepatocelular centrolobular e mediozonal;lesces vasculares intra-hepaticas arterias e venosas necrose e lesao epitelial dos ductos biliares intra-hepaticos; colangite e trombos biliares, que cosntituem os achados caracteristicos da rejeicao dos figados transplantados em caes

Secrecao de insulina e derivacao pancreatojejunal em pacientes com pancreatite cronica alcoolica. / Insulin secretion and pancreatojejunal diversion in patients with chronic alcoholic pancreatitis

Em quatro pacientes com pancreatite cronica de etiologia alcoolica estudou-se no pre-operatorio a secrecao da insulina atraves do GTT oral e endovenoso, teste da tolerancia a tolbutamida e teste agudo de secretina. Estes testes foram repetidos apos 2 meses no pos-operatorio de anastomose pancretojejunal.Nao se observaram modificacoes na secrecao de insulina apos a descompressao ductal,nao sendo possivel utilizar os testes de funcao insular do pan creas como parametro para avaliar o sucesso das derivacoes