Acute Iron Poisoning: A Case of Fulminant Hepatic Failure.

Acute iron poisoning is an exceedingly rare occurrence, mainly when resulting from intentional ingestion in adults. It can lead to multi-organ toxicity and, in severe cases, may evolve into acute liver failure and cardiovascular collapse, which are the main causes of death. The clinical outcome is largely dependent on the amount of elemental iron ingested and the readiness of treatment, which includes support, early intestinal decontamination and deferoxamine. Despite timely intervention, acute liver failure can be life-threatening, with liver transplantation being the only potentially life-saving measure. In this case report, we describe a case of severe acute iron poisoning due to intentional ingestion that led to fulminant liver failure, which was successfully managed with liver transplantation.

Hepatopulmonary Syndrome Diagnosis in the ICU: The Relevance of Bedside Contrast Saline Echocardiography.

Hepatopulmonary syndrome (HPS) is an underdiagnosed complication of chronic liver disease (CLD) characterised by the presence of hypoxaemia due to intrapulmonary vascular dilatations. We present two cases of HPS diagnosed during their stay in the ICU. Both patients had a medical history of alcoholic CLD with portal hypertension (PH). The first patient was transferred to the ICU for acute hypoxic respiratory failure (AHRF) due to decompensated cirrhosis with large-volume hydrothorax and diagnosis of acute-on-chronic liver failure (ACLF) grade 2. The presence of orthodeoxia, an alveolar-arterial oxygen gradient (O2 A-a grad) of 27 mmHg and positive contrast saline echocardiography confirmed the HPS diagnosis. The second patient was transferred to our general ICU from the surgical ward where he was initially admitted with mild AHRF due to polytrauma conditioning left side rib fractures and a small contusion in the left inferior lobe. Upon ICU admission, he was diagnosed with septic shock (nosocomial pneumonia as the primary site of infection) and required invasive mechanical ventilation. During the initial period of his ICU stay, although an improvement in multiple organ dysfunction was observed, severe AHRF persisted. Moreover, O2 A-a grad of 30 mmHg and positive bedside contrast saline echocardiography confirmed the HPS diagnosis. In this study, we discuss the diagnostic approach of HPS and the increasing relevance of contrast saline echocardiography at the bedside, particularly in critically ill patients. The performance of this technique by trained intensivists at the bedside in the ICU minimises critical moments, such as the time required for intra-hospital transport of patients for complementary examinations, considering they have severe ventilatory compromise, thereby allowing HPS diagnosis with high sensitivity.

Anthracycline Cardiotoxicity in a Patient with Diffuse Large B-Cell Lymphoma: A Case Report.

Cardiotoxicity is a relevant side effect of cancer therapy that leads to increased patient morbidity and mortality. It is fundamental to understand and remember it as a cause of disease since accurate and timely diagnosis is crucial. We present the case of a patient who developed chemotherapy-associated cardiac dysfunction after receiving treatment for a diffuse large B-cell lymphoma. Clinical history, echocardiography, and differential diagnosis led us to attribute her condition to heart failure (HF) due to early doxorubicin-induced cardiomyopathy. The patient outcome was favorable. We discuss the pathogenesis and incidence of anthracycline-induced cardiotoxicity as well as strategies for its detection, prevention, and treatment.

Effects of a previous schistosomal infection on development of experimental leishmaniasis

A influência da infecçäo esquistossomótica no desenvolvimento da leishmaniose por Leishmania mexicana amazonensis foi estudada tendo o camundongo como modelo experimental. Os animais foram infectados com a cepa LE de Schistosoma mansoni 45 dias antes da infecçäo leishmaniótica (105 promastigotas de cultura recentemente isolada de hamsters infectados). Os animais controle receberam apenas a infecçäo pelo protozoário. Verificou-se uma significativa diminuiçäo do período de incubaçäo das lesöes leishmanióticas no grupo de animais com esquistossomose prévia e, neste caso, tais lesöes também eram significativamente maiores que as observadas no grupo controle.

Experimental Schistosoma mansoni and Leishmania mexicana concomitant infections in mice: enhancement of susceptibility to the trematode

Camundongos albinos heterozigotos foram inoculados com a cepa IFLA/BR/67/PH8 de Leishmania mexicana amazonensis (10 elevado a 5 promastigotas por camundongo) e, depois que as lesöes cutâneas estavam bem caracterizadas (78 dias após), com a cepa LE de Schistosoma mansoni (cerca de 30 cercárias por camundongo). Os camundongos controle receberam apenas a inoculaçäo pelo helminto. Durante as necrópsias, realizadas 63 dias após a infecçäo pelo S. mansoni, um aumento significativo no número de vermes foi observado nos animais com infecçäo concomitante pela L. m. amazonensis. Os achados säo atribuídos a uma possível alteraçäo na resposta imune do hospedeiro à infecçäo pelo S. mansoni, alteraçäo essa devida à infecçäo leishmaniótica prévia.