ABSTRACT
A 51-year-old woman presented with constitutional symptoms, polydipsia, early satiety, nausea, vomiting, and a pruritic vesicular rash. On physical examination, she was febrile, had low peripheral oxygen saturation in room air (91%), hepatomegaly, lower limb edema, and palpable cervical adenopathies. She was hospitalized for diagnostic investigations and treatment. An autoimmune panel was requested which was positive for anti-parietal gastric cell, anti-endomysial, and anti-tissue transglutaminase antibodies, raising the suspicion for coeliac disease (CD). Gastric and duodenal biopsies were not diagnostic for CD, which was compatible with necrolytic migratory erythema similar to the vesicular rash biopsy. Thoracic-abdomino-pelvic computed tomography scan and fludeoxyglucose F18-positron emission tomography identified supra- and infra-diaphragmatic hypermetabolic adenopathies, with hypermetabolic activity in the lungs, suggestive of pulmonary lymphomatous involvement. Fine-needle aspiration of one supraclavicular adenopathy was performed but was not enough for histological diagnosis. The patient's respiratory insufficiency worsened and she died on day 63 of hospitalization. The final diagnosis was achieved on an anatomopathological autopsy that showed lymphocyte-depleted Hodgkin's lymphoma. The association of CD with other lymphomas besides enteropathy-type T-cell lymphoma is not clear. There is no clear relationship between CD and lymphocyte-depleted Hodgkin's lymphoma, which is the rarest subtype of classic Hodgkin's lymphoma and, by itself, has a very poor prognosis. This case highlights the challenge in diagnosis and significant delay due to isolation associated with coronavirus disease 2019 infection.
ABSTRACT
Heart failure is a chronic and progressive disease that is estimated to affect approximately 20 million people worldwide and is one of the major public health problems. Its prevalence is reaching epidemic levels with about 550,000 new cases diagnosed annually, partly due to increased life expectancy in developed countries. And as it is a systemic disease, it can cause dysfunction in various organs, but especially in the kidney. The renal failure is often associated with heart failure and, when present together, make the treatment more complex and the prognosis is worse. This is the cardio-renal syndrome. The definition of cardio-renal syndrome varies according to the working groups, and there isn't a consensus. The exact cause of deterioration of renal function and the mechanism behind this interaction are complex, multifactorial in nature and not fully known at present. The treatment available is the one used for the treatment of heart failure. It is necessary to maintain the normal function of filtration, secretion and reabsorption in kidney to have a real improvement of the clinical condition of the patient. Patients with higher risk of developing nephropathy and those who have diagnosed renal failure should have prescribed drugs that are handled very carefully. But as in many other clinical situations, there aren't perfect drugs available to treat cardio-renal syndrome and the existing ones may have serious side effects in medium/long term causing the deterioration of renal function and possibly an increased mortality. The treatment is truly challenging in patients with severe fluid overload that is refractory to diuretics. This article aims to present the existing definitions of cardio-renal syndrome, its epidemiology, describe the current knowledge about the pathophysiology and its relationship to therapeutic interventions, some actual strategies and future technologies in an attempt to preserve the kidney, mainly during the decompensation of chronic heart failure.
Subject(s)
Cardio-Renal Syndrome/etiology , Cardio-Renal Syndrome/therapy , Heart Failure/complications , Heart Failure/therapy , Cardio-Renal Syndrome/diagnosis , Cardio-Renal Syndrome/epidemiology , Cardio-Renal Syndrome/physiopathology , HumansABSTRACT
Com o objetivo de determinar o valor nutritivo da silagem de milheto [Pennisetum glaucum (L.) R. Brown], conduziu-se um experimento, nas dependências do Departamento de Zootecnia da UFLA, utilizando o milheto estabelecido em um Latossolo Vermelho Distroférrico típico textura muito argilosa. Os tratamentos constituíram-se de três cultivares (BRS 1501, BN 1 e Comum) e três idades de corte, 70, 90 e 110 dias, para silagem, semeados em novembro/2003. O delineamento experimental utilizado foi o de blocos ao acaso, constituindo-se em fatorial com 3 x 3 (3 cultivares x 3 idades de corte), com 3 repetições. Foram avaliados os teores de MS, PB, pH, N-NH3 ( por cento N total), FDN e FDA. Para as silagens, houve diferenças significativas entre as idades de corte para os teores de MS, PB, nitrogênio amoniacal e pH, variando de 21,34 a 36,83 por cento, 7,13 a 9,50 por cento, 1,21 a 1,38 por cento e 3,48 a 3,77, respectivamente. Para a produção de silagem de milheto, o cultivar BN 1 semeado em novembro deve ser colhido aos 90 dias de idade, por ter superado os demais cultivares em composição bromatológica.
With the aim of evaluating the nutritive value of millet silage [Pennisetum glaucum (L.) R. Brown], an experiment was carried out in the dependencies of the Animal Science Department of UFLA, using the millet established on a Typical Very Clay Texture Distroferric Red Latosol. The treatments consisted of three cultivars (BRS 1501, BN 1 and Comum) and three cutting ages, 70, 90 and 110 days for silage, sown in November/2003. The experimental outline used was the one of randomized blocks, constituting into a factorial with 3 x 3 (3 cultivars x 3cutting ages) with three replications. For the silages, there were significant differences among cutting ages for the contents of DM, CP, N-NH3 and pH, varying from 21.34 to 36.83 percent, 7.13 to 9.50 percent, 1.21 to 1.38 percent and 3.48 to 3.77, respectively. For the production of millet silage, the cultivar BN 1 planted in November can be harvested at 90 days of age, for overcoming the others in bromathological composition.
