Influence of Donor Obesity on Long-Term Liver Transplantation Outcomes.

OBJECTIVE: To analyze liver transplantation outcomes according to the body mass index (BMI) of donors. MATERIAL AND METHODS: A retrospective descriptive study was conducted in patients transplanted at our center between January 2006 and December 2014, comparing outcomes between grafts from obese (body mass index [BMI] ≥30) and nonobese (BMI ≤30) donors. We analyzed the reasons for transplantation, the morbidity-mortality related variables, and survival after a minimum follow-up of 24 months. A multivariate logistic model was constructed to predict the mortality. Survival was analyzed with the Kaplan-Meier method, and survival curves were compared using the log-rank test. RESULTS: The study included 50 obese and 175 nonobese donors. A significant difference between the groups was found in the pre-extraction intensive care unit (ICU) stay of the donors (P = .006) but not in the post-transplantation complications or survival of the respective recipients (P > .05). In the multivariate analysis, mortality was significantly associated with the presence of the hepatitis C virus (HCV) (P = .001) in the recipient and with the age of the donor (P = .043), finding the risk of death to be 2.87-fold higher in patients with HCV versus without HCV (95% confidence interval [1.641-5.043]) and 1.7% higher with every additional year of donor age (odds ratio 1.017, 95% confidence interval [1-1.034]). CONCLUSIONS: A significantly longer pre-extraction ICU stay was observed in obese (BMI ≥30) versus nonobese (BMI <30) donors, but no significant between-group difference was found in the post-transplant complications or survival of the respective recipients. The mortality risk was higher in HCV-positive recipients and in those receiving grafts from older donors.

Analysis of Ischemic Cholangiopathy After Treatment of Arterial Thrombosis in Liver Transplantation in Our Series.

Liver transplantation offers patients with terminal liver disease an effective treatment accompanied by excellent quality of life, but it also has complications, such as hepatic artery thrombosis and development of ischemic cholangiopathy, described in 3%-17% of patients. It is a very important cause of morbidity and mortality. The objective of this report was to analyze the efficacy of the treatment they received in relation to the development of ischemic cholangiopathy and a comparative survival analysis and to propose prophylactic measures for high-risk patients.

Liver Transplantation Results by Donor Age.

OBJECTIVE: The objective of this study was to compare liver transplantation outcomes as a function of donor age. MATERIAL AND METHODS: We performed 212 liver transplantations between 2008 and 2014. We described a prospective cohort study and grouped the patients by liver donor age. We compared quantitative and categorical variables using statistical analysis. RESULTS: No statistically significant differences were found among any graft age groups in gender (always more males), time on waiting list, age, height, Child Pugh Turcotte (CHILD) score, Model for End-stage Liver Disease (MELD) score, need for intraoperative blood products, or intensive care unit stay. The most frequent etiology of liver failure was alcohol. A brain-dead donor was the most frequent type in all groups. The whole graft was used except in 4 cases. No statistically significant differences were found among groups in the surgical technique, postreperfusion syndrome, arterial complications, biliary complications, venous complications, acute rejection, and retransplantation. The 3-year patient survival rate was 64% in the <60-year graft age group, 48% in the 60- to 69-year group, 64% in the 70- to 79-year group, and 40% in the ≥80-year group (P = .264). The 3-year graft survival rate was 62% in the <60-year graft age group, 47% in the 60- to 69-year group, 65% in the 70- to 79-year group, and 40% in the ≥80-year group (P = .295). CONCLUSIONS: Given the need to increase the pool of liver donors, older donors should be considered as a source for liver transplantation, although careful selection is required.

Liver Transplantation Outcomes Using Grafts From Donors Older Than the Age of 80 Years.

We performed a retrospective cohort study between 2002 and 2014 to compare liver transplantation outcomes between recipients of grafts from donors older than and younger than the age of 80 years. Numerical variables were compared with the Student t test when their distribution was normal and the Mann-Whitney test when it was not, whereas categorical variables were compared with Pearson chi-squared test or Fisher test, as appropriate; P < .05 was considered significant. The study included 312 patients with organs from donors younger than 80 years of age and 17 with organs from older donors. The 2 recipient groups did not significantly differ in weight, height, gender, body mass index (BMI), CHILD or MELD score, intensive care unit (ICU) or hospital stay, need for intraoperative hemoderivatives, postreperfusion syndrome, biliary or vascular complications, ischemic cholangiopathy, number of repeat surgeries, graft rejection, retransplantation, or survival at 6 months. Although earlier studies considered livers from elderly donors to be suboptimal, our results support the proposition that octogenarian donors can be an excellent source of liver grafts.

Hallazgos radiológicos en ecografía y tomografía computada multidetector de 64 canales de una invaginación colo-cólica secundaria a lipoma

Si bien la mayoría de los lipomas intestinales son asintomáticos y se diagnostican de manera casual, en algunas ocasiones pueden tener síntomas, como sangrado, diarrea o, con menor frecuencia, obstrucción o invaginación intestinal. Esta última en el adulto es una patología poco común y por lo general tiene una presentación subaguda crónica, cuyo diagnóstico es complicado. La principal técnica de imagen para el diagnóstico de la invaginación intestinal en adultos es la tomografía computada (TC). Solamente un 20% de las invaginaciones son colo-cólicas y en su mayoría son secundarias a un carcinoma. No obstante, en algunas pocas oportunidades pueden ser secundarias a una causa benigna, siendo el lipoma la más usual.(AU)

Even though most of the intestinal lipomas are asymptomatic and are diagnosed by chance, sometimes may have symptoms such as bleeding or diarrhea, and less frequently obstruction or intussusception. Intussusception in adults is a rare condition, and usually has a chronic-subacute presentation, and diagnosis is difficult. CT is the main radiological imaging test for diagnosis. Only 20% of the colonic invaginations are colo-colic, and in most cases are secondary to carcinoma. Rarely are secondary to a benign cause, being the intussusception secondary to a lipoma the most frecuent.(AU)

Hallazgos radiológicos en ecografía y tomografía computada multidetector de 64 canales de una invaginación colo-cólica secundaria a lipoma / Radiological findings on ultrasonography and multidetector computed tomography of 64 channels of a colo-colonic intussusception secondary to lipoma

Si bien la mayoría de los lipomas intestinales son asintomáticos y se diagnostican de manera casual, en algunas ocasiones pueden tener síntomas, como sangrado, diarrea o, con menor frecuencia, obstrucción o invaginación intestinal. Esta última en el adulto es una patología poco común y por lo general tiene una presentación subaguda crónica, cuyo diagnóstico es complicado. La principal técnica de imagen para el diagnóstico de la invaginación intestinal en adultos es la tomografía computada (TC). Solamente un 20% de las invaginaciones son colo-cólicas y en su mayoría son secundarias a un carcinoma. No obstante, en algunas pocas oportunidades pueden ser secundarias a una causa benigna, siendo el lipoma la más usual.

Even though most of the intestinal lipomas are asymptomatic and are diagnosed by chance, sometimes may have symptoms such as bleeding or diarrhea, and less frequently obstruction or intussusception. Intussusception in adults is a rare condition, and usually has a chronic-subacute presentation, and diagnosis is difficult. CT is the main radiological imaging test for diagnosis. Only 20% of the colonic invaginations are colo-colic, and in most cases are secondary to carcinoma. Rarely are secondary to a benign cause, being the intussusception secondary to a lipoma the most frecuent.

Avaliação do papel do farmacêutico nas ações de promoção da saúde e prevenção de agravos na atenção primária / Evaluation of the role of the pharmacist in actions promoting health and preventing accidents and diseases within primary health care

Para o farmacêutico, atividades baseadas nos preceitos da promoção da saúde e prevenção de agravos dentro da Atenção Primária à Saúde constituem-se em um desafio. Esse estudo teve como objetivo analisar as ações de promoção à saúde e prevenção de agravos realizadas pelo profissional farmacêutico desenvolvidas em grupos de usuários de uma Unidade de Saúde da Família. Foram desenvolvidas atividades educativas em dois Grupos (Gestantes e Idosos) da Unidade de Saúde da Família Emocy Krause, Recife-PE. Para descrição das atividades foi utilizado o Diário de Campo do Farmacêutico e ao término de cada atividade foi aplicado um Questionário de Avaliação. Três atividades foram realizadas no Grupo de Gestantes: Desenvolvimento do feto durante a gestação, Plantas medicinais e chás na gravidez e Uso racional de medicamentos, e seis para o Grupo de idosos: Higiene do sono, Hipertensão arterial sistêmica e Diabetes, Uso racional de medicamentos, Doenças reumáticas, Oficina de memória e Prevenção de quedas na terceira idade. O julgamento dos usuário sem relação ao conteúdo das atividades foi de Muito Satisfatório por 15/22 gestantes e 40/72 idosas. Em relação às metodologias utilizadas, 17/22 e 45/72 dos questionários analisados do grupo de gestantes e idosos, respectivamente, apresentaram como resposta o item Muito Satisfatório. O entendimento dos participantes antes da realização da atividade era tido como Ruim ou Muito Ruim (11/22 Gestantes e 33/72 Idosas) sendo a compreensão dos participantes avaliada como Satisfatória ou Muito Satisfatória, após a realização das atividades, por 22/22 gestantes e 72/72 idosas. A inserção do farmacêutico na Atenção Primária, considerando as características de um espaço multidisciplinar e a adequação de metodologias participativas, minimiza uma prática tecnicista e o individualismo profissional...

For the pharmacist, activities based on the principles of health promotion and prevention of disorders within Primary Health Care constitute a challenge. The aim in this study was to analyze the actions of health promotion and disease prevention carried out by the resident pharmacist working with user groups at a Family Health Unit. Educational activities were developed with two groups of users (pregnant women and elderly) at the Emocy Krause Family Health Care Unit in Recife (PE, Brazil). To describe the activities, we used the pharmacist's Field Diary and, at the end of each activity, an Assessment Questionnaire was used. Three activities were carried out with the Group of Pregnant Women: Development of the fetus during pregnancy, Use of medicinal plants and herbal teas for pregnancy and Rational drug use, and six with the Elderly group: Sleeping hygiene, Hypertension and diabetes, Rational drug use, Rheumatic disorders, Memory workshop and Prevention of falls among the elderly. The evaluation of the content of activities by the users was Very Satisfactory for 15/22 of the pregnant women and 40/72 of the elderly group. Regarding the methods used, 17/22 and 45/72 of the replies to the questionnaires by the groups of pregnant women and elderly, respectively, were Very Satisfactory. The understanding of the participants prior to the activity was described as Poor or Very Poor (11/22 pregnant women and 33/72 elderly), whereas it was assessed as Satisfactory or Very satisfactory after the completion of activities by 22/22 women and 72/72 elderly participants. The inclusion of the pharmacist in Primary Health Care, given the characteristics of a multidisciplinary space and the adequacy of participatory methods, minimizes professional individualism and a technicist practice...

Síndrome de Cowden. Importancia del diagnóstico precoz / Cowden's syndrome. Importance of early diagnosis

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Antinociceptive, anti-inflammatory and antioxidant activities of aqueous extract from Remirea maritima (Cyperaceae).

ETHNOPHARMACOLOGICAL RELEVANCE: Remirea maritima Aubl., popularly known as "capim-da-praia", is popularly employed in the treatment of diarrhea, kidney disease, fever, and for analgesic and anti-inflammatory purposes through the preparation of teas. Few studies have focused on the chemical composition and its biological properties. AIM OF THE STUDY: This work evaluated the antinocipetive, anti-inflammatory and antioxidant activities of the aqueous extract from Remirea maritima Aubl. as well as the isolation and identification of the chemical compounds. MATERIALS AND METHODS: Compounds were isolated from aqueous extract of Remirea maritima through preparative HPLC and the structures were identified by means of NMR and MS analysis. The tests for antinociceptive, anti-inflammatory, and antioxidant activities, along with motor coordination test (Rota rod), were performed over the aqueous extract. RESULTS: The phytochemical investigation of aqueous extract of Remirea maritima resulted in the isolation of three flavone glycosides. The structures of these compounds were determined by means of MS and 1D and 2D NMR data as vitexin-2″-O-ß-D-glucopyranoside, isovitexin-2″-O-ß-D-glucopyranoside, and luteolin-7-O-glucuronide. Acute pretreatment with aqueous extract (100, 200 or 400mg/kg, i.p.) caused a significant decrease (p<0.001) in the number of abdominal writhes. In the formalin test, higher doses significantly inhibited the late (inflammatory pain) phase of formalin-induced licking (p<0.05 or 0.001). In the hot plate test, there was no significant difference in nociceptive behavior, discarding the possible central effect of the aqueous extract. In the rota rod test, it was verified that the aqueous extract in all concentration evaluated does not alter the motor coordination of mice, such antinociceptive results were unlikely to be caused by motor abnormality. In the peritonitis test, induced by carrageenan, the treatment with aqueous extract produced a significant reduction in leukocyte migration in all concentration evaluated. Additionally, a significant reduction of lipoperoxidation (TBARS test) and in nitric oxide formation (.NO Scavenging assay) was observed in antioxidant activity assay. CONCLUSION: The biological and phytochemical investigations of the aqueous extract of Remirea maritima resulted in the identification of three flavone glycosides that have been described here for the first time in Remirea and effective analgesic activity in various pain models, probably mediated via the inhibition of peripheral mediators which could be related to its strong antioxidant effect observed in vitro.

[Visuomotor behaviour of preterm infants in the first month of life. A comparison between the chronological and corrected ages]. / Comportamiento visuomotor de lactantes pretérmino en el primer mes de vida. Comparación entre las edades cronológica y corregida.

INTRODUCTION: Technological advances have helped to lower the rate of infantile mortality and to raise the survival rate of preterm infants. Thus, studies need to be conducted in this segment of the population, while prematurity continues to be one of the risk factors for neuro-sensory-motor disorders. There is evidence to show that these children present visual and visuoperceptual disorders. With regard to visual problems, the literature suggests the hypothesis that the gestational age at the moment of birth exerts an influence on the child's visual behaviour. Bearing this evidence in mind, doubts are raised as to whether such alterations can be detected in periods that are appropriate for the development of vision. SUBJECTS AND METHODS: We carried out a cross-sectional follow-up study of preterm infants in the first month of life who had their visuomotor behaviour evaluated at the chronological and corrected age. All of them were evaluated by applying the method for assessing the visual behaviour of infants, which is based on tests from the Bayley scales of infant development, as an instrument for investigating visuomotor behaviour. RESULTS: Most of the preterm infants presented a response, with a higher frequency in the eye contact tests, smiling as a social response, horizontal and vertical visual tracking, and increased mobility of the upper limbs on seeing the object at the corrected age. CONCLUSIONS: The responses obtained in this study allow us to confirm the importance of taking into account the corrected age when measuring the parameters involved in the development of visuomotor behaviour.

Comparison of left ventricular mass and function in obese versus nonobese women <40 years of age.

We evaluated, through Doppler echocardiography, left ventricular (LV) mass and function in 82 obese young women (aged <40 years) who were asymptomatic, without any cardiovascular or pulmonary disease compared with a lean control group matched by age and height. LV mass, LV mass/height, and LV mass/volume were increased in obese women, and a lower LV E- and A-wave velocity ratio was noted, suggesting early cardiac involvement.

The left shifted oxyhemoglobin curve in sepsis: a preventable defect.

Nine patients with severe sepsis were studied to determine causes for any alterations in oxygen dissociation. Seven of the patients had oxyhemoglobin curves shifted to the left of expected and diminished DPG levels. These deficiences were not corrected in one case. The other eight patients survived or expired with normal to elevated P(50T) and DPG levels. In this study, three factors occurring either individually, in concordance, or in sequence were present when P(50T) was decreased. Correction of these deficiencies lead to normalization and, in one case, exceedingly high P(50T) and DPG levels. Where hypophosphatemia, acidosis, and transfusion of DPG deficient blood were avoided, no such change occurred. Hypophosphatemia is a common occurrence in the seriously ill patient whether or not hyperalimentation is used and may occur in spite of phosphate supplementation. Blood transfusions with CPD as the preservative are effective in reducing the severity of this disorder by the addition of an inorganic phosphate load. Septic shock itself had no untoward effect on oxygen dissociation. This held true even in the terminal stages of the disease process.