Recurrence of hepatitis C after orthotopic liver transplantation is one of the major clinical challenges faced by the liver transplantation community. Treatment of hepatitis C recurrence with ...peguilated interferon and ribavirin has been associated with sustained virological response in 21% to 45% of treated patients. Furthermore, it has been shown to halt disease progression after orthotopic liver transplantation and to prevent graft failure and the need for retransplantation at least in those subjects with sustained virological response. However, treatment of hepatitis C recurrence after orthotopic liver transplantation in Brazil was not recommended according to ministerial Law number 863.
To assess the management and treatment options of hepatitis C recurrence after orthotopic liver transplantation in different liver transplantation centers in Brazil.
Inquiries were sent to active liver transplantation centers throughout the country.
Nineteen centers accepted to participate and answered the questionnaire. Altogether they transplanted around 2,800 subjects, half of them with hepatitis C. Immunosuppressive regimen is comprised by tacrolimus and short-term prednisone in 53% of the centers. One third of them claim to use different schedules for hepatitis C patients. Protocol biopsies for diagnosis of recurrence are employed by 13 centers. Different histological criteria are used for the either diagnosis or decision for treatment in most of the centers. Approximately half of them (42%) indicate treatment in subjects with less severe stages of fibrosis (less than F2 according to METAVIR classification). All centers are referring patients for treatment with peguilated interferon and ribavirin, for 1 year, for 6 months or 1 year based on the genotype, or a la carte based on response, respectively, in 32%, 21% and 47% of the centers. Most of them (84%) do not stop treatment in early non-responders at the 12th week.
Even in the absence of national guidelines and federal support, most of the liver transplantation centers in Brazil are treating patients with hepatitis C recurrence after orthotopic liver transplantation.
Domino liver transplantation (DLT) has been performed for selected recipients at several centers, but de novo amyloidosis in recipients of livers from patients with familial amyloid polyneuropathy ...(FAP) remains a serious concern.
To evaluate the occurrence of de novo amyloidosis in recipients of DLT.
Seven recipients of FAP livers were followed for clinical and electroneuromyographic signs of FAP and also for de novo amyloid deposition in the gut.
No signs and symptoms of de novo FAP nor any evidence of amyloid deposits in the gut were observed in recipients of DLT after a mean follow-up of 24 12-40 months.
Signs and symptoms of FAP do not occur early in recipients of DLT. These livers could therefore be offered to patients suitable for conventional LT, particularly older subjects in whom the event of de novo amyloidosis would seem improbable.
RACIONAL: A recurrência da hepatite C no período pós-operatório do transplante hepático é um dos principais desafios atualmente enfrentados pela comunidade transplantadora. O tratamento com ...interferon peguilado e ribavirina tem sido associado à resposta virológica sustentada em 21% a 45% dos casos e constitui a única conduta eficaz, até o momento, para mudar o curso da progressão acelerada da doença no período pós-operatório do transplante hepático, que pode levar à perda do enxerto e à necessidade de retransplante. No entanto, a portaria n° 863 do Ministério da Saúde não disponibiliza esse tratamento para pacientes com recidiva da hepatite C após o transplante hepático. OBJETIVOS: Avaliar as condutas de acompanhamento e tratamento de pacientes com vírus C submetidos a transplante hepático em diferentes centros nacionais. MÉTODOS: Foram enviados questionários à maioria dos centros de transplante hepático nacionais de adultos sobre condutas acerca de acompanhamento e/ou tratamento de pacientes com hepatite C. RESULTADOS: Dezenove centros nacionais que congregam mais de 2 800 pacientes (51% com hepatite C) submetidos a transplante hepático responderam o questionário. A maioria (53%) usa tacrolimus e prednisona como esquema de indução e 32% usam esquemas diferenciados para hepatite C. Treze centros fazem biopsia protocolar para seguimento, sendo empregados diferentes critérios histológicos para diagnóstico de recurrência. Todos os centros indicam tratamento com interferon peguilado e ribavirina apenas na recurrência histológica da hepatite C e 46% empregam estádios de fibrose inferiores a F2 de acordo com a classificação METAVIR, mais leves do que aqueles preconizados para tratamento de pacientes não transplantados. A duração do tratamento é de 1 ano em 32% dos centros, baseada no genótipo em 21% e a la carte em 47%. A maioria dos centros (84%) não interrompe o tratamento na 12ª semana, na ausência de resposta virológica. CONCLUSÕES: A despeito da portaria nº. 863 do Ministério da Saúde, todos os centros estão viabilizando tratamento mediante acordo com secretarias regionais de saúde ou por intermédio de liminares concedidas aos pacientes pela justiça comum.
RESUMO Objetivo: Definir o perfil epidemiológico e os principais determinantes de morbimortalidade dos pacientes cirúrgicos não cardíacos de alto risco no Brasil. Métodos: Estudo prospectivo, ...observacional e multicêntrico. Todos os pacientes cirúrgicos não cardíacos admitidos nas unidades de terapia intensiva, ou seja, considerados de alto risco, no período de 1 mês, foram avaliados e acompanhados diariamente por, no máximo, 7 dias na unidade de terapia intensiva, para determinação de complicações. As taxas de mortalidade em 28 dias de pós-operatório, na unidade de terapia intensiva e hospitalar foram avaliadas. Resultados: Participaram 29 unidades de terapia intensiva onde foram realizadas cirurgias em 25.500 pacientes, dos quais 904 (3,5%) de alto risco (intervalo de confiança de 95% - IC95% 3,3% - 3,8%), tendo sido incluídos no estudo. Dos pacientes envolvidos, 48,3% eram de unidades de terapia intensiva privadas e 51,7% de públicas. O tempo de internação na unidade de terapia intensiva foi de 2,0 (1,0 - 4,0) dias e hospitalar de 9,5 (5,4 - 18,6) dias. As taxas de complicações foram 29,9% (IC95% 26,4 - 33,7) e mortalidade em 28 dias pós-cirurgia 9,6% (IC95% 7,4 - 12,1). Os fatores independentes de risco para complicações foram Simplified Acute Physiology Score 3 (SAPS 3; razão de chance − RC = 1,02; IC95% 1,01 - 1,03) e Sequential Organ Failure Assessment Score (SOFA) da admissão na unidade de terapia intensiva (RC =1,17; IC95% 1,09 - 1,25), tempo de cirurgia (RC = 1,001; IC95% 1,000 - 1,002) e cirurgias de emergências (RC = 1,93; IC95% 1,10 - 3,38). Em adição, foram associados com mortalidade em 28 dias idade (RC = 1,032; IC95% 1,011 - 1,052) SAPS 3 (RC = 1,041; IC95% 1,107 - 1,279), SOFA (RC = 1,175; IC95% 1,069 - 1,292) e cirurgias emergenciais (RC = 2,509; IC95% 1,040 - 6,051). Conclusão: Pacientes com escores prognósticos mais elevados, idosos, tempo cirúrgico e cirurgias emergenciais estiveram fortemente associados a maior mortalidade em 28 dias e mais complicações durante permanência em unidade de terapia intensiva.
Gallstones, granulomatous hepatitis, liver abscess, portal vein thrombosis and hepatic amyloidosis are more frequently observed in Crohns disease (CD), while PSC, autoimmune hepatitis (AIH) and ...AIH/PSC overlap syndrome are more prevalent in ulcerative colitis (UC). The estimated prevalence of PSC in Europe is 2 to 7 cases per 100,000 habitants, and it is a relatively rare disease in Brazil. In patients with PSC, in turn, UC and CD are observed in 60 to 80% and 13% of cases, respectively. Patients with PSC usually present predominant elevation of alkaline phosphatase and gamma-glutamyl transpeptidase. The presence of PSC should be investigated in all patients with IBD and unexplained cholestasis in the absence of antimitochondrial antibody. Sulfasalazine and, less frequently, 5-ASA can cause hepatocellular or cholestatic acute hepatitis, and also granulomatous hepatitis. Cyclosporine, in turn, has been associated with the occurrence of cholestatic acute hepatitis.
Sperm cryopreservation is a tool for the conservation of the genetic material of animals of genetic importance or for species preservation. In the case of domestic cats, this can be used to generate ...information about seminal harvest, evaluation and preservation, which is especially important due to its applicability to wild felids. This study evaluated seminal samples harvested by urethral catheterisation from 13 adult domestic cats. Samples were cryopreserved with experimental groups of extenders were defined by the penetrating cryoprotectant: 6% glycerol (GLY6%), 3% dimethylacetamide (DMA3%) and 3% dimethylformamide (DMF3%). The samples were thawed and evaluated by conventional microscopy and by computer-assisted sperm analysis (CASA). The structural and functional membrane integrity was assessed by supravital tests (EOS), hypoosmotic swelling tests (HOST) and flow cytometry (FC). There was a correlation (P < 0.05) between total motility and EOS (r = 0.54), HOST and FC (r = −0.62) and total motility and flow cytometry (r = 0.63), indicating that these are complementary parameters that increase the accuracy of the feline sperm quality evaluation post-thaw. The results regarding the structural and functional integrity of the sperm plasma membrane did not differ (P > 0.05) among groups. However, the DMA3% group had a lower (P < 0.05) percentage of morphological changes in the sperm tail compared to samples cryopreserved with GLY6% and DMF3%. Additionally, DMA3% provided lower values of immobile sperm post-thaw when compared to DMF3%. DMA is an interesting alternative to GLY and superior to DMF for the cryopreservation of feline semen at the studied concentrations.
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•Semen collection by catheterisation, after asministration with Alpha agonist is an efficient technique in domestic cats.•Dimethylacetamide demostrates greater protection against sperm tail injuries in cats, than glycerol and dimethylformamide.•Dimethylacetamide is an alternative cryoprotectant to glycerol and superior than dimethylformamide, for domestic cats.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Introducción: La administración de de un agonista de un fármaco alfa- 2-adrenérgicos asociada con la técnica del cateterismo uretral , es un método de desarrollo reciente en la colección seminal en ...felinos, ofreciendo las ventajas sobre la colecta por electroeyaculación y la colecta epididimária. La técnica se ha probado en Panthera onca y felinos de pequeño porte. Métodos: En este estudio se utilizaron individuos de Panthera onca , Puma yagouaroundi y Leopardus wedii en cautiverio en el parque Zoobotánico Getúlio Vargas, Salvador, Bahia, Brasil. Fue utilizado los farmácos de clorhidrato de medetomidina (0,1mg /kg) y cetamina (5mg /kg) y fue colectado semen por medio del cateterismo uretral. Durante el desarrollo del procedimiento, se realizó la colecta de los datos biométricos corporales y testiculares, así como la ultrasonografáa de los testículos. Las muestras seminales frescas fueron evaluadas los parámetros de volumen, por microscopía convencional, el vigor espermático, motilidad total, motilidad progresiva, la integridad estructural y funcional de la membrana plasmática y la morfología espermática. Las muestras se sometieron a un proceso de congelación - descongelación utilizando tres diferentes crioprotectores. Las muestras descongeladas fueron evaluadas por microscopía convencional, análisis seminal computarizado y citometría de flujo. Resultados: En este estudio fue realizado con éxito la técnica de colección seminal en las tres especies, siendo el primer estudio que informa de los parámetros seminales de P. yagouaroundi y el primero que reporta la colección seminal uretral en L. wiedii. Los datos presentados describen la morfocinética espermática de las especies incluidas de forma pionera. No hubo diferencias (P>0,05) en la calidad seminal evaluando por grupo de crioprotector, ni diferencias en la integridad de las membranas pré e post-congelamento. Discusión: Foi posible solamente la comparación con otras técnicas de colección seminal o con resultados de calidad seminal obtenidos de muestras de gato doméstico. El establecimiento de una potencial asociación de las características físicas del animal y la calidad seminal, es información de suma importancia en la aplicabilidad para la elección de reproductores en los programas de reproducción asistida.
Perception of Brazilian medical students toward organ donation Batista, Eduardo Luis de Oliveira; Nascimento, Melissa Macedo Peixoto; Castro, Alexia Rangel de ...
Revista da Associacao Medica Brasileira (1992),
2022, Volume:
68, Issue:
12
Magazine Article
Peer reviewed
Open access
Brazil ranks second in gross numbers of kidney and liver transplantations, but deceased organ donation is still far below the national demand for organs. Apart from a high family refusal rate, ...another significant barrier is healthcare workers' inappropriate knowledge concerning organ donation and transplantation. Since most of them have recently graduated from university, this study aimed to evaluate the awareness and attitudes of medical students concerning organ donation.
Between August and September 2021, a web-based survey with 10 overlapping questions was sent to medical students from several Brazilian universities after advertisements on social media.
A total of 391 (60% female, mean age: 23 17-41 years) students answered the survey. Most of them (91%) would like to donate organs in case of death, and 75% have already notified their family. The main reasons for not becoming a donor were fear of body manipulation (n=3) or family reaction (n=2) and religious reasons (n=2). When inquired, 54% were unaware of brain death criteria, and half of them claimed to have never discussed the topic in medical classes. Except for Glasgow coma scale (97%), pupillary (72%), and corneal (53%) reflexes, less than 25% knew other reflexes required for brain death diagnosis.
Most medical students declared themselves as organ donors, and most informed their families. However, many students have never learned about crucial steps toward organ donation, which may impact their adequate recognition of potential organ donors later in life.
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