McArdle disease is a myopathy caused by mutations in PYGM gene that is characterized by reduced or absent activity of myophosphorylase. Reports of patients with concomitant McArdle disease and ...diabetes are scarce. We report a case of a patient with a late diagnosis of McArdle disease and we postulate that symptoms may be related to hypoinsulinemia.
This report describes the evolution of an elderly diabetic patient with confirmed diagnosis of McArdle's disease based on the absence of myophosphorylase activity in the analysis of muscle biopsy, and a homozygous mutation in the PYGM gene. The variant - Chr11: 64.525 (p. Asn168*fs) has not been previously described. The diagnosis of McArdle disease was confirmed after two episodes of rhabdomyolysis, at 77 and 81 years of age, as the symptoms were, until then, discrete. The "second-wind phenomenon" was not spontaneously reported, but it was confirmed when directly questioned. We postulate that the later episodes of rhabdomyolysis occurred because of a progressive decrease in insulin production with a consequent reduction in the uptake of blood glucose by muscle cells, thus compromising the cellular energy balance. To our knowledge, this is the first report of recurrent rhabdomyolysis in an elderly diabetic patient with genetically proven McArdle disease. Our initial attempt to reduce insulin resistance with metformin and pioglitazone was not effective, possibly because of inadequate insulinemia. However, an improvement was evident after the administration of low doses of intermediate-acting insulin.
In view of the patient's clinical evolution, we suggest the use of medication that reduces insulin resistance for patients with McArdle disease and type 2 diabetes, pre-diabetes or even normoglycemic metabolic syndrome.
Introduction:
The kidney may be affected by coronavirus (COVID-19) in the setting of acute kidney injury (AKI). Data about AKI in intensive care unit (ICU) patients in Latin America are scarce. We ...aimed to evaluate the risk of AKI, dialysis (HD), and death in ICU COVID-19 patients in a Brazilian center.
Methods:
Analysis from medical records of COVID-19 patients in a Brazilian center.
Results:
A total of 95 patients were analyzed. There was male predominance (64.2%), median age: 64.9 years, and previous history of hypertension and diabetes in 51.6 and 27.4%, respectively. AKI was diagnosed in 54 (56.8%) patients, and 32 (59.2%) of them required HD. Mortality rate was 17.9%. AKI patients when compared with no-AKI were more frequently hypertensive/diabetic and more often needed organ support therapies. Workups depicted more anemia, lymphopenia, and higher levels of inflammatory markers and higher mortality. Comparing patients who had undergone death to survivors, they were older, more frequently diabetic, and had worse SAPS3 and SOFA scores and need for organ support therapies, AKI, and HD. Multinomial logistic regression revealed that hypertension (
p
= 0.018) and mechanical ventilation (
p
= 0.002) were associated with AKI; hypertension (
p
= 0.002), mechanical ventilation (
p
= 0.008), and use of vasopressor (
p
= 0.027) to HD patients; and age >65 years (
p
= 0.03) and AKI (
p
= 0.04) were risk factors for death.
Conclusions:
AKI was a common complication of ICU COVID-19 patients, and it was more frequent in patients with hypertension and need of organ support therapies. As well as age >65 years, AKI was an independent risk factor for death.
Cardiovascular disease is the main cause of death in patients with chronic kidney disease (CKD). Several heart conditions have been associated with CKD, including myocardial and pericardial diseases. ...This paper describes a case of Dialysis-related constrictive pericarditis in a patient diagnosed with sudden hypotension during a hemodialysis session. A 65-year-old man diagnosed with hypertension, diabetes, obesity, and cirrhosis on hemodialysis for two years complained of symptoms during one of his sessions described as malaise, lipothymia, and confusion. The patient had a record of poor compliance with the prescribed diet and missed dialysis sessions. He was sluggish during the physical examination, and presented hypophonetic heart sounds, a blood pressure of 50/30mmHg, and a prolonged capillary refill time. The patient was referred to the intensive care unit and was started on antibiotics and vasoactive drugs. His workup did not show signs of infection, while electrocardiography showed low QRS-wave voltage. His echocardiogram showed signs consistent with a thickened pericardium without pericardial effusion. Cardiac catheterization showed equalization of diastolic pressures in all heart chambers indicative of constrictive pericarditis. The patient underwent a pericardiectomy. Examination of surgical specimens indicated he had marked fibrosis and areas of dystrophic calcification without evidence of infection, consistent with Dialysis-related constrictive pericarditis. Hypotension for unknown causes must be considered in the differential diagnosis of dialysis patients.
Purpose:
The purpose of this study is to evaluate the safety and efficacy of the mechanical thrombectomy with the Indigo System in the treatment of thrombosed arteriovenous fistulas and grafts.
...Methods:
A retrospective search of endovascular procedures performed from November 2018 to June 2020 was conducted. Inclusion criteria were: acute arteriovenous fistula or graft thrombosis that underwent endovascular mechanical thrombectomy with Indigo System. The following information was collected from each case: sex, age, fistula modality, fistula location, treatment modality, and outcomes. Endpoints evaluated were: technical and clinical success rates; primary, assisted primary, and secondary patency rates; complication rates.
Results:
Twenty-six mechanical thrombectomy procedures for declotting of arteriovenous fistula thrombosis, using the Indigo System, were performed in 22 patients. Technical and clinical success was achieved in 23/26 cases (88%). Mean follow-up was 9 months (range 11–539 days). The 6-month primary, primary assisted, and secondary patency rates were 71%, 86%, 93% and the 12-month primary, primary assisted, and secondary patency rates were 71%, 72%, 80%, respectively. No technical or device-related complications were observed during thrombectomy, however two venous ruptures occurred on the angioplasty of the underlying stenosis.
Conclusion:
In conclusion, vacuum-assisted thrombectomy of acutely thrombosed arteriovenous fistulas and grafts with Indigo System is safe and effective, providing good short term patency rates.
Resumo Abarema cochliacarpos é uma espécie nativa do Brasil, pertence à família Leguminosae - Mimosoidae, muito utilizada na medicina popular. Objetivou-se avaliar a atividade antibacteriana in vitro ...dos extratos ciclohexânico, acetônico e etanólico da casca de Abarema cochliacarpos (Gomes) Barneby & J.W. Grimes contra bactérias isoladas de feridas cutâneas de cães. A atividade antibacteriana dos extratos foi determinada pelo método de difusão em meio sólido enquanto que a Concentração Mínima Inibitória foi determinada em microplacas. Alíquotas dos poços sem crescimento bacteriano após 24h de incubação a 35-37 ºC foram adicionadas em placas com meio de cultura para determinação da Concentração Mínima Bactericida. A análise fitoquímica da planta revelou resultados positivos para alcalóides, flavonóides, saponinas, taninos (condensáveis), terpenos e esteróides. As bactérias isoladas foram: Staphylococcus intermedius, Bacillus sp., Pasteurella sp. e Escherichia coli. Os ensaios in vitro dos extratos da casca de Abarema cochliacarpos mostraram inibição contra as bactérias Gram-positivas Staphylococcus intermedius e Bacillus sp. nas concentrações testadas (100, 50, 25, 12,5 e 6,25 mg/mL), exceto para o extrato em ciclohexano que não demonstrou inibição nas concentrações de 12,5 e 6,25 mg/mL contra o Staphylococcus intermedius. Não houve halos de inibição frente aos isolados Gram-negativos Pasteurella sp. e Escherichia coli. Concluiu-se que os extratos ciclohexânico, acetônico e etanólico da casca de Abarema cochliacarpos mostraram atividade antibacteriana, para a maioria das concentrações testadas, frente às cepas Gram-positivas Staphylococcus intermedius e Bacillus sp. isoladas de feridas cutâneas de cão.
An analysis was made of irrigated perimeters as a geopolitical strategy for expanding Brazilian agricultural frontiers and the "development" of the northeastern semi-arid region with respect to ...social determinants in health in rural communities. Research was conducted in the Chapada do Apodi in the states of Ceará and Rio Grande do Norte between 2007 and 2011. Various research techniques and tools were adopted, such as research-action, ethnographic studies, questionnaires and laboratory exams, water contamination analyses, social cartography and focal groups. In the context of agribusiness expansion, it was revealed that public policies of irrigation have had consequences for health, labor and the environment with the implementation of the Jaguaribe-Apodi Irrigated Perimeter in Ceará. The social and environmental conflict and resistance in the phase prior to the installation of the Santa Cruz do Apodi Irrigated Perimeter in Rio Grande do Norte was significant as it had consequences for the health-disease process on rural communities. It is important for the evaluation of public irrigation policies to consider the impacts of the perimeters on the lifestyle, labor, health and the environment of the affected territories.
A agricultura irrigada utiliza cerca de 70% da água consumida no Brasil, podendo comprometer a garantia prioritária para o abastecimento humano, especialmente no semiárido. O Governo Federal planeja ...acentuá-la através da nova Política Nacional de Irrigação. A proposta do Estado é estimular a modernização da agricultura e a competitividade do agronegócio ampliando em 393.000 hectares as áreas de perímetros irrigados. Com o objetivo de investigar tal política, este artigo analisa as fases de desapropriação, instalação e operação de cinco estudos de caso de perímetros irrigados no Ceará e no Rio Grande do Norte. A pesquisa utilizou-se de estudos bibliográficos, documentais e materiais produzidos por movimentos sociais. A política de irrigação, nesse sentido, tem conformado conflitos ambientais e violado os direitos dos povos do campo a terra, ao território, à água, ao ambiente, à saúde, ao trabalho e à participação política, quando estes deveriam ser concretizados pelas políticas públicas.
An analysis was made of irrigated perimeters as a geopolitical strategy for expanding Brazilian agricultural frontiers and the "development" of the northeastern semi-arid region with respect to ...social determinants in health in rural communities. Research was conducted in the Chapada do Apodi in the states of Ceara and Rio Grande do Norte between 2007 and 2011. Various research techniques and tools were adopted, such as research-action, ethnographic studies, questionnaires and laboratory exams, water contamination analyses, social cartography and focal groups. In the context of agribusiness expansion, it was revealed that public policies of irrigation have had consequences for health, labor and the environment with the implementation of the Jaguaribe-Apodi Irrigated Perimeter in Ceara. The social and environmental conflict and resistance in the phase prior to the installation of the Santa Cruz do Apodi Irrigated Perimeter in Rio Grande do Norte was significant as it had consequences for the health-disease process on rural communities. It is important for the evaluation of public irrigation policies to consider the impacts of the perimeters on the lifestyle, labor, health and the environment of the affected territories. Key words Health of the rural population, Health-disease process, Agricultural Irrigation, Occupational health, Environmental health, Public policies Objetiva-se analisar os perimetros irrigados enquanto estrategia geopolitica para a expansao da fronteira agricola brasileira e o "desenvolvimento" do semiarido nordestino, em sua relacao com os determinantes sociais da saude em comunidades camponesas. Trata-se de pesquisa realizada na Chapada do Apodi, nos estados do Ceara e Rio Grande do Norte, entre 2007 e 2011. Adotaram-se variados desenhos, tecnicas e instrumentos de pesquisa, como pesquisa-acao, estudo etnografico, questionario e exames laboratoriais, analise de contaminacao de aguas, cartografia social e grupo focal. Identificou-se que, na conjuntura da expansao do agronegocio, as politicas publicas de irrigacao trouxeram consequencias para a saude, o trabalho e o ambiente, com a implantacao do Perimetro Irrigado Jaguaribe-Apodi, no Ceara. Sao expressivos o contexto de conflito socioambiental e a resistencia na fase previa a instalacao do Perimetro Irrigado Santa Cruz do Apodi no Rio Grande do Norte, o que traz consequencias para o processo saude-doenca em comunidades camponesas. E importante a avaliacao da politica publica de irrigacao considerar os impactos dos perimetros sobre o modo de vida, o trabalho, a saude e o ambiente nesses territorios atingidos. Palavras-chave Saude da populacao rural, Processo saude-doenca, Irrigacao agricola, Saude do trabalhador, Saude ambiental, Politicas publicas
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