RESUMO
Este es el segundo artículo de una serie de dos publicados en esta revista, en los que examinamos las características histopatológicas, así como el diagnóstico diferencial, de las principales entidades que se presentan en forma de estructuras quísticas y pseudoquísticas en la biopsia cutánea. En este segundo artículo, abordamos los quistes cutáneo ciliado, branquial, de Bartholino, onfalomesentérico, tímico, del conducto tirogloso, sinovial, y del rafe medio, así como el mucocele, el ganglión y los pseudoquistes auricular y mixoide digital. (AU)
This is the second article in a two-part series published in this journal, in which we examine the histopathological characteristics, as well as the differential diagnosis, of the main entities that present as cystic and pseudocystic structures in cutaneous biopsy. In this second article, we address ciliated cutaneous cysts, branchial cysts, Bartholin's cysts, omphalomesenteric cysts, thymic cysts, thyroglossal duct cysts, synovial cysts, and median raphe cysts, as well as mucocele, ganglion, and auricular and digital myxoid pseudocysts. (AU)
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Humanos, Cistos, Cisto Epidérmico, Diagnóstico Diferencial, Biópsia, Cistos Glanglionares, MucoceleRESUMO
Objective To better understand drivers of disease progression in non-alcoholic steatohepatitis (NASH), we assessed clinical and sociodemographic markers of fibrosis progression in adults with NASH.Patients and methodsPhysician-reported patient demographics and clinical characteristics were utilised from the real-world Global Assessment of the Impact of NASH (GAIN) study. Factors associated with likelihood of fibrosis progression since NASH diagnosis were identified using a logistic regression model.ResultsOverall, 2349 patients in Europe from the GAIN study were included; mean age was 54.6 years and 41% were women. Significant covariates included age, years since diagnosis, employment status, fibrosis stage at diagnosis, type 2 diabetes mellitus, hypertension, liver transplant and liver biopsy at diagnosis. Risk of progression was 1.16 (95% confidence interval 1.121.20; p<0.001) times higher for each additional year since NASH diagnosis and 5.43 (2.6811.37; p<0.001) times higher when physicians proposed a liver transplant at diagnosis. Compared with full-time employed patients, risk of progression was 1.77 (1.192.60; p=0.004) times higher for unemployed patients and 3.16 (1.307.63; p=0.010) times higher for those unable to work due to NASH.ConclusionsDisease duration, NASH severity and presence of other metabolic comorbidities could help to assess risk of progression in patients with NASH. (AU)
Objetivo Para comprender mejor los factores que impulsan la progresión de la enfermedad en la esteatohepatitis no alcohólica (NASH), evaluamos los marcadores clínicos y sociodemográficos de la progresión de la fibrosis en adultos con NASH.Pacientes y métodosSe utilizaron las características demográficas y clínicas de los pacientes informadas por los médicos del estudio de Evaluación Global del Impacto de NASH (GAIN) del mundo real. Los factores asociados con la probabilidad de progresión de la fibrosis desde el diagnóstico de EHNA se identificaron mediante un modelo de regresión logística.ResultadosEn total, se incluyeron 2.349 pacientes en Europa del estudio GAIN; la edad media fue 54,6 años y el 41% eran mujeres. Las covariables significativas incluyeron edad, años desde el diagnóstico, situación laboral, estadio de fibrosis en el momento del diagnóstico, diabetes mellitus tipo 2, hipertensión, trasplante de hígado y biopsia de hígado en el momento del diagnóstico. El riesgo de progresión fue 1,16 (intervalo de confianza del 95% 1,12-1,20; p < 0,001) veces mayor por cada año adicional desde el diagnóstico de EHNA y 5,43 (2,68-11,37; p < 0,001) veces mayor cuando los médicos propusieron un trasplante de hígado. en el momento del diagnóstico. En comparación con los pacientes empleados a tiempo completo, el riesgo de progresión fue 1,77 (1,19-2,60; p = 0,004) veces mayor para los pacientes desempleados y 3,16 (1,30-7,63; p = 0,010) veces mayor para aquellos que no podían trabajar debido a a NASH.ConclusionesLa duración de la enfermedad, la gravedad de NASH y la presencia de otras comorbilidades metabólicas podrían ayudar a evaluar el riesgo de progresión en pacientes con NASH. (AU)
Assuntos
Humanos, Masculino, Feminino, Pessoa de Meia-Idade, Hepatopatia Gordurosa não Alcoólica/prevenção & controle, Hepatopatias/prevenção & controle, Cirrose Hepática/prevenção & controle, Cirrose Hepática/terapia, Biópsia, Fatores de RiscoRESUMO
OBJECTIVE: The objective of this study was to examine the influence of total intravenous anaesthesia (TIVA) compared to combined intravenous and inhalation anaesthesia (CIIA) in paediatric patients undergoing renal biopsy. METHODS: A total of 86 children with nephrotic syndrome, acute glomerulonephritis, chronic glomerulonephritis, IgG nephropathy, systemic lupus erythematosus and purpura nephritis were selected from January 2018 to January 2023 in our hospital. All children were divided into the total intravenous anaesthesia group and intravenous inhalational anaesthesia group according to the anaesthesia method. The experimental group comprised 46 children with renal diseases who underwent static aspiration compound anaesthesia during renal biopsy at our hospital from January 2018 to January 2023. Conversely, the control group included 40 children with renal diseases who underwent total intravenous anaesthesia during renal biopsy at the hospital within the same period. Hemodynamic parameters, such as mean arterial pressure (MAP), heart rate (HR), and oxygen saturation (SPO2), were assessed at four different time points: Before anesthesia induction (T0), during anesthesia induction (T1), after anesthesia induction (T2), and at the conclusion of the surgery (T3). Puncture success rate, time to renal puncture, time to get out of bed, postoperative recovery from anaesthesia (including time to postoperative awakening and time to return to spontaneous respiration) and incidence of adverse anaesthetic reactions were also included. RESULTS: We observed notable variations in HR and MAP at T2 and T3, as well as SPO2 levels, duration of awakening from anaesthesia and time taken to resume spontaneous respiration between the two groups at T2 (p < 0.05). No statistically significant variances were detected between the two groups concerning adverse reactions to anaesthesia, puncture success rate, duration to renal puncture and time to mobilisation from bed (p > 0.05). CONCLUSIONS: In conclusion, compared with the total intravenous anaesthesia, the implementation of the sedation-aspiration-combined anaesthesia in renal biopsy in children with renal disease features less haemodynamic fluctuation, better postoperative anaesthesia recovery and does not increase the incidence of adverse reactions.
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Anestesia por Inalação, Anestesia Intravenosa, Rim, Humanos, Criança, Masculino, Feminino, Anestesia Intravenosa/efeitos adversos, Anestesia por Inalação/efeitos adversos, Rim/patologia, Biópsia/efeitos adversos, Pré-Escolar, Nefropatias/etiologia, Nefropatias/patologia, Adolescente, Complicações Pós-Operatórias/etiologia, Complicações Pós-Operatórias/epidemiologiaRESUMO
RATIONALE AND OBJECTIVES: Bleeding is a major complication of transbronchial lung cryobiopsy (TBLC), and pre-placing a bronchial balloon is one of the clinical practices used to prevent it, but with very weak evidence, which should be confirmed. This study aimed to conduct whether pre-placing a bronchial balloon in TBLC for diagnosing interstitial lung disease (ILD) is more safety. MATERIALS AND METHODS: In this prospective, single-center, randomized controlled trial, patients with suspected ILD were enrolled and randomly assigned to pre-placed balloon and none-pre-placed balloon groups. The primary outcome was incidence of moderate bleeding in each group. The secondary endpoints were the incidence of severe bleeding, pneumothorax, and other procedural complications. RESULTS: Exactly 250 patients were enrolled between August 2019 and March 2022, with 125 in each group. There were no significant differences in severe bleeding between the none-pre-placed balloon group and pre-placed balloon group (1.6% vs. 0.8%; adjusted p = 0.520), while more moderate bleeding occurred in the none-pre-placed balloon group (26.4% vs. 6.4%, adjusted p = 0.001), as well as more use of hemostatic drug (28.0% vs. 6.4%, adjusted p = 0.001). Three patients in the none-pre-placed balloon group used the bronchial balloon. More samples could be acquired in the pre-placed balloon group than in the none-pre-placed balloon group (3.8 ± 0.9 vs. 3.1 ± 0.9, p < 0.001). There were no significant differences in multidisciplinary discussion (MDD) between the two groups (89.6% vs. 91.2%, adjusted p = 0.182). CONCLUSION: A pre-placed bronchial balloon can reduce the incidence of moderate bleeding and increase the confidence of the bronchoscopists. However, it had no effect on increasing the diagnostic rate of MDD and reducing severe bleeding. REGISTRATION NUMBER: NCT04047667 ( www. CLINICALTRIALS: gov identifier).
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Broncoscopia, Criocirurgia, Doenças Pulmonares Intersticiais, Humanos, Masculino, Feminino, Doenças Pulmonares Intersticiais/diagnóstico, Doenças Pulmonares Intersticiais/patologia, Pessoa de Meia-Idade, Idoso, Estudos Prospectivos, Broncoscopia/métodos, Broncoscopia/efeitos adversos, Criocirurgia/métodos, Criocirurgia/efeitos adversos, Biópsia/métodos, Biópsia/efeitos adversos, Hemorragia/etiologia, Hemorragia/diagnóstico, Hemorragia/prevenção & controle, Pulmão/patologia, Brônquios/patologiaRESUMO
INTRODUCTION: Men who have sex with men (MSM), especially those living with HIV, are at an increased risk of anal cancer. The prevalence and incidence of its precursor, anal high-grade squamous intraepithelial lesions (HSILs), among MSM who started antiretroviral therapy during acute HIV acquisition are yet to be explored. METHODS: Participants in an acute HIV acquisition cohort in Bangkok, Thailand, who agreed to take part in this study, were enrolled. All participants were diagnosed and started antiretroviral therapy during acute HIV acquisition. Human papillomavirus (HPV) genotyping and high-resolution anoscopy, followed by anal biopsy as indicated, were done at baseline and 6-monthly visits. RESULTS: A total of 89 MSM and four transgender women were included in the analyses. Median age at enrolment was 26 years. Baseline prevalence of histologic anal HSIL was 11.8%. With a total of 147.0 person-years of follow-up, the incidence of initial histologic anal HSIL was 19.7 per 100 person-years. Factors associated with incident anal HSIL were anal HPV 16 (adjusted hazards ratio [aHR] 4.33, 95% CI 1.03-18.18), anal HPV 18/45 (aHR 6.82, 95% CI 1.57-29.51), other anal high-risk HPV (aHR 4.23, 95% CI 1.27-14.14), syphilis infection (aHR 4.67, 95% CI 1.10-19.90) and CD4 count <350 cells/mm3 (aHR 3.09, 95% CI 1.28-7.48). CONCLUSIONS: With antiretroviral therapy initiation during acute HIV acquisition, we found the prevalence of anal HSIL among cisgender men and transgender women who have sex with men to be similar to those without HIV. Subsequent anal HSIL incidence, although lower than that of those with chronic HIV acquisition, was still higher than that of those without HIV. Screening for and management of anal HSIL should be a crucial part of long-term HIV care for all MSM.
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Infecções por HIV, Homossexualidade Masculina, Lesões Intraepiteliais Escamosas, Pessoas Transgênero, Humanos, Tailândia/epidemiologia, Masculino, Adulto, Infecções por HIV/tratamento farmacológico, Infecções por HIV/epidemiologia, Infecções por HIV/complicações, Prevalência, Pessoas Transgênero/estatística & dados numéricos, Incidência, Feminino, Homossexualidade Masculina/estatística & dados numéricos, Lesões Intraepiteliais Escamosas/epidemiologia, Lesões Intraepiteliais Escamosas/patologia, Adulto Jovem, Neoplasias do Ânus/epidemiologia, Papillomaviridae/isolamento & purificação, Papillomaviridae/genética, Infecções por Papillomavirus/epidemiologia, Estudos de Coortes, Biópsia, Genótipo, Canal Anal/patologia, Canal Anal/virologiaRESUMO
The KDIGO guideline for acute rejection treatment recommends use of corticosteroids and suggests using lymphocyte-depleting agents as second line treatment. Aim of the study was to determine the current practices of detection and treatment of TCMR of kidney allografts amongst European kidney transplant centres. An invitation was sent through ESOT/EKITA newsletters and through social media to transplant professionals in Europe for taking part in the survey. A total of 129 transplant professionals responded to the survey. There was equal representation of small and large sized transplant centres. The majority of centres treat borderline changes (BL) and TCMR (Grade IA-B, IIA-B) in indication biopsies and protocol biopsies with corticosteroids as first line treatment. Thymoglobulin is used mainly as second line treatment for TCMR Grade IA-B (80%) and TCMR IIA-B (85%). Treatment success is most often evaluated within one month of therapy. There were no differences observed between the large and small centres for the management of TCMR. This survey highlights the common practices and diversity in clinics for the management of TCMR in Europe. Testing new therapies for TCMR should be in comparison to the current standard of care in Europe. Better consensus on treatment success is crucial for robust study designs.
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Rejeição de Enxerto, Transplante de Rim, Humanos, Rejeição de Enxerto/diagnóstico, Europa (Continente), Inquéritos e Questionários, Linfócitos T/imunologia, Imunossupressores/uso terapêutico, Corticosteroides/uso terapêutico, Biópsia, Soro Antilinfocitário/uso terapêuticoRESUMO
Tacrolimus is pivotal in pancreas transplants but poses challenges in maintaining optimal levels due to recipient differences. This study aimed to explore the utility of time spent below the therapeutic range and intrapatient variability in predicting rejection and de novo donor-specific antibody (dnDSA) development in pancreas graft recipients. This retrospective unicentric study included adult pancreas transplant recipients between January 2006 and July 2020. Recorded variables included demographics, immunosuppression details, HLA matching, biopsy results, dnDSA development, and clinical parameters. Statistical analysis included ROC curves, sensitivity, specificity, and predictive values. A total of 131 patients were included. Those with biopsy-proven acute rejection (BPAR, 12.2%) had more time (39.9% ± 24% vs. 25.72% ± 21.57%, p = 0.016) and tests (41.95% ± 13.57% vs. 29.96% ± 17.33%, p = 0.009) below therapeutic range. Specific cutoffs of 31.5% for time and 34% for tests below the therapeutic range showed a high negative predictive value for BPAR (93.98% and 93.1%, respectively). Similarly, patients with more than 34% of tests below the therapeutic range were associated with dnDSA appearance (38.9% vs. 9.4%, p = 0.012; OR 6.135, 1.346-27.78). In pancreas transplantation, maintaining optimal tacrolimus levels is crucial. Suboptimal test percentages below the therapeutic range prove valuable in identifying acute graft rejection risk.
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Rejeição de Enxerto, Imunossupressores, Transplante de Pâncreas, Tacrolimo, Humanos, Rejeição de Enxerto/imunologia, Tacrolimo/uso terapêutico, Masculino, Estudos Retrospectivos, Feminino, Adulto, Imunossupressores/uso terapêutico, Pessoa de Meia-Idade, Isoanticorpos/sangue, Isoanticorpos/imunologia, Doadores de Tecidos, Fatores de Tempo, Biópsia, Sobrevivência de EnxertoRESUMO
BACKGROUND While many studies have been conducted on sugammadex sodium and neostigmine in patients undergoing general anesthesia, few have explored their effects in patients with interstitial lung diseases (ILDs). MATERIAL AND METHODS Sixty-three patients who underwent transbronchial cryobiopsy under general anesthesia were enrolled in a prospective randomized study. The patients were randomly divided into 2 groups: neostigmine combined with atropine group (group C, n=32) and sugammadex group (group S, n=31). Induction and maintenance of anesthesia were the same in both groups. Patients received rocuronium during anesthesia. At the end of the procedure, when the T2 of the train-of-four stimulation technique (TOF) monitoring appeared, neostigmine 0.04 mg/kg combined with atropine 0.02 mg/kg was injected intravenously in group C, and sodium sugammadex 2 mg/kg was injected intravenously in group S. Time from administration of muscle relaxant antagonist to recovery of TOF ratio (TOFr) to 0.9 and extubation time were recorded. The residual rate of neuromuscular blockade at 1, 3, 5, 7, and 10 min after extubation was calculated. RESULTS Compared to group C, group S had a significantly shorter recovery time of TOFr to 0.9 (4.0[2.0] min vs 14.0[11.0] min, P<0.001) and extubation time (4.0[3.0] min vs 11.0[7.0] min, P<0.001). The residual rate of neuromuscular blockade was remarkably lower in group S than in group C at 3, 5, and 7 min after extubation (3.2% vs 31%, 0% vs 25%, 0% vs 6%, P<0.05). CONCLUSIONS Sugammadex is more effective than neostigmine in reversing the muscle-relaxant effect of rocuronium bromide in patients with ILDs.
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Doenças Pulmonares Intersticiais, Neostigmina, Bloqueio Neuromuscular, Sugammadex, Adulto, Idoso, Feminino, Humanos, Masculino, Pessoa de Meia-Idade, Período de Recuperação da Anestesia, Biópsia/métodos, Broncoscopia/métodos, Doenças Pulmonares Intersticiais/tratamento farmacológico, Neostigmina/uso terapêutico, Bloqueio Neuromuscular/métodos, Período Pós-Operatório, Estudos Prospectivos, Rocurônio, Sugammadex/uso terapêuticoRESUMO
BACKGROUND: The incidence rates of cutaneous squamous cell carcinoma (cSCC) and basal cell carcinoma (BCC) skin cancers are rising, while the current diagnostic process is time-consuming. We describe the development of a novel approach to high-throughput sampling of tissue lipids using electroporation-based biopsy, termed e-biopsy. We report on the ability of the e-biopsy technique to harvest large amounts of lipids from human skin samples. MATERIALS AND METHODS: Here, 168 lipids were reliably identified from 12 patients providing a total of 13 samples. The extracted lipids were profiled with ultra-performance liquid chromatography and tandem mass spectrometry (UPLC-MS-MS) providing cSCC, BCC, and healthy skin lipidomic profiles. RESULTS: Comparative analysis identified 27 differentially expressed lipids (p < 0.05). The general profile trend is low diglycerides in both cSCC and BCC, high phospholipids in BCC, and high lyso-phospholipids in cSCC compared to healthy skin tissue samples. CONCLUSION: The results contribute to the growing body of knowledge that can potentially lead to novel insights into these skin cancers and demonstrate the potential of the e-biopsy technique for the analysis of lipidomic profiles of human skin tissues.
Assuntos
Carcinoma Basocelular, Carcinoma de Células Escamosas, Eletroporação, Lipidômica, Neoplasias Cutâneas, Pele, Humanos, Carcinoma Basocelular/patologia, Carcinoma Basocelular/metabolismo, Carcinoma Basocelular/diagnóstico, Neoplasias Cutâneas/patologia, Neoplasias Cutâneas/metabolismo, Carcinoma de Células Escamosas/patologia, Carcinoma de Células Escamosas/metabolismo, Carcinoma de Células Escamosas/química, Lipidômica/métodos, Biópsia, Pele/patologia, Pele/metabolismo, Pele/química, Feminino, Masculino, Eletroporação/métodos, Pessoa de Meia-Idade, Idoso, Lipídeos/análise, Espectrometria de Massas em Tandem/métodosRESUMO
BACKGROUND: Lymphadenopathy (LAP) is a common finding in pediatric patients. It was aimed to determine predictive factors in distinguishing cases with malignant or benign lymphadenopathy in this study. SUBJECTS AND METHODS: Between January 2022 and January 2023, 101 patients (1-16 years old) with lymphadenopathy were retrospectively examined. RESULTS: LAP was localized in 80.2% (n=81) cases and generalized in 19.8% (n=20) cases. In 60 cases (59.4%), lymph node sizes were found to be greater than 20×20 mm in width and length. The most common infectious causative agent was Epstein Barr Virus (EBV). Seven (6.9%) patients underwent biopsy and all were diagnosed with malignancy. When the benign and malignant groups were compared, age, lymph node length, and width on physical examination, anteroposterior and longitudinal diameter of the lymph node on ultrasonography (USG) were statistically significantly higher in the malignant group (p<0.05). The presence of supraclavicular lymphadenopathy was found to be an important factor in differentiating the malignant group (p<0.003). The most important factors in distinguishing the groups are respectively were the anteroposterior diameter of the lymph node on ultrasonography and the presence supraclavicular lymph node in multivariate logistic regression analysis. CONCLUSION: It is not always easy to distinguish benign and malignant etiologies in patients with lymphadenopathy. A detailed history, a careful physical examination, laboratory studies, and excisional biopsy are guiding.
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Infecções por Vírus Epstein-Barr, Linfonodos, Linfadenopatia, Humanos, Criança, Pré-Escolar, Masculino, Adolescente, Feminino, Linfadenopatia/patologia, Linfadenopatia/diagnóstico por imagem, Linfadenopatia/etiologia, Lactente, Estudos Retrospectivos, Linfonodos/patologia, Infecções por Vírus Epstein-Barr/diagnóstico, Infecções por Vírus Epstein-Barr/patologia, Diagnóstico Diferencial, Ultrassonografia, BiópsiaRESUMO
OBJECTIVE: The purpose of this study was to analyze the clinical, pathological, prognostic features and treatment response of the coexistence of focal segmental glomerulosclerosis lesions with idiopathic membranous nephropathy. METHODS: This is a two-center retrospective cohort study. Patients of idiopathic membranous nephropathy were enrolled and divided into two groups with or without focal segmental glomerulosclerosis lesions according to the renal biopsy. Laboratory data and pathological manifestation were compared. Renal phospholipase A2 receptor was detected by immunofluorescence. During the follow-up, the effects of different therapies and renal function were estimated. RESULTS: A total of 236 patients were finally enrolled in this study, of which 60 and 176 idiopathic membranous nephropathy patients were enrolled in the FSGS+ and FSGS- groups, respectively. The FSGS+ group showed a higher percentage of hypertension history (38.3 vs. 20.0%, p=0.004), with a significantly higher level of systolic pressure [137 (120, 160) mmHg vs. 130 (120, 140) mmHg, p=0.009]. Main laboratory findings, including serial albumin (20.4±7.8 g/L vs. 24.5±6.7 g/L, p<0.001), 24-h proteinuria [5.61 (3.10, 7.87) g/day vs. 3.82 (2.31, 5.79) g/day, p=0.002], serial creatinine [80.8 (65.8, 97.9) µmol/L vs. 72.0 (58.7, 84.9) µmol/L, p=0.003], and estimated glomerular filtration rate [86 (66, 101) mL/min/1.73 m2 vs. 95 (81, 108) mL/min/1.73 m2, p=0.007] showed significant differences between the two groups. Pathologically, patients with focal segmental glomerulosclerosis lesions appeared with a higher percentage of crescents, a more severe degree of interstitial fibrosis, and a higher level of membranous nephropathy stage. Renal phospholipase A2 receptor showed a relatively lower positive rate of only 75.0% in the FSGS+ group in comparison with the positive rate of 90.3% in the FSGS- group (p=0.031). The prognosis was generally similar between the two groups. Among patients who were given non-immunosuppression treatment, those with focal segmental glomerulosclerosis lesions took a relatively longer period of time to achieve complete remission (29.3±7.0 m vs. 15.4±8.9 m, p=0.025) and experienced a higher rate of renal function deterioration (37.5 vs. 5.4%, p=0.033) compared with the other ones. While among those receiving immunosuppression treatment, both groups received similar remission rates. CONCLUSION: Compared with FSGS- group, idiopathic membranous nephropathy with focal segmental glomerulosclerosis lesions represented more severe nephrotic syndrome and worse renal function. In view of the renal function decline during the follow-up, more aggressive treatment with the use of immunosuppressants should be considered for idiopathic membranous nephropathy patients with focal segmental glomerulosclerosis lesions.
Assuntos
Glomerulonefrite Membranosa, Glomerulosclerose Segmentar e Focal, Imunossupressores, Humanos, Glomerulonefrite Membranosa/patologia, Glomerulonefrite Membranosa/tratamento farmacológico, Glomerulonefrite Membranosa/complicações, Glomerulonefrite Membranosa/fisiopatologia, Feminino, Masculino, Glomerulosclerose Segmentar e Focal/patologia, Glomerulosclerose Segmentar e Focal/tratamento farmacológico, Glomerulosclerose Segmentar e Focal/complicações, Estudos Retrospectivos, Pessoa de Meia-Idade, Adulto, Imunossupressores/uso terapêutico, Biópsia, Taxa de Filtração Glomerular, Proteinúria/etiologia, Receptores da Fosfolipase A2/imunologia, Prognóstico, Resultado do Tratamento, Rim/patologia, Rim/fisiopatologiaRESUMO
OBJECTIVE: Liver biopsy is the gold standard method to evaluate patients with non-alcoholic fatty liver disease (NAFLD). However, due to its several limitations and complications, a reliable and non-invasive marker is required to assess liver fibrosis. In this study, we compared the performance of the FIB-4 index [based on age, aspartate aminotransferase (AST), and alanine aminotransferase (ALT) levels and platelets count] with the Scheuer scoring system of liver biopsies to evaluate the diagnostic utility of FIB-4 among NAFLD patients with different liver fibrosis severities. PATIENTS AND METHODS: A cross-sectional study was conducted at An-Najah National University Hospital (NNUH) in Palestine. The FIB-4 index was calculated using laboratory data for 128 NAFLD patients who underwent liver biopsies between November 2014 and July 2022. The results of FIB-4 were compared with the Scheuer scoring system of liver biopsies (using F0, F1+F2, F3+F4) to determine the sensitivity and specificity of FIB-4 in detecting and staging liver fibrosis. RESULTS: Out of 128 patients involved in our study, 49 of them had advanced fibrosis according to liver biopsy (F3+F4), where their FIB-4 indices showed 87% sensitivity at 1.45 cut off point and 87% specificity at 3.25 cut off point. CONCLUSIONS: The FIB-4 index may be used as a screening tool in the primary care setting. To raise awareness of liver diseases, this non-invasive, inexpensive, simple, and quick marker could identify people in need of further liver fibrosis evaluation and diagnosis.
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Alanina Transaminase, Aspartato Aminotransferases, Cirrose Hepática, Hepatopatia Gordurosa não Alcoólica, Adulto, Feminino, Humanos, Masculino, Pessoa de Meia-Idade, Alanina Transaminase/sangue, Aspartato Aminotransferases/sangue, Biomarcadores/sangue, Biópsia, Estudos Transversais, Cirrose Hepática/diagnóstico, Cirrose Hepática/patologia, Cirrose Hepática/sangue, Hepatopatia Gordurosa não Alcoólica/diagnóstico, Hepatopatia Gordurosa não Alcoólica/patologia, Hepatopatia Gordurosa não Alcoólica/sangue, Contagem de Plaquetas, Estudos Retrospectivos, Índice de Gravidade de Doença, Adolescente, Adulto Jovem, IdosoRESUMO
BACKGROUND: A xanthoma is a rare bone condition consisting of a predominant collection of lipid-rich, foamy histiocytes. The central xanthoma of the jaws is a unique benign tumor. CASE REPORT: A 15-year-old Caucasian male has been presented to our department. He had radiological changes in the area of the left mandibular angle, with an area of diffuse osteolysis of 3.0 cm by 2.0 cm. Computed tomography reveals an area of diffuse osteolysis that starts from the distal root of the lower second molar and reaches the ascending process. A bone biopsy was performed, which revealed a benign proliferative process composed of histiocytic cells involving and infiltrating trabecular bone in a background of loose fibrous connective tissue devoid of any other significant inflammatory infiltrate. The size of the formation was 2.9 cm by 2.0 cm. Immunohistochemical staining for CD68 was strongly positive and negative for S-100 and CD1a. From routine blood tests, cholesterol, triglycerides, and blood sugar are within normal values, which excludes systemic metabolic disease. Subsequent to the surgical intervention, the patient underwent postoperative assessments at intervals of 14, 30, 60 days, and a year later, revealing the absence of any discernible complications during the aforementioned observation periods. CONCLUSION: The diagnosis of primary xanthoma of the mandible is rare and can often be confused with other histiocytic lesions. A differential diagnosis should be made with nonossifying fibroma and Langerhans cell histiocytosis, as in our case. In these cases, immunohistochemistry with CD 68, S-100, and CD1a, as well as blood parameters, are crucial for the diagnosis.
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Doenças Mandibulares, Xantomatose, Humanos, Masculino, Adolescente, Xantomatose/patologia, Xantomatose/diagnóstico, Xantomatose/cirurgia, Doenças Mandibulares/patologia, Doenças Mandibulares/diagnóstico por imagem, Doenças Mandibulares/cirurgia, Doenças Mandibulares/diagnóstico, Tomografia Computadorizada por Raios X, Mandíbula/patologia, Mandíbula/diagnóstico por imagem, Mandíbula/cirurgia, BiópsiaRESUMO
OBJECTIVES: Modern immunosuppressive regimens have reduced rejection episodes in renal allograft recipients but have increased the risk of opportunistic infections. Infections are considered to be the second leading cause of death after cardiovascular complications in renal allograft recipients. Data on opportunistic infections affecting the allograft itself are scarce. The present study describes the spectrum of renal opportunistic infections and their outcomes diagnosed on renal allograft biopsies and nephrectomy specimens. MATERIALS AND METHODS: Our retrospective observational study was conducted from December 2011 to December 2021. We analyzed infectious episodes diagnosed on renal allograft biopsies or graft nephrectomy specimens. We obtained clinical, epidemiological, and laboratory details for analyses from hospital records. RESULTS: BK virus nephropathy was the most common opportunistic infection affecting the allograft, accounting for 47% of cases, followed by bacterial graft pyelonephritis (25%). Mucormycosis was the most common fungal infection. The diagnosis of infection from day of transplant ranged from 14 days to 39 months. Follow-up periods ranged from 1 to 10 years. Mortality was highest among patients with opportunistic fungal infection (62%), followed by viral infections, and graft failure rate was highest in patients with graft pyelonephritis (50%). Among patients with BK polyomavirus nephropathy, 45% had stable graft function compared with just 33% of patients with bacterial graft pyelonephritis. CONCLUSIONS: BK polyoma virus infection was the most common infection affecting the renal allograft in our study. Although fungal infections caused the highest mortality among our patients, bacterial graft pyelonephritis was responsible for maximum graft failure. Correctly identifying infections on histology is important so that graft and patient life can be prolonged.
Assuntos
Transplante de Rim, Nefrectomia, Infecções Oportunistas, Humanos, Transplante de Rim/efeitos adversos, Transplante de Rim/mortalidade, Estudos Retrospectivos, Masculino, Feminino, Nefrectomia/efeitos adversos, Pessoa de Meia-Idade, Adulto, Biópsia, Resultado do Tratamento, Fatores de Tempo, Fatores de Risco, Infecções Oportunistas/imunologia, Infecções Oportunistas/mortalidade, Infecções Oportunistas/diagnóstico, Infecções Oportunistas/microbiologia, Infecções Oportunistas/virologia, Infecções Oportunistas/epidemiologia, Aloenxertos, Doadores Vivos, Sobrevivência de Enxerto, Turquia/epidemiologia, Idoso, Pielonefrite/microbiologia, Pielonefrite/diagnóstico, Pielonefrite/mortalidade, Infecções por Polyomavirus/diagnóstico, Infecções por Polyomavirus/mortalidade, Infecções por Polyomavirus/virologia, Infecções por Polyomavirus/epidemiologia, Infecções por Polyomavirus/imunologiaRESUMO
The diagnosis of intrathoracic non-tuberculous mycobacteriosis (NTM) is challenging. We report a case of a pediatric pulmonary NTM with endobronchial lesion and lymphadenitis in a child with HIV infection diagnosed by bronchoscopic biopsy, EBUS-TBNA and probe-based confocal laser endomicroscopy (pCLE). The pCLE showed a large number of highly fluorescent cells and zones of density and disorganized elastin fibers at alveolar areas. A combination of diagnostic endoscopic procedures is required to establish the diagnosis of NTM.
Assuntos
Broncoscopia, Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico, Infecções por HIV, Microscopia Confocal, Infecções por Mycobacterium não Tuberculosas, Humanos, Broncoscopia/métodos, Criança, Microscopia Confocal/métodos, Infecções por Mycobacterium não Tuberculosas/diagnóstico, Infecções por Mycobacterium não Tuberculosas/patologia, Masculino, Infecções por HIV/complicações, Infecções por HIV/patologia, Biópsia/métodosRESUMO
Neuronal ceroid lipofuscinoses (NCLs) are a growing group of neurodegenerative storage diseases, in which specific features are sought to facilitate the creation of a universal diagnostic algorithm in the future. In our ultrastructural studies, the group of NCLs was represented by the CLN2 disease caused by a defect in the TPP1 gene encoding the enzyme tripeptidyl-peptidase 1. A 3.5-year-old girl was affected by this disease. Due to diagnostic difficulties, the spectrum of clinical, enzymatic, and genetic tests was extended to include analysis of the ultrastructure of cells from a rectal biopsy. The aim of our research was to search for pathognomonic features of CLN2 and to analyse the mitochondrial damage accompanying the disease. In the examined cells of the rectal mucosa, as expected, filamentous deposits of the curvilinear profile (CVP) type were found, which dominated quantitatively. Mixed deposits of the CVP/fingerprint profile (FPP) type were observed less frequently in the examined cells. A form of inclusions of unknown origin, not described so far in CLN2 disease, were wads of osmophilic material (WOMs). They occurred alone or co-formed mixed deposits. In addition, atypically damaged mitochondria were observed in muscularis mucosae. Their deformed cristae had contact with inclusions that looked like CVPs. Considering the confirmed role of the c subunit of the mitochondrial ATP synthase in the formation of filamentous lipopigment deposits in the group of NCLs, we suggest the possible significance of other mitochondrial proteins, such as mitochondrial contact site and cristae organizing system (MICOS), in the formation of these deposits. The presence of WOMs in the context of searching for ultrastructural pathognomonic features in CLN2 disease also requires further research.
Assuntos
Dipeptidil Peptidases e Tripeptidil Peptidases, Corpos de Inclusão, Mitocôndrias, Lipofuscinoses Ceroides Neuronais, Tripeptidil-Peptidase 1, Lipofuscinoses Ceroides Neuronais/patologia, Lipofuscinoses Ceroides Neuronais/genética, Humanos, Feminino, Pré-Escolar, Mitocôndrias/patologia, Mitocôndrias/ultraestrutura, Corpos de Inclusão/patologia, Corpos de Inclusão/ultraestrutura, Biópsia, Reto/patologia, Serina Proteases/genética, Aminopeptidases/genéticaRESUMO
Posttransplant lymphoproliferative disorder is a life-threatening complication after solid-organ transplants. In adults, recipients of heart transplants have the highest risk, whereas renal transplant recipients have the lowest risk among all solid-organ transplants. The most common site for posttransplant lymphoproliferative disorders are gastrointestinal tract followed by the graft itself. Airway involvement in posttransplant lymphoproliferative disorder is rarely encountered. We report a case of a 26-year-old renal allograft recipient who presented to the emergency room with airway obstruction necessitating an emergency tracheostomy. Imaging revealed a left tonsillar mass extending into the nasopharynx and retropharyngeal space causing complete oropharyngeal occlusion. Endoscopic biopsy from nasopharyngeal mass showed a diffuse large B-cell lymphoma and was Ebstein-Barr virus positive. Reduction in immunosuppression and treatment with posttransplant lymphoproliferative disorder-1 risk-stratified approach resulted in complete remission.
Assuntos
Obstrução das Vias Respiratórias, Imunossupressores, Transplante de Rim, Linfoma Difuso de Grandes Células B, Humanos, Transplante de Rim/efeitos adversos, Adulto, Resultado do Tratamento, Obstrução das Vias Respiratórias/etiologia, Obstrução das Vias Respiratórias/virologia, Obstrução das Vias Respiratórias/diagnóstico, Imunossupressores/efeitos adversos, Masculino, Linfoma Difuso de Grandes Células B/virologia, Doença Aguda, Biópsia, Infecções por Vírus Epstein-Barr/diagnóstico, Infecções por Vírus Epstein-Barr/virologia, Infecções por Vírus Epstein-Barr/complicações, Infecções por Vírus Epstein-Barr/imunologia, Traqueostomia/efeitos adversos, Indução de Remissão, Hospedeiro Imunocomprometido, Neoplasias Nasofaríngeas/virologia, Neoplasias Nasofaríngeas/cirurgia, Neoplasias Nasofaríngeas/diagnósticoRESUMO
Tigecycline is a parenteral glycycline antibiotic that is used to treat severe infections caused by susceptible organisms, butitis also associated with hepatotoxicity. We present 2 similar patients with hepatic steatosis possibly associated with early tigecycline after transplant. In the first case, a 61-year-old woman underwent liver transplant for acute severe hepatitis; 6 days posttransplant, because of nonroutine resistant fever, the patient received tigecycline combined with daptomycin. Retransplant was applied to the patient on day 12 posttransplant because of acute liver failure secondary to hepatic vein thrombosis. After retransplant, biochemical levels gradually increased, exceeding the upper limit of normal. In liver biopsy, the patient had macrovesicular steatosis in 70% to 80% ofthe parenchyma. In the second case, a 53-yearold woman underwent liver transplant for liver cirrhosis. Tigecycline was added to the treatment because of recurrent fever on day 6 after transplant, with treatment also comprising piperacillin-tazobactam and meropenem. On day 15 of the patient's tigecycline treatment, her liver function tests were elevated. In liver biopsy, the patient had 30% to 40% macrovesicular steatosis and canalicular cholestasis in the parenchyma, especially in zone 3. Reports of hepatic steatosis associated with early tigecycline after transplant are quite new to the literature.
Assuntos
Antibacterianos, Fígado Gorduroso, Transplante de Fígado, Tigeciclina, Humanos, Tigeciclina/efeitos adversos, Feminino, Pessoa de Meia-Idade, Transplante de Fígado/efeitos adversos, Antibacterianos/efeitos adversos, Antibacterianos/uso terapêutico, Fígado Gorduroso/induzido quimicamente, Fígado Gorduroso/diagnóstico, Resultado do Tratamento, Biópsia, Minociclina/efeitos adversosRESUMO
BACKGROUND: Exudative pleural effusions are commonly encountered in clinical practice, but in about one-fourth of cases, etiology remains elusive after initial evaluation. Medical thoracoscopy with semirigid thoracoscope is a minimally invasive procedure with high diagnostic yield for diagnosing pleural diseases, especially these undiagnosed exudative pleural effusions. In tubercular endemic areas, often, these effusions turn out to be tubercular, but the diagnosis of tubercular pleural effusion is quite challenging due to the paucibacillary nature of the disease. Although culture is the gold standard, it is time-consuming. Cartridge-based nucleic acid amplification test (CBNAAT) is a novel rapid diagnostic test for tuberculosis (TB) and has been recommended as the initial diagnostic test in patients suspected of having extrapulmonary TB (EPTB). MATERIALS AND METHODS: We conducted a prospective observational study of 50 patients with undiagnosed pleural effusion admitted to our tertiary care hospital. The primary aim of the study is to evaluate the diagnostic performance of CBNAAT on thoracoscopic guided pleural biopsy and compare it with conventional diagnostic techniques like histopathology and conventional culture. RESULTS: Of 50 undiagnosed pleural effusions, TB (50%) was the most common etiology. The overall diagnostic yield of semirigid thoracoscopy in this study was 74%. Our study showed that CBNAAT of pleural biopsies had a sensitivity of 36% only but a specificity of 100%. The sensitivity of CBNAAT was not far superior to the conventional culture. CONCLUSION: Tuberculosis (TB) is a common cause of undiagnosed pleural effusion in our set-up. CBNAAT testing of pleural biopsy, though, is a poor rule-out test for pleural TB, but it may aid in the early diagnosis of such patients.
Assuntos
Técnicas de Amplificação de Ácido Nucleico, Derrame Pleural, Toracoscopia, Tuberculose Pleural, Humanos, Derrame Pleural/diagnóstico, Toracoscopia/métodos, Estudos Prospectivos, Índia, Feminino, Técnicas de Amplificação de Ácido Nucleico/métodos, Masculino, Pessoa de Meia-Idade, Tuberculose Pleural/diagnóstico, Adulto, Sensibilidade e Especificidade, Biópsia/métodos, Pleura/patologia, IdosoRESUMO
BACKGROUND: Immune-mediated necrotizing myopathy (IMNM) is an idiopathic inflammatory myopathy (IIM). Though patients with IMNM were not considered to show skin rash, several reports have showed atypical skin conditions in patients with anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) antibody-positive IMNM (HMGCR-IMNM). The incidence and phenotype of skin conditions in patients with HMGCR-IMNM are not fully known. RESULTS: Among the 100 IIM patients diagnosed from April 2015 through August 2022, 34 (34%) presented some form of skin condition, with 27 having typical skin rashes; this included 13 patients with dermatomyositis (DM), 8 with anti-synthetase syndrome (ASS), and 6 with IMNM. Meanwhile, 8 of 19 patients with HMGCR-IMNM (42%) presented atypical skin lesions, but no patients with other IIMs did (p < 0.001). Skin eruption with ash-like scales was observed in four HMGCR-IMNM patients, and non-scaly red patches and lumps in the other four patients; accordingly, their skin manifestations were considered as other dermal diseases except for IIM. However, skin and muscle biopsies revealed the atypical skin conditions of patients with HMGCR-IMNM to have the same pathological background, formed by Bcl-2-positive lymphocyte infiltrations. CONCLUSIONS: HMGCR-IMNM patients frequently have atypical skin conditions of the neck and back. Skin biopsy specimens from these lesions showed the same Bcl-2-positive lymphocytic infiltrations as muscle biopsy specimens regardless of the different gross dermal findings. Thus, such atypical skin conditions may be suggestive for HMGCR-IMNM.
