RESUMO
Leptospirosis is a neglected infectious disease caused by pathogenic species of the genus Leptospira. The acute disease is well-described, and, although it resembles other tropical diseases, it can be diagnosed through the use of serological and molecular methods. While the chronic renal disease, carrier state, and kidney fibrosis due to Leptospira infection in humans have been the subject of discussion by researchers, the mechanisms involved in these processes are still overlooked, and relatively little is known about the establishment and maintenance of the chronic status underlying this infectious disease. In this review, we highlight recent findings regarding the cellular communication pathways involved in the renal fibrotic process, as well as the relationship between renal fibrosis due to leptospirosis and CKD/CKDu.
Assuntos
Fibrose/epidemiologia , Nefropatias/epidemiologia , Leptospira/fisiologia , Leptospirose/complicações , Animais , Fibrose/microbiologia , Humanos , Nefropatias/microbiologia , Leptospirose/microbiologiaRESUMO
PURPOSE: Weekly irradiation in breast cancer in elderly patients is a treatment option, whose tolerance may be influenced by the fractionation used. The objective of this study is to compare the tolerance and long-term side effects of two different fractionations. MATERIALS AND METHODS: 47 elderly patients were recruited after conservative or radical treatment that also received irradiation with a dose per fraction of 6.25 Gy or 5 Gy for one session per week, 6 sessions in total. The long-term tolerance results are compared by assessing toxicity using CTCAE version 5.0 scales for dermatitis, telangectasia, fibrosis and pain of the irradiated breast. In addition, objective parameters of skin status (erythema, hyperpigmentation, elasticity and hydration) by a multi-probe MultiSkin Test-Center system were obtained and compared between groups. RESULTS: After an average follow-up of 5 years, all patients were free of disease and with complete local control. A total of 20 patients with 6.25 Gy fractionation and 27 patients with 5 Gy fractionation have been included. Patients treated with lower fractionation had a lower incidence of dermatitis, telangectasia, fibrosis, or local pain. The decrease in elasticity measured by the multi-probe system was smaller with the fractionation of 5 Gy. No differences were observed in the other objective parameters. CONCLUSION: Weekly irradiation with 5 Gy fractionation is better tolerated than with higher fractionation.
Assuntos
Neoplasias da Mama/radioterapia , Hipofracionamento da Dose de Radiação , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/cirurgia , Dermatite/epidemiologia , Dermatite/etiologia , Feminino , Fibrose/epidemiologia , Fibrose/etiologia , Humanos , Margens de Excisão , Dor/epidemiologia , Dor/etiologia , Lesões por Radiação/epidemiologia , Tolerância a Radiação , Dosagem Radioterapêutica , Telangiectasia/epidemiologia , Telangiectasia/etiologia , Fatores de TempoRESUMO
The aim was to investigate the prevalence of non-alcoholic steatohepatitis (NASH) and risk factors for hepatic fibrosis in morbidly obese patients submitted to bariatric surgery. This retrospective study recruited all patients submitted to bariatric surgery from January 2007 to December 2012 at a reference attendance center of Southern Brazil. Clinical and biochemical data were studied as a function of the histological findings of liver biopsies done during the surgery. Steatosis was present in 226 (90.4%) and NASH in 176 (70.4%) cases. The diagnosis of cirrhosis was established in four cases (1.6%) and fibrosis in 108 (43.2%). Risk factors associated with NASH at multivariate analysis were alanine aminotransferase (ALT) >1.5 times the upper limit of normal (ULN); glucose ≥ 126 mg/dL and triglycerides ≥ 150 mg/dL. All patients with ALT ≥1.5 times the ULN had NASH. When the presence of fibrosis was analyzed, ALT > 1.5 times the ULN and triglycerides ≥ 150 mg/dL were risk factors, furthermore, there was an increase of 1% in the prevalence of fibrosis for each year of age increase. Not only steatosis, but NASH is a frequent finding in MO patients. In the present study, ALT ≥ 1.5 times the ULN identifies all patients with NASH, this finding needs to be further validated in other studies. Moreover, the presence of fibrosis was associated with ALT, triglycerides and age, identifying a subset of patients with more severe disease.
Assuntos
Hepatopatia Gordurosa não Alcoólica/epidemiologia , Obesidade Mórbida/complicações , Adulto , Alanina Transaminase/sangue , Glicemia/metabolismo , Feminino , Fibrose/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/sangue , Obesidade Mórbida/epidemiologia , Triglicerídeos/sangueRESUMO
Este estudio soporta sus bases en la necesidad de obtener datos claros que correspondan a la realidad de la población de la zona centro occidental de nuestro país, con el fin de aclarar el panorama con respecto a la cirrosis, condición asociada a múltiples factores que influyen, tanto en su origen y evolución, como en su pronóstico. Para ello realizamos un estudio descriptivo de cien pacientes con diagnóstico de cirrosis que consultaron al servicio de gastroenterología durante el período comprendido entre enero de 2009 hasta julio de 2012. Para un mejor análisis, el estudio se desarrolló conformando categorías epidemiológicas, etiológicas, de descompensación, de pronóstico y de muerte. La información se recolectó directamente de las historias clínicas de los pacientes y se completó con entrevistas, diligenciando un instrumento en el cual se reunían las variables necesarias para el análisis. A los pacientes que carecían de algunos datos imagenológicos se les realizaron estudios de extensión como ecografía hepática y doppler portal. Luego de la recolección de los datos, se realizó una descripción detallada de las variables propuestas encontrando algunas con mayor significancia estadística, las cuales se llevaron a análisis bivariado y multivariado. Se encontró una gran diversidad en esta población; la mayoría de los pacientes procedían de áreas urbanas; la relación de género fue 1:1. El alcohol fue el principal factor etiológico para el desarrollo de esta patología, lo cual concuerda con otros países Latinoamericanos. La causa autoinmune viene en incremento, acá ocupó un segundo puesto, seguida de la etiología viral.
The following research supports its bases in the necessity of dependable epidemiological data corresponding to population reality in the western center region of our country, in order to clarify the public health outlook for cirrhosis, understanding it as an associated condition with multiple influencing factors, both in its origin and its development, as well as in its prognosis. For this research we carry out a descriptive study with one hundred patients diagnosed with cirrhosis who consulted for a gastroenterology service in a period from January 2009 to July 2012. For a better analysis, the research was developed by creating the following categories: Epidemiological, etiological, by decompensation, by prognosis, and by death. The information was directly gathered from patient’s medical records and completed with interviews, in that way we earn an instrument which gathered the needed variables for analysis. Extension studies like hepatic ultrasound and portal Doppler were realized to patients without some imagenological information. After data garner, a detailed description of previously variables was performed, finding some of them with higher statistical significance, which were analyzed by a bivariate and multivariate system. A great variety was found in this population; most of patients came from urban areas; the relation in gender was 1:1. Consumption of alcohol was the main etiological factor to develop this pathology. Previous information matched with described data from other Latin-American countries. Autoimmune cause should be taken into account because is increasing and occupied a second place in the research, followed by infectious viral etiology.
Assuntos
Humanos , Feminino , Adulto , Fibrose , Fibrose/epidemiologia , Gastroenterologia , Cirrose Hepática , Patologia , Encaminhamento e Consulta , Prontuários Médicos , Ultrassonografia , Ranunculaceae , EtanolRESUMO
espaço-porta é o local de origem da fibrose em muitas doenças crônicas hepáticas. Essa área do fígado participa da drenagem linfática hepática e abriga diversos elementos celulares potencialmente fibrogênicos. Estudos sobre a fibrose hepática relacionados à infecção experimental de ratos pelo helminto Capillaria hepatica têm demonstrado que a fibrose começa em áreas portais com a distribuição de septos que sulcam o parênquima hepático se desenvolvendo em áreas próximas ao espaço de Disse. Entretanto, apesar de esta fibrose ocorrer de forma paralela aos sinusóides, estudos têm revelado que não apenas as células estreladas hepáticas participam da fibrose septal, mas também outros tipos celulares residentes nos espaços-porta. Diante destes aspectos, o presente estudo desenvolveu-se com o intuito de investigar a contribuição das células potencialmente fibrogênicas dos espaços-porta, nas fases iniciais da infecção, onde a fibrose se concentra. Para isso, foram utilizados fragmentos de fígado, em blocos parafinados, disponíveis nos arquivos do Laboratório de Patologia Experimental (CPqGM/Fiocruz) provenientes de ratos infectados com 800 ovos de Capillaria hepatica e foi possível observar que ocorreu a proliferação de colangiócitos e a concentração de miofibroblastos em áreas portais, além da ativação de células estreladas hepáticas, sendo todos os resultados vistos por meio da coloração de rotina HE, Picro-sírius vermelho e imunohistoquímica para α-actina de músculo liso, CD31 e GFAP.
Portal space is the local of origin for fibrosis in many chronic liver diseases. This area is involved with lymph drainage and contains several cell types, potentially fibrogenic. Experimental studies related to hepatic fibrosis during Capillaria hepatica infection in rats have suggested that the septal fibrosis indeed takes origin from portal spaces, with the distribution of the septs in the parenchymal region in proximity areas of Disse space. However, despite this fibrosis occurs in parallel to sinusoids, studies have revealed that not only the hepatic stellate cells participate in septal fibrosis, but also other resident cell types in the portal spaces. In face these aspects, the goal of present study was investigate the contribution of the cells potentially fibrogenic in the portal space, in the early phases of the infection. For this, blocks in paraffin available of the liver of rats infected with 800 eggs of Capillaria hepatica archived in the Laboratory of Experimental Pathology (Research Center Gonçalo Moniz, Fiocruz - BA), were utilized and it was observed that proliferation of colangiocytes and concentration of myofibroblasts occurred portal areas, in addition to the activation of hepatic stellate cells. All results were analised by routine staining HE, Sirius red and immunohistochemistry for α-SMA, GFAP and CD31.
Assuntos
Humanos , Capillaria/crescimento & desenvolvimento , Capillaria/patogenicidade , Ductos Biliares/imunologia , Ductos Biliares/patologia , Fibrose/diagnóstico , Fibrose/epidemiologia , Fibrose/imunologia , Fibrose/patologia , Fibrose/prevenção & controle , Fibrose/sangueRESUMO
BACKGROUND: The development of liposuction provided plastic surgeons with a safe and effective way to sculpt the human figure. The techniques and instrumentation used in the performance of liposuction have evolved significantly since its introduction. OBJECTIVE: The authors review their experience with different liposuction techniques over the past 25 years. METHODS: Data from patients who had undergone liposuction were collected from the personal databases of four different surgeons and from the database at the Corpus and Rostrum Plastic Surgery Clinic in Cali, Colombia. A retrospective review was conducted and the results from different liposuction techniques were compared. RESULTS: A total of 26,259 patient charts were reviewed. The results showed that 5% of patients experienced a postsurgical seroma. Postsurgical fibrosis developed to some degree in 2.3% of patients. Anemia was present in 18% of all patients and in 60% of those patients who underwent dry liposuction. Ninety percent of patients reported postoperative pain. The incidence of deep vein thrombosis was 0.03%, as was the incidence of pulmonary embolism. Mortality was 0.01% and was mainly caused by pulmonary embolism. Patient satisfaction was similar for all of the described techniques. CONCLUSIONS: The incidence of anemia was reduced significantly in patients undergoing tumescent liposuction versus dry liposuction. However, the occurrence of seroma increased with the introduction of tumescent liposuction. The incidence of postoperative pain and fibrosis was similar for all liposuction techniques reviewed. The aesthetic results obtained using ultrasound- or laser-assisted liposuction were similar to those obtaining using other techniques.
Assuntos
Anemia/epidemiologia , Fibrose/epidemiologia , Lipectomia/métodos , Dor Pós-Operatória/epidemiologia , Seroma/epidemiologia , Adulto , Anemia/etiologia , Fibrose/etiologia , Humanos , Terapia a Laser/métodos , Lipectomia/efeitos adversos , Lipectomia/instrumentação , Estudos Longitudinais , Pessoa de Meia-Idade , Dor Pós-Operatória/etiologia , Satisfação do Paciente , Estudos Retrospectivos , Seroma/etiologia , Taxa de Sobrevida , Resultado do Tratamento , Ultrassonografia de Intervenção/métodosRESUMO
Inflammatory fibrous hyperplasia (epulis fissuratum) (IFH) and inflammatory papillary hyperplasia (IPH) are oral mucosal diseases caused by ill-fitting denture wearing. A study was carried out on a group of Turkish people consisted of 131 female and 39 male complete denture wearers (n= 170) distributed in two age groups (30-60 and 60-80 years old). The analysis of data collected from patients showed that while the incidence of IFH was higher in women than in men, the incidence of IPH was similar. Most lesions were found in the 30-60 year-old group. The incidence of lesions increased as the denture wearing period increased. Soft tissue growth was the main complaint of the patients with IFH and IPH. In the maxilla, the incidence of IFH was higher than IPH. There was also a significant difference between the distribution of the lesion types in the jaws. There were a larger number of lesions in the maxilla compared to the mandible and most IFH lesions were located in the anterior region of the jaws.
Assuntos
Prótese Total/efeitos adversos , Hiperplasia Gengival/epidemiologia , Mucosa Bucal/patologia , Palato/patologia , Estomatite sob Prótese/epidemiologia , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Prótese Total/estatística & dados numéricos , Feminino , Fibrose/epidemiologia , Fibrose/patologia , Hiperplasia Gengival/patologia , Humanos , Hiperplasia/epidemiologia , Hiperplasia/patologia , Incidência , Masculino , Maxila , Pessoa de Meia-Idade , Distribuição por Sexo , Estomatite sob Prótese/patologia , Turquia/epidemiologiaRESUMO
Introdução: Diversos índices têm sido propostos na avaliação da gravidade da doença hepática. Objetivo: Analisar os escores de Child-Turcote- Pugh (CTP), APACHE II, MELD e SOFA como índices prognósticos de mortalidade hospitalar em pacientes cirróticos. Metodologia: Foram avaliados prospectivamente todos os cirróticos que se internaram em enfermaria provenientes da emergência de um Hosputal Geral de Porto Alegre, em um período de 6 meses. Os escores CTP, MELD, APACHE II e SOFA foram registrados, bem como o desfecho (alta ou óbito). O nível de significância adotado foi de 5%. Resultados: Foram avaliados 61 cirróticos. Quarenta e três eram homens (70%). A média de idade foi de 54,7±11,7 anos. Álcool e/ou o vírus da hepatite C (HCV) foram responsáveis pela etiologia de 50 (82%) casos. Quanto ao CTP, houve 7 (32%) mortes naqueles CTP A ou B, e 11 (38%) naqueles C (p=0,27). A mediana do escore MELD foi de 15, sendo que houve 3 (11%) mortes naqueles com MELD < 15 e 15 (45%) naqueles com MELD ≥15 (p=0,02). A mediana do escore APACHE II foi de 9, sendo que houve 0 morte naqueles com índice < 9 e 18 (41%) naqueles com índice ≥9 (p<00,1). Em relação ao SOFA, a média foi de 3,6±1,8 naqueles vivos versus 5,6±2,6 naqueles que foram a óbito durante a internação (p=0,005). A mortalidade hospitalar foi de 29% (18 casos). Conclusões: Os escores MELD, APACHE II e SOFA se mostraram bons preditores de mortalidade em cirróticos hospitalizados, mas não a classificação de CTP.
Introduction: A number of indexes have historically been proposed to assess the severity of liver disease. Aim: To evaluate the Child-Turcote-Pugh (CTP), APACHE II, MELD and SOFA scores as prognostic indexes of in-hospital mortality among cirrhotic patients. Methods: This is a prospective analysis of all cirrhotic patients who were admitted to a general hospital of Porto Alegre in a period of 6 months. CTP, MELD, APACHE II and SOFA scores were analyzed, as well as the outcome (discharge or death). The level of significance was 5%. Results: A total of 61 cirrhotic patients were evaluated. Forty-three patients were males (70%) and the mean age was 54.7±11.7 years. Alcohol and/or hepatitis C virus (HCV) were the ethiological agents in 50 (82%) cases. Concerning CTP scores, there were 7 (32%) deaths among CTP A or B and 11 (38%) deaths among CTP C (p=0.27). The median for the MELD scores was 15, and there were 3 (11%) deaths among those with MELD < 15 and 15 (45%) deaths among those with MELD ≥15 (p=0.02). The median for the APACHE II scores was 9, and there were no deaths (0) among patients with indexes ≥9 (p<00.1). Concerning the SOFA, the mean was 3.6±1.8 among living patients versus 5.6±2.6 among those who progressed to death during the hospitalization (p=0.005). The overall in-hospital mortality rate was 29% (18 cases). Conclusions: MELD, APACHE II, and SOFA scores proved to be good predictors of mortality of hospitalized cirrhotic patients, but the CTP did not.