Assuntos
Enterocolite Pseudomembranosa/terapia , Transplante de Microbiota Fecal , Clostridioides difficile , Úlcera Duodenal/patologia , Evolução Fatal , Incontinência Fecal/etiologia , Incontinência Fecal/terapia , Feminino , Hemorragia Gastrointestinal/etiologia , Humanos , Hipotensão/etiologia , Hipotensão/terapia , Leucocitose/etiologia , Leucocitose/terapia , Pessoa de Meia-Idade , Choque/etiologiaRESUMO
ABSTRACT Objective: To highlight the importance of the new classification criteria for the macrophage activation syndrome (MAS) in systemic juvenile idiopathic arthritis in order to reduce morbidity and mortality outcome related to this disease. Case description: A 12-year-old female patient with diagnosis of systemic juvenile idiopathic arthritis under immunosuppression therapy for two years developed cough, acute precordial chest pain, tachypnea, tachycardia and hypoxemia for two days. Chest tomography showed bilateral laminar pleural effusion with bibasilar consolidation. The electrocardiogram was consistent with acute pericarditis and the echocardiogram showed no abnormalities. Laboratory exams revealed anemia, leukocytosis and increased erythrocyte sedimentation rate, as well as C-reactive protein rate and serum biomarkers indicative of myocardial injury. Systemic infection and/or active systemic juvenile idiopathic arthritis were considered. She was treated with antibiotics and glucocorticoids. However, 10 days later she developed active systemic disease (fever, evanescent rash and myopericarditis with signs of heart failure) associated with macrophage activation syndrome, according to the 2016 Classification Criteria for Macrophage Activation Syndrome in Systemic Juvenile Idiopathic Arthritis. She was treated for five days with pulse therapy, using glucocorticoids, immunoglobulin and cyclosporine A, with improvement of all clinical signs and laboratory tests. Comments: Myopericarditis with signs of heart failure associated with MAS is a rare clinical presentation of systemic juvenile idiopathic arthritis. Macrophage activation syndrome occurs mainly during periods of active systemic juvenile idiopathic arthritis and may be triggered by infection. Knowledge about this syndrome is crucial to reduce morbidity and mortality.
RESUMO Objetivo: Destacar a importância do conhecimento sobre os novos critérios de classificação para síndrome de ativação macrofágica (SAM) na artrite idiopática juvenil sistêmica para reduzir a morbidade e mortalidade desse desfecho. Descrição do caso: Adolescente do sexo feminino de 12 anos de idade, em terapia imunossupressora por diagnóstico de artrite idiopática juvenil sistêmica há 2 anos, com quadro de tosse, dor precordial aguda, taquipneia, taquicardia e hipoxemia há 2 dias. A tomografia de tórax evidenciou efusão pleural laminar bilateral com consolidação bibasal. O eletrocardiograma foi compatível com pericardite aguda, e o ecocardiograma foi normal. Os exames laboratoriais revelaram anemia, leucocitose e aumento da velocidade de hemossedimentação, proteína C-reativa e marcadores séricos de lesão miocárdica. Infecção sistêmica e/ou doença sistêmica em atividade foram consideradas. A paciente foi tratada com antibióticos e glicocorticoide. Entretanto, dez dias depois, evoluiu com doença sistêmica em atividade (febre, exantema e miopericardite com insuficiência cardíaca) associada à SAM, de acordo com o 2016 Classification Criteria for Macrophage Activation Syndrome in Systemic Juvenile Idiopathic Arthritis, e necessitou de cinco dias de pulsoterapia com glicocorticoide, imunoglobulina e ciclosporina A, com melhora de todos os parâmetros clínicos e laboratoriais. Comentários: A miopericardite com sinais de insuficiência cardíaca associada à SAM é uma apresentação clínica rara da artrite idiopática juvenil sistêmica, que ocorre principalmente em períodos de atividade sistêmica da doença e pode ser deflagrada por infecções. O conhecimento sobre essa síndrome é fundamental para reduzir morbidade e mortalidade desse grave desfecho.
Assuntos
Humanos , Feminino , Criança , Ciclosporina/administração & dosagem , Glucocorticoides/administração & dosagem , Artrite Juvenil/complicações , Artrite Juvenil/diagnóstico , Artrite Juvenil/fisiopatologia , Artrite Juvenil/imunologia , Dor no Peito/diagnóstico , Dor no Peito/etiologia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Imunoglobulinas Intravenosas/administração & dosagem , Pulsoterapia/métodos , Eletrocardiografia/métodos , Síndrome de Ativação Macrofágica/etiologia , Síndrome de Ativação Macrofágica/fisiopatologia , Síndrome de Ativação Macrofágica/sangue , Síndrome de Ativação Macrofágica/terapia , Imunossupressores/administração & dosagem , Leucocitose/diagnóstico , Leucocitose/etiologiaRESUMO
OBJECTIVE: To highlight the importance of the new classification criteria for the macrophage activation syndrome (MAS) in systemic juvenile idiopathic arthritis in order to reduce morbidity and mortality outcome related to this disease. CASE DESCRIPTION: A 12-year-old female patient with diagnosis of systemic juvenile idiopathic arthritis under immunosuppression therapy for two years developed cough, acute precordial chest pain, tachypnea, tachycardia and hypoxemia for two days. Chest tomography showed bilateral laminar pleural effusion with bibasilar consolidation. The electrocardiogram was consistent with acute pericarditis and the echocardiogram showed no abnormalities. Laboratory exams revealed anemia, leukocytosis and increased erythrocyte sedimentation rate, as well as C-reactive protein rate and serum biomarkers indicative of myocardial injury. Systemic infection and/or active systemic juvenile idiopathic arthritis were considered. She was treated with antibiotics and glucocorticoids. However, 10 days later she developed active systemic disease (fever, evanescent rash and myopericarditis with signs of heart failure) associated with macrophage activation syndrome, according to the 2016 Classification Criteria for Macrophage Activation Syndrome in Systemic Juvenile Idiopathic Arthritis. She was treated for five days with pulse therapy, using glucocorticoids, immunoglobulin and cyclosporine A, with improvement of all clinical signs and laboratory tests. COMMENTS: Myopericarditis with signs of heart failure associated with MAS is a rare clinical presentation of systemic juvenile idiopathic arthritis. Macrophage activation syndrome occurs mainly during periods of active systemic juvenile idiopathic arthritis and may be triggered by infection. Knowledge about this syndrome is crucial to reduce morbidity and mortality.
Assuntos
Artrite Juvenil , Dor no Peito , Ciclosporina/administração & dosagem , Glucocorticoides/administração & dosagem , Leucocitose , Síndrome de Ativação Macrofágica , Artrite Juvenil/complicações , Artrite Juvenil/diagnóstico , Artrite Juvenil/imunologia , Artrite Juvenil/fisiopatologia , Dor no Peito/diagnóstico , Dor no Peito/etiologia , Criança , Eletrocardiografia/métodos , Feminino , Humanos , Imunoglobulinas Intravenosas/administração & dosagem , Imunossupressores/administração & dosagem , Leucocitose/diagnóstico , Leucocitose/etiologia , Síndrome de Ativação Macrofágica/sangue , Síndrome de Ativação Macrofágica/etiologia , Síndrome de Ativação Macrofágica/fisiopatologia , Síndrome de Ativação Macrofágica/terapia , Pulsoterapia/métodos , Tomografia Computadorizada por Raios X/métodos , Resultado do TratamentoRESUMO
The aim of this study was to investigate the effects of resistance exercise training (RET) on oxidative stress, systemic inflammatory markers, and muscle wasting in Walker-256 tumor-bearing rats. Male (Wistar) rats were divided into 4 groups: sedentary controls (n = 9), tumor-bearing (n = 9), exercised (n = 9), and tumor-bearing exercised (n = 10). Exercised and tumor-bearing exercised rats were exposed to resistance exercise of climbing a ladder apparatus with weights tied to their tails for 6 weeks. The physical activity of control and tumor-bearing rats was confined to the space of the cage. After this period, tumor-bearing and tumor-bearing exercised animals were inoculated subcutaneously with Walker-256 tumor cells (11.0 × 107 cells in 0.5 mL of phosphate-buffered saline) while control and exercised rats were injected with vehicle. Following inoculation, rats maintained resistance exercise training (exercised and tumor-bearing exercised) or sedentary behavior (control and tumor-bearing) for 12 more days, after which they were euthanized. Results showed muscle wasting in the tumor-bearing group, with body weight loss, increased systemic leukocytes, and inflammatory interleukins as well as muscular oxidative stress and reduced mTOR signaling. In contrast, RET in the tumor-bearing exercised group was able to mitigate the reduced body weight and muscle wasting with the attenuation of muscle oxidative stress and systemic inflammatory markers. RET also prevented loss of muscle strength associated with tumor development. RET, however, did not prevent the muscle proteolysis signaling via FBXO32 gene messenger RNA expression in the tumor-bearing group. In conclusion, RET performed prior tumor implantation prevents cachexia development by attenuating tumor-induced systemic pro-inflammatory condition with muscle oxidative stress and muscle damage.
Assuntos
Caquexia/prevenção & controle , Carcinoma 256 de Walker/terapia , Leucocitose/prevenção & controle , Debilidade Muscular/prevenção & controle , Músculo Esquelético/fisiopatologia , Estresse Oxidativo , Condicionamento Físico Animal , Animais , Biomarcadores/sangue , Biomarcadores/metabolismo , Caquexia/etiologia , Caquexia/imunologia , Carcinoma 256 de Walker/metabolismo , Carcinoma 256 de Walker/patologia , Carcinoma 256 de Walker/fisiopatologia , Citocinas/sangue , Regulação Neoplásica da Expressão Gênica , Mediadores da Inflamação/sangue , Leucocitose/etiologia , Leucocitose/imunologia , Masculino , Proteínas Musculares/genética , Proteínas Musculares/metabolismo , Debilidade Muscular/etiologia , Debilidade Muscular/imunologia , Músculo Esquelético/imunologia , Músculo Esquelético/metabolismo , Músculo Esquelético/patologia , Distribuição Aleatória , Ratos Wistar , Proteínas Ligases SKP Culina F-Box/genética , Proteínas Ligases SKP Culina F-Box/metabolismo , Serina-Treonina Quinases TOR/genética , Serina-Treonina Quinases TOR/metabolismo , Carga Tumoral , Aumento de Peso , Redução de PesoRESUMO
BACKGROUND: Diverticular disease is common in industrialized countries. Computed tomography has been used as the preferred diagnostic method; although different scales haves been described to classify the disease, none of them encompass total disease aspects and behaviour. OBJETIVE: To analyze the patients with acute diverticulitis confirmed by computed tomography at the ABC Medical Center Campus Observatorio from January 1, 2010 to December 31, 2012, in whom pericolic free air in the form of bubbles was identified by computed tomography and if this finding can be considered as a prognostic factor for the disease. METHODS: A series of 124 patients was analyzed who had acute diverticulitis confirmed by computed tomography, in order to identify the presence of pericolic bubbles. RESULTS: Of the 124 patients, 29 presented with pericolic bubbles detected by computed tomography; of these, 62.1% had localized peritoneal signs at the time of the initial assessment, (P<.001); leukocytosis (13.33 vs 11.16, P<.001) and band count (0.97 vs 0.48, P<.001) was higher in this group. Patients with pericolonic bubbles had a longer hospital stay (5.5days vs 4.3days, P<.001) and started and tolerated liquids later (4.24days vs. 3.02days, P<.001) than the group of patients without this finding. CONCLUSIONS: The presence of pericolic bubbles in patients with acute diverticulitis can be related to a more aggressive course of the disease.
Assuntos
Ar , Doença Diverticular do Colo/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Doença Aguda , Idoso , Tratamento Conservador , Doença Diverticular do Colo/complicações , Doença Diverticular do Colo/cirurgia , Doença Diverticular do Colo/terapia , Nutrição Enteral , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Leucocitose/etiologia , Masculino , Pessoa de Meia-Idade , Cavidade Peritoneal/diagnóstico por imagem , Peritonite/diagnóstico , Peritonite/etiologia , Prognóstico , Estudos Retrospectivos , Índice de Gravidade de DoençaRESUMO
OBJECTIVE: Iron deficiency is likely the most common nutritional deficiency worldwide; low iron concentrations have been related to alterations in immune system functions; therefore, the aim of this study was to determine the effect of low serum iron (LSI) concentrations on the production of proinflammatory cytokines by peripheral blood leukocytes in 8- to 12-y-old children from a local community. METHODS: We obtained 120 blood samples and determined full blood counts and serum iron concentrations. An LSI and a control group, paired by age and sex were established using serum iron <60 µg/dL as the cutoff point. Ferritin and C-reactive protein concentrations were quantified. Serum interferon (IFN)-γ and tumor necrosis factor (TNF)-α concentrations were measured in these groups by enzyme-linked immunosorbent assay. A second blood sample was taken from children in both groups to isolate peripheral blood mononuclear cells (PBMCs) and measure IFN-γ and TNF-α production by unstimulated and lipopolysaccharide/phorbol myristate acetate/ionomycin-stimulated leukocytes in vitro. RESULTS: Of the participants in the present study, 17.5% (21 children) presented LSI, as well as decreased ferritin concentrations. Differential counts from total blood samples showed a significant increase in leukocyte numbers in the LSI group, along with increased neutrophil frequencies and numbers but decreased lymphocyte frequencies. Decreased serum IFN-γ concentrations and decreased in vitro production of IFN-γ by PBMCs were found in the LSI group. CONCLUSIONS: The results of the present study suggest that low iron levels alter leukocyte subpopulations in circulation and have a detrimental effect on leukocyte production of proinflammatory cytokines after an antigenic challenge.
Assuntos
Anemia Ferropriva/fisiopatologia , Doenças Assintomáticas , Fenômenos Fisiológicos da Nutrição Infantil , Interferon gama/metabolismo , Leucócitos Mononucleares/imunologia , Leucocitose/etiologia , Fator de Necrose Tumoral alfa/metabolismo , Anemia Ferropriva/sangue , Anemia Ferropriva/imunologia , Anemia Ferropriva/metabolismo , Contagem de Células Sanguíneas , Proteína C-Reativa/análise , Ionóforos de Cálcio/farmacologia , Criança , Feminino , Ferritinas/sangue , Humanos , Interferon gama/biossíntese , Interferon gama/sangue , Ionomicina/farmacologia , Ferro/sangue , Leucócitos Mononucleares/efeitos dos fármacos , Leucócitos Mononucleares/metabolismo , Lipopolissacarídeos/farmacologia , Masculino , México , Mitógenos/farmacologia , Acetato de Tetradecanoilforbol/análogos & derivados , Acetato de Tetradecanoilforbol/farmacologia , Fator de Necrose Tumoral alfa/biossíntese , Fator de Necrose Tumoral alfa/sangueRESUMO
OBJECTIVE: To determine the clinical characteristics that indicate the presence of tubo-ovarian abscess (TOA) among patients with severe pelvic inflammatory disease (PID). METHODS: An observational cohort study was performed from October 2011 to March 2013. The study included all patients with a diagnosis of TOA and PID admitted to a university hospital in Mexico. A complete medical history and physical examination were performed, and laboratory studies were reviewed. A logistic regression analysis was performed on variables with statistical significance. RESULTS: Overall, 26 patients with PID and TOA (TOA group) and 26 with PID without TOA (PID group) were included in the study. Significant differences between patients with TOA and PID were found with regard to the patients' age (39.3years vs 33.1years; P=0.04), educational level (only elementary, 13 [50%] vs 5 [19%]; P=0.14), presentation with fever (23 [88%] vs 16 [62%]; P=0.025), white blood cell count (21.8×10(9)/L vs 14.9×10(9)/L; P<0.001), number of deliveries (2.2 vs 1.1; P=0.01), and presence of diarrhea (16 [62%] vs 5 [19%]; P<0.001). The triad of fever, leukocytosis, and diarrhea was positively related to the presence of TOA. CONCLUSION: The triad of fever, leukocytosis, and diarrhea should alert clinicians to the possibility of TOA formation in patients with PID.
Assuntos
Abscesso/diagnóstico , Doenças das Tubas Uterinas/diagnóstico , Doenças Ovarianas/diagnóstico , Doença Inflamatória Pélvica/diagnóstico , Abscesso/complicações , Adolescente , Adulto , Fatores Etários , Estudos de Coortes , Diarreia/etiologia , Doenças das Tubas Uterinas/complicações , Feminino , Febre/etiologia , Humanos , Leucocitose/etiologia , Modelos Logísticos , México , Pessoa de Meia-Idade , Doenças Ovarianas/complicações , Doença Inflamatória Pélvica/complicações , Adulto JovemAssuntos
Síndrome de Hipersensibilidade a Medicamentos/sangue , Síndrome de Hipersensibilidade a Medicamentos/terapia , Adolescente , Adulto , Idoso , Brasil , Criança , Síndrome de Hipersensibilidade a Medicamentos/complicações , Eosinofilia/etiologia , Feminino , Febre/etiologia , Hospitais de Ensino , Humanos , Hiperbilirrubinemia/etiologia , Tempo de Internação , Leucocitose/etiologia , Masculino , Pessoa de Meia-Idade , Transaminases/sangue , Adulto JovemRESUMO
El síndrome TAR (Thrombocytopenia with Absent Radius) es una patología congénita autosómica recesiva infrecuente, caracterizada por trombocitopenia con aplasia de radio bilateral. Incluye malformaciones esqueléticas, renales, hematológicas y cardíacas. Su base genética todavía no está clara. Presentamos el caso de una paciente sin diagnóstico previo de síndrome TAR que llega a la consulta, tras haber sido evaluada por varios profesionales médicos, para el diagnóstico y el tratamiento de trastornos hematológicos, que finalmente estuvieron asociados a su síndrome congénito. (AU)
Thrombocytopenia with Absent Radius (TAR) is a rare autosomic recessive disease characterized by thrombocytopenia and bilateral radial aplasia, which includes skeletal, hematologic, renal and cardiac abnormalities. The genetics bases of this syndrome remain unclear. We report here a patient without a previous diagnosis of TAR syndrome who was seen in the clinic, after being evaluated by several medical professionals for diagnosis and treatment of blood disorders, which eventually were associated with the congenital syndrome. (AU)
Assuntos
Humanos , Feminino , Adulto , Rádio (Anatomia)/anormalidades , Trombocitopenia/complicações , Síndrome , Trombocitopenia/genética , Trombocitopenia/patologia , Trombocitopenia/sangue , Diagnóstico Diferencial , Leucocitose/etiologiaRESUMO
BACKGROUND: The intestinal obstruction secondary to internal hernia is a diagnostic challenge. The absence of specific symptoms and signs during clinical examination often lead to underestimation of the severity and early surgical treatment. The purpose of this article is to review the clinical presentation of two patients with internal hernia, describe the clinical, biochemical and radiological findings, with emphasis on the L-lactate as an early serum marker of intestinal ischemia. CLINICAL CASES: Case 1: female, 44 years history of urolithiasis and 2 cesarean sections. Case 2: female, 86 year old with a history of open cholecystectomy, incisional and bilateral inguinal hernia repair with mesh placement. Both admitted with abdominal pain and intestinal obstruction data. The only significant laboratory finding was elevation of L-lactate. The abdominal films showed air-fluid levels, dilated loops of small intestine and colon. Abdominal contrast tomography showed free abdominal fluid id, internal hernia and torque of mesentery. In both cases, exploratory laparotomy was performed with bowel resection of ischemic segments, with uneventful recovery. CONCLUSIONS: Intestinal ischemia secondary to internal hernia is difficult lt to diagnose. In patients with a high suspicion, signs of intestinal obstruction by plain radiography, the elevation of L-lactate, could help in the early diagnosis of intestinal ischemia and immediate surgical treatment.