The prevalence, virological and epidemilogical aspects of the hepatitis C virus (HCV)

The hemodynamic profiles clearly define specific hemodynamic mechanisms of cardiac power reduction and/or vasodilatation as underlying intradialytic hypotensive episodes. A reduction in cardiac power (reduction of both blood pressure and cardiac output) could be the result of preload reduction due to a high ultrafiltration rate with not enough refilling or low target weight. A reduction in peripheral resistance (reduction in blood pressure and increase in cardiac output) could be the result of relative vasodilatation as arteries do not contract to compensate for volume reduction due to autonomous dysfunction. As both phenomena are independent, they may appear at the same time. Based on these results, a reduction of ultrafiltration rate and an increase in target weight to improve preload or immediate therapeutic actions to increase peripheral resistance are rational measures that could be taken to maintain blood pressure and prevent hypotensive ischemic complications in dialysis patients.

Background Intradialytic blood pressure (BP) measurement is currently the main parameter used for monitoring hemodynamics during hemodialysis (HD). Since BP is dependent on cardiac output and total peripheral resistance, knowledge of these parameters throughout the HD treatment would potentially be valuable. Methods The use of a novel non-invasive monitoring system for profiling hemodynamic response patterns during HD was explored: a whole-body bio-impedance system was used to assess cardiac index (CI), total peripheral resistance index (TPRI), cardiac power index (CPI) among other parameters in chronic HD patients from 4 medical centers. Measurements were made pre, during and post dialysis. Patients were grouped into 5 hemodynamic profiles based on their main hemodynamic response during dialysis i.e. high TPRI; high CPI; low CPI; low TPRI and those with normal hemodynamics. Comparisons were made between the groups for baseline characteristics and 1-year mortality. Results In 144 patients with mean age of 67.3 ± 12.1 years pre-dialysis hemodynamic measurements were within normal limits in 35.4% but only 6.9% overall remained hemodynamically stable during dialysis. Intradialytic BP decreased in 65 (45.1%) in whom, low CPI (47 (72.3%)) and low TPRI (18 (27.7%) were recorded. At 1-year follow-up, mortality rates were highest in patients with low CPI (23.4%) and low TPRI (22.2%). Conclusions Non-invasive assessment of patients’ response to HD provides relevant hemodynamic information that exceeds that provided by currently used BP measurements. Use of these online analyses could potentially improve the safety and performance standards of dialysis by guiding appropriate interventions, particularly in responding to hypertension and hypotension. Electronic supplementary material The online version of this article (10.1186/s12882-019-1542-4) contains supplementary material, which is available to authorized users.

Introdução: púrpura de Henoch-Schönlein (PHS) é uma vasculite sistêmica que acomete vasos de pequeno calibre com depósitos de imunocomplexos contendo IgA. Esta vasculite já foi extensamente estudada em crianças, mas sua história natural em adultos é menos conhecida. Objetivos: descrever uma série de pacientes adultos com PHS. Pacientes e Métodos: membros do Grupo Mineiro de Estudo das Vasculites foram convidados a reportar pacientes com PHS apresentando-se na idade adulta. Foi realizada revisão padronizada de prontuários. Resultados: 11 pacientes, dois homens e nove mulheres, com idade + desvio padrão (DP) de 39,4 +/-20,1 anos foram estudados. Nove pacientes apresentaram púrpura; sete apresentaram artrite; quatro apresentaram envolvimento gastrintestinal e dez (91%) pacientes apresentaram glomerulonefrite (GN). Oito pacientes foram submetidos à biópsia renal. Seis deles apresentaram GN endocapilar proliferativa e dois apresentaram apenas proeminência mesangial mínima. Em outros três pacientes, o diagnóstico de PHS foi confirmado através de biópsia de pele. Todos os pacientes receberam corticóide, em cinco associado a outros agentes imunossupressores. Após seguimento (média + DP) 39,0 + 64,6 meses, quatro pacientes (36%) apresentaram comprometimento da função renal, mas apenas um (9%) desenvolveu insuficiência renal terminal e foi submetido a transplante renal com sucesso. Após o seguimento, sete (64%) estão em remissão completa e quatro em remissão parcial. Conclusão: em adultos, PHS representa uma entidade clínica distinta, com maior freqüência de envolvimento renal e vasculite sistêmica mais grave. Entretanto, o prognóstico nesta série foi tão bom quanto em crianças, talvez pela terapia imunossupressiva mais vigorosa. Nine patients presented purpura, seven presented arthritis, four patients had gastrointestinal involvement and ten patients (91%) presented glomerulonephritis (GN). Eight patients were subjected to renal biopsies. Six of them presented endocapillary proliferative GN and only two of them had minimal mesangial proliferation. In the other three patients, HSP was confirmed by skin biopsies. All patients received steroids, in five of them steroids were combined with other immunosuppressive agents. After a follow-up of 39.0 +/-64.6 months, four patients (36%) presented impairment of renal function, but only one (9%) developed end stage renal disease and was successfully appeared to renal transplantation. At the end of follow-up, seven patients (64%) are in complete remission and four in partial remission. Conclusion: in adulthood, HSP represents a distinct clinical syndrome with a higher frequency of renal involvement and more severe systemic vasculitis. Nevertheless, the final outcome in this series was as good as reported in children, maybe due to aggressive immunosuppressive therapy. Palavras

Objectives:To determine the more frequently seen clinical and immunologic manifestations in the antiphospholipid syndrome (APS) in patients of 2 referral centers. Methods: We studied 50 patients with the diagnosis of primary or secondary APS, 49 females and 1 male, with ages ranging between 15 and 65-year-old, using a predetermined protocol in which we measured the immunologic and clinical spectrum, including the determination of anticardiolipin antibodies (ACA) and lupus anticoagulant (LA); in some cases we also measured anti-␤ 2-glycoprotein I. Results: The most frequent clinical manifestations were thromboses in several sites detected in 88% of cases; the most common location was the lower extremities (40%) and as pulmonary emboli was detected in 20%. Arthritis was found in 70% of the cases, livedo reticularis in 52%, Raynaud phenomena in 50%, migraine in 40%, hemolytic anemia in 30%, major depressive disorder in 22% and recurrent miscarriage in 18%. Immunologic studies showed antinuclear antibodies (ANA) in 80%, ACA of IgM and IgG isotypes were found in 56% and 44% respectively, LA in 34% and anti-DNA antibodies in 40%. Conclusions:The main clinical manifestations in patients with APS are: lower extremities thromboses, pulmonary emboli, cutaneous, articular and neurologic involvements, with the presence of ACA (isotype IgM). Introduction:The catastrophic antiphospholipid syndrome (CAPS) is characterized by a rapid-progressive thrombosis of small vessels, multiple organ failure in the presence of antiphospholipid antibodies, might be fatal in more than 50% of cases. The risk-factors identified in the develop of CAPS are, bacterial and/or viral infections, surgery, inadequate treatment of systemic lupus erythematosus (SLE), inadequate treatment of antiphospholipid syndrome (APS), or use of estrogens. Objectives: To identify methods to prevent the progression to CAPS in patients with primary and secondary antiphospholipid syndrome (APS). Patients: Patient 1: 28-year-old female with SLE without treatment, with a previous history of 2 fetal losses and 2 normal vaginal deliveries. During the 3rd trimester of her 5th pregnancy the patient presented with fever, hypertension, renal involvement, deep vein thrombosis, cerebral organic syndrome, convulsions and coma. Patient 2: 22-year-old female with SLE, lupus nephropathy classified as WHO class IV, secondary APS and cutaneous vasculitis. Exacerbation of the SLE was secondary to sun exposure and insufficient corticosteroids doses. Methods:The risk-factors were identified and the patients were treated with: 1. High corticosteroid doses. 2. Full anticoagulation with low molecular weight heparin. 3. Aggressive broad-spectrum antibiotic treatment. 4. Intravenous immunoglobulins infusions at the doses of 1g/kg/d for 2 subsequent days. 5. Control of the hematological disorder in the intensive care unit (ICU). Results: The outcomes of both patients were successful as demonstrated by controlling the events and not developing CAPS. Conclusions: Our experience suggests that ever...