The sundown syndrome is a complex neurobehavioral disorder in patients with dementia associated with high financial cost and significant caregiver burden. It is a multifactorial phenomenon with unclear pathophysiology, characterized by the presence of neuropsychiatric symptoms in the evening period. Objective: To analyze the main neuropsychiatric symptoms, their correlation with one another, with comorbidities, and with time of day of greatest symptom intensity in patients with Alzheimer’s disease dementia. Methods: This is a cross-sectional, observational and explanatory study in which caregivers/relatives of elderly patients with dementia were interviewed using a structured tool called the Neuropsychiatric Inventory (NPI). Results: The sample studied was composed of 38 patients, 60.5% female and 39.5% male, with mean age of 81±6 (67-94) years. A high frequency of neuropsychiatric symptoms in the evening period was observed, predominantly irritability (55.3%), nocturnal behavior (47.4%), and aggressiveness (42.1%). Only 36.8% of the family caregivers used non-pharmacological strategies. Conclusion: The frequency of neuropsychiatric symptoms was exacerbated in the evening among patients with Alzheimer’s disease, especially for those behavioral symptoms that had a positive correlation with one another.
This article presents a case of rapidly progressive glomerulonephritis following the Oxford-AstraZeneca COVID-19 vaccine in a female patient 58 years old. After 5 days, she presented fatigue, paleness, arthralgia on hands, knees, ankles, foamy urine, and elevated blood pressure. Exams showed serum creatinine of 2.2 mg/dL (baseline creatinine of 1.0 mg/dL). Urinalysis revealed hematuria, and her 24-h urinary protein excretion was 4.4 g. Additional exams showed hypercholesterolemia, severe anemia, and normal serum albumin. Testing of antineutrophil cytoplasmic antibodies anti-myeloperoxidase was positive at a titer of 1/80. Serum and urine protein electrophoresis and other exams showed no alterations. She was started on steroid pulse therapy after worsening kidney function, reaching serum creatinine of 3.3 mg/dL. A kidney biopsy revealed crescentic glomerulonephritis with glomerular sclerosis, fibrous crescents, interstitial fibrosis, and tubular atrophy. Induction therapy was given with intravenous cyclophosphamide 0.5 g/m2 for 6-monthly pulses, followed by maintenance therapy with oral azathioprine at 2 mg/kg and prednisone tapering. The patient did not develop any complications during the induction therapy, and is currently on maintenance therapy with a serum creatinine of 1.87 mg/dL.
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