Effect of hyperbaric oxygen therapy: case report of patient with hepato-pulmonary syndrome on waiting list for liver transplantation

INTRODUÇÃO: As doenças hepáticas apresentam índices de morbidade e mortalidade elevados e quando em estágio avançado têm o transplante do fígado como forma de tratamento potencialmente curativo e eficaz, embora este não possa ser oferecido a todos os pacientes. Isso faz com que essas doenças sejam consideradas problema de saúde pública em todo o mundo. Os cuidados clínicos para manter o paciente com condições de esperar e suportar o transplante continua um desafio. RELATO DO CASO: Mulher com 65 anos de idade, procedente do Recife, com diagnóstico de cirrose hepática secundária a vírus C apresentava dispnéia importante aos mínimos esforços tendo PaO2 de repouso de 60 mmHg e O2 de 90%, com espirometria normal. Realizou eco-Doppler que evidenciou shunt pulmonar importante. Durante a triagem em lista de transplante (MELD de 16 em agosto de 2006) foi optado pelo início de sessões de oxigenioterapia em câmara hiperbárica a fim de melhorar a sintomatologia respiratória da síndrome hepato-pulmonar. Apresentava melhora substancial da tolerância ao exercício após a terapia hiperbárica, assim como os valores do PaO2 à gasometria. Realizou 10 sessões de oxigenioterapia em câmara hiperbárica. Realizou transplante hepático em outubro de 2007 e vem em acompanhamento ambulatorial com boa evolução e melhora substancial da dispnéia. CONCLUSÃO: Constatou-se melhora da condição hepato-pulmonar após oxigenoterapia hiperbárica. Desta forma, ela surge como mais uma ferramenta para o tratamento das doenças hepáticas, devendo ser realizados outros estudos que avaliem sua utilização clínica.INTRODUCTION: Progressive impairment of liver function in hepatic cirrhosis is a major medical problem with limited therapeutic approaches, and liver transplantation is the only effective therapy. Reports of alternatives for liver function improvement on patients awaiting liver transplantation may include hyperbaric oxygen therapy. CASE REPORT: A 65-year old woman had diagnosis of hepatitis C and liver cirrhosis during treatment for breast cancer. In addition to liver failure and a MELD of 16, the patient presented hypoxemia with a PaO2 of 60 mmHg, and further evaluation with eco-Doppler revealed a hepatopulmonary syndrome. Clinical improvement was attempted with hyperbaric oxygeniotherapy, and substantial clinical and laboratorial improvement was acheived after 10 sessions, with significant improvement on cyanosis and arterial gas values. CONCLUSION: Oxygen therapy was effective in the improvement of dyspnea and hypoxemia secondary to hepatopulmonary syndrome in a patient with liver cirrhosis indicated for liver transplantation. The positive results of this treatment suggest that hyperbaric oxygen therapy may help on improvement of symptoms of hepatopulmonary syndrome

Exchange coupling between magnetic layers across non-magnetic superlattices

The oscillation periods of the interlayer exchange coupling are investigated when two magnetic layers are separated by a metallic superlattice of two distinct non-magnetic materials. In spite of the conventional behaviour of the coupling as a function of the spacer thickness, new periods arise when the coupling is looked upon as a function of the number of cells of the superlattice. The new periodicity results from the deformation of the corresponding Fermi surface, which is explicitly related to a few controllable parameters, allowing the oscillation periods to be tuned.Comment: 13 pages; 5 figures; To appear in J. Phys.: Cond. Matte

Model for spin coupling disorder effects on the susceptibility of antiferromagnetic nanochains

The temperature dependence of the static magnetic susceptibility of exchange-disordered antiferromagnetic Heisenberg spin-1/2 finite chains with an odd number of spins is investigated as a function of size and type of disorder in the exchange coupling. Two models for the exchange disorder distribution are considered. At sufficiently low temperatures each chain behaves like an isolated spin-1/2 particle. As the size of the chains increases, this analogy is lost and the chains evolve into the thermodynamic limit behavior. The present study provides a simple criterion, based on susceptibility measurements, to establish when odd-sized chains effectively simulate a single spin-1/2 particle.Comment: 8 pages, 3 figure

Magnetic behavior of nanoparticles in patterned thin films

The magnetic behavior of truncated conical nanoparticles in patterned thin films is investigated as a function of their size and shape. Using a scaling technique, phase diagrams giving the relative stability of characteristic internal magnetic structures of the particles are obtained. The role of the uniaxial anisotropy in determining the magnetic properties of such systems is discussed, and a simple method for stablishing its strength is proposed.Comment: 4 pages, 4 figure

Abdominal wall hernia in cirrhotic patients: emergency surgery results in higher morbidity and mortality

Abstract\ud \ud Background\ud Patients with cirrhosis have a high incidence of abdominal wall hernias and carry an elevated perioperative morbidity and mortality. The optimal surgical management strategy as well as timing of abdominal hernia repair remains controversial.\ud \ud \ud Methods\ud A cohort study of 67 cirrhotic patients who underwent hernia repair during the period of January 1998-December 2009 at the University Hospital of Sao Paulo were included. After meeting study criteria, a total of 56 patients who underwent 61 surgeries were included in the final analysis. Patient characteristics, morbidity (Clavien score), mortality, Child-Turcotte-Pugh score, MELD score, use of prosthetic material, and elective or emergency surgery have been analysed with regards to morbidity and 30-day mortality.\ud \ud \ud Results\ud The median MELD score of the patient population was 14 (range: 6 to 24). Emergency surgery was performed in 34 patients because of ruptured hernia (n = 13), incarceration (n = 10), strangulation (n = 4), and skin necrosis or ulceration (n = 7). Elective surgery was performed in 27 cases. After a multivariable analysis, emergency surgery (OR 7.31; p 0.017) and Child-Pugh C (OR 4.54; p 0.037) were risk factors for major complications. Moreover, emergency surgery was a unique independent risk factor for 30-day mortality (OR 10.83; p 0.028).\ud \ud \ud Conclusions\ud Higher morbidity and mortality are associated with emergency surgery in advanced cirrhotic patients. Therefore, using cirrhosis as a contraindication for hernia repair in all patients may be reconsidered in the future, especially after controlling ascites and in those patients with hernias that are becoming symptomatic or show signs of possible skin necrosis and rupture. Future prospective randomized studies are needed to confirm this surgical strategy

Prediction models for carbapenem-resistant Enterobacterales carriage at liver transplantation: A multicenter retrospective study

Background: Carbapenem-resistant Enterobacterales (CRE) colonisation at liver transplantation (LT) increases the risk of CRE infection after LT, which impacts on recipients’ survival. Colonization status usually becomes evident only near LT. Thus, predictive models can be useful to guide antibiotic prophylaxis in endemic centres. Aims: This study aimed to identify risk factors for CRE colonisation at LT in order to build a predictive model. Methods: Retrospective multicentre study including consecutive adult patients who underwent LT, from 2010 to 2019, at two large teaching hospitals. We excluded patients who had CRE infections within 90 days before LT. CRE screening was performed in all patients on the day of LT. Exposure variables were considered within 90 days before LT and included cirrhosis complications, underlying disease, time on the waiting list, MELD and CLIF-SOFA scores, antibiotic use, intensive care unit and hospital stay, and infections. A machine learning model was trained to detect the probability of a patient being colonized with CRE at LT. Results: A total of 1544 patients were analyzed, 116 (7.5%) patients were colonized by CRE at LT. The median time from CRE isolation to LT was 5 days. Use of antibiotics, hepato-renal syndrome, worst CLIF sofa score, and use of beta-lactam/beta-lactamase inhibitor increased the probability of a patient having pre-LT CRE. The proposed algorithm had a sensitivity of 66% and a specificity of 83% with a negative predictive value of 97%. Conclusions: We created a model able to predict CRE colonization at LT based on easy-to-obtain features that could guide antibiotic prophylaxis (Figure presented.)

Hepatite fulminante: estudo dos fatores associados à mortalidade hospitalar de 100 pacientes priorizados para transplante de fígado

Introdução. A despeito dos avanços nos cuidados de terapia intensiva e no transplante de fígado (TF), a hepatite fulminante (HF) ainda hoje apresenta alta taxa de mortalidade. A identificação de fatores prognósticos de maior acurácia deve ajudar a otimizar a priorização dos pacientes em lista de espera para o TF. Objetivo. Avaliar fatores prognósticos de mortalidade hospitalar dos pacientes com HF priorizados para TF. Métodos. Foram estudados retrospectivamente 100 pacientes adultos (78 mulheres, idade média 35,5 ± 14,7 anos) com HF priorizados para TF, em um único centro, de fevereiro de 2002 a junho de 2011. O diagnóstico etiológico foi hepatite viral em 17% dos casos, medicamentosa em 29%, autoimune em 13%, criptogênica em 34% e outras causas em 7%. A indicação do TF foi determinada de acordo com os critérios de O’Grady. Foram avaliados: idade, sexo, etiologia, intervalo icterícia/encefalopatia, intervalo entre a priorização e o TF, grau de encefalopatia, tempo de internação, RNI, fator V, bilirrubina, creatinina, AST, ALT, lactato e Model for End-Stage Liver Disease (MELD). Todos os dados foram coletados do dia da priorização. Resultados. O intervalo entre a priorização e o TF foi de 1,5 dias (0 a 9) e o tempo de internação foi de 18 ± 27 dias. A mortalidade hospitalar foi de 69%. Os pacientes não sobreviventes apresentaram na priorização maior grau de encefalopatia [3 (1 a 4) vs. 2 (1 a 4)], MELD (41 ± 9 vs. 38 ± 7) e lactato (62,2 ± 45,2 vs. 33,9 ± 16,0 mg/dL) quando comparados com os sobreviventes (p<0,05). Dos 100 pacientes, 69% foram submetidos ao TF, os outros 31% morreram antes do TF. Os pacientes não transplantados apresentaram maior grau de encefalopatia [4 (1 a 4) vs. 3 (1 a 4)], MELD (44 ± 8 vs. 38 ± 8), lactato (78,4 ± 48,3 vs. 41,8 ± 30,6 mg/dL) e creatinina (2,60 ± 2,34 vs. 1,55 ± 1,54 mg/dL) quando comparados aos pacientes submetidos ao TF (p<0.05). Conclusão. No momento da priorização para o TF, os pacientes com HF que apresentam condição clínica mais grave, com encefalopatia graus 3 ou 4, insuficiência renal, escores mais elevados de MELD e lactato elevado, têm maior taxa de mortalidade hospitalar mesmo quando submetidos ao TF, indicando pior prognóstico