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Opportunistic Infections in Late Kidney Transplantation with Death Outcome: Case Report  [PDF]
Miriam Viviane Baron, Carina Marangoni, Michele Paula dos Santos, Célia Regina Martins Korzenieski, Vitória Pereira Itaquy, Tais Michele Werle, Gabriela Di Lorenzo Garcia Scherer, Joice Nedel Ott, Marcus Vinicius de Mello Pinto, Janine Koepp, Carolina Gon？alves Pinheiro, Nathália Ken Pereira Iketani, Cristine Brandenburg, Aline Ronis Sampaio, Alexandre Sancho, Danielle de Mello Florentino, Bartira Ercília Pinheiro da Costa
Open Journal of Nephrology (OJNeph) , 2021, DOI: 10.4236/ojneph.2021.112014
Abstract: Cytomegalovirus (CMV) and Pneumocystis jirovecii fungus are the main opportunistic microorganisms that affect transplanted individuals. Immunosuppressive drugs administered to prevent organ rejection leave the immune system vulnerable to these infections. The present report is about a kidney transplanted patient using immunosuppressants who was diagnosed with cytomegalovirus and pneumocystosis requiring admission to the intensive care unit (ICU). Female patient, 57 years old, a kidney transplanted three years ago, with comorbidities, such as systemic arterial hypertension, hypertriglyceridemia and type 2 diabetes mellitus. She was admitted to the hospital in January 2020 with a history of diarrhea, cough, malaise and weight loss of seven kg in a month. She made continuous use of the immunosuppressants tacrolimus？ and mycophenolate sodium (MFS). After five days of hospitalization, she was transferred to the ICU due to refractory diarrhea, worsening renal function and respiratory pattern, requiring mechanical ventilation. Chest tomography showed changes that led to the diagnostic hypothesis of CMV pneumonia or Pneumocystis jirovecii. Treatment with Ganciclovir？ and Bactrim？ was started. The bronchial lavage polymerase chain reaction test confirmed the infectious condition for CMV and Pneumocystis jirovecii. Despite the drug therapy instituted, there was no improvement in the infectious condition. The patient started to present a general and progressive worsening of the clinical picture with loss of renal graft function, respiratory failure, metabolic acidosis, hemodynamic instability and severe distributive shock, evolving to death. In the present report, it was observed that after late kidney transplantation the fragility of the immune system caused by the use of immunosuppressants contributed to the development of a severe infection with CMV and Pneumocystis jirovecii. Adjusting the doses of immunosuppressants to individual needs can be an important measure for maintaining the proper immune system and consequently avoiding late opportunistic infections and death outcomes.
Approach to Paroxysmal Atrial Fibrillation Type Arrhythmia in a Cardiology Service: A Case Report  [PDF]
Miriam Viviane Baron, Luis Manuel Ley Dominguez, Carolina Paz Mohamad Isa, Gabriela Di Lorenzo Garcia Scherer, Michele Paula dos Santos, Vitória Pereira Itaquy, Talia Guimar？es dos Santos, Julia Braga da Silveira, Paulo Ricardo Martins, Amanda Corrêa dos Santos, Marcus Vinicius de Mello Pinto, Janine Koepp, Daiana Klein Weber Carissimi, Joice Nedel Ott, Carolina Gon？alves Pinheiro, Nathália Ken Pereira Iketani, Gabriela Feltez, Bartira Ercília Pinheiro da Costa
Modern Research in Inflammation (MRI) , 2020, DOI: 10.4236/mri.2020.92002
Abstract: Atrial fibrillation is a cardiac arrhythmia of high prevalence in the population, especially in the elderly. Its main electrical characteristics are the interval between two successive irregular R waves, absence of P waves and presence of f waves between QRS complexes. The most common symptoms of atrial fibrillation are irregular palpitations associated with dyspnea, dizziness, feeling tired, fatigue and general malaise, but not all patients have any symptoms. The present report presents the history of an elderly patient who arrived at the hospital’s emergency department with irregular heart rhythm and palpitations. The patient’s symptoms, associated with the electrocardiogram results, indicated paroxysmal atrial fibrillation. Electrical cardioversion was performed, and after, cardiac ablation via the femoral vein at the hospital’s cardiology service. There were no complications during the procedure. As a routine imaging exam after ablation, control esophagogastroduodenoscopy was requested to verify that there was no formation of atrio-esophageal fistula developed by the invasive ablation procedure and electrocardiogram, which showed normal sinus rhythm. The patient remained in the cardiac intensive care unit for observation for 24 hours. After the electrical cardioversion and catheter ablation procedures, the patient improved his clinical picture of atrial fibrillation and was discharged after 24 hours of hospitalization. He received treatment to perform at home, to reduce acid reflux into the esophagus and to prevent thrombosis. He did not present pulmonary thromboembolism after hospital discharge. It is believed, therefore, that this form of treatment and management of paroxysmal atrial fibrillation is effective for the solution of the proposed problem and can also serve as a reference for other professionals within the cardiology service.
Advanced Stage Stuck Gland Adenocarcinoma: Case Report  [PDF]
Miriam Viviane Baron, Michele Paula dos Santos, Gabriela Di Lorenzo Garcia Scherer, Luis Manuel Ley Dominguez, Vitória Pereira Itaquy, Natalia Cardoso Nascimento, Fernanda Nerys, Tais Michele Werle, Carolina Paz Mohamad Isa, Carina Marangoni, Mariana Martins Dantas Santos, Marcus Vinicius de Mello Pinto, Janine Koepp, Daiana Klein Weber Carissimi, Joice Nedel Ott, Carolina Gon？alves Pinheiro, Nathália Ken Pereira Iketani, Bartira Ercília Pinheiro da Costa
Modern Research in Inflammation (MRI) , 2020, DOI: 10.4236/mri.2020.91001
Abstract: Parotid gland adenocarcinoma is commonly a tumor of low malignancy and low incidence worldwide. The reported case shows the rapid progression of this tumor in an elderly patient and infrequent effects, such as a presentation of facial edema not commonly described in the medical literature. Patient was admitted to hospital in November 2019 with secretion and partial hearing loss in the right ear and infiltrative and stone lesion with initial skin ulceration in the right cervical region. After 42 days, he returned and was admitted to the intensive care unit with significant swelling of the face, hardened and hyperemic neck, difficulty in speech and inability to open the eye. He presented changes in the mobility of the speech and hearing organs, reduced laryngeal mobility, vocal changes, speech with altered articulation and severe oropharyngeal dysphagia with risk of bronchoaspiration. The patient was diagnosed in September 2019 with a parotid tumor (salivary gland adenocarcinoma T4). The medical team requested computed tomography, computed tomography angiography of the chest and cervical vessels and computed tomography of the neck, in addition to evaluation by the head and neck surgery service and general surgery. After analyzing the results, the medical team suggested a hypothesis of tumor invasion that could result in obstruction of local lymphatic drainage, something unusual in the evolution of this type of tumor. In addition, it was not possible to adhere to radiotherapy treatment due to the extent of the lesion and there was also no confirmation of metastases. The reported case shows us that parotid gland adenocarcinoma, when diagnosed in an advanced stage, can limit the approach to treatment. It was chosen in agreement with the family to proceed with palliative care without invasive measures. Palliative care may be the best option for cases like this, bringing some comfort to the patient and his family.
Early Hepatic Encephalopathy after a Transjugular Intrahepatic Portosystemic Shunt Procedure: Case Report  [PDF]
Miriam Viviane Baron, Gabriela Di Lorenzo Garcia Scherer, Michele Paula dos Santos, Andres Felipe Mantilla Santamaria, Cristine Brandenburg, Isabel Cristina Reinheimer, Marcus Vinicius de Mello Pinto, Aline Ronis Sampaio, Alexandre Gomes Sancho, Alexandre Gomes Sancho, Esteban Fortuny Pacheco, Felice Picariello, Danielle de Mello Florentino, Joice Nedel Ott, Carolina Gon？alves Pinheiro, Nathália Ken Pereira Iketani, Sonia Carvalho, Patrícia Froes Meyer, Bartira Ercília Pinheiro da Costa
Open Journal of Gastroenterology (OJGas) , 2021, DOI: 10.4236/ojgas.2021.116009
Abstract: Patients with decompensated hepatic cirrhosis may present systemic alterations and dysfunction of multiple organs. Ascites, portal hypertension, esophageal varices, and hepatic encephalopathy are common complications arising from cirrhosis. The aim of this paper is to report a case of a patient with liver cirrhosis and the complications of a transjugular intrahepatic portosystemic shunt. Male, elderly, and ex-alcoholic, diagnosed with liver cirrhosis, ascites, and esophageal varices. He underwent transjugular intrahepatic portosystemic shunt due to portal hypertension and returned to the hospital after 24 hours with agitation and mental confusion. He had a bowel movement stop, neurological worsening, loss of renal function, hepatic hydrothorax, hepatic encephalopathy, hypernatremia, hypocalcemia, and hypophosphatemia. He underwent a new procedure to occlude the transjugular intrahepatic portosystemic shunt, showing improvement of the mental status and ascites. However, continued with decompensation and hydro-electrolytic disorders. He evolved with worsening of the ventilatory pattern, and neurological and renal function, with a fatal outcome. Esophageal varices due to portal hypertension can be corrected with the transjugular intrahepatic portosystemic shunt. However, complications such as hypernatremia, hepatic hydrothorax, and hepatic encephalopathy may occur. Therefore, there is a need for reintervention to shunt or reduce its caliber. Thus, for patients with advanced age and decompensated cirrhosis, the potential risks and benefits of this procedure should be carefully evaluated due to the risk of complications and death.
Non-Hodgkin’s Lymphoma Associated with Metastatic Lung Cancer: Case Report  [PDF]
Miriam Viviane Baron, Gabriela Di Lorenzo Garcia Scherer, Célia Regina Martins Korzenieski, Julia Braga da Silveira, Carolina Boeira Soares, Carina Marangoni, Marcus Vinicius de Mello Pinto, Aline Ronis Sampaio, Alexandre Gomes Sancho, Esteban Fortuny Pacheco, Felice Picariello, Joice Nedel Ott, Isabel Cristina Reinheimer, Carolina Gon？alves Pinheiro, Nathália Ken Pereira Iketani, Cristine Brandenburg, Danielle de Mello Florentino, Patrícia Froes Meyer, Bartira Ercília Pinheiro da Costa
Advances in Lung Cancer (ALC) , 2021, DOI: 10.4236/alc.2021.103004
Abstract: Lymphomas are neoplastic transformations that affect lymphoid cells. Diffuse large B-cell non-Hodgkin’s lymphoma has a high degree of cell proliferation, accounting for 30% of all lymphomas. Lung cancer is the leading cause of death worldwide and the recommended treatment is chemotherapy. Among the main complications resulting from non-Hodgkin’s lymphoma, lung cancer and chemotherapy used in their treatment, we can mention sepsis, acute kidney injury and febrile neutropenia. Febrile neutropenia can occur by suppressing the production of neutrophils. Sepsis, a widespread infection, is the main cause of acute kidney injury, which can also be caused by hydroelectrolytic complications or by nephrotoxicity. This is a report of a smoking patient with metastatic lung cancer who sought care due to progressive dysphagia, cough with chest pain, fever, and lower airways critical obstruction due to mediastinal lymphadenopathy, being diagnosed with diffuse large B-cell non-Hodgkin’s lymphoma. The patient evolved to death because of a significant worsening of the ventilatory pattern of multifactorial cause, mainly due to sepsis, acute kidney injury, and febrile neutropenia. The patient had mostly classic characteristics of her comorbidities, however, the overlapping of interrelated comorbidities led to the outcome of death. What is unusual about the present case report is that the patient’s characteristics, such as age, sex, and ethnicity, are opposite to those described as risk factors for diffuse large B-cell non-Hodgkin’s lymphoma.
Pulmonary Tuberculosis Associated with Socioeconomic Vulnerability and Ineffective Support Network: Case Report  [PDF]
Michele Paula dos Santos, Gabriela Di Lorenzo Garcia Scherer, Carolina Hack Alves, Italo Trois Maestri, Carolina Boeira Soares, Carlos Augusto Treviso, Stella Duarte Pinto, Ana Paula Wagner Steinmetz, Laura Gomes Boabaid de Barros, Maria Eduarda Perobelli Buzetto, Gabriel Lorentz Trein, Guilherme Boeira Soares, Aline Porto, Brendda Pereira Gomes, Fernanda Bercht Merten, Luane Pereira Gomes, Bárbara Adelmann de Lima, Rafaela Siviero Caron-Lienert, Miriam Viviane Baron
Journal of Biosciences and Medicines (JBM) , 2023, DOI: 10.4236/jbm.2023.115010
Abstract: Tuberculosis is one of the 10 leading causes of death in the world. Its symptoms include fever, malaise, weakness, weight loss, chest pain, cough, expectoration, shortness of breath and sepsis, which is its most frequent complication. Due to these symptoms, many patients with tuberculosis require admission to the Intensive Care Unit, where they usually are placed on mechanical ventilation. Tuberculosis is more prevalent in the population in situations of social and economic vulnerability. The main factors that interfere with adherence to treatment and the prognosis of these patients are the patient’s support network and their socioeconomic status. We present the following report of a long-time smoker patient, with chronic kidney disease and previous treatment for tuberculosis, who was brought to the emergency room due to lowering of the sensorium, and was immediately placed on mechanical ventilation. The tests suggested sepsis with a respiratory focus, so a search for Alcohol-Acid-Resistant Bacillus was carried out, with a positive result. The patient was transferred to the Intensive Care Unit due to tachycardia and acute respiratory failure. The patient was a smoker with a high tobacco load, chronic kidney disease, in addition to precarious economic, educational and self-care conditions. This report shows that patients with tuberculosis and its complications can be stabilized through known pharmacological treatment. However, the most effective measure to interrupt the transmission of the disease remains the early diagnosis and the provision of adequate treatment, with guidelines aimed at the cessation of harmful habits, such as smoking.
Análise da qualidade técnica de estudos de impacto ambiental em ambientes de Mata Atlantica de Santa Catarina: abordagem faunística
Marinez Eymael Garcia Scherer
- , 2011, DOI: https://doi.org/10.5007/2175-7925.2011v24n4p171
Abstract: Altera？？es nos componentes de um ecossistema levam a modifica？？es nas intera？？es ecológicas, sendo algumas vezes irreversíveis ou de grande magnitude, podendo ocasionar a perda de biodiversidade. Para controlar as altera？？es sobre os ecossistemas existem políticas públicas e instrumentos de controle e licenciamento dos usos e atividades humanas. Nesse trabalho realizou-se uma análise crítica aspectos referentes à fauna de cinco Estudos de Impacto Ambiental (EIAs) realizados no contexto do Bioma Mata Atlantica. Os resultados identificaram carências, tais como: (i) ausência de informa？？o sobre invertebrados terrestres; (ii) ausência da identifica？？o de áreas de reprodu？？o e alimenta？？o; (iii) identifica？？o superficial de fen？menos de migra？？o e de aspectos comportamentais; (iv) caracteriza？？o superficial das intera？？es ecológicas; (v) ausência da identifica？？o da estrutura das comunidades presentes e espécies-chave; e (vi) ausência da identifica？？o de bioindicadores. A maioria dos estudos de impacto ambiental n？o realiza um diagnóstico do meio biótico suficientemente adequado para subsidiar a posterior avalia？？o de impactos, e a avalia？？o de impactos ambientais n？o relaciona as intera？？es ecológicas com as interven？？es humanas resultantes do empreendimento/atividade analisado. Conclui-se, dessa forma, que o EIA é um instrumento que ainda pode ser bastante melhorado nas quest？es ecológicas analisadas, visando subsidiar o processo decisório
Neural Modulation of Hemiparetic Shoulder Pain by Repetitive Ultrasound-Guided Suprascapularis Nerve Block  [PDF]
Luigi Di Lorenzo,Santopadre Domenico
Open Journal of Anesthesiology (OJAnes) , 2013, DOI: 10.4236/ojanes.2013.33030
Abstract: Background: Neural blockade is widely used in clinical practice to alleviate acute or chronic pain, including pain during rehabilitation. To date there is little controlled evidence to confirm the efficacy of nerve blocks in hemiparetic shoulder pain after stroke. Design: This study is a prospective, open label, cohort trial reporting result from a cohort of stroke patients affected by shoulder pain. Aim: As a cohort study report, in which it is often firstly reported the possibility of an association between an observed effect and a specific environmental based on detailed clinical evaluations and histories, we aim to firstly provide clues in identifying Suprascapularis Nerve blockade as further valuable approach for shoulder pain after stroke. Population: We studied a cohort of patients affected by hemiparetic shoulder pain after Stroke. Methods: Our protocol foresees nerve blocks to be performed each 3 out of 4 days (treatment lasting 30 days) in conjunction with a rehabilitation program with the first aim to provide the window of opportunity to proceed with effective rehabilitation. 47 potential study subjects fulfilled the study criteria and were enrolled. Twenty-four subjects were randomised to the study Group to receive SSNB for the pain of their hemiparetic shoulder while 23 subjects randomized to the control Group whose member did not receive SSNB. They received serial blocks each 3 out of 4 days during rehabilitation.Results: Both treatment reported a reduction in the intensity of their shoulder pain, according to data collected from day 1 through day 42 (6 weeks). Study Group patients, receiving SSNBs, reported significant improvement from entry through the whole follow-up period. The efficiency data were higher for SSNB Group after 2 weeks and again for SSNb group at the end of treatment. Conclusion: Excellent pain relief was achieved in SSNB without clinically relevant complications, these patients having a better improvement on pain during rehabilitation, than the control subjects. Great efficacy has been achieved by combining a nerve block and rehabilitation. About Clinical Rehabilitation Impact, we believe that Suprascapularis nerve blocks can help the stroke survivors maintain an ambulatory or outpatient treatment status, maintain participation in a physical therapy or rehabilitation program, decrease the need for analgesics and in some cases lead to a complete pain relief.
Neural Modulation of Hemiparetic Shoulder Pain by Repetitive Ultrasound-Guided Suprascapularis Nerve Block  [PDF]
Luigi Di Lorenzo, Santopadre Domenico
Open Journal of Anesthesiology (OJAnes) , 2013, DOI: 10.4236/ojanes.2013.33030
Abstract:

Background: Neural blockade is widely used in clinical practice to alleviate acute or chronic pain, including pain during rehabilitation. To date there is little controlled evidence to confirm the efficacy of nerve blocks in hemiparetic shoulder pain after stroke. Design: This study is a prospective, open label, cohort trial reporting result from a cohort of stroke patients affected by shoulder pain. Aim: As a cohort study report, in which it is often firstly reported the possibility of an association between an observed effect and a specific environmental based on detailed clinical evaluations and histories, we aim to firstly provide clues in identifying Suprascapularis Nerve blockade as further valuable approach for shoulder pain after stroke. Population: We studied a cohort of patients affected by hemiparetic shoulder pain after Stroke. Methods: Our protocol foresees nerve blocks to be performed each 3 out of 4 days (treatment lasting 30 days) in conjunction with a rehabilitation program with the first aim to provide the window of opportunity to proceed with effective rehabilitation. 47 potential study subjects fulfilled the study criteria and were enrolled. Twenty-four subjects were randomised to the study Group to receive SSNB for the pain of their hemiparetic shoulder while 23 subjects randomized to the control Group whose member did not receive SSNB. They received serial blocks each 3 out of 4 days during rehabilitation.Results: Both treatment reported a reduction in

LOS FORMADORES DE PROFESORES: EL DESAFíO DE ENSE AR ENSE ANDO
María Gabriela Lorenzo
PROFESORADO , 2012,
Abstract: Un desafío de las investigaciones en Didáctica de las Ciencias Naturales reside en poder transformar o transponer aquellos conocimientos construidos en el ámbito de la investigación científica en alternativas o propuestas que puedan concretarse a nivel del aula. En este trabajo intentaremos mostrar como los aportes de las investigaciones en este campo nos pueden ayudar a desempe ar nuestra tarea docente con un alto grado de calidad y eficiencia. Organizamos esta presentación proponiendo un modelo para teorizar sobre la formación de los profesores de química, el BiPiT, que combina el triángulo químico con la propuesta del conocimiento didáctico del contenido. A lo largo de la misma iremos reflexionando sobre las estrechas relaciones entre la ense anza y el aprendizaje, planteando un ida y vuelta entre la didáctica de la química, la química y su ense anza.
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