Frequent Etiology Research Articles

Glomerular Diseases in the Colombian Caribbean

Our study aimed to describe the glomerular diseases, both primary glomerular disease (PGD) and secondary glomerular disease (SGD) in the Colombian Caribbean based on the first regional Colombian Nephropathy Registry (NEFRORED®). A descriptive and retrospective study of adult patients with glomerular diseases from the Colombian Caribbean region was made. All diagnoses by renal biopsy with light microscopy and immunofluorescence obtained between January 2008 and June 2018 were recorded. Eight hundred and seventy-one renal biopsies were obtained. The main clinical indication for biopsy was nephritic syndrome (36%). SGD was more frequent than PGD (55% vs. 45%). Within SGD group, lupus nephritis (LN) was the most frequent etiology (83%). Within PGD group, membranous nephropathy (33%) and focal segmental glomerulosclerosis (FSGS) (19%) were the most common glomerular diseases. At a 24-month follow-up, the patients with FSGS and paraproteinemia-mediated glomerular disease had the worst renal survival prognosis. This is the first Colombian Nephropathy Registry in a Caribbean population, demonstrating a high predominance of SGD due to LN.

Subcutaneous intracardiac defibrillator (s-icd): the better icd-alternative in athletes with arrhythmogenic risks?

Sudden Cardiac Arrest (SCA) is the leading cause of sudden death (SCD). In athletes under 35 years, SCA is believed to be mostly arrhythmogenic and often due to an underlying structural or electrical pathological heart condition, whereas coronary atherosclerosis is the most frequent aetiology of SCA among athletes above 35 years. Implantable Cardioverter Defibrillators (ICDs) with a transvenous lead are the therapy of choice for individuals at risk of SCD in both primary and secondary prevention. It bears the risk of lead-associated complications (fracture, dislocations, infection), which occur significantly more often in physically active patients like athletes. Considering these limitations,a completely subcutaneous ICD (S-ICD) system was designed to provide the life-saving benefit of the conventional TV-ICD, while avoiding the shortcomings of TV-lead ICD systems. Randomized comparison of S-ICD versus traditional TV-ICD sconfirmed S-ICD systems as a valid alternative in patients in whom bradycardia pacing or cardiac resynchronization therapy is not required. Because lead complications are associated with physical activity level (i.e. chest/shoulder/upper arm), S-ICD is the better ICD-therapy not only in young patients with an anticipated long-term need for defibrillation function but also in athletes.

POS-123 Determinants of Outcome in Crescentic Glomerulonephritis: A Retrospective Study of 78 patients from Tunisia, North Africa

Crescentic glomerulonephritis is a rare but severe disease. It is responsible for acute kidney injury which is potentially fatal mostly when associated with pulmonary haemorrhage. We evaluated in this study the outcomes of Tunisian patients with crescentic glomerulonephritis. Seventy-eight patients were consecutively diagnosed by kidney biopsy from January 2000 till Avril 2016 and followed for a median period of 230 days [2;1825 days]. Study endpoints were a response to therapy, end-stage renal disease (ESRD) and death. The median age of our patients was 49,6 years. The sex ratio was 1,5. Rapidly progressive renal insufficiency was present in all patients with the necessity of acute dialysis for 47,29% of patients. The pulmonary signs were the most frequent extrarenal manifestations. Hemorragic alveolitis was present in 16,7%. Anaemia and high white cells were observed respectively in 66% and 33,33% of patients. The most frequent etiologies of crescentic glomerulonephritis were ANCA associated glomerulonephritis objective in 50 patients, postinfectious glomerulonephritis in 12 patients and anti-glomerular basement membrane disease in 6 patients. Treatment was based on corticosteroids and cyclophosphamide. Eighteen patients were dead. Remission was observed in 37,83%. Renal failure was objective in 37,83%. The predictor factors of renal failure were old age, anaemia, high white cells, thrombocytosis, erythrocyte sedimentation rate, the percentage of crescents, cellular and fibrous crescents and interstitial fibrosis. The factors associated with mortality were the time between the apparition of symptoms and the instauration of treatment, the pulmonary injury, anaemia, high systolic hypertension and dialysis at presentation. The current report highlights the outcome of crescentic glomerulonephritis independently to their aetiology. Early diagnosis and treatment are essential for better outcomes.

A systematic review and meta-analysis of factors involved in bone flap resorption after decompressive craniectomy.

Decompressive craniectomy (DC) is effective in controlling increasing intracranial pressure determined by a wide range of conditions, mainly traumatic brain injury (TBI) and stroke, and the subsequent cranioplasty (CP) displays potential therapeutic benefit in terms of overall neurological function. While autologous bone flap (ABF) harvested at the time of DC is the ideal material for skull defect reconstruction, it carries several risks. Aseptic bone flap resorption (BFR) is one of the most common complications, often leading to surgical failure. The aim of our study was to systematically review the literature and carry out a meta-analysis of possible factors involved in BFR in patients undergoing ABF cranioplasty after DC. A systematic review and meta-analysis was performed in accordance with the PRISMA guidelines. Different medical databases (PubMed, Embase, and Scopus) were screened for eligible scientific reports until April 30th 2021. The following data were collected for meta-analysis to assess their role in BFR: sex, age, the interval time between DC and CP, the presence of systemic factors, the etiology determining the DC, CP surgical time, CP features, VP shunt placement, CP infection. Studies including pediatric patients or with less than 50 patients were excluded. Fifteen studies were included. There was a statistically significant increased incidence of BFR in patients with CPF > 2 compared to patients with CPF ≤ 2 (54.50% and 22.76% respectively, p = 0.010). TBI was a significantly more frequent etiology in the BFR group compared to patients without BFR (61.95% and 47.58% respectively, p < 0.001). Finally, patients with BFR were significantly younger than patients without BFR (39.12 ± 15.36years and 47.31 ± 14.78years, respectively, p < 0.001). The funnel plots were largely symmetrical for all the studied factors. Bone flap fragmentation, TBI etiology, and young age significantly increase the risk of bone resorption. Further studies are needed to strengthen our results and to clarify if, in those cases, a synthetic implant for primary CP should be recommended.

Cerebral border zone infarctions: An etiologic study

Background: Cerebral border zone infarctions (BZIs) are a subtype of acute ischemic stroke that occur at the junction between two major cerebral arterial territories. Internal and external BZIs are defined based on the known patterns in brain magnetic resonance imaging (MRI). However, the etiology and pathophysiology of these two types of BZI are still debated. This study aimed to determine the etiologic differences of two types of BZI to guide tailor appropriate treatment strategies for these patients. Methods: In this prospective study, patients with BZIs were enrolled from patients with acute ischemic stroke admitted to the hospitals affiliated with Tabriz University of Medical Sciences, Tabriz, Iran, from 2017 to 2019. Appropriate clinical and laboratory workups were applied to determine possible etiologies of ischemic stroke according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification system. Results: The study included 106 patients with BZI, 53 patients in each group. Both types of BZI were more frequent in males. However, there was no significant difference between the two types concerning sex, age, and profile of major stroke risk factors. The results showed no correlation between the type of BZI and hemodynamic factors (P = 0.086). However, large artery atherosclerosis (LAA) was the most frequent etiology within each subtype of BZI; LAA in internal (P = 0.016) and cardioembolism (P = 0.046) in external BZI were more frequent etiologic subtypes of cerebral infarction. Conclusion: LAA might be the most common etiology for internal and external cerebral BZIs. Cardioembolism might have a more important etiologic role in the external subtype.

Infectious Spondylodiscitis in the Elderly in a Rheumatological Setting in Togo

Infectious spondylodiscitis in the elderly is a diagnostic and therapeutic emergency. They are mainly a functional and sometimes vital prognosis issue, with long-term chronic disabling sequelae and significant social costs. Study aim: To describe the epidemiological, clinical, paraclinical, therapeutic and evolutionary aspects of infectious spondylodiscitis in the elderly in a rheumatological setting in Togo. Patients and methods: This was a multicenter, cross-sectional study conducted on the records of patients aged at least 65 years, suffering from infectious spondylodiscitis and hospitalized in four rheumatology units from their respective opening dates till December 31, 2020. Data collection lasted three months (December 1, 2020 to February 29, 2021). The diagnosis of infectious spondylodiscitis was radioclinical and laboratory-based. Results: 83 (49 women, 34 men) of the 1281 patients (6.48%) examined had infectious spondylodiscitis. The mean age at consultation was 70.59 ± 5.09 years, and the mean duration of the clinical course was 12 months. Spondylodiscitis was of tuberculous etiology (89.20%). It was most often found in the lumbar (56.62%) and dorsal (21.69%) segments. The location was multifocal in 12.05% of cases. It was associated with pulmonary involvement in 22.64% of cases. A neurological complication was identified in 48.19%. The main risk factors identified were promiscuity (48.82%), chronic alcoholism (18.07%), HIV infection (8.43%), diabetes (6.03%) and sickle cell disease (6.03%). The clinical course under medical treatment was favorable in 57 patients (68.68%). Conclusion: Infectious spondylodiscitis remains a frequent reason for hospitalization, tuberculosis being the most frequent etiology. Multifocal location, deterioration of general condition, gibbosity and neurological complications are exclusive to the elderly subject.

Screening for hypertension-mediated organ damage and aetiology: Still of value after 65 years of age?

Pathophysiological aspects and the consequences of hypertension may differ between younger and older patients. The aim of the present study was to explore the specificity of hypertension-mediated organ damage (HMOD) and secondary forms in patients ≥ 65 years in comparison to younger ones in a contemporary cohort. A total of 938 hypertensive patients who had at baseline HMOD and secondary forms screening were included among them 190 were ≥ 65 years. The mean ± SD number (2.1 ± 0.8 vs. 1.2 ± 0.9, P < 0.001) and frequency of HMOD (96.3% vs. 72.9%, P < 0.001) was higher in patients ≥ 65 years than younger ones. Carotid femoral pulse wave velocity > 10 m/s was the most frequent HMOD in patients ≥ 65 years (90.1%), while echocardiographic left ventricular hypertrophy was the most common in the younger patients (45.0%). Among ECG left ventricular ECG indexes, only R wave in aVL lead was significantly more frequently observed in patients ≥ 65 years (32.6%) than in younger ones (19.0%, P < 0.001). The frequency of secondary hypertension was not significantly different between younger and older patients (respectively; 30.5% vs. 27.8%, P = 0.487). The most frequent aetiology was primary aldosteronism regardless of age. The frequency of renovascular hypertension was higher in patients ≥ 65 years (6.3% vs. 3.3%, P = 0.038). Among older patients, 3.2% were treated with adrenalectomy (primary aldosteronism or Cushing syndrome) and 6.3% with percutaneous transluminal renal angioplasty. In a tertiary centre, secondary forms of hypertension have a similar frequency in both subgroups. Extensive screening of HMOD in patients aged ≥ 65 years may be questionable because of its very high frequency.

Direct costs of hospital care of heart failure at cardiology institute of Abidjan

To evaluate the direct cost of hospitalization for heart failure (HF) at Institut de Cardiologie d’Abidjan. From December 1, 2019 to June 30, 2020, we conducted a prospective study on a sample of 150 patients hospitalized in the medicine department of Institut de Cardiologie d’Abidjan. 150 patients hospitalized for HF were included in our study. 61% of the patients were male. The mean age was 54.5 ± 17.2 years. Nearly 40% of our patients had a monthly income of less than 60,000 CFA Francs. The majority of patients did not have health insurance, 83.3%. Most of our patients were admitted with NYHA stages III and IV (32% and 56%). Dilated cardiomyopathy (42.7%) was the most frequent etiology. As regards the economic aspect, the average direct cost per patient for the management of heart failure in our study was estimated at 490,500.8 CFA Francs with extremes of 74,414 and 1,512,857 CFA Francs and the cost of the paraclinical assessment occupied an important part (211,130 CFA Francs) (43%). This cost increased with male sex, low monthly income, NYHA stage, ischemic heart disease and the occurrence of death but without any statistically significant relationship. The cost of treating heart failure is high in our country, where the guaranteed minimum wage is 60,000 CFA Francs. This suggests that a policy should be implemented to identify and treat the risk factors of the pathology among people at risk and to put in place a good system of health insurance and mutual health insurance in Côte d’Ivoire.

Etiology and Secular Trends in Primary Amenorrhea in 856 Patients: A 17-Year Retrospective Multicenter Study in Korea.

BackgroundThis study was performed to evaluate etiologies and secular trends in primary amenorrhea in South Korea.MethodsThis retrospective multi-center study analyzed 856 women who were diagnosed with primary amenorrhea between 2000 and 2016. Clinical characteristics were compared according to categories of amenorrhea (hypergonadotropic/hypogonadotropic hypogonadism, eugonadism, disorders of sex development) or specific causes of primary amenorrhea. In addition, we assessed secular trends of etiology and developmental status based on the year of diagnosis.ResultsThe most frequent etiology was eugonadism (39.8%). Among specific causes, Müllerian agenesis was most common (26.2%), followed by gonadal dysgenesis (22.4%). Women with hypergonadotropic hypogonadism were more likely to have lower height and weight, compared to other categories. In addition, the proportion of cases with iatrogenic or unknown causes increased significantly in hypergonadotropic hypogonadism category, but overall, no significant secular trends were detected according to etiology. The proportion of anovulation including polycystic ovarian syndrome increased with time, but the change did not reach statistical significance.ConclusionThe results of this study provide useful clinical insight on the etiology and secular trends of primary amenorrhea. Further large-scale, prospective studies are necessary.

Postpartum Hemorrhage; Incidence and Prognosis

During the study period a total of 1000 deliveries; 74 parturients presented with PPH, an incidence of 7.4% [95% CI 6.3-6.5] with that of severe PPH at 2.7% [95% CI 1.6-1.8]. maternal age varied between 30 and 42 years. The average age in our sample was: 34.33 ± 6.030 years. Mean term: 38.69 ± 1.25 weeks gestation mean was 3.8 ± 1.6. The oldest parity was 3.2 ± 2 with extremes of 1 and 8. 73.7% were multiparous (2 deliveries and more). RBC transfusion was done in 97.5%. Oxytocics were administered in 95.8%. Uterine inertia following a placentation anomaly (accreta, increta and percreta) remains the most frequent etiology in 79.8%, and coagulation disorders 15.2% (congenital or acquired) and 5% of entangled causes (ATCD from Covid19, death in utero, help ). As for the mode of delivery, the upper route is the most frequent with 70% of cases RBC transfusion was done in 97.5%. Oxytocics were administered in 95.8%. Uterine revision was performed in 80.6%. , artificial delivery was done in 26.4%. Vascular ligation was done in 20.8%. Hemostatic hysterectomy was required in 19.4%. Hospitalization in the maternal intensive care unit was necessary in 70.9% with an average duration of 3.5 days. There were 73% cases of disseminated intravascular coagulation (DIC), 50% renal failure (IR) of which two were hemodialysis. The death rate was 18%. Three risk factors associated with a poor maternal prognosis: severe hypovolaemia (p = 0.0001), disseminated intravascular coagulation abnormalities (p = 0.006) and organic renal failure (p = 0.0013).

Etiological profile of peripheral neuropathies in an academic hospital in southern Morocco

BackgroundPeripheral neuropathies constitute a common complaint in general and neurology practice, and are a source of handicap to patients. Epidemiological data in the Middle East and North Africa region as well as in the African continent are sparse. Nevertheless, regional etiological profiles are crucial in navigating the diagnostic maze of neuropathies. This study outlines the etiological profile of peripheral neuropathies in an academic hospital in southern Morocco.ResultsA total of 180 cases were recorded in a span of 8 years (22.5 cases per year). The mean age of patients was 42.35 years. Male gender was predominant (68.88%), with a sex ratio of 2.2. Motor symptoms were the most frequently reported (86.6%). The axonal form (40.56%) was the most frequently encountered electrophysiologic form. The most frequent etiologies in the study were diabetes (26.7%), acute polyradiculoneuropathy (26.1%) and amyotrophic lateral sclerosis (16.1%). Alcohol neuropathy was found in 2.2% of the cohort. No cause was found in 5% of cases. Outcome was mostly favorable under treatment, although 10 deaths due to acute polyradiculoneuropathy were recorded (mortality = 21.3%).ConclusionsKnowledge of the etiological profile of peripheral neuropathies should guide clinicians to an early diagnosis and aid in an adapted management of patients.

The prognostic significance of the discordance between right- and left-side filling pressures in advanced heart failure: Data from the right heart catheterization registry of rajaie heart center (RHC-RHC Registry)

Introduction: The prognostic significance of filling pressures and the relationship between left and right heart filling pressures have been well characterized in patients with heart failure. In the present study, we sought to evaluate the prevalence of discordance between left- and right-sided filling pressures and their relationship with clinical characteristics, laboratory data, and outcome measures (mortality and heart transplantation) in patients who were registered in right heart catheterization registry of Rajaie Heart Center (RHC-RHC registry). Methods: The hospital information system was queried for all adult patients with diagnosis of chronic heart failure who had undergone right heart catheterization between July 2009 and July 2019 in heart failure and transplantation department. The following variables were measured for each patient: mean right atrial pressure; systolic and end-diastolic right ventricular pressures; systolic, diastolic, and mean pulmonary artery pressure; pulmonary capillary wedge pressure (PCWP); mixed venous oxygen saturation; and cardiac output and cardiac index by Fick technique. The RAP/PCWP ratio was also calculated. The outcome of interest was all-cause mortality and heart transplantation after the index right heart catheterization. All of the patients were monitored for all-cause mortality or heart transplantation until July 2020. Results: Among 1941 patients, a total of 1078 patients (75% male) were selected. The mean (standard deviation) of age was 42.7 (15.7) years. Heart failure reduced ejection fraction (HFREF) was found in the majority of patients (85.1%), with nonischemic dilated cardiomyopathy and ischemic cardiomyopathy being the most frequent etiologies. The concordance between right and left filling pressures is more noticeable in patients with HFREF and heart failure mildly reduced EF than in patients with heart failure preserved EF (HFPEF). The median (interquartile range) of follow-up duration was 24 (6–48) months. During the follow-up time, 676 (62.7%) patients met the study outcomes of interest within <5 days to 96 months following the index RHC. Conclusion: The results of this study show that right and left filling pressure may be discordant in up to one-third of patients with advanced heart failure. However, the right and left heart-filling pressures would be more concordance as the disease is more advanced.

CAUSES OF DECOMPENSATION IN HOSPITALIZED CIRRHOTIC PATIENTS

Decompensation of liver cirrhosis represents a turning point in the prognosis of cirrhotic patients presenting more complex medical needs that can lead to a prolonged hospital stay and a significant risk of in-hospital death. Likewise, mean survival decreases from 12 years for compensated cirrhosis to almost two years for decompensated cirrhosis. Apica BS et al. (2013) reported ascites as the most frequent cause of decompensation in 95.3% cases in the African population. On the other hand, the Colombian study of Sanchez (2016) conducted with the Latin population indicates as the leading cause of decompensation ascites (36.1%), variceal bleeding (28.4%). Unfortunately, in Mexico, we do not have data indicating the most frequent cause of decompensation in hospitalized patients. Therefore, knowing the frequency and most common causes of decompensation will direct prevention and timely treatment strategies. Objective: To determine the cause and prevalence of liver cirrhosis decompensation in patients admitted to the Hospital General de México. Observational, descriptive, retrospective study, Inpatients, hospitalized in the Gastroenterology Service of the General Hospital of Mexico "Dr. Eduardo Liceaga" with a diagnosis of liver cirrhosis, during the period from March 2019 to March 2021. The results were analyzed by descriptive statistics, frequency measures, and measures of central tendency (to obtain percentages, mean and average). We reviewed 454 records of patients diagnosed with liver cirrhosis with an average age of 59 years with a range of 18-75 years, predominantly male 59.25%. The most frequent etiology was alcohol in 44.71%, followed by non-alcoholic steatohepatitis 9.91%, autoimmune causes 7%, and viral (hepatitis B and C) 3.30%; however, up to 31.7% the etiology cannot be determined. According to the Child-Pugh classification, the predominant one was C up to 53.96%. The most frequent decompensation was gastrointestinal bleeding with 52.64%, of which 47.57% were of variceal origin, acute kidney injury with 50%, hepatic encephalopathy 46.03%, and ascites 40.96%. It should be noted that 15.19% presented acute on chronic hepatic failure, and 11.23% toxic-alcoholic hepatitis: less frequently hyponatremia 8.37%, spontaneous bacterial peritonitis (SBP) 7.92%, hepatorenal syndrome 1.98%, and hepatopulmonary syndrome 1.10%. See table 1. In this study, the most frequent cause of decompensation was variceal bleeding, which differs from that reported in the literature in previous studies; however, this may be because the study population attends assessment in advanced stages of the disease and sometimes in the terminal phase to receive specialized care. The authors declare that there is no conflict of interest.

Effect of sacubitril/valsartan in Moroccan patients with Chronic Heart Failure

Chronic heart failure became more frequent in Moroccan patients. The aim of our study is to determinate the benefit of saccubitril/valartan in patients with chronic heart failure. It's a prospective study included 80 patients with chronic heart failure with reduced ejection fraction (HFrEF), admitted in Cardiac Rehabilitation unit, Cardiology centre, Mohammed V Military Hospital of Rabat, Morocco. All of them had clinical evaluation, echocardiography and cardio respiratory capacities evaluation. The average age of patients was 68,43 ± 8,4 years with male predominance, they have more than three cardiovascular risk factors dominated by smoking and hypertension, coronary artery disease is the most frequent etiology, they had reduced ejection fraction (EF: 34 ± 7,2%). After 20 sessions of exercise training and therapeutic education specially optimisation of treatment by introducing precociously of saccubitril/valsartan and increasing doses gradually along the program, patients have a good quality of life, they become less symptomatic (dyspnea class III to II of NYHA); they significantly improve maximal work load (from 55, 6 ± 11,9 to 67, 2 ± 21,8 watt) and VO2max (from 13,1 ± 5,1 to 19,4 ± 7,4 ml/kg/min) This study demonstrated that exercise training and optimisation of treatment specially saccubril/valsartan is clearly benefit for patients with chronic heart failure to improve their exercise capacities and quality of life.

Spontaneous spinal cord infarction in Austria: a two-center comparative study.

Background:Spinal cord infarction (SCI) is a neurological emergency associated with high rates of persistent neurological deficits. Knowledge about this rare but potentially treatable condition needs to be expanded.Objective:To describe the characteristics of spontaneous SCI in a large retrospective series of patients treated at two tertiary care centers in Austria.Methods:We performed a descriptive and comparative analysis of spontaneous SCI treated at the University Hospitals of Salzburg and Graz between the years 2000 and 2020. The analysis included pre- and in-hospital procedures, clinical presentation, etiology, diagnostic certainty, reperfusion therapy, and functional outcome at discharge.Results:We identified 88 cases, 61% were ascertained in the second half of the study period. The median age was 65.5 years [interquartile range (IQR) = 56–74], 51.1% were women. Anterior spinal artery infarction was the predominant syndrome (82.9%). Demographics, vascular comorbidities, and clinical presentation did not differ between the centers. The most frequent etiology and level of diagnostic certainty were distinct, with atherosclerosis (50%) and definite SCI (42%), and unknown (52.5%) and probable SCI (60%) as front runners in Salzburg and Graz, respectively. Patients arrived after a median of 258.5 min (IQR = 110–528) at the emergency room. The first magnetic resonance imaging (MRI) of the spinal cord was performed after a median of 148 min (IQR = 90–312) from admission and was diagnostic for SCI in 45%. Two patients received intravenous thrombolysis (2.2%). The outcome was poor in 37/77 (48%).Conclusion:Demographics, clinical syndromes, and quality benchmarks for spontaneous SCI were consistent at two Austrian tertiary care centers. Our findings provide the foundation for establishing standards for pre- and in-hospital care to improve outcomes.

Neurological infection by chikungunya and a triple Arbovirus co-infection in Mato Grosso, Central Western Brazil during 2019.

Neurological viral infection is frequently associated to enterovirus, herpesvirus and arboviruses. These infections may cause severe clinical outcomes, long lasting sequelae or death. Few studies have addressed viral neurological infections etiology in Brazil. Identification of viruses in the cerebral spinal fluid (CSF) of human neurological infections suspected of viral etiology during January and May 2019 in Midwestern Brazil. Clinical, laboratory and epidemiological information was gathered from medical records. In addition, an aliquot of the sampled CSF was subjected to viral RNA/DNA extraction, randomic dscDNA amplification by PCR, DNA purification and Ilumina HiSeq 2500 sequencing. Six viral genomes belonging to Chikungunya virus (CHIKV) East-Central-South African (ECSA) genotype (10.834-11.804nt in length) confirmed lately by RT-PCR for CHIKV envelope were present in all six liquor samples. These genomes present two mutations, nsP2:T31I and nsP3:A388V, shared with other Mato Grosso State strains from 2019, not present in sequences of the virus from previous years obtained in the State. One case was a triple co-infection also confirmed through RT-PCR, with Dengue virus serotype 4 genotype II (NS5; 874nt) and Oropouche virus genotype IA (segment S; 302nt). CSF was clear and colorless (5/6 patients), with >10% of lymphomononuclear cells (6/6), 1-99erythrocytes/mm3 (5/6), glucose levels >50mg/dl (4/5) e>10mg/dl of proteins (4/4). One patient evolved to death, and another, a newborn, presented sequelae after recovery. Despite herpesviruses and enteroviruses are frequent etiologies of neurological infections, the casuistic here reported was associated to arboviruses already known to be responsible for acute febrile illness outbreaks in the state of Mato Grosso, Midwestern Brazil.

Severity of gastrointestinal bleeding is similar between patients receiving direct oral anticoagulants or vitamin K antagonists.

Gastrointestinal bleeding (GIB) is a common adverse event related to anticoagulation therapy. However, evidence comparing the severity, etiology and outcome of GIB in patients taking direct oral anticoagulants (DOAC) vs. vitamin K antagonists (VKA) is scarce. To evaluate the severity, etiology and outcomes of GIB in patients under DOACs compared to VKA. Patients under oral anticoagulant therapy admitted to the emergency department with acute GIB were prospectively recruited from July 2016 to January 2018 at a tertiary referral hospital. Demographic and clinical outcome were obtained from medical records. Severity of the GIB event was classified as mild, major or severe according to clinical presentation and the type of support needed. Etiology and location of bleeding, number of packed red blood cells transfused (PRBC) and length of hospital stay were recorded until discharge or in-hospital death. A total of 208 patients with acute GIB under oral anticoagulant treatment were recruited: 119 patients were on VKA and 89 patients on DOAC with similar characteristics. Thirty-one patients had severe GIB; 134 major and 43 mild, with no differences in severity, number of PRBC and length of hospital stay between the groups. Peptic disease was the most frequent etiology of GIB in patients on VKA (20.2 % vs. 13.6%, p=0.20). Diverticular bleeding was the most frequent adverse event in patients on DOAC (14.3% vs. 24.8%, p= 0.056). Severity and clinical outcomes of GIB are similar between patients on DOAC and patients on VKA, regardless of etiology of GIB.

Acute interstitial nephritis: clinical presentation and diagnosis

Acute interstitial nephritis is characterized by renal inflammation and interstitial edema. The clinical presentation is pauci-symptomatic and often non-specific. Acute interstitial nephritis typically presents with acute renal failure, alone or with fever, eosinophilia, hematuria, sterile pyuria and small range proteinuria. An early diagnosis is crucial to prevent the morbidity and mortality associated with renal function decline. The most frequent etiology of this disease is drug-induced. A kidney biopsy is not systematically required to establish the diagnosis. It should be considered in the absence of renal function improvement 5 to 7 days after withdrawal of the causal agent. Although the benefits of glucocorticoid treatment have not been proven to date, its use may be associated with a better kidney function recovery.

Liver transplantation in the Intensive Care Unit: twenty years experience in a center medium income on Peru

Liver transplantation is the major treatment for end-stage liver disease. Postoperative care is a great challenge to reduce morbidity and mortality in patients. In this sense, management in the liver ICU allows hemodynamic management, coagulation monitoring, renal support, electrolyte disturbances, respiratory support and early weaning from mechanical ventilation and evaluation of the liver graft. Objective: The present study shows the results of the management of liver transplant patients in 20 years of experience in a transplant center in a low- to middle-income country. Materials and methods: The medical records of 273 adult patients in the ICU in the immediate postoperative liver transplant were reviewed, from March 20, 2000 to November 30, 2020, including the effect of the pandemic caused by COVID-19. Liver-kidney, retransplanted, SPLIT, and domino transplant patients were excluded. Results: The most frequent etiology for LTx was NASH (35%), the mean age was 49 years, MELD Score ranged 15 - 20 (47.5%), 21 - 30 (46%) &gt; 30 (6.2%). ICU pre transplant stay 7%, average ICU stay: 7.8 days. APACHE average admission: 14.9 points. Weaning extubation of 91.8% patients in ICU and Fast Track in 8.2%. The most frequent respiratory complication was atelectasis 56.3%, pneumonia (31.3%); AKI 1 (60.9%), and 11.1% with hemodyalisis support (AKI3). Immunosuppression: Tacrolimus (8.9%). Post-operative ICU mortality was 6.2%. Conclusions: The management of liver transplantation in the ICU is essential to achieve optimal results in patients who present advanced liver disease and require advanced life support in the immediate postoperative period and thus optimize graft survival.

Cirrhosis etiology trends in developing countries: Transition from infectious to metabolic conditions. Report from a multicentric cohort in central Mexico

Cirrhosis is a public health threat associated with high mortality. Alcoholic Liver Disease (ALD) is the leading cause in Latin America and Metabolic Associated Fatty Liver Disease (MAFLD) in western countries. In Mexico, ALD and chronic Hepatitis C Virus infection (HCV) were the most frequent aetiologies during the past decades. We aimed to describe the trends in the aetiologies of cirrhosis in a middle-income country. We performed a retrospective cohort study including patients diagnosed with cirrhosis between 2000 and 2019 from six different tertiary care hospitals in central Mexico. We collected information regarding cirrhosis etiology, year of diagnosis, hepatocellular carcinoma development, liver transplantation, and death. We illustrated the change in the tendencies of cirrhosis aetiologies by displaying the proportional incidence of each etiology over time stratified by age and gender, and we compared these proportions over time using chi square tests. Overall, 4,584 patients were included. In 2019, MAFLD was the most frequent cirrhosis etiology (30%), followed by ALD (24%) and HCV (23%). During the study period, MAFLD became the leading etiology, ALD remained second, and HCV passed from first to fourth. When analysed by gender, ALD was the leading etiology for men and MAFLD for women. The annual incidence of HCC was 3·84 cases/100 persons-year, the median survival after diagnosis was 12·1 years, and seven percent underwent LT. Increased alcohol consumption and the obesity epidemic have caused a transition in the aetiologies of cirrhosis in Mexico. Public health policies must be tailored accordingly to mitigate the burden of alcohol and metabolic conditions in developing countries. None.