Einstein-Sao Paulo最新文献

Pseudomyogenic hemangioendothelioma is an ultra-rare vascular sarcoma that most commonly affects young adults, with a male predominance. It is diagnosed using a combination of imaging studies, histopathological examinations, and immunohistochemical staining. Surgical excision is the mainstay of treatment for pseudomyogenic hemangioendothelioma, with the goal of achieving a wide local excision and reducing the risk of recurrence. The role of systemic therapies is not well established because of the rarity of pseudomyogenic hemangioendothelioma, uncertainty regarding its response to currently approved medications, and lack of randomized controlled trials. We describe the case of an 18-year-old male patient diagnosed with multifocal pseudomyogenic hemangioendothelioma of the left lower limb who was treated with everolimus in addition to denosumab, achieving a partial response that was consolidated with resection, radiofrequency ablation, and radiotherapy of multiple local lesions, achieving a long-lasting response. Following subsequent disease progression, the patient responded favorably to pazopanib, with no significant toxicities.

Objective: This study compared the outcomes of two cohorts of patients with coronavirus disease 2019 (COVID-19) who received COVID-19 convalescent plasma transfusions between 2020 and 2021.

Methods: This retrospective study was conducted at a tertiary hospital in São Paulo, Brazil. We included a retrospective cohort of patients who received convalescent compassionate plasma, and another group of patients from a previous clinical study. We collected clinical and laboratory data on the day of and 5 days after transfusion. Patients with hematological or immunological conditions were excluded. Statistical significance was set at p<0.05.

Results: COVID-19 convalescent plasma did not affect the outcomes of patients with severe COVID-19 when comparing the two cohorts transfused with different volumes and titers of neutralizing antibodies. Despite improvements in some laboratory parameters, no effect on clinical outcomes was observed. Dialysis negatively affected the length of intensive care unit stay, hospitalization, and mechanical ventilation use. Each higher point on the day 0 World Health Organization scale reduced the probability of hospital and intensive care unit discharge and the risk of mechanical ventilation discontinuation.

Conclusion: Dialysis and the assessed clinical severity represented by the World Health Organization scale on day 0 influenced the outcomes, whereas COVID-19 convalescent plasma transfusion did not.

We report a case of computed tomography-guided percutaneous radiofrequency ablation of a bleeding renal angiomyolipoma. Radiofrequency ablation was performed as an alternative to partial nephrectomy and super-selective renal artery embolization for ruptured renal angiomyolipoma with slow persistent bleeding in a patient with elevated serum creatinine levels and other comorbidities. Computed tomography-guided radiofrequency ablation successfully stopped the active hemorrhage and did not affect long-term renal function during the 3-year follow period. No complications were associated with the procedure. Radiofrequency ablation of a bleeding renal angiomyolipoma may be considered a more invasive surrogate procedure in an urgent setting; however, further studies are necessary to evaluate the long-term benefits of this approach and its overall impact on renal function compared to traditional methods.

Objective: This study aimed to estimate the direct costs of peripherally inserted central catheterization by nurses for hospitalized patients.

Methods: A cost estimation study using a quantitative approach was conducted in a public teaching hospital in northern Paraná to calculate the direct costs of peripherally inserted central catheterization. The population included all medical records of patients between 15 and 99 years of age who were hospitalized and underwent peripherally inserted central catheterization by nurses between January 1, 2019, and December 31, 2021, totaling 664 insertions. The sample comprised 631 insertions.

Results: The catheter kits (epicutaneous catheter + introducer + angulators) corresponded to the items with the highest unit costs and the greatest impact on the composition of costs. The cost of peripherally inserted central catheterization was US$ 217.14 (SD=75.21), with the cost of materials and staff's labor being US$ 195.39 (SD=74.15) and US$ 20.00 (SD=2.22), respectively.

Conclusion: Materials represented the highest cost, which was explained by the high unit cost of catheters and kits used in echocardiography, followed by the staff's labor costs. The estimated average direct cost allowed for financial visibility of the inputs used. The key challenge is promoting lasting changes in the behavior of managers who carry out administrative functions in healthcare institutions, where proper budget management directly affects the allocative efficiency of resources and the quality of care.

Spontaneous non-aneurysmal aortic rupture is rare and is usually attributed to penetrating aortic ulcers, infections, tumor infiltrations, or inflammatory and collagen diseases. Chronic rupture is infrequent but extremely rare in non-aneurysmal aortas, which makes diagnosis difficult because the absence of an aneurysm can mislead the physician to rule out rupture. Here, we describe the case of an 85-year-old male, who was undergoing oncological investigation for weight loss, inappetence, and back pain. Computed tomography and magnetic resonance imaging performed 3 months before admission showed a contained pseudoaneurysm of the infrarenal aorta associated with significant aortoiliac calcification and images suggestive of peritoneal implants. The patient was referred to our oncological center and underwent abdominal computed tomography for oncological investigation and staging. The patient was urgently admitted to the intensive care unit after a critical finding of contained rupture of the infrarenal aorta during the scan. Endovascular repair was indicated, and the patient was successfully treated with implantation of an Endurant IIs 25 × 25 × 70 mm endoprosthesis. No procedural complications were observed. Postoperative course was uneventful, and the patient was discharged on the fifth postoperative day. Control computed tomography performed 1 and 6 months after surgery showed no leaks. This case emphasizes the importance of communication between the radiologists and attending physicians. As the rupture was punctual and well defined in the computed tomography and angiography images, endovascular repair with an aortic cuff was safely performed, and the procedure time was reduced.

Purulent pericarditis is rare condition in the modern era of antibiotics. However, it is a serious condition as it has an accelerated progression and is difficult to diagnose due to its nonspecific clinical presentation, resulting in high mortality. Herein, we present a case in which a 36-year-old male patient with otherwise unremarkable medical history developed abdominal sepsis complicated by purulent pericarditis post-appendectomy. While the initial clinical presentation was not compatible with the classic signs of purulent pericarditis, the diagnosis was made using electrocardiography (ST elevation/PR depression) and point-of-care ultrasonography (pericardial effusion). The condition was successfully managed with pericardial drainage and broad-spectrum antibiotics. The present case reinforces and reiterates the need for high diagnostic suspicion and careful clinical reasoning in the diagnosis of purulent pericarditis. Furthermore, it highlights the applicability of point-of-care ultrasonography in the diagnosis of the same.

Hemangiomas are benign congenital vascular tumors that commonly arise in the head and neck regions. Although they present with indolent growth and involution in most cases, they can cause facial deformities. Hemangiomas have three subtypes: capillary, cavernous, and mixed. The cavernous type is most commonly observed on the lateral wall of the nose or the inferior turbinate. This report describes a case of cavernous hemangioma diagnosed in a rare location in the left retromaxillary masticatory space in a 67-year-old woman. Total excision of the lesion was performed with surgical treatment through the Caldwell-Luc access. Anatomopathological and immunohistochemical examinations suggested a malformative vascular lesion with a cavernous hemangioma pattern and without signs of malignancy.

Objective: To study the efficacy of tranexamic acid at reducing bleeding during bipolar prostate resection surgery (B-TURP) in patients with benign prostatic hyperplasia.

Methods: We searched registers with MESH terms "prostate hyperplasia," "prostate surgery," and "tranexamic acid." Studies available in full and online, published from 2013 to 2023, in Portuguese, English, Spanish, and French were included; review articles were excluded. Information sources: Portal Regional da Biblioteca Virtual em Saúde and PubMed Central. The Cochrane RoB2 tool was used to analyze risk of bias in randomized clinical trials.

Results: Two randomized clinical trials involving 256 patients were included. Both groups had minimal risk of bias. Both studies showed a positive effect of tranexamic acid on blood loss parameters. Only one study in the tranexamic acid group had a lower transfusion rate, and another had a lower irrigation fluid volume and operation time in the tranexamic acid group. A meta-analysis was not performed because of the limited number of eligible studies.

Conclusion: For patients undergoing B-TURP for benign prostatic hyperplasia symptoms, the use of tranexamic acid reduced blood loss. However, a limited number of patients were studied, and the available randomized clinical trials presented conflicting conclusions. Therefore, further studies are needed to explore this aspect in detail.

Prospero database registration: (www.crd.york.ac.uk/prospero) under registration ID CRD42023416383.

Objective: Inflammation causes the progressive destruction of the supporting tissues around teeth in patients with periodontitis. Therefore, this study aimed to investigate the immunological effects of omega-3 polyunsaturated fatty acids (n-3 PUFAs) as adjunctive therapy in patients with periodontal disease and identify potential biomarkers for the disease.

Methods: This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to investigate the impact of omega-3 therapy with or without acetylsalicylic acid on the immunological parameters of periodontal treatment. Eligible studies included those conducted on patients with normoglycemia and diabetes, published after 2002 in English, and containing relevant keywords. The exclusion criteria included pre-2002 publications, literature reviews, animal studies, and articles without immunological analysis. This review involved careful study selection by two double-blind researchers using the Rayyan software, with data extraction and analysis performed by the third and fourth reviewers.

Results: Seven randomized clinical trials that compared control/placebo and n-3 PUFA groups or the follow-ups of the n-3 PUFA groups were included. The concentration of inflammatory cytokines was reduced following dietary supplementation with n-3 PUFA in the reviewed studies. Specifically, IL-1β, TNF-α, IL-6, and RANKL levels were reduced after dietary supplementation with n-3 PUFA as an adjunctive therapy for periodontitis. Changes in inflammatory outcomes were associated with the clinical benefits of periodontitis. However, significant divergence in the evaluated inflammatory markers, samples, and methods impairs direct comparisons and quantitative analyses in the available literature.

Conclusion: This study highlights the need for clinical trials to advance our understanding and assessment of inflammatory outcomes in patients with periodontitis.

Natural Killer cells are immune leukocytes required for responses against tumor cells and virus-infected cells. In the last decade, natural killer cells have emerged as promising tools in cancer therapy, and clinical studies on patients treated with natural killer cells have revealed increased rates of disease-free survival. In this article, we review results from the major clinical trials that have used natural killer cells for cancer treatment, including their global distribution. We also discuss the major mechanisms of natural killer cell activation and expansion and focus on the advantages and disadvantages of each mechanism for clinical applications. Although natural killer cells can be isolated from several sources, primary natural killer cells are most commonly used in clinical trials. However, the frequency of natural killer cells available in peripheral and cord blood is low, necessitating development of methods for expansion of natural killer cells for clinical use. The development of a platform for the expansion of large-scale good manufacturing practice-compliant natural killer cells has limitations as several methods for natural killer cell activation and expansion yield conflicting results. Only techniques using feeder cells can produce large numbers of cells, allowing the "off-the-shelf" use of natural killer cells. However, advances in cell culture have supported the development of feeder-free platforms for natural killer cell expansion, which is fundamental for improving the safety of this type of cell therapy.