ABSTRACT BACKGROUND: Sarcopenia is a common complication in patients with cirrhosis and may lead to increased morbidity and mortality. OBJECTIVE: To investigate the prevalence of sarcopenia and its association with disease severity scores, among patients with cirrhosis. DESIGN AND SETTING: Observational and retrospective cohort study carried out in a tertiary-care hospital in southern Brazil. METHODS: This study was conducted among patients with chronic liver disease who were followed up at the gastroenterology and hepatology outpatient clinic of a tertiary-care hospital in southern Brazil and who underwent computed tomography scans of the abdomen through any indication. RESULTS: We included 83 patients in the study. In the population evaluated, there was a predominance of males (57.80%) and the mean age was 56 years. Hepatitis B or C virus was present in the genesis of the disease in 34.9% of the cases, followed by an etiology of alcohol abuse (30.1%). Sarcopenia was diagnosed in 41 (49.4%) of the patients when the cutoff point for cirrhotic patients was used. There was no significant correlation between the Child-Pugh and MELD severity scores and the occurrence of sarcopenia. CONCLUSION: Sarcopenia presents high prevalence among patients with chronic liver disease, without any association with predictors of severity.

Abstract Background: malnutrition is a common problem in hospitalized patients, being associated with increased morbidity, mortality and costs. Multiple factors contribute to a deficient nutritional status, making malnutrition the cause or consequence of severe diseases. Percutaneous endoscopic gastrostomy (PEG) is a minimally invasive procedure indicated for long-term administration of enteral nutrition in patients with limited ability for oral intake who have an intact, functional gastrointestinal tract. The aim of this study was to determine the profile of patients undergoing PEG in a tertiary hospital in southern Brazil. Methods: single-center retrospective study of all patients who underwent PEG from January 1st to December 31st, 2016, in a private tertiary hospital located in southern Brazil. Data were collected retrospectively from the patients' medical records, including nutritional status, indications, complications and outcomes. Results: one hundred and thirty-three patients underwent PEG at our institution and were eligible for inclusion in the study. Median patient age was 82 years, and 57.9% were females. The main indication for PEG was dementia syndrome, followed by stroke. As much as 68.4% were diagnosed as severely malnourished and 23.0% had procedure-related complications. Conclusions: PEG tubes are being increasingly used for enteral nutrition in patients with dysphagia or inability to maintain adequate nutritional intake. The findings of the present study highlight the importance of regular nutritional risk screening by a multidisciplinary team, paying special attention to the patient's nutritional status and conditions that may place the patient at risk of developing dysphagia, with the implementation of measures to minimize malnutrition in hospitalized patients.

Resumen Introducción: la desnutrición es común en pacientes hospitalizados y se está convirtiendo en causa o consecuencia de enfermedades graves, asociándose a morbilidad, mortalidad y costos aumentados. Múltiples factores contribuyen a un estado nutricional deficiente. La gastrostomía endoscópica percutánea (PEG) es un procedimiento mínimamente invasivo para la administración de nutrición enteral en pacientes con capacidad limitada de ingesta oral que tengan el tracto gastrointestinal intacto y funcional. El objetivo de este estudio fue determinar el perfil de pacientes sometidos a PEG en un hospital terciario del sur de Brasil. Métodos: estudio retrospectivo unicéntrico de todos los pacientes sometidos a PEG del 1 de enero al 31 de diciembre de 2016 en un hospital terciario privado del sur de Brasil. Se recolectaron los datos retrospectivamente en los registros médicos, incluyendo estado nutricional, indicaciones, complicaciones y evolución. Resultados: ciento treinta y tres pacientes se sometieron a PEG en nuestra institución y fueron elegibles para el estudio. La edad mediana fue de 82 años y el 57,9% eran mujeres. Las principales indicaciones para PEG fueron demencia y accidente cerebrovascular. El 68,4% fueron diagnosticados con desnutrición grave y el 23,0% presentaron complicaciones relacionadas al procedimiento. Conclusiones: se utilizan cada vez más tubos de PEG para nutrición enteral en pacientes disfágicos o incapaces de mantener una ingesta nutricional adecuada. Nuestros hallazgos señalan la importancia del cribado para riesgo nutricional por un equipo multidisciplinario, con atención especial al estado nutricional del paciente y a condiciones que pueden ponerlo en riesgo para disfagia y la implementación de medidas para minimizar la desnutrición.

OBJECTIVE: To evaluate the influence of hepatitis C virus on immunological and virological responses after highly active antiretroviral therapy initiation in human immunodeficiency virus/hepatitis C virus coinfected patients compared to monoinfected human immunodeficiency virus-infected patients. METHODS: The study enrolled 65 human immunodeficiency virus-1-infected subjects who initiated highly active antiretroviral therapy and attended follow-up visits over 48 weeks from 2008 to 2010. They were grouped based on hepatitis C virus-RNA results. Virological and immunological responses were monitored at baseline and at the end of weeks 12, 24, 36, and 48. RESULTS: There were 35 human immunodeficiency virus monoinfected and 30 human immunodeficiency virus/hepatitis C virus coinfected patients. In the present study human immunodeficiency virus/hepatitis C virus coinfection did not seem to influence CD4 Tlymphocytes recovery. There was no difference between the curves of CD4 T-lymphocytes raise of coinfected and monoinfected groups. CONCLUSION: This prospective study confirms that hepatitis C virus infection does not seem to be associated with impaired CD4 T-lymphocytes recovery after HAART.

Doença de Whipple é uma rara infecção sistêmica causada pelo Tropheryma whipplei. Caracteriza-se por fase prolongada de sintomas inespecíficos, levando longo período até o seu diagnóstico. Sem tratamento, pode ser grave e fatal, mas com antibioticoterapia tem ótima resposta clínica e laboratorial. Relatamos o caso de paciente masculino, 61 anos, internado por astenia, anorexia, diarréia intermitente e perda de 10 kg em um ano. Apresentava-se com hemoglobina (Hb) 7,5 g/dL, albumina de 2,5 mg/dL, peso 50,3 kg (IMC 17,4). Endoscopia digestiva alta com áreas de enantema focal da mucosa duodenal e biópsia compatível com doença de Whipple. O diagnóstico foi confirmado com PCR sérica positiva, sendo instituído tratamento com ceftriaxone seguido de sulfametoxazol-trimetropim. Após um ano de tratamento, encontrava-se assintomático, com Hb 13,5 g/dL, albumina sérica de 5,3 mg/dL e peso de 70 kg. Doença de Whipple deve fazer parte da lista de diagnósticos diferenciais em pacientes com sintomas constitucionais e/ou com queixas gastrointestinais com evolução prolongada. O tratamento antibiótico pode curar a infecção, recuperando a qualidade de vida do paciente.

Whipple's disease is a rare systemic infectious disorder caused by the bacterium Tropheryma whipplei. We report the case of a 61-year-old male patient who presented to emergency room complaining of asthenia, arthralgia, anorexia, articular complaints intermittent diarrhea, and a 10-kg weight loss in one year. Laboratory tests showed the following results: Hb = 7.5 g/dL, albumin = 2.5 mg/dL, weight = 50.3 kg (BMI 17.4 kg/m²). Upper gastrointestinal endoscopy revealed areas of focal enanthema in the duodenum. An endoscopic biopsy was suggestive of Whipple's disease. Diagnosis was confirmed based on a positive serum polymerase chain reaction. Treatment was initiated with intravenous ceftriaxone followed by oral trimethoprim-sulfamethoxazole. After one year of treatment, the patient was asymptomatic, with Hb = 13.5 g/dL, serum albumin = 5.3 mg/dL, and weight = 70 kg (BMI 24.2 kg/m²). Whipple's disease should be considered a differential diagnosis in patients with prolonged constitutional and/or gastrointestinal symptoms. Appropriate antibiotic treatment improves the quality of life of patients.

Dermatose perfurante adquirida é uma condição rara, em geral associada a algumas doenças sistêmicas, ocorrendo especialmente em pacientes diabéticos com insuficiência renal crônica submetidos a diálise. O sintoma principal é o prurido e a apresentação clínica característica é a presença de lesões papulares marrom-avermelhadas no tronco, cabeça e pescoço. Biópsia da lesão revela invaginação epidérmica com preenchimento por plug ceratótico. A etiologia é pouco compreendida e várias tentativas terapêuticas têm sido desapontadoras.

Acquired perforating dermatosis is a rare condition often associated with some systemic diseases, especially diabetic patients with chronic renal failure undergoing dialysis. The main symptom is pruritus and it is clinically characterized by the presence of redish-brown papular lesions in the trunk, head and neck. Biopsy of the lesion reveals epidermal invagination with keratotic plug. The etiology is poorly understood and several therapeutic measures have been disappointing.

Cromoblastomicose é uma infecção fúngica crônica do tecido subcutâneo causada pela inoculação traumática de um grupo específico de fungos através da pele, encontrados eventualmente em trabalhadores do campo descalços em países de clima tropical e subtropical. Relatamos aqui o caso de um paciente do sexo masculino com uma lesão dermatológica de crescimento lento e pruriginosa nos membros inferiores por 20 anos, diagnosticada e tratada com sucesso para cromoblastomicose. Apesar da prevalência desta doença em nossa região, o tratamento ainda é um desafio.

Chromoblastomycosis is a chronic human melanized fungi infection of the subcutaneous tissue caused by traumatic inoculation of a specific group of dematiaceous fungi through the skin, often found in barefooted agricultural workers, in tropical and subtropical climate countries. We report the case of a male patient presenting a slow-growing pruriginous lesion on the limbs for 20 years, mistreated over that time, which was diagnosed and successfully treated as chromoblastomycosis. Besides the prevalence of this disease, treatment is still a clinical challenge.

A avaliação de dor torácica é prática de rotina em serviços de emergência. Embora seja queixa comum e com amplo diagnóstico diferencial. é na suspeita de síndrome coronariana aguda (SCA) que a preocupação é maior. Eletrocardiograma e dosagem de enzimas cardíacas são ferramentas importantes na investigação dos pacientes. mas. quando negativos. podem não identificar algumas doenças. Relatamos o caso de uma paciente com angina. cujos exames iniciais na emergência não apresentavam alterações sugestivas de cardiopatia isquêmica. Doença de conhecimento recente. a síndrome de Wellens consiste em uma variante da angina instável. que. quando não reconhecida. pode acarretar em significativa morbidade e mortalidade.

The assessment of chest pain is a routine in emergency health services. Although this is a common complaint with a broad differential diagnosis. the major concern is the possibility of acute coronary syndrome (ACS). Electrocardiography and cardiac enzyme levels are important tools in the investigation of these patients; however. negative results may actually be overlooking the identification of some conditions. We report the case of a female patient with angina. whose baseline tests in the emergency room were negative for changes suggestive of ischemic heart disease. The Wellens syndrome. a recently described disease. is a variant of unstable angina which. if not identified. may result in significant morbidity and mortality.

La evaluación de dolor torácico es práctica de rutina en servicios de emergencia. Aunque es queja común y con amplio diagnóstico diferencial, es en la sospecha de síndrome coronario agudo (SCA) que la preocupación es más grande. Electrocardiograma y dosificación de enzimas cardíacas son herramientas importantes en la investigación de los pacientes, sin embargo, cuando negativos, pueden no identificar algunas enfermedades. Referimos el caso clínico de una paciente con angina, cuyos exámenes iniciales en la emergencia no presentaban alteraciones sugestivas de cardiopatía isquémica. Enfermedad de conocimiento reciente, el síndrome de Wellens consiste en una variante de angina inestable, que cuando no reconocida, puede conllevar significativa morbilidad y mortalidad.

A varfarina é droga amplamente utilizada na prevenção de fenômenos tromboembólicos e o conhecimento de seus efeitos adversos faz-se necessário para o acompanhamento dos pacientes. Embora o desenvolvimento de discrasias sanguíneas seja complicação potencial nesses pacientes, a ocorrência de sangramento retroperitoneal é rara. Este artigo discute o caso de um paciente que evoluiu com hematoma do músculo iliopsoas durante tratamento com a referida droga, pós-implante de prótese aórtica metálica, com quadro clínico envolvendo importantes diagnósticos diferenciais.

Warfarin is a widely used drug for the prevention of thromboembolic events. Knowledge of its adverse effects is necessary for patient follow-up. Although the development of blood dyscrasias is a potential complication in these patients, retroperitoneal bleeding is rare. This article reports the case of a patient who developed iliopsoas muscle hematoma during treatment with warfarin after implantation of a metallic prosthetic aortic valve. The clinical manifestations involved important differential diagnoses.

La warfarina es un fármaco ampliamente utilizado en la prevención de fenómenos tromboembólicos, y el conocimiento de sus efectos adversos se hace necesario para el seguimiento de los pacientes. Aunque el desarrollo de discrasias sanguíneas es la complicación potencial en estos pacientes, la ocurrencia de sangrado retroperitoneal es rara. Este artículo discute el caso de un paciente que evolucionó con hematoma del músculo ileopsoas durante tratamiento con el referido fármaco en el postimplante de prótesis mitral metálica, con cuadro clínico implicando importantes diagnósticos diferenciales.