Einstein-Sao Paulo最新文献

{"title":"Aortic calcium score predicts early outcomes in aortoiliac revascularization.","authors":"Adalberto Batalha Megale, Nelson Wolosker, Vitoria Magliari Kalil, João Mário Nigro, Carolina Sciammarella Wakisaka, Bianca Oberhuber Dias, Marcelo Passos Teivelis, Marcelo Assis Rocha, Cynthia de Almeida Mendes","doi":"10.31744/einstein_journal/2025AO0527","DOIUrl":"10.31744/einstein_journal/2025AO0527","url":null,"abstract":"<p><strong>Background: </strong>Calcium scores were evaluated in the lower limbs of patients with clinical limb ischemia after aortoiliac revascularization. The aortic calcium score was related to the short-term outcomes of amputation and subsequent revascularization. Similarly, the calcium score in below-the-knee arteries was associated with revascularization and amputation at 12 months. ■ The calcium score can be calculated using computed tomography angiography. ■ The aortic calcium score was associated with amputation and subsequent revascularization within 30 days. ■ The calcium score in below-the-knee arteries was higher in the patients who underwent subsequent revascularization and amputation at 12 months.</p><p><strong>Objective: </strong>To evaluate the association between lower limb artery calcium scores in preoperative computed tomography angiography and outcomes of patients with critical limb ischemia who underwent revascularization procedures in the aortoiliac segment.</p><p><strong>Methods: </strong>We retrospectively reviewed 14 interventions performed on 11 patients. The calcium score was calculated in segments of the aorta, iliac, femoropopliteal, and below-the-knee arteries. The evaluated outcomes included amputation, patency, death, subsequent revascularization, and readmission. Major adverse limb events were defined as amputation, subsequent revascularization, or readmission. The patients were followed through a 12-month period.</p><p><strong>Results: </strong>Higher aortic calcium scores were associated with amputation within 30 days (5,767.6 versus 805.3; p=0.02). Amputation during the first year correlated with a higher below-the-knee arteries calcium score (672.4 versus 163.25; p=0.04). Subsequent revascularization within 30 days was associated with a higher aortic calcium score (3,686.8 versus 645.2; p=0.008), while below-the-knee arteries calcium scores were associated with revascularization within 30 days (155.5 versus 817; p=0.05) and 12 months (158.875 versus 679.4; p=0.019). Readmissions within 1 year were more prevalent with higher below-the-knee arteries calcium scores (882.4 versus 32; p=0.011). Major adverse limb events were related to below-the-knee arteries calcium scores at 30 days (158.875 versus 679.4; p=0.019) and 1 year (12.3 versus 910.1; p=0.002).</p><p><strong>Conclusion: </strong>Below-the-knee arteries calcium score is a predictor of long-term revascularization, amputation, readmission, and major adverse limb events. The aortic calcium score was associated with amputation and subsequent revascularization within the first 30 days.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 ","pages":"eAO0527"},"PeriodicalIF":1.1,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11908746/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation of an ultra-high performance liquid chromatography/UV method to quantify busulfan in plasma: application to therapeutic drug monitoring.","authors":"Laura Ben Olivo, Gabriel Giron Corrêa, Bruna Bernar Dias, Janaína Aparecida Risczik Arruda Corrêa, Bruna Martins Schweinberger, Raiza Lima do Carmo, Liane Esteves Daudt, Teresa Dalla Costa, Bibiana Verlindo de Araujo","doi":"10.31744/einstein_journal/2025AO0964","DOIUrl":"https://doi.org/10.31744/einstein_journal/2025AO0964","url":null,"abstract":"<p><strong>Background: </strong>Olivo et al. validated an in-house precise UHPLC/UV method for quantifying busulfan in human plasma for therapeutic monitoring. The method shows linearity (0.5-10 μg/mL) with a lower limit of quantification of 0.5 μg/mL, demonstrating accuracy and precision. It effectively supported therapeutic drug monitoring in a Brazilian public hospital by providing rapid and reliable results. ■ We validated the UHPLC/UV method for accurate busulfan quantification in plasma. ■ Inaccuracy and imprecision were below 15%, ensuring reliable therapeutic drug monitoring results. ■ This enables effective pharmacokinetic studies with rapid turnaround times in patient samples.</p><p><strong>Objective: </strong>This study aimed to validate a sensitive, accurate, and precise bioanalytical ultra-high-performance liquid chromatography coupled with ultraviolet (UHPLC/UV) method for the determination of busulfan in human plasma using 1,6-bis-(methanesulfonyloxy) hexane as an internal standard for therapeutic drug monitoring.</p><p><strong>Methods: </strong>Plasma samples were deproteinized with acetonitrile (1:2, v/v) and, after derivatization with sodium diethyl dithiocarbamate, submitted to liquid-liquid extraction with ethyl acetate and evaporation at 50ºC under a nitrogen stream. Analyses were performed on a Shimadzu® system using a C18 column and isocratic elution with methanol/water (70:30, v/v) at a flow rate of 0.4mL min-1 and detection at 277nm.</p><p><strong>Results: </strong>The retention times of busulfan and the IS were approximately 2.87 and 6.35 min, respectively. The plasma calibration curves were linear in the concentration range of 0.5-10 µg mL-1 with a coefficient of determination greater than 0.99. The lower limit of quantification was 0.5 µg mL-1. The inaccuracies and imprecisions of this method are less than 15%. The applicability of this method to pharmacokinetic studies was confirmed using patient samples obtained after 4 h of 3.2-5.4 mg kg-1 busulfan intermittent infusion.</p><p><strong>Conclusion: </strong>This method demonstrated the feasibility of quantifying samples within the target concentration range and quickly releasing results to allow for busulfan therapeutic monitoring.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 ","pages":"eAO0964"},"PeriodicalIF":1.1,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cutaneous manifestations of diabetes mellitus: a narrative review.","authors":"Maria Carolina Mendes de Oliveira Abate, Priscila Maria Teixeira Aroucha, Diego Vanderlei Medeiros da Nóbrega, Iara Patrícia Moura Rocha, Sofia Duarte Soares, Anita Andrade Reis, Isabella Cristina Paliares, Fernando de Mello Almada Giuffrida, Sergio Atala Dib, André Fernandes Reis, Joao Roberto de Sa","doi":"10.31744/einstein_journal/2025RW1193","DOIUrl":"10.31744/einstein_journal/2025RW1193","url":null,"abstract":"<p><p>Diabetes mellitus is a highly prevalent human endocrine disorder. Skin lesions are reported in approximately one-third of all diabetes mellitus patients. The clinical presentation and frequency vary according to the subtype of diabetes mellitus, metabolic control, and clinical course, with certain skin diseases occurring before diagnosing hyperglycemia. In this regard, the correct definition of cutaneous manifestations associated with diabetes mellitus can help define the etiology of hyperglycemia as well as the need to optimize glycemic control. In this narrative review, the most common cutaneous diseases observed in diabetes mellitus are discussed, including pruritus, acanthosis nigricans, necrobiosis lipoidica, bullosis diabeticorum, scleroderma diabeticorum, granuloma annulare, diabetic dermopathy, skin reactions due to device use, diabetic foot ulcers, recurrent cutaneous infections in diabetes mellitus and other dermatoses associated with hyperglycemia. The epidemiology, pathophysiology, differential diagnosis, and treatment of this disease are discussed. Therefore, knowledge and recognition of the most common dermatological lesions in patients with diabetes mellitus are essential for both endocrinologists and primary care physicians.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 ","pages":"eRW1193"},"PeriodicalIF":1.1,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11908747/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers to cardiac rehabilitation and their association with hospital readmission in patients with heart failure.","authors":"Ana Carla Soares Mota de Carvalho, Raphaela Vilar Groehs, Carolina Pereira, Vivian Lavor Soares, Tarsila Perez Mota, Sherry L Grace, Luciana Diniz Nagem Janot de Matos","doi":"10.31744/einstein_journal/2025AO0713","DOIUrl":"https://doi.org/10.31744/einstein_journal/2025AO0713","url":null,"abstract":"<p><strong>Background: </strong>High rehospitalization rates and limited access to cardiac rehabilitation characterize heart failure in South America. This study highlights the significant barriers faced by patients, including lack of energy, awareness, and accessibility. Despite these challenges, professional exercise supervision has reduced readmission rates by more than 50%, underscoring its importance. ■ Barriers to rehabilitation: high inactivity rates (88.4%) and significant barriers, such as fatigue and lack of awareness, hinder recovery. ■ Professional supervision: only 1% of patients were enrolled in formal cardiac rehabilitation; however, those who received professional supervision experienced lower readmission rates (14.6% versus 35.1%). ■ Systematic gaps: addressing systemic gaps, such as coverage and referral to rehabilitation programs, is critical for improving patient outcomes and reducing rehospitalization rates.</p><p><strong>Objective: </strong>This study assessed the barriers to cardiac rehabilitation in inpatients with heart failure, the use of formal exercise supervision, and its relationship to readmissions.</p><p><strong>Methods: </strong>This study was a prospective, observational design. The Cardiac Rehabilitation Barriers Scale, the Readiness Scale focusing on physical activity, and the International Physical Activity Questionnaire were administered before hospital discharge. Participants were followed up via telephone at 30- and 90-days post-discharge, during which the International Physical Activity Questionnaire was readministered, and formal exercise supervision and readmission rates were assessed.</p><p><strong>Results: </strong>Of the 95 patients who provided consent, 88.4% were inactive. A total of 85 (89.5%) were retained at the 30-day follow-up, and 86 (90.5%) patients at the 90-day follow-up; 2 patients died. The mean total Cardiac Rehabilitation Barriers Scale score was 2.3±6.5 (out of 5), with the highest item scores for lack of energy, prior exercise, lack of awareness, distance, and exercise-related pain/fatigue. Only one participant was enrolled in cardiac rehabilitation. Nearly half had engaged in professional exercise (n=48, 56.5% at 30 days and n=45, 52.3% at 90 days) at both follow-ups. At 30 days, 25.8% of the patients were readmitted, and 25.5% were readmitted at 90 days. Participants who received professional exercise supervision within 30 days had significantly fewer readmissions (n=7, 14.6%) than those who did not (n=13, 35.1%; p=0.03).</p><p><strong>Conclusion: </strong>Barriers to cardiac rehabilitation are high among patients with heart failure. Despite access to professional exercise training, most participants remain insufficiently active. Systematic referral for cardiac rehabilitation and advocacy for coverage could mitigate poor self-management and, ultimately, reduce high readmission rates.</p><p><strong>Registry of clinical trials: </strong>NCT03385837.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 ","pages":"eAO0713"},"PeriodicalIF":1.1,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ideal time and self-reported time to ejaculate, frequent use of virtual pornography, and disorders of ejaculation among internet users in the Metropolitan Region of São Paulo, Brazil. Cross-sectional study.","authors":"Margareth de Mello Ferreira Dos Reis, Eduardo Augusto Corrêa Barros, Leonardo Monteiro, Cristiano Linck Pazeto, Willy Baccaglini, Sidney Glina","doi":"10.31744/einstein_journal/2025AO1282","DOIUrl":"10.31744/einstein_journal/2025AO1282","url":null,"abstract":"<p><strong>Background: </strong>Almost half (46%) of adult men living in São Paulo metropolis who responded an anonymous survey think they ejaculate earlier than it would be ideal. Only 10% watched virtual pornography frequently (every day or for several hours 2-4 days a week). No associations were found between ejaculation disorders and frequent use of virtual pornography. ■ About one in every 10 social network male users in São Paulo frequently use virtual pornography. ■ Over half of the respondents believed that the ideal time to ejaculate would be of 15 minutes or more. ■ Frequent use of virtual pornography was not associated with ejaculation disorders.</p><p><strong>Objective: </strong>To investigate the association between frequent use of virtual pornography, perceptions of the ideal time to ejaculate, and changes in ejaculation.</p><p><strong>Methods: </strong>Adult men living in São Paulo metropolis responded to an online anonymous survey between May 2019 and March 2020. The questions were about sociodemographics, sexual behavior, frequency and time of virtual pornography use, and responses to three instruments for assessing ejaculation disorders: self-reported estimated time from vaginal or anal penetration to ejaculation; self-assessment of what is a normal, premature, or delayed ejaculation, and the Premature Ejaculation Diagnostic Tool (PEDT).</p><p><strong>Results: </strong>Of 528 participants, 27.3% said the ideal time (for them and for the partner) to ejaculate during sex with a partner would be 6-15 minutes, and for 44.1%, longer than 15 minutes. However, 45.8% said they usually ejaculate earlier than the ideal time. Only 55 men (10.4%; 95% confidence interval, 95%CI= 7.9-13.3) participants were frequent users of virtual pornography (defined as the use during solitary masturbation for at least one hour/day every day or many hours/day two to four times/week). Frequent use of pornography was associated with not being heterosexual (odds ratio, OR= 1.81; 95%CI= 1.02-3.23), lower educational level (OR= 2.21; 95%CI= 1.12-4.32) and using virtual pornography during sexual intercourse (OR= 2.58; 95%CI= 1.21-5.48). No associations were observed between frequent virtual pornography use and ejaculation disorders.</p><p><strong>Conclusion: </strong>Approximately half of the men surveyed are not satisfied with the time they take to ejaculate and around 10% of them use virtual pornography frequently, although this is not associated with ejaculation dysfunction.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 ","pages":"eAO1282"},"PeriodicalIF":1.1,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11869794/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intravenous immunoglobulin therapy in erythromelalgia management: a case report.","authors":"Renato Ádler Pomilio de Sousa, Luydson Richardson Silva Vasconcelos, Marcus Villander Barros de Oliveira Sá","doi":"10.31744/einstein_journal/2025RC1236","DOIUrl":"10.31744/einstein_journal/2025RC1236","url":null,"abstract":"<p><p>A 49-year-old woman presented with a 16-year history of burning pain, warmth, redness, and edema in both toes, feet, legs and calves. Despite extensive medical testing, including genetic analysis, no specific cause was identified. Initial treatments failed to improve symptoms, leading to impaired quality of life and mental health. Eventually, a six-month course of intravenous immunoglobulin therapy provided complete relief, allowing the patient to resume normal activities. Erythromelalgia is a rare neurovascular condition characterized by pain, warmth, and erythema in the extremities. It can manifest as primary, inherited or sporadic, or secondary to underlying conditions, such as hematological neoplasms. Although genetic studies suggest a pivotal role of a gain-of-function mutation in the Nav1.7 voltage-gated sodium channel in familial cases, the pathogenesis underlying sporadic adult-onset cases remains uncertain. The frequent coexistence of autoimmune connective tissue diseases and the expanding evidence supporting immunotherapies in idiopathic small-fiber neuropathies underscores the possible involvement of adaptive immunity in such conditions. Given the potential complications in untreated patients, risks associated with long-term opioid therapy, and the absence of disease-modifying strategies, intravenous immunoglobulins may offer a more effective approach to pain control than conventional pain relievers, representing a promising direction for understanding the pathogenesis of erythromelalgia.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 ","pages":"eRC1236"},"PeriodicalIF":1.1,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11869793/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tranexamic acid in the management of traumatic brain injury: a systematic review and meta-analysis with trial sequential analysis.","authors":"Thiago Gebrin, Júlia Pinho Neodini, André Felix Gentil, Eduardo Carvalhal Ribas, Mario Lenza, Arthur Werner Poetscher","doi":"10.31744/einstein_journal/2025RW0753","DOIUrl":"10.31744/einstein_journal/2025RW0753","url":null,"abstract":"<p><strong>Introduction: </strong>Traumatic brain injury is a leading cause of death and disability. Tranexamic acid, an antifibrinolytic agent, holds the potential for managing intracranial hemorrhages secondary to traumatic brain injury. However, its efficacy and safety remain subjects of ongoing debate.</p><p><strong>Objective: </strong>To better clarify the efficacy and safety of tranexamic acid in that context and to evaluate the need for further studies.</p><p><strong>Methods: </strong>We conducted a comprehensive search of seven electronic databases, eight study repositories, and tertiary sources between January 2021 and 2022 for randomized controlled trials involving victims of traumatic brain injury aged 15 or older who received tranexamic acid versus placebo or standard care. The primary outcomes were all-cause mortality and hemorrhagic complications during treatment. This review incorporated elements of PRISMA guidelines, Cochrane's Risk of Bias assessment, and GRADE to assess evidence quality. Sensitivity analyses were also conducted.</p><p><strong>Results: </strong>Out of 6,958 references retrieved, 14 of the 17 randomized controlled trials were analyzed, encompassing a total of 15,017 patients. Analyses for all-cause mortality did not reach statistical significance (RR= 0.95, 95%CI= 0.88-1.02 | trial sequential analysis RR= 0.95, 95%CI= 0.87-1.03). However, the analysis of hemorrhagic complications during treatment showed statistical significance for progressive intracranial hemorrhage (RR= 0.82, 95%CI= 0.68-0.99 | trial sequential analysis RR= 0.82, 95%CI= 0.38-1.78). Analyses of secondary outcomes, namely unfavorable neurological outcome and other adverse effects, did not demonstrate statistical significance.</p><p><strong>Conclusion: </strong>Tranexamic acid use did not demonstrate efficacy based on all-cause mortality but showed a favorable safety profile. Additional clinical trials may shed light on remaining clinical uncertainties. Prospero database registration: CRD42021221949.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 ","pages":"eRW0753"},"PeriodicalIF":1.1,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11869795/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Alcohol consumption among pregnant women in Brazilian capitals: How many, where, and who are they?","authors":"Rinelly Pazinato Dutra, Giulia Piamolini Marques, Mariana Manfredi, Maria Eduarda Rodrigues Martins Chermont de Sá, Ane Priscila Konrad, Samuel de Carvalho Dumith","doi":"10.31744/einstein_journal/2025AO0754","DOIUrl":"10.31744/einstein_journal/2025AO0754","url":null,"abstract":"<p><strong>Background: </strong>Alcohol consumption during pregnancy poses serious risks to maternal and fetal health, making it a public health concern. This study sheds light on the sociodemographic disparities linked to alcohol use among pregnant women in Brazilian capital cities, highlighting vulnerable groups and regional variations. These findings underscore the urgent need to develop tailored preventive strategies to protect maternal and child health. ■ Any alcohol consumption during pregnancy: prevalence of 11.5%. ■ Excessive alcohol consumption during pregnancy: prevalence of 3.0%. ■ Risk factors: older age, low education, and Indigenous ethnicity. ■ Protective factors: being married and living in Northern Brazil.</p><p><strong>Objective: </strong>To analyze the prevalence and factors associated with alcohol consumption among pregnant women.</p><p><strong>Methods: </strong>This cross-sectional study examined pregnant women living in Brazilian capitals using information collected by the Noncommunicable Chronic Disease Risk Factor Surveillance System (Vigitel) between 2006 and 2021. This study calculated the prevalence of both excessive and any amount of alcohol consumption by pregnant women and their associations with sociodemographic variables. Multivariate analysis was performed with prevalence ratios based on Poisson crude and adjusted regressions; the threshold for statistical significance was set at p<0.05.</p><p><strong>Results: </strong>The sample comprised 4,734 pregnant women. The prevalence of any amount of alcohol consumption was 11.5% (95%CI = 9.8-13.6), and that of excessive consumption was 3.0% (95%CI = 2.1-4.2); both remained stable throughout the analyzed period. Being 35-54 years old and having low educational attainment were the main factors associated with both consumption patterns. Being Indigenous was highly associated only with excessive alcohol consumption, whereas being legally married and living in Northern Brazil were protective factors.</p><p><strong>Conclusion: </strong>These findings emphasize the need for focused preventive strategies targeting the most vulnerable groups to mitigate alcohol consumption and its associated risks during pregnancy.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 ","pages":"eAO0754"},"PeriodicalIF":1.1,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11869783/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Azacitidine-induced bullous pemphigoid-like localized toxic reaction.","authors":"Rodrigo Brêtas Emerich Nogueira, Nelson Hidekazu Tatsui, Laura Ramos de Almeida, Marcella Soares Pincelli, Celina Wakisaka Maruta, José Antonio Sanches, Elvira Deolinda Rodrigues Pereira Velloso, Youko Nukui","doi":"10.31744/einstein_journal/2025RC0699","DOIUrl":"10.31744/einstein_journal/2025RC0699","url":null,"abstract":"<p><p>Azacitidine is a hypomethylating agent recommended for the treatment of patients with high-risk myelodysplastic syndromes. Here, we report the case of a patient with myelodysplastic syndrome who was not eligible for allogeneic stem cell transplantation (allo-SCT) and presented with a rare and previously unreported cutaneous side effect after the use of subcutaneous azacitidine. We propose that changing the route of azacitidine administration from subcutaneous to intravenous could potentially decrease the occurrence of bullous pemphigoid-like localized toxic reactions in some patients.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 ","pages":"eRC0699"},"PeriodicalIF":1.1,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11869782/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severe dengue, aneurysmal sub-arachnoid hemorrhage, and hemophagocytic lymphohistiocytosis: a rare case combination.","authors":"Saboor Mateen, Ajay Mishra, Shivesh Singh, Firdaus Jabeen","doi":"10.31744/einstein_journal/2025RC1209","DOIUrl":"10.31744/einstein_journal/2025RC1209","url":null,"abstract":"<p><p>Dengue, a vector-borne acute febrile illness caused by members of the Flavivirus genus, has dramatically increased its occurrence worldwide. Neurological complications of dengue range from 2.63 to 40%, and subarachnoid hemorrhage is a rare, but significant manifestation. Hemophagocytic lymphohistiocytosis is a life-threatening hyperinflammatory syndrome, sometimes secondary to infections such as dengue. This report presents a rare case of severe dengue with subarachnoid hemorrhage and hemophagocytic lymphohistiocytosis. A 19-year-old male presented with a 7-day history of fever and myalgia, followed by severe headache and vomiting. Initial examination revealed high fever, hepatosplenomegaly, and pancytopenia. Lumbar puncture confirmed via computed tomography showed a Fisher Grade 2 subarachnoid hemorrhage with a small aneurysm at the junction of the left anterior coronary and anterior communicating arteries. Secondary hemophagocytic lymphohistiocytosis was diagnosed based on the criteria from 2004, with elevated inflammatory markers, hypertriglyceridemia, and hyperferritinemia. The patient was treated conservatively with intravenous fluids, osmotic diuretics, antiepileptics, steroids, and nimodipine. The patient showed clinical improvement and was discharged on the 11th day. Isolated subarachnoid hemorrhage is rare in dengue. The hyperinflammatory state in hemophagocytic lymphohistiocytosis, which is often overlooked due to nonspecific symptoms, can lead to aneurysm formation and rupture. Persistent fever, cytopenia, and hyperferritinemia should raise suspicion of hemophagocytic lymphohistiocytosis in cases of severe dengue with neurological complications. In patients with severe dengue and intracranial hemorrhage, clinicians should remain cautious for hemophagocytic lymphohistiocytosis to reduce the associated morbidity and mortality.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"23 ","pages":"eRC1209"},"PeriodicalIF":1.1,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11869786/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143504795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}