ABSTRACT Introduction: Ammonia is a resultant molecule from the protein metabolism that can be neurotoxic when present in high concentrations, causing brain edema and encephalopathy. Extracorporeal blood purification technique (EBPT) can play a role in reducing both ammonia and urea blood levels. However, there are no specific guidelines for its use in hyperammonemia, due to its low incidence and scarce literature on this subject, particularly in adults. Case report: The authors describe a case of a 22‑year‑old previously healthy woman. She presented with polyuria, polydipsia, anorexia, vomiting and significant (>10%) weight loss over a month. Laboratory data revealed hypoglycemia and a high anion gap metabolic acidosis with severe acidemia with normal lactate, serum creatinine of 1.12 mg/dl and 260 (reference value 26‑74)umol/l of ammonia. Urine analysis showed ketone bodies. She evolved with progressive encephalopathy and neurological deterioration. The hypothesis of hyperammonemic encephalopathy secondary to a hereditary metabolic disease was suspected. Medical supportive therapy was initiated. An EBPT for ammonia removal and acid‑base correction was initiated using continuous venovenous hemodiafiltration (CVVHDF) with a drastic neurologic improvement. A fatty acid beta‑oxidation deficit was discovered. The patient was discharged with no neurological changes, with a strict diet free of fat, animal protein and high‑protein vegetables, plus supplementation with benzoate, carnitine, riboflavin, maltodextrine and essential amino acids. Discussion and conclusion: In adults, hyperammonemia related to metabolic disorders is rare, and in the presence of encephalopathy, ECDT should be considered. Ammonia is easily dialysable either by intermittent or continuous techniques. CVVHDF provides a continuous clearance with less rebound effect.

Background: In December 2019, a new form of coronavirus was identified (COVID-19) and quickly became a worldwide pandemic. Previous data reported a more severe disease in older patients, with high comorbidities, which are common features in hemodialysis patients. Scarce data is available about the clinical presentation and outcomes in this population. For this reason, we aim to report the characteristics of COVID-19 disease in hemodialysis patients admitted to our center. Methods: We retrospectively reviewed all patients on chronic hemodialysis admitted with a laboratory-confirmed COVID-19 infection from March 2nd to May 20th of 2020. Baseline characteristics, clinical, laboratory and radiological presentation were registered and treatment and outcomes Results: Fourteen patients were included, 57% female, with a median age of 81 years old and a high number of comorbidities. Cough and fever were the most common symptoms and lymphocytopenia, increased inflammatory parameters and coagulation dysregulation were frequently registered. Ground-glass opacities were present in each thorax computerized tomography performed. Five patients developed respiratory insufficiency, but none needed invasive ventilation or ICU admission. In a significant proportion, discharge was postponed due to the impossibility of ensuring social isolation. Median viral shedding was 38 days. Discussion and conclusion: Hemodialysis patients who required hospitalization were very old and had multiple comorbidities. Even so, the impaired immune response of this population seems to cause a less severe course of the disease and a longer time of viral shedding. HD units have required a reformulation of their circuits in order to avoid disease spreading.

A hipercalcemia é rara na prática clínica e é, muitas vezes, sugestiva da presença de uma doença não suspeita. O hiperparatiroidismo e as neoplasias são responsáveis por 80 -90% dos casos de hipercalcemia. O hiperparatiroidismo primário (HPTP) resulta da hiperprodução autónoma da hormona paratiroideia (PTH) e ocorre habitualmente em doentes com mais de 50 anos e mulheres na pós -menopausa. Raramente, o HPTP pode ser uma manifestação de uma síndrome familiar, como a síndrome de neoplasia endócrina múltipla tipo 1. O diagnóstico do HPTP é, muitas vezes, tardio uma vez que se trata de uma doença frequentemente assintomática, sendo apenas identificada após aparecimento de sinais e sintomas graves, como fracturas ósseas, que condicionam morbilidade significativa. A paratiroidectomia constitui o tratamento de escolha, uma vez que é eficaz na normalização dos níveis de cálcio e PTH e tem poucas complicações. Os autores descrevem o caso de um doente jovem com hipercalcemia grave, com tumor castanho e uma fratura patológica que conduziram ao diagnóstico de HPTP. Partindo do caso clínico, realizou -se uma breve revisão da literatura

Hypercalcaemia is rare in the clinical practice and is often a clue to the presence of an unsuspected illness. Hyperparathyroidism and malignancy account for 80 -90% of hypercalcaemia states. Primary hyperparathyroidism (PHPT) results from an autonomous overproduction of parathyroid hormone (PTH) and it occurs most commonly in over 50-year-old individuals and in post -menopausal women. On rare occasions, it may be a feature of a familial condition, such as multiple endocrine neoplasia type 1 syndrome. The diagnosis of PHPT is frequently delayed because it is commonly asymptomatic and is often identified only after development of severe signs and symptoms, such as bone fractures, with significant morbidity. Parathyroidectomy is the treatment of choice, as it is effective at restoring normal serum calcium and PTH levels and has few complications. We report the case of a young patient presenting with severe hypercalcaemia, a solitary brown tumour and pathological bone fracture that led to the diagnosis of PHPT. A brief review of the current literature on this topic is performed

Estudou-se a comunidade de nematoides do solo em quatro sistemas de manejo no Sistema Integrado de Produção Agroecológica (SIPA): pasto, capoeira, figo com Paspalum notatum e horta. As amostras de solo foram coletadas a cada quatro meses durante um ano. A comunidade de nematoides foi identificada e descrita com os parâmetros: riqueza de famílias, diversidade de Shannon-Weaner, de dominância de Simpson, além da diversidade trófica e dominância trófica. Os fitoparasitas e bacteriófagos dominaram as comunidades de nematoides nas áreas. Os onívoros foram menos abundantes em todos os sistemas estudados. O sistema pasto apresentou maior diversidade de famílias de nematoides enquanto que, no sistema capoeira se encontraram valores de diversidade baixos, porém constantes no tempo, indicando condição de maior estabilidade. A ação antrópica induzida pelo manejo modificou a distribuição trófica em benefício dos nematoides bacteriófagos, normalmente associados à maior taxa de decomposição da matéria orgânica. Nematoides fitoparasitas e bacteriófagos foram dominantes nos sistemas estudados, o que sugere a influência de densidade radicular elevada no pasto e alta taxa de mineralização na horta. A distribuição relativa de grupos tróficos de nematoides do solo confirmou ser uma eficiente forma de se determinar o nível de perturbação de solos submetidos a distintos manejos.

Soil nematode communities were studied in four differents crop systems at the Integrated System of Agroecological Production. Soil samples were collected at four-month intervals during one year, with three replications for each location. Nematode communities were measured by the following parameters: family richness, Shannon-Weaner's index, Simpson's index, trophic diversity (T) and dominance index (Ig). These data were submitted to ANOVA statistical analysis at 5% level of Tukey's test. The population of bacterivores and herbivore nematodes was high in all areas. Omnivores were found in lower abundance in all systems. The highest diversity of nematode families was found on pasture. In forests, the values of richness and abundance were always lower but constant in time, suggesting an ecosystem of higher stability. Soil management induced the proliferation of bacterivores usually associated with higher decomposition rates of organic matter. Herbivores and bacterivores were dominant in all systems, suggesting it is important to have high root (for pasture) or high decomposition rates (for horticulture system). The relative distribution of trophic groups of soil nematodes proved to be a good way to determine the level of perturbation of ecosystems.