2224 research outputs found
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Pancreatoscopy-guided electrohydraulic lithotripsy in a patient with calcific chronic pancreatitis
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Kounis Syndrome Associated With Selective Anaphylaxis to Cefazolin.
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Reclassification of Treatment Strategy by Routine Coronary Pressure Assessment-Episode 7 of the Saga: The More You Look, the More You Find It!
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Respiratory quotient estimations as additional prognostic tools in early septic shock
No full textCentral venous-to-arterial carbon dioxide difference (PcvaCO2), and its correction by the arterial-to-venous oxygen content difference (PcvaCO2/CavO2) have been proposed as additional tools to evaluate tissue hypoxia. Since the relationship between pressure and content of CO2 (CCO2) might be affected by several factors, some authors advocate for the use of CcvaCO2/CavO2. The aim of the present study was to explore the factors that might intervene in the difference between PcvaCO2/CavO2 and CcvaCO2/CavO2, and to analyze their association with mortality. Observational study in a 30-bed mixed ICU. Fifty-two septic shock patients within the first 24 h of ICU admission were studied. After restoration of mean arterial pressure, hemodynamic and metabolic parameters were evaluated. A total of 110 sets of measurements were performed. Simultaneous PcvaCO2/CavO2 and CcvaCO2/CavO2 values were correlated, but agreement analysis showed a significant proportional bias. The difference between PcvaCO2/CavO2 and CcvaCO2/CavO2 was independently associated with pH, ScvO2, baseline CcvaCO2/CavO2 and hemoglobin. A stepwise regression analysis showed that pH was the single best predictor for the magnitude of such difference, with very limited effect of other variables. At inclusion, variables associated with ICU-mortality were lactate, pH, PcvaCO2/CavO2, and the difference between PcvaCO2/CavO2 and CcvaCO2/CavO2. Initial ScvO2, PcvaCO2, CcvaCO2/CavO2, and cardiac index were not different in survivors and non-survivors. In a population of early septic shock patients, simultaneous values of PcvaCO2/CavO2 and CcvaCO2/CavO2 were not equivalent, and the main determinant of the magnitude of the difference between these two parameters was pH. The PcvaCO2/CavO2 ratio was associated with ICU mortality, whereas CcvaCO2/CavO2 was not.info:eu-repo/semantics/publishedVersio
HIV-2 infection is associated with preserved GALT homeostasis and epithelial integrity despite ongoing mucosal viral replication.
No full textThe mechanisms that enable preservation of gut mucosal integrity during persistent viral replication and inherent inflammation remain unclear. Here, we investigated, for the first time, gut homeostasis in HIV-2 infection, a naturally occurring form of attenuated HIV disease. We found viral replication in both sigmoid and ileum of asymptomatic HIV-2+ patients (range: 240-851 circulating CD4+T-cells per μl) despite their undetectable viremia, accompanied by interferon-γ-producing CD8 T-cell expansion, irrespective of antiretroviral treatment. Nevertheless, there was no CD4 T-cell depletion, and Foxp3+ and IL-17- or IL-22-producing CD4 T-cell numbers were unaffected. Moreover, IL-22-producing innate lymphoid cells and IL-22-induced antimicrobial peptides and mucins were maintained. In agreement, the epithelium histology was preserved, including tight junction protein zonula occludens (ZO-1) levels. Furthermore, in vitro infection of colon epithelia with primary isolates revealed no HIV-2 impact on ZO-1 expression. Notably, sigmoid transcriptional levels of CCL20 and CCL28 were significantly increased, in direct correlation with GM-CSF, indicating a local response able to enhance CD4 T-cell recruitment. In conclusion, maintenance of mucosal integrity in HIV-2 infection was associated with T-cell recruitment responses, potentially counteracting CD4 T-cell depletion due to HIV-2 replication. These data have unique implications for the design of therapies targeting gut homeostasis in HIV-1 infection and other chronic inflammatory settings.info:eu-repo/semantics/publishedVersio
Pancreatoscopy-guided laser lithotripsy in a patient with difficult ductal stone
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Area Rastreio Neonatal de Hemoglobinopatias: A Experiência de um Hospital de Nível II na Área Metropolitana de Lisboa
Get PDFIntrodução: As hemoglobinopatias são doenças genéticas, causadas por alterações da produção de hemoglobina, das quais se
destacam, pela gravidade e prevalência, a doença falciforme e as síndromes talassémicas. O diagnóstico precoce das hemoglo -
binopatias é essencial, permitindo a implementação de medidas que reduzem a morbilidade e a mortalidade nestes doentes.
Este estudo caracteriza uma amostra de recém-nascidos incluídos num programa de rastreio de hemoglobinopatias no ano de
2013, num hospital de nível II na área metropolitana de Lisboa.
Métodos: Estudo retrospetivo descritivo baseado em dados colhidos nos registos clínicos e laboratoriais hospitalares de crian -
ças nascidas entre 1 de janeiro e 31 de dezembro de 2013 com origem familiar em áreas de risco indicadas pela Direção Geral
da Saúde ou com história familiar de hemoglobinopatia. Aos recém-nascidos incluídos foi realizado hemograma e eletroforese
de hemoglobinas entre o primeiro e o terceiro dia de vida.
Resultados: Realizados 739 rastreios (27,7% das crianças nascidas neste período). Foram detetadas 86 (12%) variantes do
padrão normal de hemoglobinas, incluindo três casos de doença falciforme (dois casos de hemoglobinopatia SS e um caso de
hemoglobinopatia SC) e 83 casos de portadores de hemoglobinopatias. Todos os recém-nascidos com variantes de hemoglo -
bina foram observados em consulta de hematologia pediátrica.
Discussão: Este rastreio permitiu a deteção precoce de novos casos de doença falciforme, com consequente melhoria dos
cuidados prestados a estes doentes, e a deteção de portadores, possibilitando o aconselhamento às famílias.info:eu-repo/semantics/publishedVersio
Accidental Father-to-Son HIV-1 Transmission During the Seroconversion Period
Get PDFA 4-year-old child born to an HIV-1 seronegative mother was diagnosed with HIV-1, the main risk factor being transmission from the child's father who was seroconverting at the time of the child's birth. In the context of a forensic investigation, we aimed to identify the source of infection of the child and date of the transmission event. Samples were collected from the father and child at two time points about 4 years after the child's birth. Partial segments of three HIV-1 genes (gag, pol, and env) were sequenced and maximum likelihood (ML) and Bayesian methods were used to determine direction and estimate date of transmission. Neutralizing antibodies were determined using a single cycle assay. Bayesian trees displayed a paraphyletic-monophyletic topology in all three genomic regions, with the father's host label at the root, which is consistent with father-to-son transmission. ML trees found similar topologies in gag and pol and a monophyletic-monophyletic topology in env. Analysis of the time of the most recent common ancestor of each HIV-1 gene population indicated that the child was infected shortly after the father. Consistent with the infection history, both father and son developed broad and potent HIV-specific neutralizing antibody responses. In conclusion, the direction of transmission implicated the father as the source of transmission. Transmission occurred during the seroconversion period when the father was unaware of the infection and was likely accidental. This case shows how genetic, phylogenetic, and serological data can contribute for the forensic investigation of HIV transmission.info:eu-repo/semantics/publishedVersio
Pseudohypoparathyroidism type 1B - a rare cause of tetany: case report.
No full textPseudohypoparathyroidism (PHP) is a rare group of disorders characterised by end-organ resistance to the parathyroid hormone (PTH). A 16-year-old boy presented with a 2-year history of involuntary dystonic movements involving mainly the left hand, initially after writing and later during physical exercise. Serum calcium was 1.37 mmol/L (2.20-2.69), phosphate 2.1 mmol/L (0.8-1.45) and PTH 302 ng/L (12-88). CT scan of the head demonstrated multiple subcortical and diffuse basal ganglia calcifications. Genetic analysis confirmed a methylation defect in the GNAS cluster on chromosome 20q13.32 which established the diagnosis. Treatment with calcitriol and calcium carbonate led to complete remission of symptoms. Causes of hypocalcaemia should be considered in evaluating patients with movement disorders. The diagnosis of PHP-1B is challenging but the overall prognosis is excellent.info:eu-repo/semantics/publishedVersio