2224 research outputs found
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SomosHFF (35): Newsletter do Hospital Prof. Dr. Fernando Fonseca, E.P.E.
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Time to invest on research during medical training.
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SomosHFF (32): Newsletter do Hospital Prof. Dr. Fernando Fonseca, E.P.E.
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Case Report: Pure Red Cell Aplasia due to Angioimmunoblastic T-Cell Lymphoma.
Get PDFPure red cell aplasia (PRCA) is a rare bone marrow failure characterized by a progressive normocytic anemia and reticulocytopenia without leukopenia and thrombocytopenia. It can be associated with various hematological disorders but exceedingly rarely with angioimmunoblastic T-cell lymphoma (AITL). We report the case of a 72-year-old woman with PRCA associated with AITL. The patient presented with severe anemia (hemoglobin 2.6 g/dL) and a low reticulocyte count 0.7%. Direct and indirect Coombs tests were positive. A CT scan of the chest, abdomen, and pelvis revealed multiple lymphadenopathies. A cervical lymph node biopsy was compatible with AITL. A bone marrow biopsy showed medullary involvement by AITL and a severe erythroid hypoplasia with a myeloid:erythroid ratio of 19.70. The patient was started on CHOP and after 6 cycles the PET scan confirmed complete remissioninfo:eu-repo/semantics/publishedVersio
The association of serotonin reuptake inhibitors and benzodiazepines with ictal central apnea
No full textOBJECTIVE:
Ictal (ICA) and postconvulsive central apnea (PCCA) have been implicated in sudden unexpected death in epilepsy (SUDEP) pathomechanisms. Previous studies suggest that serotonin reuptake inhibitors (SRIs) and benzodiazepines (BZDs) may influence breathing. The aim of this study was to investigate if chronic use of these drugs alters central apnea occurrence in patients with epilepsy.
METHODS:
Patients with epilepsy admitted to epilepsy monitoring units (EMUs) in nine centers participating in a SUDEP study were consented. Polygraphic physiological parameters were analyzed, including video-electroencephalography (VEEG), thoracoabdominal excursions, and pulse oximetry. Outpatient medication details were collected. Patients and seizures were divided into SRI, BZD, and control (no SRI or BZD) groups. Ictal central apnea and PCCA, hypoxemia, and electroclinical features were assessed for each group.
RESULTS:
Four hundred and seventy-six seizures were analyzed (204 patients). The relative risk (RR) for ICA in the SRI group was half that of the control group (p = 0.02). In the BZD group, ICA duration was significantly shorter than in the control group (p = 0.02), as was postictal generalized EEG suppression (PGES) duration (p = 0.021). Both SRI and BZD groups were associated with smaller seizure-associated oxygen desaturation (p = 0.009; p ≪ 0.001). Neither presence nor duration of PCCA was significantly associated with SRI or BZD (p ≫ 0.05).
CONCLUSIONS:
Seizures in patients taking SRIs have lower occurrence of ICA, and patients on chronic treatment with BZDs have shorter ICA and PGES durations. Preventing or shortening ICA duration by using SRIs and/or BZD in patients with epilepsy may play a possible role in SUDEP risk reduction.info:eu-repo/semantics/publishedVersio
Hyperbaric Oxygen Therapy in Retinal Arterial Occlusion: Epidemiology, Clinical Approach, and Visual Outcomes
Get PDFPURPOSE:
To evaluate the efficacy and safety of hyperbaric oxygen therapy (HBOT) in patients with acute retinal artery occlusion (RAO). Secondarily, to analyse the epidemiology and the clinical approach.
METHODS:
Retrospective study of 13 patients submitted to HBOT between 2013 and 2018. The analysed parameters consisted of: systemic history, time between symptoms onset and treatment, initial approach, number of HBOT sessions, complications of HBOT and best corrected visual acuity-BCVA (of the total sample, central RAO-CRAO-group, and branch RAO-BRAO group).
RESULTS:
Arterial hypertension was the most prevalent systemic risk factor (53.8%). Initial therapies were 100% normobaric oxygen administration, topical and oral hypotensive medication, eye massage and aspirin. CRAO was observed in 69.2% and BRAO in 30.8% of the cases, with clinically significant visual improvement (a decrease in logMAR of 0.3) in 55.5% and 75%, respectively. Time between symptoms onset and treatment had a median of 9 hours. The median number of HBOT sessions was 7, without complications.
CONCLUSIONS:
HBOT provide BCVA improvement in patients with RAO, when it is performed in an early time after the symptom onset. It seems to be an effective and safe therapeutic option for a pathology that still remains without approved treatment.info:eu-repo/semantics/publishedVersio
Mutational mechanism for DAB1 (ATTTC)n insertion in SCA37: ATTTT repeat lengthening and nucleotide substitution.
No full textDynamic mutations by microsatellite instability are the molecular basis of a
growing number of neuromuscular and neurodegenerative diseases. Repetitive
stretches in the human genome may drive pathogenicity, either by expansion above
a given threshold, or by insertion of abnormal tracts in nonpathogenic
polymorphic repetitive regions, as is the case in spinocerebellar ataxia type 37
(SCA37). We have recently established that this neurodegenerative disease is
caused by an (ATTTC)n insertion within an (ATTTT)n in a noncoding region of DAB1.
We now investigated the mutational mechanism that originated the (ATTTC)n
insertion within an ancestral (ATTTT)n . Approximately 3% of nonpathogenic
(ATTTT)n alleles are interspersed by AT-rich motifs, contrarily to mutant alleles
that are composed of pure (ATTTT)n and (ATTTC)n stretches. Haplotype studies in
unaffected chromosomes suggested that the primary mutational mechanism, leading
to the (ATTTC)n insertion, was likely one or more T>C substitutions in an
(ATTTT)n pure allele of approximately 200 repeats. Then, the (ATTTC)n expanded in
size, originating a deleterious allele in DAB1 that leads to SCA37. This is
likely the mutational mechanism in three similar (TTTCA)n insertions responsible
for familial myoclonic epilepsy. Because (ATTTT)n tracts are frequent in the
human genome, many loci could be at risk for this mutational process.info:eu-repo/semantics/publishedVersio
O impacto da microscopia eletrónica na biópsia renal. Em colaboração com o Serviço de Hefrologia
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Development of a prediction model for postoperative pneumonia: A multicentre prospective observational study.
No full textBACKGROUND:
Postoperative pneumonia is associated with increased morbidity, mortality and costs. Prediction models of pneumonia that are currently available are based on retrospectively collected data and administrative coding systems.
OBJECTIVE:
To identify independent variables associated with the occurrence of postoperative pneumonia.
DESIGN:
A prospective observational study of a multicentre cohort (Prospective Evaluation of a RIsk Score for postoperative pulmonary COmPlications in Europe database).
SETTING:
Sixty-three hospitals in Europe.
PATIENTS:
Patients undergoing surgery under general and/or regional anaesthesia during a 7-day recruitment period.
MAIN OUTCOME MEASURE:
The primary outcome was postoperative pneumonia.
DEFINITION:
the need for treatment with antibiotics for a respiratory infection and at least one of the following criteria: new or changed sputum; new or changed lung opacities on a clinically indicated chest radiograph; temperature more than 38.3 °C; leucocyte count more than 12 000 μl.
RESULTS:
Postoperative pneumonia occurred in 120 out of 5094 patients (2.4%). Eighty-two of the 120 (68.3%) patients with pneumonia required ICU admission, compared with 399 of the 4974 (8.0%) without pneumonia (P < 0.001). We identified five variables independently associated with postoperative pneumonia: functional status [odds ratio (OR) 2.28, 95% confidence interval (CI) 1.58 to 3.12], pre-operative SpO2 values while breathing room air (OR 0.83, 95% CI 0.78 to 0.84), intra-operative colloid administration (OR 2.97, 95% CI 1.94 to 3.99), intra-operative blood transfusion (OR 2.19, 95% CI 1.41 to 4.71) and surgical site (open upper abdominal surgery OR 3.98, 95% CI 2.19 to 7.59). The model had good discrimination (c-statistic 0.89) and calibration (Hosmer-Lemeshow P = 0.572).
CONCLUSION:
We identified five variables independently associated with postoperative pneumonia. The model performed well and after external validation may be used for risk stratification and management of patients at risk of postoperative pneumonia.info:eu-repo/semantics/publishedVersio
