Traumatic diaphragmatic hernias: retrospective analysis

AIMS: This study classifies cases of traumatic diaphragmatic hernias (TDH) in patients admitted to the Intensive Care Unit (ICU) of the Coimbra University Hospitals (HUC) from 1990 to 2004. METHODS: Retrospective analysis of 34 cases of TDH, studying anatomical location, place and time of diagnosis, complementary tests aiding diagnosis, herniated organs, associated traumatism, morbidity and mortality. RESULTS: Twenty-eight male and six female patients with an average age of 40.5 years +/- 20.5, average SAPS score 38.8. Average length of stay was 19.1 +/- 13.6 days, all suffered from closed traumatism and were put on artificial ventilation. The left-side diaphragm was more frequently affected (94.1%) then the right. Diagnosis in 19 cases was made up in the first six hours following the diagnosis of traumatism, in four cases within 12 hours and in the remaining cases between 48 hours and 16 years after traumatism. In 13 patients the diagnosis was established intra-operatively. The stomach was typically one of the herniated organs. The most frequently associated lesions at the thoracic level were pulmonary contusion, haemothorax and pneumothorax, and at the abdominal level, haemoperitoneum and splenic lesion. The rates for complications and mortality were 55.8% and 11.7% respectively. CONCLUSIONS: TDH mainly occurs on the left side through closed thoraco-abdominal trauma following road traffic accidents. This group of patients, on average younger than others admitted to ICU, presents a longer average hospitalisation period, but has lower rates of mortality and lower SAPS severity scores. The most commonly herniated organ was the stomach and the most frequently encountered lesions were cranial-encephalic, splenic and pleural traumatisms. Pre-operative diagnosis of diaphragmatic injuries is difficult and a high index of clinical suspicion is needed after thoraco-abdominal trauma. This diagnosis should always be considered a possibility in cases of closed thoraco-abdominal traumas

Small scale trial of photodynamic treatment of onychomycosis in São Paulo

The use of methylene blue and toluidine blue in the photodynamic treatment of onychomycosis at an ambulatory clinic in São Paulo, Brazil is reported. Local application and illumination of infected nails produced a response in 53 of 62 patients, without any pain or burning associated with the therapy

Impact of antibiotic therapy in severe community-acquired pneumonia: Data from the Infauci study

Antibiotic therapy (AT) is the cornerstone of the management of severe community-acquired pneumonia (CAP). However, the best treatment strategy is far from being established. To evaluate the impact of different aspects of AT on the outcome of critically ill patients with CAP, we performed a post hoc analysis of all CAP patients enrolled in a prospective, observational, multicentre study. Of the 502 patients included, 76% received combination therapy, mainly a β-lactam with a macrolide (80%). AT was inappropriate in 16% of all microbiologically documented CAP (n=177). Hospital and 6months mortality were 34% and 35%. In adjusted multivariate logistic regression analysis, combination AT with a macrolide was independently associated with a reduction in hospital (OR 0.17, 95%CI 0.06-0.51) and 6months (OR 0.21, 95%CI 0.07-0.57) mortality. Prolonged AT (>7days) was associated with a longer ICU (14 vs. 7days; p7days had no survival benefit and was associated with a longer LOS.info:eu-repo/semantics/publishedVersio

A utilização de sémen fresco na fertilização in vitro de embriões ovinos melhora a qualidade dos blastocistos na raça portuguesa Merino

A produção de embriões em ovinos é uma tarefa difícil, exigindo experiência e condições onerosas, principalmente na produção de embriões in vivo. A recolha sistemática de oócitos em animais de matadouro ou em animais vivos por ovum pick-up, permite a produção in vitro de embriões (IVP), em larga escala e menos dispendiosa, nos pequenos ruminantes. Esta possibilidade é importante não só como fonte de embriões mas também de oócitos e zigotos para fins comerciais ou de investigação, facilitando a sua disponibilidade em tecnologias emergentes tais como a clonagem ou a transgénese. Para IVP foram desenvolvidos vários protocolos de maturação, utilizando fertilização in vitro (IVF) com sémen fresco ou congelado. Em Portugal, a produção de embriões in vitro foi somente realizada com sémen congelado dada a sua disponibilidade em condições de rotina. Contudo, o sémen fresco poderá melhorar a produção de embriões frescos ou criopreservados. Este trabalho teve como objectivo comparar a eficiência da IVP em ovinos usando diferentes protocolos de maturação de oócitos e IVF com sémen fresco ou congelado. Oócitos (n=1768) recolhidos em matadouro foram maturados em meio TCM199 com 100 μM cisteamine, 10 ng mL-1 EGF, 10 μg mL-1 E2 e gentamicina (mat A, n=692) ou suplementada com 10 μg mL-1 FSH e 0,3 mM piruvato de sódio (mat B, n=707) a 39 ºC e 5% CO2 durante 22h. O sémen fresco (FS) e congelado/descongelado (TS) de carneiros de raça Merino Branco (n=3) foi lavado ou submetido a swim-up, respectivamente. Após a fertilização (18h p.i.), os presumíveis zigotos foram cultivados em meio de fluido sintético do oviducto (SOF) enriquecido com aminoácidos e BSA a 38,5 ºC, em atmosfera humidificada com 5% O2, 5% CO2 e 90% N2 até ao estadio de 2-4-8 células. Após clivagem, o desenvolvimento embrionário prosseguiu até ao estadio de blastocisto em meio SOF, BSA e 10% FCS. A qualidade foi avaliada no dia 6-7, classificando-se como bons, médios e maus, baseado nos parâmetros IETS. Os dados das taxas de produção embrionária foram analisados utilizando ANOVA. Foi utilizado o teste de Mann-Whitney U para avaliação da qualidade dos embriões. Os diferentes protocolos de maturação não interferiram (p>0,05) quer com as taxas de maturação quer com as taxas de produção de embriões. A qualidade embrionária foi superior (p=0,004) na fertilização com sémen fresco (bom: FS=40,1±8,0% vs TS=32,9±5,6%; média: FS=20,1±4,7% vs TS=35,7±5,8%; má: FS=39,8±9,8% vs TS=31,4±7,6%). Em conclusão, estes resultados preliminares mostram que o sémen fresco de carneiro pode ser facilmente utilizado para fertilização in vitro e melhora a qualidade dos embriões produzidos.#Embryo production in sheep is a difficult task demanding experience and expensive facilities, particularly when dealing with in vivo embryo production. Easy ways to obtain ovine embryos consist of collecting oocytes at slaughterhouses or systematically pick them up from live animals, allowing a large scale and cheaper in vitro embryo production (IVP) for small ruminants. Those are important sources of embryos, oocytes and zygotes for commercial, laboratorial and research proposes, making easier the availability of resources for emerging techniques like cloning or transgenesis. For IVP, several oocyte maturation protocols have been developed using fertilization (IVF) either with fresh or frozen-thawed semen. In Portugal, IVP has been done through IVF using cryopreserved semen because it is easily available for routine use. However, the use of fresh semen could improve embryo production and cryopreservation results. The aim of this work was to compare the efficiency of in vitro embryo production in ovine using different oocyte maturation protocols and fresh or frozen semen for IVF. Abattoir-derived oocytes (n=1768) were matured in TCM199, 10 μM cysteamine, 10 ng mL-1 EGF, 10 μg mL-1 E2 and gentamicin (mat A, n=692) or plus 10 μg mL-1 FSH and 0.3 mM sodium piruvate (mat B, n=707) at 39 ºC and 5% CO2 for 22h. Prior to fertilization, either fresh (FS) or frozen/thawed (TS) semen from Merino rams (n=3) was washed or submitted to swim-up respectively. Presumptive zygotes (18h p.i.) were cultured in synthetic oviductal fluid (SOF) enriched with aminoacids and 6 mg mL-1 BSA at 38.5 ºC, under 5% O2, 5% CO2 and 90% N2 in an humidified atmosphere until the stage of 2-4-8 cell embryos. After assessing cleavage, embryo development proceeded until the blastocyst stage in SOF+BSA and 10% FCS. Quality was evaluated on D6-7 by scoring embryos as good, fair and bad based on IETS guidelines. Data from embryo production rates were analysed using ANOVA. Mann-Whitney U test was used for embryo quality evaluation. Different maturation protocols did not interfere (P>0.05) either on maturation or on embryo quality or production rates. Embryo quality was higher (P=0.004) when fertilization was accomplished with fresh semen (good: FS=40.1±8.0% vs TS=32.9±5.6%; fair: FS=20.1±4.7% vs TS=35.7±5.8%; bad: FS=39.8±9.8% vs TS=31.4±7.6%). Preliminar results show that ram fresh semen can be easily used for in vitro fertilization and improves the quality of produced embryos

Raquitismo hipofosfatêmico ligado ao X: uma nova mutação

Phosphopenic rickets may be caused by mutations in the PHEX gene (phosphate regulating endopeptidase homolog X-linked). Presently, more than 500 mutations in the PHEX gene have been found to cause hypophosphatemic rickets. The authors report a clinical case of a 4-year-old girl with unremarkable family history, who presented with failure to thrive and bowing of the legs. Laboratory tests showed hypophosphatemia, elevated alkaline phosphatase, normal calcium, mildly elevated PTH and normal levels of 25(OH)D and 1.25(OH)D. The radiological study showed bone deformities of the radius and femur. Clinical diagnosis of phosphopenic rickets was made and the genetic study detected a heterozygous likely pathogenic variant of the PHEX gene: c.767_768del (p.Thr256Serfs*7). This variant was not previously described in the literature or databases. Knowledge about new mutations can improve patient’s outcome. Genetic analysis can help to establish a genotype-phenotype correlation.info:eu-repo/semantics/publishedVersio

Production and transfer of energy and information in Hamiltonian systems

We present novel results that relate energy and information transfer with sensitivity to initial conditions in chaotic multi-dimensional Hamiltonian systems. We show the relation among Kolmogorov-Sinai entropy, Lyapunov exponents, and upper bounds for the Mutual Information Rate calculated in the Hamiltonian phase space and on bi-dimensional subspaces. Our main result is that the net amount of transfer from kinetic to potential energy per unit of time is a power-law of the upper bound for the Mutual Information Rate between kinetic and potential energies, and also a power-law of the Kolmogorov-Sinai entropy. Therefore, transfer of energy is related with both transfer and production of information. However, the power-law nature of this relation means that a small increment of energy transferred leads to a relatively much larger increase of the information exchanged. Then, we propose an ?experimental? implementation of a 1-dimensional communication channel based on a Hamiltonian system, and calculate the actual rate with which information is exchanged between the first and last particle of the channel. Finally, a relation between our results and important quantities of thermodynamics is presented

Maintaining extensivity in evolutionary multiplex networks

In this paper, we explore the role of network topology on maintaining the extensive property of entropy. We study analytically and numerically how the topology contributes to maintaining extensivity of entropy in multiplex networks, i.e. networks of subnetworks (layers), by means of the sum of the positive Lyapunov exponents, HKS, a quantity related to entropy. We show that extensivity relies not only on the interplay between the coupling strengths of the dynamics associated to the intra (short-range) and inter (long-range) interactions, but also on the sum of the intra-degrees of the nodes of the layers. For the analytically treated networks of size N, among several other results, we show that if the sum of the intra-degrees (and the sum of inter-degrees) scales as N?+1, ? > 0, extensivity can be maintained if the intra-coupling (and the inter-coupling) strength scales as N??, when evolution is driven by the maximisation of HKS. We then verify our analytical results by performing numerical simulations in multiplex networks formed by electrically and chemically coupled neurons