Tender red subcutaneous nodules in an adult female: a challenging diagnosis

Pancreatic panniculitis is an uncommon and rare skin complication of systemic fat necrosis associated with pancreatitis post-ampullectomy. Besides the rarity of the condition, the clinical history and physical examination for diagnosis is also important.info:eu-repo/semantics/publishedVersio

Correlation between HIV and HCV in Brazilian prisoners: evidence for parenteral transmission inside prison

OBJETIVO: É um fato correntemente aceito que as condições de confinamento aumentam o risco de algumas infecções relacionadas às práticas sexuais e/ou ao uso de drogas injetáveis. Realizou-se estudo para estimar a densidade de incidência da infecção pelo HIV na população prisional com aplicação de técnicas matemáticas. MÉTODOS: Foram entrevistados em São Paulo, SP, 631 prisioneiros da maior prisão da América do Sul, que abrigava aproximadamente 4.900 presos na ocasião do estudo. Foi colhido sangue da população entrevistada, analisado o risco para a infecção pelo HIV e realizados testes sorológicos para HIV, HCV e sífilis. Técnicas matemáticas foram usadas para se estimar a densidade de incidência do HIV relacionada ao tempo de encarceramento. RESULTADOS: As prevalências gerais encontradas foram: HIV -- 16%; HCV -- 34%; sífilis -- 18%. Os principais fatores associados à infecção pelo HIV foram a soropositividade ao HCV (OR=10,49) e a confissão do uso de drogas injetáveis (OR=3,36). A análise matemática mostrou que o risco de adquirir a infecção pelo HIV aumenta com o tempo de detenção, atingindo o máximo por volta de 3 anos de aprisionamento. CONCLUSÕES: A correlação entre a soroprevalência do HIV e do HCV e os resultados da análise matemática sugerem que a transmissão do HIV nestsa população se dá preferencialmente pela via parenteral e que seu risco aumenta com o tempo de encarceramento.OBJECTIVE: It is an accepted fact that confinement conditions increase the risk of some infections related to sexual and/or injecting drugs practices. Mathematical techniques were applied to estimate time-dependent incidence densities of HIV infection among inmates. METHODS: A total of 631 prisoners from a Brazilian prison with 4,900 inmates at that time were interviewed and their blood drawn. Risky behavior for HIV infection was analyzed, and serological tests for HIV, hepatitis C and syphilis were performed, intended as surrogates for parenteral and sexual HIV transmission, respectively. Mathematical techniques were used to estimate the incidence density ratio, as related to the time of imprisonment. RESULTS: Prevalence were: HIV -- 16%; HCV -- 34%; and syphilis -- 18%. The main risk behaviors related to HIV infection were HCV prevalence (OR=10.49) and the acknowledged use of injecting drugs (OR=3.36). Incidence density ratio derivation showed that the risk of acquiring HIV infection increases with the time of imprisonment, peaking around three years after incarceration. CONCLUSIONS: The correlation between HIV and HCV seroprevalence and the results of the mathematical analysis suggest that HIV transmission in this population is predominantly due to parenteral exposure by injecting drug, and that it increases with time of imprisonment

Correlation between HIV and HCV in Brazilian prisoners: evidence for parenteral transmission inside prison

OBJETIVO: É um fato correntemente aceito que as condições de confinamento aumentam o risco de algumas infecções relacionadas às práticas sexuais e/ou ao uso de drogas injetáveis. Realizou-se estudo para estimar a densidade de incidência da infecção pelo HIV na população prisional com aplicação de técnicas matemáticas. MÉTODOS: Foram entrevistados em São Paulo, SP, 631 prisioneiros da maior prisão da América do Sul, que abrigava aproximadamente 4.900 presos na ocasião do estudo. Foi colhido sangue da população entrevistada, analisado o risco para a infecção pelo HIV e realizados testes sorológicos para HIV, HCV e sífilis. Técnicas matemáticas foram usadas para se estimar a densidade de incidência do HIV relacionada ao tempo de encarceramento. RESULTADOS: As prevalências gerais encontradas foram: HIV -- 16%; HCV -- 34%; sífilis -- 18%. Os principais fatores associados à infecção pelo HIV foram a soropositividade ao HCV (OR=10,49) e a confissão do uso de drogas injetáveis (OR=3,36). A análise matemática mostrou que o risco de adquirir a infecção pelo HIV aumenta com o tempo de detenção, atingindo o máximo por volta de 3 anos de aprisionamento. CONCLUSÕES: A correlação entre a soroprevalência do HIV e do HCV e os resultados da análise matemática sugerem que a transmissão do HIV nestsa população se dá preferencialmente pela via parenteral e que seu risco aumenta com o tempo de encarceramento.OBJECTIVE: It is an accepted fact that confinement conditions increase the risk of some infections related to sexual and/or injecting drugs practices. Mathematical techniques were applied to estimate time-dependent incidence densities of HIV infection among inmates. METHODS: A total of 631 prisoners from a Brazilian prison with 4,900 inmates at that time were interviewed and their blood drawn. Risky behavior for HIV infection was analyzed, and serological tests for HIV, hepatitis C and syphilis were performed, intended as surrogates for parenteral and sexual HIV transmission, respectively. Mathematical techniques were used to estimate the incidence density ratio, as related to the time of imprisonment. RESULTS: Prevalence were: HIV -- 16%; HCV -- 34%; and syphilis -- 18%. The main risk behaviors related to HIV infection were HCV prevalence (OR=10.49) and the acknowledged use of injecting drugs (OR=3.36). Incidence density ratio derivation showed that the risk of acquiring HIV infection increases with the time of imprisonment, peaking around three years after incarceration. CONCLUSIONS: The correlation between HIV and HCV seroprevalence and the results of the mathematical analysis suggest that HIV transmission in this population is predominantly due to parenteral exposure by injecting drug, and that it increases with time of imprisonment

Pulmonary Emphysema Regional Distribution and Extent Assessed by Chest Computed Tomography Is Associated With Pulmonary Function Impairment in Patients With COPD

Objective: This study aimed to evaluate how emphysema extent and its regional distribution quantified by chest CT are associated with clinical and functional severity in patients with chronic obstructive pulmonary disease (COPD). Methods/Design: Patients with a post-bronchodilator forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) < 0.70, without any other obstructive airway disease, who presented radiological evidence of emphysema on visual CT inspection were retrospectively enrolled. A Quantitative Lung Imaging (QUALI) system automatically quantified the volume of pulmonary emphysema and adjusted this volume to the measured (EmphCTLV) or predicted total lung volume (TLV) (EmphPLV) and assessed its regional distribution based on an artificial neural network (ANN) trained for this purpose. Additionally, the percentage of lung volume occupied by low-attenuation areas (LAA) was computed by dividing the total volume of regions with attenuation lower or equal to -950 Hounsfield units (HU) by the predicted [LAA (%PLV)] or measured CT lung volume [LAA (%CTLV)]. The LAA was then compared with the QUALI emphysema estimations. The association between emphysema extension and its regional distribution with pulmonary function impairment was then assessed. Results: In this study, 86 patients fulfilled the inclusion criteria. Both EmphCTLV and EmphPLV were significantly lower than the LAA indices independently of emphysema severity. CT-derived TLV significantly increased with emphysema severity (from 6,143 ± 1,295 up to 7,659 ± 1,264 ml from mild to very severe emphysema, p < 0.005) and thus, both EmphCTLV and LAA significantly underestimated emphysema extent when compared with those values adjusted to the predicted lung volume. All CT-derived emphysema indices presented moderate to strong correlations with residual volume (RV) (with correlations ranging from 0.61 to 0.66), total lung capacity (TLC) (from 0.51 to 0.59), and FEV1 (~0.6) and diffusing capacity for carbon monoxide DLCO (~0.6). The values of FEV1 and DLCO were significantly lower, and RV (p < 0.001) and TLC (p < 0.001) were significantly higher with the increasing emphysema extent and when emphysematous areas homogeneously affected the lungs. Conclusions: Emphysema volume must be referred to the predicted and not to the measured lung volume when assessing the CT-derived emphysema extension. Pulmonary function impairment was greater in patients with higher emphysema volumes and with a more homogeneous emphysema distribution. Further studies are still necessary to assess the significance of CTpLV in the clinical and research fields.This research was supported by the Brazilian Council for Scientific and Technological Development (Conselho Nacional de Desenvolvimento Científico e Tecnológico, Grants Nos. 302702/2017-2 and 302839/2017-8) and the Rio de Janeiro State Research Supporting Foundation (Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro, Grants Nos. E-26/211.867/2016, E-26/202.785/2017, E-26/203.001/2018), and by national funds through FCT, Cardiovascular R&D Center – UnIC (UIDB/00051/2020 and UIDP/00051/2020)

Successful management of bilateral orbital metastases from invasive lobular breast cancer with abemaciclib and letrozole: a case report and literature review

Breast cancer is a significant global health concern, contributing to substantial morbidity and mortality among women. Hormone receptor-positive (HR+)/HER2- negative (HER2-) breast cancer constitutes a considerable proportion of cases, and significant advancements have been made in its management. CDK4/6 inhibitors (CDK4/6is) are a new targeted therapy that has demonstrated efficacy in adjuvant, advanced and metastatic settings. The propensity of lobular breast carcinomas for estrogen-rich sites, such as periocular tissues and orbital fat, may explain their tendency for orbital metastases. Current treatment strategies for these cases are predominantly palliative, and the prognosis remains poor. This article presents a unique case of a 51-year-old female with progressive right periorbital edema, pain, and limited ocular motility. An imaging work-up showed bilateral intra and extraconal orbital infiltration, which was biopsied. The histopathologic analysis disclosed mild chronic inflammatory infiltrate with thickened fibrous tissue and moderately differentiated lobular carcinoma cells, positive for GATA3 and CK7 markers, with 100% of tumor nuclei expressing estrogen receptors (ER+). A systemic evaluation showed a multicentric nodular formation in both breasts. Further diagnostic assessments unveiled an HR+/HER2- bilateral lobular breast carcinoma with synchronous bilateral orbital metastases. Systemic treatment was initiated with abemaciclib 150mg twice daily and letrozole 2.5mg once a day. However, this regimen was interrupted due to toxicity. After two weeks, treatment was resumed with a reduced abemaciclib dose (100mg twice daily) alongside letrozole, with a reasonable tolerance. Nearly two years after the initial diagnosis of inoperable metastatic cancer, the patient remains on the same systemic treatment regimen with no signs of invasive disease. This case report is the first of a patientpresenting with bilateral orbital metastases from bilateral lobular breast cancer, showing an impressive and sustained response to a first-line treatment regimen combining abemaciclib and letrozole. A literature review on bilateral orbital metastases from breast cancer is also presented.info:eu-repo/semantics/publishedVersio

LA FORMAÇÃO DO ENFERMEIRO DOCENTE DO ENSINO MÉDIO PROFISSIONALIZANTE NA RELAÇÃO COM O PRINCÍPIO DA INTERDISCIPLINARIDADE

This study is placed in the Center of Investigation, Education and Management and Professional Occupation of Nursing (NUPEGEPEN, its abbreviation in Spanish) that researches nursing instruction in nursing undergraduate education in order to apply the interdisciplinary pedagogical practice. Based in the Brazilian education changes as a result of the Guideline and Ground Act of Brazilian National Education (Act n. 9.394/460) and similar to n. 16/99 of the Education National Board, that deals with the National Curricular Guidelines for Undergraduate Education at a Technical level, being the interdisciplinary principle the guidance for skills development. Study Challenges: To identify the coordination of knowledge of the professors of nursing in an interdisciplinary way during the Nursing Technical Course. Additionally, to analyze the relations between the nursing professor training process and the interdisciplinary application in the pedagogical practice, during the Nursing Technical Course. Literature, regarding teaching skills and training of the Swiss teacher Philippe Perrenoud was used as a theoretical reference. Methodology: Descriptive study, qualitative approach case study. The data collection was carried out in an institution of Undergraduate Education in Rio de Janeiro. Eight professors of nursing of this school were interviewed using a semi-structured outline, followed by the participant observation. Three descriptive categories were established in the data analysis: Changes in the curricular organization; interdisciplinary principle as didactic recommendation for skills development; training of professor of nursing and interdisciplinary application in the pedagogical practice. The obtained results showed a necessity for continued education through a common training project in the same institution, in order to facilitate an interdisciplinary application.El presente artículo se inserta en el Núcleo de Pesquisa, Educación, Gerencia y Ejercicio Profesional de Enfermería (NUPEGEPEn) para investigar la formación del enfermero docente de la Enseñanza Media en Enfermería para aplicar la interdisciplinariedad en su práctica pedagógica. Tuvo como base los cambios en la educación brasileña, resultantes de la Ley de Directrices y bases de la Educación Nacional (Ley nº 9.394/460) y del Parecer nº 16/99 del Consejo Nacional de Educación, que trata de las Directrices Curriculares Nacionales para la Educación Profesional de Nivel Técnico, teniendo la interdisciplinariedad como principio de orientación para el desarrollo de competencias. Retos del estudio: identificar la articulación de los saberes de forma interdisciplinar por enfermeros docentes del curso técnico en Enfermería en su práctica docente, y analizar las relaciones entre los procesos de formación del enfermero docente y la aplicación de la interdisciplinariedad en su práctica pedagógica en el curso técnico en Enfermería. Como referencial teórico fue utilizada la literatura sobre competencias y formación docente del educador suizo Philippe Perrenoud. Metodología: estudio descriptivo, abordaje cualitativo del tipo de estudio de caso, siendo la recolecta de datos realizada en una institución de Enseñanza Media Profesional, en la ciudad de Río de Janeiro, por medio de entrevistas con ocho enfermeros docentes de la institución, a partir de un guión semi-estructurado, seguidas de observación participante. En el análisis de los datos se establecieron tres categorías descriptivas: los cambios en la organización curricular; el principio de la interdisciplinariedad como didáctica recomendada para el desarrollo de competencias; la formación del enfermero docente y la aplicación de la interdisciplinariedad en la práctica pedagógica. Los resultados obtenidos evidenciaron la necesidad de una formación continua a través de un proyecto de formación común en la propia institución, para facilitar la aplicación de la interdisciplinariedad.O presente se insere no Núcleo de Pesquisa, Educação, Gerência e Exercício Profissional de Enfermagem (NUPEGEPEn) visando investigar a formação do enfermeiro docente do Ensino Médio em Enfermagem para aplicar a interdisciplinaridade em sua prática pedagógica. Teve como base as mudanças na educação brasileira, resultantes da Lei de Diretrizes e Bases da Educação Nacional (Lei nº. 9.394/46) e pelo Parecer nº. 16/99 do Conselho Nacional de Educação, que trata das Diretrizes Curriculares Nacionais para a Educação Profissional de Nível Técnico, tendo a interdisciplinaridade como princípio norteador para o desenvolvimento de competências. Objetivos do estudo: identificar a articulação de saberes de forma interdisciplinar, por enfermeiros docentes do curso técnico em Enfermagem em sua prática docente, e analisar as relações entre o processo de formação do enfermeiro docente e a aplicação da interdisciplinaridade na sua prática pedagógica no curso técnico em Enfermagem. Como referencial teórico foi utilizada a literatura sobre competências e formação docente do educador suíço Philippe Perrenoud. Metodologia: estudo descritivo, abordagem qualitativa, do tipo estudo de caso, sendo a coleta de dados realizada em uma instituição de Ensino Médio profissionalizante, no Rio de Janeiro, mediante entrevistas com oito enfermeiros docentes da instituição, a partir de um roteiro semi-estruturado, seguidas de observação participante. Na análise dos dados foram estabelecidas três categorias descritivas: As mudanças na organização curricular; O princípio da interdisciplinaridade como didática recomendada para o desenvolvimento de competências; A formação do enfermeiro docente e a aplicação da interdisciplinaridade na prática pedagógica. Os resultados obtidos evidenciaram a necessidade de uma formação contínua através de um projeto de formação comum, na própria instituição, para facilitar a aplicação da interdisciplinaridade

The importance of serological assays in diagnosing acute pulmonary histoplasmosis

Histoplasmosis is a systemic mycosis caused by inhalation of Histoplasma capsulatum microconidia. The disease does not normally affect immunocompetent individuals after a single, transient inhalation exposure. However, longer exposure may cause chronic or disseminated acute pulmonary infection. Herein, we report the case of a 24-year-old immunocompetent patient, who presented fever, cough and dyspnea for one month. The chest radiography revealed interstitial infiltrate and diffuse micronodules. The patient reported having had close and prolonged contact with bats. Diagnosis was confirmed by positive double immunodifusion and immunoblotting assays. She was treated with ketoconazole (400 mg) and there was complete resolution of the disease

Reshaping the future of Portuguese azulejo patterns

This paper introduces a new approach to the inventory and catalogue of azulejo patterns found in Portuguese buildings. It uses computer-vision based software tools for automatic search and matching of azulejo patterns, thereby improving the scalability and speed of existing cataloguing methodologies. The online catalogue of azulejo patterns is called Az Infinitum (Azulejo Referencing and Indexation System), a publicly accessible online portal suitable for both researchers and the general public who are interested in exploring and understanding this cultural heritage of Portugal. The effectiveness of this catalogue as a research support tool is demonstrated using a case study based on the Marvila pattern (i.e. P-17-00999). The online catalogue has inspired the development of an engaging application, called Azulejar, which allows one to create new patterns or understand the mathematical process behind existing azulejos patterns. This application has a potential to become an effective educational tool for inspiring everyone to explore and understand the science behind the beauty of azulejo patterns. Reshaping the future of Portuguese azulejo patterns

Local fetal lung renin-angiotensin system as a target to treat congenital diaphragmatic hernia

Antenatal stimulation of lung growth is a reasonable approach to treat congenital diaphragmatic hernia (CDH), a disease characterized by pulmonary hypoplasia and hypertension. Several evidences from the literature demonstrated a possible involvement of renin-angiotensin system (RAS) during fetal lung development. Thus, the expression pattern of renin, angiotensin-converting enzyme, angiotensinogen, type 1 (AT₁) and type 2 (AT₂) receptors of angiotensin II (ANGII) was assessed by immunohisto-chemistry throughout gestation, whereas the function of RAS in the fetal lung was evaluated using fetal rat lung explants. These were morphometrically analyzed and intracellular pathway alterations assessed by Western blot. In nitrofen-induced CDH model, pregnant rats were treated with saline or PD-123319. In pups, lung growth, protein/DNA ratio, radial saccular count, epithelial differentiation and lung maturation, vascular morphometry, right ventricular hypertrophy and overload molecular markers, gasometry and survival time were evaluated. Results demonstrated that all RAS components were constitutively expressed in the lung during gestation and that ANGII had a stimulatory effect on lung branching, mediated by AT₁ receptor, through p44/42 and Akt phosphorylation. This stimulatory effect on lung growth was mimicked by AT₂-antagonist (PD-123319) treatment. In vivo antenatal PD-123319 treatment increased lung growth, ameliorated indirect parameters of pulmonary hypertension, improved lung function and survival time in nonventilated CDH pups, without maternal or fetal deleterious effects. Therefore, this study demonstrated a local and physiologically active RAS during lung morphogenesis. Moreover, selective inhibition of AT₂ receptor is presented as a putative antenatal therapy for CDH