Symptomatic Solitary Gastric Diverticulum: A Rare Endoscopic Finding

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Acidente vascular cerebral isquémico: complicações infecciosas segundo o volume e a localização de enfarte

Introdução. Em Portugal, o Acidente Vascular Cerebral (AVC) é a primeira causa de mortalidade e a segunda de morbilidade. As complicações infecciosas são comuns e afectam negativamente o prognóstico dos doentes. Já foram identificados vários factores de risco associados àquelas, mas a relação com o volume e a localização de enfarte ainda são alvo de controvérsia. Assim, este estudo pretende avaliar estes últimos como predictores independentes do risco de desenvolver infecção. Material e Métodos. Estudo analítico caso-controlo retrospectivo de 358 doentes internados numa unidade especializada, por AVC isquémico. Determinaram-se os factores de risco associados ao desenvolvimento de infecção pós-AVC, particularmente Pneumonia, Infecção do Tracto Urinário (ITU) e Sépsis. O volume de enfarte foi determinado a partir das áreas de cada corte da Tomografia axial computorizada das 24-48h após a admissão e, a localização segundo o OxfordShire Community Stroke Project. A análise estatística baseou-se na determinação dos Odds Ratio (OR) pelas análises univariável e multivariável e, da Curva ROC; para um valor de p de 0,05. Resultados. Noventa e seis doentes desenvolveram infecções (26,8%), das quais aproximadamente metade foram do tracto urinário. Os volumes de enfarte grande e pequeno foram positiva e negativamente associados a quaisquer infecções, respectivamente. Os enfartes da circulação anterior parcial e/ou posterior foram associados à infecção e ITU, os da circulação anterior total à infecção e pneumonia e, os enfartes não lacunares a qualquer tipo de infecção. Após a análise multivariável, apenas os enfartes não pequenos foram associados à infecção (OR 4,5; valor de p <0,001) e os não lacunares à ITU (OR 12,5; valor de p <0,001). Não foi possível demonstrar uma associação entre a Sépsis e os factores volume ou localização de enfarte. Conclusão. Ambos os factores, volume e localização de enfarte, foram estatisticamente associados ao desenvolvimento de infecção, sendo o primeiro, o principal predictor de infecção e o segundo, o principal predictor de ITU.Background. In Portugal, Stroke is the leading mortality cause and the second morbidity cause. Poststroke infections are common and adversely affect the outcome. Several risk factors were identified in previous studies, but the evidences about stroke volume and stroke location are currently inconclusive. Therefore, this study aims to evaluate stroke size and location as independent predictors for poststroke infections. Materials and Methods. Case-control study with retrospective design of 358 patients admitted in a Hospital Stroke Unit with an Ischemic Stroke diagnosis. The risk factors of poststroke infections were determined, particularly pneumonia, urinary-tract infection (UTI) and sepsis. Infarct volume was calculated by the ischemic areas of computerized tomography slices whithin the firstly 24-48 hours at admission. Infarct location was classified according to Oxfordshire Community Stroke Project definitions. Statistical analysis was based in a determination of Odds Ratio (OR) by single-one-factor and multivariate analysis and, the determination of ROC curve; to a 0.05 two-sided p value. Results. Ninety-six patients developed poststroke infections (26.8%) and approximately 50% were of urinary-tract. The largest and smallest infarct volumes were positively and negatively associated with all infections, respectively. The partial anterior and posterior circulation territories were associated with all infections and UTI, the total anterior circulation territory with all infections and pneumonia and, non-lacunar stroke with any type of infection. After multivariate analysis, only non-smallest strokes were associated with all infections (OR 4.5; pvalue <0,001) and non-lacunar strokes with UTI (OR 12.5; p-value <0.001). There were no association between volume or location of stroke and sepsis. Conclusion. Both stroke volume and stroke location were significantly associated with infection. Infarct volume was the most significative predictor in all infections. Stroke location was the most significative predictor in UTI

A Rare Clinical Presentation of Cholangiocarcinoma

Cholangiocarcinoma is an uncommon tumor, often diagnosed in the context of obstructive jaundice. Brain metastasis rarely occurs with the cerebellum being a rare site of spread of this type of tumor. Few cases of cholangiocarcinoma have been reported in the literature and this type of tumor is associated with a very poor outcome. We present a very rare form of clinical presentation of cholangiocarcinoma with neurologic symptoms due to cerebellar metastases

Lysosomal Acid Lipase: Can it be a New Non-Invasive Serum Biomarker of Cryptogenic Liver Fibrosis and Cirrhosis?

Introduction and aim. The association between lysosomal acid lipase (LAL) activity and liver steatosis or fibrosis is poorly studied. The aim of our study was to determine the predictive power of LAL for cryptogenic liver steatosis and cryptogenic significant fibrosis/cirrhosis.Material and methods. Cross-sectional observational study of 101 adult patients with unexplained elevated liver enzymes/hepatomegaly with or without dyslipidemia submitted to the determination of LAL activity and LIPA gene (E8SJM-C.894G^A) mutation. Seventy-one patients underwent liver biopsy or FibroScan®. Patients with an identifiable liver dysfunction cause and well-stablished NAFLD/NASH risk factors were excluded. Predictors for liver steatosis, significant fibrosis (> F2) or cirrhosis (F4) were evaluated.Results. Liver steatosis and fibrosis were mainly assessed by liver biopsy (74.6%; n = 53). Steatosis was present in 62.0% (n = 44), significant fibrosis in 47.9% (n = 34) and cirrhosis in 39.4% (n = 28). The median LAL was 0.36 (0.21-0.46)nmol/spot/h (vs. 0.29 (0.20-0.47); p = 0.558) for liver steatosis, 0.22 (0.11-0.29) nmol/spot/h (vs. 0.40 (0.34-0.51); p <0.001) for significant fibrosis and 0.21 (0.11-0.27) nmol/spot/h (vs. 0.40 (0.32-0.52); p < 0.001) for cirrhosis. No LIPA gene mutations were found. LAL activity was the strongest predictor of significant fibrosis (AUROC: 0.833; p < 0.001) with a cut-off of 0.265 (sensitivity: 85.9%; specificity: 75.0%) and cirrhosis (AUROC: 0.859; p < 0.001) with a cut-off of 0.235 (sensitivity: 86.2%; specificity: 75.0%), being higher than FIB4, GUCI or APRI. However, LAL activity was not associated with liver steatosis (AUROC: 0.536; p =0.558).Conclusion. LAL activity can be considered a non-invasive new marker of cryptogenic liver fibrosis with higher accuracy than other known biomarkers. LAL activity < 0.265 nmol/spot/h was strongly associated with cryptogenic significant fibrosis and <0.235 nmol/spot/h with cryptogenic cirrhosis. LAL activity was not associated with cryptogenic liver steatosis

Red cell distribution width and red cell distribution width to total serum calcium ratio as major predictors of severity and mortality in acute pancreatitis

Abstract Background Acute pancreatitis (AP) is associated with considerable morbidity and mortality. Current severity scores include multiple variables and some of them are only complete within 48 h of admission. Red cell distribution width (RDW) is a simple and routine parameter that seems to be related to inflammatory status. Our aims were to evaluate the diagnostic value of RDW in severity and mortality of AP comparing with other prognostic scoring systems. Methods Retrospective case-control study of a total of 312 patients with AP admitted between 2014 and 2016. Patients with severe AP (cases) were compared with patients with mild AP (controls) in the 1:1 proportion. Additionally, a comparison between survivor and nonsurvivor AP patients was performed. Diagnosis and severity of AP were defined according to the revised Atlanta classification 2012. Variables evaluated included demographics, comorbidities, hospital stay, laboratorial parameters, arterial blood gas analysis, prognostic scores within 24 h of admission (Ranson, BISAP and Modified Marshall) and mortality. Results Included 91 cases of severe AP, most males (58.2% vs 51.6%; p = 0.228) with mean age of 64.8 ± 16.3 years (vs 67.9 ± 13.7; p = 0.239). RDW0h was higher in patients with severe AP (14.6 ± 1.3 vs 12.7 ± 0.5; p  13.0 and RDW0h-to-total serum calcium ratio > 1.4 were excellent predictors for severity and RDW0h > 14.0 and RDW0h-to-total serum calcium ratio > 1.7 were very-good predictors for mortality, being superior to conventional prognostic scoring systems