Lesão expansiva cerebral devida a citomegalovírus: relato de caso e revisão da literatura

Cytomegalovirus (CMV) disease in acquired immunodeficiency syndrome (AIDS) patients most commonly presents as chorioretinitis and gastro-intestinal infection. Neurological involvement due to CMV may cause several clinical presentations: polyradiculitis, myelitis, encephalitis, ventriculo-encephalitis, and mononeuritis multiplex. Rarely, cerebral mass lesion is described. We report a 39 year-old woman with AIDS and previous cerebral toxoplasmosis. She presented with fever, seizures, and vulval ulcers. Her chest X-ray showed multiple lung nodules, and a large frontal lobe lesion was seen in a brain computed tomography scan. She underwent a brain biopsy through a frontal craniotomy, but her condition deteriorated and she died in the first postoperative day. Histopathological studies and immunohistochemistry disclosed CMV disease, and there was no evidence of cerebral toxoplasmosis, bacterial, mycobacterial or fungal infection. CMV disease should be considered in the differential diagnosis of cerebral mass lesion in AIDS patients. High suspicion index, timely diagnostic procedures (surgical or minimally invasive), and proper utilization of prophylactic and therapeutic medication could improve outcome of these patients.As doenças causadas pelo citomegalovírus (CMV) em pacientes com a síndrome da imunodeficiência adquirida apresentam-se principalmente como corioretinite ou comprometimento gastrointestinal. No sistema nervoso central, o CMV pode causar diversas síndromes clínicas: poliradiculite, mielite, encefalite, ventrículo-encefalite e mononeurite múltipla. Raramente, lesões expansivas cerebrais são descritas. Os autores relatam o caso de uma paciente de 39 anos com antecedentes de infecção pelo HIV e toxoplasmose cerebral, que apresentou-se com febre, convulsões e úlceras vulvares. O raios-X de tórax demonstrou múltiplos nódulos pulmonares e a tomografia computadorizada de crânio evidenciou extensa lesão no lobo frontal esquerdo. Após ser submetida à craniotomia, evoluiu com piora clínica, falecendo no primeiro dia de pós-operatório. Os estudos histopatológicos e imunohistoquímicos demonstraram doença citomegálica. Foram excluídas toxoplasmose cerebral e infecção bacteriana, micobacteriana ou fúngica. Concluímos que, embora seja extremamente raro, o CMV deve ser considerado no diagnóstico diferencial das lesões expansivas cerebrais em pacientes com infecção pelo HIV. Um elevado índice de suspeita, procedimentos diagnósticos oportunos (cirúrgicos ou minimamente invasivos), e o adequado uso de antivirais (terapêuticos e profiláticos) podem melhorar o prognóstico desta letal manifestação

Segmented lordotic angles to assess lumbosacral transitional vertebra on EOS

Purpose: To test the vertical posterior vertebral angles (VPVA) of the most caudal lumbar segments measured on EOS to identify and classify the lumbosacral transitional vertebra (LSTV). Methods: We reviewed the EOS examinations of 906 patients to measure the VPVA at the most caudal lumbar segment (cVPVA) and at the immediately proximal segment (pVPVA), with dVPVA being the result of their difference. Mann\u2013Whitney, Chi-square, and ROC curve statistics were used. Results: 172/906 patients (19%) had LSTV (112 females, mean age: 43 \ub1 21 years), and 89/172 had type I LSTV (52%), 42/172 type II (24%), 33/172 type III (19%), and 8/172 type IV (5%). The cVPVA and dVPVA in non-articulated patients were significantly higher than those of patients with LSTV, patients with only accessory articulations, and patients with only bony fusion (all p <.001). The cVPVA and dVPVA in L5 sacralization were significantly higher than in S1 lumbarization (p <.001). The following optimal cutoff was found: cVPVA of 28.2\ub0 (AUC = 0.797) and dVPVA of 11.1\ub0 (AUC = 0.782) to identify LSTV; cVPVA of 28.2\ub0 (AUC = 0.665) and dVPVA of 8\ub0 (AUC = 0.718) to identify type II LSTV; cVPVA of 25.5\ub0 (AUC = 0.797) and dVPVA of 12 7.5\ub0 (AUC = 0.831) to identify type III\u2013IV LSTV; cVPVA of 20.4\ub0 (AUC = 0.693) and dVPVA of 12 1.8\ub0 (AUC = 0.665) to differentiate type II from III\u2013IV LSTV; cVPVA of 17.9\ub0 (AUC = 0.741) and dVPVA of 12 4.5\ub0 (AUC = 0.774) to differentiate L5 sacralization from S1 lumbarization. Conclusion: The cVPVA and dVPVA measured on EOS showed good diagnostic performance to identify LSTV, to correctly classify it, and to differentiate L5 sacralization from S1 lumbarization

Perception of sleep duration in adult patients with suspected obstructive sleep apnea

PURPOSE: Discrepancies between subjective and objective measures of total sleep time (TST) are frequent among insomnia patients, but this issue remains scarcely investigated in obstructive sleep apnea (OSA). We aimed to evaluate if sleep perception is affected by the severity of OSA. METHODS: We performed a 3-month cross-sectional study of Brazilian adults undergoing overnight polysomnography (PSG). TST was objectively assessed from PSG and by a self-reported questionnaire (subjective measurement). Sleep perception index (SPI) was defined by the ratio of subjective and objective values. Diagnosis of OSA was based on an apnea/hypopnea index (AHI) ≥ 5.0/h, being its severity classified according to AHI thresholds: 5.0-14.9/h (mild OSA), 15.0-29.9/h (moderate OSA), and ≥ 30.0/h (severe OSA). RESULTS: Overall, 727 patients were included (58.0% males). A significant difference was found in SPI between non-OSA and OSA groups (p = 0.014). Mean SPI values significantly decreased as the OSA severity increased: without OSA (100.1 ± 40.9%), mild OSA (95.1 ± 24.6%), moderate OSA (93.5 ± 25.2%), and severe OSA (90.6 ± 28.2%), p = 0.036. Using logistic regression, increasing SPI was associated with a reduction in the likelihood of presenting any OSA (p = 0.018), moderate/severe OSA (p = 0.019), and severe OSA (p = 0.028). However, insomnia was not considered as an independent variable for the presence of any OSA, moderate/severe OSA, and severe OSA (all p-values > 0.05). CONCLUSION: In a clinical referral cohort, SPI significantly decreases with increasing OSA severity, but is not modified by the presence of insomnia symptoms.publishersversionpublishe

Development, validation and comparative study with no-apnea, STOP-bang, and NoSAS

Background: Obstructive sleep apnea (OSA) is a very prevalent disorder. Here, we aimed to develop and validate a practical questionnaire with yes-or-no answers, and to compare its performance with other well-validated instruments: No-Apnea, STOP-Bang, and NoSAS. Methods: A cross-sectional study containing consecutively selected sleep-lab subjects underwent full polysomnography. A 4-item model, named GOAL questionnaire (gender, obesity, age, and loud snoring), was developed and subsequently validated, with item-scoring of 0–4 points (≥2 points indicating high risk for OSA). Discrimination was assessed by area under the curve (AUC), while predictive parameters were calculated using contingency tables. OSA severity was classified based on conventionally accepted apnea/hypopnea index thresholds: ≥5.0/h (OSA≥5), ≥15.0/h (OSA≥15), and ≥30.0/h (OSA≥30). Results: Overall, 7377 adults were grouped into two large and independent cohorts: derivation (n = 3771) and validation (n = 3606). In the derivation cohort, screening of OSA≥5, OSA≥15, and OSA≥30 revealed that GOAL questionnaire achieved sensitivity ranging from 83.3% to 94.0% and specificity ranging from 62.4% to 38.5%. In the validation cohort, screening of OSA≥5, OSA≥15, and OSA≥30, corroborated validation steps with sensitivity ranging from 83.7% to 94.2% and specificity from 63.4% to 37.7%. In both cohorts, discriminatory ability of GOAL questionnaire for screening of OSA≥5, OSA≥15, and OSA≥30 was similar to No-Apnea, STOP-Bang or NoSAS. Conclusion: All four instruments had similar performance, leading to a possible greater practical implementation of the GOAL questionnaire, a simple instrument with only four parameters easily obtained during clinical evaluation.publishersversionpublishe

Exposure knowledge and perception of wireless communication technologies

The presented survey investigates risk and exposure perceptions of radio frequency electromagnetic fields (RF EMF) associated with base stations, mobile phones and other sources, the key issue being the interaction between both sets of perceptions. The study is based on a cross-sectional design, and conducted with an online sample of 838 citizens from Portugal. The results indicate that respondents’ intuitive exposure perception differs from the actual exposure levels. Furthermore, exposure and risk perceptions are found to be highly correlated. Respondents’ beliefs about exposure factors, which might influence possible health risks, is appropriate. A regression analysis between exposure characteristics, as predictor variables, and RF EMF risk perception, as the response variable, indicates that people seem to use simple heuristics to form their perceptions. What is bigger, more frequent and longer lasting is seen as riskier. Moreover, the quality of exposure knowledge is not an indicator for amplified EMF risk perception. These findings show that exposure perception is key to future risk communication

Nanostructure And Giant Hall Effect In Tmx(sio2) 1-x (tm=co,fe,ni) Granular System

Granular TMx (Si O2) 1-x (TM=Co,Fe,Ni) thin films were thermally treated at different temperatures and their magnetotransport and structural properties were studied. Hall resistivity decreases with thermal annealing. Structure was analyzed based on small angle x-ray scattering results. A model of polydisperse system of hard spheres was used for obtaining structural parameters. Analysis reveals that a volume fraction of transition-metal atoms (less than 29%) are forming nanospheres. Changes in giant Hall effect upon annealing can depend on a particular combination of nanoparticle diameter, interparticle distance, and size distribution. © 2006 American Institute of Physics.998Pakhomov, A.B., Yan, X., Zhao, B., (1995) Appl. Phys. Lett., 67, p. 3497Denardin, J.C., Knobel, M., Zhang, X.X., Pakhomov, A.B., (2003) J. Magn. Magn. Mater., 262, p. 15Hurd, C.M., (1972) The Hall Effect in Metals and Alloys, , Plenum, New YorkZhang, X.X., Wan, C., Liu, H., Li, Z.Q., Sheng, P., Lin, J.J., (2001) Phys. Rev. Lett., 86, p. 5562Jing, X.N., Wang, N., Pakhomov, A.B., Fung, K.K., Yan, X., (1996) Phys. Rev. B, 53, p. 14032Aronzon, B.A., Granovskii, A.B., Kovalev, D.Y., Meilikhov, E.Z., Ryl'kov, V.V., Sedova, M.V., (2000) JETP Lett., 71, p. 469Wan, C.C., Sheng, P., (2002) Phys. Rev. B, 66, p. 075309Socolovsky, L.M., Denardin, J.C., Brandl, A.L., Knobel, M., (2003) Mater. Charact., 50, p. 117Robertus, C., Philipse, W.H., Joosten, J.G.H., Levine, Y.K., (1989) J. Chem. Phys., 90, p. 4482Svergun, D.I., Konarev, P.V., Volkov, V.V., Koch, M.H.J., Sager, W.F.C., Smeets, J., Blokhuis, E.M., (2000) J. Chem. Phys., 113, p. 1651Socolovsky, L.M., Oliveira, C.L.P., Denardin, J.C., Knobel, M., Torriani, I., (2005) Phys. Rev. B, 72, p. 18442