Pólipos fibroepitelial ureteral em mulher grávida: relato de caso

CONTEXT: Ureteral fibroepithelial polyps are rare benign nonepithelial tumors, and less than 200 cases have been reported in the literature. We report on a pregnant patient with ureteral fibroepithelial polyps that were successfully treated with laparotomy. CASE REPORT: A 23-year-old pregnant woman presented with a three-month history of intermittent lumbar pain of low intensity. Abdominal ultrasonography showed that she was 13 weeks pregnant and found severe left-side ureterohydronephrosis and a heterogeneous solid mass measuring 11 x 8 x 7 centimeters in the middle portion of the ureteral topography. The investigation was complemented with magnetic resonance imaging, which confirmed the previous findings. Nephroureterectomy was performed without complications. The specimen revealed three solid tumors in the ureter, of which the largest was around eight centimeters in length. The anatomopathological report confirmed that they were fibroepithelial tumors without malignant components.CONTEXTO: Pólipos fibroepiteliais de ureter são tumores não-epiteliais benignos raros, e menos de 200 casos foram relatados na literatura. Nós reportamos o caso de uma mulher grávida com pólipos fibroelitelial ureteral que foram tratados com sucesso por laparotomia. RELATO DE CASO: Mulher de 23 anos de idade, grávida, apresentava história de dor lombar intermitente de baixa intensidade há três meses. Ultra-sonografia abdominal revelou gravidez de 13 semanas, ureterohidronefrose grave à esquerda e massa sólida heterogênea medindo 11 x 8 x 7 cm na porção média da topografia ureteral. A investigação foi complementada com ressonância magnética, que confirmou os achados. Foi realizada nefroureterectomia sem complicações. A peça revelou três tumores sólidos em ureter, o maior apresentando aproximadamente oito centímetros longitudinalmente. O relatório anatomopatológico confirmou tumor fibroepitelial sem componentes de malignidade

Trauma urológico

The genitourinary trauma represents 10% of all traumas in our Emergency Service (HC-FMUSP). The kidney is the organ most frequently affected. The ureteral and bladder traumas are rarer and are associated with traumas of high energy and with other severe injuries. The ureteral injuries are, mostly, caused by penetrating traumas or by surgical and iatrogenic injuries. The urethral injuries, otherwise, are associated with pelvis fracture in almost all cases and withbladder injury in 10 to 17% of the cases. An essential principle to be applied on diagnosis of urologic injuries is the evaluation of the mechanisms and the energy involved in the trauma, especially in victims of blunt injuries. Knowing the etiology, physiopathology, diagnosis and treatment of the genitourinary trauma is essential for the correct approach of the polytraumatized patient at the Emergency Service. The interaction between the Urologist and the Trauma Surgeon since the earlier moments at the emergency room can help to guide the therapeutic decisions on an integrated and congruent way. In this article we will discuss the main aspects of diagnosis and treatment of genitourinary tract trauma.Os traumas geniturinários representam 10% de todos os traumas em nosso serviço de emergência (HC-FMUSP). O rim é, em geral, o órgão mais freqüentemente envolvido, sendo os traumas de ureter e bexiga mais raros e associados a traumas de alta energia e a outras lesões severas concomitantes. As lesões de ureter são causadas em sua maioria por traumas penetrantes ou por lesões cirúrgicas iatrogênicas. As lesões de uretra, por sua vez, são quase sempre associadas a fraturas do anel pélvico, estando associadas a lesões vesicais em 10 a 17% dos casos. Um princípio primordial a ser aplicado no diagnóstico do trauma urológico é suspeitar-se da lesão pela avaliação do seu mecanismo e das forças envolvidas no traumatismo, pois os sinais envolvidos são inespecíficos, principalmente em vítimas de trauma fechado. O conhecimento da etiologia, fisiopatologia, diagnóstico e tratamento das principais lesões traumáticas do trato urinário é fundamental para a abordagem adequada do paciente politraumatizado no serviço de emergência. A interação do urologista com o cirurgião do trauma desde os momentos iniciais do atendimento permite guiar as decisões terapêuticas de maneira integrada e congruente. Neste artigo discutiremos os aspectos centrais do diagnóstico e do tratamento das principais lesões do trato geniturinário (TGU)

Residues of antibiotics in integral and standard pasteurized milk produced and commercialized in Goiás, Brazil

A presença de antibióticos no leite é um fator de risco para o consumidor, podendo causar alergia, resistência bacteriana e até mesmo choques anafiláticos em indivíduos suscetíveis. Com o objetivo de investigar os resíduos de antibióticos no leite, fez-se um estudo em 533 amostras de leite pasteurizado padronizado em Goiás, no período de junho de 1997 a agosto de 1998. O método foi baseado na difusão de resíduos de antibióticos em ágar, tendo o Bacillus subtilus e o Bacillus stearothermophilus como microrganismos-testes. Embora os resíduos tenham sido somente encontrados em 9,95% das amostras, 32,65% das 98 marcas comerciais mostraram-se positivas. Os resultados indicam que, apesar da baixa ocorrência, a presença desses resíduos comprova que os procedimentos sanitários padronizados, recomendados pelo Serviço de Inspeção Federal, não foram seguidos. _______________________________________________________________________________ ABSTRACTThe presence of antibiotics in milk is a risk factor for consumers. It may cause allergy, bacterial resistance and even anaphylatic shocks in sensitive individuals. In order to investigate the residues of antibiotics in milk, we performed a study in 533 samples of integral and standard pasteurized milk produced and commercialized in Goiás, Brazil, from June 1997 to August 1998. The method was based on the diffusion of residues of antibiotics in agar with Bacillus subtilus and Bacillus stearothermophilus, which act as testing microrganisms. Although residues were only found in 9,95% of the samples, 32,65% were positive as far as trade marks were concerned. The results indicate that, despite of the low occurrence, the presence of these residues in milk demonstrates that the standard sanitary procedures recommended by the Brazilian Federal Inspection Service have not been followed

Evaluationof the stability of polihexametilene biguanide hydrochloride in footbath for bovines

O presente estudo avaliou a estabilidade da solução desinfetante de cloridrato de polihexametileno biguanida (PHMB) utilizada em pedilúvio. Foram avaliadas três concentrações (1%, 3% e 5%) por um período de sete dias. Durante esse período, dez animais saudáveis passaram no pedilúvio, na freqüência de três vezes, com intervalos entre as passagens de 48 horas. De cada solução foram colhidas quatro amostras, com intervalos de 48 horas, sendo que a primeira colheita foi realizada imediatamente após o preparo da solução. As análises físico-químicas constaram da determinação do pH e da concentração do PHMB. As análises microbiológicas realizadas foram as contagens de microrganismos aeróbios ou facultativos mesófilos e de anaeróbios mesófilos. Para classificar o tipo de crescimento microbiológico foi utilizada uma adaptação da metodologia proposta por Andrade e Macêdo (1996). A seleção da melhor concentração baseou-se nas menores médias das contagens dos microrganismos anaeróbios mesófilos, nas menores contagens de aeróbios ou facultativos mesófilos, no menor custo/benefício da solução e no conforto animal. As características físico-químicas mantiveram-se praticamente estáveis e não se observou diferença no crescimento microbiológico entre as concentrações a 5% e 1%, sendo isolados somente Staphylococcus epidermidis e Bacillus spp. Estabeleceu-se, a partir do custo/benefício, a concentração de 1% como sendo a mais viável para ser utilizada em pedilúvio. _______________________________________________________________________________ ABSTRACTThe present study evaluated the stability of the polihexametilene biguanide hydrochloride solution (PHMB) used in footbath as disinfectant. Three concentrations (1%, 3% and 5%) were appraised for a period of seven days. During that period, ten healthy animals passed three times through the footbath, with intervals of 48 hours among the passages. Of each solution four samples were picked, with intervals of 48 hours, and the first crop was accomplished immediately as solution was prepared. The physical-chemistry analysis consisted of the determination of pH and the concentration of PHMB. The microbiological analyses consisted of aerobic microorganism or optional mesophilics and of anaerobics mesophilics. The microbial growth was based on an adaptation of the methodology proposed by Andrade and Macêdo (1996). The selection of the best concentration was based on the smallest averages of the anaerobic mesophilics, in the smallest aerobic or optional mesophilics, in the smallest cost/benefit of the solution and in the animal comfort. The physical and chemical characteristics remained practically stable and no difference was observed in the microbial growth among the concentrations of 5% and 1% and only Staphylococcus epidermidis and Bacillus spp. were isolated. The use of PHMB at 1% was considered to be the most viable regarding the economical point of view

AVALIAÇÃO DA ESTABILIDADE DO CLORIDRATO DE POLIHEXAMETILENO BIGUANIDA EM PEDILÚVIO PARA BOVINOS

O presente estudo avaliou a estabilidade da solução desinfetante de cloridrato de polihexametileno biguanida (PHMB) utilizada em pedilúvio. Foram avaliadas três concentrações (1%, 3% e 5%) por um período de sete dias. Durante esse período, dez animais saudáveis passaram no pedilúvio, na freqüência de três vezes, com intervalos entre as passagens de 48 horas. De cada solução foram colhidas quatro amostras, com intervalos de 48 horas, sendo que a primeira colheita foi realizada imediatamente após o preparo da solução. As análises físico-químicas constaram da determinação do pH e da concentração do PHMB. As análises microbiológicas realizadas foram as contagens de microrganismos aeróbios ou facultativos mesófilos e de anaeróbios mesófilos. Para classificar o tipo de crescimento microbiológico foi utilizada uma adaptação da metodologia proposta por Andrade e Macêdo (1996). A seleção da melhor concentração baseou-se nas menores médias das contagens dos microrganismos anaeróbios mesófilos, nas menores contagens de aeróbios ou facultativos mesófilos, no menor custo/benefício da solução e no conforto animal. As características físico-químicas mantiveram-se praticamente estáveis e não se observou diferença no crescimento microbiológico entre as concentrações a 5% e 1%, sendo isolados somente Staphylococcus epidermidis e Bacillus spp. Estabeleceu-se, a partir do custo/benefício, a concentração de 1% como sendo a mais viável para ser utilizada em pedilúvio. PALAVRAS-CHAVE: Pedilúvio, bovinos, cloridrato de polihexametileno biguanida

Convalescent plasma for COVID-19 in hospitalised patients : an open-label, randomised clinical trial

Background: The effects of convalescent plasma (CP) therapy in hospitalised patients with coronavirus disease 2019 (COVID-19) remain uncertain. This study investigates the effect of CP on clinical improvement in these patients. Methods: This is an investigator-initiated, randomised, parallel arm, open-label, superiority clinical trial. Patients were randomly (1:1) assigned to two infusions of CP plus standard of care (SOC) or SOC alone. The primary outcome was the proportion of patients with clinical improvement 28 days after enrolment. Results: A total of 160 (80 in each arm) patients (66.3% critically ill, 33.7% severely ill) completed the trial. The median (interquartile range (IQR)) age was 60.5 (48–68) years; 58.1% were male and the median (IQR) time from symptom onset to randomisation was 10 (8–12) days. Neutralising antibody titres >1:80 were present in 133 (83.1%) patients at baseline. The proportion of patients with clinical improvement on day 28 was 61.3% in the CP+SOC group and 65.0% in the SOC group (difference −3.7%, 95% CI −18.8–11.3%). The results were similar in the severe and critically ill subgroups. There was no significant difference between CP+SOC and SOC groups in pre-specified secondary outcomes, including 28-day mortality, days alive and free of respiratory support and duration of invasive ventilatory support. Inflammatory and other laboratory marker values on days 3, 7 and 14 were similar between groups. Conclusions: CP+SOC did not result in a higher proportion of clinical improvement on day 28 in hospitalised patients with COVID-19 compared to SOC alone

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Ureteral fibroepithelial polyps in a pregnant woman: case report

CONTEXT: Ureteral fibroepithelial polyps are rare benign nonepithelial tumors, and less than 200 cases have been reported in the literature. We report on a pregnant patient with ureteral fibroepithelial polyps that were successfully treated with laparotomy. CASE REPORT: A 23-year-old pregnant woman presented with a three-month history of intermittent lumbar pain of low intensity. Abdominal ultrasonography showed that she was 13 weeks pregnant and found severe left-side ureterohydronephrosis and a heterogeneous solid mass measuring 11 x 8 x 7 centimeters in the middle portion of the ureteral topography. The investigation was complemented with magnetic resonance imaging, which confirmed the previous findings. Nephroureterectomy was performed without complications. The specimen revealed three solid tumors in the ureter, of which the largest was around eight centimeters in length. The anatomopathological report confirmed that they were fibroepithelial tumors without malignant components