Lemierre Syndrome in a Teenager Presenting as Pulmonary Septic Embolism

Lemierre syndrome is easily missed and may be more common than generally believed. Usually a complication of a deep neck abscess, it can present suddenly with shortness of breath and hypoxemia. Accurate diagnosis and orientation are mandatory for the treatment of an otherwise potentially life-threatening disease. We describe a case of an adolescent with Lemierre syndrome and septic pulmonary embolism.info:eu-repo/semantics/publishedVersio

An open and parallel multiresolution framework using block-based adaptive grids

A numerical approach for solving evolutionary partial differential equations in two and three space dimensions on block-based adaptive grids is presented. The numerical discretization is based on high-order, central finite-differences and explicit time integration. Grid refinement and coarsening are triggered by multiresolution analysis, i.e. thresholding of wavelet coefficients, which allow controlling the precision of the adaptive approximation of the solution with respect to uniform grid computations. The implementation of the scheme is fully parallel using MPI with a hybrid data structure. Load balancing relies on space filling curves techniques. Validation tests for 2D advection equations allow to assess the precision and performance of the developed code. Computations of the compressible Navier-Stokes equations for a temporally developing 2D mixing layer illustrate the properties of the code for nonlinear multi-scale problems. The code is open source

Atypical Bartonellosis in Children: What do We Know?

Aim: To characterise Bartonella infections in a paediatric population requiring hospital admission and review its treatment. Methods: Longitudinal observational retrospective data analysis of children and adolescents admitted with Bartonella infection at a paediatric tertiary hospital from 2010 to 2019. Results: We identified 16 cases of bartonellosis, with a mean age of 8.0 ± 4.5 years old, no sex predominance and 14 had contact with cats. Most of the cases occurred in fall and winter. Clinical presentations included osteomyelitis/arthritis (n = 9), hepatosplenic disease (n = 2), lymphadenitis (n = 2), neuroretinitis (n = 2) and encephalitis (n = 1). Clinical diagnosis was confirmed by serology (n = 16) and Bartonella DNA detection in patient's lymph nodes/hepatic lesion (n = 3). Therapeutic approach varied according to the clinical presentation: azithromycin in lymphadenitis, rifampicin plus ciprofloxacin in hepatosplenic disease, rifampicin and doxycycline in neuroretinitis, ceftriaxone in encephalitis and azithromycin, cotrimoxazole or rifampicin plus azithromycin, cefuroxime, ciprofloxacin or doxycycline in osteomyelitis/arthritis. Immunodeficiency was excluded in seven patients. Seven patients' cats were screened by veterinarians and treated when infected (n = 5). Conclusions: In these clinical presentations, where other infections may be involved, a high index of suspicion is necessary, with emphasis on the epidemiological context. The association of systemic forms with immunodeficiency did not occur in our study. The lack of recommendations for treatment of atypical infection makes the approach of these cases a challenge. Randomised control studies are essential to define the best approach in each case.info:eu-repo/semantics/publishedVersio

18F-FDG-PET/CT in diagnosis of Q fever endocarditis

info:eu-repo/semantics/publishedVersio

Pre- and Post-Septal Orbital Cellulitis in a Paediatric Department: A 17-Year Retrospective Review

Introdução: A celulite orbitária, pré e pós-septal, é a principal infeção dos tecidos e anexos do olho, tendo diferentes abordagens e implicações clínicas. Métodos: Análise retrospectiva de crianças internadas num hospital de nível II da região metropolitana de Lisboa por celulite orbitária ao longo de 17 anos. Comparação entre celulite pré-septal e infeção pós-septal no que respeita à sua apresentação clínica, achados imagiológicos e tratamento. Os dados clínicos e abordagens diagnóstica e terapêutica foram ainda analisados antes e após a implementação de um protocolo de atuação, 1996-2002 e 2003-2013, respetivamente. Resultados: Foram incluídas 305 crianças, 241 com celulite pré-septal e 64 pós-septal, homogeneamente distribuídas pelas fases anterior e posterior à implementação do protocolo de atuação (150 vs 155, respetivamente). Na celulite pós-septal, o fator predisponente mais comum foi a sinusite (82,8 vs 46,9%, p < 0,001) e a existência de portas de entrada foi menos frequente (17,2 vs 40,6%, p < 0,001). Laboratorialmente, constatou-se um maior aumento da proteína C reativa (9,6 vs 4,4 mg/ dL, p < 0,001). Após a implementação do protocolo, constatou-se um maior número de internamentos com atingimento pós- -septal (29 vs 12,7%, p = 0,001), com quadros clínicos mais exuberantes: mais fotofobia (p = 0,001), dor ocular (p < 0,001) e proptose (p < 0,05); a sinusite foi mais frequentemente diagnosticada (p < 0,05). Nesse período, registou-se ainda alteração na escolha e duração da antibioterapia, tendo sido o ceftriaxone a primeira opção na maioria dos casos. Apesar da maior taxa de complicações (1,3% vs 12,9%, p < 0,001), não se verifi cou aumento do número de sequelas a longo prazo. A implementação do protocolo de atuação com critérios de internamento mais restritos levou à admissão preferencial de casos mais graves e maior racionalização da terapêuticainfo:eu-repo/semantics/publishedVersio

The effect of the electric field on lag phase, β-galactosidase production and plasmid stability of a recombinant Saccharomyces cerevisiae strain growing on lactose

Ethanol and β-galactosidase production from cheese whey may significantly contribute to minimise environmental problems while producing value from lowcost raw materials. In this work, the recombinant Saccharomyces cerevisiae NCYC869-A3/pVK1.1 flocculent strain expressing the lacA gene (coding for β-galactosidase) of Aspergillus niger under ADHI promoter and terminator was used. This strain shows high ethanol and β-galactosidase productivities when grown on lactose. Batch cultures were performed using SSlactose medium with 50 gL−1 lactose in a 2-L bioreactor under aerobic and microaerophilic conditions. Temperature was maintained at 30 °C and pH 4.0. In order to determine the effect of an electric field in the fermentation profile, titanium electrodes were placed inside the bioreactor and different electric field values (from 0.5 to 2 Vcm−1) were applied. For all experiments, β-galactosidase activity, biomass, protein, lactose, glucose, galactose and ethanol concentrations were measured. Finally, lag phase duration and specific growth rate were calculated. Significant changes in lag phase duration and biomass yield were found when using 2 Vcm−1. Results show that the electric field enhances the early stages of fermentation kinetics, thus indicating that its application may improve industrial fermentations’ productivity. The increase in electric field intensity led to plasmid instability thus decreasing β-galactosidase production.The authors gratefully acknowledge Fundacao para a Ciencia e a Tecnologia (Portugal) for the scholarships SFRH/BD/11230/2002 and SFRH/BDP/63831/2009 granted to authors I. Castro and C. Oliveira, respectively

LINC complex-Lisl interplay controls MT1-MMP matrix digest-on-demand response for confined tumor cell migration

Cancer cells' ability to migrate through constricting pores in the tissue matrix is limited by nuclear stiffness. MT1-MMP contributes to metastasis by widening matrix pores, facilitating confined migration. Here, we show that modulation of matrix pore size or of lamin A expression known to modulate nuclear stiffness directly impinges on levels of MT1-MMP-mediated pericellular collagenolysis by cancer cells. A component of this adaptive response is the centrosome-centered distribution of MT1-MMP intracellular storage compartments ahead of the nucleus. We further show that this response, including invadopodia formation in association with confining matrix fibrils, requires an intact connection between the nucleus and the centrosome via the linker of nucleoskeleton and cytoskeleton (LINC) complex protein nesprin-2 and dynein adaptor Lis1. Our results uncover a digest-on-demand strategy for nuclear translocation through constricted spaces whereby confined migration triggers polarization of MT1-MMP storage compartments and matrix proteolysis in front of the nucleus depending on nucleus-microtubule linkage

Prognostic Value of Isolated Elevated Troponin I Levels in Patients without Acute Coronary Syndrome Admitted to the Emergency Department

Background: Although non-ischemic troponin elevation is frequently seen in patients admitted to the emergency department (ED), consensus regarding its management is lacking. Objectives: This study aimed to characterize patients admitted to the ED with non-ischemic troponin elevation and to identify potential mortality predictors in this population. Methods: This retrospective observational study included ED patients with a positive troponin test result between June and July of 2015. Patients with a clinical diagnosis of acute coronary syndrome (ACS) were excluded. Data on patient demographics and clinical and laboratory variables were extracted from medical records. Follow-up data were obtained for 16 months or until death occurred. The statistical significance level was 5%. Results: Troponin elevation without ACS was found in 153 ED patients. The median (IQR) patient age was 78 (19) years, 80 (52.3%) were female and 59(38.6%) died during follow-up. The median (IQR) follow-up period was 477(316) days. Survivors were significantly younger 76 (24) vs. 84 (13) years; p=0.004) and featured a higher proportion of isolated troponin elevation (without creatine kinase or myoglobin elevation) in two consecutive evaluations: 48 (53.9%) vs. 8 (17.4%), p<0.001. Survivors also presented a lower rate of antiplatelet treatment and same-day hospitalization. In the multivariate logistic regression with adjustment for significant variables in the univariate analysis, isolated troponin elevation in two consecutive evaluations showed a hazard ratio= 0.43 (95%CI 0.17-0.96, p=0.039); hospitalization, previous antiplatelet treatment and age remained independently associated with mortality. Conclusions: Isolated troponin elevation in two consecutive measurements was a strong predictor of survival in ED patients with troponin elevation but without ACS.info:eu-repo/semantics/publishedVersio

Elucidating the aetiology of human Campylobacter coli infections

Peer reviewedPublisher PD

Prevalence of syphilis in pregnancy and prenatal syphilis testing in Brazil: Birth in Brazil study

OBJETIVO Analisar a cobertura de testagem para sífilis durante a assistência pré-natal e estimar a prevalência de sífilis na gestação. MÉTODOS Coorte nacional de base hospitalar, realizada no Brasil, de 2011 a 2012, com 23.894 mulheres. Foram utilizados dados obtidos na entrevista com a puérpera, no prontuário hospitalar e nos cartões de pré-natal. Foram considerados casos de sífilis na gestação todas as gestantes com resultado de sorologia reagente no cartão ou diagnóstico de sífilis durante a internação para o parto. Prevalência de sífilis e coberturas de testagem foram analisadas segundo região de residência, cor da pele, escolaridade, idade materna e tipo de serviço de assistência pré-natal e ao parto, com utilização do teste estatístico Qui-quadrado. RESULTADOS Houve cobertura pré-natal de 98,7% das mulheres, cobertura de testagem para sífilis de 89,1% (um exame) e 41,2% (dois exames), bem como prevalência de sífilis na gestação de 1,02% (IC95% 0,84;1,25). Menor cobertura pré-natal foi observada na região Norte, em indígenas, em mulheres com menor escolaridade e naquelas atendidas em serviços públicos. Coberturas mais baixas de testagem ocorreram em residentes nas regiões Norte, Nordeste e Centro-Oeste, Sul em mulheres não brancas, mais jovens, de menor escolaridade e atendidas em serviços públicos. Maior prevalência de sífilis foi estimada em mulheres com menos de oito anos de escolaridade (1,74%), que se declararam pretas (1,8%) ou pardas (1,2%), mulheres sem pré-natal (2,5%) e naquelas atendidas em serviços públicos (1,37%) ou mistos (0,93%). CONCLUSÕES A prevalência estimada de sífilis na gestação foi semelhante à encontrada no último Estudo-Sentinela Parturiente realizado em 2006. Houve ampliação da cobertura pré-natal e de testagem, com alcance das metas sugeridas pela Organização Mundial da Saúde em duas regiões. Desigualdades regionais e sociais no acesso aos serviços de saúde, aliadas a outras falhas na assistência, para a persistência da sífilis congênita como importante problema de saúde pública no País.OBJECTIVE Determine the coverage rate of syphilis testing during prenatal care and the prevalence of syphilis in pregnant women in Brazil. METHODS This is a national hospital-based cohort study conducted in Brazil with 23,894 postpartum women between 2011 and 2012. Data were obtained using interviews with postpartum women, hospital records, and prenatal care cards. All postpartum women with a reactive serological test result recorded in the prenatal care card or syphilis diagnosis during hospitalization for childbirth were considered cases of syphilis in pregnancy. The Chi-square test was used for determining the disease prevalence and testing coverage rate by region of residence, self-reported skin color, maternal age, and type of prenatal and child delivery care units. RESULTS Prenatal care covered 98.7% postpartum women. Syphilis testing coverage rate was 89.1% (one test) and 41.2% (two tests), and syphilis prevalence in pregnancy was 1.02% (95%CI 0.84;1.25). A lower prenatal coverage rate was observed among women in the North region, indigenous women, those with less education, and those who received prenatal care in public health care units. A lower testing coverage rate was observed among residents in the North, Northeast, and Midwest regions, among younger and non-white skin-color women, among those with lower education, and those who received prenatal care in public health care units. An increased prevalence of syphilis was observed among women with < 8 years of education (1.74%), who self-reported as black (1.8%) or mixed (1.2%), those who did not receive prenatal care (2.5%), and those attending public (1.37%) or mixed (0.93%) health care units. CONCLUSIONS The estimated prevalence of syphilis in pregnancy was similar to that reported in the last sentinel surveillance study conducted in 2006. There was an improvement in prenatal care and testing coverage rate, and the goals suggested by the World Health Organization were achieved in two regions. Regional and social inequalities in access to health care units, coupled with other gaps in health assistance, have led to the persistence of congenital syphilis as a major public health problem in Brazil