Esophageal and Gastroduodenal Hemorrhagic Necrosis: A Unique Finding in the Setting of Septic Shock and Vasopressor Use

Esophageal and gastroduodenal necrosis are rare conditions with poor prognosis. We describe a case that was diagnosed with upper endoscopy in the setting of severe septic shock. To our knowledge, this is the first case in which esophageal and gastroduodenal necrosis occurred simultaneously in this setting. We discuss the pathophysiology, diagnostic approach, and treatment options of this rare entity.info:eu-repo/semantics/publishedVersio

Chylothorax in paracoccidioidomycosis

A previously healthy, 52-year-old woman presented with a nine months history of low fever and weight loss (> 30 kg). Physical examination disclosed generalized lymphadenopathy, skin lesions, abdominal distension, mild tachypnea and a left breast mass. Laboratory tests showed anemia; (prerenal) kidney injury, low serum albumin level; and negative serology for HIV and viral hepatitis. Computed tomography (neck/chest/abdomen) showed generalized lymph node enlargement, splenomegaly, pleural effusion and ascites. We performed thoracocentesis and paracentesis, and the findings were consistent with chylothorax and chylous ascites (with no neoplastic cells). Biopsies of the breast mass, skin and lymph nodes were performed and all of them showed large round yeast cells with multiple narrow-based budding daughter cells, characteristic of Paracoccidioides brasiliensis. Consequently, paracoccidioidomycosis was diagnosed, and liposomal amphotericin B was prescribed, as well as a high protein and low fat diet (supplemented with medium chain triglycerides). Even so, her clinical status worsened, requiring renal replacement therapy. She evolved with pneumonia, septic shock and respiratory failure and subsequently died. To our knowledge, this is the first description of a case with chylothorax and breast mass due to paracoccidioidomycosis. Additionally, we discuss: 1- the importance of the inclusion of this mycosis in the differential diagnosis of chylothorax and breast mass (breast cancer), especially in endemic areas; and 2- the possible mechanism involved in the development of chylous effusions

EuReCa ONE—27 Nations, ONE Europe, ONE Registry A prospective one month analysis of out-of-hospital cardiac arrest outcomes in 27 countries in Europe

AbstractIntroductionThe aim of the EuReCa ONE study was to determine the incidence, process, and outcome for out of hospital cardiac arrest (OHCA) throughout Europe.MethodsThis was an international, prospective, multi-centre one-month study. Patients who suffered an OHCA during October 2014 who were attended and/or treated by an Emergency Medical Service (EMS) were eligible for inclusion in the study. Data were extracted from national, regional or local registries.ResultsData on 10,682 confirmed OHCAs from 248 regions in 27 countries, covering an estimated population of 174 million. In 7146 (66%) cases, CPR was started by a bystander or by the EMS. The incidence of CPR attempts ranged from 19.0 to 104.0 per 100,000 population per year. 1735 had ROSC on arrival at hospital (25.2%), Overall, 662/6414 (10.3%) in all cases with CPR attempted survived for at least 30 days or to hospital discharge.ConclusionThe results of EuReCa ONE highlight that OHCA is still a major public health problem accounting for a substantial number of deaths in Europe.EuReCa ONE very clearly demonstrates marked differences in the processes for data collection and reported outcomes following OHCA all over Europe. Using these data and analyses, different countries, regions, systems, and concepts can benchmark themselves and may learn from each other to further improve survival following one of our major health care events

OBTENÇÃO DE ÓXIDO DE CÁLCIO A PARTIR DA CASCA DE OVO DE GALINHA

Diariamente, toneladas de cascas de ovos de galinha são descartadas, gerando um resíduo desvalorizado comercialmente, proveniente de restaurantes, indústria alimentícia e até mesmo residências. A casca de ovo é rica em carbonato de cálcio, um precursor para a obtenção de óxido de cálcio. Comercialmente conhecido como cal, o óxido de cálcio possui maior empregabilidade se comparado a casca de ovo in natura. Atualmente, tem sido utilizado em diversas áreas, como na indústria civil, na indústria de biomanteriais, e na agricultura. A casca adquirida na indústria alimentícia ainda contém elementos orgânicos e por isso precisa ser previamente preparada. Esse estudo demonstra a preparação dessa casca até a referida obtenção do óxido de cálcio. A conversão é viabilizada a partir da realização de um tratamento térmico, chamado calcinação, onde a casca de ovo é submetida a uma temperatura de 850ºC durante uma hora e meia. Durante a calcinação uma reação química ocorre e gás carbônico é liberado, gerando assim, o óxido de cálcio. Foram realizados ensaios de caracterização, como a Difração e Espectometria de Raio X (DRX) e  a Análise Termogravimétrica (TG),  para a certificação do produto final

Tympanomastoidectomy: comparison between canal wall-down and canal wall-up techniques in surgery for chronic otitis media

INTRODUCTION: Chronic otitis media (COM) is an inflammatory condition associated with otorrhea as well as large and persistent perforations of the tympanic membrane in some cases. COM can also lead to cholesteatoma. Surgical treatment with canal wall-down and canal wall-up tympanomastoidectomy is considered for both types of illness. The choice of technique is controversial and is dependent on several factors, including the extent of disease. OBJECTIVE: We aimed to evaluate surgical outcomes in COM patients with and without cholesteatoma treated with canal wall-down and canal wall-up tympanomastoidectomy. Disease eradication and post-operative auditory thresholds were assessed. METHOD: Patient records from the otorhinolaryngology department of a tertiary hospital were assessed retrospectively. RESULTS: Patients who underwent canal wall-up tympanomastoidectomy had a higher rate of revision surgery, especially those with cholesteatoma. However, there were no statistically significant differences in post-operative hearing thresholds between the two techniques. CONCLUSION: The canal wall-down technique is superior to the canal wall-up technique, especially for patients with cholesteatoma

Spatial variability of available water and micro-sprinkler irrigation in cambisol

ABSTRACT The technology of irrigation is vital for agricultural production. Thus, description of spatial patterns of both water application and available water capacity in the soil, as well as their interactions, is essential to maximize efficiency of water use in irrigated areas. The objective of this study was to analyze spatial variability of available water capacity in the soil and water application via irrigation using geostatistics. The experiment was conducted in a commercial mango orchard in Cambisol irrigated by micro sprinkler system, in the municipality of Alto do Rodrigues, RN. Analyses of descriptive statistics and geostatistics were performed using the programs GeoR and GS+. Geostatistics was found suitable for describing the structure of spatial dependence of available water capacity in the soil and the flow rate distributed in the area by sprinklers. Moreover, even with good results for Christiansen Uniformity Coefficient (CU) and Distribution Uniformity Coefficient (DU), the area showed spatial variability of flow rate