50 research outputs found
Pitfalls in gynaecologic imaging
Para o diagnóstico radiológico das patologias
ginecológicas é essencial conhecer e compreender
as indicações dos vários exames disponíveis e,
para cada achado radiológico, integrar a idade,
o contexto clínico e a história pregressa da
doente. A Ressonância Magnética (RM) tem hoje
um papel crucial no diagnóstico das doenças
ginecológicas. Contudo, para maximizar o
potencial desta técnica é imprescindível adequar
o protocolo utilizado a cada caso e a cada doente
e ter em conta algumas regras imprescindíveis
à interpretação dos exames, que descreveremos
neste artigo.
A RM ginecológica é principalmente útil no
estadiamento do carcinoma do colo do útero
e do endométrio, podendo por vezes ser
também útil na sua detecção, na avaliação da
resposta ao tratamento, detecção da recidiva ou
complicações e na avaliação de lesões anexiais
de natureza indeterminada na ecografia. Nas
doenças benignas é frequentemente usada na
avaliação pré-terapêutica de leiomiomas uterinos,
bem como na adenomiose e na endometriose.
Em muitas destas situações há potenciais erros
e pitfalls, para os quais o médico radiologista
deve estar alerta, de forma a minimizar eventuais
falhas diagnósticas ou erros de estadiamento.In gynaecologic imaging it is crucial to choose
the most appropriate imaging method for each
situation, as well as combining imaging findings
with the age, clinical picture and previous clinical
history of the patients. Magnetic resonance
imaging (MRI) is currently indispensable in the
diagnosis of gynaecological diseases. However,
to take advantage of this technique, the use
of adequate protocols is mandatory, specially
designed for each patient and each clinical
problem. On the other hand, the radiologist
should bear in mind some critical rules and
interpretation pearls, that we aim to describe in
this paper.
Gynaecologic MRI has a role to play in
cervical and endometrial cancer staging, and
sometimes also in tumour detection, in response
evaluation after treatment and detection of
recurrence and complications, and in the
evaluation of indeterminate adnexal masses on
ultrasonography. In benign disease, it is mainly
used in the pre-therapeutic evaluation of uterine
leiomyomas, as well as in adenomyosis and
endometriosis. In each situation the radiologist
has to be aware of potential pitfalls, to avoid
diagnostic and staging errors
Pelvic Inflammatory disease: what the radiologist needs to know?
O diagnóstico da doença inflamatória pélvica
é clínico, baseando-se numa combinação de
sintomas e sinais, que incluem dor pélvica e febre.
A referenciação ao médico radiologista ocorre
na fase aguda da doença, quando é necessário
excluir diagnósticos diferenciais (ginecológicos,
gastrointestinais ou urinários) ou em doentes
que tiveram um episódio agudo prévio, por vezes
assintomático, que recorrem ao médico assistente
por complicações, como dor pélvica crónica,
gravidez ectópica e infertilidade. Neste contexto,
é fundamental que o médico radiologista
reconheça as manifestações radiológicas dos
diferentes estádios da doença inflamatória
pélvica, com especial ênfase para o abcesso tuboovárico,
cujas características radiológicas colocam
diagnóstico diferencial com carcinoma do ovário.The diagnosis of pelvic inflammatory disease is
clinical, based on a combination of signs and
symptoms, which include pelvic pain and fever.
The patient is referred to the radiologist either in
the acute phase, when it is important to exclude
other differential diagnosis (gynaecological,
gastrointestinal or urinary) or after the infectious
episode, that can be asymptomatic, if the patient
presents with complications, such as pelvic pain,
ectopic pregnancy and infertility.
Therefore, it is fundamental for the radiologist
to recognise the radiologic manifestations of the
different stages of pelvic inflammatory disease,
particularly the tubo-ovarian abscess, which
characteristics make differential diagnosis with
carcinoma of the ovary
Pitfalls em radiologia ginecológica
Para o diagnóstico radiológico das patologias ginecológicas é essencial conhecer e compreender as indicações dos vários exames disponíveis e, para cada achado radiológico, integrar a idade, o contexto clínico e a história pregressa da doente. A Ressonância Magnética (RM) tem hoje um papel crucial no diagnóstico das doenças ginecológicas. Contudo, para maximizar o potencial desta técnica é imprescindível adequar o protocolo utilizado a cada caso e a cada doente e ter em conta algumas regras imprescindíveis à interpretação dos exames, que descreveremos neste artigo.A RM ginecológica é principalmente útil no estadiamento do carcinoma do colo do útero e do endométrio, podendo por vezes ser também útil na sua detecção, na avaliação da resposta ao tratamento, detecção da recidiva ou complicações e na avaliação de lesões anexiais de natureza indeterminada na ecografia. Nas doenças benignas é frequentemente usada na avaliação pré-terapêutica de leiomiomas uterinos, bem como na adenomiose e na endometriose. Em muitas destas situações há potenciais erros e pitfalls, para os quais o médico radiologista deve estar alerta, de forma a minimizar eventuais falhas diagnósticas ou erros de estadiamento
Doença Inflamatória Pélvica: O que o Radiologista precisa saber?
O diagnóstico da doença inflamatória pélvica é clínico, baseando-se numa combinação de sintomas e sinais, que incluem dor pélvica e febre. A referenciação ao médico radiologista ocorre na fase aguda da doença, quando é necessário excluir diagnósticos diferenciais (ginecológicos, gastrointestinais ou urinários) ou em doentes que tiveram um episódio agudo prévio, por vezes assintomático, que recorrem ao médico assistente por complicações, como dor pélvica crónica, gravidez ectópica e infertilidade. Neste contexto, é fundamental que o médico radiologista reconheça as manifestações radiológicas dos diferentes estádios da doença inflamatória pélvica, com especial ênfase para o abcesso tubo-ovárico, cujas características radiológicas colocam diagnóstico diferencial com carcinoma do ovário
Snapshot of resistome, virulome and mobilome in aquaculture
Aquaculture environments can be hotspots for resistance genes through the surrounding environment. Our objective was to study the resistome, virulome and mobilome of Gram-negative bacteria isolated in seabream and bivalve molluscs, using a WGS approach. Sixty-six Gram-negative strains (Aeromonadaceae, Enterobacteriaceae, Hafniaceae, Morganellaceae, Pseudomonadaceae, Shewanellaceae, Vibrionaceae, and Yersiniaceae families) were selected for genomic characterization. The species and MLST were determined, and antibiotic/disinfectants/heavy metals resistance genes, virulence determinants, MGE, and pathogenicity to humans were investigated. Our study revealed new sequence-types (e.g. Aeromonas spp. ST879, ST880, ST881, ST882, ST883, ST887, ST888; Shewanella spp. ST40, ST57, ST58, ST60, ST61, ST62; Vibrio spp. ST206, ST205). >140 different genes were identified in the resistome of seabream and bivalve molluscs, encompassing genes associated with β-lactams, tetracyclines, aminoglycosides, quinolones, sulfonamides, trimethoprim, phenicols, macrolides and fosfomycin resistance. Disinfectant resistance genes qacE-type, sitABCD-type and formA-type were found. Heavy metals resistance genes mdt, acr and sil stood out as the most frequent. Most resistance genes were associated with antibiotics/disinfectants/heavy metals commonly used in aquaculture settings. We also identified 25 different genes related with increased virulence, namely associated with adherence, colonization, toxins production, red blood cell lysis, iron metabolism, escape from the immune system of the host. Furthermore, 74.2 % of the strains analysed were considered pathogenic to humans. We investigated the genetic environment of several antibiotic resistance genes, including blaTEM-1B, blaFOX-18, aph(3″)-Ib, dfrA-type, aadA1, catA1-type, tet(A)/(E), qnrB19 and sul1/2. Our analysis also focused on identifying MGE in proximity to these genes (e.g. IntI1, plasmids and TnAs), which could potentially facilitate the spread of resistance among bacteria across different environments. This study provides a comprehensive examination of the diversity of resistance genes that can be transferred to both humans and the environment, with the recognition that aquaculture and the broader environment play crucial roles as intermediaries within this complex transmission network.Highlights: - New STs (17) and possible evolutionary relationships with other STs were identified. - Over 140 resistance genes provided a snapshot of the aquaculture resistome. - Many resistance genes found are common to those of clinical isolates (e.g. qnrB19). - Many ARGs detected (e.g. sul) are associated to antibiotics used in aquaculture. - Several (74.2 %) strains studied were classified as pathogenic to human.V.S. has a Ph.D. fellowship granted by the FCT (Fundação para a
Ciência e a Tecnologia) with the reference SFRH/BD/133100/2017
cofinanced by European Social Fund and the Operational Program for
Human Capital (POCH), Portugal. This work was supported by funding
from the European Union’s Horizon 2020 Research and Innovation
programme under grant agreement No 773830: One Health European
Joint Programme (WORLDCOM project), and by FCT/MCTES [UIDB/
00211/2020] through national funds.info:eu-repo/semantics/publishedVersio
Genomic Analysis of a mcr-9.1-Harbouring IncHI2-ST1 Plasmid from Enterobacter ludwigii Isolated in Fish Farming
This article belongs to the Special Issue Antibiotic Resistance and Virulence Profiles of Gram-Negative Bacteria.This study analyzed the resistome, virulome and mobilome of an MCR-9-producing Enterobacter sp. identified in a muscle sample of seabream (Sparus aurata), collected in a land tank from multitrophic fish farming production. Average Nucleotide Identity analysis identified INSAq77 at the species level as an Enterobacter ludwigii INSAq77 strain that was resistant to chloramphenicol, florfenicol and fosfomycin and was susceptible to all other antibiotics tested. In silico antimicrobial resistance analyses revealed genes conferring in silico resistance to β-lactams (blaACT-88), chloramphenicol (catA4-type), fosfomycin (fosA2-type) and colistin (mcr-9.1), as well as several efflux pumps (e.g., oqxAB-type and mar operon). Further bioinformatics analysis revealed five plasmid replicon types, including the IncHI2/HI2A, which are linked to the worldwide dissemination of the mcr-9 gene in different antibiotic resistance reservoirs. The conserved nickel/copper operon rcnR-rcnA-pcoE-ISSgsp1-pcoS-IS903-mcr-9-wbuC was present, which may play a key role in copper tolerance under anaerobic growth and nickel homeostasis. These results highlight that antibiotic resistance in aquaculture are spreading through food, the environment and humans, which places this research in a One Health context. In fact, colistin is used as a last resort for the treatment of serious infections in clinical settings, thus mcr genes may represent a serious threat to human health.V.S. had her Ph.D. fellowship granted by FCT (Fundação para a Ciência e a Tecnologia)
[SFRH/BD/133100/2017], co-financed by European Social Fund and the Operational Program for
Human Capital (POCH), Portugal. The work was supported with funding from FCT/MCTES [UIDB/00211/2020] through national funds. This work was partially supported by funding from
the European Union’s Horizon 2020 Research and Innovation programme under grant agreement
No 773830: One Health European Joint Programme (WORLDCOM project), and partially from
FCT/MCTES [UIDB/00211/2020] through national funds.info:eu-repo/semantics/publishedVersio
HLA-G 14 bp insertion/deletion polymorphism is not associated to proviral load levels and presence of HAM/TSP in Peruvian HTLV-1 infected individuals
The GeV to TeV connection in the environment of SNR IC 443
We have recently interpreted the source MAGIC J0616+225 as a result of
delayed TeV emission of cosmic-rays diffusing from IC 443 and interacting with
a cloud in the foreground of the remnant. This model was used to make
predictions for future observations, especially those to be made with the Fermi
satellite. Just recently, AGILE, Fermi, and VERITAS have released new results
of their observations of IC 443. In this work, we compare them with the
predictions of our model, exploring the GeV to TeV connection in this region of
space. We use Fermi data to consider the possibility of constraining the
cosmic-ray diffusion features of the environment. We analyze the cosmic-ray
distributions, their interactions, and a possible detection of the SNR
environment in the neutrino channel.Comment: Accepted for publication in MNRAS. 20 pages, 10 figures, 1 tabl
Hypoglossal nerve stimulation : a new treatment approach for obstructive sleep apnea. A review
Introducción: la apnea obstructiva del sueño (AOS) es el trastorno respiratorio del sueño más frecuente. La terapia de elección es la presión positiva continua de la vía aérea (CPAP), pero se ha descrito mala adherencia en su uso. La estimulación del nervio hipogloso (ENH) se encuentra entre las nuevas modalidades de tratamiento en estudio.Objetivo: revisar la fisiopatología de este trastorno, así como la efectividad y seguridad de la ENH como terapia de la AOS.Metodología: se realizó una búsqueda en la base de datos de Medline utilizando las palabras clave: Sleep Apnea, Syndrome; Sleep Apnea, Obstructive; Hypoglossal Nerve; Electrodes, Implanted; Implantable Neurostimulators, y Electric Stimulation Therapy.Resultados: se encontraron 267 artículos, de los cuales se seleccionaron 27 según los criterios de inclusión y exclusión. Adicionalmente, se hizo una búsqueda secundaria de estos artículos. La ENH ha mostrado un perfil de efectividad y seguridad favorable con alta adherencia como tratamiento de la AOS. Sin embargo, no se recomienda en pacientes con un índice apnea-hipopnea > 50, ya que produce una reducción parcial, inferior que la que puede producir el CPAP.Conclusiones: la ENH ayuda a corregir, parcialmente, uno de los mecanismos fisiopatológicos de la AOS. Si bien en la revisión se encontraron datos que sugieren efectividad y seguridad aceptables en corto plazo, se necesitan más estudios sobre efectividad y seguridad a largo plazo, sobre comparación directa con CPAP en algunos casos y sobre uso bilateral de esta nueva modalidad terapéutica.Artículo de revisión286-296Introduction: Obstructive Sleep Apnea (OSA)
is the most common sleep respiratory disorder.
Although Continuous Positive Airway Pressure
(CPAP) is the treatment of choice, it has poor
adherence. The Hypoglossal Nerve Stimulation
(HNS) is being studied as a new therapeutic
approach. Objective: To review the pathophysiology
of this disorder and the effectiveness
and safety of HNS as a treatment for OSA.
Methods: Information was retrieved from the
database Medline using the search terms: Sleep
Apnea, Syndrome; Sleep Apnea, Obstructive;
Hypoglossal Nerve; Electrodes, Implanted; Implantable
Neurostimulators, and Electric Stimulation
Therapy. Results: 267 articles were
found, of which 27 met the inclusion and exclusion
criteria. In addition, a secondary search
from these articles was performed. The HNS
has shown a favorable effectiveness and safety
profile with a high adherence as a treatment
for OSA. However, it is not recommended for
patients with an Apnea-Hypopnea Index >50
since it only causes a partial reduction of the
AHI; a less effective result than the one observed
with CPAP. Conclusion: The HNS partially
improves one of the pathophysiological mechanisms
of OSA. In this review, the data shows
an acceptable effectiveness and safety profile
in short-term, but more research is needed on
the long-term effectiveness and safety of HNS
as well as the bilateral use of this new therapy
and a clinical study comparing it with CPAP
Epidemiological characterization of ophidian accidents in a Colombian tertiary referral hospital. Retrospective study 2004-2014
Introducción. En Colombia se presentan 5 000 casos de ofidismo anuales, un problema de salud pública que por manejo inadecuado provoca mortalidad en el 8% de los casos y discapacidad en el 10%.
Objetivo. Describir las características clínicoepidemiológicas de los pacientes diagnosticados con accidente ofídico en un hospital de tercer nivel en Colombia.
Materiales y métodos. Se realizó una revisión de las historias clínicas con diagnóstico de ofidismo del Hospital Universitario De
La Samaritana Empresa Social del Estado, en el período 2004-2014, analizando la frecuencia en las variables asociadas a la mordedura de serpiente, el tratamiento previo y el manejo intrahospitalario.
Resultados. Se revisaron 42 historias clínicas. Predominó el ofidismo en hombres agricultores, con mordedura en miembros inferiores y asistidos inicialmente por curanderos. 90% de los pacientes presentó sobreinfección, 30% tuvo cultivo de la herida, 4% recibió antibiótico, al 50% se les realizó fasciotomía y al 95.2% se le suministró antiveneno.
Conclusiones. Se evidenció variabilidad en el manejo de los pacientes y discrepancia en la dosis de antiveneno y la clasificación de severidad del envenenamiento, alta incidencia de infecciones a pesar del esquema antibiótico y procedimientos quirúrgicos reevaluados en ofidismo. El manejo médico del accidente ofídico debe estar en continua actualización para disminuir discapacidad y mortalidad en los pacientes.Q4Artículo original153-158Introduction: In Colombia, there are 5 000 cases of ophidism per year. This is a public health issue that causes mortality in 8% of cases and disability in 10% due to inadequate clinical attention.
Objective: To describe the clinical and epidemiological characteristics of patients diagnosed with ophidic accident in a tertiary hospital in Colombia.
Materials and methods: A review of clinical charts that included a diagnosis of ophidism during the 2004-2014 period was made at Hospital Universitario de La Samaritana Empresa Social del Estado. The frequency of the variables associated with snake bites, previous treatment and in-hospital management was analyzed.
Results: 42 medical charts were reviewed. Ophidism predominated in male farmers, who presented with bites in the lower limbs and were initially treated by medicine men/women. 90% of patients developed superinfections, 30% wound culture, 74% received antibiotics, 50% underwent fasciotomy and 95.2% were given antivenin.
Conclusions: Significant variability in the management of patients, discrepancy in antivenin dose and in classification of poisoning severity were observed throughout the study, as well as a high incidence of infections despite antibiotic schemes and surgical procedures. Medical management of ophidic accidents must be continuously updated to reduce disability and mortality in patients