Traumatic diaphragmatic hernias: retrospective analysis

AIMS: This study classifies cases of traumatic diaphragmatic hernias (TDH) in patients admitted to the Intensive Care Unit (ICU) of the Coimbra University Hospitals (HUC) from 1990 to 2004. METHODS: Retrospective analysis of 34 cases of TDH, studying anatomical location, place and time of diagnosis, complementary tests aiding diagnosis, herniated organs, associated traumatism, morbidity and mortality. RESULTS: Twenty-eight male and six female patients with an average age of 40.5 years +/- 20.5, average SAPS score 38.8. Average length of stay was 19.1 +/- 13.6 days, all suffered from closed traumatism and were put on artificial ventilation. The left-side diaphragm was more frequently affected (94.1%) then the right. Diagnosis in 19 cases was made up in the first six hours following the diagnosis of traumatism, in four cases within 12 hours and in the remaining cases between 48 hours and 16 years after traumatism. In 13 patients the diagnosis was established intra-operatively. The stomach was typically one of the herniated organs. The most frequently associated lesions at the thoracic level were pulmonary contusion, haemothorax and pneumothorax, and at the abdominal level, haemoperitoneum and splenic lesion. The rates for complications and mortality were 55.8% and 11.7% respectively. CONCLUSIONS: TDH mainly occurs on the left side through closed thoraco-abdominal trauma following road traffic accidents. This group of patients, on average younger than others admitted to ICU, presents a longer average hospitalisation period, but has lower rates of mortality and lower SAPS severity scores. The most commonly herniated organ was the stomach and the most frequently encountered lesions were cranial-encephalic, splenic and pleural traumatisms. Pre-operative diagnosis of diaphragmatic injuries is difficult and a high index of clinical suspicion is needed after thoraco-abdominal trauma. This diagnosis should always be considered a possibility in cases of closed thoraco-abdominal traumas

CIDP na Idade Pediátrica - Desafio Diagnóstico

Introdução: A polirradiculoneuropatia desmielinizante inflamatória crónica (CIDP) é uma patologia auto-imune caracterizada pela desmielinização dos nervos periféricos e raízes espinhais, rara na idade pediátrica. Apresenta-se de forma progressiva ou mais raramente recorrente, tornando-se por vezes difícil o seu diagnóstico e o diagnóstico diferencial com Síndrome de Guillain-Barré. Caso Clínico: Criança de 3 anos, com quadro de dor nos membros superiores e inferiores, proximal, simétrica, de agravamento nocturno, associada a recusa ou dificuldade no início da marcha e com 5 dias de evolução, sem outra sintomatologia acompanhante. Refere 2 episódios semelhantes nos 6 meses precedentes, com resolução espontânea em alguns dias. Nas 4 semanas prévias ao actual episódio, apresentou uma gastroenterite aguda sem agente isolado. Objectivamente salienta-se ausência de sinais inflamatórios locais, dor à mobilização dos membros (com possível sinal de Lasègue), diminuição da força muscular (grau 4) proximal e distal nos membros superiores e inferiores, tremor postural e intencional nos membros superiores, reflexos miotáticos presentes nos membros superiores mas ausentes nos inferiores e instabilidade na marcha. Não havia história de exposição a drogas ou tóxicos nem história familiar de neuropatia. Avaliação analítica para doenças auto-imunes e ecografias articulares não revelaram alterações. O estudo electromiográfico (EMG) demonstrou aumento das latências distais, com diminuição das velocidades de condução e atraso/dispersão das ondas F em múltiplos nervos. A análise do LCR revelou dissociação albumino-citológica. Estudo etiológico do LCR, sangue e fezes com resultados negativos. Em D9 de doença pela persistência das queixas álgicas, repetiu o EMG demonstrando agravamento da polineuropatia. Fez Imunoglobulina intravenosa (0,4 g/Kg/dia) durante 5 dias, com melhoria progressiva da sintomatologia e recuperação parcial da capacidade funcional. Discussão: O diagnóstico de CIDP baseia-se em elementos clínicos (interpretamos como episódios recorrentes de neuropatia num período de cerca de 6 meses, embora a nossa observação da criança seja apenas a actual) e no estudo electrofisiológico (reúne critérios de diagnóstico). Está planeada biópsia de nervo para confirmação diagnóstica embora nem todas as guidelines considerem necessária esta investigação. É importante diagnosticar precocemente a CIDP de forma a instituir a terapêutica mais adequada, determinante para o prognóstico

Application of the low-cost sensing technology for indoor air quality monitoring: A review

In recent years, low-cost air pollution technologies have gained increasing interest and, have been studied widely by the scientific community. Thus, these new sensing technologies must provide reliable data with good precision and accuracy. Accordingly, this review aimed to evaluate and compare the low-cost sensing technology against other instruments used for comparison by various studies from the scientific literature to monitor indoor air quality in different indoor environments. After exclusions, a total of 42 studies divided into two subsections (11 laboratory studies and 31 field studies) were analysed considering their aim, location, study duration, sampling area, pollutant(s) evaluated, sensor/device and instrument used for comparison, performance indexes and main outcomes.& nbsp;The reviewed studies aimed to assess different low-cost sensors/devices to monitor indoor air quality against other instruments used for comparison. The vast majority of the studies took place in USA. The laboratory studies were mainly conducted in a controlled chamber, and field studies were performed in homes, offices, educational buildings, among others. In both cases, particulate matter was the most assessed pollutant, either with commercial devices (e.g.: Speck, Dylos, Foobot) or sensors (e.g. Sharp GP2Y1010AU0F). In general, based on statistical parameters, the air quality low-cost sensors/devices tested presented moderate correlations with the instruments used for comparison, revealing sufficient precision for monitoring air quality in indoor microenvironments, especially for qualitative analysis. Thus, low-cost sensing technology to monitor indoor air quality is encouraged, but not waiving the relevance of high quality instruments (mainly reference instruments).& nbsp;(c) 2022 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Lymphangiogenesis and angiogenesis during human fetal pancreas development

Background: The complex endocrine and exocrine functionality of the human pancreas depends on an efficient fluid transport through the blood and the lymphatic vascular systems. The lymphatic vasculature has key roles in the physiology of the pancreas and in regulating the immune response, both important for developing successful transplantation and cell-replacement therapies to treat diabetes. However, little is known about how the lymphatic and blood systems develop in humans. Here, we investigated the establishment of these two vascular systems in human pancreas organogenesis in order to understand neovascularization in the context of emerging regenerative therapies. Methods: We examined angiogenesis and lymphangiogenesis during human pancreas development between 9 and 22 weeks of gestation (W9-W22) by immunohistochemistry. Results: As early as W9, the peri-pancreatic mesenchyme was populated by CD31-expressing blood vessels as well as LYVE1- and PDPN-expressing lymphatic vessels. The appearance of smooth muscle cell-coated blood vessels in the intra-pancreatic mesenchyme occurred only several weeks later and from W14.5 onwards the islets of Langerhans also became heavily irrigated by blood vessels. In contrast to blood vessels, LYVE1- and PDPN-expressing lymphatic vessels were restricted to the peri-pancreatic mesenchyme until later in development (W14.5-W17), and some of these invading lymphatic vessels contained smooth muscle cells at W17. Interestingly, between W11-W22, most large caliber lymphatic vessels were lined with a characteristic, discontinuous, collagen type IV-rich basement membrane. Whilst lymphatic vessels did not directly intrude the islets of Langerhans, three-dimensional reconstruction revealed that they were present in the vicinity of islets of Langerhans between W17-W22. Conclusion: Our data suggest that the blood and lymphatic machinery in the human pancreas is in place to support endocrine function from W17-W22 onwards. Our study provides the first systematic assessment of the progression of lymphangiogenesis during human pancreatic development

Radon in Indoor Air: Towards Continuous Monitoring

Radon poses significant health risks. Thus, the continuous monitoring of radon concentrations in buildings' indoor air is relevant, particularly in schools. Low-cost sensors devices are emerging as promising technologies, although their reliability is still unknown. Therefore, this is the first study aiming to evaluate the performance of low-cost sensors devices for short-term continuous radon monitoring in the indoor air of nursery and primary school buildings. Five classrooms of different age groups (infants, pre-schoolers and primary school children) were selected from one nursery and one primary school in Porto (Portugal). Radon indoor concentrations were continuously monitored using one reference instrument (Radim 5B) and three commercially available low-cost sensors devices (Airthings Wave and RandonEye: RD200 and RD200P2) for short-term sampling (2-4 consecutive days) in each studied classroom. Radon concentrations were in accordance with the typical profiles found in other studies (higher on weekends and non-occupancy periods than on occupancy). Both RadonEye low-cost sensors devices presented similar profiles with Radim 5B and good performance indices (R-2 reaching 0.961), while the Airthings Wave behavior was quite different. These results seem to indicate that the RadonEye low-cost sensors devices studied can be used in short-term radon monitoring, being promising tools for actively reducing indoor radon concentrations

The Gamification of Augmented Reality Art

Augmented Reality (AR) and its applications are being used in many applications, including gaming, education, industry, research, and art. Gamification refers to the merging of games with interactive media (video games, Virtual and Augmented Realities, for example) to allow for the completion of difficult digital labour of research in a more fun, intuitive fashion. In this chapter, the merging of gamification and Augmented Reality-based art is discussed, its impact in terms of digital labour as well as examples of Augmented Reality that exhibit gamification or elements of it. Speculative design fictions of gamified Augmented Reality are examined to determine possible future outcomes of this genre. Lastly historical experiments in user interface design are mentioned to propose future solutions for Augmented Reality applications, artistic installations and gamification scenarios

Candidemia in Acute Leukemia Patients

Fungal infections are an important cause of morbidity and mortality in patients with acute leukemia (AL). Candidemia, once rare, is now a common nosocomial infection because of the intensity of chemotherapy, prolonged neutropenia, administration of broad-spectrum antibiotics and use of central venous catheters (CVC). We retrospectively identified patients treated for AL from 6/86 to 6/95 who also had candidemia. We describe 28 patients (incidence 6.3%) with a median age of 39 years, 24 of whom were on remission induction and 4 on postremission chemotherapy. All patients had CVC and empiric antimicrobial therapy, 4 had been given prophylactic antifungal drugs, and 2 had parenteral nutrition. Neutropenia was profound (median leukocyte nadir 200/microliters, median duration 19 days). Candida was isolated in blood cultures 10 days (median) after the start of neutropenia. The clinical presentation included fever (100%), respiratory symptoms (71.4%), skin lesions (39.2%) and septic shock (17.8%). Amphotericin B was given to 17 patients and liposomal amphotericin to 5 patients. Infection resolved in 18 patients (64.2%). 10 of whom were in complete remission. Mortality from candidemia was 17.8% (5/28). In conclusion, fungal infections are responsible for death in a significant number of patients. In our series treatment success was related to its rapid onset and to the recovery of neutropenia