The geometry of Hrushovski constructions, II. The strongly minimal case.

We investigate the isomorphism types of combinatorial geometries arising from Hrushovski's at strongly minimal structures and answer some questions from Hrushovski's original paper

Pancreatite Hipertrigliceridémica: Tratamento Convencional Versus Troca Plasmática Terapêutica

Introduction: Acute pancreatitis (AP) induced by hypertriglyceridemia (HTG) can be treated with therapeutic plasma exchange (TPE), resulting in rapid reduction of triglyceride level. However, there are no definitive comparative studies that prove the real benefits of this therapy. Objectives: Comparison of treatment methods (TPE versus conventional) in patients with HTG AP during a period of 12 years (2000-2012). Methods: Retrospective, descriptive and inferential analysis of 37 patients, evaluating: gender, age, personal pathologic history, severity of disease, HTG values and evolution depending on treatment with therapeutic plasma exchange (“TPE”) or with conventional therapy (“C”). Results: Both groups TPE and C demonstrated homogeneity considering gender (p = 0.647), age (43.5 ± 9.74 years TPE vs 45.30 ± 9.90 years C; p = 0.320), prior AP episode (40% TPE vs 40.7% C; p = 1.0), chronic alcohol consumption (50% TPE vs 70.4% C; p = 0.275) and severity disease scores: APACHE II (p = 0.054) and Ranson (p = 0.258). More than one secondary HTG risk factor was presented in 45.95% of patients . TPE group presented higher TG levels at admission: 4850 ± 2802 mg/dL vs 1845 ± 1858 mg/dL (p = 0.001). No significant statistical differences were observed considering length of hospital stay [14.2 ± 6.8 days vs 13.5 ± 9.0 days (p = 0.56)] or mortality rate (p = 0.47). At discharge, TG reduction was greater in TPE group: 4433.70 ± 2896.08 mg/dL – 91.41% vs 1582.95 ± 2051.06 mg/dL – 83,92% (p = 0.002). Six minor complications associated to TPE occurred. Discussion/Conclusion: Despite the selection bias (retrospective study), a greater TG reduction was observed with TPE technique. Complications associated with the technique were simple to resolveinfo:eu-repo/semantics/publishedVersio

Fenómeno de Raynaud com isquémia acral – um caso de crioglobulinémia essencial

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Hypertriglyceridemic Pancreatitis: Conventional Treatment Versus Therapeutic Plasma Exchange

Introdução:A pancreatite aguda (PA) por hipertrigliceridemia (HTG) pode ser tratada com troca plasmática terapêutica (TPT), com redução rápida dos valores de triglicerídeos. Contudo, não existem estudos comparativos definitivos que comprovem o real benefício desta terapêutica. Objetivo: Comparação dos métodos de tratamento (troca plasmática terapêutica versus convencional) em doentes com PA HTG, durante um período de 12 anos (2000-2012). Métodos: Estudo retrospetivo descritivo e inferencial de 37 doentes, avaliando: sexo, idade, antecedentes pessoais, gravidade, valores de TG e evolução consoante o tratamento (“TPT” ou terapêutica convencional “C”). Resultados: Os dois grupos TPT e C mostraram-se homogéneos quanto ao sexo (p = 0,647), idade (43,5 ± 9,74 anos TPT versus 45,30 ± 9,90 anos C; p = 0.320), pancreatite prévia (40% TPT vs 40,7% C; p = 1,0) alcoolismo crónico (50% TPT vs 70,4% C; p = 0,275) e gravidade pelo score de APACHE II (p = 0,054) e Ranson às 48 horas (p = 0,258). Dos doentes 45,95% apresentava mais de um fator de risco secundário para HTG. O grupo TPT apresentou maiores valores de TG à admissão: 4850 ± 2802 mg/dL vs 1845 ± 1858 mg/dL (p = 0,001). Não se verificaram diferenças na duração do internamento 14,2 ± 6,8 dias vs 13,5 ± 9,0 dias (p = 0,56) ou na taxa de mortalidade (p = 0,47). À data de alta a redução dos TG foi superior no grupo TPT: 4433,70 ± 2896,08 mg/dL - 91,41% vs 1582,95 ± 2051,06 mg/dL – 83,92% (p = 0,002). De referir seis intercorrências minor durante a troca plasmática terapêutica. Discussão/Conclusões: Apesar do viés de seleção (estudo retrospetivo), foi constatada uma maior redução dos TG por esta técnica. As intercorrências inerentes à técnica de troca plasmática terapêutica foram de simples resolução.info:eu-repo/semantics/publishedVersio

Insights Into the Effects of Mucosal Epithelial and Innate Immune Dysfunction in Older People on Host Interactions With Streptococcus pneumoniae

In humans, nasopharyngeal carriage of Streptococcus pneumoniae is common and although primarily asymptomatic, is a pre-requisite for pneumonia and invasive pneumococcal disease (IPD). Together, these kill over 500,000 people over the age of 70 years worldwide every year. Pneumococcal conjugate vaccines have been largely successful in reducing IPD in young children and have had considerable indirect impact in protection of older people in industrialized country settings (herd immunity). However, serotype replacement continues to threaten vulnerable populations, particularly older people in whom direct vaccine efficacy is reduced. The early control of pneumococcal colonization at the mucosal surface is mediated through a complex array of epithelial and innate immune cell interactions. Older people often display a state of chronic inflammation, which is associated with an increased mortality risk and has been termed ‘Inflammageing’. In this review, we discuss the contribution of an altered microbiome, the impact of inflammageing on human epithelial and innate immunity to S. pneumoniae, and how the resulting dysregulation may affect the outcome of pneumococcal infection in older individuals. We describe the impact of the pneumococcal vaccine and highlight potential research approaches which may improve our understanding of respiratory mucosal immunity during pneumococcal colonization in older individuals

The whole blood phagocytosis assay: a clinically relevant test of neutrophil function and dysfunction in community-acquired pneumonia.

ObjectiveTo refine and validate a neutrophil function assay with clinical relevance for patients with community-acquired pneumonia (CAP).DesignTwo phase cross-sectional study to standardise and refine the assay in blood from healthy volunteers and test neutrophil phagocytic function in hospital patients with CAP.ParticipantsPhase one: Healthy adult volunteers (n = 30). Phase two: Critical care patients with severe CAP (n = 16), ward-level patients with moderate CAP (n = 15) and respiratory outpatients (no acute disease, n = 15).ResultsOur full standard operating procedure for the assay is provided. Patients with severe CAP had significantly decreased neutrophil function compared to moderate severity disease (median phagocytic index 2.8 vs. 18.0, p = 0.014). Moderate severity pneumonia neutrophil function was significantly higher than control samples (median 18.0 vs. 1.6, p = 0.015). There was no significant difference between critical care and control neutrophil function (median 2.8 vs. 1.6, p = 0.752).ConclusionsOur whole blood neutrophil assay is simple, reproducible and clinically relevant. Changes in neutrophil function measured in this pneumonia cohort is in agreement with previous studies. The assay has potential to be used to identify individuals for clinical trials of immunomodulatory therapies, to risk-stratify patients with pneumonia, and to refine our understanding of 'normal' neutrophil function in infection

Síndrome hipertensiva hiponatrémica em destaque – um caso clínico

Descrita pela primeira vez em 1952, a síndrome hipertensiva hiponatrémica (SHH) é a combinação de hipertensão severa, hiponatremia e isquémia renal. Mais do que rara, a síndrome é principalmente subdiagnosticada. Isto limita o conhecimento real e completo da sua fisiopatologia e jus_fica a inexistência de estudos aleatorizados prospe_vos com avaliação real de opções terapêu_cas. A necessidade de aumentar a consciencialização para a síndrome por parte da comunidade médica é premente, especialmente se _vermos em consideração que é uma síndrome potencialmente curável e com taxas de mortalidade que chegam aos 25% nos adultos. Assim, apresenta-se um caso de SHH, com necessidade de nefrectomia para controlo e tratamento definitivo da síndrome.info:eu-repo/semantics/publishedVersio

The role of different strain backgrounds in bacterial endotoxin-mediated sensitization to neonatal hypoxic-ischemic brain damage

Genetic background is known to influence the outcome in mouse models of human disease, and previous experimental studies have shown strain variability in the neonatal mouse model of hypoxia-ischemia. To further map out this variability, we compared five commonly used mouse strains: C57BL/6, 129SVJ, BALB/c, CD1 and FVB in a pure hypoxic-ischemic setup and following pre-sensitization with lipopolysaccharide (LPS). Postnatal day 7 pups were subjected to unilateral carotid artery occlusion followed by continuous 30 min 8% oxygen exposure at 36 °C. Twelve hours prior, a third of the pups received a single intraperitoneal LPS (0.6 μg/g) or a saline (vehicle) administration, respectively; a further third underwent hypoxia-ischemia alone without preceding injection. Both C57BL/6 and 129SVJ strains showed minimal response to 30min hypoxia-ischemia alone, BALB/c demonstrated a moderate response, and both CD1 and FVB revealed the highest brain damage. LPS pre-sensitization led to substantial increase in overall brain infarction, microglial and astrocyte response and cell death in four of the five strains, with exception of BALB/c that only showed a significant effect with terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL). Saline administration prior to hypoxia-ischemia resulted in an increase in inflammatory-associated markers, particularly in the astroglial activation of C57BL/6 mice, and in combined microglial activation and neuronal cell loss in FVB mice. Finally, two of the four strongly affected strains--C57BL/6 and CD1--revealed pronounced contralateral astrogliosis with a neuroanatomical localization similar to that observed on the occluded hemisphere. Overall, the current findings demonstrate strain differences in response to hypoxia-ischemia alone, to stress associated with vehicle injection, and to LPS-mediated pre-sensitization, which partially explains the high variability seen in the neonatal mouse models of hypoxia-ischemia. These results can be useful in future studies of fetal/neonatal response to inflammation and reduced oxygen-blood supply

Acute Intoxications in an Intensive Care Department: Years 2002 to 2014

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