The disenchanted mountain's Heritage. Protection and reuse of sanatoriums in the Alps

Imaging studies are expected to produce reliable information regarding the size and fat content of the pancreas. However, the available studies have produced inconclusive results. The aim of this study was to perform a systematic review and meta-analysis of imaging studies assessing pancreas size and fat content in patients with type 1 diabetes (T1DM) and type 2 diabetes (T2DM).Medline and Embase databases were performed. Studies evaluating pancreatic size (diameter, area or volume) and/or fat content by ultrasound, computed tomography, or magnetic resonance imaging in patients with T1DM and/or T2DM as compared to healthy controls were selected. Seventeen studies including 3,403 subjects (284 T1DM patients, 1,139 T2DM patients, and 1,980 control subjects) were selected for meta-analyses. Pancreas diameter, area, volume, density, and fat percentage were evaluated.Pancreatic volume was reduced in T1DM and T2DM vs. controls (T1DM vs. controls: -38.72 cm3, 95%CI: -52.25 to -25.19, I2 = 70.2%, p for heterogeneity = 0.018; and T2DM vs. controls: -12.18 cm3, 95%CI: -19.1 to -5.25, I2 = 79.3%, p for heterogeneity = 0.001). Fat content was higher in T2DM vs. controls (+2.73%, 95%CI 0.55 to 4.91, I2 = 82.0%, p for heterogeneity<0.001).Individuals with T1DM and T2DM have reduced pancreas size in comparison with control subjects. Patients with T2DM have increased pancreatic fat content

O Brasil e a construção de uma fábrica de medicamentos em Moçambique: estratégia de fortalecimento da cooperação sul-sul?

This work investigates the goals of Brazil from the implementation of a pharmaceutical plant in Mozambique. Interviews with authorities involved in the construction of the plant and documentary analysis of official publications was performed. The results indicate that Brazil seeks greater inclusion in international organizations, trying to increase South-South Cooperation.Este trabalho investiga os objetivos do Brasil a partir da implantação de uma fábrica de medicamentos em Moçambique. Foram realizadas entrevistas com autoridades envolvidas na construção da fábrica e análise documental de publicações oficiais. Os resultados indicam que o Brasil busca maior inserção nas organizações internacionais, incrementando a Cooperação Sul-Sul

Decrease in pancreatic perfusion of patients with type 2 diabetes mellitus detected by perfusion computed tomography

Objectives: The objectives of the study was to compare pancreatic perfusion by computed tomography in type 2 diabetes and non-diabetic subjects. Material and Methods: In this case–control study, 17 patients with type 2 diabetes and 22 non-diabetic controls were examined with a dynamic 192-slices perfusion computed tomography for estimating pancreatic perfusion parameters. Results: thirty-nine patients were included (22 with Type 2 diabetes mellitus [T2DM]), with a mean age of 64 years. There were significant differences in some pancreatic perfusion parameters in patients with and without type 2 diabetes. Blood volume (BV) was lower in pancreatic head (with T2DM: 14.0 ± 3.4 vs. without T2DM: 16.1 ± 2.4 mL/100 mL; P = 0.033), pancreatic tail (with: 14.4 ± 3.6 vs. without: 16.8 ± 2.5 mL/100 mL; P = 0.023), and in whole pancreas (with: 14.2 ± 3.2 vs. without: 16.2 ± 2.5 mL/100 mL; P = 0.042). Similar behavior was observed with mean transit time (MTT) in pancreatic head (with: 7.0 ± 1.0 vs. without: 7.9 ± 1.2 s; P = 0.018), pancreatic tail (with: 6.6 ± 1.3 vs. without: 7.7 ± 0.9 s; P = 0.005), and in whole pancreas (with: 6.8 ± 1.0 vs. without: 7.7 ± 0.9 s; P = 0.016). BV in head, tail, and whole pancreas had negative correlations with age (head r: –0.352, P = 0.032; tail r: –0.421, P = 0.031; whole pancreas r: –0.439, P = 0.007), and fasting plasma glucose (head r: –0.360, P = 0.031; tail r: –0.483, P = 0.003; whole pancreas r: –0.447, P = 0.006). In a multivariate linear regression model, HbA1c was independently associated with decrease in BV in whole pancreas (β: –0.884; CI95%: –1.750 to –0.017; P = 0.046). Conclusion: Pancreatic BV and MTT were significantly lower in patients with type 2 diabetes. BV was decreased with older age and poorer glycemic control

Osteochondroma of the scapula

A 29 years old, female, presented with pain in the right dorsal and scapullary region after excruciating physical effort. Ultrasonography was performed and it was reported an anechoic collection with internal debris, measuring 10.0 x 8.0 x2.7 cmin diameters. After this result it was conducted a Magnetic Resonance Imaging (MRI) exam of the chest, with gadolinium injection and it was identified soft tissue injury, lying between the latissimus dorsi and the rib cage, without infiltration of the nearby fat tissue. It was seen bone proliferation in the medial aspect of the body of the scapula, with regular borders, in contact with the soft tissue lesion, that motivate an evalution with Multidetector Computer Tomography (MDCT) (figs. 1, 2 and 3). In this MDTC, it was identified bone lesion showing continuity of cortical and medullary bone, characteristic of osteochondroma. The anatomo-pathologic (AP) analysis demonstrated the presence of osteochondroma without signs of malignancy

Diagnostic accuracy of multiorgan point-of-care ultrasound compared with pulmonary computed tomographic angiogram in critically ill patients with suspected pulmonary embolism

Background: Critically ill patients have a higher incidence of pulmonary embolism (PE) than non-critically ill patients, yet no diagnostic algorithm has been validated in this population, leading to the overuse of pulmonary artery computed tomographic angiogram (CTA). This study aimed to comparatively evaluate the diagnostic accuracy of point-of-care ultrasound (POCUS) combined with laboratory data versus CTA in predicting PE in critically ill patients. Methods: A prospective diagnostic accuracy study. Critically ill patients with suspected acute PE undergoing CTA were prospectively enrolled. Demographic and clinical data were collected from electronic medical records. Blood samples were collected, and the Wells and revised Geneva scores were calculated. Standardized multiorgan POCUS and CTA were performed. The discriminatory power of multiorgan POCUS combined with biochemical markers was tested using ROC curves, and multivariate analysis was performed. Results: A total of 88 patients were included, and 37 (42%) had PE. Multivariate analysis showed a relative risk (RR) of PE of 2.79 (95% CI, 1.61-4.84) for the presence of right ventricular (RV) dysfunction, of 2.54 (95% CI, 0.89-7.20) for D-dimer levels >1000 ng/mL, and of 1.69 (95% CI, 1.12-2.63) for the absence of an alternative diagnosis to PE on lung POCUS or chest radiograph. The combination with the highest diagnostic accuracy for PE included the following variables: 1- POCUS transthoracic echocardiography with evidence of RV dysfunction; 2- lung POCUS or chest radiograph without an alternative diagnosis to PE; and 3- plasma D-dimer levels >1000 ng/mL. Combining these three findings resulted in an area under the curve of 0.85 (95% CI, 0.77-0.94), with 50% sensitivity and 96% specificity. Conclusions: Multiorgan POCUS combined with laboratory data has acceptable diagnostic accuracy for PE compared with CTA. The combined use of these methods might reduce CTA overuse in critically ill patients