Síndrome hemofagocítica devido a sarcoidose pulmonar Hemophagocytic syndrome due to pulmonary sarcoidosis

Embora seja uma condição clínica rara, a síndrome hemofagocítica é associada com alta mortalidade e o número de casos descritos na literatura vem aumentando progressivamente. O diagnóstico de síndrome hemofagocítica depende da presença de hemofagocitose. A sarcoidose é uma doença de alta prevalência cujo curso e prognóstico podem correlacionar-se com a apresentação clínica inicial e a extensão da doença. Relatamos o caso de um paciente com sarcoidose de longa duração que apresentava febre intermitente e fadiga. O diagnóstico de síndrome hemofagocítica foi realizado por aspirado de medula óssea, e o tratamento específico foi ineficaz. Trata-se do terceiro caso de síndrome hemofagocítica relacionada a sarcoidose na literatura mundial e o primeiro na literatura latino-americana. Os três casos tiveram desfecho desfavorável.<br>Although hemophagocytic syndrome is a rare clinical condition, it is associated with high mortality and the number of cases described in the literature has progressively increased. The diagnosis of hemophagocytic syndrome is made on the basis of a finding of hemophagocytosis. Sarcoidosis is a highly prevalent disease whose course and prognosis might correlate with the initial clinical presentation and the extent of the disease. We report the case of a patient with long-standing sarcoidosis who presented with intermittent fever and fatigue. The diagnosis of hemophagocytic syndrome was made by bone marrow aspiration, and specific treatment was ineffective. This is the third case of sarcoidosis-related hemophagocytic syndrome reported in the literature and the first reported in Latin America. All three cases had unfavorable outcomes

Value of the CT “capsular sign” as a potential indicator of acute adrenal ischemia

Acute adrenal ischemia represents a rare cause of adrenal insufficiency which should be promptly diagnosed in order to preserve adrenal vitality and function. Our study aims to retrospectively evaluate the diagnostic accuracy of the CT capsular sign as an indicator of adrenal ischemia and its association with vascular involvement. Between January 2013 and January 2014, 69 consecutive patients (47 men, 22 women; mean age 46; range 22-67) with suspected adrenal insufficiency based on clinical and biochemical data underwent 320-row CT examination in our Emergency Department. Written informed consent was obtained for the CT examinations, and the institutional review board approval was obtained for our retrospective study. CT multi-planar images were retrospectively and independently analyzed by two radiologists searching for the patency of adrenal vessels, enlarged adrenals, the presence of the "capsular sign" represented by a peripheral subtle hyperdense line around a hypodense enlarged adrenal, and the presence of any periadrenal inflammatory changes. All CT findings were then compared with the surgical findings (n = 5), follow-up examinations (n = 20), or autopsy (n = 4). Sensitivity, specificity, diagnostic accuracy (DA), positive predictive value (PPV), and negative predictive value (NPV) were calculated for the "capsular sign" and were further evaluated by ROC analysis. Acute adrenal ischemia occurred in 29/69 patients (42 %), unilateral in 20, and bilateral in 9. Forty of sixty-nine patients (58 %) had no evidence of adrenal disease on CT. Thrombosis of the main adrenal vein was found in 20/29 (69 %) and non-venous ischemia in 9/29 (31 %). The capsular sign was found in 24/29 patients (83 %). Sensitivity, specificity, DA, PPV, and NPV values of 83, 100, 93, 100, and 89 %, respectively, were obtained. The capsular sign represents a CT indicator of acute adrenal ischemia, with a specificity of 100 % and leading to a prompt diagnosis in the early phase of the disease

A review on electric vehicles and their interaction with smart grids: the case of Brazil

This work provides a comprehensive literature review to evaluate the expected impacts of the introduction of electric vehicles into the power electric system with smart grid, examining the case of Brazil. Previous studies point out to different impact levels with the introduction of electric vehicles in the country’s electric grid, varying from small impacts for substitution of 10 % of the fleet, to potential difficulties if more than 20 % of the fleet is replaced. Electric vehicles offer significant advantages over their internal combustion engine powered vehicles counterparts, including the higher efficiency and performance of the electric motor, reduced pollution emissions during operation, and decreased noise levels. The current disadvantages lie mainly with the higher vehicle and battery costs, relatively long battery-charging period required, limited battery lifetime, and the need to increase market availability. Brazil’s electricity generation capacity is primarily based on clean and renewable energy (hydropower, wind, biomass), providing the preferred approach to charge electric vehicles with minimal carbon and other pollutant emissions. With the introduction of smart grids in the country’s electricity distribution structure, electric vehicles also provide a pathway (with renewable energy options) toward cleaner electricity, leveling the power demand cycle, and lowering the need to add costly central station generation by integrating them into the grid itself during periods when they are not used for transportation. However, careful studies must be conducted mainly due to the need to increase electric power generation to meet existing and imminent demands