Apresentamos os resultados de uma investigação que analisou as percepções de um grupo de estudantes acerca das usinas nucleares e do resíduo radioativo. Trata-se de um recorte de um projeto maior, o ...qual culminou na produção de uma dissertação de mestrado do primeiro autor. As percepções dos estudantes estão associadas aos riscos de catástrofes que as instalações nucleares podem ocasionar e às consequências que a exposição à radioatividade pode causar ao corpo humano. Essas percepções podem estar associadas a informações obtidas por meio de notícias veiculadas na mídia impressa ou televisiva, programas televisivos, filmes, documentários e séries streaming que abordam a temática da energia nuclear. Tanto as notícias quanto as produções televisivas reforçam o estereótipo do medo em relação aos riscos da radiação e da radioatividade. Os resultados de nosso estudo podem ser utilizados por professores de física ou química quando do ensino das Radiações Ionizantes. Defendemos que discussões sobre as Radiações Ionizantes sejam levadas para a sala de aula, a fim de que concepções equivocadas sejam minimizadas e que os estudantes se apropriem das ideias e dos conceitos pertencentes a Física das radiações ionizantes.
Abstract
OBJECTIVES
Only few studies compared the surgical morbidity and mortality of thoracoscopic segmentectomy versus lobectomy for non-small-cell lung cancer, in particular, by relating the ...segmental resections with the corresponding anatomical lobes.
METHODS
We enrolled a total of 7487 patients who underwent VATS lobectomy (7269) or segmentectomy (218) from January 2014 to July 2019. A propensity score matching approach was used to account for potential confounding factors between the 2 groups. After matching, 349 lobectomies and 208 segmentectomies were included in the analysis. We analysed the operative and postoperative outcomes of video-assisted anatomical segmentectomy compared with video-assisted lobectomy and, in details, the results of segmentectomy with its corresponding lobectomy in a large cohort of patients from the Italian VATS Group Registry.
RESULTS
The overall conversion rate to thoracotomy was not statistically different between the groups (27 patients 8% vs 7 patients 3%, P = 0.1). The lobectomy group had a greater number of resected lymph nodes (median 11 vs 8, P = 0.006). No significant differences were detected in 30-day mortality (1.4%, 5 patients vs 0.9%, 2 patients), overall complications (18%, 62 patients vs 14%, 29 patients) and prolonged air leakage (31 patients, 9% vs 12 patients, 6%) between lobectomy and segmentectomy, respectively. No statistical differences were found regarding the median duration of drainage (3.2 days, P = 1) and the overall median length of hospital stay (6.4 days, P = 0.1) between the 2 groups. In the context of segmentectomy versus corresponding lobectomy, the right upper lobectomy compared with right upper segmentectomy showed a higher number of resected lymph nodes (P = 0.027). No statistical differences were reported in terms of conversion rate and postoperative complication and mortality.
CONCLUSIONS
Segmentectomy could be considered a safe procedure without significant differences compared to thoracoscopic lobectomy in terms of postoperative morbidity and mortality.
Since 2000, many studies have been published, including randomized ones, which have demonstrated that anatomical segmentectomy for early-stage non-small-cell lung cancer (NSCLC) yields oncological equivalent results with respect to those of lobectomy, with a potential lung-sparing effect 1–4.
Aim To examine the interpretive performance of digital breast tomosynthesis (DBT) as an adjunct to digital mammography (DM) compared to DM alone in a series of invasive lobular carcinomas (ILCs) and ...to assess whether DBT can be used to characterise ILC. Materials and methods A retrospective, multi-reader study was conducted of 83 mammographic examinations of women with 107 newly diagnosed ILCs ascertained at histology. Consenting women underwent both DM and DBT acquisitions. Twelve radiologists, with varying mammography experience, interpreted DM images alone, reporting lesion location, mammographic features, and malignancy probability using the Breast Imaging-Reporting and Data System (BI-RADS) categories 1–5; they then reviewed DBT images in addition to DM, and reported the same parameters. Statistical analyses compared sensitivity, false-positive rates (FPR), and interpretive performance using the receiver operating characteristics (ROC) curve and the area under the curve (AUC), for reading with DM versus DM plus DBT. Results Multi-reader pooled ROC analysis for DM plus DBT yielded AUC=0.89 (95% confidence interval CI: 0.88–0.91), which was significantly higher ( p <0.0001) than DM alone with AUC=0.84 (95% CI: 0.82–0.86). DBT plus DM significantly increased pooled sensitivity (85%) compared to DM alone (70%; p <0.0001). FPR did not vary significantly with the addition of DBT to DM. Interpreting with DBT (compared to DM alone) increased the correct identification of ILCs depicted as architectural distortions (84% versus 65%, respectively) or as masses (89% versus 70%), increasing interpretive performance for both experienced and less-experienced readers; larger gains in AUC were shown for less-experienced radiologists. Multifocal and/or multicentric and bilateral disease was more frequently identified on DM with DBT. Conclusion Adding DBT to DM significantly improved the accuracy of mammographic interpretation for ILCs and contributed to characterising disease extent.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
The association of epilepsy and migraine has been long recognized. Migraine and epilepsy are both chronic disorders with episodic attacks. Furthermore, headache may be a premonitory or postdromic ...symptom of seizures, and migraine headaches may cause seizures per se (migralepsy). Migraine and epilepsy are comorbid, sharing pathophysiological mechanisms and common clinical features. Several recent studies identified common genetic and molecular substrates for migraine and epilepsy, including phenotypic-genotypic correlations with mutations in the
CACNA1A
,
ATP1A2
, and
SCN1A
genes, as well as in syndromes due to mutations in the
SLC1A3
,
POLG
, and
C10orF2
genes. Herein, we review the relationship between migraine and epilepsy, focusing on clinical aspects and some recent pathophysiological and molecular studies.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Introdução
Cefaleia é sintoma da infecção por COVID-19, bem como febre, dor de garganta e tosse; pode ser sintoma inicial ou único. Séries de casos sugerem que características migranosas são comuns ...na fase aguda. Dor pode ser limitante e de difícil manejo.
Objetivos
Relatar evolução de 4 pacientes do sexo feminino, diagnóstico de migrânea sem aura (ICHD-3), e sua evolução e manejo (ambulatorial) na fase aguda.
Material e Métodos
4 pacientes, que concederam autorização por escrito para relato de seus casos. (1) 39 anos, migrânea episódica infrequente (MEI), previamente migrânea crônica (MC) com uso excessivo de analgésicos (UEA), topiramato até 125mg até há 1 ano, sem profilaxia atual. Crise intensa, características de migrânea, duração de 7 dias, inaugurando quadro infeccioso. Sem melhora com naproxeno/domperidona (3 doses), dipirona/metoclopramida EV. Melhora após 48h com prednisona 0,5mg/Kg, 5 dias. (2) 31a, MEI (previamente MC com UEA, tendo feito uso de topiramato até 50mg até há 8m e metoprolol 25mg suspenso há 2m). Tosse e febre; recebeu prednisona 1mg/Kg como tratamento para COVID pelo pneumologista. Não apresentou cefaleia. (3) 26a, migrânea episódica frequente (previamente MC com UEA, em uso de topiramato 150mg e magnésio 400mg). Cefaleia no 4o dia de sintomas, sem resposta a Zolmitriptano (3 doses), dipirona e metoclopramida EV. Melhora após 72h com prednisona 0,5mg/Kg. (4) 45a, MEI sem profilaxia. Cefaleia com características da migrânea, intensa, 3 dias, início no 5o dia. Sem melhora com dipirona (5 doses), naproxeno (2 doses).
Resultados
A cefaleia associada à infecção por COVID-19 em pacientes com migrânea é frequente e por vezes de difícil manejo. O abortivo usual do paciente por vezes não é efetivo e corticóide oral pode ser uma opção.
Conclusão
Corticoide pode ser opção no manejo da cefaleia na infecção aguda por COVID.
Pneumocystis jiroveci
pneumonia in non-HIV patients is infrequent and characterized by atypical presentations and increased severity. Although hematogenous dissemination from the lungs can lead to ...extrapulmonary infections, isolation of oocysts from blood in human subjects has not been documented. We report a case of
P. jiroveci
pneumonia with persistent isolation of oocysts from blood and positivity of
P. jiroveci
polymerase chain reaction. The patient presented with bilateral diffuse pulmonary nodules and received prolonged treatment with trimethoprim/sulfamethoxazole.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Abstract
Objectives
To evaluate the incidence and risk factors for liver enzyme elevations (LEE) in patients initiating first-line ART in the ICONA prospective observational cohort, between June 2009 ...and December 2017.
Patients and methods
In total, 6575 ART-naive patients were selected, initiating two NRTIs with the third drug being a boosted PI (n=2436; 37.0%), an NNRTI (n=2384; 36.3%) or an integrase strand transfer inhibitor (INSTI) (n=1755; 26.7%). HBV surface antigen and HCV RNA were detected in 3.9% and 5.8% of the study population. Inverse probability weighted Cox regression analysis was used to calculate the HRs, according to first-line regimen, for LEE, defined as ALT or AST increases of ≥2.5× upper limit of normal (ULN) for patients with normal baseline values or ≥2.5× baseline for patients with higher baseline values.
Results
One hundred and eighty-three LEE occurred over 20722 patient-years of follow-up. After adjusting for the main confounders, the risk of LEE halved with INSTIs compared with NNRTIs (HR 0.46, 95% CI 0.25–0.86), with a significant reduction in the raltegravir group (HR 0.11, 95% CI 0.02–0.84 using the NNRTI class as reference). HRs for LEE were significantly higher in subjects with HBV or HCV coinfection, in patients with poorly controlled HIV infection and in those who acquired HIV through homosexual transmission.
Conclusions
In our study, INSTI use almost halved the risk of LEE compared with other regimens. This finding could be particularly important for choosing ART in patients with risk factors for liver toxicity such as HCV and HBV coinfections.
Kefir—a traditional beverage whose consumption has been associated with health benefits—is a logical natural product to investigate for new probiotic strains. The aim of the present work was to ...isolate and identify kefir yeasts and select those with acid and bile tolerance to study their adhesion to epithelial cells and their transit through mouse gut. From 4 milky and 3 sugary kefir grains, 34 yeast strains were isolated and identified by means of classical microbiological and molecular-genetic methods (whole-cell protein pattern, internal-transcribed-spacer amplification, and analysis of restriction-fragment–length polymorphisms). We identified 4 species belonging to 3 genera—Saccharomyces cerevisiae (15 strains), Saccharomyces unisporus (6 strains), Issatchenkia occidentalis (4 strains), and Kluyveromyces marxianus (9 strains)—and selected 13 strains on the basis of resistance to low pH and bile salts. Among the strains selected, Kluyveromyces marxianus CIDCA 8154 and Saccharomyces cerevisiae CIDCA 8112 were further studied. Both strains evidenced the capacity to adhere to epithelial intestine-derived cells in vitro and to survive passage through the gastrointestinal tract of BALB/c mice. The investigation of the potential probiotic features of these kefir-yeast strains should be useful for the development of novel functional foods.
HCV infection has been hypothesized as a contributor of poor CD4+ recovery in patients living with HIV (PLWHIV). Aim of this study was to evaluate CD4+, CD8+ cells and CD4/CD8 ratio trends before and ...after HCV treatment with direct acting agents (DAA) in PLWHIV. HIV/HCV patients enrolled in ICONA and HepaICONA cohorts with HIV‐RNA≤50 copies/ml who achieved a sustained viral response after DAA treatment were studied. A linear regression model was used to investigate CD4+, CD8+ and CD4/CD8 changes 12 months before and after DAA treatment. A total of 939 HIV/HCV patients were included, 225 (24.0%) female, median age: 53 years (IQR 50–56). At DAA initiation, CD4+ T cell count was <350 cells/mm3 in 164 patients (17.5%), and 246 patients (26.2%) had liver stiffness>12.5 kPa. Trends of CD4+ and CD4/CD8 ratio were similar before and after DAA in all study populations (CD4+ change +17.6 cells/mm3 (95%CI −33.5; 69.4, p = 0.494); CD4/CD8 change 0.013 (95%CI −0.061; 0.036, p = 0.611). However, patients treated with ribavirin (RBV)‐free DAA showed a significant decrease in CD8+ cells (−204.3 cells/mm3, 95%CI −375.0;‐33.4, p = 0.019), while patients treated with RBV experienced CD8+ cell increase (+141.2 cells/mm3, 95%CI 40.3; 242.1, p = 0.006). In conclusion, HCV eradication following DAA treatment does not seem to have an impact on CD4+ T cell recovery in PLWHIV. However, a fast decline of CD8+T cells has been observed in patients treated without RBV, suggesting a favourable effect of HCV clearance on the general state of immune activation.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
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