Angiocentric glioma: Literature review and first case in Brazil da Silva, Joseph Franklin Chenisz; de Souza Machado, Gustavo Henrique; Pedro, Matheus Kahakura Franco ...
Interdisciplinary neurosurgery : Advanced techniques and case management,
December 2019, 2019-12-00, 2019-12-01, Letnik:
18
Journal Article
Recenzirano
Odprti dostop
Angiocentric glioma (AG) was recently added in the World Health Organization (WHO) classification of tumors (2007) after two case reports published in 2005 as neoplasm of the central nervous system ...(CNS). AG predominantly affects children and young adults, and very often patients presenting with difficult to control epilepsy. Since its initial description, AG has been considered a rare entity with fewer than 100 cases reported hitherto. We report the first case of AG in Brazil, to our knowledge, in a male patient presenting refractory seizures, which neuroimaging results evidenced compatible lesion.
Male patient, 23-year-old, with a history of long-standing headache and episodes of tonic-clonic seizures. His clinical evaluation and physical examination were normal. According to the MRI were evidenced tumefactive lesions next to the pars opercularis of the inferior frontal gyrus and part of the corresponding subcentral gyrus. The patient was submitted to total resection of the lesion. Patient was kept awaken with intraoperative monitoring and using left frontotemporal approach. Three days after surgery the patient was discharged, without neurological deficits and no seizure in the postoperative period. The anatomical pathology exam was compatible with AG.
Angiocentric Glioma is a rare neoplasm mostly present in patients with difficult to control epilepsies. Tumoral resection provides broad control of symptoms, besides reducing recurrence and the progression of the disease, leading to an extremely favorable prognosis.
•Angiocentric gliomas were only added to the WHO classification in 2007.•Only a hundred cases have been reported so far, none in Brazil.•Clinical presentation often includes refractory epilepsy and headaches.•Complete surgical ressection is the treatment of choice.
The epidemiology of Clostridium difficile-associated diarrhea (CDAD) in an endemic setting was investigated by use of DNA typing methods to determine the strain identity of C. difficile isolates. Two ...predominant toxigenic clones were found in the environment and accounted for 29.8% (type 1) and 15.5% (type 2) of CDAD cases, respectively. In endemic settings, the environment and cross-transmission may play a role in acquisition of CDAD.
To review and summarize the status of diagnosis, epidemiology, infection control, and treatment of Clostridium difficile-associated disease (CDAD).
A case definition of CDAD should include the ...presence of symptoms (usually diarrhea) and at least one of the following positive tests: endoscopy revealing pseudomembranes, stool cytotoxicity test for toxin B, stool enzyme immunoassay for toxin A or B, or stool culture for C difficile (preferably with confirmation of organism toxicity if a direct stool toxin test is negative or not done). Testing of asymptomatic patients, including those who are asymptomatic after treatment, is not recommended other than for epidemiologic purposes. Lower gastrointestinal endoscopy is the only diagnostic test for pseudomembranous colitis, but it is expensive, invasive, and insensitive (51% to 55%) for the diagnosis of CDAD. Stool culture is the most sensitive laboratory test currently in clinical use, but it is not as specific as the cell cytotoxicity assay.
C difficile is the most frequently identified cause of nosocomial diarrhea. The majority of C difficile infections are acquired nosocomially, and most patients remain asymptomatic following acquisition. Antimicrobial exposure is the greatest risk factor for patients, especially clindamycin, cephalosporins, and penicillins, although virtually every antimicrobial has been implicated. Cases of CDAD unassociated with prior antimicrobial or antineoplastic use are very rare. Hands of personnel, as well as a variety of environmental sites within institutions, have been found to be contaminated with C difficile, which can persist as spores for many months. Contaminated commodes, bathing tubs, and electronic thermometers have been implicated as sources of C difficile. Symptomatic and asymptomatic infected patients are the major reservoirs and sources for environmental contamination. Both genotypic and phenotypic typing systems for C difficile are available and have enhanced epidemiologic investigation greatly.
Successful infection control measures designed to prevent horizontal transmission include the use of gloves in handling body substances and replacement of electronic thermometers with disposable devices. Isolation, cohorting, handwashing, environmental disinfection, and treatment of asymptomatic carriers are recommended practices for which convincing data of efficacy are not available. The most successful control measure directed at reduction in symptomatic disease has been antimicrobial restriction.
Treatment of symptomatic (but not asymptomatic) patients with metronidazole or vancomycin for 10 days is effective; metronidazole may be preferred to reduce risk of vancomycin resistance among other organisms in hospitals. Recurrence of symptoms occurs in 7% to 20% of patients and is due to both relapse and reinfection. Over 90% of first recurrences can be treated successfully in the same manner as initial cases. Combination treatment with vancomycin plus rifampin or the addition orally of the yeast Saccharomyces boulardii to vancomycin or metronidazole treatment has been shown to prevent subsequent diarrhea in patients with recurrent disease.
Faulty spring causing a gas leak Terry, Louise, MB BCh, BAO (Specialist Trainee); da Silva, Egidio Joseph, MB ChB, DA, FRCA, PGCME (Consultant)
Journal of clinical anesthesia,
08/2009, Letnik:
21, Številka:
5
Journal Article
Recenzirano
To the Editor: Over the years there have been a number of case reports of gas leaks occurring from the back bar of the anesthetic machine 1-4. The fresh gas flows were reduced to 1.5 L/min, in line ...with maintaining low-flow anesthesia, and the percentage dialed on the isoflurane vaporizer remained unchanged.
In order to determine genetic relatedness of
Bacteroides fragilis isolates from different clinical sources, arbitrarily primed polymerase chain reaction (PCR) (AP-PCR) was used to compare 17 strain
s ...isolated from patients with inflammatory bowel disease (IBD) and 20 strains isolated from foals with diarrhea. Three reference ATCC strains were also analyzed. Eighteen unique types were identified with a 22-mer arbitrary primer (ERIC-2) among the 20 patient isolates. Types 1 (enterotoxigenic) and 9 (nonenterotoxigenic), were each found in the stools of two patients. All other isolates showed a distinct and unique DNA banding pattern indicating a high degree of genotypic variability. Eleven types were identified among the foal isolates. Type 20, a nonenterotoxigenic type, was present in 30% of the foals. No correlation was found between the human and horse isolates. No clear relationship between a disease state (diarrhea or IBD) and specific types was observed. AP-PCR will be useful as a rapid method to determine genetic relatedness and in future epidemiologic studies of diarrheal diseases due to
B. fragilis.
AIDA D'silva, Joseph Vinish; De Moor, Florestan; Kemme, Bettina
Proceedings of the VLDB Endowment,
07/2018, Letnik:
11, Številka:
11
Journal Article
Recenzirano
With the tremendous growth in data science and machine learning, it has become increasingly clear that traditional relational database management systems (RDBMS) are lacking appropriate support for ...the programming paradigms required by such applications, whose developers prefer tools that perform the computation outside the database system. While the database community has attempted to integrate some of these tools in the RDBMS, this has not swayed the trend as existing solutions are often not convenient for the incremental, iterative development approach used in these fields. In this paper, we propose AIDA - an abstraction for advanced in-database analytics. AIDA emulates the syntax and semantics of popular data science packages but transparently executes the required transformations and computations inside the RDBMS. In particular, AIDA works with a regular Python interpreter as a client to connect to the database. Furthermore, it supports the seamless use of both relational and linear algebra operations using a unified abstraction. AIDA relies on the RDBMS engine to efficiently execute relational operations and on an embedded Python interpreter and NumPy to perform linear algebra operations. Data reformatting is done transparently and avoids data copy whenever possible. AIDA does not require changes to statistical packages or the RDBMS facilitating portability.
An impairment in lymphocyte response to mitogen stimulation, a correlate of cell-mediated immunity, has been reported in patients with depressive illness. To investigate whether such impairment in ...lymphocyte function is related to excessive secretion of cortisol, an immunosuppressive hormone, we compared mitogen-induced lymphocyte proliferation in three groups of subjects: (1) depressed patients with elevated 24-hour urinary free Cortisol (UFC) excretion; (2) depressed patients with normal UFC excretion; and (3) normal controls. Depressed patients in both groups showed significant reductions in lymphocyte mitogenic activity, in comparison with the normal controls, but the two depressive groups did not significantly differ from each other in their lymphocytic responses to any of the mitogens used. Furthermore, no significant correlations were found, within depressed patients, between UFC excretion and lymphocyte mitogenic responses. Depression is therefore associated with an impairment in lymphocyte function that cannot be explained solely on the basis of increased cortisol secretion.
A homosexual man with the acquired immune deficiency syndrome had an unusually wide array of opportunistic infections. Despite antibiotic treatment over a period of two and a half years, the patient ...died. Perianal herpetic ulcers, oral candidiasis, cytomegalovirus infection, and disseminated infections with both Histoplasma capsulatum and Mycobacterium avium-intracellulare were diagnosed during illness. An autopsy revealed invasive pulmonary aspergillosis and a cerebellar lesion caused by cytomegalovirus. The latter was probably responsible for the patient's gait disturbance.
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