RESUMO
Due to the presence of artefacts in stool samples, the copromicroscopic diagnosis of Ascaris lumbricoides is not always straightforward, particularly in the case of fertilized decorticated eggs. A total of 286 stool samples from 115 schoolchildren in India and 171 adult immigrants in Italy were screened for the presence of A. lumbricoides eggs by both Kato-Katz thick smear and Mini-FLOTAC. If the outer layer of A. lumbricoides eggs was absent, two aliquots of each stool sample were preserved: one for coproculture to identify larvae after development and one to compose a pool of stool for molecular analysis. A total of 64 stool samples (22.4%) were positive for A. lumbricoides using the Kato-Katz thick smear; 36 (56.3%) of these showed mammillated A. lumbricoides eggs, 25 (39.1%) showed elements resembling fertilized decorticated eggs, while three samples (4.7%) showed both mammillated and decorticated eggs. By Mini-FLOTAC, 39 stool samples (13.6%) were positive, while decorticated A. lumbricoides-like eggs were identified as artefacts. These results were confirmed by negative coprocultures and quantitative polymerase chain reaction. Mini-FLOTAC can be used for a reliable diagnosis of A. lumbricoides, thanks to the flotation and translation features which allow a clearer view, resulting in the correct identification of A. lumbricoides eggs.
Assuntos
Ascaris lumbricoides , Helmintíase , Animais , Artefatos , Fezes , Helmintíase/diagnóstico , Sensibilidade e EspecificidadeRESUMO
Due to abundant pathogen diversity and mounting antimicrobial resistance, sepsis is more common in sub-Saharan Africa (sSA). However, there is a lack of consistent reports regarding the prevalence of adult sepsis in the region. Therefore, this study aimed to determine pooled estimates of sepsis prevalence and associated mortality among adults admitted to hospitals in sSA. Medline (through PubMed), Scopus, Embase, and Web of Science were systematically searched for studies of sepsis in sSA published before 13th February 2023. A random-effects meta-analysis of hospital-wide and intensive care unit (ICU)-based sepsis prevalence was performed with a 95% confidence interval (CI). Subgroup analysis was conducted considering geographic region and sepsis diagnostic criteria. Funnel plots and Egger's test were used to assess publication bias. The protocol was submitted to the Prospective Register for Systematic Reviews (PROSPERO) with an identifier (CRD42023396719). Overall, 14 observational studies, published between 2009 and 2022, from eight different sSA countries comprising 31,653 adult patients (5723 with sepsis) were included in the review. Nine studies that were conducted in a hospital-wide setting showed a pooled prevalence and mortality of 17% (95% CI: 12-21%) and 15% (95% CI: 17-35%), respectively. Five studies in the ICUs presented a pooled prevalence and mortality of 31% (95% CI: 24-38%) and 46% (95% CI: 39-54%), respectively. Based on the sub-group analysis, the pooled hospital-wide prevalence of sepsis in East and Southern Africa was 18% (95% CI: 11-25%), and 20% (95% CI: 2-42%), respectively. The pooled prevalence in the ICU was 14% (95% CI: 4-23%) and 13% (95% CI: 5-20%) for East and Southern Africa, respectively. The hospital-wide and ICU-based sepsis prevalence and mortality are high in sSA. Addressing the burden of adult sepsis should be a priority for healthcare systems in sub-Saharan Africa.
Assuntos
Sepse , Adulto , Humanos , Prevalência , África Subsaariana/epidemiologia , Sepse/epidemiologia , Hospitalização , HospitaisRESUMO
Meckel's diverticulum is a common congenital anomaly of the small intestine, affecting 2% of the population. Neoplastic transformation is infrequent and gastrointestinal stromal tumours are exceptional in this location. We report a case of gastrointestinal bleeding caused by a gastrointestinal stromal tumour of Meckel's diverticulum.
Assuntos
Hemorragia Gastrointestinal/etiologia , Tumores do Estroma Gastrointestinal/diagnóstico , Divertículo Ileal/patologia , Idoso , Hemorragia Gastrointestinal/cirurgia , Tumores do Estroma Gastrointestinal/cirurgia , Humanos , Masculino , Divertículo Ileal/cirurgiaRESUMO
Metastatic tumours of the spleen are rare and most frequently diagnosed at the time of autopsy. Most patients with splenic metastases have widely disseminated metastatic disease. We report a case of an asymptomatic, isolated splenic metastasis in a 67-year-old man diagnosed 2 years after resection of an adenocarcinoma of the lung.
Assuntos
Adenocarcinoma/secundário , Neoplasias Pulmonares/patologia , Neoplasias Esplênicas/secundário , Adenocarcinoma/diagnóstico , Adenocarcinoma/cirurgia , Idoso , Diagnóstico Diferencial , Seguimentos , Humanos , Laparotomia , Neoplasias Pulmonares/cirurgia , Masculino , Pneumonectomia , Esplenectomia/métodos , Neoplasias Esplênicas/diagnóstico , Neoplasias Esplênicas/cirurgia , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVES: Our objective was to examine whether or not women with symptoms of a urinary tract infection but with a negative culture (20%-30%) do have an infection. METHODS: We performed quantitative PCR (qPCR) for Escherichia coli and Staphylococcus saprophyticus, on top of a standard culture, in urine samples from 220 women with dysuria and/or frequency and/or urgency and from 86 women without symptoms. For symptomatic women, qPCR was also carried out for four sexually transmitted agents. RESULTS: In the symptomatic group, 80.9% (178/220) of the urine cultures were positive for any uropathogen and 95.9% (211/220) were E. coli qPCR-positive. For the control group, cultures for E. coli and E. coli qPCR were positive in, respectively, 10.5% (9/86) and 11.6% (10/86). In the symptomatic group, qPCR yielded 19 positive samples for S. saprophyticus qPCR, one positive sample for Mycoplasma genitalium and one for Trichomonas vaginalis. CONCLUSIONS: These findings suggest that almost all women with typical urinary complaints and a negative culture still have an infection with E. coli.
Assuntos
Técnicas Bacteriológicas/métodos , Escherichia coli/genética , Reação em Cadeia da Polimerase/métodos , Infecções Urinárias , Adulto , Bacteriúria , Escherichia coli/isolamento & purificação , Feminino , Humanos , Pessoa de Meia-Idade , Staphylococcus saprophyticus/genética , Staphylococcus saprophyticus/isolamento & purificação , Infecções Urinárias/diagnóstico , Infecções Urinárias/epidemiologia , Infecções Urinárias/microbiologia , Adulto JovemRESUMO
The use of a state-of-the-art commercial solvent-elimination interface for liquid chromatography-infrared spectroscopy is discussed from the perspective of quantitative analysis. The effect of eluent flow-rate is investigated with respect to the homogeneity of the deposit and the trace width along the deposition trace. Low flow-rates (50 microl/min or less) turn out to be favorable for obtaining a good trace and a high sensitivity. The trace width decreased from 2.20 to 1.13 mm when the flow-rate was reduced from 500 to 25 microl/min. Preservation of chromatographic detail during deposition was evaluated at different substrate moving speeds. The additional (extra-column) band broadening that is inherent to nebulizer-deposition interfaces, causes a loss in resolution in size-exclusion chromatography (SEC)-Fourier transform infrared (FTIR) spectroscopy in comparison with SEC-UV. The repeatability of the deposition is evaluated by SEC-FTIR analyses of polystyrene standards (peak molar-masses: 1250-2,950 000 g/mol) and the RSD is found to range from 3.2 to 5.8% in response and from 0.21 to 0.47% in retention time.
Assuntos
Cromatografia em Gel/métodos , Espectroscopia de Infravermelho com Transformada de Fourier/métodos , Indicadores e Reagentes , Poliestirenos/química , Padrões de Referência , Reprodutibilidade dos Testes , Solventes , Espectrofotometria UltravioletaRESUMO
Psoas abscess complicating Crohn's disease is a rare condition. Fever, abdominal tenderness, limb pain and hip contracture are typical signs but only present in half of the cases. Cultures of the pus mostly grow a mixture of enterobacteria. The diagnosis is made by CT-scan. Medical therapy always results in recurrence of the abscess. Resection of the fistula and the affected bowel segment with end-to-end anastomosis is the therapy of choice. A case report is presented, followed by a review of the literature.
Assuntos
Doença de Crohn/complicações , Abscesso do Psoas/etiologia , Adulto , Colite/complicações , Colite/cirurgia , Doenças do Colo/complicações , Doenças do Colo/etiologia , Doença de Crohn/cirurgia , Feminino , Humanos , Perfuração Intestinal/complicações , Perfuração Intestinal/etiologia , Abscesso do Psoas/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
Necrolytic migratory erythema (NME) is a rare skin condition consisting of migrating areas of erythema with blisters that heal with hyperpigmentation. NME is a pathognomonic feature of a glucagonoma. When confronted with a xerosis cutis one should always exclude the possibility of a NME caused by a glucagonoma as demonstrated in this case report where the rash was wrongly attributed to an acrodermatitis enteropathica due to zinc deficiency. We describe a case of a glucagonoma with its classic features, diagnosis and treatment.
Assuntos
Eritema/etiologia , Glucagonoma/complicações , Glucagonoma/diagnóstico , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas/diagnóstico , Deficiências Nutricionais/diagnóstico , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Necrose , Zinco/deficiênciaRESUMO
Primary omental leiomyosarcomas are rare intra-abdominal tumours. A few cases only have been reported in the literature. We present a case of a 79-year old woman, whose tumour was surgically removed. We include a hort review of the literature.
Assuntos
Cistadenoma/diagnóstico , Cistadenoma/cirurgia , Leiomiossarcoma/diagnóstico , Leiomiossarcoma/cirurgia , Neoplasias Primárias Múltiplas/diagnóstico , Neoplasias Primárias Múltiplas/cirurgia , Omento , Neoplasias Ovarianas/diagnóstico , Neoplasias Ovarianas/cirurgia , Neoplasias Peritoneais/diagnóstico , Neoplasias Peritoneais/cirurgia , Assistência ao Convalescente/métodos , Idoso , Biópsia , Diagnóstico Diferencial , Feminino , Humanos , Recidiva Local de Neoplasia/prevenção & controle , Exame Físico , Tomografia Computadorizada por Raios XRESUMO
Small bowel diverticulosis (SBD) have the lowest incidence of diverticulosis of the alimentary tract. The incidence differs from 0.09% to 2.3% depending on the reporting physician. SBD are pseudodiverticula, consisting of mucosa only. The causes of SBD are not clear, but the "locus minoris resistentiae" theory is most widely accepted. Overactive or irregular peristalsis bulges the mucosa out through vascular defects in the bowel wall. Only meticulous radiographic techniques can lead to a diagnosis. Preoperative diagnosis is exceptional. SBD can produce chronic abdominal discomfort. Acute complications are also numerously described, giving rise to a surgical emergency. Resection of the involved segment is then the only good procedure. Two cases presenting major complications are discussed, followed by a review of the literature.
Assuntos
Divertículo/diagnóstico , Doenças do Jejuno/diagnóstico , Idoso , Divertículo/complicações , Evolução Fatal , Feminino , Humanos , Perfuração Intestinal/etiologia , Perfuração Intestinal/cirurgia , Doenças do Jejuno/complicações , Masculino , Recidiva , ReoperaçãoRESUMO
The case of a 56-year old male with an intra-abdominal metastasis from a primary lung cancer is presented. He was admitted for abdominal obstruction, toxic syndrome and paraumbilical pain. He had a previous history of squamous cell carcinoma of the right lung, for which he had undergone a right upper lobectomy in 1995, four years prior to the development of the abdominal obstruction. A debulking operation and bowel resection for the intestinal metastasis was performed. Eleven months after this operation the patient developed a recurrence: he underwent another debulking operation with resection of the sigmoid colon, jejunal segment and a small part of the bladder. The patient is alive and well 13 months after the initial operation. Intra-abdominal metastases of bronchial carcinoma may be observed with greater frequency, because of the improved survival of the patients with lung cancer. Metastatic small bowel carcinomas are rare and should be considered in the differential diagnosis of acute abdominal syndromes of patients with known history of the lung cancer. Bowel resection and debulking of the metastatic tumour mass give the best palliation and improve short-term survival.
Assuntos
Carcinoma de Células Escamosas/patologia , Neoplasias Intestinais/secundário , Neoplasias Pulmonares/patologia , Carcinoma de Células Escamosas/diagnóstico por imagem , Humanos , Neoplasias Intestinais/diagnóstico por imagem , Neoplasias Intestinais/cirurgia , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XAssuntos
Adenocarcinoma/genética , Neoplasias Retais/genética , Síndromes de Usher/genética , Proteínas Adaptadoras de Transdução de Sinal/genética , Adenocarcinoma/complicações , Adulto , Proteínas de Ciclo Celular , Proteínas do Citoesqueleto , Feminino , Humanos , Proteínas/genética , Neoplasias Retais/complicações , Síndromes de Usher/complicaçõesRESUMO
Fistulas between the large bowel and the prostatic urethra, due to Crohn's disease, are very uncommon. Pneumaturia and an abnormal urethral discharge are the most common symptoms. Diagnosis is made by a voiding cystourethrogram or a retrograde urethrography. Treatment is usually difficult with a high percentage of recurrence. A well documented case is presented.