Exploring the clinical outcomes after deep brain stimulation in Tourette syndrome.

INTRODUCTION: Deep brain stimulation (DBS) of the thalamic centromedian-parafascicular (CM-Pf) region is the most common target to treat refractory Tourette syndrome (TS), but the improvement among the patients is quite variable. This study describes the outcomes of stimulation in TS patients and attempts to determine whether the volume of tissue activated (VTA) inside the thalamus or the structural connectivity between the area stimulated and different regions of the brain is associated with tic improvement. METHODS: The DBS patient response was measured as the percentage change in the Yale Global Tic Severity Scale (YGTSS) before and 12 months after surgery. The sum of the two overlapping VTA/CM-Pf volumes from both hemispheres was correlated with the percent change in YGTSS scores to assess whether the area stimulated inside the CM-Pf affects the clinical outcome. Structural connectivity estimates between the VTA (of each patient) and different regions of the brain were computed using a normative connectome that was taken from healthy subjects. RESULTS: Five male patients aged 26.8 ±â€¯9.3 years were included. No relationships were found between the areas stimulated and the changes in patient tics (p = .374). However, the right frontal middle gyrus (R = 0.564, p = .03), the left frontal superior sulci region (R = 0.900, p = .030) and the left cingulate sulci region (R = 0.821, p = .045) structurally correlated with tic improvement. CONCLUSION: These data suggests that the volume of thalamic area that is stimulated does not explain the variance in outcomes in TS, however, the pattern of connectivity between the region stimulated and specific brain cortical areas is linked to patient outcome.

Severe sepsis from a Ciprofloxacin resistant salmonellosis in a kidney transplant recipient.

INTRODUCTION: Salmonellosis is a relatively rare complication in kidney transplant recipients that cannot be clinically distinguished from other forms of enteritis. Among kidney transplant patients, it varies broadly in intensity, and is highly associated with extra-intestinal disease, bacteremia, and, in this case, a high mortality rate. CASE REPORT: Here we describe a clinical case of ciprofloxacin resistant salmonellosis in a kidney transplant patient. CONCLUSION: This case illustrates how immunosuppressed patients can be exposed to rare forms of infection, often clinically difficult to identify, and possibly with severe clinical courses and poor outcomes despite evidence-based empiric antibiotic therapy.

Severe sepsis from a Ciprofloxacin resistant salmonellosis in a kidney transplant recipient / Sepse grave por salmonelose Ciprofloxacino-resistente em paciente transplantado renal

Abstract Introduction: Salmonellosis is a relatively rare complication in kidney transplant recipients that cannot be clinically distinguished from other forms of enteritis. Among kidney transplant patients, it varies broadly in intensity, and is highly associated with extra-intestinal disease, bacteremia, and, in this case, a high mortality rate. Case Report: Here we describe a clinical case of ciprofloxacin resistant salmonellosis in a kidney transplant patient. Conclusion: This case illustrates how immunosuppressed patients can be exposed to rare forms of infection, often clinically difficult to identify, and possibly with severe clinical courses and poor outcomes despite evidence-based empiric antibiotic therapy.

Resumo Introdução: A salmonelose é uma complicação relativamente rara em transplantados renais, e não pode ser diferenciada de outras formas de enterite pela apresentação clínica. Em pacientes transplantados renais, a salmonelose varia em gravidade, e é frequentemente associada com formas extra intestinais, bacteremia, e, neste caso, com elevada mortalidade. Relato de Caso: Descrevemos o caso clínico de um paciente transplantado renal com salmonelose Ciprofloxacino-resistente. Conclusão: Este caso ilustra o risco, relacionado à imunossupressão, da ocorrência de formas raras de infecção, por vezes de difícil diagnóstico, e com cursos clínicos potencialmente graves e prognóstico ruim, apesar do emprego de antibioticoterapia empírica adequada e de acordo com as evidências disponíveis.

Entendendo melhor a insuficiência respiratória aguda / A better understanding of acute respiratory failure

A insuficiência respiratória aguda (IRpA) é uma síndrome potencialmente grave, constituindo uma das principais indicações de internação em unidades de terapia intensiva. Embora diferentes condições clínicas possam evoluir com IRpA, todas apresentarão comprometimento nas trocas gasosas que caracterizarão a síndrome.O conhecimento da fisiologia das trocas gasosas e os mecanismos pelos quais elas podem ser alteradas permite compreender a fisiopatologia da IRpA e as repercussões dos diferentes distúrbios sobre os gases arteriais. Este conhecimento permite a interpretação adequada da gasometria arterial e de indicadores derivados da mesma, facilitando a condução dos pacientes com IRpA, tanto em relação ao diagnóstico etiológico, quanto ao tratamento de suporte.Estes conceitos da fisiologia das troas gasosas e da fisiopatologia da IRpA e suas aplicações clínicas serão revisados neste artigo...

Acute respiratory failure (ARF) is a potentially severe syndrome, which is a common indication for admission to an intensive care unit. Although the ARF can be caused by different clinical conditions, all of them will present gas exchange impairments that will characterize the syndrome.By knowing the gas exchanges physiology and the mechanisms by which they can be impaired, one can understand the physiopathology of the ARF and how it can compromise the arterial gases. This knowledge allows the correct interpretation of arterial blood gases and other useful indicators, such as the alveolar-arterial oxygen gradient, which help us to manage patients with ARF, both in their diagnosis, and in their supportive treatment.These concepts about the gas exchange physiology and the ARF physiopathology, and their clinical relevance, will be discussed in this article...