The role of clinically relevant intra-abdominal collections after pancreaticoduodenectomy : Clinical impact and predictors. A retrospective analysis from a European tertiary centre.

BACKGROUND: There is controversial evidence regarding the impact of clinically relevant postoperative intra-abdominal collections (CR-IC) on the clinical course after pancreaticoduodenectomy. C-reactive Protein (CRP) has been validated as a predictor of postoperative pancreatic fistula (POPF). Still, its role in predicting CR-IC has not been studied. METHODS: A retrospective analysis was conducted on patients who underwent PD at a tertiary hospital between October 2012 and October 2017. The incidence of CR-IC, clinically relevant POPF and other complications, as well as mortality and length of hospitalisation, was retrieved. The impact of CR-IR on mortality and major complications was analysed. The serum CRP levels were retrieved on the third and fifth postoperative days (POD3 and POD5), followed by an analysis of sensitivity, specificity, and area under the curve to predict CR-IC using CRP. RESULTS: One hundred forty patients were enrolled following inclusion and exclusion criteria. The mean age was 66.5 years (15-83). The incidence of CR-IC was 33.7% (47), and CR-POPF was 24.3%. Pancreatic duct diameter ≤ 4 mm was identified as a risk factor related to CR-IC occurrence. The group of patients who developed CR-IC after PD exhibited a higher rate of complications Clavien-Dindo ≥ III compared to patients without CR-IC (40.4% vs 7.5%, p < 0.001), as well as other events such as admission to the intensive care unit (25.5% vs 4.3%, p < 0.001), the incidence of CR-POPF (66% vs 3.2%, p < 0.001), prolonged hospital stay (32 vs 13 days, p < 0.001), postoperative haemorrhage (23.4 vs 5.4%, p = 0.002), and delayed gastric empty (38.8% vs 11.8%, p < 0.001) respectively. Logistic regression analysis identified CR-IC related to POPF as a risk factor for Clavien-Dindo > III: OR = 10.6 (95% CI: 3.90-28.7). No differences in mortality were reported between the CR-IC group and non-CR-IC group. CRP at postoperative day 3 (POD3) > 17.55 mg/dl and CRP at postoperative day 5 (POD5) > 13.46 mg/dl were predictors of CR-IC (AUC: 0.731 and AUC:0.821, respectively). CONCLUSIONS: CR-IC has a significant impact after pancreaticoduodenectomy and is associated with a higher incidence of Clavien-Dindo ≥ III complications. Additionally, CRP levels at POD3 and POD5 play a role in predicting CR-IC. Prospective studies are essential to explore strategies for mitigating the occurrence of CR-IC after PD.

Impact of comorbidities on hospital mortality in patients with acute pancreatitis: a population-based study of 110,021 patients.

BACKGROUND: The impact of pre-existing comorbidities on acute pancreatitis (AP) mortality is not clearly defined. Our study aims to determine the trend in AP hospital mortality and the role of comorbidities as a predictor of hospital mortality. METHODS: We analyzed patients aged ≥ 18 years hospitalized with AP diagnosis between 2016 and 2019. The data have been extracted from the Spanish National Hospital Discharge Database of the Spanish Ministry of Health. We performed a univariate and multivariable analysis of the association of age, sex, and comorbidities with hospital mortality in patients with AP. The role of the Charlson and Elixhauser comorbidity indices as predictors of mortality was evaluated. RESULTS: A total of 110,021 patients diagnosed with AP were hospitalized during the analyzed period. Hospital mortality was 3.8%, with a progressive decrease observed in the years evaluated. In multivariable analysis, age ≥ 65 years (OR: 4.11, p < 0.001), heart disease (OR: 1.73, p < 0.001), renal disease (OR: 1.99, p < 0.001), moderate-severe liver disease (OR: 2.86, p < 0.001), peripheral vascular disease (OR: 1.43, p < 0.001), and cerebrovascular disease (OR: 1.63, p < 0.001) were independent risk factors for mortality. The Charlson > 1.5 (OR: 2.03, p < 0.001) and Elixhauser > 1.5 (OR: 2.71, p < 0.001) comorbidity indices were also independently associated with mortality, and ROC curve analysis showed that they are useful for predicting hospital mortality. CONCLUSIONS: Advanced age, heart disease, renal disease, moderate-severe liver disease, peripheral vascular disease, and cerebrovascular disease before admission were independently associated with hospital mortality. The Charlson and Elixhauser comorbidity indices are useful for predicting hospital mortality in AP patients.

The relation between holistic processing as measured by three composite tasks and face processing: A latent variable modeling approach.

We investigated the relationship between holistic processing and face processing using a latent variables approach. Three versions of the composite paradigm were used to measure holistic processing: Vanderbilt Holistic Face Processing Test, a sequential composite matching task, and a simultaneous composite matching task. Three tasks were used to measure face perception and face memory abilities respectively. We had three pairs of tasks such that within each pair (of memory and perception task), the stimuli involved, the requirement for matching across viewpoints, etc., are the same, such that the only difference is whether perception or memory is taxed. There were no significant correlations between the different versions of the composite task. We discovered no evidence to support a distinction between face perception and face memory, suggesting the existence of a general face processing factor. Finally, there was no evidence that holistic processing (as captured by either of the three composite tasks) is predictive of better face processing per se, casting doubts on the role of holistic processing in differentiating different levels of efficiency in face processing.

Polystyrene nanoplastics and microplastics can act as Trojan horse carriers of benzo(a)pyrene to mussel hemocytes in vitro.

In this work we studied the ability of polystyrene (PS) nanoplastics (NPs) and microplastics (MPs) to transfer benzo(a)pyrene (BaP) to mussel hemocytes and to produce toxic effects in vitro. For this, intracellular fate and toxicity of PS NPs (0.05 µm) and MPs (0.5 and 4.5 µm) alone or with BaP and of BaP alone were assessed. Particles of 0.05 and 0.5 µm largely aggregated in the exposure medium whereas presence of BaP reduced particle aggregation. Cells internalized PS NPs and MPs alone or with BaP and these were found inside and outside lysosomes, depending on their size. PS particles alone or with BaP were cytotoxic to hemocytes only at the highest concentrations tested. The same was true for most sublethal endpoints except for increased phagocytic activity provoked by NPs and 0.5 µm MPs at lower concentrations. Plastic particles appeared to be the main drivers for reduced plasma membrane integrity and increased phagocytic and lysosomal activities whereas BaP appeared to contribute more to reduced cell viability and phagocytosis and increased ROS production and genotoxicity. Overall, PS NPs and MPs can act as carriers of BaP to mussel hemocytes, rising concerns about risks plastics associated to pollutants may pose to aquatic organisms.

All about portal vein: a pictorial display to anatomy, variants and physiopathology.

The portal vein (PV) is the main vessel of the portal venous system (PVS), which drains the blood from the gastrointestinal tract, gallbladder, pancreas, and spleen to the liver. There are several variants affecting the PV, and quite a number of congenital and acquired pathologies.In this pictorial review, we assess the embryological development and normal anatomy of the PVS, displaying selected cases consisting of normal variants, congenital anomalies, and a large and heterogeneous group of acquired conditions that may affect the PV.

O espelho: entre o si mesmo e um outro / The mirror: between myself and another one

Este ensaio analisa o conto O espelho, de Machado de Assis, atentando para suas confluências com a teoria sobre o narcisismo, apresentada por S. Freud em 1914. Por meio da análise deste conto é possível notar que os conceitos psicanalíticos surgem como subsídios de uma leitura do texto literário, evidenciando as relações entre literatura e psicanálise (AU)

O espelho: entre o si mesmo e um outro / The mirror: between myself and another one

Este ensaio analisa o conto O espelho, de Machado de Assis, atentando para suas confluências com a teoria sobre o narcisismo, apresentada por S. Freud em 1914. Por meio da análise deste conto é possível notar que os conceitos psicanalíticos surgem como subsídios de uma leitura do texto literário, evidenciando as relações entre literatura e psicanálise.

Fatores de risco, aspectos clínicos e laboratoriais da asma em crianças / Risk factors, clinical and laboratory aspects of asthma in children

Objetivo: avaliar os aspectos clínicos, laboratoriais, e os fatores de risco associados à asma em crianças atendidas no Ambulatório de Pediatria, do Hospital Universitário Júlio Müller. Método: estudo de caso-controle, incluindo 59 crianças asmáticas (casos) e 104 não-asmáticas (controles). Os seguintes fatores foram considerados para análise de risco: escolaridade dos pais, exposição aos alérgenos domiciliares, tabagismo passivo, aleitamento materno, renda e antecedentes familiares alérgicos. Foram coletadas amostras de sangue para hemograma e dosagem de IgE total e específica para alérgenos. Realizou-se teste cutâneo de hipersensibilidade imediata pelo método de puntura para os seguintes alérgenos: ácaros, animais, fungos e baratas com controles positivo (histamina) e negativo (solução fisiológica).Um modelo de regressão logística foi usado para calcular odds ratio (OR) e intervalo de confiança (IC) 95 por cento ajustado para outros fatores de risco e confundidores Resultados: dentre os fatores de risco estudados, sexo, baixa escolaridade, baixa renda, tempo de aleitamento materno e tabagismo passivo não estiveram associados à ocorrência de asma. A exposição aos alérgenos foi semelhante nos dois grupos, a não ser pela maior freqüência de animais nos domicílios dos controles (X2=16,9; p<0,05). Rinite paterna foi o único antecedente familiar associado à asma (OR=3,33; IC 95 por cento:1,03-11,17; p<0,05). As crianças asmáticas apresentaram maior freqüência de positividade do teste cutâneo que os controles, principalmente para ácaros: D.pteronyssinus (69,5por cento), D.farinae (59,3por cento) e B.tropicalis (59,3por cento); baratas: P.americana (59,3por cento) e gato: F.domesticus (37,3por cento); com OR variando de 11,2- 21,0; p<0,05. Eosinofilia e níveis séricos de IgE total foram mais elevados no grupo de asmáticos (p<0,05). A positividade do teste de IgE específica para D.pteronyssinus e B.tropicalis foi maior nos casos em relação aos controles (p<0,05). A análise multivariada mostrou que sensibilização às baratas (OR=9,26, 95por centoIC:2,59-33,4), animais (OR=3,93, 95por cento IC:1,05-14,67) e ácaros (OR=3,74, 95por centoIC: 1,18-11,8) foram os mais importantes fatores de risco para asma. Conclusões: a sensibilização aos alérgenos domiciliares, principalmente ácaros, barata e animais mostrou uma forte associação com asma neste estudo

Sintomas respiratórios e tabagismo passivo em crianças: 2ª parte / Respiratory symptoms and passive smoking in children: 2nd part

Foram estudados em 511 crianças de 0 a 10 anos de idade (288(56,4%) fumantes passivos e 223(43,6%) näo fumantes passivos), sorteadas nos domicílios selecionados através de amostragem estratificada, a presença de sintomas respiratórios, sua associaçäo com hábito tabágico domiciliar, a presença de doença pulmonar pregressa e a necessidade de tratamento para doenças respiratórias nos últimos seis meses. O método utilizado foi o da aplicaçäo de questionário padronizado respondido pela mäe ou responsável no domicílio. Os resultados mostraram que 30,7% desta populaçäo eram sintomáticos respiratórios, sendo a faixa estária mais acometida a de 0 a 2 anos de idade. Os sintomas mais encontrados foram tosse (19,4%), coriza (17,2%) e expectoraçäo (14,1%). O sintoma chiado apareceu em 9,4% dos indivíduos entrevistados. Existe associaçäo entre o fator de risco tabagismo passivo e a presença de sintomas respiratórios em todas as faixas etárias estudadas. A necessidade de tratamento para "doenças dos pulmöes e/ou dos brônquios nos últimos seis meses" apareceu em 81 (15,8%) dos indivíduos estudados e, dentre eles, 60 (74,1%) pertenciam ao grupo fumante passivo. Conclui-se que o tabagismo passivo está associado a uma maior prevalência de sintomáticos respiratórios, além de aumento do risco de gravidade nos casos de infecçäo respiratória agudas que exijam açöes dos serviços de saúde

Agamaglobulinemia congênita / Congenital agammaglobulinemia

Descreve-se o caso de um menino de 5a10m, portador de agamaglobulinemia congênita, aparentemente sem herança ligada ao sexo. O diagnóstico foi realizado com base nos baixos níveis de IgG (70-90mg%), IgA e IgM näo detectáveis, ausência de linfócitos com imunoglobulinas de superfície (linfócitos B), ao lado de uma imunidade mediada por linfócitos T, normal. Além de pneumonias de repetiçäo, otite média supurada e sinusite maxilar prolongadas, o paciente apresentou quadro de poliartrite crônica em joelhos e quadril D, simulando uma artrite reumatóide seronegativa. O líquido sinovial foi estéril, com ausência de fraçäo gama à eletroforese de proteínas. HLA - A2, A29, B7, B44, CW2. Na discussäo, tece comentários sobre a abordagem global deste tipo de paciente, incluindo a socializaçäo, escolarizaçäo e psicoprofilaxia