Urological complications caused by inferior vena cava filters: a systematic review.

INTRODUCTION: Inferior vena cava (IVC) filters act in preventing pulmonary embolisms (PE). Various complications have been reported with their use. However, a credible urological complication rate, filter characteristics, and clinical presentation has yet to be summarized. Thus, we reported these complications in the form of a systematic review. EVIDENCE ACQUISITION: A search strategy was designed using PubMed, MEDLINE, and EMBASE on February 10th, 2022. The design of this search strategy did not include any language restrictions. The key words (and wildcard terms) used in the search strategy were urolog*, ureter*, bladder, kidney coupled with filter, inferior vena cava, and cava*. Inclusion criteria were: patients older than 18, with previous IVC filter placement, and urologic complication reported. Exclusion criteria were: patients younger than 18, no IVC filter placement, and no urologic complication reported. Other case series and reviews were excluded to avoid patient duplication. EVIDENCE SYNTHESIS: Thirty-five articles were selected for full-text screening. Thirty-seven patient cases were reviewed, and the median age was 53 (range: 21-92 years old). Abdominal and or flank pain was reported in 16 (43%) patients, hematuria was seen in eight (22%) and two (5%) patients died due to acute renal failure resulting from the urologic complications of the IVC filter. Indications for IVC filter placement were recurrent pulmonary embolism (PE), contraindication to or noncompliance with anticoagulant therapy. The IVC filters were infrarenal in 29 (78.4%) patients, suprarenal in five (13.5%) patients, not reported in two patients, and misplaced into the right ovarian vein in one patient. Three or more imaging modalities were obtained in 19 patients (51%) for planning. IVC filter removal was not performed in 17 (45.9%) patients, endovascular retrieval occurred in nine (24.3%) patients, and open removal was performed in seven (18.9%) patients, and tissue interposition was performed in two (5.4%) patients. One patient did not have the management reported. CONCLUSIONS: Urological complications caused by IVC filters although rare, are likely underreported, require extensive workup, and pose surgical challenges. Due to their complex management, filter retrieval should be planned for as soon as feasible, and plans should be made as early as during the IVC filter implant. For those that do develop complications, clinical judgement must be exercised in management, and open surgical, endovascular or even conservative management strategies can be viable options and should be discussed in a multidisciplinary setting.

Subtle white matter intensity changes on fluid-attenuated inversion recovery imaging in patients with ischaemic stroke.

Leukoaraiosis is a neuroimaging marker of small-vessel disease that is characterized by high signal intensity on fluid-attenuated inversion recovery MRI. There is increasing evidence from pathology and neuroimaging suggesting that the structural abnormalities that characterize leukoaraiosis are actually present within regions of normal-appearing white matter, and that the underlying pathophysiology of white matter damage related to small-vessel disease involves blood-brain barrier damage. In this study, we aim to verify whether leukoaraiosis is associated with elevated signal intensity on fluid-attenuated inversion recovery imaging, a marker of brain tissue free-water accumulation, in normal-appearing white matter. We performed a cross-sectional study of adult patients admitted to our hospital with a diagnosis of acute ischaemic stroke or transient ischaemic attack. Leukoaraiosis was segmented using a semi-automated method involving manual outlining and signal thresholding. White matter regions were segmented based on the probabilistic tissue maps from the International Consortium for Brain Mapping 152 atlas. Also, normal-appearing white matter was further segmented based on voxel distance from leukoaraiosis borders, resulting in five normal-appearing white matter strata at increasing voxel distances from leukoaraiosis. The relationship between mean normalized fluid-attenuated inversion recovery signal intensity on normal-appearing white matter and leukoaraiosis volume was studied in a multivariable statistical analysis using linear mixed modelling, having normal-appearing white matter strata as a clustering variable. One hundred consecutive patients meeting inclusion and exclusion criteria were selected for analysis (53% female, mean age 68 years). Mean normalized fluid-attenuated inversion recovery signal intensity on normal-appearing white matter was higher in the vicinity of leukoaraiosis and progressively lower at increasing distances from leukoaraiosis. In a multivariable analysis, the mean normalized fluid-attenuated inversion recovery signal intensity on normal-appearing white matter was positively associated with leukoaraiosis volume and age (B = 0.025 for each leukoaraiosis quartile increase; 95% confidence interval 0.019-0.030). This association was found similarly across normal-appearing white matter strata. Voxel maps of the mean normalized fluid-attenuated inversion recovery signal intensity on normal-appearing white matter showed an increase in signal intensity that was not adjacent to leukoaraiosis regions. Our results show that normal-appearing white matter exhibits subtle signal intensity changes on fluid-attenuated inversion recovery imaging that are related to leukoaraiosis burden. These results suggest that diffuse free-water accumulation is likely related to the aetiopathogenic processes underlying the development of white matter damage related to small-vessel disease.

Surveillance and risk factors for early restenosis following transcarotid artery revascularization.

OBJECTIVE: Restenosis after transcarotid artery revascularization (TCAR) is a known complication. When identified in the early postoperative period, it may be related to technique. We evaluated our TCAR experience to identify potentially modifiable factors impacting restenosis. METHODS: This is a single-institution, retrospective review of patients undergoing TCAR from November 2017 to July 2022. Restenosis was defined as >50% stenosis on duplex ultrasound (DUS) examination or computed tomographic angiography (CTA). Continuous variables were compared using Kruskal-Wallis's test. Categorical variables were compared using the Fisher's exact test. RESULTS: Of 61 interventions, 11 (18%) developed restenosis within the median follow-up of 345 days (interquartile range, 103-623 days). Among these patients, 82% (9/11) had >50% stenosis, and 18% (2/11) had >80% stenosis. Both patients with high-grade restenosis were symptomatic and underwent revascularization. Diagnosis of post-TCAR restenosis was via DUS examination in 45% (5/11), CTA in 18% (2/11), or both CTA/DUS examination in 36% (4/11). Restenosis occurred within 1 month in 54% (6/11) and 6 months in 72% (8/11) of patients. However, three of the six patients with restenosis within 1 month had discordant findings on CTA vs DUS imaging. Patient comorbidities, degree of preoperative stenosis, medical management, balloon size, stent size, lesion characteristics, and predilatation angioplasty did not differ. Patients with restenosis were younger (P = .02), had prior ipsilateral endarterectomy (odds ratio [OR], 6.5; P = .02), had history of neck radiation (OR, 18.3; P = .01), and lower rate of postdilatation angioplasty (OR, 0.11; P = .04), without an increased risk of neurological events. CONCLUSIONS: Although post-TCAR restenosis occurred in 18% of patients, only 3% of patients had critical restenosis and required reintervention. Patient factors associated with restenosis were younger age, prior endarterectomy, and history of neck radiation. Although early restenosis may be mitigated by improved technique, the only technical factor associated with restenosis was less use of postdilatation angioplasty. Balancing neurological risk, this factor may have increased application in appropriate patients. Diagnosis of restenosis was inconsistent between imaging modalities; current surveillance paradigms and diagnostic thresholds may warrant reconsideration.

Taxonomic Revision, Morphology and Natural History of the Stick Insect Genus Xerosoma Serville, 1831 (Insecta: Phasmatodea).

Stick insects (Phasmatodea) are quite diverse in the Neotropical region. Among them, Xerosoma Serville belongs to Pseudophasmatidae and comprises winged, roughly brownish phasmids that resemble bark or dry branches and inhabit the Atlantic Forest in Brazil. In this study, we present a redescription and revision of the genus that include three valid species, Xerosoma canaliculatum, Xerosoma michaelis, and Xerosoma nannospinus sp. nov. Xerosoma senticosum syn. nov. was found to be a junior synonym of X. canaliculatum. We also provide an identification key and geographic records for these three species. Additionally, we present a detailed study on the morphology and natural history of X. canaliculatum with the description of its nymphal stages, egg, male genitalia, ontogeny, oviposition method, life habits, defense mechanisms, mating behavior, and other aspects regarding its biology. The study also highlights the shortcomings related to the classification of Xerosomatinae, since its tribes find themselves without proper characterization and contain heterogeneous genera. We expect to provide a basis for a proper diagnosis of Xerosomatinae and encourage future studies on this group, as there is still much to be discovered about this lineage of Neotropical stick insects.

Serum Neurofilament Light Chain in the Diagnostic Evaluation of Patients with Cognitive Symptoms in the Neurological Consultation of a Tertiary Center.

Serum light-chain neurofilaments (sNfL) have been investigated as a potential minimally invasive biomarker that could help in the diagnosis of patients with cognitive symptoms. We assessed the correlation between sNfL and cerebrospinal fluid (CSF) biomarkers (sNfL versus CSF NfL, ρ= 0.70, p < 0.001), the performance of sNfL in distinguishing controls from patients (controls versus frontotemporal dementia, area under curve 0.86), and sNfL differences in mild cognitive impairment according to amyloid-ß (Aß) deposition (Aß versus non-Aß, p = 0.017). Our results support the role of this biomarker in the screening and risk stratification of patients followed in a neurological consultation of a tertiary center.

Acute Cocaine Intoxication: An Approach to Severe Hepatic and Renal Dysfunctions.

Cocaine is a highly addictive substance. Its poisoning can lead to potentially fatal multi-organ dysfunction. We report a case of cocaine overdose with severe multi-organ dysfunction. A healthy 51-year-old man was admitted to the emergency room due to behaviour changes and seizure after inhaling crack. Multiple dysfunctions were developed, with emphasis on liver and kidney dysfunction, due to their severity. The patient had marked hepatic cytolysis with a peak on the third day with alanine aminotransferase (ALT) and aspartate aminotransferase (AST): 7941 and 4453 IU/L, respectively with mild coagulopathy and hyperbilirubinemia. Underwent empirical treatment with acetylcysteine ​​with good clinical response. Also developed anuric AKIN3 acute kidney injury secondary to rhabdomyolysis, requiring treatment with intermittent haemodialysis. The approach to a case with severe multiorgan dysfunction is described, with special emphasis on the use of acetylcysteine. The good evolution of the patient can corroborate the use of this drug as a potential modifier of prognosis.

Levelling-up rhodolith-bed science to address global-scale conservation challenges.

Global marine conservation remains fractured by an imbalance in research efforts and policy actions, limiting progression towards sustainability. Rhodolith beds represent a prime example, as they have ecological importance on a global scale, provide a wealth of ecosystem functions and services, including biodiversity provision and potential climate change mitigation, but remain disproportionately understudied, compared to other coastal ecosystems (tropical coral reefs, kelp forests, mangroves, seagrasses). Although rhodolith beds have gained some recognition, as important and sensitive habitats at national/regional levels during the last decade, there is still a notable lack of information and, consequently, specific conservation efforts. We argue that the lack of information about these habitats, and the significant ecosystem services they provide, is hindering the development of effective conservation measures and limiting wider marine conservation success. This is becoming a pressing issue, considering the multiple severe pressures and threats these habitats are exposed to (e.g., pollution, fishing activities, climate change), which may lead to an erosion of their ecological function and ecosystem services. By synthesizing the current knowledge, we provide arguments to highlight the importance and urgency of levelling-up research efforts focused on rhodolith beds, combating rhodolith bed degradation and avoiding the loss of associated biodiversity, thus ensuring the sustainability of future conservation programs.

Idiopathic acute exudative polymorphous vitelliform maculopathy: the importance of multimodal imaging, systemic workup and genetic testing.

The authors describe a case of acute exudative polymorphous vitelliform maculopathy (AEPVM) in an otherwise healthy man in his 60s complaining of subacute bilateral blurred vision. At examination, best-corrected visual acuity was 20/32 in the right eye and 20/40 in the left eye. Bilateral central large serous detachments with inferior meniscus-like deposition of a vitelliform-like material were observed at funduscopy and confirmed by spectral-domain optical coherence tomography. Small vitelliform-like lesions along the temporal superior vascular arcades were also seen. The lesions with vitelliform appearance appeared hyperautofluorescent on fundus autofluorescence. A complete systemic workup and genetic testing were performed and the diagnosis of idiopathic AEPVM was established. Six months later, a complete resolution of the lesions was observed.

Emergence Response of Telenomus podisi (Hymenoptera: Scelionidae) to Field Temperature Originated from Colonies Reared at Different Temperature Regimes.

We studied the impact of field temperature on the emergence of Telenomus podisi Ashmead (Hymenoptera: Scelionidae) after being released as either protected (encapsulated) or unprotected pupae close to adult emergence. Two independent bioassays (protected pupae vs. unprotected pupae) were carried out in a randomized block experimental design in a 2 (parasitoid rearing temperature regimes) ×4 (release positions within plant canopy) factorial scheme. One of the T. podisi colonies was reared at a constant temperature (25 °C) and 12:12 h L:D (Light: Dark) photoperiod. The second T. podisi colony was reared at fluctuating temperatures (20 °C during 12 h D and 30 °C during 12 h of L). Each bioassay had five replicates. Each replicate contained 40 pupae from each rearing temperature and release position within plant canopy. Parasitoid pupae were released in the bottom third, middle third, or upper third of the plant's canopy, as well as between planting lines. Each bioassay was repeated six times (in different plant developmental stages: R1, R2, R3, R4, R5 and R6). There was no difference in emergence of parasitoids between colonies reared at different temperatures after exposure to field conditions. Emergence of T. podisi was reduced after pupae exposure to temperatures above 35 °C in the field, regardless of the rearing temperature. Telenomus podisi tolerates temperature fluctuations for emergence as long as they fit the optimal range (20 to 30 °C).

[Evaluation of the Knowledge of Women of Childbearing Age with Epilepsy about the Impact of Their Disease in Contraception, Pregnancy and Breastfeeding: A Multicenter Cross-Sectional Study]. / Avaliação do Conhecimento das Mulheres com Epilepsia em Idade Fértil sobre o Impacto da sua Doença na Contraceção, Gravidez e Amamentação: Um Estudo Transversal Multicêntrico.

INTRODUCTION: The interaction of antiseizure medication with contraceptives, its potential teratogenicity and implications in pregnancy and breastfeeding are aspects to consider in the neurological care of women with epilepsy of childbearing age. To ensure the commitment in therapeutic decisions and the appropriate planning of maternity, it is essential that women are informed about the implications of their disease in these domains. The main aim of this study was to assess the knowledge of women of childbearing age with epilepsy concerning the impact of epilepsy in contraception, pregnancy and breastfeeding. As secondary aims we defined (1) the demographic, clinical and therapeutic characterization of this group of patients, (2) the identification of variables that correlated with the level of knowledge of women with epilepsy, and (3) the identification of preferential methods to acquire new knowledge about epilepsy. MATERIAL AND METHODS: The study was observational, cross-sectional and multicentric, and was carried out in five hospitals of the Lisbon metropolitan area. After identifying all women of childbearing age with epilepsy followed in the epilepsy clinic of each center, we applied an electronic questionnaire based on a non-systematic review of the literature. RESULTS: One hundred and fourteen participants were validated, with a median age of 33 years. Half of the participants were on monotherapy, and the majority had no seizures in the last six months. We identified important gaps in the participants' knowledge. Sections about complications and administration of antiseizure medication during pregnancy were the ones with the worst results. None of the clinical and demographic variables correlated with the final questionnaire score. Having had a previous pregnancy and the desire to breastfeed in a future pregnancy were positively correlated with the performance in breastfeeding section. Face-to-face discussion during medical outpatient visits was selected as the preferential method to learn about epilepsy, and the internet and social media were the least preferred ones. CONCLUSION: The knowledge of women of childbearing age with epilepsy in the Lisbon metropolitan area concerning the impact of epilepsy in contraception, pregnancy and breastfeeding seems to have significant gaps. Medical teams should consider engaging in patient education particularly during outpatient clinics.

Introdução: A interação dos fármacos anticrise epilética com os métodos contracetivos, a sua potencial teratogenicidade e as implicações na gravidez e amamentação são aspetos a considerar no acompanhamento de mulheres com epilepsia em idade fértil. Para o seu desejado envolvimento nas decisões terapêuticas e o adequado planeamento da maternidade, é essencial que as mulheres estejam corretamente informadas acerca das implicações da sua doença. O objetivo principal do presente estudo foi avaliar o conhecimento das mulheres com epilepsia em idade fértil sobre o impacto da epilepsia na contraceção, gravidez e amamentação. Como objetivos secundários definiram-se (1) a caracterização demográfica, clínica e terapêutica deste grupo de doentes, (2) a identificação de variáveis correlacionadas com o nível de conhecimento das mulheres com epilepsia, e (3) a identificação de meios e suportes preferenciais para aquisição de novos conhecimentos sobre epilepsia. Material e Métodos: O estudo foi observacional, transversal e multicêntrico, tendo decorrido em cinco centros hospitalares da região metropolitana de Lisboa. Após identificação das mulheres com epilepsia em idade fértil seguidas na Consulta de Epilepsia de cada centro, aplicou-se um questionário eletrónico construído após revisão não sistemática da literatura. Resultados: Foram validadas 114 participantes, com uma idade mediana de 33 anos. Metade das participantes apresentavam-se sob monoterapia, tendo a maioria a epilepsia controlada há pelo menos seis meses. Identificaram-se importantes lacunas no conhecimento das participantes. Conceitos sobre complicações dos fármacos anticrise epilética e a sua administração durante a gravidez motivaram piores resultados. Não houve correlação entre variáveis clinico-demográficas e o resultado no questionário. A ocorrência de gravidez prévia e o desejo de amamentar numa gravidez futura correlacionaram-se com o desempenho na secção sobre amamentação. A discussão oral na consulta foi a forma preferencial para aquisição de novos conhecimentos sobre epilepsia, tendo a internet e as redes sociais sido os meios menos escolhidos. Conclusão: O conhecimento das mulheres com epilepsia em idade fértil na área metropolitana de Lisboa sobre o impacto da sua doença na contraceção, gravidez e amamentação parece apresentar lacunas importantes. A educação para a saúde deste grupo deverá constituir uma preocupação por parte das equipas médicas, devendo privilegiar-se a consulta como local de ensino.

Atherectomy to treat femoropopliteal atherosclerotic disease.

Atherectomy as an endovascular modality to treat peripheral arterial disease has gained traction over the past 10 years. Unlike most other available technologies, atherectomy works by physically debulking atherosclerotic plaque via a variety of mechanisms being the femoropopliteal segment the most targeted one. The aims of this review were to detail the types of atherectomy available, existing evidence available for atherectomy use in the femoropopliteal segment as compared to other interventions, critical appraisal of its current use and the possible influences on its indication. Future steps regarding atherectomy usage and data presentation are also described.

Angiopathy and Stroke Associated with Homocystinuria in Childhood.

A previously healthy 13 year-old boy presented with acute-onset headaches, aphasia and right-sided hemiparesis. Imaging showed cerebral ischemic infarction due to bilateral carotid occlusion, and investigation for stroke etiology diagnosed homocystinuria. Homocystinuria is an autosomal recessive condition that affects the metabolism of the amino acid methionine due to an enzyme deficiency. This disorder involves multiple organs systems, and complications include thromboembolic events, ectopia lentis, mental retardation, and skeletal abnormalities. The early diagnosis and treatment of hyperhomocystinemia can significantly improve outcomes. Therefore, metabolic screening for homocystinuria is strongly recommended for children presenting with stroke.

Is preoperative fat infiltration in lumbar spine muscles associated with worse clinical outcomes after lumbar interbody fusion?

PURPOSE: Lumbar musculature has a fundamental role in spine stability and spinal balance. Muscle atrophy and fat infiltration play an important role in pain pathophysiology. Accordingly, the preoperative condition of lumbar muscles may influence clinical outcomes after surgical treatment. In this context, the aim of this study was to evaluate the association between preoperative lumbar paravertebral muscle fat infiltration and clinical outcomes after lumbar interbody fusion. METHODS: A retrospective study of patients with lumbar pathology submitted to lumbar transforaminal (TLIF) or posterior interbody fusion (PLIF) was performed, with a minimum of two years of follow-up. Preoperative lumbar magnetic resonance imaging (MRI) images were classified for fat infiltration in lumbar multifidus muscle and correlated with clinical outcomes. RESULTS: Seventy-five patients were included: 24 submitted to PLIF and 51 to TLIF. Most patients underwent surgery for spondylolisthesis (67%). Higher degrees of fat infiltration were associated with more advanced age (54.8 vs. 49.1 years old, p = 0.04) and more leg pain after surgery (p = 0.04). No statistically significant differences in other clinical outcomes such as Oswestry Disability Index, visual analogue scale for back and leg pain, self-reported back pain relief, return to work and overall satisfaction were found between different groups of fat infiltration. The improvement in leg pain was associated with improvement in self-reported lumbar pain (p < 0.001). CONCLUSION: Age and preoperative degree of fat infiltration may be important to predict improvement in leg pain after lumbar interbody fusion. The absence of solid literature on this topic and universal assessment methodologies reinforce the need for further studies.

O papel de cartas pessoais na saúde mental de idosos em instituições asilares no contexto pandêmico de COVID-19

O contexto de pandemia do vírus Sars-Cov-2 contribuiu para a diminuição significativa do contato dos idosos com seus companheiros e familiares, além de desencadear sentimentos de vulnerabilidade e solidão. Além disso, o olhar sensível às subjetividades e demandas individuais deve ser continuamente estimulado durante todo o processo de educação médica, de modo a promover uma formação profissional mais sensível às necessidades do outro. Nesse sentido, a ação intitulada "Cartas aos Idosos" foi criada com o intuito de estabelecer uma comunicação entre idosos e estudantes por meio de cartas com conteúdo de afeto e suporte emocional. A ação "Cartas aos Idosos'', desenvolvida remotamente pela Federação Internacional das Associações de Estudantes de Medicina do Brasil (IFMSA Brazil) da Universidade Federal da Bahia, Campus Anísio Teixeira (UFBA-CAT), entre os meses de agosto e outubro, consistiu na escrita de cartas por estudantes de Medicina, de cunho pessoal, para idosos em situação asilar. O impacto da ação foi medido por meio de uma análise qualitativa dos envolvidos. A atividade foi bem-sucedida no que se refere ao acolhimento e ao amparo dos idosos envolvidos.

Halochromic Inks Applied on Cardboard for Food Spoilage Monitorization.

Control of food spoilage is a critical concern in the current world scenario, not only to ensure the quality and safety of food but also to avoid the generation of food waste. This paper evaluates a dual-sensor strategy using six different pH indicators stamped on cardboard for the detection of spoilage in three different foods: beef, salmon, and strawberries. After function validation and formulation optimizations in the laboratory, the halochromic sensors methyl orange and bromocresol purple 2% (w/v) were stamped on cardboard and, in contact with the previously mentioned foods, were able to produce an easily perceptible signal for spoilage by changing color. Additionally, when it comes to mechanical characterization the inks showed high abrasion (>100 cycles) and adhesion resistance (>91%).

Arcada coronária: raro padrão de anomalia coronariana - relato de caso / Coronary arcade: rare pattern of coronary anomaly - case report

INTRODUÇÂO: A arcada coronária é uma anomalia de "terminação" congênita rara das artérias coronárias, cuja incidência descrita é inferior a 0,1%. Pode ocorrer entre as artérias coronária direita (CD) e circunflexa (ACx) ou entre as artérias descendente anterior e descendente posterior. DESCRIÇÂO DO CASO: Paciente homem, 60 anos, com histórico prévio de obesidade, dislipidemia, HAS, IAM em 2010, tratado com stent farmacológico (DES) em terço distal da CD e relato de, em contexto de investigação de rotina, ter realizado Angiotomografia de Coronárias que demonstrava CD ocluída distal intrastent. Em fevereiro de 2022, evolui com quadro novo de dor precordial com irradiação à mandíbula aos esforços menores que os habituais, com a duração de uma semana. Procurou serviço de emergência, onde ECG não apresentou alterações isquêmicas agudas e troponina permaneceu negativa. Recebeu diagnóstico de Angina instável e foi encaminhado ao laboratório de hemodinâmica. Realizada coronariografia via artéria radial direita, sem intercorrências, que evidenciou ateromatose severa do terço proximal ao terço médio seguida de oclusão total de aspecto crônico intrastent no terço distal da CD. A coronária esquerda estava isenta de aterosclerose, mas observou-se comunicação de trajeto entre as artérias ACx e CD de aspecto não tortuoso e maior que 01 (um) mm de diâmetro, padrão diferente de circulações colaterais usuais e compatível com arcada coronária. A ventriculografia esquerda demonstrou função contrátil preservada. CONCLUSÂO: Ainda não há esclarecimento sobre a importância funcional desta rara anomalia, podendo tanto ser causa de isquemia por roubo de fluxo, como proteção em caso de lesão severa em uma das coronárias. Neste caso, devido à oclusão distal da CD protegida pela comunicação enviada pela ACx, optou-se por manutenção deste paciente em tratamento clínico otimizado. Em seguimento de 60(sessenta) dias, paciente evolui sem recorrência em dor torácica.