Vasculitis, a Rare Presentation of a Post-Streptococcal Syndrome

Post-streptococcal vasculitis is not awell-recognized non-suppurative complication of Group A streptococcal infections. Seventeen-year-old male was admitted with palpable purpura in the limbs, ankle swelling, microscopic hematuria and elevated inflammation markers. After short remission period, an extensive exudative pleural effusion was identified. High anti-streptococcal antibodies titers were found. This report illustrates an atypical and rare presentation of a post-streptococcal syndrome.

TAFRO Syndrome in a Patient of South-American Descent

A 31-year-old Caucasian woman of South-American descent was diagnosed with a variant of multicentric Castleman disease (MCD) that has been reported in Japan as Castleman-Kojima disease. This is a systemic inflammatory disorder known as TAFRO Syndrome which includes thrombocytopenia, polyserositis (ascites/pleural effusion), microcytic anemia, myelofibrosis, fever, renal dysfunction and organomegaly, with immunologic disorder, polyclonal hypergammaglobulinemia, and elevated levels of interleukin-6 (IL-6) and the vascular endothelial growth factor present in serum and/or effusions. Optimal therapies are not well established. The patient was treated with methylprednisolone and rituximab. Following the start of treatment, the patient has been asymptomatic for over 8 months.

Acute Acalculous Cholecystitis as a Presenting Manifestation in Systemic Lupus Erythematosus

Systemic lupus erythematosus (SLE) is known to involve the gastrointestinal tract, but gallbladder involvement is rare. The authors report the case of a 26-year-old postpartum female who presented with acute right upper quadrant abdominal pain and was diagnosed with acute acalculous cholecystitis (AAC). In the presence of concomitant features of nephritis, pericardial effusion, anaemia and positive ANA titre, the diagnosis of SLE was confirmed during hospitalisation. Histopathological analysis of the gall bladder revealed evidence of vasculitis. Although rare, AAC can be the first presentation of patients diagnosed with SLE. Prompt diagnosis and management results in a better patient outcome.

Black Urine and Black Pleural Fluid: A Distinctive Presentation of Metastatic Melanoma

Metastatic melanoma is an uncommon clinical entity which can have an unusual presentation. We describe a patient with metastatic melanoma who presented with diffuse melanosis cutis, black urine and black pleural effusion. Very few medical conditions can cause black discoloration of body fluids, so this should prompt physicians to search for a number of potential underlying causes.

Preparo de amostras citológicas de efusões, lavados (broncoalveolar e peritoneal) e líquor pelo método “plasma-tromboplastina”

Dissertação (mestrado)—Universidade de Brasilia, Faculdade de Ciências da Saúde, Programa de Pós-Graduação em Ciências da Saúde, 2016.

The Role of Lung Ultrasound in Diagnosis of Respiratory Distress Syndrome in Newborn Infants

Background: Respiratory distress syndrome (RDS) is one of the most common causes of neonatal respiratory failure and mortality. The risk of developing RDS decreases with both increasing gestational age and birth weight. Objectives: The aim of this study was to evaluate the value of lung ultrasound in the diagnosis of respiratory distress syndrome (RDS) in newborn infants. Materials and Methods: From March 2012 to May 2013, 100 newborn infants were divided into two groups: RDS group (50 cases) and control group (50 cases). According to the findings of chest x-ray, there were 10 cases of grade II RDS, 15 grade III cases, and 25 grade IV cases in RDS group. Lung ultrasound was performed at bedside by a single expert. The ultrasound indexes observed in this study included pleural line, A-line, B-line, lung consolidation, air bronchograms, bilateral white lung, interstitial syndrome, lung sliding, lung pulse etc. Results: In all of the infants with RDS, lung ultrasound consistently showed generalized consolidation with air bronchograms, bilateral white lung or alveolar-interstitial syndrome, pleural line abnormalities, A-line disappearance, pleural effusion, lung pulse, etc. The simultaneous demonstration of lung consolidation, pleural line abnormalities and bilateral white lung, or lung consolidation, pleural line abnormalities and A-line disappearance co-exists with a sensitivity and specificity of 100%. Besides, the sensitivity was 80% and specificity 100% of lung pulse for the diagnosis of neonatal RDS. Conclusions: This study indicates that using an ultrasound to diagnose neonatal RDS is accurate and reliable too. A lung ultrasound has many advantages over other techniques. Ultrasound is non-ionizing, low-cost, easy to operate, and can be performed at bedside, making this technique ideal for use in NICU.

Estenosis esofágica. Aplicación de una técnica quirúrgica. Caso clínico

Se presenta el caso clínico de un paciente que presenta estenosis esofágica tras ingesta de caústicos, con disfagia a líquidos por lo que se realizó esofagectomía transhiatal con técnica de tubo gástrico como alternativa para reemplazo esofágico con ascenso mediastinal y yeyunostomía de alimentación, luego del procedimiento presenta fístula a nivel de la anastomosis proximal cervical y derrame pleural que se drena mediante avenamiento pleural bilateral, se maneja de manera conservadora sin desfuncionalización la fistula cervical mediante dren semirígido, con cierre espontaneo y se da de alta al paciente luego de tolerar dieta

CHARACTERIZING THE FIRST HISTORIC ERUPTION OF NABRO, ERITREA: INSIGHTS FROM THERMAL AND UV REMOTE SENSING

June 2011 saw the first historic eruption of Nabro volcano, one of an ongoing sequence of eruptions in the Afar-Red Sea region since 2005. It halted air travel in northern Africa, contaminated food and water sources, and displaced thousands from their homes. Due to its remote location, little was known about this event in terms of the quantity of erupted products and the timing and mechanisms of their emplacement. Geographic isolation, previous quiescence and regional civil unrest meant that this volcano was effectively unmonitored at the time of eruption, and opportunities for field study are limited. Using free, publicly available satellite data, I examined rates of lava effusion and SO2 emission in order to quantify the amount of erupted products and understand the temporal evolution of the eruption, as well as explore what information can be gleaned about eruption mechanisms using remote sensing data. These data revealed a bimodal eruption, beginning with explosive activity marked by high SO2 emission totalling 1824 - 2299 KT, and extensive ash fall of 270 - 440 km2. This gave way to a period of rapid effusion, producing a ~17 km long lava flow, and a volume of ~22.1 x 106 m3. Mass balance between the SO2 and lava flows reveals no sulfur 'excess', suggesting that nearly all of the degassed magma was extruded. The 2011 eruption of Nabro lasted nearly 6 weeks, and may be considered the second largest historic eruption in Africa. Work such as this highlights the importance of satellite remote sensing for studying and monitoring volcanoes, particularly those in remote regions that may be otherwise inaccessible.

Glue ear, hearing loss and IQ:an association moderated by the child's home environment

BACKGROUND: Glue ear or otitis media with effusion (OME) is common in children and may be associated with hearing loss (HL). For most children it has no long lasting effects on cognitive development but it is unclear whether there are subgroups at higher risk of sequelae. OBJECTIVES: To examine the association between a score comprising the number of times a child had OME and HL (OME/HL score) in the first four/five years of life and IQ at age 4 and 8. To examine whether any association between OME/HL and IQ is moderated by socioeconomic, child or family factors. METHODS: Prospective, longitudinal cohort study: the Avon Longitudinal Study of Parents and Children (ALSPAC). 1155 children tested using tympanometry on up to nine occasions and hearing for speech (word recognition) on up to three occasions between age 8 months and 5 years. An OME/HL score was created and associations with IQ at ages 4 and 8 were examined. Potential moderators included a measure of the child's cognitive stimulation at home (HOME score). RESULTS: For the whole sample at age 4 the group with the highest 10% OME/HL scores had performance IQ 5 points lower [95% CI -9, -1] and verbal IQ 6 points lower [95% CI -10, -3] than the unaffected group. By age 8 the evidence for group differences was weak. There were significant interactions between OME/HL and the HOME score: those with high OME/HL scores and low 18 month HOME scores had lower IQ at age 4 and 8 than those with high OME/HL scores and high HOME scores. Adjusted mean differences ranged from 5 to 8 IQ points at age 4 and 8. CONCLUSIONS: The cognitive development of children from homes with lower levels of cognitive stimulation is susceptible to the effects of glue ear and hearing loss.