Hospital Estadual Centra

The diagnosis and treatment of leptospirosis in high-burden, low-resource settings pose a challenge due to the limited availability of confirmatory diagnostics. Therefore, the initiation of treatment relies primarily on the clinical assessment of patients suspected of having leptospirosis in resource-poor settings. This study aimed to both early diagnostic indicators and predictors of disease severity. A total of 170 patients suspected of having leptospirosis admitted to selected hospitals in Western Province, Sri Lanka were enrolled. MAT, qPCR, and culture were used for confirmatory diagnosis. Patients with confirmed leptospirosis were grouped as severe and non severe based on presenting with at least one organ failure and/or dysfunction. Out of 170 leptospirosis suspected patients, 79 (46.47%) were confirmed by PCR (n = 49), MAT (n = 44) and/or culture (n = 2). Myalgia, oliguria, elevated neutrophils, serum creatinine, serum urea, SGOT, SGPT and CRP, decreased lymphocytes, haemoglobin and platelets had a significant association with confirmed leptospirosis. Of patients with confirmed leptospirosis, 51 were categorized as non severe and 28 were categorized as severe. Leptospirosis severity was correlated with decreased haemoglobin, lymphocyte and platelet counts, and elevated WBC, neutrophil, K+, SGOT, SGPT, serum urea, serum creatinine, total and direct bilirubin and CRP. A bacterial load between 1.21 × 102 to 1.26 × 106 (median 3,326) Leptospira/ml was reported with no significant association between severity of the disease and leptospiraemia. Clinical and basic laboratory findings play a crucial role in supporting the diagnosis of leptospirosis and predicting disease severity, particularly in tropical, resource-poor settings.

Abstract Traumatic ear amputation secondary to human ear-bite is one of the common emergencies. If left untreated, it results in a deformity that causes social embarrassment and stigmatizes the victim. This case study documents primary ear reconstruction with “spare-part” amputated cartilage in a middle-aged, diabetic male after 24 hours of amputation. This reconstruction was performed using modified Mladick's Pocket technique in three stages over 90 days. There was complete cartilage take. Partial flap necrosis was managed conservatively. Over 18 months, the ear settled well and was nearly symmetrical to the opposite ear. There was a good skin match and minimal donor site morbidity. In favorable circumstances, primary non-microsurgical reconstruction using amputated cartilage of the ear in human bite is a feasible option even after 24 hours of amputation in patients with comorbidities. Primary ear reconstruction has the technical advantage of having unscarred tissues for repair.

ABSTRACT Purpose To investigate the effects of tobacco use, smoking duration, and number of cigarettes/day on the vocal dynamic field of male smokers. Methods A cross-sectional, comparative observational study was conducted with 62 men aged 18 to 59 years: 31 smokers (SG) and 31 non-smokers (NSG). Vocal dynamic field measurements were obtained using phonetography, which assesses frequency (minimum, maximum, and vocal range) and intensity (minimum, maximum, and maximum dynamic range). Comparisons between groups were made using the Student’s t-test, and correlations with smoking duration and number of cigarettes/day were analyzed using Pearson’s correlation test (5% significance level). Results Compared to the NSG, the SG showed significantly lower values (p < 0.05) for maximum frequency, vocal range, and maximum dynamic range, and higher values for minimum intensity. Increased smoking duration was associated with reductions in minimum and maximum frequencies, vocal range, and maximum intensity. Additionally, a higher number of cigarettes/day was correlated with lower minimum frequency. Conclusion The dynamic field of male smokers, compared to non-smokers, showed a reduction in the values of maximum frequency, vocal range and maximum dynamic range and an increase in minimum intensity. The longer the time of tobacco use, the lower the minimum and maximum frequencies, vocal range and maximum intensity. The greater the number of cigarettes/day, the lower the value of minimum frequency. Phonetography is an effective resource in voice assessments.

Este artigo apresenta resultados de um projeto realizado em parceria entre uma universidade e uma escola pública, que propõe oficinas de trabalho como forma de condução das aulas de matemática, articuladas a uma base teórica centrada nas obras de Gilles Deleuze. O projeto envolve professores da rede pública e visa contribuir para realçar a importância da estética (e da ética) em práticas pedagógicas criativas e afetivas, em contraposição ao ensino conteudista que privilegia a rigidez lógico-racional. O texto inclui a narrativa de uma professora de matemática da rede pública, bolsista do projeto, que relata seu processo criativo ao integrar arte, ciência e matemática, evidenciando uma experiência estética, compreendida como uma forma de conhecer e relacionar por meio da sensibilidade. O projeto mostra-se pertinente diante do aumento da violência escolar, ao fortalecer o sentimento de pertencimento e a qualidade da convivência no ambiente escolar.

Objetivo: Analisar o que tem sido publicado cientificamente sobre os aspectos relacionados ao uso do protocolo E-FAST por enfermeiros no departamento de emergência. Método: Revisão integrativa realizada nas bases PubMed, EMBASE, CINAHL, Scopus, SciELO, e LiLACS, no mês de agosto de 2025. Resultado: A seleção final foi de 4 artigos. Os estudos foram realizados entre os anos de 2009 e 2017, com predomínio dos Estados Unidos; foram classificados em sua totalidade em grau de evidência nível 3, 50% foram estudo prospectivos e 50% Revisões Sistemáticas. Conclusão: O protocolo E-FAST demonstrou ser uma ferramenta viável e eficiente nos departamentos de emergência, com destaque para sua utilização por enfermeiros de práticas avançadas em diferentes países. Apesar das limitações relacionadas ao número de publicações e nível de evidência dos estudos, destaca-se a capacitação profissional como fator contribuinte para otimizar seu uso. Reforça-se a necessidade de estudos metodologicamente robustos para ampliar a base de evidências e consolidar sua aplicação neste contexto.

Choroid plexus tumors (CPT), especially in pediatric patients, present a major surgical challenge due to their hypervascularity and frequent intraventricular location. Preoperative embolization has emerged as a strategy to minimize intraoperative blood loss and improve surgical outcomes, yet its application in large-volume tumors via the anterior choroidal artery (AChA) remains limited. We report a case of a 10-month-old infant with a giant choroid plexus carcinoma (CPC) measuring 189cm³, treated with superselective embolization through the AChA using Squid™ prior to surgical resection. A systematic review was also conducted, including 9 studies on preoperative embolization via AChA for CPTs, with attention to technique, tumor volume, agents used, and outcomes. Microcatheterization beyond the plexal point of the AChA enabled safe delivery of the embolic agent, achieving substantial tumor devascularization without ischemic or hemorrhagic complications. Surgical resection was completed without intraoperative blood transfusion or neurological sequelae. The systematic review confirmed the rarity of embolization in tumors exceeding 100cm³, highlighting our case as one of the largest successfully treated using this approach. Superselective preoperative embolization of choroid plexus tumors via the anterior choroidal artery is technically feasible and safe when performed beyond the plexal point. In high-risk pediatric cases with large-volume tumors, this strategy can significantly improve surgical safety and should be considered as part of a multimodal treatment approach.

Relato de Caso: Caso 1, Homem 38 anos, com diagnóstico de diabetes tipo MODY há 22 anos, desconhecia doença renal, em uso de metformina 1,7g/dia e glibenclamida 10mg/dia. Admitido em pronto socorro com quadro de náuseas, vômitos, fadiga e dispneia. Ao exame, PA 100x60 mmHg, glicemia capilar 48 mg/dL, FC 112 bpm, FR 38 irpm. Laboratoriais: Ur 267 mg/dL, Cr 9,4 mg/dL, Na 144 mEq/L, K 6,3 mEq/L, pH 6,82, HCO3 1,9, BE -30,6. AG calculado 38,4. Lactato 22,3 mmol/L (VR 0,9-1,7). Iniciou hemodiálise (HD), evoluindo para doença renal crônica em programada de HD ambulatorial. Caso 2, Mulher, 43 anos, hipertensa, diabética tipo 2, com DRC G5 encaminhada da UPA com quadro de diarreia, inapetência e astenia, evoluindo com hipoglicemia refratária e RNC. Fazia uso de metformina 3g/dia, empaglifozina 25mg e linagliptina 5mg. Admitida em VM e com choque em uso de DVA em altas doses. Laboratoriais: Ur 243 mg/dL, Cr 11 mg/dL, K 8,2 mEq/L, Na 149 mEq/L, pH 6,98, HCO3 4,2, BE -26. Lac 30,9 mmol/L. AG: 46. Iniciou TRS continua, após 24 horas evoluiu com anisocoria, realizada TC de crânio com extensa lesão expansiva hemática com isquemia contralateral, constatada morte encefálica. Caso 3, Homem 63 anos, com diagnóstico de diabetes tipo 2 e transtorno depressivo, encontrado desacordado em casa e com 04 cartelas de metformina (28 comprimidos) vazias. Admitido no pronto socorro já intubado pelo SAMU, com hipoglicemia e choque com baixa dose de DVA. Laboratoriais: Ur 214 mg/dL; Cr 7,6 mg/dL; Na 142 mEq/L, K 5,5 meq/L, pH 6,9; HCO3 2,4; BE -32. Lac 22,8. AG 29. Iniciou HD intermitente, com necessidade de 05 sessões de hemodiálise, com melhora do quadro e recuperação de função renal. Recebe alta sem necessidade de diálise, com Cr 1,3 mg/dL. Discussão: A acidose lática associada à metformina (MALA) é uma condição rara, mas potencialmente fatal, causada por elevadas concentrações plasmáticas de metformina. A diálise, apesar de não ser indicada em todos os casos, pode contribuir significativamente para o tratamento e melhoria do prognóstico em situações graves. O prognóstico depende das comorbidades, do mecanismo subjacente e do tratamento precoce. finais: A acidose lática associada à metformina, apesar de não ser uma causa frequente de internação apresenta uma elevada taxa de mortalidade. É imprescindível a utilização criteriosa de metformina, principalmente no doente renal crônico ou quando existem comorbidades que predisponham à acidose lática.

Abstract Background: Mycotic aneurysms (MAs) are rare, life-threatening vascular complications of systemic infections that are most commonly associated with endocarditis. While the majority of research has focused on ruptured MAs, the role of endovascular treatment (EVT) in managing unruptured cases remains unclear. Given the limited availability of data specific to unruptured MAs, we conducted a systematic review and meta-analysis to evaluate the outcomes of EVT in this subgroup, with a focus on technical success, follow-up occlusion, complications, functional outcomes, and mortality. Methods: A comprehensive literature search was conducted in PubMed, EMBASE, and Web of Science to identify studies reporting outcomes of EVT in unruptured MAs. Screening and full-text review were performed via Rayyan AI, and data extraction was conducted via Microsoft Excel. We included studies that explicitly reported outcomes for unruptured cases, and a proportional meta-analysis was performed via a random-effects model in R 4.4.2, with publication bias assessed via a funnel plot. Results: A total of eight studies with 43 unruptured mycotic aneurysms met the inclusion criteria. EVT demonstrated excellent procedural success, whereas endovascular procedures achieved universal technical success and complete occlusion at follow-up (both 100%; 95% CI: 95–100%). Complications were rare, occurring in only 4% of the patients (95% CI: 0–17%). The functional outcomes were favorable, with 90% of patients achieving mRS 0 or GOS 5 at follow-up (95% CI: 74–100%), indicating a high likelihood of preserved neurological function posttreatment. No mortality was reported among the unruptured patients (0%, 95% CI: 0–13%), further supporting the safety profile of EVT in this patient population. Conclusion: EVT appears to be a safe and effective treatment for unruptured mycotic aneurysms, with high technical and angiographic success rates, low complication rates, and favorable functional outcomes. However, data on unruptured cases remain scarce, as most of the available literature has focused primarily on ruptured MAs. This underscores the need for larger studies and prospective data collection to better define the role of EVT in managing these rare lesions.