Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo

Infectious keratitis remains a sight-threatening condition, yet its aetiological diagnosis is often hampered by low culture positivity, largely due to limited corneal scraping material. Identifying alternative, high-yield methods is crucial to optimise treatment protocols. This study evaluates the diagnostic performance of paediatric blood culture bottles (PBCB) compared with the conventional multi-sampled method. MALDI-TOF mass spectrometry (MS) was used as the standardised identification tool for isolates recovered using both approaches. This prospective study included patients with infectious keratitis at a tertiary referral centre (2019-2023). Corneal scrapings were cultured using PBCB and, in parallel, using a conventional multi-sampled approach (thioglycolate broth, brain heart infusion broth with antibiotics, blood agar, chocolate agar, Sabouraud dextrose agar). Pathogens were identified by MALDI-TOF MS. Diagnostic agreement between methods was assessed using Cohen's kappa with 95% confidence intervals. Among 150 corneal scrapings, the overall culture positivity was 49.3%. PBCB yielded positive cultures in 41.3% (62/150) of cases, comparable to the multi-sampled approach (43.3%; 65/150). Pseudomonas aeruginosa was the most frequently isolated pathogen in both methods (22.9% vs 20.8%). Diagnostic agreement between the two techniques was substantial (kappa = 0.69; 95% CI: 0.57-0.80). Of note, the conventional method detected fungal pathogens in some cases where PBCB were negative. PBCB represents an effective diagnostic alternative for bacterial keratitis, performing comparably to conventional multi-sampling. Although standard techniques remain necessary for fungal detection, PBCB offers practical advantages, particularly in small-volume samples. Its use may reduce the number of corneal scrapings required, contributing to a safer diagnostic approach.

Headache disorders are the leading cause of neurological disability globally, yet their management remains marked by profound inequities in access to diagnosis, evidence-based treatment, specialist care, and policy prioritization. This review examines current regional disparities in headache care delivery and highlights emerging system-level approaches aimed at reducing the global treatment gap. High-income regions in Western and Northern Europe, East Asia, and North America have developed advanced care models but continue to face inequities related to socioeconomic gradients, insurance coverage, and fragmented care pathways. In contrast, Eastern Europe, South and Central Asia, Latin America, and much of Africa experience substantial limitations in workforce capacity, diagnostic infrastructure, and medication availability, with population-based surveys indicating high prevalence but minimal health-system readiness. Transitional health systems, including Türkiye and the MENA region, demonstrate increasing awareness and partial integration of structured headache pathways, though coverage remains insufficient. Across regions, telemedicine, digital health tools, community-based initiatives, and workplace programs have shown promise in expanding access, reducing stigma, and improving continuity of care, while reinforcing the central role of primary care. Collectively, these developments signal a shift toward more coordinated and equity-oriented headache service models. Sustainable progress will require strengthened global collaboration, integration of AI-supported decision tools, expansion of cross-border registries and real-world data platforms, and the systematic inclusion of headache disorders within national noncommunicable disease frameworks to ensure high-quality care across diverse populations.

The pulmonary renin-angiotensin system (RAS) is a key regulator of endothelial function, inflammation, and tissue remodeling. Emerging evidence indicates that both hypertension and biological sex shape lung RAS signaling by shifting the balance between the ACE/Ang II/AT1R and ACE2/Ang-(1–7)/Mas pathways. This imbalance promotes oxidative stress, inflammatory activation, and fibrotic remodeling, increasing susceptibility to lung injury. Experimental and clinical data show that hypertension is associated with reduced pulmonary ACE2 activity and enhanced pro-inflammatory signaling, while sex-dependent differences further modulate lung RAS composition and disease vulnerability. These mechanisms may predispose the lungs to exaggerated responses to secondary insults, including acute lung injury, respiratory distress syndromes, and viral infections such as COVID-19. This mini-review summarizes current evidence linking hypertension- and sex-dependent lung RAS dysregulation to pulmonary injury and highlights therapeutic strategies aimed at restoring local RAS balance.

Computed tomography angiography (CTA) is the reference standard for comprehensive evaluation of the native aorta, providing simultaneous assessment of luminal, mural, and perivascular structures within a single rapid acquisition. Accurate diagnosis and appropriate management increasingly depend on standardized terminology, consistent anatomic segmentation, and reproducible measurement techniques. This review presents a practical framework for systematic interpretation of adult aortic CTA. Key aspects include detailed anatomic considerations, standardized measurement principles, contemporary acquisition protocols, and structured reporting strategies. The imaging spectrum of the main aortic disease categories-degenerative, congenital, and inflammatory-is reviewed, with emphasis on atherosclerosis, acute aortic syndromes, aneurysmal disease, coarctation, Kommerell diverticulum, and large-vessel vasculitis. Particular attention is given to morphologic patterns, prognostic imaging features, and common diagnostic pitfalls, as well as to terminology that more accurately reflects underlying pathophysiology. By integrating technical recommendations with disease-specific imaging criteria, this review aims to improve diagnostic precision, facilitate longitudinal follow-up, and enhance multidisciplinary communication. A structured approach to aortic CTA interpretation reinforces the central role of radiology in clinical decision-making and risk stratification in patients with aortic disease.

A child was born with duplication of the right upper limb, including 2 humeri, radii, and a mirror hand. The child also had multiple cardiac anomalies that required early surgeries. Surgical removal of the supernumerary limb was successfully performed without complications. Due to the rarity of polymelia, this case highlights the importance of individualized and multidisciplinary approaches. It also emphasizes the role of detailed surgical planning, continuous follow-up, and psychological support in optimizing outcomes and quality of life.

Transcranial US is a noninvasive, portable, real-time imaging technique that enables targeted evaluation of the intracranial circulation and select brain parenchymal structures through cranial bone windows. Traditionally, transcranial Doppler (TCD) has been used in well-established clinical scenarios, including vasospasm monitoring, stroke risk assessment, and ancillary testing for brain death. TCD encompasses two main techniques: nonimaging TCD (niTCD) and TCD imaging (TCDi). niTCD is a "blind" US technique that relies on standardized depths for vessel localization, guided by characteristic flow waveforms. In contrast, TCDi is a triplex approach that integrates gray-scale (B-mode) US, color Doppler US, and spectral Doppler US into an image-guided examination, enabling direct visualization of the intracranial anatomy and improving diagnostic confidence and reproducibility. In parallel, transcranial B-mode sonography (TCS), incorporated into modern TCDi, has demonstrated promising applications in adult patients, both in the neurointensive care unit and in outpatient practice. In addition, contrast-enhanced US (CEUS) has emerged as a powerful adjunct, markedly enhancing the Doppler signal in patients with poor bone windows, and has expanded the scope of transcranial US toward new exploratory vascular and cerebral perfusion applications. This article provides a comprehensive update on transcranial US in adults, including gray-scale imaging, Doppler techniques, and CEUS applications. With a focus on evidence-based indications and practical techniques, this article aims to support broader awareness and clinical adoption of transcranial US in contemporary adult neuroimaging, with a particular emphasis on TCDi, which remains underrecognized and underused despite its demonstrated clinical value in select indications. © The Author(s) 2026. Published by the Radiological Society of North America under a CC BY 4.0 license.

Maternal mortality in Brazil remains elevated despite local initiatives. The TeleICU Obstetric (TIO) project was created to assist intensive care units in reference obstetric hospitals. 25 Brazilian hospitals were selected by the Ministry of Health for the TIO programme, running from April 2022 to May 2024. The programme included teletraining for multidisciplinary teams, teleinterconsultations with specialists and monitoring of maternal health indicators. Training modalities included asynchronous, synchronous and in loco formats. Teleinterconsultations were conducted between hospital professionals and the obstetrics team and intensivists from Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, available 7 days a week. The maternal mortality ratio (MMR) was calculated for the 6 months prior to the project (baseline) and for the 7 months following its implementation. Median project participation was 7 (6-10) months. Training was completed by 564 professionals (asynchronous), 1707 (synchronous) and 831 (in loco), with a Net Promoter Score of 85 (81-92), 100 (93-100) and 95 (92-100), respectively. Teleinterconsultations assisted 1351 patients across 4556 sessions. 16 hospitals provided full data for analysis. MMR reduced significantly by 45% (p<0.05), from 190 (63-346) pre-intervention to 104 (55-213) during implementation. The TIO project is feasible and scalable for other economically disadvantaged countries facing similar challenges to reducing maternal mortality.

Cerebrotendinous xanthomatosis (CTX) is a rare autosomal recessive disorder caused by variants in the CYP27A1 gene, resulting in cholestanol accumulation in various tissues, including peripheral nerves. Polyneuropathy is common but often under-recognized in CTX. This study aimed to evaluate the cross-sectional area (CSA) of peripheral nerves in CTX. Six genetically confirmed CTX patients underwent clinical, electrophysiological, and ultrasonographic evaluations. Clinical severity was assessed using the Scale for the Assessment and Rating of Ataxia (SARA) and the Polyneuropathy Disability (PND) score. Nerve ultrasound was performed at standardized sites of the median, ulnar, tibial, and sural nerves, and at the supraclavicular brachial plexus. CSA values were compared with healthy controls. Nerve conduction studies (NCS) identified demyelinating polyneuropathy in three patients. However, ultrasound showed nerve enlargement in all six, including those with normal NCS. The supraclavicular brachial plexus was enlarged in every patient. In 5 adult patients, enlargement was most consistently observed in the median nerve (4 at the wrist and forearm; 5 at the cubital fossa and upper arm), the ulnar nerve at the upper arm (5), and the fibular nerve at the fibular head (4). This study demonstrates that nerve ultrasound can detect peripheral nerve enlargement in CTX, even in preclinical stages of polyneuropathy. Enlargement of peripheral nerves may be a sensitive marker of disease severity and peripheral nerve involvement. The role of nerve ultrasound as a diagnostic tool in CTX is promising, and future longitudinal studies are needed to determine its value in disease monitoring.