Immune thrombocytopenic purpura induced by intestinal tuberculosis in a liver transplant recipient

A variety of clinical manifestations are associated directly or indirectly with tuberculosis. Among them, haematological abnormalities can be found in both the pulmonary and extrapulmonary forms of the disease. We report a case of immune thrombocytopenic purpura (ITP) associated with intestinal tuberculosis in a liver transplant recipient. The initial management of thrombocytopenia, with steroids and intravenous immunoglobulin, was not successful, and the lack of tuberculosis symptoms hampered a proper diagnostic evaluation. After the diagnosis of intestinal tuberculosis and the initiation of specific treatment, a progressive increase in the platelet count was observed. The mechanism of ITP associated with tuberculosis has not yet been well elucidated, but this condition should be considered in cases of ITP that are unresponsive to steroids and intravenous immunoglobulin, especially in immunocompromised patients and those from endemic areas.     

Monte Carlo validation of the irradiator parameters of the Portuguese gamma irradiation facility after its replenishment

In December 2003 the irradiator of the Portuguese ⁶⁰Co irradiation facility, UTR, was replenished. Monte Carlo simulation studies were used to characterize the facility. Comparison of simulation results with experimental measurements were useful in estimating where the source elements were positioned and what the total activity was. For this purpose the MCNPX code was used. From the experimental point of view ionization chambers and PMMA dosemeters were used.The results indicate that the geometry of the irradiator used for simulation studies shows a shift on the vertical dimension relative to the actual geometry of approximately 8 cm, but with reduced influence on the irradiation process. Considering the uncertainties of the experimental and simulated approaches the activity of the irradiator stated by supplier has been confirmed.     

Additional cardiac investigation prior to the introduction of the CAD-RADS classification in coronary computed tomography angiography reports

Introduction

The CAD-RADS^TM classification was recently introduced in an attempt to standardize coronary computed tomography angiography (CCTA) reports and to provide recommendations for further management. The aim of this study was to assess how additional cardiac investigations were being ordered before the introduction of the CAD-RADS classification in a tertiary hospital's CCTA reports.

Impact of auditory feedback alterations in individuals with stuttering

IntroductionElectrophysiological evidence has reinforced the hypothesis that stuttering is associated with a deficit in modulation of the cortical auditory system during speech planning, contributing to an inefficient auditory feedback monitoring and, consequently, resulting in disfluencies.ObjectiveTo verify the impact of auditory feedback modifications on the spontaneous speech of individuals with stuttering.MethodsSixteen individuals, of both genders, aged 8–17 years and 11 months, with a diagnosis of persistent neurodevelopmental stuttering, were divided into two groups: Moderate Stuttering Group and Severe Stuttering Group. The testing procedures consisted of three stages: collection of identification data, audiological assessment and fluency evaluation of spontaneous speech in four auditory feedback conditions (non-altered, delayed, masked and amplified). The speech sample obtained in the non-altered feedback was considered the control; the others were considered as modified listening conditions.ResultsRegarding the stuttering-like disfluencies, a statistically significant difference was observed in the intragroup analysis of the Moderate Stuttering Group between non-altered and masked auditory feedback (p = 0.042), as well as between non-altered and amplified (p = 0.042). There was a statistically significant difference in the Severe Stuttering Group for all auditory feedback modifications in relation to the non-altered (delayed p = 0.012, masked p = 0.025 and amplified p = 0.042). There was also a reduction in flows of syllables and words-per-minute in the Moderate Stuttering Group for the delayed auditory feedback, as compared to non-altered (p = 0.017 and p = 0.025, respectively).ConclusionThe effect of delayed auditory feedback was favorable for the Severe Stuttering Group, promoting speech fluency. The conditions of masked and amplified auditory feedback resulted in speech benefits in both groups, decreasing the number of stuttering-like disfluencies. The speech rate was not impaired by any listening condition analyzed.     

The relationship between uric acid and brain health from observational studies

Metabolic Brain Disease - This study conducts a systematic literature review and meta-analysis regarding the potential influence of serum uric acid levels on cerebral small vessel diseases and the...