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Open Journal of Respiratory Diseases 2016年第2期6卷 35-40页

作者： Vera Clérigo lígia fernandes Tiago Abreu Pedro Barradas Oncologic Pulmonology Department Hospital Pulido Valente Centro Hospitalar Lisboa Norte Lisboa Portugal

Pulmonary mucormycosis is an emergent and life-threatening invasive fungal infection underdiagnosed by clinicians due to unspecific clinical picture and lack of awareness. Although the acknowledgment of risk factors, clinical and radiological findings may increase early recognition, the definite diagnosis is challenging to establish and the ideal treatment has never been delineated. The authors describe a rare case of pulmonary mucormycosis that was successfully treated with dual antifungal treatment and surgery in a patient with uncontrolled diabetes. When last evaluated, he was asymptomatic with no evidence of relapse. To our knowledge this is a rare report of a successfully treated diabetic patient with pulmonary mucormycosis with l-AmB, triazole posaconazole and surgery with no evidence of recurrence. We highlight the importance of clinicians’ awareness to early diagnosis, combined antifungal treatment and adjuvant surgery as the greatest chance of cure of a rapidly progressive disease with high mortality and morbidity.

关键词： Pulmonary Mucormycosis Diabetes High Mortality

Gangrenous Cholecystitis with Atypical Presentation in an Elderly Diabetic Woman

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Case Reports in Clinical Medicine 2014年第9期3卷 503-507页

作者： Vera Clerigo Cláudia Rocha Andre Rodrigues lígia fernandes Dora Sargento Gloria Silva Servico de Medicina III Hospital Pulido ValenteCentro Hospitalar Lisboa NorteLisboaPortugal

In elderly patients, numerous factors subsidize the diagnostic challenge and high incidence of complications in this specific population, taking gangrenous cholecystitis as a critical example. The aim of this work is to report an unusual case of gangrenous choleystitis in an elderly diabetic women and its atypical clinical presentation. A 79-year-old female patient came to our observation;her medical history showed nausea and vomiting of about 2 hours which rapidly ended with symptomatic therapy, without recurrence, and a 3-week history of intermittent fever associated with productive cough. No abdominal discomfort was declared. Physical examination of the abdomen was negative. laboratory analysis revealed leukocytosis with the remaining criteria within the normal range. After 2 days, she started with a mildabdominal pain in the epigastric region that rapidly progressed to the right upper quadrant, right flank and right iliac fossa, without nausea, vomiting or fever. Abdominal computer tomography findings revealed thickness of the gall-bladder and important densification of the vascular bed. Acute cholecystitis was diagnosed. The patient was then submitted to a laparoscopic cholecystectomy under general anaesthesia with findings suggestive of gangrenous acute cholecystitis confirmed by histologic examination of the specimen. Delays in diagnosing acute cholecystitis in specific populations, such as elderly diabetics, result in a higher prevalence of morbidity and mortality due to potentially serious complications as gangrenous cholecystitis. Consequently, the diagnosis should be measured and investigated promptly in order to prevent poor outcomes.

关键词： Diabetes Mellitus Elderly Gangrenous Acute Cholecystitis

Infective Endocarditis with Negative Cultures:A Defiant Diagnosis

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Case Reports in Clinical Medicine 2014年第8期3卷 460-464页

作者： Cláudia Rocha Vera Clérigo lígia fernandes Andre Rodrigues Dora Sargento Glória Silva Servico de Medicina III Hospital Pulido ValenteCentro Hospitalar Lisboa NorteLisboaPortugal

The diagnosis and management of blood culture-negative endocarditis constitute a real clinical challenge and a systemic approach is necessary for a successful outcome. The authors report a case of a female patient aged 26, with previous clinical history of valve disease and heart failure NYHA class II, with decompensation of co-morbidities associated with fever, productive cough, nonselective anorexia and unquantified weight loss with one month of evolution with negative blood cultures. Transesophageal echocardiography revealed the presence of severe pulmonary hypertension and mitral valve vegetations in the context of positive serology for Q fever. Herein, the authors report a case of blood culture-negative endocarditis and present a brief review on the management of this medical condition. We highlighted the diagnostic difficulties of blood culture-negative endocarditis and subacute clinical presentation, which sometimes present with fever of unknown origin and complaints of deterioration of cardiac function, thus creating a challenging differential diagnosis.

关键词： Coxiella burnetii Endocarditis Blood Culture-Negative Endocarditis

Swimming Heart: A Pleural, Pulmonary and Pericardial Disseminated Thymoma

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Open Journal of Clinical Diagnostics 2014年第4期4卷 212-216页

作者： lígia fernandes André Rodrigues Vera Clérigo Cláudia Rocha Dora Sargento Glória Silva Servico de Medicina III Hospital Pulido Valente Centro Hospitalar Lisboa Norte Lisboa Portugal

Thymoma is the most common neoplasm of the anterior mediastinum and accounts for one quarter of all mediastinal tumours and half of all anterior mediastinal masses. Pericardial effusion may be present in approximately 20% of cases. This report presents a patient with a previously diagnosed thymoma without surgical indication and with poor response to chemotherapy and radiotherapy who had a pericardial effusion that likely resulted from the malignancy dissemination to pericardium.

关键词： Thymoma Metastases Pericardial Effusion Myasthenia Gravis

A Rare Case of Diaphragmatic Mass: The Key to Diagnosis of a lung Adenocarcinoma

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Advances in lung Cancer 2014年第3期3卷 62-65页

作者： Cláudia Rocha Vera Clérigo lígia fernandes André Rodrigues Dora Sargento Glória Silva Servico de Medicina III Hospital Pulido Valente Centro Hospitalar Lisboa Norte Lisboa Portugal

lung cancer is a leading cause of death due to malignancy worldwide. Diaphragmatic metastasis secondary to primary lung cancer is rare. In the literature, only a few cases have been described as the majority of cases of diaphragmatic metastasis which are secondary to gastrointestinal neoplasia. The authors report a rare case of diaphragmmatic metastasis from a primary adenocarcinoma of the lung in a 76-year-old female patient with no history of active or passive smoking with progressive worsening fatigue, asthenia, malaise, and unquantified weight loss with three months of evolution, associated with pleuritic chest pain and edema of the lower limbs for fifteen days previous to hospital admission. Chest X-ray showed elevation of the right hemi-diaphragm and thoracic-abdominal-pelvic computed tomography revealed a complex multilobuled mass with neoformative characteristics intersecting the diaphragm and invading the dome liver and the right lung region. Biopsy of the mass was performed whose histological examination was consistent with moderately differentiated adenocarcinoma. Immunohistochemical examination was positive for cytokeratin 7 and negative forcytokeratin 20, suggesting primary lung tumor. A positron emission tomography was performed without uptake in other locations. Diagnosis of adenocarcinoma with diaphragmatic metastasis was then admitted and the patient started chemotherapy with carboplatin and gemcitabine. The patient died six months after the diagnosis. The authors also present a brief theoretical discussion based on the current and scarce literature on this rare entity.

关键词： Diaphragmatic Metastasis Metastatic lung Adenocarcinoma Muscle Metastasis

Portuguese Society of Intensive Care Score for Predicting SARS-CoV-2 Infection Applied to Inpatients with Pneumonia: A Reliable Tool?

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Open Journal of Respiratory Diseases 2021年第2期11卷 49-60页

作者： Ana Alfaiate David Noivo Vera Clérigo Vera Durão Fernando Durão Margarida Castanho Susana Sousa lígia fernandes Paula Duarte COVID-19 Service Pulmonology Department Setúbal Hospital Center Setúbal Portugal DECivil/CERENA Técnico Lisboa Lisboa Portugal

Objectives: Early identification of patients with the novel coronavirus induced-disease 2019 (COVID-19) and pneumonia is currently challenging. Few data are available on validated scores predictive of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection. The Portuguese Society of Intensive Care (PSIC) proposed a risk score whose main goals were to predict a higher probability of COVID-19 and optimize hospital resources, adjusting patients’ intervention. This study aimed to validate the PSIC risk score applied to inpatients with pneumonia. Methods: A retrospective analysis of 207 patients with pneumonia admitted to a suspected/confirmed SARS-CoV-2 infection specialized ward (20/03 to 20/05/2020) was performed. Score variables were analyzed to determine the significance of the independent predictive variables on the probability of a positive SARS-CoV-2 rRT-PCR test. The binary logistic regression modeling approach was selected. The best cut-off value was obtained with the Receiver Operating Characteristic (ROC) curve together with the evaluation of the discriminatory power through the Area Under the Curve (AUC). Results: The validation cohort included 145 patients. Typical chest computed-tomography features (OR, 12.16;95% le="font-family:Verdana;">

关键词： SARS-CoV-2 Infection COVID-19 Pneumonia Risk Score

New immune regulators of sciatic nerve regeneration?lessons from the neighborhood

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Neural Regeneration Research 2024年第4期19卷 705-706页

作者： Andrél.Bombeiro Rodrigo G.Q.fernandes Julie C.Ribot Instituto de Medicina Molecular João lobo Antunes Faculdade de MedicinaUniversidade de LisboaLisbonPortugal

For decades,the immune system has been associated with host protection against infectious pathogens or tumors,while also contributing to ***,this paradigm is now changing,with recent studies highlighting novel roles for immune mediators in the maintenance of steady-state tissue *** this perspective,we review some of the latest findings featuring immune modulators of the nervous system pathophysiology,with a special focus on interleukin(Il)-17.

关键词： homeostasis neighborhood finding

Histological Assessment of Bone Regeneration in the Maxilla with Homologous Bone Graft:A Feasible Option for Maxillary Bone Reconstruction

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Journal of Renewable Materials 2024年第1期12卷 131-148页

作者： Sergio Henrique Gonçalves Motta Ana Paula Ramos Soares Juliana Campos Hasse fernandes Gustavo Vicentis Oliveira fernandes Graduate Center of Faculdade Redentor CLIVORio de JaneiroBrazil Periodontics and Oral Medicine Department University of Michigan School of DentistryAnn ArborMI48109USA Centre for Interdisciplinary Research in Health(CIIS) Universidade Católica PortuguesaViseu3504-505Portugal

Bone biomaterials have been increasingly used to reconstruct maxillary atrophic ***,the aim of this study was to evaluate bone reconstruction in the maxilla using a homologous cortico-cancellous FFB(lyophilized)graft and verify its *** individuals were included from 2014 to *** first surgery was performed to install homologous bone blocks in the *** period of the second intervention varied between 5 months and 15 days to 11 months(≈7.93 months).The biopsies were taken from the central region of the matured graft during the surgery for implant *** patients presented clinical and radiographic conditions for the installation of dental *** was a 100%of survival *** histological assessment showed that the homologous block bone graft was an osteoconductive biomaterial,with connective tissue present,and newly formed bone juxtaposed on its *** were bone trabeculae with osteocytes and active osteoblasts with connective tissue in the mineralization process;the remodeling process can be found through the reverse lines.A limited focus of necrosis with fibrosis was detected,with small resorption and areas of inflammatory infiltrate,but without clinical *** homologous block bone graft can be considered a feasible option to substitute the autogenous bone graft(gold standard),with predictable clinical and favorable histological *** patients had a shorter surgical period,low morbidity,and an unlimited amount of biomaterial available at an accessible cost.

关键词： Regeneration bone graft histology homologous allogenous autogenous

Stochastic seismic inversion and Bayesian facies classification applied to porosity modeling and igneous rock identification

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Petroleum Science 2024年第2期21卷 918-935页

作者： Fábio Júnior Damasceno fernandes leonardo Teixeira Antonio Fernando Menezes Freire Wagner Moreira lupinacci Exploratory Interpretation and Reservoir Characterization Group(GIECAR) Department of Geology and GeophysicsFederal Fluminense UniversityNiter oiRJ24210-346Brazil Petrobras Rio de JaneiroRJ20231-030Brazil National Institute of Science and Technology of Petroleum Geophysics(INCT-GP/CNPQ) Niter oiRJ24210-346Brazil

We apply stochastic seismic inversion and Bayesian facies classification for porosity modeling and igneous rock identification in the presalt interval of the Santos Basin. This integration of seismic and well-derived information enhances reservoir characterization. Stochastic inversion and Bayesian classification are powerful tools because they permit addressing the uncertainties in the model. We used the ES-MDA algorithm to achieve the realizations equivalent to the percentiles P10, P50, and P90 of acoustic impedance, a novel method for acoustic inversion in presalt. The facies were divided into five: reservoir 1,reservoir 2, tight carbonates, clayey rocks, and igneous rocks. To deal with the overlaps in acoustic impedance values of facies, we included geological information using a priori probability, indicating that structural highs are reservoir-dominated. To illustrate our approach, we conducted porosity modeling using facies-related rock-physics models for rock-physics inversion in an area with a well drilled in a coquina bank and evaluated the thickness and extension of an igneous intrusion near the carbonate-salt interface. The modeled porosity and the classified seismic facies are in good agreement with the ones observed in the wells. Notably, the coquinas bank presents an improvement in the porosity towards the top. The a priori probability model was crucial for limiting the clayey rocks to the structural lows. In Well B, the hit rate of the igneous rock in the three scenarios is higher than 60%, showing an excellent thickness-prediction capability.

关键词： Stochastic inversion Bayesian classification Porosity modeling Carbonate reservoirs Igneous rocks

Production of Artificial Fog in the PAVIN Fog and Rain Platform: In Search of Big Droplets Fog

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Atmospheric and Climate Sciences 2024年第1期14卷 42-61页

作者： Pierre Duthon Mickaël Ferreira fernandes Sébastien liandrat Cerema Reasearch Team STI 8-10 Rue Bernard Palissy Clermont-Ferrand France

In fog, visibility is reduced. This reduction in visibility is measured by the meteorological optical range (MOR), which is important for studying human perception and various sensors in foggy conditions. The Cerema PAVIN Fog & Rain platform is capable of producing calibrated fog in order to better analyses it and understand its consequences. The problem is that the droplets produced by the platform are not large enough to resemble real fog. This can have a major impact on measurements since the interaction between electromagnetic waves and fog depends on the wavelength and diameter of the droplets. To remedy this, Cerema is building a new platform with new equipment capable of generating fog. This study analyses different nozzles and associated usage parameters such as the type of water used and the pressure used. The aim is to select the best nozzle with the associated parameters for producing large-diameter droplets and therefore more realistic fog.

关键词： Fog Physical Simulation Droplets Size Distribution Meteorological Optical Range