The Ketone Bridge Between the Heart and the Bladder: How Fast Should We Go?

Metabolic syndrome (MS) is associated with both cardiovascular and bladder dysfunction. Insulin resistance (IR) and central obesity, in particular, are the main risk factors. In these patients, vicious pathological cycles exacerbate abnormal carbohydrate metabolism and sustain an inflammatory state, with serious implications for both the heart and bladder. Ketone bodies serve as an alternative energy source in this context. They are considered a "super-fuel" because they generate adenosine triphosphate with less oxygen consumption per molecule, thus enhancing metabolic efficiency. Ketone bodies have a positive impact on all components of MS. They aid in weight loss and glycemic control, lower blood pressure, improve lipid profiles, and enhance endothelial function. Additionally, they possess direct anti-inflammatory, antioxidant, and vasodilatory properties. A shared key player in dysfunction of both the heart and bladder dysfunction is the formation of the NLRP3 inflammasome, which ketone bodies inhibit. Interventions that elevate ketone body levels-such as fasting, a ketogenic diet, ketone supplements, and sodium-glucose cotransporter 2 inhibitors-have been shown to directly affect cardiovascular outcomes and improve lower urinary tract symptoms derived from MS. This review explores the pathophysiological basis of the benefits of ketone bodies in cardiac and bladder dysfunction.

Stereotactic anatomy of the third ventricle.

PURPOSE: Endoscopic third ventriculostomy (ETV) is a surgical procedure that can lead to complications and requires detailed preoperative planning. This study aimed to provide a more accurate understanding of the anatomy of the third ventricle and the location of important structures to improve the safety and success of ETV. METHODS: We measured the stereotactic coordinates of six points of interest relative to a predefined stereotactic reference point in 23 cadaver brain hemi-sections, 200 normal brain magnetic resonance imaging (MRI) scans, and 24 hydrocephalic brain MRI scans. The measurements were statistically analyzed, and comparisons were made. RESULTS: We found some statistically significant differences between genders in MRIs from healthy subjects. We also found statistically significant differences between MRIs from healthy subjects and both cadaver brains and MRIs with hydrocephalus, though their magnitude is very small and not clinically relevant. Some stereotactic points were more posteriorly and inferiorly located in cadaver brains, particularly the infundibular recess and the basilar artery. It was found that all stereotactic points studied were more posteriorly located in brains with hydrocephalus. CONCLUSION: The study describes periventricular structures in cadaver brains and MRI scans from healthy and hydrocephalic subjects, which can guide neurosurgeons in planning surgical approaches to the third ventricle. Overall, the study contributes to understanding ETV and provides insights for improving its safety and efficacy. The findings also support that practicing on cadaveric brains can still provide valuable information and is valid for study and training of neurosurgeons unfamiliar with the ETV technique.

Experiências emocionais de enfermeiros após cuidarem de utentes infetados pelo vírus Sarscov-2: Um estudo qualitativo / Emotional experiences of nurses after caring for patients infected with the Sarscov-2 virus: A qualitative study

COVID-19 é uma doença respiratória grave causada pelo vírus SARS-CoV-2, identificado pela primeira vez em dezembro de 2019 em Wuhan. Dada a potencial gravidade da situação, causada por um vírus sobre o qual muito pouco se sabia, em 30 de janeiro de 2020, a Organização Mundial da Saúde (OMS) declarou a epidemia pela COVID-19 como um grave problema de saúde pública internacional. A doença respiratória aguda grave COVID-19 tem e terá impactos económicos, sociais e psicológicos substanciais. Esta pesquisa tem por finalidade reverenciar as experiências emocionais e psicológicas de enfermeiros após cuidarem de utentes infetados pelo vírus SARS-CoV-2. O estudo tem como objetivos: identificar as emoções positivas, negativas e de background que os enfermeiros manifestaram ao cuidar de utentes infetados, relacionadas com os utentes e consigo própria como cuidador e pessoa. Assim como identificar fatores de risco para a vivência da ansiedade, analisar a forma como os profissionais vivenciaram o processo de cuidar e identificar as estratégias pessoais que desenvolveram para lidar com as diversas reações emocionais. A pesquisa foi realizada a dez profissionais de enfermagem que tenham cuidado de utentes infetados pelo SARS-CoV-2, em contexto de serviços de urgência, cuidados intensivos, cuidados de saúde primários ou serviços de internamento, por um período igual ou superior a 30 dias. Para a recolha de dados foi utilizada a entrevista semiestruturada. Trata-se de um estudo de natureza qualitativa. Os resultados obtidos permitem afirmar que a COVID-19 teve um impacto maioritariamente negativa, nos utentes que foram infectados e nos profissionais de saúde que mantiveram um contacto mais direto com estes utentes.

COVID-19 is a severe respiratory disease caused by the SARS-CoV-2 virus, first identified in December 2019 in Wuhan. Given the potential urgency of the situation, caused by a virus that very little was known about, on January 30, 2020, the World Health Organization (WHO) declared the epidemic by COVID-19 a serious international public health problem. COVID-19, a severe acute respiratory disease, has and will have substantial economic, social and psychological impacts. This research aims to revere the emotional and psychological experiences of nurses after taking care of patients infected by the SARS-CoV-2 virus. The study aims to: identify the positive, negative and background emotions that nurses expressed when caring for infected patients, related to the patients and to themselves as caregivers and persons. As well as identifying risk factors for experiencing anxiety, analysing how professionals experienced the care process and identifying the personal strategies they developed to deal with the various emotional reactions. The survey was conducted with ten nursing professionals who have taken care of patients infected with SARS-CoV-2, in the context of emergency services, intensive care, primary health care or inpatient care, for a period equal to or greater than 30 days. For data collection, semi-structured interviews were used. This is a qualitative study. The results obtained allow us to state that COVID-19 had a mostly negative impact, not only on its casualties, but also on patients who were infected, who somehow managed to recover and on health professionals who had more direct contact with these patients.

Brain metastases from breast cancer.

BACKGROUND: Breast cancer (BC) is one of the commonest causes of brain metastases (BM): approximately 10-16 % of patients diagnosed with metastatic breast cancer will eventually develop BM during the course of their disease, however, certain subtypes have a higher risk of this event. The aim of this analysis was therefore to evaluate the prognosis and the pattern and imaging features of BM according to different BC subtypes. PATIENTS AND METHODS: We retrospectively reviewed the case records of patients with breast cancer and evidence of brain metastases from the database of IPO Porto between 2014-2018. The data obtained were statistically analysed. RESULTS: We analysed 147 patients with BM from BC. The triple-negative subtype had the shortest overall survival (OS) after BM, besides a short period of time between BC and BM. HER2 overexpressing tumors had the longest OS. The estrogen-receptor positive group had the greatest interval between initial BC diagnosis and diagnosis of BM. Larger lesions showed a heterogeneous contrast enhancement and were heterogeneous pn T2WI sequences; a hyposignal on T2*WI was also associated with larger lesions. Triple-negative BC tended to have more heterogeneous lesions on T1WI. We noticed that the hippocampus is rarely affected by metastatic lesions. CONCLUSIONS: Based on the BC subtype it is possible to make a prediction about the prognosis of the disease and some imaging features of the BM, but not about their pattern of distribution. These data support further research concerning prevention, early detection, and treatment of BM from BC.

Morphology and Navigational Landmarks of the Cranio-orbital Foramen in a Portuguese Population.

PURPOSE: The cranio-orbital and accessory foramina are located in the lateral wall of the orbit and adjacent to the superior orbital fissure. In the literature, there is a lack of consistency concerning the location and morphology of these foramina in different populations. Therefore, considering its clinical importance during orbital surgeries, it was the authors' aim to determine the incidence, location, and number of cranio-orbital and accessory foramina in a Portuguese population and compare the findings with data from other studies. METHODS: A total of 310 orbits from 155 dry skulls from the collection of the Museum of Anatomy of the Faculty of Medicine of Porto were studied. The characterization of both cranio-orbital and accessory cranio-orbital foramina was performed. RESULTS: The cranio-orbital foramen was present in at least 1 orbit per skull in 58.17% with a median diameter of 0.60 ± 0.33 mm. No relation was found between the presence of this foramen and the gender of the individuals or a tendency for laterality. However, it was found that the presence of 1 or more accessory foramina was related to higher diameters of the cranio-orbital foramen. CONCLUSIONS: There might be a relationship between the localization, diameter, and communication of foramina with the cranial fossae. Foramina located on the greater wing of the sphenoid bone presented a larger diameter and communicated with the middle cranial fossa. High diameters of the main vessel in the cranio-orbital foramen may imply more developed branches and collateral irrigation of the orbital structures using 1 or more accessory foramina. Surgeons should be aware of the location of the cranio-orbital foramen to reduce potential sources of hemorrhage during orbital dissections.

Nosocomial sepsis: evaluation of the efficacy of preventive measures in a level-III neonatal intensive care unit.

OBJECTIVE: To evaluate nosocomial infections preventive bundle, implemented in April 2010 in Centro Hospitalar de São João (CHSJ) Neonatal Intensive Care Unit (NICU) effectiveness. METHODS: Newborns admitted to level-III NICU of CHSJ, between 1 April 2007 and 31 March 2013, with sepsis as discharge diagnosis, were selected and divided into two periods (Period 1 and 2, before and after new preventive bundle introduction). Data from the two periods were compared. RESULTS: Nosocomial sepsis incidence density decreased significantly from 8.6 to 4.8 per 1000 patient days from Period 1 to 2. Nosocomial infections preventive bundle implementation led to a significant decrease in central line-associated bloodstream infections (CLABSI) rates from 14.1 to 10.4 per 1000 catheter days. CONCLUSIONS: Nosocomial infections preventive bundle implemented revealed efficient in decreasing the incidence density of nosocomial sepsis. However, CLABSI rates remain high. Physicians should be alert to the need to adhere to strict infection control protocols and institute effective measures for nosocomial infection surveillance.