Nuno Vicente

Antithyroid Drug-Induced Agranulocytosis: State of the Art on Diagnosis and Management

Agranulocytosis is a rare but serious complication of antithyroid drug therapy, and an up-to-date understanding of this topic is important. Both direct toxicity and immune-mediated responses have been described as possible mechanisms. Some major susceptibility loci have recently been identified, which may lead the diagnosis of agranulocytosis into a genomic era. Onset is acute and patients present with symptoms and signs of infection together with high fever. Clinical suspicion is pivotal and should prompt blood sampling. An absolute neutrophil count of <500/μl in the presence of antithyroid drugs establishes the diagnosis. The causative drug should immediately be stopped to prevent further damage. Treatment includes broad-spectrum antibiotics and granulocyte-colony stimulation factor in selected patients. Later, patients will need definitive treatment for hyperthyroidism, usually with radioactive iodine or surgery. The best way to avoid the mortality associated with antithyroid drug-induced agranulocytosis is patient education.

Controversies in the management of hyperglycaemic emergencies in adults with diabetes

Hyperglycaemic emergencies are associated with significant morbi-mortality and healthcare costs. Management consists on fluid replacement, insulin therapy, and electrolyte correction. However, some areas of patient management remain debatable. In patients without respiratory failure or haemodynamic instability, arterial and venous pH and bicarbonate measurements are comparable. Fluid choice varies upon replenishment phase and patients condition. If patient is severely hypovolaemic, normal saline solution should be the first option. However, if patient has mild/moderate dehydration, fluid choice must take in consideration sodium concentration. Insulin therapy should be guided by β-hydroxybutyrate normalization and not by blood glucose. Variations of conventional insulin infusion protocols emerged recently. Priming dose of insulin may not be required, and fixed rate insulin infusion represents the best option to suppress hepatic glucose production, ketogenesis, and lipolysis. Concomitant administration of basal insulin analogues with regular insulin infusion accelerates ketoacidosis resolution and prevents rebound hyperglycaemia. Simpler protocols using subcutaneous rapid-acting insulin analogues for mild/moderate diabetic ketoacidosis treatment have proven to be safe and effective, but further studies are required to confirm these results. Treatment with bicarbonate, phosphate, and low-molecular-weight heparin is still disputable, and randomized controlled trials are urgently needed to optimize patient management and decrease the morbi-mortality of hyperglycaemic emergencies.

The role of ablative treatment in differentiated thyroid cancer management

ABSTRACT Introduction: The role of ablative treatment in differentiated thyroid cancer management has been evolving over the years. After its introduction in clinical practice, the use of postsurgical radioiodine treatment was generalized to almost every patient with differentiated thyroid cancer, with the exception of unifocal microcarcinomas. However, in the last decade several studies questioned its benefit in low- and intermediate-risk patients. Areas covered: In this review we discuss the role of postsurgical radioiodine treatment at the present time. Expert commentary: Although there is general consensus about the recommendation for very low-risk (microcarcinomas) and high-risk patients – no indication for routine postoperative radioiodine and clear indication for radioiodine treatment, respectively, the recommendation for low- and intermediate-risk patients is still under debate. The most recent guidelines from the American Thyroid Association make a statement against routine postoperative radioiodine in both low- and intermediate-risk cases, recommending an individualized approach that takes into consideration the risk of disease persistence or recurrence after surgery. We consider that these recommendations are in accordance with the best evidence available today, and we would like to emphasize that radioiodine is generally favored for most intermediate-risk patients, especially in the presence of extensive lymph node disease or older age.

Mobile 4K / 2K / HD video streaming supported by real-time FEC raptorQ codes

With the growth of packet-switch networks in the mobile consumer electronics market, fountain codes are coming to play an increasingly important role as they allow high packet loss rates while still supporting high QoS. This is particularly critical for video streaming in multimedia delivery on moving handheld mobile consumer devices. A powerful forward error-correction mechanism is the fountain coding scheme implemented by RaptorQ codes, defined over GF(256), whose decoding algorithms are very complex from a computational perspective, but highly suitable for parallelization. With multimedia delivery for handheld consumer electronics in mind, this paper proposes several decoding schemes for embedded mobile SoCs, exploiting both the parallel potential of the GPU and CPU, sharing a common memory space. The OpenCL and OpenMP frameworks are used to exploit both accelerators for the roles of matrix multiplication and inversion that comprise the bulk of computation in RaptorQ decoding. Reported results indicate low-power requirements within the range of typical handheld consumer devices (1.5~2.4W) for data processing rates of dozens of Mbit/s that are fully within the real-time requirements of HD, 2K and 4K coded video streaming resolutions and beyond.

Anterior pituitary insufficiency and spontaneous fertility: case report

 Referenced due to Short stature.  Identification: PJON, ♂, DB 22.03.1981 Age: 7,63 years-old  Auxology: Height 108 cm (-2,86 SD) Predicted Adult Stature (PAS) 169.5 cm (-0.78 SD) Bone age 6 years (-2,82 SD) Growth velocity 2 cm  Past history of traumatic delivery; irrelevant familial history.  Cranial CT: intrasellar arachnoidocele. Daytime mean 0,2±0,28 ng/mL (max 1 ng/mL) Night mean 0,46 ±0,48 ng/ML (max 1,7 ng/mL)