Dieulafoy’s lesion is a rare but potentially fatal cause of gastrointestinal bleeding, typically located in the stomach, with even rarer extragastric locations, as in the colon. Although endoscopy is the gold standard for diagnosis, it can be challenging due to the lesion’s small size, intermittent bleeding, or inaccessible location. In such cases, contrast-enhanced computed tomography has demonstrated a key role in identifying the source of bleeding and localizing the lesion, enabling prompt and effective endoscopic treatment, as illustrated in the present case. The diagnosis of Dieulafoy’s lesion remains challenging and requires high suspicion and close multidisciplinary collaboration.
Early breast cancer detection and correct staging are of utmost importance to ensure a good prognosis. Current imaging modalities have limitations, particularly among women with dense breasts, and Microwave Imaging (MWI) is a promising technique to aid breast cancer screening while assessing the involvement of axillary lymph nodes. In this paper, we evaluate an MWI prototype to image both the breast and the axillary region with 22 healthy volunteers and 5 breast cancer patients. The prototype operates in a monostatic configuration, using monopole antennas operating in the frequency band from 2 to 4 GHz. The breast imaging part consists of 10 antennas arranged in a circular configuration with an adjustable radius in a single plane, while the axillary region is imaged with 9 antennas in a planar 3×3 configuration. Our breast imaging results suggest a relationship between average dielectric properties and breast cup size, while the findings from the five cancer cases provide preliminary feasibility evidence for the potential of the prototype for cancer detection. To quantify left-right asymmetry, a maximum-image-intensity ratio was calculated between the two breasts. Healthy subjects exhibited differences of up to 50%, whereas differences of up to 316% were observed in patients with breast cancer. Our axillary imaging tests showed the challenges of repeatability and correct positioning of the axillary region in the prototype, illustrating the complexity of conforming to the axillary region. Future work comprises improving hardware components in line with the observations drawn in this study.
BACKGROUND:Sepsis remains a major global health challenge. International guidelines exist, but their implementation is inconsistent, and supporting evidence largely comes from high-income settings. The objective of this study was to generate international, multidisciplinary expert consensus on controversial aspects of sepsis management within the framework of sepsis code programs. METHODS:A multinational modified Delphi study was conducted with 164 experts from 22 countries, 12 specialties, and 105 scientific societies. Seven domains were evaluated: early diagnosis, biomarkers, diagnostic microbiology, hemodynamic monitoring, source control, antimicrobial therapy, and hemodynamic management. Consensus was defined as ≥70% agreement across three iterative rounds using Likert scales (Rounds 1-2) and binary format (Round 3). RESULTS:Consensus was achieved for 40 statements. Strong endorsement (82%-95%) was reached for structured hospital sepsis programs, NEWS-2 as the preferred early recognition tool, biomarker use (notably procalcitonin) to complement clinical assessment, urgent source control within 6 h independent of hemodynamic status, rapid molecular diagnostics integrated with antimicrobial stewardship, and norepinephrine as first-line vasopressor therapy. Experts also supported pharmacokinetic- and pharmacodynamic-guided antibiotic dosing, prolonged infusion of time-dependent agents, and dynamic rather than fixed fluid strategies. No consensus was reached on routine reliance on Sepsis-2, Sepsis-3, or qSOFA; high mean arterial pressure targets; or universal combination antimicrobial therapy. CONCLUSIONS:These results provide multidisciplinary guidance for sepsis management, with emphasis on rapid recognition, targeted antimicrobial therapy, timely source control, and hemodynamic management guided by patient physiology. The recommendations are applicable to high- and middle-income healthcare systems.
Continuous glucose monitoring (CGM) has revolutionised diabetes management, transforming both clinical practice and the self-management of people with diabetes. By providing a more detailed understanding of individual glycaemic patterns, CGM supports more informed therapeutic decisions and sustained behavioural changes that promote improved clinical outcomes and quality of life. In light of new evidence and accumulated experience, it has become necessary to update the clinical indications and public health strategy for the use of CGM in Portugal. The recommendations focused on three priority areas: (1) the clear definition of target populations for CGM use, namely, all individuals with diabetes treated with any insulin regimen (including basal therapy), as well as those not treated with insulin but at increased risk of hypoglycemia and its consequences, based on eligibility criteria grounded in scientific evidence and clinical needs; (2) the strengthening of therapeutic education and health literacy, promoted by multidisciplinary teams trained to support self-management and the appropriate use of technology; and (3) ensuring the quality and integrated functioning of CGM systems with other medical devices, including insulin pumps and digital monitoring platforms, in order to guarantee interoperability, reliability, and data management security.
