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Rhus aromatica inhabits humid oak and oakpine forests in the State of Michoacán (Mexico). The fruit of R. aromatica is edible and is traditionally used in the preparation of soft drinks, ice pops, ice creams and ‘atole’. The objective of the present investigation was to carry out a physical and chemical characterization and analysis of the antioxidant capacity of fruit. For the physical characterization, the equatorial and longitudinal diameter, weight and percentage of pulp were determined. In the chemical characterization, a proximal analysis was carried out, quantification of polyphenols and flavonoids was performed, and the antioxidant capacity was determined. The results showed that the fruit had a longitudinal diameter of 6.58 ± 1.02 mm, an equatorial diameter of 7.17 ± 0.66, a weight of 55.22 ± 5.47 mg, and a 40 % pulp proportion. The chemical characterization analysis indicated 8.7 % moisture, 30.6 % lipids, 8.7 % proteins, 29.4 % total sugars, 3.8 % ashes and 18.7 % crude fibre, 3.1 °Brix, pH 3.1, 1.92 % acidity total and a caloric intake of 4.27 kcal/g. The polyphenol content was higher in 60 % ethanol extracts with 88.6 ± 50.89 mg EAG/g; for flavonoids from extracts with 100 % acetone, it was 26.52 ± 0.65 mg EQ/g, and the total carotenoid content was 46.37 mg/100 g. The total antioxidant activity was higher in extracts with 80 % acetone, with 87.17 % inhibition of the DPPH radical and 90 % inhibition of ABTS without showing a significant difference with the different solvents used. The lowest IC50 values were presented in 100 % ethanol and 60 % methanol extracts for the DPPH radical and for the ABTS radical were the 80 % ethanol and 60 % methanol extracts. The lipid, protein, carotenoid, and polyphenol contents and antioxidant capacity of the fruit of R. aromatica were as high as those of other fruits consumed in the human diet.

Summary: Iliac crest free flap is still essential as a source of vascularized bone tissue, having a definite role in osseous reconstruction of the face and other small bone defects. Some of its drawbacks include laborious dissection and donor site morbidity. We report a case of a patient that presented to our follow-up consultation ten years after iliac crest free flap harvest with new complaints of pain, gait disturbance and swelling in the right hip. Imaging exams revealed a heterotopic bone formation and helped with the diagnosis of heterotopic ossification (HO) of the right iliacus bone. Surgical intervention was needed for debridement of the heterotopic bone, with resolution of the symptoms. To our knowledge, this is the first report of HO after iliac crest free flap harvest. This rare condition adds to an already well-known number of donor zone complications of this flap. Plastic surgeons should be aware of this complication, as it can cause disability many years after the original surgery.

Membrane distillation (MD) technology is increasingly gaining attention as an environmentally sustainable water treatment method of emerging interest. During last three decades there has been wide efforts to model and improve the performance of this technology. In this study we examine both the mathematical and computational modeling methods used in MD with a data-driven method. To gather the dataset, a broad range of terms related with theoretical modeling of MD were searched in the Scopus database. The collection consists of 526 documents including 116 journals, 14,291 references used by authors, 1252 involved authors and 29.47 % international co-authorship rate. The overall pattern of publications is found to increase over time indicating the enhancing interest on theoretical modeling of MD process. Journal of Membrane Science and Desalination are the top two journals publishing theoretical modeling of MD, with 105 and 100 articles, respectively. Dr. Ghaffour N. contributed with the highest number of articles, 24; and Dr. Khayet M. has the highest articles fractionalized value with 7.08. The dataset was categorized first into mathematical and computational modeling, then into the used mass transport approaches through membrane hydrophobic pores. Recently, in MD field computational modeling has been considered more than mathematical modeling. The combined Knudsen diffusion/ordinary molecular diffusion model is the dominant mass transport approach considered in MD mathematical modeling with 117 articles. On the other hand, computational fluid dynamics is the most used computational method with 114 articles.

Background: We performed a retrospective trial to determine asymptomatic CMV reactivation and CMV disease in kidney allograft recipients with positive CMV serostatus. Methods: Preemptive modified strategy under low dose thymoglobulin versus basiliximab induction was evaluated. Patients were monitored by CMV-polymerase chain reaction (PCR); if the viral load was >4000 copies/μl, they received valganciclovir adjusted for their renal function. Results: 132 recipients were included in the study, 84 and 48 receiving basiliximab and thymoglobulin induction respectively, and followed up for 12 months. Asymptomatic CMV reactivation was significantly higher for thymoglobulin (77.1% vs. 16.7%, p

Background and aims: Dyslipidaemia is a significant risk factor for cardiovascular disease in the Mexican population. This analysis aimed to describe the baseline LDL-c levels of patients presenting to cardiovascular clinics and evaluate the proportion who achieved their risk-based LDL-c goals as recommended by 2021 ESC prevention guidelines. Methods: The REMECAR registry is an observational study of patients attending a specialized cardiovascular clinic for their first visit. The cardiovascular risk was retrospectively determined using the 2021 ESC guideline stratification and the SCORE2 and SCORE-OP. Results: A total of 5443 patients were included in the analysis. Within this population, 55.96% presented as very high, 39.98% as high and 4.06% as moderate to low risk. 63% of the participants were not on any lipid-lowering treatment at entry, while 12.4% were receiving high-intensity statin therapy. Patients presenting with established atherosclerotic cardiovascular disease had a mean LDL-c of 90.9 ± 40.7 mg/dL. Of these, 14.1% were achieving LDL-c levels of 70–55 mg/dL and 19.3% were achieving LDL-c levels

Introduction and Objectives: Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related death worldwide. Still, there are epidemiological and clinical data in Latin America. In Chile, this is the first study regarding HCC with a significant number of patients. This study aimed to obtain and analyze clinical and epidemiological data of Chilean patients with HCC. Materials and Methods: Multicenter study from 12 Chilean hospitals that have members of the Chilean Association of Hepatology as members of their staff. Clinical records from 2015-2021 were included. Kaplan-Meier survival curves and Cox regression analysis were obtained. Results: We obtained data from 856 patients with HCC from 12 different centers. Median age 67 years old; 58.7% male. Cirrhosis is present in 91.2% (779) of cases. Main risk factors reported: fatty liver 47.9%(410), alcohol 19.6% (68), viral 12.2%(104) and autoimmune 3.5% (30). The median MELD score was 11.7 (CI95% 11,4-12). 38% (322) were diagnosed during surveillance; this was associated with earlier BCLC stage (OR 2,6; CI95%1,9-3,4). BCLC stages at diagnosis were 0; 8,2%(69), A: 38,5%(326), B:29,9%(253), C: 15,4%(130) and D: 8,2%(69). The main initial treatments were TACE, ablation, resection, liver transplant and sorafenib in 27,4%(226), 19,3%(159), 11,4%(94), 8%(66) and 5,5%(45), respectively. 53,4%(452) pts were in Milan Criteria at diagnosis. 9,1%(78) patients got a liver transplant. Five-year survival was 24% (CI95%20-28). The main factors associated with survival are depicted in Figure 1. Conclusions: Fatty liver was remarkably the main risk factor reported for HCC in our Chilean cohort. This is a worrisome number since NAFLD is on the rise worldwide, and especially in Latin America. Surveillance is key for early detection. The liver function defined by Child-Pugh and HCC stage using BCLC staging is strongly associated with survival. Liver transplant is still a scarce treatment resource.

Aim: Preeclampsia is a very complex multisystem disorder characterized by mild to severe hypertension. Methods: PubMed and the Cochrane Library were searched from January 1, 2002 to March 31, 2022, with the search terms “pre-eclampsia” and “hypertensive disorders in pregnancy”. We also look for guidelines from international societies and clinical specialty colleges and we focused on publications made after 2015. Results: The primary issue associated with this physiopathology is a reduction in utero-placental perfusion and ischemia. Preeclampsia has a multifactorial genesis, its focus in prevention consists of the identification of high and moderate-risk clinical factors. The clinical manifestations of preeclampsia vary from asymptomatic to fatal complications for both the fetus and the mother. In severe cases, the mother may present renal, neurological, hepatic, or vascular disease. The main prevention strategy is the use of aspirin at low doses, started from the beginning to the end of the second trimester and maintained until the end of pregnancy. Conclusion: Preeclampsia is a multisystem disorder; we do not know how to predict it accurately. Acetylsalicylic acid at low doses to prevent a low percentage, especially in patients with far from term preeclampsia. There is evidence that exercising for at least 140 min per week reduces gestational hypertension and preeclampsia. Currently, the safest approach is the termination of pregnancy. It is necessary to improve the prediction and prevention of preeclampsia, in addition, better research is needed in the long-term postpartum follow-up.

ABSTRACT: Objective: To document antiretroviral use in Latin America during the last decade. Methods: We collected indicators from 79 HIV health care centres in 14 Latin American Spanish-speaking countries for 2013–2017. Indicators were analysed by age, sex and other characteristics and weighted by the estimated people under care (PUC) population in each country. Results: We gathered information on 116 299 PUC. One-third belonged to centres reporting a shortage of at least one antiretroviral therapy (ART) drug for >30 days during 2017. At end 2017, 95.1% of PUC were receiving ART. During 2013–2017, 45 329 people living with HIV were admitted to 39 centres. ART initiated during the first year after admission increased from 76.7% in 2013 to 83.8% in 2017. In 35 centres across the study period, 71.7% of PUC started ART with tenofovir disoproxil fumarate and lamivudine, and zidovudine use decreased. The third most common ART drug, EFV, reached 64.8%. Raltegravir and other alternatives increased annually to almost 10% of total use in 2017. Conclusions: Initial ART in Latin America is not based on the most recent scientific evidence and recommendations; use of drugs with higher efficacy and safety profiles and guarantee of ART availability continues to be a public health challenge.

Summary: Determining the protection an individual has to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) variants of concern (VoCs) is crucial for future immune surveillance, vaccine development, and understanding of the changing immune response. We devised an informative assay to current ELISA-based serology using multiplexed, baited, targeted proteomics for direct detection of multiple proteins in the SARS-CoV-2 anti-spike antibody immunocomplex. Serum from individuals collected after infection or first- and second-dose vaccination demonstrates this approach and shows concordance with existing serology and neutralization. Our assays show altered responses of both immunoglobulins and complement to the Alpha (B.1.1.7), Beta (B.1.351), and Delta (B.1.617.1) VoCs and a reduced response to Omicron (B1.1.1529). We were able to identify individuals who had prior infection, and observed that C1q is closely associated with IgG1 (r > 0.82) and may better reflect neutralization to VoCs. Analyzing additional immunoproteins beyond immunoglobulin (Ig) G, provides important information about our understanding of the response to infection and vaccination. Motivation: Assays for measuring serum antibody responses are typically limited to measurement of a total or single immunoglobulin isotype. The antibody response is far more complex, with multiple immunoglobulin classes, isotypes, and complement factors involved. This is a potential wealth of information that is typically understudied and missed by existing tests. The global COVID-19 pandemic has highlighted the need to understand better the immune response in respect to vaccine development and emerging new severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) variants. Using the ability of tandem mass spectrometry to multiplex and directly and accurately measure the antibody complex, we devised an alternative assay to capture this valuable information.

The present study concentrates on the bioactive behavior of HVOF-sprayed HAp/TiO2 graded coatings on a Ti-6Al-4V alloy. In-vitro bioactivity was evaluated by immersing graded coating samples in Hank’s solution at body temperature up to 28 days. Natural in-vitro bioactivity of the graded coatings was compared with in-vitro electrochemical analysis also performed for 28 days. Potentiodynamic polarization, open circuit potential, linear polarization resistance, and electrochemical impedance spectroscopy measurements in Hank’s solution, at body temperature, were performed to study the interaction of the HVOF-sprayed HAp/TiO2 graded coating with the simulated body fluid. Electrochemical in-vitro data of graded coatings were compared with those from an uncoated Ti-6Al-4V alloy. Graded coatings presented a rapid interaction with simulated body fluid during the first 4 days of immersion. The interaction between HAp/TiO2 graded coating and simulated body fluid led to the formation of a bone like-apatite layer on the top surface of the graded coating. This layer was not observed on the surface of the Ti-6Al-4V alloy. The growing kinetics of the apatite layer on the top surface of the graded coatings varied on time and provided useful information for future in-vivo studies focused on studying medical healing times. From a bioactive standpoint, the present study shows the advantages that a HVOF-sprayed HAp-based coating architecture has over an un-coated Ti-6Al-4V alloy, and how it represents a step forward in the development of bioactive coatings for implant technology.

Summary: Background: Molecular diagnostics are considered the most promising route to achievement of rapid, universal drug susceptibility testing for Mycobacterium tuberculosis complex (MTBC). We aimed to generate a WHO-endorsed catalogue of mutations to serve as a global standard for interpreting molecular information for drug resistance prediction. Methods: In this systematic analysis, we used a candidate gene approach to identify mutations associated with resistance or consistent with susceptibility for 13 WHO-endorsed antituberculosis drugs. We collected existing worldwide MTBC whole-genome sequencing data and phenotypic data from academic groups and consortia, reference laboratories, public health organisations, and published literature. We categorised phenotypes as follows: methods and critical concentrations currently endorsed by WHO (category 1); critical concentrations previously endorsed by WHO for those methods (category 2); methods or critical concentrations not currently endorsed by WHO (category 3). For each mutation, we used a contingency table of binary phenotypes and presence or absence of the mutation to compute positive predictive value, and we used Fisher's exact tests to generate odds ratios and Benjamini-Hochberg corrected p values. Mutations were graded as associated with resistance if present in at least five isolates, if the odds ratio was more than 1 with a statistically significant corrected p value, and if the lower bound of the 95% CI on the positive predictive value for phenotypic resistance was greater than 25%. A series of expert rules were applied for final confidence grading of each mutation. Findings: We analysed 41 137 MTBC isolates with phenotypic and whole-genome sequencing data from 45 countries. 38 215 MTBC isolates passed quality control steps and were included in the final analysis. 15 667 associations were computed for 13 211 unique mutations linked to one or more drugs. 1149 (7·3%) of 15 667 mutations were classified as associated with phenotypic resistance and 107 (0·7%) were deemed consistent with susceptibility. For rifampicin, isoniazid, ethambutol, fluoroquinolones, and streptomycin, the mutations' pooled sensitivity was more than 80%. Specificity was over 95% for all drugs except ethionamide (91·4%), moxifloxacin (91·6%) and ethambutol (93·3%). Only two resistance mutations were identified for bedaquiline, delamanid, clofazimine, and linezolid as prevalence of phenotypic resistance was low for these drugs. Interpretation: We present the first WHO-endorsed catalogue of molecular targets for MTBC drug susceptibility testing, which is intended to provide a global standard for resistance interpretation. The existence of this catalogue should encourage the implementation of molecular diagnostics by national tuberculosis programmes. Funding: Unitaid, Wellcome Trust, UK Medical Research Council, and Bill and Melinda Gates Foundation.

The kinetics of the pyrolysis of Brazil nut residues (Bertholletia excelsa), in this case, shells (BNS) and husks (BNH), were investigated via a thermogravimetric analysis in an inert atmosphere. The Flynn–Wall–Ozawa, Kissinger-Akahira-Sunose, Starink and Vyazovkin isoconversional models were used to estimate kinetic and thermodynamic parameters. The mean activation energy values ranged from 135.59 to 138.51 kJ/mol for the shells and from 151.94 to 153.92 kJ/mol for the husks in the active pyrolysis region. High values of the pre-exponential factor (>108 s−1) indicated the presence of complex reactions for both samples, which was confirmed in the analysis of the reaction mechanism using the master-plot method, through the multiple types of behavior during the variation of the conversion levels. Thermodynamic parameters, such as the enthalpy change, Gibbs free energy change and entropy change, characterized a nonspontaneous endothermic process, with little energy required. TG-MS analyses revealed less harmful gas emission behavior for the environment compared to fossil fuels. The results of the study, with an emphasis on its satisfactory higher heating value (13.8 and 14.6 MJ/kg), showed that Brazil nut residues, an Amazon Forest waste, have great potential in pyrolysis applications for the generation of renewable energy, which can contribute to forest preservation through the development of the circular bioeconomy.

Tabebuia rosea has been reported to have anti-cancer, antioxidant, and hypoglycemic activities, and other species of the same genus have anti-obesity effect. Ethanol extract of T. rosea (TrEtOH) produced a significant decrease in body weight (12.1%), and a diminution in lipid profile markers in high fat diet-induced obese C57BL/6 mice. A reduction in the number of hypertrophic adipocytes and a decrease of triglycerides was observed in adipose tissue, added to a reduction in size and fat in hepatocytes. The administration of TrEtOH leads to the mRNA overexpression of UCP1, TBX1, and GLUT4, suggesting that the extract promotes adipocyte browning as a possible mechanism of action. A glycosylated coumarin, lapachol and quercetin were quantified in TrEtOH extract. Interestingly TrEtOH extract did not show mutagenicity, genotoxicity, or toxic effects after acute or 28 days repeated administration. TrEtOH extract could be used for the development of new drugs against obesity and its comorbidities.

Superficial modification of implants via the incorporation of biocompatible coatings is an attractive option in biomedicine because of the positive attributes associated with bioactive materials. Bioactive glasses are an important subset of biomaterials that are known to stimulate bone regeneration; they are interesting materials that can be employed as bioactive coatings due to their unique response in physiological environments. Numerous clinical case histories and scientific studies have focused on successful examples of bioactive glasses being used in-vitro and in-vivo. However, unlike other biomaterials such as hydroxyapatite, bioactive glasses have not yet reached full potential as thermally sprayed coatings. The lack of fundamental research focused on establishing correlations between the available bioactive glass chemical compositions, the processing parameters selected for specific thermal spray processes, and the obtained coating performance has limited the use of bioactive glass compositions as reliable coatings. This paper reviews the current state of the art of thermally sprayed bioactive glass coatings; it looks at different studies dealing with thermally sprayed bioactive glass coatings in order to identify their strengths and weaknesses and provides key scientific points that could be explored in future investigations. This manuscript includes a brief introduction to bioactive glasses, an overview of thermal spraying techniques and current products, and a discussion of recent developments in this field. Keywords: Bioactive glasses, Thermal spraying, Coatings, Implants

Background: Surgical site infection (SSI) is both the most frequently studied healthcare-associated infection and the most common healthcare-associated infection in the developing world. A systematic review and meta-analysis was conducted to evaluate the relative size of this burden and to estimate the prevalence of SSI in clean and clean-contaminated surgeries in a large sample of countries in the developing world. Methods: A systematic search of the MEDLINE/PubMed, Scopus, and LILACS databases was conducted to identify studies providing the prevalence of SSI in elective clean and clean-contaminated surgeries in 39 countries or regions around the world. Data of interest were limited to publications from January 2000 to December 2017. Studies with information on the number of cases of SSI and number of total elective clean and clean-contaminated surgeries during the same period were included in this evaluation. Studies lacking clear definition of the total number of exposed patients were excluded. Results: Based on the combined data from the 99 articles evaluated in this analysis, the overall prevalence of SSI in elective clean and clean-contaminated surgeries was estimated to be 6% (95% confidence interval (CI) 5–7%). This increased to 15% (95% CI 6–27%) when considering only those reports with post-discharge surveillance data. The overall prevalence of SSI in Africa/Middle East, Latin America, Asia, and China was 10% (95% CI 6–15%), 7% (95% CI 5–10%), 4% (95% CI 4–5%), and 4% (95% CI 2–6%), respectively. Significant variability in the data was confirmed by both the funnel plot and the Egger test (p = 0.008). Conclusions: Although the data are variable, it is clear that the incidence of SSI in the developing world is higher than that in the developed world. Keywords: surgical site infection, Staphylococcus aureus, elective clean surgery, clean-contaminated surgery, post-discharge surveillance

An 8-year-old boy visited the emergency department due to bilious vomiting and colicky abdominal pain for 3 days. No past surgical or trauma history was declared. On physical examination the child presented with distension and global abdominal tenderness. The blood tests were normal. Ultrasound was negative for acute appendicitis and the CT scan showed a conglomerate of multiple intestinal loops.An urgent laparoscopic exploration was performed to obtain the correct diagnosis. On exploration, the patient had a sac on the right upper abdominal quadrant formed by a mesodiverticular band with distended bowel loops within. As the vascularity of herniated loops had not been compromised, we were able to reduce the hernia contents and excise the mesodiverticular band. The Meckel's diverticulum was then exteriorized, and an extracorporeal resection was performed. Postoperative recovery was uneventful.

The Moens-Korteweg equation predicts changes in pulse wave velocity (PWV) after changes in arterial radius; therefore, an increase in arterial radius, as seen in a reactive hyperemia (RH) condition, should slow PWV over a given arterial segment. If this assumption is true, then the deceleration of PWV over the brachial artery (flow-mediated slowing [FMS]) should be an equivalent signal of endothelial function during a conventional RH flow-mediated dilation (FMD) procedure. Our aim was to compare FMS with FMD after RH in healthy individuals as part of a study that seeks to evaluate the clinical usefulness of FMS as a noninvasive approach to characterize endothelial function. This cross-sectional study included 25 healthy participants (18 women [72%]) with a mean ± SD age of 21.12±0.73 years. The FMD and FMS were simultaneously measured. A significant correlation was observed between both measures of FMS (absolute difference and percentage variation) and echo FMD: R=−0.42 (P=.04) and r=0.46 (P=.02), respectively. The FMS was shown to depend on the baseline brachial diameter, with smaller variations depicted for smaller baseline brachial diameters. It seems to be a promising and feasible method for measuring changes after RH, although further studies are needed to evaluate how this correlation holds in different clinical conditions and to demonstrate its clinical usefulness.

Abstract: Although FLT3 internal tandem duplication (ITD) mutations in acute myeloid leukemia (AML) confer an adverse prognosis, co-occurrence with a nucleophosphomin (NPM1) mutation partially improves response and survival outcomes. In contrast, simultaneous NPM1 and FLT3 tyrosine kinase domain (TKD) mutations were reported to improve response over that of an isolated NPM1 mutation in one as yet unverified report. To validate this, we explored the impact of the co-occurrence of FLT3-TKD and NPM1 mutations on clinical outcomes. Study populations included 21 patients (8%) with FLT3-TKD+NPM1+ mutated, 18 patients (7%) with FLT3-TKD-only–mutated, 117 patients (44%) with NPM1-only–mutated, and 107 patients (41%) with FLT3-ITD+NPM1–mutated AML. Compared with NPM1+-only–mutated AML, FLT3-TKD/NPM1 double mutation status was associated with a significantly superior relapse-free survival (median, not reached vs 18.3 months; P = .03) and a trend toward improved overall survival (OS). The presence of FLT3-TKD/NPM1 double mutation status was an independent positive predictor in multivariable analysis. Allogeneic stem cell transplant did not improve outcomes in the FLT3-TKD/NPM1 cohort. Consistent with historical data, the co-mutation status defined a highly favorable prognostic group characterized by high response rates and prolonged disease-free and OS. These study findings substantiate previous data describing this intriguing paradoxical cooperative effect. Our results emphasize the need for elucidating the mechanistic links between FLT3-TKD and NPM1 in future molecular and murine model studies.

Tyrosine kinase inhibitors have changed the management and outcomes of chronic myeloid leukemia patients. Quantitative polymerase chain reaction is used to monitor molecular responses to tyrosine kinase inhibitors. Molecular monitoring represents the most sensitive tool to judge chronic myeloid leukemia disease course and allows early detection of relapse. Evidence of achieving molecular response is important for several reasons: 1. early molecular response is associated with major molecular response rates at 18-24 months; 2. patients achieving major molecular response are less likely to lose their complete cytogenetic response; 3. a durable, stable major molecular response is associated with increased progression-free survival. However, standardization of molecular techniques is still challenging.

Resumo: Introdução: O enfisema lobar congénito (ELC) é uma anomalia rara do desenvolvimento pulmonar e a apresentação neonatal ocorre em cerca de 50% dos casos. Os autores apresentam quatro casos clínicos de ELC no recém-nascido. Casos clínicos: Quatro recém-nascidos de termo, 3 M/1 F, admitidos por dificuldade respiratória com início variável entre as 20 horas e os 18 dias de vida, apresentaram radiografia de tórax na admissão sugestiva de ELC, diagnóstico confirmado por tomografia axial computorizada. O ELC afectou o lobo superior direito em três casos e o lobo médio em um caso. Foi efectuada lobectomia nos quatro recém-nascidos. O estudo anatomopatológico das peças operatórias confirmou o diagnóstico nos quatro casos, tendo revelado hipoplasia da cartilagem da árvore brônquica em três. Conclusão: A casuística está de acordo com a literatura no predomínio no sexo masculino, forma de apresentação, tempo variável até ao diagnóstico, envolvimento unilobar e não identificação de causa evidente num dos casos. O tratamento cirúrgico foi universal.Rev Port Pneumol 2010; XVI (5): 849-857 Abstract: Introduction: Congenital lobar emphysema (CLE) is a rare anomaly of lung development that presents in the neonatal period in about 50% of the cases. The authors report four clinical cases of congenital lobar emphysema in the newborn.Clinical cases: Four term newborns, 3 M/ 1 F, were admitted for respiratory distress starting between 20 hours of life and 18 days. The chest x-ray at admission was suggestive of CLE and the diagnosis was confirmed by computorized tomography. The CLE affected the right upper lobe in three cases and the medium lobe in one case. All patients were treated with lobectomy. The pathological study of the surgical specimens confirmed the diagnosis in the four cases, and revealed hypoplasia of the bronquiolar tree cartilage in three. Conclusions: Our series is according to literature regarding to male gender preponderance, clinical presentation, different time to diagnosis, unilobar involvement and no identification of an evident aetiology in one case. Surgical treatment was universal.Rev Port Pneumol 2010; XVI (5): 849-857 Palavras-chave: Enfisema lobar congénito, recém-nascido, Key-words: Congenital lobar emphysema, newborn

Introdução: O enfisema lobar congénito (ELC) é uma anomalia rara do desenvolvimento pulmonar e a apresentação neonatal ocorre em cerca de 50% dos casos. Os autores apresentam quatro casos clínicos de ELC no recém-nascido. Casos clínicos: Quatro recém-nascidos de termo, 3M/1F, admitidos por dificuldade respiratória com início variável entre as 20 horas e os 18 dias de vida, apresentaram radiografia de tórax na admissão sugestiva de ELC, diagnóstico confirmado por tomografia axial computorizada. O ELC afectou o lobo superior direito em três casos e o lobo Resumo Introdução: O enfisema lobar congénito (ELC) é uma anomalia rara do desenvolvimento pulmonar e a apresentação neonatal ocorre em cerca de 50% os casos. Os autores apresentam quatro casos clínicos de ELC no recém-nascido. Casos clínicos: Quatro recém-nascidos de termo, 3M/1F, admitidos por dificuldade respiratória com início variável entre as 20 horas e os 18 dias de vida, apresentaram radiografia de tórax na admissão sugestiva de ELC, diagnóstico confirmado por tomografia axial computorizada. O ELC afectou o lobo superior direito em três casos e o lobo médio em um caso. Foi efectuada lobectomia nos quatro recém-nascidos. O estudo anatomopatológico das peças operatórias confirmou o diagnóstico nos quatro casos, tendo revelado hipoplasia da cartilagem da árvore brônquica em três. Conclusão: A casuística está de acordo com a literatura no predomínio no sexo masculino, forma de apresentação, tempo variável até ao diagnóstico, envolvimento unilobar e não identificação de causa evidente num dos casos. O tratamento cirúrgico foi universal.Introduction: Congenital lobar emphysema (CLE) is a rare anomaly of lung development that presents in the neonatal period in about 50% of the cases. The authors report four clinical cases of congenital lobar emphysema in the newborn. Clinical cases: Four term newborns, 3M/ 1F, were admitted for respiratory distress starting between 20 hours of life and 18 days. The chest x-ray at admission was suggestive of CLE and the diagnosis was confirmed by computorized tomography. The CLE affected the right upper lobe in three cases and the medium lobe in one case. All patients were treated with lobectomy. The pathological study of the surgical specimens confirmed the diagnosis in the four cases, and revealed hypoplasia of the bronquiolar tree cartilage in three. Conclusions: Our series is according to literature regarding to male gender preponderance, clinical presentation, different time to diagnosis, unilobar involvement and no identification of na evident aetiology in one case. Surgical reatment was universal.

ABSTRACT Acute promyelocytic leukemia has good prognosis in view of the high complete remission and survival rates achieved with therapies containing all-trans retinoic acid or arsenic trioxide. However, there is a significant risk of death during induction due to hemorrhage secondary to disseminated intravascular coagulation. This has contributed to a gap in the prognosis of patients between developed and developing countries. The International Consortium on Acute Promyelocytic Leukemia was created in 2005 and proposed a treatment protocol based on daunorubicin and all-trans retinoic acid stratified by risk geared toward developing countries. Herein are presented the results from the first patient cohort treated in a single developing country hospital employing a slightly modified version of the International Consortium protocol in a real life setting. Twenty patients with acute promyelocytic leukemia were enrolled: 27.8% had low-risk, 55.6% intermediate risk and 16.7% high-risk. The complete remission rate was 94.4% after a median of 42 days. Both relapse rates and death rates were one patient (5.5%) each. No deaths were observed during consolidation. After a median follow-up of 29 months, the overall survival rate was 89.1%. Efficacy and safety of the International Consortium on Acute Promyelocytic Leukemia protocol has been reproduced in acute promyelocytic leukemia patients from a developing country.

Physically active individuals are less likely to develop chronic pain, and physical exercise is an established strategy to control inflammatory diseases. Here, we hypothesized that 1) peripheral pro-inflammatory macrophages phenotype contribute to predisposition of the musculoskeletal to chronic pain, and that 2) activation of PPARγ receptors, modulation of macrophage phenotypes and cytokines through physical exercise would prevent persistent muscle pain. We tested these hypotheses using swimming exercise, pharmacological and immunochemical techniques in a rodent model of persistent muscle hyperalgesia. Swimming prevented the persistent mechanical muscle hyperalgesia most likely through activation of PPARγ receptors, as well as activation of PPARγ receptors by 15d-PGJ 2 and depletion of muscle macrophages in sedentary animals. Acute and persistent muscle hyperalgesia were characterized by an increase in pro-inflammatory macrophages phenotype, and swimming and the 15d-PGJ 2 prevented this increase and increased anti-inflammatory macrophages phenotype. Finally, IL-1β concentration in muscle increased in the acute phase, which was also prevented by PPARγ receptors activation through swimming. Besides, swimming increased muscle concentration of IL-10 in both acute and chronic phases, but only in the persistent phase through PPARγ receptors. Our findings suggest physical exercise activates PPARγ receptors and increases anti-inflammatory responses in the muscle tissue by modulating macrophages phenotypes and cytokines, thereby preventing the establishment of persistent muscle hyperalgesia. These results further highlight the potential of physical exercise to prevent chronic muscle pain., (Copyright © 2021 Elsevier Inc. All rights reserved.)