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Syphilis is a sexually transmitted disease caused by Treponema pallidum, progressing through active and latent stages if left untreated. Hepatic involvement can occur in secondary syphilis, but this is an uncommon complication, with few published case reports. A 34-year-old man without significant medical history was admitted to the gastroenterology department with a 2-week history of unexplained jaundice and acute cholestatic hepatitis. He also presented with erythematous papules and plaques in the genital area, suggestive of secondary syphilis. T. pallidum hemaglutination assay and venereal disease research laboratory test were both positive, the latter with a 1:16 titer. The diagnosis of secondary syphilis with hepatic involvement was considered. The improvement of cutaneous and laboratory findings after intramuscular benzathine penicillin injection supported this hypothesis. Symptomatic cholestatic hepatitis is a rare feature of the systemic spectrum of secondary syphilis. The clinical and laboratorial response after penicillin treatment is a strong clue for this diagnosis. info:eu-repo/semantics/publishedVersion

Introduction: In order to maintain assistential activity while ensuring social distancing and mobility restrictions imposed during the COVID-19 pandemic, the Dermatovenereology Department of Hospital de Santo António dos Capuchos implemented an asynchronous teledermatology platform based on e-mail and smartphones. This study aims to evaluate its application to urgent outpatient and inpatient consultations while considering its benefits and limitations. Methods: All written communications received via e-mail or smartphone between April 1, 2020 and April 31, 2021 were reviewed. Data was evaluated and statistical analysis was made using SPSS Statistics 25® software. Results: We reviewed 471 referrals (329 for outpatient and 142 for inpatient urgent consultations). E-mail was the most used platform (68.8%) and most referrals were composed of clinical information and clinical images (70.3%). Only 29% of these contained adequate clinical information and clinical images simultaneously. The majority of referrals received a response by a dermatologist in less than 24 hours (89%) and conversion to in-person evaluation was made in 58% of cases. The average time for in-person evaluation after triage was 0.25 days for inpatients and 4 days for outpatients. Conclusion: The COVID-19 pandemic hastened teledermatology implementation in order to maintain good healthcare. This study demonstrates that these platforms where wildly accepted by healthcare professionals and patients and remote consultations were possible in a significant percentage of cases. Teledermatology struggles with its own limitations and can never fully replace in-person evaluation, but can present itself as a useful tool in daily practice. Introdução: Com o objectivo de manter a actividade assistencial numa altura em que o distanciamento social e as restrições de mobilidade entre hospitais consequentes à pandemia COVID-19 se apresentavam como fundamentais, o departamento de Dermatovenereologia do Hospital de Santo António dos Capuchos implementou uma plataforma assíncrona de teledermatologia baseada em e-mail e smartphones. Este estudo pretende avaliar a sua aplicação a consultas de urgência de ambulatório e internamento, dando destaque aos seus benefícios e limitações. Métodos: Todas as comunicações escritas recebidas por e-mail ou smartphone entre 1 de Abril de 2020 e 31 de Abril de 2021 foram analisadas. Os dados foram avaliados e foi realizada análise estatística com recurso ao software SPSS Statistics 25®. Resultados: Foram analisadas 471 referenciações (329 consultas urgentes de ambulatório e 142 consultas urgentes em internamento). O e-mail foi a plataforma mais usada (68.8%) e a maioria das referenciações eram compostas por informação clínica escrita e imagens clínicas (70.3%). Apenas 29% destas continham, em simultâneo, informação clínica e imagens clínicas adequadas. A maior parte dos pedidos recebeu uma resposta por um dermatologista em menos de 24 horas (89%) e, em 58% dos casos, foi efectuada uma conversão a consulta presencial. O tempo médio para uma consulta presencial após triagem foi de 0.25 dias para consultas em internamento e 4 dias para consultas de ambulatório. Conclusão: A pandemia COVID-19 acelerou a implementação da teledermatologia de modo a assegurar a manutenção de bons cuidados de saúde. Este estudo demonstrou que estas plataformas foram amplamente adoptadas por profissionais de saúde e doentes e a realização de consultas remotas foi possível numa percentagem significativa de casos. A teledermatologia apresenta várias limitações e nunca poderá substituir integralmente uma avaliação presencial, podendo ser, no entanto, uma ferramenta útil no dia-a-dia. info:eu-repo/semantics/publishedVersion

This article focuses on the geriatric market segment which is becoming increasingly important as a result of demographic trends and aging populations. Using network science approach, this study maps the structure of knowledge, its changes over time and research opportunities in Tai-chi. Data collected from Web-of-Science and Scopus between 1996-2019 was used to build a network of 2,202 articles and 6,820 authors. The results show Tai-chi represents a small-world network as the majority of the articles were produced among universities and medical schools, displaying a connection between theoretical knowledge and pragmatic applications. The scientific achievements mainly emerge from the USA, China, and UK. The collaborative efforts focused on a giant component and converge on a small area of research. Future opportunities at the intersection of Tai-chi and geriatrics include mindfulness-meditation, osteoarthritis, sleep quality, cardio-respiratory function and pain management. This article provides contributes to the literature on Tai-chi and offers insights into the capabilities of CiteSpace, Vosviewer, Gephi, and Python. info:eu-repo/semantics/publishedVersion

A atividade coral formalmente instituída no âmbito do associativismo musical tem em Portugal uma expressão significativa revelada pelas várias centenas de grupos que mobilizam regularmente largos milhares de indivíduos na realização de distintos repertórios. Este artigo dá a conhecer as dinâmicas e complexidades desta atividade em Portugal a partir da análise dos dados de um inquérito extensivo aos grupos corais (n = 503) realizado em 2013, no âmbito dos projetos de investigação «“A música no meio”: O canto em coro no contexto do orfeonismo (1880-2012)» e «“A nossa música, o nosso mundo”: Associações musicais, bandas filarmónicas e comunidades locais (1880-2018)», na Universidade de Aveiro pelo INET-md. O inquérito permitiu conhecer a dimensão deste movimento em Portugal, evidenciando o perfil das instituições e dos indivíduos nelas envolvidos, bem como a diversidade de atividades (públicas e privadas) desenvolvidas, os repertórios musicais executados, contextos de atuação e os espaços performativos utilizados. Conclui-se que se trata de uma realidade multifacetada, dinâmica, em franco crescimento e com uma forte participação na vida social local, embora fortemente dependente dos apoios de instituições locais (sobretudo autarquias). info:eu-repo/semantics/publishedVersion

Idiopathic membranous nephropathy with high-risk criteria for renal disease progression is considered an indication for immunosuppressive treatment. HIV infection has been associated with membranous nephropathy in a minority of patients. A 44-year-old female diagnosed with HIV infection 11 years ago was referred for a nephrology consultation due to nephrotic syndrome. She presented with peripheral edema for 2 months and normal blood pressure. Serum creatinine was 0.74 mg/dL, total cholesterol 490 mg/dL, albumin 2.0 g/dL; urinary examination revealed leukoerythrocyturia and 24h proteinuria was 4.5g. Renal ultrasound showed normal-sized kidneys with preserved corticomedullary differentiation. Kidney biopsy showed thickening of the glomerular basal membrane and staining with Masson trichrome showed sub-epithelial humps. Immunofluorescence was negative except for IgA (+), C3c (+) and IgG (+). A diagnosis of membranous nephropathy was made. Secondary causes, such as neoplasic, infectious and autoimmune, were ruled out. Despite 6 months of conservative measures, proteinuria increased to 11 g/day. Since HIV viral load had been undetectable for several years, along with a CD4+ T cell count persistently above 400/mm3, a modified Ponticelli regimen was started: 3 pulses of methylprednisolone (1g/day), followed by 60 mg of prednisolone/day at months 1, 3 and 5, and cyclophosphamide 200mg/day at months 2, 4 and 6. At the end of the treatment, there was a partial response with proteinuria 3.94 g/day, albumin 3.2 g/dL, and creatinine 0.8 mg/dL. At 48 months of follow-up, the patient is asymptomatic, with creatinine 0.84 mg/dL and proteinuria 0.97 g/day. Conclusion: Membranous nephropathy should be considered in the differential diagnosis in patients with HIV infection complicated by nephrotic syndrome even in the absence of other coinfections and comorbidities typically associated with membranous nephropathy. In patients with sustained negative viral loads and at high risk of progression to end-stage renal disease, in whom secondary causes have been excluded, immunosuppressive therapy might be considered.

Background: Infective endocarditis (IE) is rarely described among renal transplant recipients. Methods: We conducted a retrospective study to identify all cases of IE in our renal transplant unit between 1992 and 2012 to elucidate IE’s clinical features and outcomes. Modified Duke criteria were applied to confirm diagnosis and patient evolution was evaluated. Results: Between 1992 and 2012, our renal transplant unit performed 1065 renal transplants. Seven episodes of IE were identified in six patients. Median age at presentation was 59 years and most cases occurred in males (71.4%). Blood cultures were negative in 42.9% of patients. Gram positive coccus were the most frequent etiologic agents. There were no fungal endocarditis. Aortic valve was involved in all patients. Three patients underwent cardiac surgery. Mortality at 30 days and 2 years were 16.7%. Conclusion: Infective endocarditis in renal transplant patients remains a rare disease. The diagnosis is challenging considering nonspecific presentation and the high proportion of negative blood cultures.

A correcção da clorose férrica em fruteiras instaladas em solos calcários faz-se frequentemente recorrendo a aplicações massivas de quelatos férricos sintéticos ao solo. No entanto, a aquisição destes quelatos é muito dispendiosa e o ferro aplicado num ano não previne o aparecimento da clorose no ano seguinte, e estas aplicações repetemse anualmente para o mesmo pomar. Com o presente trabalho pretende-se fazer uma revisão sobre o actual estado de conhecimentos relativo às práticas alternativas de correcção da clorose férrica e apresentar os resultado obtidos em ensaios realizados em campo onde se testou a aplicação foliar de diversos compostos em citrinos estabelecidos num solo calcário. A capacidade de recuperação das árvores foi estimada pelo aparelho SPAD-502 através da variação da concentração foliar de clorofila total entre o início e o final dos ensaios. No final dos ensaios foi ainda analisado o efeito dos tratamentos na composição mineral das flores. Simultaneamente, avaliou-se a duração dos efeitos de algumas das pulverizações efectuadas. Os resultados obtidos sugerem que as aplicações foliares de ferro em pomares de citrinos permitem controlar os decréscimos de produção e de qualidade do fruto motivados pela clorose férrica induzida pelo calcário. Além disso, estes tratamentos podem ser efectuados com produtos economicamente mais viáveis, como sejam as soluções com sulfato de ferro., Revista de Ciências Agrárias, vol. 32 n.º 1 (2009)

Incident and prevalent patients on dialysis are progressively older, with high comorbidity burden and functional dependency. Many could have benefited from a conservative approach, since considerations of symptoms, autonomy, quality of life and hospital-free days are sometimes more important for patients and families than survival. As result, nephrologists around the world are facing challenges to determine which treatment best fits their patients. Comprehensive conservative care in chronic kidney disease care has been recently defined as a holistic, multidisciplinary and patient-centered approach for care of patients with stage 5 CKD. It does not include dialysis, and a shared-decision-making process and advanced care planning are central pillars, providing a way to meet patient and families goals. This review will focus on comprehensive conservative care in CKD in order to provide a communication framework for decision-making process as a guide for nephrologists and other health care professionals.

The body of relevant literature in the digital information age is growing rapidly. Detecting the signs of potential valuable ideas has theoretical and practical benefits which can help one understand when, how and why a research issue has potential value in the scientific domain. The perceived value of this paper is to show the contribution of a scientometric analysis for an up-to date understanding of the scientific field’s intellectual structure and identify exactly how a current issue connects with previously disparate patches of knowledge, creating a network of ideas cognitively demanding. Applying a multiple temporal, structural and semantic metrics, scientometric analysis allows the visualization of patterns from both citing and cited items. The temporal interval is sliced into equal mutually exclusive time periods, and an individual citation network is derived from each slice. Networks of keywords, authors, categories, sources of publication are included for a better understanding of the subject of the scientific domain. This analysis allows the identification of trends and areas of research conducted so far, and an appreciation of the most relevant authors, papers, sources of publication, showing where most of the studies have been performed. This is pertinent if the trust of future research is to incorporate more innovative approaches. By building on prior research this creates a strong theoretical background, which is an issue in various areas of research, namely, tourism and marketing. Executives who continue to attempt to navigate with out-of-date strategies will be ill-prepared to avail themselves of the immense opportunities. Scientometrics provides a reflexive marking of research into any knowledge domain. info:eu-repo/semantics/acceptedVersion

A limit number of studies have applied bibliometric visualisation to explore the network structure of Alzheimer’s Disease (AD). This paper uses CiteSpace, Carrot and VOSviewer to analyse and visualise the intellectual structure of AD, characterizing, quantitatively and qualitatively, the global scientific outputs, and identifying their trends. The 9,753 articles obtained from the science citation index expanded database (SCI-E), from Web-of-Science, were analysed. The publication data is analysed computationally to identify publication patterns, a rate of growth of publications, types of authorship collaboration, the most productive authors, countries, institutions, journals, keywords, the citation and keyword patterns, the hotspots and the areas of research on the AD. The paper presents a detailed analytical mapping of AD research and charts the progress of discipline with various useful parameters. The authors expect to contribute to the theory, supplying researchers with new tools and enabling practitioners to improve their knowledge about the AD evolution and trends. info:eu-repo/semantics/acceptedVersion

This paper seeks to make three contributions to the senior tourism literature. The first apllies a scientometric review to analyse when, how and why the subject title has potential value in scientific domain; the second measure and validate senior tourists’ emotional experiences when vacationing in Lisbon, adapting Hosany and Gilbert Destination Emotion Scale (DES); and the third identifies the effect of positive emotions on push motivations. The scientometric review over 18479 bibliographical records published since 1900, were retrieved by terms from the Web-of-Science and exported to CiteSpace. A sample of 464 senior tourists vacationing in Lisbon was conducted to analyses the synergetic effect of emotions on the travel motivations of senior tourists, applying structural equations modeling (SEM). The results shows the association between positive emotions, place attachment and push motivations in seniors tourist experience, through the connection between ten areas of research in the knowledge domain: the first seven major clusters (#0 to #6), and three small clusters: #10 with the reference Jang, (2009); # 41, with the reference Sangpikul, (2008) and cluster #48 with the reference Pearce, (2005).

A number of molecules have been shown recently to be involved in the pathogenesis and progression of immunoglobulin (Ig)A nephropathy(IgAN). Among these, we have selected C4d (complement lectin pathway involvement), CD3 (T cell marker, traducing interstitial inflammation),transglutaminase 2 (TGase-2, involved in tissue fibrosis development) and p-extracelluar-regulated kinase (ERK)1/2 (protein kinase intracellular signaling molecule) to perform a panel of immunohistological biomarkers and assess its predictive value for disease progression. Immunohistochemical staining of these biomarkers was performed in paraffin sections from 74 renal biopsy cases with the clinical diagnosis of IgAN. Association between score analysis of these parameters and disease course was assessed through univariate and multivariate analysis, including baseline clinical and histological data. Univariate analysis showed that glomerular C4d,tubulointerstitial TGase2 and CD3 scores were associated with baseline proteinuria and disease progression. Multivariate analysis showed that only baseline estimated glomerular filtration rate (eGFR), C4d and CD3 were associated independently with progressive kidney disease (decline of at least 50% in the eGFR or progression to end-stage renal disease (ESRD) during the follow-up period). Establishing an accurate prediction model for IgAN progression is still a matter of research in clinical nephrology. The complement system, particularly lectin pathway activation, and T cell activation, have been shown previously to be potential modifiers of the disease course. Here we show that the combination of two histological biomarkers (C4d and CD3) can be a powerful predictor of IgAN progression and a potential useful tool for the clinical approach of this disease.

Changes in nutritional status and high blood pressure are very common in elderly with mental disorders. Currently, the interest in knowing associated factors to those variables is to prevent morbidity and mortality risk. The study aim was to evaluate the relationship between mental disorders, nutritional status and blood pressure. It´s a cross-sectional study in a sample of 99 elderly living in community that had a psychiatric emergency episode. Data were collected from the initial evaluation form (IE). Results show multiple pathologies, cognitive deficits, high blood pressure and change in body mass index (BMI). Conclusion: In most of the sample BMI is associated with several co morbidities and co-exists with a temporal disorientation and arterial hypertension. Prevention is the key to maintaining health and well-being. info:eu-repo/semantics/publishedVersion

Aim: Increased FGF23 blood levels were found intact and biologically active in peritoneal dialysis (PD) patients. We aimed to evaluate in PD patients the associations between regulators of phosphate (Pi) metabolism including FGF23 and peritoneal daily Pi removal (PDPiR). Methods: Sixty-four adult patients (male 56%, mean age 48 ± 13 years, median time on PD 3.4 months) were evaluated in a cross-sectional study (ST1). Daily Pi intake was assessed by food frequency questionnaire. Intact FGF23 blood levels were evaluated by ELISA (Immutopics, Inc., San Clemente, CA). The first 33 patients who completed 1 year after the first evaluation were re-evaluated. (longitudinal study, ST2). Results: In ST1, both circulating FGF23 and Pi serum levels were associated with PDPiR (β=0.533, p=0.002 and β=0.342, p=0.045, respectively) independent of iPTH, dietary Pi intake, renal daily Pi removal, dialysate/plasma creatinine concentration ratio (D/P Cr), residual renal function (RRF), ultrafiltration volume, dwell volume, number of exchanges and dialysis vintage. In ST2, the increase in PDPiR was only correlated with the increase in FGF23 (β=0.480, p=0.012) independently of changes in serum Pi, RRF, renal daily Pi removal and D/P Cr. Conclusions: Differences in circulating FGF23 and Pi serum levels contribute both independently to heterogeneity of PDPiR in PD patients

Pathogenic mutations in genes COL4A3/COL4A4 are responsible for autosomal Alport syndrome (AS) and thin basement membrane nephropathy (TBMN). We used Sanger sequencing to analyze all exons and splice site regions of COL4A3/COL4A4, in 40 unrelated Portuguese probands with clinical suspicion of AS/TBMN. To assess genotype-phenotype correlations, we compared clinically relevant phenotypes/outcomes between homozygous/compound heterozygous and apparently heterozygous patients. Seventeen novel and four reportedly pathogenic COL4A3/COL4A4 mutations were identified in 62.5% (25/40) of the probands. Regardless of the mutated gene, all patients with ARAS manifested chronic renal failure (CRF) and hearing loss, whereas a minority of the apparently heterozygous patients had CRF or extrarenal symptoms. CRF was diagnosed at a significantly younger age in patients with ARAS. In our families, the occurrence of COL4A3/COL4A4 mutations was higher, while the prevalence of XLAS was lower than expected. Overall, a pathogenic COL4A3/COL4A4/COL4A5 mutation was identified in50% of patients with fewer than three of the standard diagnostic criteria of AS. With such a population background, simultaneous next-generation sequencing of all three genes may be recommended as the most expedite approach to diagnose collagen IV-related glomerular basement membrane nephropathies.

As quedas na população psicogeriátrica são um importante problema de saúde particularmente em situações de internamento ou institucionalização de longo prazo. São reconhecidas as repercussões na funcionalidade e na qualidade de vida e os elevados custos socio económicos. De etiologia multifatorial, pela sua gravidade e custos requer intervenção preventiva. Objetivos: Determinar a prevalência de quedas das pessoas idosas com perturbação mental residentes numa unidade saúde de longa duração (USLD) e os fatores associados. Metodologia: Trata-se de um estudo quantitativo, correlacional transversal a 80 idosos com perturbação mental, residentes numa ULSD do Centro de França. Estudou-se a prevalência de queda e fatores associados. Os dados foram colhidos da ficha de dados sociodemográficos; escala de funcionalidade Aggir e o evento de queda. Foram respeitados os princípios éticos. Resultados: Os resultados sugerem uma prevalência de 25% de quedas numa população envelhecida. A perturbação mental e a dependência são fatores em realce. Conclusão: Uma complexa interação entre múltiplos fatores pessoais, ambientais e sociais na etiologia de queda sugere a importância da prevenção e de programas de monitorização do risco a ela associados.

O objectivo deste artigo é examinar os hábitos de estudo e os estilos de aprendizagem entre os alunos do primeiro ano que frequentam universidades públicas e compará-los com os que frequentam universidades privadas, tendo em vista identificar os atributos desses estudantes que podem influenciar a adopção de um ou outro estilo. A compreensão destas diferenças por parte dos professores permite uma maior probabilidade de se orientarem para a excelência do ensino, com consequentes melhorias na aprendizagem e no sucesso académico dos estudantes. FCT

[Resumo] [Abstract]

WOS:000309753200004 (Nº de Acesso Web of Science) Sensory assessment of individuals with profound intellectual and multiple disabilities (PIMD) can be extremely difficult for several reasons, including the idiosyncratic reactions that these individuals commonly exhibit to environmental stimuli. This case report presents a combination of behavioural and physiological measurements aimed at providing an objective assessment of the sensory responsiveness of a child with PIMD. Settings/location, subjects, and interventions: The participant was presented, at his home, with a set of stimuli commonly used during sensory interventions. Responsiveness to these stimuli was assessed in terms of motor movements, heart rate and electrodermal responses. Treatment outcomes: Although the child only seemed to react to two of the presented items, interesting connections were observed between his motor and physiological responsiveness. Conclusions: The methodological approach here presented appears to constitute a useful resource for understanding and ascribing meaning to the behaviours of children with PIMD that represent specific reactions to particular stimuli. With such a resource

To assess the effect of mycophenolate mofetil compared with intravenous pulses of cyclophosphamide on the nonrenal manifestations of lupus nephritis.Patients with active lupus nephritis (renal biopsy class III, IV, or V) were recruited for the study (n = 370) and treated with mycophenolate mofetil (target dosage 3 gm/day) or intravenous cyclophosphamide (0.5-1.0 gm/m(2)/month), plus tapered prednisone, for 24 weeks. Nonrenal outcomes were determined using measures of whole body disease activity, including the British Isles Lupus Assessment Group (BILAG) disease activity index, the Safety of Estrogens in Lupus Erythematosus: National Assessment (SELENA) version of the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), and immunologic variables.Both treatments were effective on whole body disease activity in the systems examined, as indicated by changes in the classic BILAG index. With either treatment, remission was induced, notably in the mucocutaneous, musculoskeletal, cardiovascular/respiratory, and vasculitis systems, and flares were rare, as measured by the SELENA-SLEDAI. Levels of complement C3, C4, and CH50 and titers of anti-double-stranded DNA antibodies were normalized after treatment with either mycophenolate mofetil or intravenous cyclophosphamide.In addition to the efficacy of both treatments on the renal system, this analysis showed that remission could also be induced in other systems. There was no clear difference in efficacy between mycophenolate mofetil and intravenous cyclophosphamide in ameliorating either the renal or nonrenal manifestations. Mycophenolate mofetil is, therefore, a suitable alternative to cyclophosphamide for the treatment of renal and nonrenal disease manifestations in patients with biopsy-proven lupus nephritis.

Proceedings of the International Conference “Environmentally friendly and safe technologies for quality of fruit and vegetables”, held in Universidade do Algarve, Faro, Portugal, on January 14-16, 2009. This Conference was a join activity with COST Action 924. Iron deficiency (iron chlorosis) is an important nutritional disorder in several plants, including fruit trees and strawberry. Iron chlorosis does not result from a small level of iron in soils but rather from impaired acquisition and use of this metal by plants. Calcium carbonate, present in great amounts in calcareous soils, and the resulting large levels of bicarbonate ions, are the main causes of iron deficiency. Countries in southern Europe, such as Portugal, Spain, Italy and Greece, have large areas of calcareous soils with established orchards, where iron chlorosis is a major factor that limits yield and profit for the farmer. Iron chlorosis affects several metabolic processes and leads to nutrient imbalances in sensitive plants. Decreased yield and poor quality of fruit resulting from the iron deficiency justify the development of methods to diagnose and correct this disorder. No single approach has been found to solve iron chlorosis satisfactorily, making it one of the most complex nutritional deficiencies known. In this chapter we describe some aspects of the effects of iron availability on quality of strawberry and citrus fruit.

In this work we compare the results of three experimental series of tests used as a first approach on selection of natural products for wood preservation.

Recent studies have suggested that mycophenolate mofetil (MMF) may offer advantages over intravenous cyclophosphamide (IVC) for the treatment of lupus nephritis, but these therapies have not been compared in an international randomized, controlled trial. Here, we report the comparison of MMF and IVC as induction treatment for active lupus nephritis in a multinational, two-phase (induction and maintenance) study. We randomly assigned 370 patients with classes III through V lupus nephritis to open-label MMF (target dosage 3 g/d) or IVC (0.5 to 1.0 g/m(2) in monthly pulses) in a 24-wk induction study. Both groups received prednisone, tapered from a maximum starting dosage of 60 mg/d. The primary end point was a prespecified decrease in urine protein/creatinine ratio and stabilization or improvement in serum creatinine. Secondary end points included complete renal remission, systemic disease activity and damage, and safety. Overall, we did not detect a significantly different response rate between the two groups: 104 (56.2%) of 185 patients responded to MMF compared with 98 (53.0%) of 185 to IVC. Secondary end points were also similar between treatment groups. There were nine deaths in the MMF group and five in the IVC group. We did not detect significant differences between the MMF and IVC groups with regard to rates of adverse events, serious adverse events, or infections. Although most patients in both treatment groups experienced clinical improvement, the study did not meet its primary objective of showing that MMF was superior to IVC as induction treatment for lupus nephritis.

The correction of iron chlorosis in trees grown on calcareous soils is normally achieved by the application of Fe (III)chelates such as iron ethylenediaminedi-ohydroxyphenylacetate (Fe-EDDHA) to the soil. This practice is very expensive and has to be repeated every year because iron is rapidly immobilized in the soil or leached out of the root zone. The responses of orange trees (Citrus sinensis (L.) Osb. cv. ‘Valencia Late’) grown on a calcareous soil to different foliar sprays were studied. In all the experiments, the recovery from iron chlorosis was evaluated with the SPAD-502 apparatus and the values converted to total chlorophyll concentration. The effects of treatments on themineral composition of flowers were studied. The residual effect of some treatments was also evaluated one year later. These results suggest that foliar sprays with Fe could help to avoid yield and quality losses caused by Fe chlorosis in citrus orchards. Furthermore, these treatments could be done with relatively cheap materials such as solutions containing Fe (II) sulphate