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Context Lithothamnion calcareum is a calcitic seaweed (CS), rich in calcium (Ca) and other minerals, with potential for use in piglet feeding. Aim The aims were to compare L. Calcareum (CS) with calcitic limestone (CL) as a source of Ca for use in piglet feeding for effects on total tract digestibility and daily balance of Ca, growth performance and serum variables, and to assess solubility of Ca sources through in vitro testing. Methods In Expt 1, an availability assay was performed on 24 crossbred male piglets with initial average body weight (BW) of 15.17 ± 0.70 kg in a randomised complete block design with six replicates of four treatments and one piglet per experimental unit. The starter dietary treatments were: basal diet with minimal amount of Ca (0.068%); diet with low Ca (0.018%); and two diets containing either CL or CS to provide 0.82% total Ca. In Expt 2 (growth performance), 96 crossbred male piglets, with initial average BW of 6.01 ± 0.70 kg were assigned in a randomised complete block design with eight replicates of three treatments (CL, CL + CS, or CS) and four piglets per experimental unit, assessed over pre-starter phases I and II and the starter phase. Key results In Expt 1, Ca source did not influence (P > 0.05) apparent and true digestibility or daily balance and concentration of Ca in the piglets. In Expt 2, no significant differences (P > 0.05) existed for growth performance during the pre-starter I and II phases, although a trend (P ≤ 0.1) was evident for final BW, daily weight gain and feed conversion ratio (FCR) during the pre-starter II phase. Piglets fed CL showed a reduction in FCR during the starter phase (P = 0.02) and for the total period (P = 0.007). Final BW and daily weight gain did not differ between CL and CS diets during the starter phase or for the total period. No effect (P > 0.05) was observed of Ca source on Ca and phosphorus concentrations in serum. CS had a solubility 1.9 times higher than CL. Conclusion Piglet performance parameters were generally similar for diets including CS and CL as a source of Ca. Implications Based on the evaluation criteria used in these experiments, L. calcareum has potential to replace calcitic limestone as an alternative source of Ca.

Concentrated agave sap is a product with in vivo proven hypocholesterolemic and hypoglycemic activities, as well as in vitro anticancer potential. In the present work, a factorial design was used to determine the suitable drying conditions of concentrated agave by studying the effect of inlet temperature (150 °C, 180 °C and 210 °C) and the type of carrier agent (maltodextrin, hydroxypropyl methylcellulose, guar gum and xanthan gum). The response variables for each treatment were the product recovery and microencapsulated saponins. Further characterization of concentrated agave powders was performed: solubility in water, hygroscopicity, moisture content, tap density, bulk density, Carr’s index followability and morphology by scanning electron microscopy analysis. The hydroxypropyl methylcellulose proved to improve physicochemical properties and enhance product yield, using 210 °C inlet temperature and a mix of carrier agents of maltodextrin/hydroxypropyl methylcellulose/xanthan gum at 50/48.5/1.5 (w/w/w) proportion exhibited the highest saponin recovery of 53.81%. Moreover, different carrier agents in powders revealed two shapes, regular spherical shape with smooth surface and collapsed shapes. The use of polymers excipients helped to decrease the stickiness of the desired product and enhanced the powder stability and microencapsulation of the steroidal saponins.

Objective Evaluate the partial replacement of soybean meal with different protein sources in piglet feed during the nursery phase in terms of digestibility of feed, nitrogen balance, growth performance and blood parameters. Methods Experiment I involved 24 crossbred entire male pigs with an initial body weight of 18.28 ± 0.7 kg, and used a randomized complete block design consisting of three treatments (Fish Meal - FM, Soybean Protein Concentrate - SPC, and Soybean Meal - SM) and eight replicates, with one pig per experimental unit. Experiment II involved 1843 crossbred male and female pigs with an initial body weight of 6.79 ± 0.90 kg, and was based on a completely randomized design with a 2 × 3 factorial arrangement (two sexes and three protein sources) and 13 replicates. Results The results of Experiment I indicate a significant effect (p

Neutral electrolyzed water (NEW) was tested as a disinfectant against Listeria monocytogenes on the surface of table eggs. Eggs were collected from a single Bovans White flock and were exposed to L. monocytogenes. Artificially contaminated eggs were divided into three different treatment groups: NEW, 2% citric acid solution (CAS), and saline solution (SS). To evaluate the bactericidal effect, the Mexican norm for antimicrobial activity determination protocol was performed. The observed bactericidal effect was compared against those obtained from CAS and SS. Bacterial cells present on the eggshells were quantified. NEW exhibited a significantly higher bactericidal effect than CAS when evaluated on the surfaces of chicken eggshells (6.11 log10CFU/ml reduction in vitro and a 2.18 log10 CFU/egg reduction on eggs vs. 1.06 log10CFU/ml in vitro reduction and 1.74 log10CFU/egg). Additionally, CAS was found to react with the carbonate egg shield, resulting in a loss of cuticle integrity. Mineral content of NEW‐treated eggshells was similar to SS‐treated eggshells; however, CAS‐treated eggshells showed a significant decrease in phosphorous concentration compared to NEW treatment. In this study, we demonstrated the effect of NEW and CAS on the integrity of the L. monocytogenes wall using transmission electron microscopy. To the best of our knowledge, this is the first report of the effect of NEW against L. monocytogenes on eggshells. Our results show that NEW is a viable alternative solution for the disinfection of table eggs that does not affect the cuticle or shell.

The genus Diaporthe is a cosmopolitan group of fungi that includes important plant pathogens, endophytes and saprobes with the ability to colonize a wide range of plant hosts. Pathogenic Diaporthe species are often reported to cause symptoms like dieback, stem canker, leaf spots, fruit rots and seed decay resulting in important economic losses on several crops. However, the occurrence of Diaporthe species associated with forest hosts and their pathogenic potential is poorly understood. We studied a collection of Diaporthe isolates obtained from a survey of forest‐related fungal diseases on Eucalyptus globulus, Pinus pinaster and Quercus suber in Portugal. Several Diaporthe species (D. eres, D. rudis, D. crousii, D. malorum and D. foeniculina) were found among the studied hosts. Pathogenicity trials were conducted to analyse the pathogenic potential and the ability to colonize putative new hosts. We report the occurrence of D. eres on P. pinaster in Portugal and a new host association with Q. suber. Additional new host reports were as follows: D. malorum and D. crousii on E. globulus, D. foeniculina on Q. suber and D. rudis on P. pinaster. Overall, Diaporthe species were shown to have low pathogenic impact on forest hosts under non‐stress conditions, despite their capability to colonize different hosts during the pathogenicity trials.

Egg-yolk based supplements have demonstrated biological effects. We have developed a novel processed egg-yolk (PEY) complement, and we have tested whether it has inflammation modulatory properties. These were evaluated in a lipopolysaccharide (LPS)-challenge in 1-month male rats by in vivo circulating cytokine profiles measured by multiplexing techniques. Cell culture was used to explore ex vivo properties of derived serum samples. We explored growth factor composition, and mass-spectrometry metabolome and lipidome analyses of PEY to characterize it. PEY significantly prevented LPS-induced increase in IL-1 &beta, TNF-&alpha, and MCP-1. Further, serum from PEY-treated animals abrogated LPS-induced iNOS build-up of the Raw 264.7 macrophage-like cell line. Immunochemical analyses demonstrated increased concentrations of insulin-like growth factor 1 (IGF-1), connective tissue growth factor (CTGF), and platelet-derived growth factor (PDGF) in the extract. PEY vs. egg-yolk comparative metabolomic analyses showed significative differences in the concentrations of at least 140 molecules, and in 357 in the lipidomic analyses, demonstrating the complexity of PEY. Globally, PEY acts as an orally-bioavailable immunomodulatory extract that may be of interest in those conditions associated with disarranged inflammation, such as inflammaging.

Phenolic compounds are a widespread group of phytochemicals derived from the secondary metabolism of herbs and plants. Phytochemicals are mainly produced as a plant response to biotic and abiotic stresses to overcome/adapt these adverse conditions. The study of abiotic stress response of plants has led to numerous discoveries regarding flavonoids and phenolic acids biosynthetic pathways. Since phenolic compounds such as flavonoids and phenolic acids have been related to numerous bioactive health effects, it is of interest to enhance the content of these compounds in plants and herbs. One of the most studied abiotic stresses on herbs is manipulation of light, whether through use of different light colors, light intensity, and/or sunlight. One of the most active groups of compounds elicited in response of light stress is flavones, flavonols, and some phenolic acids. These groups of compounds have been related to health benefits to humans such as antioxidant, cardiovascular disease, and against metabolic syndrome. This chapter aims to comprehensive review recent works on this field.

Physical activity (PA) may improve COPD prognosis, thus its assessment and promotion are crucial. The International Physical Activity Questionnaire Short-Form (IPAQ-sf) is widely used for assessing PA but there is limited evidence on its clinimetric properties in COPD. We assessed the test-retest reliability and validity of the IPAQ-sf in patients with COPD. Fifty-five participants (68.6±7.8yrs, 48 males, FEV1 52.3±22.5%pred) completed the IPAQ-sf, wore an accelerometer for 7 days and completed a second IPAQ-sf. Test-retest reliability/agreement was assessed with: Intraclass Correlation (ICC, 95%CI), 95% Limits of Agreement (LoA), standard error of measurement (SEM) and minimal detectable change (MDC95) for continuous variables; %agreement for categories (“active” vs “inactive”). Validity was assessed with Spearman’s correlations (ρ) between the IPAQ-sf (METs-min/week, time in vigorous [VPA] and moderate PA [MPA] per week) and accelerometry [time in MVPA, VPA and MPA per week] for continuous variables; %agreement, Cohen’s kappa, sensitivity and specificity (95%CI) for categories. Reliability was acceptable (ICC=0.738, 0.629→0.873) but with wide LoA (-5713→4793.3 METs-min/week). SEM and MDC95 were 1844.7 and 5113.3 METs-min/week, respectively. %agreement of the two IPAQ-sf was 85.5% (kappa=0.660, 0.444→0.876). Significant correlations were found between METsmin/week and accelerometry (0.515≤ρ≤0.596), except for VPA (p>0.05). %agreement between tools was 67.3% (kappa=0.350, 0.279→0.571) with high sensitivity (0.89, 0.887→0.891) but low specificity (0.46, 0.46→0.47). The IPAQ-sf could be used as PA measurement tool in COPD although caution is needed to avoid misclassification. info:eu-repo/semantics/publishedVersion

1. Catarina S. Oliveira, MD, MMed* 2. Ines Pessanha, MD, MMed† 3. Liliana Santos, MD, MMed† 4. Marta Machado, MD, MMed* 5. Raquel Zenha, MD* 1. *Department of Pediatrics, Baixo Vouga Medical Center, Aveiro, Portugal 2. †Department of Pediatric Surgery, Coimbra Hospital and Universitary Centre, Coimbra, Portugal A 21-day-old boy presents to the emergency department for the third time in 24 hours due to a 2-day history of an umbilical mass noted to be draining fluid. The mass is growing in size and increasing its drainage. The patient has an unremarkable medical history, and his umbilical stump fell off when he was 15 days old. During the patient’s first 2 trips to the emergency department, it was assumed that he had a bleeding granuloma. He was first treated with silver nitrate and then with a porcine gelatin absorbable sponge. The physical examination during this third visit reveals a comfortable boy with an umbilical mass that is draining a blood-tinged greenish-yellow liquid. Abdominal palpation seems to cause airflow from a small stoma in the umbilical mass (Fig 1). A catheter is inserted into the stoma, and airflow through the catheter is noted. Additional imaging confirms the diagnosis. Figure 1. Photograph of the umbilical mass where a small stoma is seen (white arrow). The physical examination suggests a patent omphalomesenteric duct (POMD). Ultrasonography is performed, revealing a hypoechogenic area between the umbilical mass and the small bowel. No other abdominal anomalies are observed. To better characterize the hypoechogenic mass, fistulography is performed and shows a patent duct between the stoma of the umbilical mass …

The acute idiopathic scrotal edema (AISE) is a self-limited condition of uncertain etiology, characterized by an inflammatory scrotal sac thickening without expansion to the underlying layers of the scrotal wall or to the endoscrotal structures. We describe a case of a 9-year-old boy with no previous relevant medical or surgical history who presented with left acute scrotal edema and erythema extending to the ipsilateral inguinal region, perineum, buttock and upper thigh. Laboratory results were normal and the ultrasound showed thickening and edema of the left scrotal layers with a color-Doppler sign revealing intense hypervascularity of the peritesticular scrotal soft tissue with a normal testis and epididymis. Remission of symptoms occurred 60 h after presentation. This case highlights the importance of recognizing this rare condition that has characteristic clinical and ultrasonographic features. A correct diagnosis can avoid unnecessary surgical exploration of the scrotum.

Background Kidney transplantation is the treatment of choice for patients with end-stage renal disease. The standard surgery uses the recipient's iliac vessels for vascular anastomosis. Thrombosis and/or stenosis of the iliac vein, which are possible complications of multiple vascular access points for dialysis, can be detected intraoperatively, constituting a surgical challenge. An infrequently reported option is the use of the gonadal vein. Objectives This study aims to evaluate the outcomes of venous anastomosis in the gonadal vein in patients with iliac vein thrombosis and/or stenosis submitted to kidney transplantation. Methods. We reviewed the records of five adult recipients with iliac vein thrombosis and/or stenosis detected intraoperatively during emergency kidney transplantation with deceased donor due to vascular access failure from February 2013 to December 2014. Antithrombotic prophylaxis was not performed. We evaluated the postoperative complications, length of stay, early graft echo-Doppler, and renal function during the first year postoperatively. Results Delayed graft function occurred in three cases. Two patients developed postoperative infection requiring antibiotics. One patient required reoperation due to post-renal biopsy complications. The mean length of stay was 31.2 days and the mean serum creatinine levels at discharge, at 6 months, and at 12 months postoperatively were 1.42 mg/dL, 0.86 mg/dL, and 0.82 mg/dL, respectively. All patients had normal ultrasonography. There were no losses of graft or deaths during follow-up. Conclusion Venous anastomosis using the gonadal vein in kidney transplantation for patients with iliac vein thrombosis and/or stenosis showed good clinical and surgical results, showing this method to be a viable alternative to venous drainage in these complex patients.

The family Rosaceae includes a large number of species ranging from herbaceous (Fragaria) to ornamental plants (Rosa and Pyracantha) and fruit trees (Malus and Pyrus). Diaporthe species have been associated with twig canker, shoot blight, dieback, wood decay and fruit rot on members of the Rosaceae. In this study a collection of isolates from several Rosaceae hosts were characterised by multi-locus sequence analyses using the internal transcribed spacer, translation elongation factor 1-alpha, beta-tubulin, histone H3 and calmodulin loci. The phylogenetic analyses of the combined five loci revealed that the isolates studied were distributed among four clades, of which two correspond to D. foeniculina and D. eres. The other two clades, closely related to D. passiflorae and D. leucospermi represent two new species, D. pyracanthae sp. nov. and D. malorum sp. nov., respectively. Further, pathogenicity assays have shown that of the four species tested, D. malorum was the most aggressive species on apple fruit and D. eres was the most aggressive species on detached pear twigs. A revision of all Diaporthe (and Phomopsis) names that have been associated with Rosaceae hosts as well as their current status as pathogens of members of this family is presented.

Neutral Electrolyzed Water (NEW) was tested in vitro and on artificially contaminated eggs against Salmonella enterica subsp. enterica or Escherichia coli. The antibacterial effect was measured 30 s after treatment. NEW microbicide activity results were compared against 2% citric acid and 0.9% saline solutions. NEW caused an in vitro decrease in Salmonella titers by ˃5.56 Log10 CFU mL−1 and in artificially contaminated eggs by ˃1.45 Log10 CFU/egg. When it was tested against E. coli, it decreased in vitro bacterial titers by ˃3.28 Log10 CFU mL−1 and on artificially contaminated eggs by ˃6.39 Log10 CFU/egg. The 2% citric acid solution caused an in vitro decrease of 0.4 Log10 CFU mL−1 of Salmonella and E. coli and on eggs artificially contaminated with E. coli or Salmonella there was a decrease of 0.06 and 0.62 Log10 CFU/egg respectively. We evaluated egg cuticle integrity by scanning electron microscopy after treatments with evaluated solutions; the 2% citric acid solution caused damage to the cuticle and exposed eggshell pores and no interaction of NEW or NaCl with the cuticle was observed. NEW treatment showed a fast-bactericidal effect in vitro and table eggs.

Von Willebrand disease (vWD) is the most prevalent hereditary bleeding disorder, affecting 0.6-1.3% of the population. While gastrointestinal bleeding from angiodysplasia is a well-known complication of vWD, the same is not true for Dieulafoy’s lesions (DLs). We report the case of a 21-year-old black male with type 1 vWD and 2 previous hospital admissions for severe anemia with no visible blood loss. In both episodes, DLs were identified and treated endoscopically, one in the stomach and another in the duodenum. The patient presented to the emergency department in September 2016 with dizziness, fatigue, and again no visible blood loss. He was hemodynamically stable, and laboratory workup showed a hemoglobin level of 3.4 g/dL. After transfusion of packed red blood cells, intravenous iron, and von Willebrand factor/factor VIII concentrate infusions, the patient underwent upper endoscopy and colonoscopy, which were normal. Small-bowel capsule endoscopy showed dark blood and a fresh clot in the proximal jejunum. At this site, push enteroscopy identified a pulsatile vessel with an overlying minimal mucosal defect, consistent with a DL, type 2b of the Yano-Yamamoto classification, which was successfully treated with adrenaline and 2 hemoclips. The patient remains stable after 18 months of follow-up, with a hemoglobin level of 13.2 g/dL. This is a case of recurrent severe occult gastrointestinal bleeding from multiple DL in a young patient with vWD who is otherwise healthy. Three other cases of DL bleeding in the setting of vWD have been reported in the literature, suggesting a possible association between these 2 entities. A doença de von Willebrand é a perturbação hemorrágica hereditária mais frequente, afetando 0.6 a 1.3% da população. A hemorragia por angiectasias do tubo digestivo é uma complicação bem estabelecida desta doença. Contudo, o mesmo não é verdade para as lesões de Dieulafoy. Apresentamos o caso de um doente de 21 anos, melanodérmico, com doença de von Willebrand tipo 1 e dois internamentos prévios por anemia grave sem perdas hemáticas visíveis. Em ambos os episódios foram identificadas lesões de Dieulafoy que foram tratadas endoscopicamente, uma das quais no estômago e outra no duodeno. O doente foi admitido no serviço de urgência em Setembro de 2016 por quadro de tonturas e cansaço, novamente sem perdas visíveis. Apresentava-se hemodinamicamente estável e a avaliação laboratorial mostrou hemoglobina de 3.4 g/dL. Após transfusão de concentrados eritrocitários, terapêutica com ferro endovenoso e concentrados de fator de von Willebrand/fator VIII, foram realizadas endoscopia digestiva alta e colonoscopia, sem alterações. A enteroscopia por cápsula detetou a presença de sangue digerido e um coágulo fresco no jejuno proximal. A enteroscopia de pulsão identificou nessa topografia uma solução de continuidade da mucosa milimétrica sobre lesão vascular pulsátil procidente, compatível com lesão de Dieulafoy tipo 2b da Classificação de Yano-Yamamoto, que foi tratada eficazmente com adrenalina e dois hemoclips. Após 18 meses, o doente mantém-se clinicamente estável e com Hb 13.2 g/dL. Este é um caso particular de hemorragia gastrointestinal oculta recorrente por múltiplas lesões de Dieulafoy num jovem com doença de von Willebrand, sem outras patologias. Há três casos semelhantes descritos na literatura, sugerindo uma possível associação entre estas duas entidades.

Background: Smartphone apps may be valuable to promote physical activity (PA) behaviours in patients with COPD. However, studies assessing their effectiveness and actual usage have yielded mixed results. Assessing patients’ perspectives may result in more engaging and effective mHealth solutions. Aim: This study aimed to assess the needs and expectations of patients with COPD on the use of smartphone apps for PA promotion. Methods: Two focus groups were conducted with 9 patients (64.3±7.6yrs, 8 male, FEV1 59.4±18.1%pred). Data were analysed thematically. Results: All patients reported having a smartphone and using it for calls and text messages only (n=3), plus for accessing social networks (n=6), monitoring PA (n=3) and watching videos (n=1). When asked about a smartphone app for PA promotion, all patients were interested in using the app if it proves to able to encourage and guide them towards being more physically active. Needs and expectations regarding the app consisted of: 1) the use of a simple/clear language without foreign expressions, appropriate to their culture/education levels (n=8); 2) receiving detailed progress on PA with personalised goals adjusted to their health condition (n=8); 3) sharing experiences with other patients (n=4) and 4) monitoring physiological data (e.g., heart rate, oxygen saturation; n=2). Patients reported fear of being “abandoned” by health professionals if they used the app (n=4) and of exercising above their limits (n=2). Most patients highlighted the need for support on how to use the app and information about benefits and risks of PA (n=6). Conclusion: Findings from this study provide guidance to future mHealth PA interventions. published

Low physical activity (PA) is associated with reduced survival in patients with chronic obstructive pulmonary disease (COPD). Pulmonary rehabilitation (PR) is essential in COPD management but its influence on patients’ perspectives about PA has been overlooked. This study assessed PA enablers, barriers, needs and preferences of patients attending or not PR. Two focus groups were conducted. One with 6 patients (70.2±8.8yrs; FEV1 55.5±14.4pp) attending a PR programme and another with 6 patients (65±7.6yrs; FEV1 58.2±21.4pp) naïve to PR. Interviews were analysed thematically. Enablers, barriers and needs were similar in both groups. Enablers/barriers fitted in health-related, psychosocial and environmental sub-themes. Identified enablers included: recognising that PA delays the onset of frailty and promotes wellbeing and functionality, being motivated by their family and health professionals, and the availability of green spaces. Main barriers were dyspnoea/fatigue and cough, exacerbations, comorbidities, fear of feeling breathless, frailty, cold/humid weather, smoke, crowded places and not having a current job. Main needs were health professional guidance and self-management education, including training on how to dose PA. Both groups identified (dog) walking as a preferred activity. Other PA preferences differed between groups: patients naïve to PR preferred activities such as playing with grandchildren, gardening and walking in daily tasks (e.g., shopping), whereas the PR group preferred exercise-related activities such as cycling or treadmill. This study provides guidance for future PA-enhancing interventions in those with/without PR previous experience. published

Respiratory muscle weakness is frequent in chronic respiratory diseases. Several equations exist to predict maximum respiratory pressures but there are no recommendations of which should be used and none was developed for Portugal. This study revised predictive equations of maximum inspiratory (MIP) and expiratory (MEP) pressure for healthy adults and explored their suitability for the Portuguese population. A systematic review was conducted. Studies were eligible if they presented at least 1 equation for MIP or MEP developed for healthy adults. For equation testing, MIP/MEP were collected from healthy adults. Predicted values were computed from the equations and compared with actual values using Wilcoxon tests and Bland-Altman plots. 19 studies were included. 36 MIP and 30 MEP equations were found but only 32 and 25 were possible to test in 229 subjects (62%♂, 101.8±20.5FEV1pp, 66.7±9.7yrs). 4 MIP equations showed no significant differences between actual and predicted values (p>0.05, rs=0.32-0.47, R2=9-47%). From these, 3 overestimated (bias=0.19-4.06 cmH2O, men) and 1 underestimated (bias=0.99 cmH2O, women) the actual values (Fig. 1). All MEP equations showed significant differences between actual and predicted values. Only 4 MIP equations seem to be useful for the Portuguese population. Future studies should aim to develop an equation for the Portuguese population with higher coefficients of determination. published

Sap from agave plants (“aguamiel”) is traditionally consumed in Mexico as a fresh beverage, fermented or concentrated. Concentrated agave sap (CAS) is used as a sweetener but, due to heating, a brown color develops and intensifies during storage. Browning varies among CAS batches and this work was focused on its correlation with the chemical composition changes observed during 20 weeks of storage. The browning index (BI), measured as the optical density at 490 nm (OD 490 nm ) per gram of sample, increased 54.4% in the batch that initially had 57 OD 490 nm /g but in the other two batches that had a lower BI, the increase was less than 26.1%. Antioxidant capacity only increased in the batch with the highest BI going from 18 to 23 Trolox equivalent μmol/g dry weight. Saponin content was different in the three batches (224.2–434.7 protodioscin equivalents/gram dry weight) but did not change after 20 weeks of storage. Browning index and antioxidant capacity were negatively correlated with free amino acid concentration, particularly serine, phenylalanine and lysine decreased 29.4, 50 and 30%, respectively. Browning was positively correlated to furosine, an early Maillard reaction derivative of lysine previously reported as a free radical scavenger.

Submitted by arminda sustelo (arminda.sustelo@hff.min-saude.pt) on 2019-01-29T16:49:12Z No. of bitstreams: 1 Intern Emerg Med. 2018.pdf: 812672 bytes, checksum: 5f4ec3b9c26b1f3f06539c55ca33f888 (MD5) Made available in DSpace on 2019-01-29T16:49:12Z (GMT). No. of bitstreams: 1 Intern Emerg Med. 2018.pdf: 812672 bytes, checksum: 5f4ec3b9c26b1f3f06539c55ca33f888 (MD5) Previous issue date: 2018 info:eu-repo/semantics/publishedVersion

Introduction: Walled-off necrosis (WON) is a potentially lethal late complication of acute pancreatitis (AP) and occurs in less than 10% of AP cases. It can be located in or outside the pancreas. When infected, the mortality rate increases and can reach 100% if the collection is not drained. Its treatment is complex and includes, at the beginning, intravenous antibiotics, which permit sepsis control and a delay in the therapeutic intervention, like drainage. Nowadays, a minimally invasive approach is advised. Dependin on the location of the collection, computed tomography (CT)-guided drainage or endoscopic necrosectomy are the primary options, then complemented by surgical necrosectomy if needed. Infected WON of the abdominal wall has been rarely described in the literature and there is no report of any infection with Citrobacter freundii. Case: We present the case of a 61-year-old man with necrotizing AP complicated by WON of the left abdominal wall, infected with Citrobacter freundii that was successfully treated with CT-guided percutaneous drainage and intravenous antibiotics. Conclusion: Infected WON accounts for considerable mortality and its location in the abdominal wall is rare; it can be treated with antibiotics and CT-guided drainage with no need for further intervention. Introdução: A necrose pancreática coletada (NPC) é uma complicação potencialmente fatal da pancreatite aguda (PA) e ocorre em menos de 10% dos casos. Pode estar localizada dentro ou fora do pâncreas. Quando infetada, a mortalidade aumenta, podendo atingir os 100% se a coleção não for drenada. O seu tratamento é complexo e inclui, de início, antibioterapia intravenosa que permite o controlo da sepsis e um atraso na terapêutica de intervenção, como a drenagem. Atualmente é aconselhada uma abordagem minimamente invasiva. Dependendo da localização da coleção, a drenagem guiada por tomografia computorizada (TC) ou a necrosectomia endoscópica são as opções de primeira linha, posteriormente complementadas por necrosectomia cirúrgica, caso seja necessário. A NPC infetada na parede abdominal foi raramente descrita na literatura e não existe até ao momento nenhum caso de uma NPC infetada por Citrobacter freundii. Caso: Apresentamos o caso de um doente do sexo masculino de 61 anos com uma PA necrotizante complicada por NPC da parede abdominal esquerda, infetada por Citrobacter freundii, que foi tratada com sucesso através de drenagem percutânea guiada por TC e antibioterapia intravenosa. Conclusão: A NPC infetada condiciona mortalidade considerável e a sua localização na parede abdominal é rara; pode ser tratada através de antibioterapia e drenagem percutânea guiada por TC, sem necessidade de intervenção posterior.

Submitted by arminda sustelo (arminda.m.sustelo@hff.min-saude.pt) on 2020-06-22T15:51:18Z No. of bitstreams: 1 Clin Res Hepatol Gastroenterol.pdf: 516436 bytes, checksum: ac1051e7de87ed75dcd05a1c10bc94b4 (MD5) Made available in DSpace on 2020-06-22T15:51:18Z (GMT). No. of bitstreams: 1 Clin Res Hepatol Gastroenterol.pdf: 516436 bytes, checksum: ac1051e7de87ed75dcd05a1c10bc94b4 (MD5) Previous issue date: 2018 info:eu-repo/semantics/publishedVersion

Cardiovascular disease represents one of the most important public health problem in the Western countries, with sudden cardiac death (SCD) being the most common cause of death in adults under 65 years of age. The objective of the present study is to evaluate the leading causes of SCD in young adults who died suddenly in Northern Portugal between 2007 and 2012. This study included 288 cases of 20- to 45-year-old adults who died suddenly of a cardiac cause and whose forensic autopsy was performed in the North Branch of the National Institute of Legal Medicine and Forensic Sciences between 2007 and 2012. Data included the cause of death, forensic autopsy findings, previous medical history and cardiovascular risk factors. The mean age of the population was 37.36 years. Coronary artery disease (CAD) was the leading cause of death, representing 55.6 % of all cases (92.5 % of men and 7.5 % of women). Females died mostly from probable primary arrhythmia. From those who died of coronary disease, 72 (25 % of total cases) had histological evidence of a fatal acute infarction. Age, previous coronary disease, hypercholesterolemia, smoking habits and alcohol consumption seem to be associated with an increased risk of SCD by CAD. A total of 55.6 % of deaths were attributed to CAD. Prevention of cardiovascular risk factors should therefore be considered to prevent atherosclerosis in young adults.

To investigate the tensile biomechanical properties of round and uterosacral ligaments.Tissue samples were obtained from 15 female cadavers without pelvic organ prolapse. Uniaxial tensile tests were performed to obtain stiffness and maximum stress of round and uterosacral ligaments. Correlations were calculated using the Pearson correlation coefficient. Statistical differences between groups were tested using Student's paired and unpaired t test.There was a great variability in the measurements of stiffness and maximum stress in pelvic ligaments. The round ligaments demonstrated stiffness of 9.1 ± 1.6 MPa (mean ± SEM) (ranging from 2 to 25.6 MPa) and maximum stress of 4.3 ± 0.7 MPa (ranging from 1.2 to 11.5 MPa). The stiffness of the uterosacral ligaments was 14.1 ± 1.4 MPa (ranging from 5.7 to 26.1 MPa) with maximum stress of 6.3 ± 0.8 MPa (ranging from 2.2 to 11.9 MPa). There was a strong positive correlation between stiffness and maximum stress in female pelvic ligaments (ρ = 0.851; p0.001). The uterosacral ligaments demonstrated higher stiffness and maximum stress compared to the round ligaments (p = 0.006 and p = 0.034; respectively). Age, body mass index and menopausal status were not associated with the biomechanical proprieties of round and uterosacral ligaments. Nulliparous women had lower uterosacral stiffness (15.5 ± 1.3 vs. 10 ± 1.8 MPa; p = 0.033) and maximum stress (8.2 ± 0.9 vs. 4.2 ± 1.1 MPa; p = 0.028) compared to parous women.The uterosacral ligaments are significantly more resistant than round ligaments. Parturition seems to enhance the stiffness and maximum stress of the ligaments.

ResumoO tumor de Buschke-Löwenstein (TBL) é uma variante rara de condiloma acuminatum que possui comportamento maligno pelo crescimento local, mas não apresenta potencial metastático. Afeta primariamente a área genital e, menos frequentemente a região perianal. Os fatores de risco para o seu desenvolvimento incluem a terapêutica imunossupressora e a infeção VIH. Possui elevada taxa de recorrência e de transformação maligna, sendo a cirurgia o tratamento inicial recomendado. Apresenta-se um caso de TBL perianal e anal num doente com infeção VIH cuja histologia não revelou transformação maligna e para o qual a terapêutica cirúrgica isolada foi eficaz. Revê-se o conhecimento atual sobre esta entidade tendo em atenção a história natural nos indivíduos infetados pelo VIH.AbstractThe Buschke-Löwenstein tumor (TLB) is a rare variant of condyloma acuminatum that presents local malignant behavior but no metastatic potential. It affects primarily the genital area and less frequently the perianal region. Risk factors for its development include immunosuppressive therapy and HIV infection. This tumor has a high rate of malignant transformation and the recommended initial treatment is surgery. We present a case of perianal and anal TBL in a HIV patient whose histology revealed no malignant transformation and that was treated successfully with surgery alone. We review the current knowledge about this entity taking into account its natural history in individuals infected with HIV.

ResumoO vírus da hepatite D (VHD) é um vírus satélite, que necessita do vírus da hepatite B (VHB) para a sua replicação. Na maioria dos casos, o VHD suprime a replicação do VHB e, nestas circunstâncias, está recomendado o tratamento com Interferão. Nos doentes em que não se observa resposta virológica após o 1.° ano de terapêutica, o seu prolongamento pode aumentar a taxa de resposta virológica sustentada.Caso clínicoHomem, 42 anos, com hepatite crónica B, anti-HBe positivo e baixa carga viral. Apresentava aminotransferases aumentadas que persistiram, mesmo após negativação do ADN-VHB. A positividade da fração IgM do AcVHD conduziu ao diagnóstico de co-infecção VHB-VHD. Foi tratado com PegInterfeão α-2a durante 102 semanas. Observou-se normalização das aminotransferases à 33.ª semana, negativação da IgM do AcVHD à 88.ª semana e resposta virológica sustentada com perda do AgHB.ComentáriosEste caso ilustra a importância de se manter o tratamento nos doentes com infecção VHD até resposta virológica, uma vez que a cura do VHD pode acompanhar-se da cura da infecção VHB.AbstractHepatitis D virus (HDV) is a satellite virus which needs hepatitis B virus (HBV) for its replication. In most cases, HDV suppresses HBV replication and in these circumstances the treatment should be with Interferon. In patients that have no virological response after the 1th year of therapy, continuing it will possible increase the virological response and the loss of the HBs antigen.Case report42 years old man with chronic HBV, anti-HBe positive and low HBV viral load. He had increased transaminases which had persisted even after HBV-DNA negativation. We performed antibody anti-HDV that came positive and treated the patient with PegInterferon α-2a during 102 weeks. We assist to normalization of the transaminases at week 33 and negativation of IgM-HVD at week 88. At the end of the treatment RNA-HDV was negative and the patient lost HBs antigen that persisted over the next sixth months.CommentsThis case illustrates the importance of maintaining treatment until HDV virological response since the cure of the HDV may be accompanied by the cure of HBV infection.

The objective of the present study was to investigate the tensile biomechanical properties of the human female bladder. Tissue samples were obtained from 13 cadavers without pelvic floor dysfunctions. We performed uniaxial tensile tests to measure the stiffness and maximum stress of the bladder tissue. Correlations were calculated using the Pearson correlation coefficient. The bladder tissue stiffness ranged from 1 to 4.1 MPa (mean stiffness, 1.9 ± 0.2 MPa) and the maximum stress ranged from 0.5 to 2.6 MPa (mean maximum stress, 0.9 ± 0.1 MPa). There was a strong positive correlation between stiffness and maximum stress in the bladder tissue (ρ = 0.829, p

The existing data suggest that individuals experiencing intra-familial abuse are affected more significantly than those experiencing extra-familial abuse. This study aims to identify possible differences between these types of abuse. A retrospective study was performed based on medico-legal reports related to children suspected of being sexually abused (n=1054). The results revealed that 40.2% of the suspected abuses were intra-familial and were significantly different than extra-familial cases with respect to the following: (a) the complainants were younger; (b) their relationship to the alleged abuser was closer; (c) the alleged abusers had higher rates of previous sexual abuse; (d) the suspected abuses were less intrusive physically; (e) there was less physical but more psychological violence; (f) the delay between the last abuse and the medico-legal examination was greater; and (g) there were fewer physical signs and DNA evidence (none in the great majority of cases). These results highlight aspects of intra-familial abuse that have been identified as factors influencing the severity of its consequences - physically, these instances of abuse were less intrusive but psychologically they were more intrusive than extra-familial abuse. This justifies the use of different strategies in the diagnosis and support for victims within the family.

Polyglutamine diseases are a class of dominantly inherited neurodegenerative disorders for which there is no effective treatment. Here we provide evidence that activation of serotonergic signalling is beneficial in animal models of Machado-Joseph disease. We identified citalopram, a selective serotonin reuptake inhibitor, in a small molecule screen of FDA-approved drugs that rescued neuronal dysfunction and reduced aggregation using a Caenorhabditis elegans model of mutant ataxin 3-induced neurotoxicity. MOD-5, the C. elegans orthologue of the serotonin transporter and cellular target of citalopram, and the serotonin receptors SER-1 and SER-4 were strong genetic modifiers of ataxin 3 neurotoxicity and necessary for therapeutic efficacy. Moreover, chronic treatment of CMVMJD135 mice with citalopram significantly reduced ataxin 3 neuronal inclusions and astrogliosis, rescued diminished body weight and strikingly ameliorated motor symptoms. These results suggest that small molecule modulation of serotonergic signalling represents a promising therapeutic target for Machado-Joseph disease., This work was supported by Fundação para a Ciência e Tecnologia (FCT) and COMPETE through the projects ‘[PTDC/SAU-GMG/112617/2009] (to P.M.) and [EXPL/ BIM-MEC/0239/2012] (to A.T.C.)’, by National Ataxia foundation (to P.M.), by Ataxia UK (to P.M.), by National Institutes of Health (NIH) ‘[GM038109, GM081192, AG026647, and NS047331] (to R.I.M.)’, by The Chicago Biomedical Consortium (to R.I.M.) and by the Ellison Medical Foundation (to R.I.M.). A.T.C., A.J., S.E., L.S.S., C.B., S.D.S., A.S.F. and A.N.C. were supported by the FCT individual fellowships SFRH/BPD/79469/2011, SFRH/BD/76613/2011, SFRH/BD/78554/2011, SFRH/BD/ 84650/2012, SFRH/BPD/74452/2010, SFRH/BD/78388/ 2011, SFRH/BPD/91562/2012 and SFRH/BD/51059/2010, respectively. FCT fellowships are co-financed by POPH, QREN, Governo da República Portuguesa and EU/FSE., info:eu-repo/semantics/publishedVersion

Tuberous sclerosis complex (TSC) is a genetic disorder with multisystem involvement that is due to autosomal-dominantly inherited or sporadic mutations in TSC1 and TSC2 genes. Involvement of the gastrointestinal tract is rare. We report the case of a 51-year-old woman with diagnosis of TSC established by genetic testing, who presented with colorectal hamartomatous polyposis. Multiple small polyps were found scattered through the left colon and rectum. Histology revealed a distinct spindle cell proliferation in the lamina propria, originating from the muscularis mucosae. The cells lacked atypia or mitotic activity and were diffusely positive for smooth muscle actin and negative for S100 protein. Genetic testing proved a disease causing frameshift mutation in the TSC1 gene. Although gastrointestinal involvement is rare in TSC, hamartomatous polyps can be the initial manifestation of this syndrome. Genetic testing should be considered in every case for which TSC is clinically suspected.

Train-person collisions have a significant impact in our society, due to their negative economic and psychological effects. This work aims to study fatalities resulting from train-person collisions in Portugal., Ricardo Dinis-Oliveira acknowledges Fundacao para a Ciencia e a Tecnologia (FCT) for his Investigator Grant (IF/01147/2013).

O objetivo principal desse trabalho é identificar as oportunidades de inserção do Sanitarista na carreira pública, via concurso, e os requisitos para investidura no cargo no âmbito do Sistema Único de Saúde (SUS). Trata-se de uma pesquisa do tipo exploratória e descritiva, com o uso de procedimentos da pesquisa documental. Foram localizados 22 editais de concursos públicos no período de 2012 a 2015. Deste total, 16 editais (73%) são para o cargo de Sanitarista, 2 editais (9%) para o cargo de Bacharel em Saúde Coletiva. Outros 4 editais (18%) são para cargos como Analista/Técnico/Especialista e Gestão em Saúde. Referente aos requisitos para provimento no cargo, 13 editais (59%) eram direcionados para outra graduação seguida de Especialização em Saúde Pública ou Coletiva, 6 editais (27%) para graduados em Saúde Coletiva, e 3 (14%) eram dirigidos a outras graduações da área da saúde sem exigência de especialização. Do total de editais, 9 (40%) exigiam inscrição ou registro em conselho de classe competente. A maioria dos concursos ainda não privilegia o profissional graduado em Saúde Coletiva. O desconhecimento da formação do Sanitarista em nível de graduação direciona as vagaspara profissionais de outras formações da área da saúde e exigência de especialização em Saúde Pública ou Saúde Coletiva. The main objective of this paper is to identify the Sanitarian insertion career opportunities in the public sector, and the requirements for taking office under the Health National System. It is an exploratory and descriptive survey, using procedures of documentary research. Were located 22 notices of public contracts in the period 2012 to 2015. Of this total, 16 bids (73%) are for the post of Sanitary, two notices (9%) for the position of Bachelor of Collective Health. Other 4 notices (18%) are for positions as an Analyst/Technical/Specialist and Health Management. Regarding the requirements for appointment in office, 13 notices (59%) were directed to another graduation followed by specialization in Public or Collective Health, 6 notices (27%) for graduates in Collective Health, and 3 (14%) were directed to other grades of health without requirement of expertise. Of all notices, 9 (40%) required registration on professional council. Most of the contracts still does not favor the professional graduate in Collective Health. Not knowing about the graduation of Sanitarian Professionals at the undergraduate level directs the vacancies for professionals from other health education and demand for specialization in Public Health or Collective Health.

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The World Health Organization reviewed the classification for serrated colonic polyps in 2010. A new entity, sessile serrated adenoma, was included with two variants: with and without cytological dysplasia. This lesion's malignant potential has been recognized and according to the new classification, many polyps may be reclassified. The impact of this change is yet to be assessed.Analyze the proportion of lesions that were reclassified according to the new World Health Organization classification and the variables that influenced it.Every patient with at least one sessile serrated adenoma diagnosed in a 5 year period was included. All polyps (regardless of type) resected during the study period were reviewed. Data concerning polyp's characteristics and patient variables were collected. Forty consecutive patients were included [13 female, mean age at 1st sessile serrated adenoma -59 yrs (34-80)].Were reviewed 247 polyps: hyperplastic--42%; conventional adenomas--29%; sessile serrated adenoma--24%; serrated adenomas--5%. Sixty-three polyps were reclassified: 43 hyperplastic, 12 serrated adenomas, 7 sessile serrated adenoma and 1 conventional adenoma with low grade dysplasia. Reclassification was significantly greater for hyperplastic polyps when compared with the other subtypes. Forty-three of one hundred and four (41%) hyperplastic polyps were reclassified all as sessile serrated adenoma. In these polyps the probability of reclassification was independent from polyp location but was greater if polyp size ≥ 5 mm.This is a single center, rectrospective study. The fact that it was done in an Oncology Referral Institution with a Family Risk Clinic may have influenced the results. Nevertheless the impressive reclassification rate for Hyperplastic Polyps and the fact that they were reclassified mainly as Serrated Adenomas makes these results relevant to daily practice.Our results suggest that, according to the new World Health Organization classification for serrated colonic polyps, a considerable proportion of hyperplastic polyps will be reclassified. The serrated pathway of colorectal carcinogenesis has probably been underestimated and at-risk patients may have been under inappropriate surveillance.Introdução: A Organização Mundial de Saúde reviu a classificação para os pólipos serreados do cólon em 2010. Uma nova entidade, o adenoma serreado séssil, foi incluída com duas variantes: com e sem displasia citológica. O potencial de malignização desta lesão foi reconhecido e, de acordo com a nova classificação, muitos pólipos poderão ser reclassificados. O impacto desta mudança ainda não foi aferido. Objectivo: Analisar a proporção de lesões reclassificadas de acordo com a nova classificação da Organização Mundial de Saúde e as variáveis que a influenciaram. Material e Métodos: Todos os doentes com pelo menos um adenoma serreado séssil diagnosticado num período de cinco anos foram incluídos. Todos os pólipos (independentemente do tipo histológico) ressecados durante o período considerado foram revistos. Recolhidas variáveis dos pólipos e dados dos doentes. Incluídos 40 doentes consecutivos [13 mulheres, idade média no diagnóstico do 1º adenoma serreado séssil - 59 anos (34-80)]. Resultados: Revistos 247 pólipos: hiperplásicos - 42%; adenomas convencionais - 29%; adenoma serreado séssil - 24%; adenomas serreados-5%. Reclassificados 63 pólipos: 43 hiperplásicos, 12 adenomas serreados, 7 adenoma serreado séssil e 1 adenoma convencional com displasia de baixo brau. A reclassificação foi significativamente mais provável para os pólipos hiperplásicos em relação aos outros subtipos. 41% (43/104) dos pólipos hiperplásicos foram reclassificados como adenoma serreado séssil. Para estes pólipos a probabilidade de reclassificação foi independente da localização mas maior se a dimensão ≥ 5 mm. Discussão: Este é um estudo rectrospectivo que foi conduzido num único Centro Oncológico de Referenciação com uma Clínica de Risco Familiar associada, o que pode ter influenciado os resultados. No entanto, a elevada taxa de reclassificação para os pólipos hiperplásicos e o facto de estes terem sido reclassificados quase sempre como adenomas serreados tornam estes resultados relevantes para a prática do dia a dia. Conclusão: Os nossos resultados mostram que, de acordo com a nova classificação da Organização Mundial de Saúde para os pólipos serreados, uma proporção considerável de pólipos hiperplásicos seria reclassificada. A via serreada de carcinogénese colorectal tem sido provavelmente subestimada e doentes em risco podem estar sob vigilância inadequada.

Biodegradable polydioxanone stents were developed for the treatment of refractory benign esophageal strictures but have been suggested as a new therapeutic option for intestinal strictures. The primary advantage of biodegradable stents over self-expandable metallic stents is that removal is not required. There are, however, few data available on their use in the small or large bowel. We herein describe the case of a 33-year-old patient with long-standing Crohn's disease (CD) who developed a fibrotic stricture of the sigmoid too long to be amenable to balloon dilation. The use of a biodegradable polydioxanone stent was chosen to avoid surgery. Combined endoscopic and fluoroscopic placement of the stent was technically simple, safe and clinically successful, and no recurrence of obstructive symptoms occurred during a 16-mo follow-up. Further studies are needed to evaluate the long-term efficacy and safety of biodegradable stents in the treatment of intestinal strictures, particularly in the context of CD.

Background/Aims: To compare biomechanical properties of vaginal tissues between women with and without pelvic organ prolapse (POP) and investigate factors that may influence these properties. Methods: Forty patients submitted to POP surgery and 15 non-POP cadavers were evaluated. The tissue was excised from anterior and posterior middle third vagina. The biomechanical properties considered were stiffness (E) and maximum stress (Smax), and they were evaluated by means of uniaxial tension tests. Results: POP patients were associated with higher values of E (13.1 ± 0.8 vs. 9.5 ± 0.7 MPa; p < 0.001) and Smax (5.3 ± 0.5 vs. 3.2 ± 0.9 MPa; p < 0.001) in the anterior vaginal wall compared to the posterior wall. In contrast, non-POP women presented lower values of E (6.9 ± 1.1 vs. 10.5 ± 1.0 MPa; p = 0.01) and Smax (2.6 ± 0.4 vs. 3.5 ± 0.4 MPa; p = 0.043) in the anterior wall. The occurrence of POP was the only independent predictor of higher values of E and Smax in anterior vaginal samples (p = 0.003 and p = 0.008, respectively). Women with severe anterior vaginal prolapse presented higher levels of E and Smax in the anterior sample compared to those with lower POP stages (p = 0.001 and p = 0.01; respectively). Conclusion: Women with POP present significant changes of biomechanical properties in the vagina.

The aim of this study is to characterize and model the damage process in the anterior rectus abdominal aponeurosis (anterior rectus sheath) undergoing finite deformations. The resistance of the anterolateral abdominal aponeuroses is important when planning the surgical repair of incisional hernias, among other medical procedures. Previous experiments in prolapsed vaginal tissue revealed that a softening process occurs before tissue rupture. This nonlinear damage behaviour requires a continuum damage theory commonly used to describe the softening behaviour of soft tissues under large deformations. The structural model presented here was built within the framework of non-linear continuum mechanics. Tissue damage was simulated considering different damage behaviours for the matrix and the collagen fibres. The model parameters were fit to the experimental data obtained from anterior rectus sheath samples undergoing finite deformations in uniaxial tension tests. The tests were carried out with samples cut along the direction of the collagen fibres, and transversal to the fibres. Longitudinal and transverse mechanical properties of human anterior rectus sheath are significantly different. The damage model was able to predict the stress–strain behaviour and the damage process accurately. The error estimations pointed to an excellent agreement between experimental results and model fittings. For all the fitted data, the normalized RMS error e presented very low values and the coefficient of determination R 2 was close to 1. The present work constitutes the first attempt (as far as the authors know) to present a damage model for the human rectus sheath.

Background/Aims: This study aims to evaluate the pelvic floor (PF) tension response during simulated increased intra-abdominal pressure (IAP) and the vaginal biomechanical properties. Methods: A 3-dimensional computational finite element model for PF was developed based on magnetic resonance imaging from a nulliparous healthy volunteer. The model was used to simulate an IAP of 90 cm H2O and to evaluate the PF stresses in the longitudinal and transversal axes. The vaginal samples were obtained from 15 non-prolapsed female cadavers. A uniaxial tensile test to obtain stiffness and maximum stress of vaginal tissue in the longitudinal and transversal axes was performed. Results: The simulated IAP was associated with a similar PF stress state in the longitudinal and transversal axes. The stiffness and maximum stress in vaginal tissues presented a great variability between subjects. There was no difference in the vaginal tissue elasticity (6.2 ± 1.5 vs. 5.4 ± 1.1 MPa; p = 0.592) and maximum stress (2.3 ± 0.5 vs. 2.6 ± 0.9 MPa; p = 0.692) regarding the measurements in the longitudinal and transversal axes. Conclusion: The isotropic biomechanical behavior of vagina is in agreement with the PF stress state response during increased IAP.

Background: Fatalities resulting from paraquat (PQ) self-poisonings represent a major burden of this herbicide. Specific therapeutic approaches have been followed to interrupt its toxic pathway, namely decontamination measures to prevent PQ absorption and to increase its excretion from organism, as well as the administration of anti-inflammatory and immunosuppressive drugs. Until now, none of the postmortem studies resulting from human PQ poisonings have assessed the relationship of these therapeutic measures with PQ toxicokinetics and related histopathological lesions, these being the aims of the present study. Methodology/principal findings: For that purpose, during 2008, we collected human fluids and tissues from five forensic autopsies following fatal PQ poisonings. PQ levels were measured by gas chromatography-ion trap mass spectrometry. Structural inflammatory lesions were evaluated by histological and immunohistochemistry analysis. The samples of cardiac blood, urine, gastric and duodenal wall, liver, lung, kidney, heart and diaphragm, showed quantifiable levels of PQ even at 6 days post-intoxication. Structural analysis showed diffused necrotic areas, intense macrophage activation and leukocyte infiltration in all analyzed tissues. By immunohistochemistry it was possible to observe a strong nuclear factor kappa-B (NF-kappaB) activation and excessive collagen deposition. Conclusions/significance: Considering the observed PQ levels in all analyzed tissues and the expressive inflammatory reaction that ultimately leads to fibrosis, we conclude that the therapeutic protocol usually performed needs to be reviewed, in order to increase the efficacy of PQ elimination from the body as well as to diminish the inflammatory process. info:eu-repo/semantics/publishedVersion

Recently, it has been suggested an association between red cell distribution width (RDW) and Crohn's disease activity index (CDAI), but its use is not yet performed in daily clinical practice.To determine whether RDW can be used as a marker of Crohn's disease (CD) activity.This was a cross-sectional study including patients with CD, observed consecutively in an outpatient setting between January 1st and September 30th 2013. Blood cell indices, erythrocyte sedimentation rate (ESR), and C-reactive protein were measured. CD activity was determined by CDAI (active disease if CDAI ≥ 150). Associations were analyzed using logistic regression (SPSS version 20).119 patients (56% female) were included in the study with a mean age of 47 years (SD 15.2). Twenty patients (17%) had active disease. The median RDW was 14.0 (13-15). There was an association between RDW and disease activity (In this study, RDW proved to be an independent and relatively specific marker of CD activity. These results may contribute to the implementation of this simple parameter, in clinical practice, aiming to help therapeutic decisions.Recentemente, tem vindo a ser sugerida uma associação entre o valor de RDW e a atividade da doença de Crohn (DC), mas a sua utilização não está ainda implementada na prática clínica diária.Determinar se o RDW pode ser utilizado como marcador de atividade da DC.Estudo transversal, em doentes com DC, observados consecutivamente em consulta de Doença Inflamatória Intestinal, entre 1 de janeiro e 30 de setembro de 2013. Analisaram-se índices do hemograma, proteína C reativa e velocidade de sedimentação. A gravidade da doença foi avaliada peloIncluídos 119 doentes (56% do sexo feminino), com idade média de 47 anos (DP 15,2 anos). Vinte doentes (17%) tinham doença ativa. O valor do RDW mediano foi 14,0% (13-15). Verificou-se uma associação entre RDW e atividade da doença (Neste estudo, o valor do RDW demonstrou ser um marcador independente e relativamente específico da atividade da doença de Crohn. Estes resultados poderão contribuir para a aplicação deste parâmetro simples, na prática clinica diária, visando auxiliar decisões terapêuticas.

A 74-year-old man attended our gastroenterology outpatient clinic with hipogastric aching pain for the past 5 years associated with recent worsening of chronic constipation. Physical examination as well as abdomino-pelvic ultrasound and colonoscopy was unremarkable. Anti-antispasmodics and dietary measures did not improve the clinical condition. For this reason, we performed an abdomino-pelvic computed tomography (CT) scan which showed thickening of the terminal ileum. The patient repeated colonoscopy with ileoscopy and regular hogback in the terminal ileum was observed that could not be overcome, lined by normal mucosa. It was biopsed, but histologic examination was normal. The entero-resonance was suggestive of nonspecific mesenteritis, but did not reveal changes in small bowel. Serologies to Crohn’s disease and celiac disease were negative. A video capsule enteroscopy was performed which revealed diffuse pattern of linfagiectasia and segmental pseudopolypoid whitish areas in jejunum and ileum (Fig. 1). Through push enteroscopy (Fig. 2) with a pediatric colonoscope, biopsies of proximal jejunum were taken. Microscopic examination demonstrated neoplastic proliferation of lymphoid tissue with follicular pattern (Fig. 3). The tumor cells were positive for CD20, CD10, BCL2, BCL6 and negative for CD3, CD5, CD23, and 5 blasts per high power field were observed. Based on these findings, a diagnosis of follicular lymphoma grade 1 was established.