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Vários estudos demonstram que os doentes com síndroma de apneia obstrutiva do sono (SAOS) têm um risco aumentado de acidentes de viação. O objectivo do presente trabalho consistiu em analisar, nestes doentes, se há diferenças nos que referem acidentes e/ /ou quase acidentes e aqueles que o não fazem. Material e métodos: Estudaram-se prospectivamente 163 doentes com SAOS (índice apneia/hipopneia (IAH)>10/h) diagnosticados por polissonografia nocturna (PSG), todos condutores de veículos, 18,4% do quais profissionais. Na altura da entrevista clínica foi inquirido se tinham tido, nos três anos antes acidentes e/ou quase acidentes devido a hipersonia diurna (Grupo II = 74) ou não (Grupo I = 89). Estes dois grupos foram comparados quanto a: idade, índice de massa corporal (IMC), escala de sonolência de Epworth (ESE), PaO2 e PaCO2 diurnas, avaliação da qualidade de vida pelo inquérito Functional Outcomes of Sleep Questionnaire (FOSQ teste) e dados da polissonografia - tempo total de sono (TTS), eficiência do sono, estádios do sono, índice de microdespertares (IMD), índice de apneia/hipopneia (IAH), SaO2 mínima e média, % tempo SaO2Several studies have demonstrated that obstructive sleep apnoea syndrome (OSAS) patients have a higher rate of road traffic accidents. Our study aimed to analyse any differences in OSAS patients between those who reported having had road traffic accidents and/or near misses and those who did not. Methods: We studied 163 patients with OSAS (apnoea-hypopnoea index (AHI)>10/h) diagnosed using nocturnal polysomnography (NPSG), all drivers, 18.4% of whom drove for a living. Patients were asked at their first clinical interview to self-report road traffic accidents and/or near misses over the past 3 years which had been caused by abnormal daytime drowsiness. This allowed patients to be divided into two groups, those who had had road traffic accidents and/or near misses and those who had not. Both were compared as to age, body mass index (BMI), Epworth Sleepiness Scale (ESS), daytime PaO2 and PaCO2, Functional Outcomes of Sleep Questionnaire (FOSQ) test and NPSG data. This latter was total sleep time (TTS), sleep efficiency, sleep stages, arousal index (ARI), AHI, minimal and average SaO2, % of time with SaO2 < 90% (T90), desaturation index (ODI), total duration of apnoea-hypopnoea (TDAH) (T test). Results: (Grupo I / Grupo II) idade (anos) – 57,6±11,8 / 54,7±10,9 (ns); sexo masculino – 75%/ /78,4%; ESE – 12,3±5,4 / 17,6±4,3 (p

O tabagismo é uma importante causa de patologia pulmonar e a sua dependência poderá ser considerada uma doença crónica e recorrente. Os benefícios da cessação tabágica são inquestionáveis e todos os médicos têm responsabilidade na sua recomendação. Objectivo: Caracterização da população que recorre à consulta de apoio ao fumador (CAF) do nosso hospital e procurar entender as razões do sucesso. Materiais e métodos: Análise retrospectiva dos processos clínicos de todos os doentes que foram seguidos na CAF entre Janeiro de 2003 e Junho de 2006. Foram avaliados os seguintes parâmetros: idade, sexo, idade de início, carga tabágica (unidades maço ano-UMA), patologias associadas, grau de dependência (teste de Fargerström), tentativas prévias, motivações para cessação tabágica, necessidade de apoio cognitivo-comportamental e taxas de sucesso e abandono. Resultados: Foram avaliados 526 doentes, 50% (n=263) do sexo masculino. A média de idades situava -se nos 45,5±11,4 anos. Iniciaram o consumo antes dos 15 anos 43,1% (n=227). A carga tabágica foi de 35,8 ± 20 UMA, observando-se em 21,4% (n=113) dos doentes um consumo superior a 50 UMA. Patologia pulmonar esteve presente em 52,1% (DPOC - 39,9%; outras - 12,2%) e a cardiovascular em 14,6% (n=77) dos doentes. Em 46% (n=242) foi identificada uma patologia psiquiátrica importante: perturbações depressivas (21,4%), transtorno de ansiedade (19,4%), outra toxicodependência (2,1%), doença bipolar (1,5%) e esquizofrenia (0,6%). Trezentos e sessenta e sete doentes (69,7%) obtiveram pontuação máxima no teste de Fagerström. Em 72,2% (n=380) dos casos foram mencionadas tentativas prévias de abandono do tabagismo. Os motivos actuais evocados para a cessação tabágica relacionaram -se com: saúde (83,5%); factores económicos 8,2%; qualidade de vida (5,7%). Foram submetidos a terapêutica de substituição nicotínica 81,7% (n=430) dos doentes, sendo a via de administração: sistema transdérmicos (53,3%), nicotina oral (1,1%) ou ambos (45,6%). O suporte psicofarmacológico utilizado foi: ansiolítico (86,5%); cloridrato bupropiona (2,3%); antidepressivo (0,6%). Foi solicitado apoio cognitivo-comportamental a 14,4% (n=76) dos doentes. A taxa de cessação tabágica foi de 42,4% (n=223). A redução do consumo de tabaco superior a 50% foi de 1,9% (n=10). A taxa de abandono da consulta, a maioria logo após a primeira consulta, foi de 41,6% (n=219). A taxa de abandono da consulta relacionou -se com as características dos doentes, a falta de motivação, o preço da terapêutica e o meio ambiente desencorajador. Conclusão: Verificou -se nesta população elevada percentagem de indivíduos com patologia psiquiátrica e alto grau de dependência a nicotina, factores que, aliados ao stress como causa major de aumento de consumo de tabaco, implicaram uma especial atenção ao suporte cognitivo-comportamental no sentido de garantir melhores resultados. O sucesso terapêutico esteve sem dúvida relacionado com a aderência à consulta, a terapia comportamental e a terapêutica farmacológica.Smoking is an important cause of pulmonary pathology and this addiction can be regarded as a chronic, recurrent disease. The benefits of smoking cessation are unquestionable and all physicians should become more active and assertive in recommending it. Aim: To characterise the population seeking medical support for smoking cessation and understand why some successfully stop smoking and others do not. Material and methods: Retrospective analysis of medical records of outpatients in follow-up between January 2003 and June 2006. Age, gender, age at smoking initiation, smoking burden (number of pack-years), associated diseases, degree of dependence (Fagerström test for nicotine addiction), prior attempts at and motivation for smoking cessation, need for cognitive/behavioural support and success and abandonment rates were evaluated. Results: Five hundred and twenty six patients were studied, 50% male with an average age of 45.5±11.4 years. Almost half (43.1 %; n=227) of the patients started smoking before the age of 15. Average smoking burden was 35.8±20 pack-years although 21.4% (n=113) smoked more than 50 pack-years. Respiratory disease was present in 52.1% (COPD, 39.9% and others, 12.2%) and cardiovascular disease in 14.6% of the patients. In 46% of patients (n=242) a relevant psychiatric disorder was identified; depression (21.4%), anxiety disorder (19.4%), other dependencies (2.1%) bipolar disorder (1.5%) and schizophrenia (0.6%). The evaluation of degree of addiction revealed maximum level in 69.7% of the patients (n=380). Many patients (72.2%; n=380) reported prior attempts to quit smoking. The strongest reasons for giving up smoking were concern over health (83.5%), financial issues (8.2%) and search for better quality of life (5.7%). Most patients (81.7%; n=430) had undergone nicotine replacement therapy; skin patches (53.3%), chewing gum (1.1%) or both (45.6%). Psychopharmacological treatment included administration of sedative-hypnotics (86.5%), bupropion hydrochloride (2.3%) and antidepressants (0.6%). Se venty six patients (14%) benefited from cognitive/behavioural support. Two hundred and twenty three patients (42.4%) were successful in giving up smoking while 219 (41.6%) abandoned follow up, the majority after the first appointment. Most patients that abandoned follow up reported lack of motivation and the price of therapy. Conclusions: The population under study had a high rate of psychiatric disorders and a high level of dependence and lack of motivation that might justify the drop-out rate. Successful treatment was associated with close follow up, behavioural support and pharmacological therapy.

This correction refers to two new genera (Corollosporella and Corollosporopsis) and three new species combinations published in Journal of Fungi [...]

The present study, initially to resolve the cryptic species within Corollospora maritima, is to determine how to attain taxonomic discrimination at species and generic levels. Multiple sequence alignments (MSAs) of the ITS, 28S, and 18S regions of the nuclear ribosomal cistron were separately subjected to pairwise distance assessments, Bayesian, and Maximum likelihood phylogenetic analyses. Morphological descriptions of 15 type strains of Corollospora species, along with MSAs involving representatives of the whole genus Corollospora (268 isolates, many from C. maritima sensu lato) totaling 355 published sequences, allowed phylogenetic assessments conducted to the following p-distance thresholds in the ITS/28S regions: ≥3%/1% for species segregation and ≥8%/2% for generic segregation. This resulted in the introduction of 10 new genera encompassing 13 new combinations of current Corollospora species: Ajigaurospora pseudopulchella, Corollosporella anglusa, Corollosporella ramulosa, Corollosporopsis portsaidica, Garethelia parvula, Honshuriella fusca, Keraliethelia pulcehlla, Nakagariella filiformis, Paracorollospora angusta, Paracorollospora luteola, Paracorollospora marina, Shirahamella gracilis, and Tokuratelia colossa. Furthermore, seven undefined genera considered putative new genera (pNGenus A to G), and 16 undefined putative new species (seven spp. come from the resolution of the C. maritima complex), await re-assessment of their morphology and additional molecular data, which may result in the recognition of new taxa.

Arbuscular mycorrhizal fungi (AMF) are determinant for the performance of plant communities and for the functionality of terrestrial ecosystems. In natural ecosystems, grazing can have a major impact on mycorrhizal fungi and consequently on plant growth. The objective of this study was to evaluate the statements referred above in Mediterranean arid areas in Tunisia. Root samples and rhizosphere soils of five dominant herbaceous plants were studied at six distinct arid sites differing on soil proprieties and grazing intensity. At each site, chemical and dynamic properties of the soil were characterized as well as the AMF colonization intensity and the soil functionality. Results showed that the mycorrhizal frequency and intensity and spore density, varied between plants in the same site and, for each plant, between sites and evidenced a positive effect of mycorrhized plants on soil microbial activity. Grazing and soil properties strongly affected AMF composition and the soil microbial and biochemical dynamics, which presented the lowest values at the sites with the highest grazing intensities. In conclusion, these results demonstrate that AMF improve soil biological properties, supporting the hypothesis that mycorrhiza and grazing compete for plant photosynthates, and highlight the importance of mycorrhizal symbiosis towards soil functionality under arid conditions.

RESUMO: A literatura regista muito poucos casos de doença do neurónio motor que apresentem como manifestação inaugural dispneia por paralisia do diafragma.Por outro lado, o diagnóstico de paralisia do diafragma como causa de falência respiratória é, em regra, difícil na ausência de outras manifestações de envolvimento muscular.Neste contexto descrevem dois casos clínicos de esclerose lateral amiotrofica que tiveram como a presentação inicial uma história, com vários meses de evolução, de ortopneia, dispneia paroxística nocturna e intolerância ao esforço de agravamento progressivo.Em ambos os casos o exame cardiológico não revelou alterações apreciáveis.A identificação e valorização de um padrão de respiração abdominal paradoxal, associado à evidência radiológica de elevação de uma ou de ambas as hemicúpulas diafragmáticas e a um padrão funcional de hipoventilação alveolar, conduziram à suspeita clínica de paralisia do diafragma no contexto de uma doença neuromuscular. Esta hipótese levou a realização de electromiograma que veio confirmar, em ambos os casos, este diagnóstico.Os dois doentes encontramse, presentemente, sob ventilação domiciliária permanente, o primeiro através de traqueostomia definitiva eo segundo de ventilação nasal não invasiva com BIPAP.Concluíse tecendo algumas considerações sobre a paralisia do diafragma como causa de falência respiratória em doentes com esclerose lateral amiotrófica, realçando as dificuldades no seu diagnóstico e os indicadores clínicos a valorizar. SUMMARY: Very few cases of motor neuron diseases presenting with dispnea as the first symptom have been reported in literature.On the other hand, it is very difficult to identify a diaphragmatic paralysis as a cause of respiratory failure in patients without other evidence of muscular weakness.The authors describe two cases of amiatrophic laterat sclerosis in which the presenting symptoms were orthopnea and exertional dispnea. In both cases the cardiological evaluation was irremarkable. The identification of a paradoxial abdominal respiration associated to the radiological evidence of diaphragmatic elevation and a functional pattern of alveolar hypoventilation led us to the clinical suspicion of a primary neuromuscular disease with diaphragmatic involvement. This hypothesis was, in both cases, confirmed by electromiography.At the present, both patients are in a home ventilation program (the first one through a tracheostomy and the second one under nasal non invasive ventilation with BIPAP).The authors conclude drawing some considerations about the difficulties in the diagnosis of diaphragmatic paralysis as a cause of respiratory failure in patients with amiotrophic lateral sclerosis. Palavras-chave: Paralisia do diafragma, Ortopneia, Esclerose lateral amiotrófica, Key-words: Diaphragmatic paralysis, Orthopnea, Amiotrophic lateral sclerosis

Mycorrhizal symbioses are considered indicators of ecosystem biodiversity. However, their diversity and relevance in arid and semi-arid ecosystems are poorly understood. This study addressed this subject, the main objective being to evaluate arbuscular mycorrhizal fungi (AMF) diversity and heterogeneity in a semi-arid region. Samples of bulk and rhizosphere soil and fine roots of Medicago truncatula were collected at four different sites with the same aridity index (6.1), in Bou-Hedma National Park, Tunisia, a semi-arid ecosystem. AMF taxa were assessed by 454- pyrosequencing and identified by BLAST matching of operational taxonomic units (OTUs) against the MaarjAM database, targeting AMF SSU rRNA gene diversity. Roots were the hotspots of AMF diversity (107 OTUs out of a total of 138). Of the 138 OTUs, 113 found correspondence in the MaarjAM database, with 32 AMF virtual taxa (VTX),19 Site-exclusive (SE) and 13 common to at least two sites (Non-site exclusive, NSE); the remaining 25 OTUs grouped in 16 putative new AMF taxa (pNTX), each one consisting of OTUs sharing pairwise distances not higher than 3%. We found a high diversity and heterogeneity of AMF across the four sites, which showed, in a regression analysis, significant relation to six out of the eight environmental parameters evaluated: grazing activity and soil texture, electrical conductivity, organic matter, total phosphorus and total nitrogen. AMF colonization of plants also presented significant differences among the four sites, as well as spore density, microbial biomass and several enzymatic activities (dehydrogenase, β-glucosidase and phosphatase) evaluated in rhizosphere soils. The four sites clustered in two groups in a hierarchical clustering evaluation based on their AMF diversity (total numbers of OTU, VTX and pNTX) and the parameters referred above. The crucial role of abiotic factors, other than aridity index, on AMF community composition, was evidenced by the high heterogeneity found between AMF communities across sites under identical aridity conditions.

Resumo: Vários estudos demonstram que os doentes com síndroma de apneia obstrutiva do sono (SAOS) têm um risco aumentado de acidentes de viação. O objectivo do presente trabalho consistiu em analisar, nestes doentes, se há diferenças nos que referem acidentes e/ /ou quase acidentes e aqueles que o não fazem.Material e métodos: Estudaram-se prospectivamen-te 163 doentes com SAOS (índice apneia/hipopneia (IAH)>10/h) diagnosticados por polissonografia noc-turna (PSG), todos condutores de veículos, 18,4% do quais profissionais. Na altura da entrevista clínica foi inquirido se tinham tido, nos três anos antes acidentes e/ou quase acidentes devido a hipersonia diurna (Grupo II=74) ou não (Grupo I=89).Estes dois grupos foram comparados quanto a: idade, índice de massa corporal (IMC), escala de sonolência de Epworth (ESE), PaO2 e PaCO2 diurnas, avaliação da qualidade de vida pelo inquérito Functional Outcomes of Sleep Questionnaire (FOSQ teste) e dados da polissonografia â tempo total de sono (TTS), eficiência do sono, estádios do sono, índice de microdespertares (IMD), índice de apneia/hipopneia (IAH), SaO2 mínima e média, % tempo SaO210/h) diagnosed using nocturnal polysomnography (NPSG), all drivers, 18.4% of whom drove for a living. Patients were asked at their first clinical interview to self-report road traffic accidents and/or near misses over the past 3 years which had been caused by abnormal daytime drowsiness. This allowed patients to be divided into two groups, those who had had road traffic accidents and/or near misses and those who had not. Both were compared as to age, body mass index (BMI), Epworth Sleepiness Scale (ESS), daytime PaO2 and PaCO2, Functional Outcomes of Sleep Questionnaire (FOSQ) test and NPSG data. This latter was total sleep time (TTS), sleep efficiency, sleep stages, arousal index (ARI), AHI, minimal and average SaO2, % of time with SaO2

Resumo: O tabagismo é uma importante causa de patologia pulmonar e a sua dependência poderá ser considerada uma doença crónica e recorrente. Os benefícios da cessação tabágica são inquestionáveis e todos os médicos têm responsabilidade na sua recomendação.Objectivo: Caracterização da população que recorre à consulta de apoio ao fumador (CAF) do nosso hospital e procurar entender as razões do sucessoMateriais e métodos: Análise retrospectiva dos processos clínicos de todos os doentes que foram seguidos na CAF entre Janeiro de 2003 e Junho de 2006. Foram avaliados os seguintes parâmetros: idade, sexo, idade de início, carga tabágica (unidades maço ano-UMA), patologias associadas, grau de dependência (teste de Fargerström), tentativas prévias, motivações para cessação tabágica, necessidade de apoio cognitivo-comportamental e taxas de sucesso e abandono.Resultados: Foram avaliados 526 doentes, 50% (n=263) do sexo masculino. A média de idades situava-se nos 45,5±11,4 anos. Iniciaram o consumo antes dos 15 anos 43,1% (n=227). A carga tabágica foi de 35,8±20 UMA, observando-se em 21,4% (n=113) dos doentes um consumo superior a 50 UMA. Patologia pulmonar esteve presente em 52,1% (DPOC â 39,9%; outras â 12,2%) e a cardiovascular em 14,6% (n=77) dos doentes. Em 46% (n=242) foi identificada uma patologia psiquiátrica importante: perturbações depressivas (21,4%), transtorno de ansiedade (19,4%), outra toxicodependência (2,1%), doença bipolar (1,5%) e esquizofrenia (0,6%). Trezentos e sessenta e sete doentes (69,7%) obtiveram pontuação máxima no teste de Fagerström. Em 72,2% (n=380) dos casos foram mencionadas tentativas prévias de abandono do tabagismo. Os motivos actuais evocados para a cessação tabágica relacionaram-se com: saúde (83,5%); factores económicos 8,2%; qualidade de vida (5,7%). Foram submetidos a terapêutica de substituição nicotínica 81,7% (n=430) dos doentes, sendo a via de administração: sistema transdérmicos (53,3%), nicotina oral (1,1%) ou ambos (45,6%). O suporte psicofarmacológico utilizado foi: ansiolítico (86,5%); cloridrato bupropiona (2,3%); antidepressivo (0,6%). Foi solicitado apoio cognitivo-comportamental a 14,4% (n=76) dos doentes. A taxa de cessação tabágica foi de 42,4% (n=223). A redução do consumo de tabaco superior a 50% foi de 1,9% (n=10). A taxa de abandono da consulta, a maioria logo após a primeira consulta, foi de 41,6% (n=219). A taxa de abandono da consulta relacionou-se com as características dos doentes, a falta de motivação, o preço da terapêutica e o meio ambiente desencorajador.Conclusão: Verificou-se nesta população elevada percentagem de indivíduos com patologia psiquiátrica e alto grau de dependência a nicotina, factores que, aliados ao stress como causa major de aumento de consume de tabaco, implicaram uma especial atenção ao suporte cognitivo-comportamental no sentido de garantir melhores resultados. O sucesso terapêutico esteve sem dúvida relacionado com a aderência à consulta, a terapia comportamental e a terapêutica farmacológica.Rev Port Pneumol 2009; XV (2): 179-197 Abstract: Smoking is an important cause of pulmonary pathology and this addiction can be regarded as a chronic, recurrent disease. The benefits of smoking cessation are unquestionable and all physicians should become more active and assertive in recommending it.Aim: To characterise the population seeking medical support for smoking cessation and understand why some successfully stop smoking and others do not.Material and methods: Retrospective analysis of medical records of outpatients in follow-up between January 2003 and June 2006. Age, gender, age at smoking initiation, smoking burden (number of packâyears), associated diseases, degree of dependence (Fagerström test for nicotine addiction), prior attempts at and motivation for smoking cessation, need for cognitive/behavioural support and success and abandonment rates were evaluated.Results: Five hundred and twenty six patients were studied, 50% male with an average age of 45.5±11.4 years. Almost half (43.1 %; n=227) of the patients started smoking before the age of 15. Average smoking burden was 35.8±20 pack-years although 21.4% (n=113) smoked more than 50 pack-years. Respiratory disease was present in 52.1% (COPD, 39.9% and others, 12.2%) and cardiovascular disease in 14.6% of the patients. In 46% of patients (n=242) a relevant psychiatric disorder was identified; depression (21.4%), anxiety disorder (19.4%), other dependencies (2.1%) bipolar disorder (1.5%) and schizophrenia (0.6%). The evaluation of degree of addiction revealed maximum level in 69.7% of the patients (n=380). Many patients (72.2%; n=380) reported prior attempts to quit smoking. The strongest reasons for giving up smoking were concern over health (83.5%), financial issues (8.2%) and search for better quality of life (5.7%). Most patients (81.7%; n=430) had undergone nicotine replacement therapy; skin patches (53.3%), chewing gum (1.1%) or both (45.6%). Psychopharmacological treatment included administration of sedative-hypnotics (86.5%), bupropion hydrochloride (2.3%) and antidepressants (0.6%). Seventy six patients (14%) benefited from cognitive/behavioural support. Two hundred and twenty three patients (42.4%) were successful in giving up smoking while 219 (41.6%) abandoned follow up, the majority after the first appointment. Most patients that abandoned follow up reported lack of motivation and the price of therapy.Conclusions: The population under study had a high rate of psychiatric disorders and a high level of dependence and lack of motivation that might justify the drop-out rate. Successful treatment was associated with close follow up, behavioural support and pharmacological therapy.Rev Port Pneumol 2009; XV (2): 179-197 Palavra-chave: Desabituação tabágica, fumador, consulta, Key-words: Smoking cessation, outpatient smokers

Ranaviruses in amphibians and fish are considered emerging pathogens and several isolates have been extensively characterized in different studies. Ranaviruses have also been detected in reptiles with increasing frequency, but the role of reptilian hosts is still unclear and only limited sequence data has been provided. In this study, we characterized a number of ranaviruses detected in wild and captive animals in Europe based on sequence data from six genomic regions (major capsid protein (MCP), DNA polymerase (DNApol), ribonucleoside diphosphate reductase alpha and beta subunit-like proteins (RNR-α and -β), viral homolog of the alpha subunit of eukaryotic initiation factor 2, eIF-2α (vIF-2α) genes and microsatellite region). A total of ten different isolates from reptiles (tortoises, lizards, and a snake) and four ranaviruses from amphibians (anurans, urodeles) were included in the study. Furthermore, the complete genome sequences of three reptilian isolates were determined and a new PCR for rapid classification of the different variants of the genomic arrangement was developed. All ranaviruses showed slight variations on the partial nucleotide sequences from the different genomic regions (92.6-100%). Some very similar isolates could be distinguished by the size of the band from the microsatellite region. Three of the lizard isolates had a truncated vIF-2α gene; the other ranaviruses had full-length genes. In the phylogenetic analyses of concatenated sequences from different genes (3223 nt/10287 aa), the reptilian ranaviruses were often more closely related to amphibian ranaviruses than to each other, and most clustered together with previously detected ranaviruses from the same geographic region of origin. Comparative analyses show that among the closely related amphibian-like ranaviruses (ALRVs) described to date, three recently split and independently evolving distinct genetic groups can be distinguished. These findings underline the wide host range of ranaviruses and the emergence of pathogen pollution via animal trade of ectothermic vertebrates.

RESUMO: Os sarcomas primitivos do pulmão são raros, representando 0.1 % de todas as neoplasias pulmonares malignas.No presente trabalho os autores reveem 5 casos clinicos diagnosticodos no periodo compreendido entre 1985 e 1997.A série inclui 4 doentes do sexo musculino e l do sexo femimino, com idades entre os 21 e os 73 anos. Apenas um doente era fumador.A sintomatologia mais frequente foi a toracalgia, a tosse seca. a dispneia e a expeetoração hemoptoica.O diagnóstieo hislopatológico foi feito em 3 casos através da peça operatória e cm 2 por biópsia brôm quica. Os tipos histológicos encontrados foram: 2 leiomiossarcomas, I rabdomiossarcoma, 1 careinos-sarcoma e 1 sarcoma poueo diferenciado.No que sc refere à terapêutica, todos os doentes tratados foram submetidos a cirurgia, tendo efectua-do cm 3 casos terapêutica adjuvante com quimiote-rapia ou quimioterapia+radioterapia.Após o dingnóstieo, os doentes sobreviveram entre 6 dias e 49 meses. Apesar da maioria ter sido submetida a cirurgia. apenas um doente sobreviveu para além dos 3 anos, o que está de acordu cum a agressividade destas neoplasias.REV PORT PNEUMOL 1998; IV (4): 403-412 ABSTRACT: Primary pulmonary sarcomas represent 0.1% of all primary lung neoplasms.In this work w e reviewed a consecutive serie of patients with this diagnosis, treated al our department between the period of 1985 and 1997.Four patients were males and I female, aged between 21 and 72 years old. Only one was a smoker.The most frequent symptoms were chest pain, cough, dyspnea and hemoptoic sputum.The diagnosis was obtained by surgery in 3 patients and by bronchial biopsy in 2 cases. The histologic types observed w ere 2 leiomyossareomas. 1 rabdomyossarcoma, I carcinossarcoma and I low diferentiated sarcoma.Four patients were treated with pulmonary surgery and in 3 cases plus thoracic irradiation and chemotherapy or simply chemotherapy.After the diagnosis, patients had survived between 6 days and 49 months. Although surgery, only I patient survived more than 3 years.REV PORT PNEUMOL 1998; IV (4): 403-412 : Key-words, Lung neoplasms, Pulmonary sarcomas, Palavras-chavc: Neoplasia, pulmoares, Sarcomas pulmonares

The occurrence, diversity and similarity of marine fungi detected by the sum of direct and indirect observations in Fagus sylvatica and Pinus pinaster baits submerged at two Portuguese marinas are analyzed and discussed. In comparison with the data already published in 2010, the higher number of specimens considered in this study led to the higher number of very frequent taxa for these environments and substrata; the significant difference in substrata and also in fungal diversity detected at the two environments is also highlighted, in addition to the decrease in fungal similarity. Because the identification of Lulworthia spp., Fusarium sp., Graphium sp., Phoma sp. and Stachybotrys sp. down to species level was not possible, based only on the morphological characterization, a molecular approach based on the amplification of the LSU rDNA region was performed with isolates of these fungi. This was achieved for three isolates, identified as Fusarium solani, Graphium eumorphum and Stachybotrys chartarum. To achieve this with the other isolates which are more complex taxa, the sequencing of more regions will be considered. Key words: Marine fungi, Wood baits, Fungal diversity, Ascomycota, Anamorphic fungi, Sequence alignment.

Central venous catheters are a frequently used vascular access for hemodialysis. Fibrin sheath formation is a common complication and is associated with catheter malfunction. Although fibrin sheath angioplasty with catheter exchange is a frequently employed procedure, it can be associated with mechanical complications. An important technical step in this procedure is progression of the guide-wire into the inferior vena cava. Focal alveolar hemorrhage is a very rare complication of this procedure. We report a case of a 70-year old patient on dual antiplatelet therapy who underwent fibrin sheath angioplasty with guide-wire catheter exchange and experienced focal alveolar hemorrhage presenting as hemoptysis and acute type 1 respiratory failure. Progression of the guide-wire into the pulmonary circulation and antithrombotic therapy played a significant role in the development of this complication. This report aims to call attention to a poorly described and potentially serious yet avoidable complication of fibrin sheath angioplasty with guide-wire catheter exchange., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Bone and mineral metabolism abnormalities are frequent in kidney transplant recipients and have been associated with cardiovascular morbidity. The primary aim of this study was to analyse the association between routine clinically available biochemical evaluation, non-routine histomorphometric bone evaluation, and vascular disease in kidney transplanted patients. A cross-sectional analysis was performed on 69 patients, 1-year after kidney transplantation. Laboratory analysis, radiography of hands and pelvis, bone biopsy, bone densitometry, and coronary CT were performed. One-year post-transplantation, nearly one-third of the patients presented with hypercalcemia, 16% had hypophosphatemia, 39.3% had iPTH levels > 150 pg/mL, 20.3% had BALP levels > 40 U/L, and 26.1% had hypovitaminosis D. Evaluation of extraosseous calcifications revealed low Adragão and Agatston scores. We divided patients into three clusters, according to laboratory results routinely used in clinical practice: hypercalcemia and hyperparathyroidism (Cluster1); hypercalcemia and high BALP levels (Cluster2); hypophosphatemia and vitamin D deficiency (Cluster 3). Patients in clusters 1 and 2 had higher cortical porosity (p = 0.001) and osteoid measurements, although there was no difference in the presence of abnormal mineralization, or low volume. Patients in cluster 2 had a higher BFR/BS (half of the patients in cluster 2 had high bone turnover), and most patients in cluster 1 had low or normal bone turnover. Cluster 3 has no differences in volume, or turnover, but 60% of the patients presented with pre-osteomalacia. All three clusters were associated with high vascular calcifications scores. Vascular calcifications scores were not related to higher bone mineral density. Instead, an association was found between a higher Adragão score and the presence of osteoporosis at the femoral neck (p = 0.008). In conclusion, inferring bone TMV by daily clinical biochemical analysis can be misleading, and bone biopsy is important for assessing both bone turnover and mineralization after kidney transplantation, although hypophosphatemia combined with vitamin D deficiency is associated with abnormal mineralization. The presence of hypercalcemia with high levels of PTH or high levels of BALP, or hypophosphatemia and vitamin D deficiency should remind us to screen vascular calcification status of patients.Clinical Research: ClinicalTrials.gov ID NCT02751099., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background/objective: The 2019 American College of Rheumatology/European League Against Rheumatism Classification Criteria (2019 AECC) for IgG4-related disease (IgG4-RD) is considered a significant advancement in the study of this condition. Most studies evaluating their performance have focused on White and Asian patients, leaving a knowledge gap regarding Latin American populations. Therefore, this study aimed to assess the performance of the 2019 AECC for IgG4-RD in a cohort of Latin American patients., Methods: A multicenter medical records review study was conducted, involving centers from Argentina, Chile, Mexico, Peru, and Uruguay. Data on IgG4-RD patients and mimicker conditions were collected through a standardized online form. The criterion standard for diagnosing IgG4-RD was based on the fulfillment of the Comprehensive Diagnostic Criteria for IgG4-RD and/or the Consensus Statement on Pathology. The 2019 AECC was retrospectively applied., Results: We included 300 patients, with 180 (60%) having IgG4-RD and 120 (40%) having mimicker conditions. The 2019 AECC had a sensitivity of 66.7% and a specificity of 100%. Sensitivity increased to 73.3% when disease-specific autoantibody items were removed, without affecting specificity. The true-positive cases had more involved organs, a higher availability of biopsy results, and were more likely to belong to the Mikulicz/systemic and proliferative phenotypes., Conclusions: The use of the 2019 AECC for IgG4-RD in a Latin American population confirms its high specificity in excluding those without the disease. The presence of concomitant autoimmune diseases and clinically nonsignificant disease-specific autoantibodies excludes a significant number of patients from fulfilling the criteria., Competing Interests: The authors declare no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

We present a patient with a rare systemic autoinflammatory disease (mevalonate kinase deficiency -MKD-) with the identification of two heterozygous variants (c.1129G>A and c.32C>T) in the Mevalonate Kinase gene, detected by next generation sequencing and a highly prevalent glomerulonephritis (IgA nephropathy). The patient presents clinically with a monthly recurrent periodic fever from 12 days of age, accompanied by mucocutaneous lesions (maculopapular rash in extremities, aphthous stomatitis), joint (arthralgias in ankles, wrists and knees), lymphoid (cervical lymphadenopathy, splenomegaly), gastrointestinal (diarrhea, abdominal pain) and kidney (hematuria and proteinuria) with repeated biopsies showing IgA nephropathy alternating activity with chronicity. During follow-up. The patients presented a poor therapeutic response to multiple immunosuppressive regimens used for 7 years (corticosteroids, azathioprine, mycophenolate, cyclophosphamide, rituximab and tocilizumab), and finally a good response to canakinumab. Four years after starting canakinumab, during the course of an infection due to a muscle abscess, the clinical presentation is complicated by a severe renal microvascular event (renal cortical necrosis -RCN-) with acute kidney injury and dialysis requirement. Therecurrent episodes of inflammation due to MKD could act as triggers for the reactivation of glomerulonephritis (which would explain the poor response to immunosuppressants and the rapid progression to histological chronicity) and to generate a microenvironment that predisposes the development of RCN in the face of a non-serious infection. A defect in IgA molecules has been described in MKD, a phenomenon also observed in IgA nephropathy. This raises the challenging hypothesis of a common pathogenetic link between all the patient's clinical manifestations.

Adenovirus infection in transplant recipients may present from asymptomatic viremia to multisystemic involvement. Most frequently, it occurs in the first year after a kidney transplant, and it is secondary to the reactivation of latent disease. However, primary infection may occur, and disseminated disease is more common when related to primary infection. Kidney involvement may be confirmed by biopsy, although diagnosis may be presumptive. Reduction of immunosuppression and supportive care are important components of therapy. CASE DESCRIPTION: A 41-year-old female renal-pancreatic recipient 12 years before with chronic renal graft dysfunction and a functional pancreatic graft had a history of cytomegalovirus and polyoma virus infection 2 years after transplantation. She was taking tacrolimus, mycophenolate mofetil, and prednisolone. The patient was admitted after persistent uncharacteristic diarrhea 3 weeks before hospitalization without any relevant epidemiologic context. She was dehydrated, and the lab results showed worsened kidney function and leucocytosis. The viral culture revealed adenovirus. Vigorous hydration was implemented, and the mycophenolate mofetil dose was reduced. The patient was discharged, and renal function returned to previous values. DISCUSSION AND CONCLUSION: Adenovirus infection has a wide clinical presentation, and multisystemic involvement may occur in transplant recipients. Supportive care is paramount. The clinical features and viral culture confirm the diagnosis, although tissue samples and quantitative polymerase chain reaction may be required in more severe cases., Competing Interests: Declaration of Competing Interest All the authors declare no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Introduction: Acute monoarthritis (AM) represents a relevant cause of morbidity that requires prompt medical care. The study of synovial fluid becomes relevant to allow a rapid diagnostic approach. The main objective of the study was to determine the frequency and clinical-analytical characteristics of episodes of AM and acute bursitis evaluated in a hospital during a period of 6 years., Methods: Cross-sectional retrospective analytical study in a hospital at Córdoba, Argentina. All episodes of acute monoarthritis and bursitis that occurred in patients aged 18 years or older between 2012 and 2017 were included. AM in pregnant women and chronic monoarthritis were excluded., Results: One hundred and eighty episodes of AM and 12 of acute bursitis were included. Among the AM, 120 (66.7%) occurred in male patients and the average age was 62.1±16.9 years. The main cause of AM was septic, identifying 70 (36%) cases, followed by microcrystalline AM identify 54 (28%) cases, which corresponded to gout and calcium pyrophosphate dihydrate (CPPD) with 27 (14%) cases each one. Monosodium urate crystals were identified in 26 (14.3%) patients, CPPD in 28 (15.6%) and cholesterol in 1 (0.6%)., Discussion: The main cause of AM was septic arthritis, followed by microcrystalline AM (gout and secondary to CPPD). The main affected joint was the knee, followed by the shoulder. Synovial fluid analysis was a key element when making the differential diagnosis between the different causes of acute monoarthritis and bursitis.

Background/objective: Data on IgG4-related disease (IgG4-RD) come almost exclusively from cohorts from Asia, Europe, and North America. We conducted this study to describe the clinical presentation, phenotype distribution, and association with sex, ethnicity, and serological markers in a large cohort of Latin American patients with IgG4-RD., Methods: We performed a multicenter medical records review study including 184 Latin American IgG4-RD patients. We assigned patients to clinical phenotypes: group 1 (pancreato-hepato-biliary), group 2 (retroperitoneal/aortic), group 3 (head and neck-limited), group 4 (Mikulicz/systemic), and group 5 (undefined). We focused the analysis on how sex, ethnicity, and clinical phenotype may influence the clinical and serological presentation., Results: The mean age was 50.8 ± 15 years. Men and women were equally affected (52.2% vs 48.8%). Fifty-four patients (29.3%) were assigned to group 1, 21 (11.4%) to group 2, 57 (30.9%) to group 3, 32 (17.4%) to group 4, and 20 (10.8%) to group 5. Male sex was associated with biliary tract (odds ratio [OR], 3.4; 95% confidence interval [CI], 1.36-8.26), kidney (OR, 3.4; 95% CI, 1.28-9.25), and retroperitoneal involvement (OR, 5.3; 95% CI, 1.45-20). Amerindian patients presented more frequently with atopy history and gallbladder involvement. Group 3 had a female predominance., Conclusions: Latin American patients with IgG4-RD were younger, and men and women were equally affected compared with White and Asian cohorts. They belonged more commonly to group 1 and group 3. Retroperitoneal and aortic involvement was infrequent. Clinical and serological features differed according to sex, ethnicity, and clinical phenotype., Competing Interests: The authors declare no conflict of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: Arterial blood gas analysis is a minimally invasive technique used in our daily practice but is not a complication free technique. The aim of this study was to validate results from blood gas analysis obtained from the arteriovenous fistula (AVF)/graft as a surrogate marker of the arterial blood gas analysis., Methods: A prospective observational study was made in 45 patients. We performed arterial and AVF/graft blood gas analysis and results were compared by a paired sample t Student test., Results: Most of our subjects was male (68.9%) and the mean age was 67 years (±14). Hemodialysis vintage was 63 months (±66), and vascular access age was 62 months (±56). The more prevalent vascular access was left radiocephalic AVF (n = 16; 35.6%) and the main puncture artery was right radial artery (n = 27; 60.0%). There were no statistically significant differences between the samples collected., Conclusions: Our results suggest a possible alternative of arterial blood gas analysis in AVF/graft for hemodialysis patients. This could result in making an uncomfortable procedure almost painless and reducing complications. Future research should take place to include anatomical characteristics of the AVF or the circulation of recirculation., (© 2021 Wiley Periodicals LLC.)

Background: Primary Sjögren syndrome (pSS) is a chronic autoimmune disease with its main target being exocrine glands, and is the connective tissue disease more frequently associated with other autoimmune diseases. The aim of this study was to assess the frequency of another autoimmune rheumatic disease (ARD) developed in primary Sjögren syndrome (pSS) patients and to describe it's clinical, serological and histologic characteristics., Materials and Methods: This is a retrospective cohort study. Data of patients with pSS diagnosis (American-European criteria 2002), included in the GESSAR database (Grupo de Estudio Síndrome de Sjögren, Sociedad Argentina de Reumatología) were analyzed. The development of a second ARD was registered during the follow up., Results: 681 patients were included, 94.8% female. The mean age was 54 (SD 14) years and mean age at diagnosis of 50 (SD 13) years. The mean follow-up was 4.7 (SD 4.9) years; 30 patients (4.41%, CI 95%: 3.1-5.7) developed a second ARD during the follow up, incidence rate was 9.1/1000 patients-year (IR 95%: 5.8-12.4/1000 patients-year), the most frequent being rheumatoid arthritis (RA). 96% out of these 30 patients had xerophthalmia, 86.2% xerostomia, 92% positive Schirmer test, 88.24% positive Rosa Bengala test, lisamine green or Ocular Staining Score, 81.2% positive unstimulated salivary flow, 82.1% Ro(+) and 33.33% La(+). Minor salivary gland biopsy had been performed in 14 of the 30 patients, 12 with positive results. There were no statistically significant differences respect baseline characteristics when comparing the patients who developed another ARD to the ones that did not., Conclusions: Of all the patients analyzed, 4.4% presented another ARD during their follow-up. It is important to be aware of this, to make an early and proper diagnosis and treatment of our patients., (© 2022. The Author(s).)