[Thrombotic microangiopathy: when time is the key factor!]

Thrombotic microangiopathy or "TMA" including thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome (HUS) became a public health problem following the European outbreak of E. coli (O104:H4) gastroenteritis in 2011. A rapid diagnosis and therapy in an intensive care unit provide better patient survival and lower cost for society. Supportive treatment has significantly improved the prognosis over the past decade and includes fresh frozen plasma for TTP, plasmapheresis for HUS, and recently a new therapeutic agent: anti-C5 antibodies. We will provide in this article, through the current literature and four cases encountered in our department, to establish an algorithm to manage patients with TMA.

A new approach for the extraction of pollutants from wastewaters handled by the graphic industry

It is widely recognized that the Graphic Industry handles toxic products and produces, in its various operations, toxic wastes. These wastes can cause serious environmental damages and can lead to severe health problems. In this work we report an efficient, simple and cheap to run method for the removal of some of the most common pollutants involved in the various stages of the Graphic Industry production, using a Solid-Phase Extraction (SPE) methodology. We have determined equilibrium constants, K(eq), and adsorption (k(up)) and desorption (k(off)) rate constants for the extraction of benzene, xylene, toluene and ethylbenzene (BXTE) from water, using C18 disks. The removal of these compounds was monitored by UV-vis spectroscopy, at room temperature. Average extraction efficiencies were of 60% in a mixture of BXTEs and close to 80% when pollutants were assessed separately. Since the retention mechanism in the C18 disk is essentially governed by hydrophobic interactions between the compounds and the alkyl chains of the disk, we have also shown that these pollutants' lipophilicity plays an important role in the rationalization of their behavior during the extraction process.

Transport inefficiency in branched-out mesoscopic networks: an analog of the Braess paradox

We present evidence for a counterintuitive behavior of semiconductor mesoscopic networks that is the analog of the Braess paradox encountered in classical networks. A numerical simulation of quantum transport in a two-branch mesoscopic network reveals that adding a third branch can paradoxically induce transport inefficiency that manifests itself in a sizable conductance drop of the network. A scanning-probe experiment using a biased tip to modulate the transmission of one branch in the network reveals the occurrence of this paradox by mapping the conductance variation as a function of the tip voltage and position.

Comparative study of bipolar eletrocoagulation versus argon plasma coagulation for rectal bleeding due to chronic radiation coloproctopathy

BACKGROUND AND STUDY AIM

Chronic radiation coloproctopathy (CRCP) is a well-recognized complication of radiotherapy, with rectal bleeding the most common presentation. It is frequently refractory to conservative management, but the optimal endoscopic treatment of bleeding secondary to CRCP is still controversial. The efficacy and safety of bipolar eletrocoagulation (BEC) and argon plasma coagulation (APC) in the management of bleeding from CRCP were evaluated and compared.

PATIENTS AND METHODS

30 patients (mean age 67.4 years) with active and chronic bleeding from telangiectasias, were randomly allocated to BEC or APC and stratified by severity of CRCP according to clinical severity and endoscopic findings (Saunders score). Success was defined as eradication of all telangiectasias, and therapeutic failure as need for more than seven sessions or for other treatment. Complications were categorized as minor (e.g. fever, anal or abdominal pain) or major (hemorrhagic).

RESULTS

Both treatments were equally effective for the treatment of CRCP rectal bleeding. Only one failure was observed in each group (P = 1.000). There was no significant difference between the two groups regarding number of sessions, minor or major complications, or relapse. However, overall complication rate was significantly higher in the BEC group (P = 0.003).

CONCLUSIONS

BEC and APC are both effective for the therapy of bleeding telangiectasias from CRCP. There are probably no major differences between them. Although APC seemed safer than BEC in this investigation, further studies, involving a much larger population, are needed to assess the complication rates and determine the best management option.

The incidence of bacteraemia after argon plasma coagulation in patients with chronic radiation proctocolitis

AIM

Argon plasma coagulation (APC) is considered a safe treatment for haemorrhagic chronic radiation proctocolitis (CRPC), but bacteraemia is a rare complication. The study aimed to evaluate the frequency of bacteraemia after APC.

METHOD

A prospective study of 21 patients who underwent APC (30 procedures) for CRPC was carried out. Blood cultures (Bactec(®) ) were obtained before and 30 min after the procedure (60 samples total). Patients were monitored for 48 h after the procedure to detect signs of infection.

RESULTS

None of the 21 patients had fever or any sign suggestive of infection after any of the 30 sessions. All baseline blood cultures were negative and two (7%) of the 30-min blood cultures were positive (Staphylococcus hominis n = 1; Streptococcus bovis and Rhodotorula sp n = 1). The first was likely to be a contaminant and the second patient had no evidence of any other colonic disease (neoplasia or polyps) beside CRPC.

CONCLUSION

APC is a low-risk procedure regarding bacteraemia and does not warrant prophylactic antibiotic administration.

Reuma.pt - the rheumatic diseases portuguese register

INTRODUCTION

Since June 2008, Portuguese rheumatologists have been collecting on a routine basis, data into the nationwide Reuma.pt, the Rheumatic Diseases Portuguese Register from the Portuguese Society of Rheumatology (SPR), which includes rheumatic patients (rheumatoid arthritis - RA, ankylosing spondylitis - AS, psoriatic arthritis - PsA and juvenile idiopathic arthritis - JIA) receiving biological therapies or patients receiving synthetic disease modifying anti-rheumatic drugs (DMARDs). The aim of this publication is to describe the structure of Reuma.pt and the population registered since June 2008.

METHODS

Demographic and anthropometric data, life style habits, work status, co-morbidities, disease activity and functional assessment scores, previous and current therapies, adverse events codified by the Medical Dictionary for Regulatory Activities (MedDRA), reasons for discontinuation and laboratory measurements are registered at each visit. The platform is based on a structured electronic medical record linked to a SQL Server database. All Rheumatology Departments assigned to the Portuguese National Health Service (n=21), 2 Military Hospitals (Lisboa and Porto), 1 public-private Institution and 6 private centers adhered to the Register. Until now, 18 centers have entered data into Reuma.pt.

RESULTS

By January 2011, 3438 patients and 16130 visits had been registered. 2162 (63%) were RA patients, 700 of them treated with biological agents and 1462 with synthetic DMARDs. From the 515 (15%) AS patients, 297 were medicated with biological and 218 with non-biological therapies. 293 (8%) were PsA patients, 151 treated with biological drugs and 142 with other treatment strategies. 368 (11%) had the diagnosis of JIA, 68 were under biological treatment and 300 were managed with other treatment options. The register also includes 100 (3%) patients with other rheumatic diseases, submitted to treatments that required hospital day care infusions including 18 exposed to biological therapies.

CONCLUSIONS

Registers are crucial to ensure correct clinical use, adequate assessment of post-marketing biological therapies' efficacy and safety, thus contributing for a better cost-benefit ratio. Reuma.pt, is a powerful and accurate tool to answer to these unmet needs. It presents a national coverage of the rheumatology centers and constitutes an invaluable resource for scientific research and to improve rheumatic patients care.

[Evaluation of the antimicrobial susceptibility profile of microorganisms isolated from urine in the region of Vale do Sousa and Tâmega]

The urinary tract is one of the more common sites of bacterial infections, especially in women. Urinary infection can be defined as an infection of urinary tract structures which occurs, generally, as a consequence of the presence or colonization by urine bacteria. The aim of this study was to determine the etiology of urinary tract infections and their susceptibility to antimicrobial agents in the region of Vale do Sousa and Tâmega. From February 2008 to January 2009, 18653 urine cultures were analyzed. From these cultures 1037 were positive. From this total of positive cultures, 18,3% were from males and 81.7% were from females. In bacteriological positive tests, 23 different strains of microorganisms were found. It was verified that the most frequent microorganism was Escherichia coli, followed by Proteus mirabilis, Klebsiella pneumoniae, Enterococcus faecalis and Pseudomonas aeruginosa. For antimicrobial susceptibility it was verified that Escherichia coli showed low susceptibility to amoxicillin and cotrimoxazole. Proteus mirabilis showed good susceptibility to cefotaxime and low to cotrimoxazole, amoxicillin and ciprofloxacin. For Klebsiella pneumoniae was found only a reasonable susceptibility to gentamicin and Enterococcus faecalis showed amoxicillin susceptibility. Pseudomonas aeruginosa showed low susceptibility to all antibiotics analyzed with the exception of the combination piperacillin/tazobactam. In conclusion, this study shows that Escherichia coli, Proteus mirabilis and Klebsiella pneumoniae are the three main microorganisms that causes urinary infections in the region of Vale do Sousa and Tâmega. Therefore, the antimicrobial empirically used must have a spectrum against enterobacteria, because they are the most likely to be present in urinary tract infections acquired in the community. A periodic analysis of the susceptibility profile should be performed over time for each region in order to help in the beginning of the empirical antimicrobial treatment.

BioRePortAP, an electronic clinical record coupled with a database: an example of its use in a single centre

AIMS

To evaluate the efficacy and safety of the treatment of psoriatic arthritis (PsA) patients with tumor necrosis factor (TNF) antagonists in the Rheumatology Department of Hospital de Santa Maria using the BioRePortAP.

METHODS

The Portuguese Society of Rheumatology (SPR) developed an electronic medical chart coupled with a database for the follow up of PsA patients, the BioRePortAP, which was launched in May 2009. This evaluation was based on all the PsA patients that were on active treatment with TNF antagonists in September 2009 and were registered in the BioRePortAP. All the previous data on these patients were introduced in BioRePortAP using the prospective paper based follow up protocol that this Department was using since 1999. Only patients with more than 9 months of treatment were analyzed.

RESULTS

Forty-two patients with PsA, actively treated with anti-TNF agents in September 2009, for at least 9 months, were analyzed in BioRePortAP. Twenty-three patients were male (55%) and nineteen were female (45%). The average age of these patients was 49.8+/-10.9 years old, the average disease duration was of 10.7+/-5.6 years and the mean duration of biological therapy was of 37.8+/-27.8 months. For the 81% of patients with peripheral joint disease there was a mean reduction of more than 80% in the swollen and tender joint counts, and almost 50% in the health assessment questionnaire (HAQ) value. In the 19% of the patients with axial involvement the reduction of BASDAI and BASFI was not statistically significative. On top of that, PASI score suffered a reduction of 64%. Fourteen patients (33.3%) had to switch their TNF antagonist treatment. 58.8% of the switches were due to adverse effects and 41.2% due to therapy failure. Regarding the 56 adverse reactions registered, only one was a severe reaction. The remaining adverse reactions were not severe and 67% of them were due to infections.

DISCUSSION

The results of this first report of the use of the BioRePortAP in clinical practice confirm the efficacy and safety of TNF antagonist treatment in PsA. The results shown here elucidate the potential applications of BioRePortAP as a tool for efficacy and safety assessment of PsA patients treated with biotechnological drugs.

Bilateral periventricular nodular heterotopia in France: frequency of mutations in FLNA, phenotypic heterogeneity and spectrum of mutations

Bilateral periventricular nodular heterotopia (BPNH) is the most common form of periventricular heterotopia. Mutations in FLNA, encoding filamin A, are responsible for the X linked dominant form of BPNH (FLNA-BPNH). Recently, atypical phenotypes including BPNH with Ehlers-Danlos syndrome (BPNH-EDS) have been recognised. A total of 44 FLNA mutations have so far been reported in this phenotype. Most of these mutations lead to a truncated protein, but few missense mutations have also been described. Here, the results of a mutation screening conducted in a series of 32 BPNH patients with the identification of 12 novel point mutations in 15 patients are reported. Nine mutations were truncating, while three were missense. Three additional patients with BPNH-EDS and a mutation in FLNA are described. No phenotype-genotype correlations could be established, but these clinical data sustain the importance of cardiovascular monitoring in FLNA-BPNH patients.

Scanning gate microscopy of quantum rings: effects of an external magnetic field and of charged defects

We study scanning gate microscopy (SGM) in open quantum rings obtained from buried semiconductor InGaAs/InAlAs heterostructures. By performing a theoretical analysis based on the Keldysh-Green function approach we interpret the radial fringes observed in experiments as the effect of randomly distributed charged defects. We associate SGM conductance images with the local density of states (LDOS) of the system. We show that such an association cannot be made with the current density distribution. By varying an external magnetic field we are able to reproduce recursive quasi-classical orbits in LDOS and conductance images, which bear the same periodicity as the Aharonov-Bohm effect.

Evaluation of olive oil mill wastewater toxicity on the mitochondrial bioenergetics after treatment with Candida oleophila

In a previous work the ability of Candida oleophila to use phenolic compounds as sole carbon and energy source at high concentrations without an additional carbon source was reported. C. oleophila grown in bioreactor batch cultures in a diluted and sterilized olive oil mill wastewater (OMW) caused a significant decrease in the total tannins content but no significant alteration was observed in phenolic acid and fatty acid content. Both treated and untreated OMWs were tested to evaluate the capacity in interfering with mitochondrial bioenergetics. Mitochondrial respiration was not affected by treated OMW on the range of used concentrations, contrary to the untreated OMW. Furthermore, mitochondrial membrane potential and respiratory complexes were always significantly less affected by treated OMW in comparison with untreated OMW. However, supplementary treatment should be applied before OMW could be considered non-toxic.

Evaluation of olive oil mill wastewaters acute toxicity: a study on the mitochondrial bioenergetics

Acute toxicity of olive mill wastewaters (OMW), collected from a continuous olive mill, was evaluated in rat liver mitochondrial bioenergetics. Inhibition of respiratory activities in state 4, state 3, and uncoupled respiration are essentially mediated through partial inhibitions of mitochondrial complexes II and III. ATPase activity was considerably less depressed by OMW than ATP synthase activity (a difference of 42%). The inhibition observed on ATP synthase is mostly the result of an inhibition on the redox complexes. Ultimately, the OMW-induced loss of phosphorylation capacity was not only the result of a direct effect of OMW on the enzymatic complex (F(0)-F(1) ATPase), but also the result of a deleterious effect on the integrity of the mitochondrial membrane, which can promote an inhibition of the respiratory complexes and an increase of the proton permeability of the inner membrane.

Imaging electron wave functions inside open quantum rings

Combining scanning gate microscopy (SGM) experiments and simulations, we demonstrate low temperature imaging of the electron probability density |Psi|(2)(x,y) in embedded mesoscopic quantum rings. The tip-induced conductance modulations share the same temperature dependence as the Aharonov-Bohm effect, indicating that they originate from electron wave function interferences. Simulations of both |Psi|(2)(x,y) and SGM conductance maps reproduce the main experimental observations and link fringes in SGM images to |Psi|(2)(x,y).

Streptococcus agalactiae serotype Ib as an agent of meningitis in two adult nonpregnant women

Two temporally and geographically clustered cases of meningitis caused by Streptococcus agalactiae expressing the infrequent Ib serotype are reported. Characterization by pulsed-field gel electrophoresis and multilocus sequence typing revealed that the isolates were identical and represented the widely distributed ST10/ST8 lineage associated with serotype Ib.

Benthic biotope index for classifying habitats in the Sado Estuary: Portugal

An integration of sediment physical, chemical, biological, and toxicity data is necessary for a meaningful interpretation of the complex sediment conditions in the marine environment. Assessment of benthic community is a vital component for that interpretation, yet their evaluation is complex and requires a large expenditure of time and funds. Thus, there is a need for new tools that are less expensive and more understandable for managers. This paper presents a benthic biotope index to predict from physical and chemical variables the occurrence of macrobenthic habitats. Parameters such as sediment type, organic matter, depth, and hydrodynamic parameters were selected, through a discriminant analysis, to compute the index. Other authors have used multivariate methods to determine the benthic biotopes for Sado Estuary. The index proved to be a valid tool to classify and assess the spatial patterns of benthic habitat and to synthesize stress biotope gradients.

Liposomal superoxide dismutases and their use in the treatment of experimental arthritis

It has long been suggested that superoxide dismutase (SOD) be used for antioxidant therapy on the basis of its ability to catalyze the dismutation of superoxide radicals involved in the pathogenesis of several inflammatory disorders such as rheumatoid arthritis. However, the administration of SOD in free form has some disadvantages, most importantly, the low accumulation of SOD in inflamed areas due to its reduced half-life in the bloodstream and its rapid renal excretion. To overcome this, SOD can be incorporated either in highly loaded conventional liposomes (SA-liposomes) or long circulating liposomes (PEG-liposomes). After an appropriate formulation of SOD in SA-liposomes, the therapeutic effect is strongly increased, as indicated by a reduction of about 40% of inflammation edema compared with treatment with nonencapsulated enzyme. Compared with SA-liposomes, PEG-liposomes show superior therapeutic activity. A second approach consists of the construction of a hydrophobic SOD derivative (Ac-SOD) that can be partially inserted within the lipid matrix of liposomes and that expresses enzymatic activity to the external medium. This hydrophobic enzyme, Ac-SOD, associated with liposomes (so called Ac-SOD-enzymosomes), is able to exert its therapeutic activity while circulating in the organism, regardless of the integrity of the liposomes. Ac-SOD-enzymosomes have a more rapid antiinflammatory effect than SOD liposomes, confirming that the release of Ac-SOD from liposomes is no longer required to achieve dismutation. Different methodologies for the preparation of SOD and Ac-SOD liposomal formulations (conventional and long circulating) have been established and are described in detail here.

Evaluation of Etest strips for rapid susceptibility testing of Mycobacterium tuberculosis

In this study, our objective was to evaluate Etest strips containing exponential gradients of isoniazid (INH), rifampin (RIF), and streptomycin (STR) for susceptibility testing of Mycobacterium tuberculosis. M. tuberculosis isolates were tested for antimicrobial susceptibilities by the standard proportion method using Löwenstein-Jensen (LJ) medium and by the Etest. The MICs determined by the Etest were obtained at 5, 7, or 10 days. In some strains with Etest-discrepant results, radiometric susceptibility testing (BACTEC) was performed to determine a consensus result. M. tuberculosis concordance between the two methods was 97% (86 of 89 isolates) for RIF, 96% for INH (84 of 87 isolates), and 80% (61 of 76 isolates) for STR. Most of the MICs determined by the Etest were easy to interpret and readable within 5 days. Results correlated well with those obtained by the LJ proportion and BACTEC methods for INH and RIF. However, a high proportion of false-sensitive and false-resistant results were observed, most often for STR. We also observed that variations in the inoculum size of M. tuberculosis isolates affected the MICs to a substantial degree. These discrepancies, along with the expense of the media, the Etest strips, and the specialized equipment required (CO2 incubator), make this method less useful in developing countries.

[Neuroradiology of Kallmann's syndrome]

The present study refers to the magnetic resonance characteristics observed in a group of three patients with clinical and laboratory evidence of Kallmann's Syndrome. This disease, also named olfactogenital dysplasia, affects the normal gonadal and olfactory development and is clinically characterized by the association of hypogonadotrophic hypogonadism and anosmia/hyposmia. The study protocol, which included the attainment of sagittal and coronal T1-weighted MPRAGE (Multiplanar Rapid Acquisition Gradient Echo) volumetric sequences, showed defective rhinocephalon development in all patients, expressed by the aplasia/hypoplasia of the olfactory bulbs/tracts and/or of the olfactory sulci. The changes observed corroborate the predictable imaging of this genetic disorder and have been mainly visible in the coronal slices obtained. The results shown are more clear evidence that magnetic resonance is an effective method to show the abnormalities in the olfactory region that are invariably found in this syndrome.

[Subarachnoid hemorrhage and computerized tomography cerebral angiography]

We present a review of 57 cases of nontraumatic subarachnoid hemorrhagesubmitted to CT angiography of the cerebral vessels. The purpose of our study was to estimate the value of CT angiography in the detection of intracranial aneurysms. These findings were compared with those from selective angiography. The results showed that CT angiography is a rapid, low-risk technique with a low level of invasiveness and high specificity and sensitivity in the detection of cerebral aneurysms, allowing the planning of endovascular intervention and surgical approach.

[Tentorium cerebellum fistula. Diagnosis and treatment]

Among the 17 intracranial dural fistulae treated in the Department of Neuroradiology of the University Hospital of Coimbra (17 patients, 28 embolizations) between 19/10/98 and 20/11/2000, 4 cases (23%) were located on the tentorium cerebelli. Three patients were men aged 45, 53 and 56 years old. The remaining patient was an 85-year-old woman. All 4 patients were treated by embolization. One underwent post embolization surgical interruption of the draining vein. The authors analyse clinical presentation, complementary tests, therapy and outcome.

[Malformations in cortical development in patients with epilepsy. Neuroimaging of 17 cases]

This article reviews Malformations of Cortical Development (MCD) diagnosed by Magnetic Resonance Imaging (MRI) in a series of patients with epilepsy. This study spans a five year period. The frequency of these malformations was 7.1%. Most of these were focal or multifocal and the most common ones were polymicrogyria (35.3% of the patients), heterotopia (29.4%), and focal cortical dysplasia (29.4%). The frontal lobes were the most frequently affected regions. The various MCD encountered reflect the wide spectrum of MCD leading to epilepsy.

Hydrogen bonding. 47. Characterization of the ethylene glycol-heptane partition system: hydrogen bond acidity and basicity of peptides

Twelve measured ethylene glycol-heptane partition coefficients, Peh, have been combined with 20 measured literature values and 44 indirectly determined values to give a set of 76 values. Excluding one value for benzamide, the log Peh values are correlated through our general solvation equation, log Peh = 0.336 - 0.075R2 - 1. 201pi2H - 3.786 Sigmaalpha2H - 2.201 Sigmabeta2H + 2.085Vx with r2 = 0.966, sd = 0.28, and F = 386. The solute descriptor R2 is the excess molar refraction, pi2H is the dipolarity/polarizability, Sigmaalpha2H and Sigmabeta2H are the overall hydrogen bond acidity and basicity, and Vx is the McGowan volume. The log Peh equation has then been used to obtain descriptors for eleven peptides, all of which are end-protected. It is shown that for these end-protected peptides, hydrogen bond basicity makes a greater contribution to log Peh than does hydrogen bond acidity.

Spinal cord injuries--epidemiology in Portugal's central region

This study concerns spinal cord injuries (SCI) in a region of Portugal with a population of 1,721,650 inhabitants. Legislation has made it possible to identify deaths occurring during collection and transport. Between 1989 and 1992, 398 new cases of spinal cord injuries were identified, of which 77% were male and 23% female. The average age was 50, with a range of between 1 and 92. As far as the type of injury is concerned, there were 154 isolated SCI (38.7%); in 120 cases (30.1%) there were multiple associated injuries; in 66 cases (16.6%) there was an associated traumatic brain injury; in 34 cases (8.5%) there was an associated trauma of the thorax. In the hospitals concerned no Injury Severity Score (ISS) was carried out during hospitalization. Sixty-four (16%) were dead upon arrival at hospital, and 159 (40%) died before release. The average length of hospitalization was 26.6 days, with the maximum being 539 days. The annual incidence rate is 57.8 new cases per million inhabitants, including those who died before being admitted to hospital. The annual survival rate is 25.4 new cases per million inhabitants. The death rate is very high during the first week, peaking during the first 24 h.

Algorithms for skin permeability using hydrogen bond descriptors: the problem of steroids

Several algorithms that use hydrogen bond descriptors have been published for the permeation of compounds from aqueous solution through human stratum corneum. In the present work, all the skin permeability coefficients, Kp in cm s-1, used in these algorithms for non-steroids have been correlated through the Abraham equation to give a new algorithm: [equation: see text] where n is the number of solutes, r is the correlation coefficient, s.d. is the standard deviation, and F is the F-statistic. The solute descriptors are: R2 an excess molar refraction, pi 2H the dipolarity/polarizability, sigma alpha 2H and sigma beta 2H the overall or effective hydrogen-bond acidity and basicity, and Vx the McGowan characteristic volume. Equation 1 is a reasonably good predictor of log Kp values for steroids as given by Johnson et al, but not for those given by Scheuplein.

[Clinical and neuropathological aspects of Wernicke-Korsakoff syndrome]

Alcohol abuse is one of most serious problems in public health and the Wernicke-Korsakoff syndrome one of the gravest consequences of alcoholism. The pathology is often undiagnosed in its less evident presentations, therefore an accurate diagnostic approach is a critical step in planning treatment. Besides new pharmacological proposals, treatment is based on the restoration of thiamine, although this is insufficient to prevent the psychological decline of a great number of patients. The cognitive impact of the pathology is derived from the interaction of alcoholic neurotoxicity, thiamine deficiency and personal susceptibility. In this article the history, epidemiology, clinical and neuropathological features of the Wernicke-Korsakoff syndrome, as well as some aspects of its treatment and prognosis, are described.