MKRN3 inhibits puberty onset via interaction with IGF2BP1 and regulation of hypothalamic plasticity

Makorin ring finger protein 3 (MKRN3) was identified as an inhibitor of puberty initiation with the report of loss-of-function mutations in association with central precocious puberty. Consistent with this inhibitory role, a prepubertal decrease in Mkrn3 expression was observed in the mouse hypothalamus. Here, we investigated the mechanisms of action of MKRN3 in the central regulation of puberty onset. We showed that MKRN3 deletion in hypothalamic neurons derived from human induced pluripotent stem cells was associated with significant changes in expression of genes controlling hypothalamic development and plasticity. Mkrn3 deletion in a mouse model led to early puberty onset in female mice. We found that Mkrn3 deletion increased the number of dendritic spines in the arcuate nucleus but did not alter the morphology of GnRH neurons during postnatal development. In addition, we identified neurokinin B (NKB) as an Mkrn3 target. Using proteomics, we identified insulin-like growth factor 2 mRNA-binding protein 1 (IGF2BP1) as another target of MKRN3. Interactome analysis revealed that IGF2BP1 interacted with MKRN3, along with several members of the polyadenylate-binding protein family. Our data show that one of the mechanisms by which MKRN3 inhibits pubertal initiation is through regulation of prepubertal hypothalamic development and plasticity, as well as through effects on NKB and IGF2BP1.

Differences in physical activity in subjects with psychosis versus a control group

Introduction

Psychiatric illnesses are related with a reduced life expectancy and an increase of mortality rates (around 60%) mainly associated with cardiovascular diseases [1]. The high prevalence of obesity, metabolic syndrome, diabetes mellitus and tobacco use among these patients undoubtelly predispose to the impairment in physical health and mortaility increase. Regular physical activity in the general population is associated with a decrease in cardiovascular risk but litle is know about iss influence in some chronic and severe mental disorders like schizophrenia ^[2].

Objectives

To quantify the physical activity performed by a sample of subjects with psychosis, borth males and female, compared to a control group.

Methods

A sample composed of 141 patients with schizoprenia was compared to 103 healthy subjects as a control group. The International Physical Activity Questionnaire - Short Form (IPAQ) scale was applied to all participants. The time (minutes) of physical activity performed in a week (METs) was collected by each participant ^[3].

Results

The differences in the total physical activity Mets for the patients with schizophrenia were highly significant (p = 0.001), showing a lower degree of physical activity compared to the control group. A higher and significant percentage of sedentary lifestyle among the psychiatric group (64.5%), compared to 35.5% in the control group was found.

Conclusions

The group of pateints with Schizophrenia showed a significant higher sedentary lifestile including less physical activity. This finding could be highly related with a higher risk of cardiovascular disease and deterioration of the physical health.

Disclosure

No significant relationships.

Hormonal alterations due to antipsychotic-related hyperprolactinemia

Introduction

The use of antipsychotics (APS) is essential. Despite their great efficacy, some of them are associated with an increase in prolactin levels that can lead to hormonal changes needing to be identified and managed [1,2,3]. Hormonal changes use to have clinical implications including hypogonadism, infertility and sexual dysfunction

Objectives

To evaluate possible hormonal alterations and some clinical implications produced by hyperprolactinemia (HPRL) derived from the use of some antipsychotic compounds.

Methods

A complete fasting blood test was performed on a sample of 113 subjects (69 men and 44 women). 54% (n = 61) showed a normal prolactin level and 46% (n = 52) showed hyperprolactinaemia ( >50ng / ml). On the global sample, 39.8% (n = 45) was treated with some hyperprolactinemic drug , mostly risperidone and paliperidone.

Results

Some differences were found depending on the gender of the subjects. A highly significant inverse relationship between the values of prolactin and testosterone was found in males (p=0.020, r=-0.285). In females, increased prolactin level was significantly related to decreased cortisol values.

Conclusions

Antipsychotic-related Hyperprolactinaemia ( mainly risperidone and paliperidone) is related with a decrease in testosterone levels in males and with an increase in cortisol levels in females.

Disclosure

No significant relationships.

Physical and rehabilitation medicine intervention in stroke in the acute hospital setting: A cross-sectional study

INTRODUCTION

Stroke represents the main cause of death and disability in Portugal. Resulting functional deficits are widely recognized. This work aims to evaluate the variation in functionality of stroke patients in the acute hospital setting under a rehabilitation program.

MATERIAL AND METHODS

Cross-sectional study of patients admitted to the Neurology department, from January to June 2019, with acute stroke. The variation in functionality was assessed using the Barthel index. Statistical analysis used Student's t-test and Spearman's correlation coefficient, with a p-value≤0.05 as significant.

RESULTS

106 patients with mean age of 63.7±14.2 years and a male predominance (60.4%) were included. Patients started rehabilitation program at 1.37±1.19 days after admission. A gain in functionality between admission and discharge was identified (50.18±32.37 versus 68.73±28.94, p<0.001). A significantly greater increase was observed in patients diagnosed under code stroke protocol (CSP) (p=0.021) and undergoing some type of acute phase treatment (p=0.017). From 90.5% of the patients that pursued rehabilitation after discharge, 40.6% were referred to an inpatient unit on average 12.7±7.0 days after admission.

DISCUSSION

In this study, Physical and Rehabilitation Medicine (PRM) provided early rehabilitation care to stroke patients. According to international evidence this is associated with greater functional gains. The variation in functionality verified during hospitalization demonstrates the importance of PRM in the acute hospital, assessing the rehabilitation needs after hospital discharge and maximizing outpatient rehabilitation. Diagnosis under CSP and undergoing acute treatment were determinants of greater functional improvement.

CONCLUSION

PRM plays a central role in the early management of functional impairment resulting from stroke and in the post-discharge guidance of patients.

The effect of climate change on domestic Rainwater Harvesting

One of the main strategies that are being applied to improve the efficiency of water consumption in buildings is the use of non-potable water for pavement washing, toilet flushing, irrigation, and others. According to several guidelines, the design and assessment of a Rainwater Harvesting System (RWHS) should be made using recent official records of precipitation. However, there is not an indication whether historical or future projections should be used, leaving space for the designer to choose. This article presents the study of RWHS in southern Europe, namely in Portugal, considering two case studies (a dwelling in Oporto and an apartment in Vila Real). The main goal was to explore the impacts that climate change will have on these systems and, for that purpose, a daily simulation using future rainfall data was performed for both cases considering two scenarios: RCP 4.5 which is more optimistic, and RCP 8.5 which is more pessimistic. The RWHS in Oporto showed a better performance in the future decades, comparing with simulations based on recent decades, for both scenarios. However, the savings will not have a significant variation (less than 5 €/year). In the future, this system will provide around 47 (±2.4) m³ of rainwater per year to the selected non-potable purposes, leading to savings of around 66 (±3.3) €/year. Vila Real case study also revealed a slight improvement of the system's efficiency in the future decades but the results for rainwater collected and used are so similar to the recent ones that it can be concluded that the performance will be sustained. This system will provide around 50 (±2.5) m³ of rainwater per year to the selected non-potable purposes, leading to savings of around 200 (±10.2) €/year. It can be concluded that there will be no significant changes in RWHS performance in the future, in the studied areas.

An approach to the implementation of Low Impact Development measures towards an EcoCampus classification

Impervious cover has important hydrologic impacts, namely the increased runoff volume and peak discharges in the rainwater network, which can lead to significant consequences like rapid urban floods with social, environmental and economic implications. LID (Low Impact Development) consist of distributed runoff management measures, like green roofs, pervious pavements, waterways covered with vegetation and filter trails, among others, that seek to control stormwater in the origin, reducing imperviousness. These solutions avoid increased runoff rate and volume, increase infiltration and groundwater recharge. The main goal of the research work here presented is to study the hydrological impact of LID's in UTAD (University of Trás-os-Montes e Alto Douro) campus, which is an institution focused on sustainability, since it has defined in its Strategic Plan to achieve, in a near future, an EcoCampus classification. To achieve the proposed goal, the campus area was studied in detail in order to evaluate the technical possibility of LID's implementation. A peak discharge comparison was made between the current situation and the one with LID's implementation, using the rational method. The results showed that peak discharges reduction between 68 and 95% may be achieved with LID solutions in UTAD campus.

Energy consumption, CO2 emissions and costs related to baths water consumption depending on the temperature and the use of flow reducing valves

In the domestic segment, various appliances and processes consume great amount of water and, consequently, energy. In this context, the main aim of this study is to analyse the impact of water temperature, flow and bath duration in water and energy consumptions. The impact on CO₂ emissions and a simple costs analysis were also carried out. It included a monitoring plan of 197 baths taken under different scenarios of water temperature and flow. It was concluded that increasing water consumption leads to an increase on energy consumption and that both resources consumptions increase with bath duration. Bath temperature had influence not only on energy consumption, as expected, but also in water consumption, what may be explained by the user's satisfaction during baths with higher temperatures. The use of a flow reducing valve is not a guarantee of water saving which can also be related to the user's satisfaction patterns, given that the introduction of a flow reducing valve can lead to a bath duration increase. In what concerns to the CO₂ emissions, it was concluded, as expected, that higher values are obtained for baths with higher temperatures given their relation with higher energy consumptions patterns. A simple costs analysis revealed that having flow reducing valves, with a bath temperature of 75 °C, increased the costs with electricity and water in 119% and 32%, respectively, when compared with a temperature of 60 °C.

Which are the factors that may explain the differences in water and energy consumptions in urban and rural environments?

Rural and urban environments present significant differences between water and energy consumptions. It is important to know, in detail, which factors related to the consumption of these two resources are different in both environments, once that will be those important to manage and discuss in order to improve its use efficiency and sustainability. This research work involves a survey whose aim is to find the factors that in rural and urban environments may justify the differences found in water and energy consumptions. Besides the collection of water and energy consumption data, this survey analyzed 80 variables (socio-demographic, economic, household characterization, among others), that were chosen among the bibliography as possible factors that should influence water and energy consumptions. After the survey application in rural and urban areas and the data statistical treatment, 42 variables remained as truly differentiating factors of rural and urban environments and so as possible determinants of water and energy consumptions. In order to achieve these objectives, a descriptive data analysis and statistical inference (Mann-Whitney-Wilcoxon test and the Chi-square test of homogeneity) were performed. All the 42 differentiating variables that result from this study may be able to justify these differences, however this will not be presented in the paper and it is reserved for future work.

Ecological and ecotoxicological responses in the assessment of the ecological status of freshwater systems: A case-study of the temporary stream Brejo of Cagarrão (South of Portugal)

The objective of the study was to assess the integrated use of macroinvertebrate indexes and ecotoxicological parameters in the evaluation of the ecological status of a temporary stream with a strong agricultural influence. Water quality was analysed at two sampling sites along the stream, considering: chemical supporting parameters; hazardous substances (pesticides); benthic macroinvertebrate communities, through quality (Iberian Biological Monitoring Working Party and Iberian Average Score Per Taxon) and multi-metric indices (Southern Portuguese Index of Invertebrates and Ecological Quality Ratio); and ecotoxicological responses using lethal and sub-lethal bioassays. The water chemical characterization showed high levels of organic matter and nutrients, mainly in the dry period ((biochemical oxygen demand (BOD₅): 18.5-25.5mgL^-1, chemical oxygen demand (COD): 60.8-193.7mgL^-1; total phosphorus (TP): 0.17-0.33mgL^-1)), which may compromise the support of biological life. In accordance with the physicochemical results, the stream had an ecological status less than good. Of the 25 pesticides analysed, only five, namely terbuthylazine, 2-methyl-chlorophenoxyacetic acid, bentazone, mecoprop and metolachlor were quantified. In general, the concentrations of pesticides detected were low, except at the source of the stream in January 2012 (sum of pesticides 2.29μgL^-1), mainly due to the concentration of bentazone (1.77μgL^-1), both values surpassing the European Commission threshold values. The analysis of benthic macroinvertebrates showed low levels of abundance and family diversity, with communities dominated by resistant groups to organic pollution and pesticides, such as the Chironomidae family. In general, the reproduction ecotoxicological results showed a very marked decrease in the number of juveniles per female. The Spearman correlation identified pesticides, namely MCPA (R=-0.89; p<0.05), as the main responsible for the observed effect. The results showed the linearity and complementarity of the two groups of biological responses, allowing to cover the interactions between the ecosystem's species and the different types of pollutants.

In situ evaluation of water and energy consumptions at the end use level: The influence of flow reducers and temperature in baths

Nowadays, water and energy consumption is intensifying every year in most of the countries. This perpetual increase will not be supportable in the long run, making urgently to manage these resources on a sustainable way. Domestic consumptions of water and electric energy usually are related and it's important to study that relation, identifying opportunities for use efficient improvement. In fact, without an understanding of water-energy relations, there are water efficiency measures that may lead to unintentional costs in the energy efficiency field. In order to take full advantage of combined effect between water and energy water management methodologies, it is necessary to collect data to ensure that the efforts are directed through the most effective paths. This paper presents a study based in the characterization, measurement and analysis of water and electricity consumption in a single family house (2months period) in order to find an interdependent relationship between consumptions at the end user level. The study was carried out on about 200 baths, divided in four different scenarios where the influence of two variables was tested: the flow reducer valve and the bath temperature. Data showed that the presence of flow reducer valve decreased electric energy consumption and water consumption, but increased the bath duration. Setting a lower temperature in water-heater, decreased electric consumption, water consumption and bath duration. Analysing the influence of the flow reducer valve and 60°C temperature simultaneously, it was concluded that it had a significant influence on electric energy consumption and on the baths duration but had no influence on water consumption.

[Rehabilitation after total knee arthroplasty of hip and knee]

Numbers of total hip and knee arthroplasties are increasing on a regular basis. Clinical pathways tend to shorten the duration of hospitalization in acute care after surgery. Therefore, the preoperative preparation of the patient and his abilities for postoperative rehabilitation should be carefully addressed. Before the surgical intervention, it is recommended that the patient receives an educational program and a physical preparation. After the surgical intervention, the patient can benefit from a home-based rehabilitation program supervised by a physiotherapist, if there were no preoperative reasons for prolonging the hospital stay and if the surgery took place without complications. Some patients may benefit from postsurgical rehabilitation in a specialized locomotor rehabilitation long-stay care unit. The indications for inpatient multidisciplinary rehabilitation are : two simultaneous arthroplasties, revision of a previous hip or knee arthroplasty, postsurgical complications, advanced age, comorbidities influencing the rehabilitation process, social difficulties, necessity for adaptation of the environment, insufficient or unadapted out-patient (para)medical care. The goals of the rehabilitation treatment depend on the patient's characteristics and environment, on the properties of the prosthesis and on the postsurgical complications. The functional prognosis of a total joint arthroplasty of the knee or hip is excellent, provided that there are no post-surgical complications and that the patient benefits from adequate rehabilitation therapy. The present paper describes the different phases of rehabilitation treatment and the general and specific complications of total hip and knee arthroplasties that may influence the rehabilitation outcome.

ESGAR consensus statement on liver MR imaging and clinical use of liver-specific contrast agents

Objectives

To develop a consensus and provide updated recommendations on liver MR imaging and the clinical use of liver-specific contrast agents.

Methods

The European Society of Gastrointestinal and Abdominal Radiology (ESGAR) formed a multinational European panel of experts, selected on the basis of a literature review and their leadership in the field of liver MR imaging. A modified Delphi process was adopted to draft a list of statements. Descriptive and Cronbach’s statistics were used to rate levels of agreement and internal reliability of the consensus.

Results

Three Delphi rounds were conducted and 76 statements composed on MR technique (n = 17), clinical application of liver-specific contrast agents in benign, focal liver lesions (n = 7), malignant liver lesions in non-cirrhotic (n = 9) and in cirrhotic patients (n = 18), diffuse and vascular liver diseases (n = 12), and bile ducts (n = 13). The overall mean score of agreement was 4.84 (SD ±0.17). Full consensus was reached in 22 % of all statements in all working groups, with no full consensus reached on diffuse and vascular diseases.

Conclusions

The consensus provided updated recommendations on the methodology, and clinical indications, of MRI with liver specific contrast agents in the study of liver diseases.

Key points

• Liver-specific contrast agents are recommended in MRI of the liver.

• The hepatobiliary phase improves the detection and characterization of hepatocellular lesions.

• Liver-specific contrast agents can improve the detection of HCC.

Patterns of tick infestation and their Borrelia burgdorferi s.l. infection in wild birds in Portugal

Wild birds may act as reservoirs for zoonotic pathogens and may be mechanical carriers of pathogen infected vector ticks through long distances during migration. The aim of this study was to assess tick infestation patterns in birds in Portugal and the prevalence of tick infection by Borrelia burgdorferi s.l. using PCR techniques. Seven tick species were collected from birds including Haemaphysalis punctata, Hyalomma spp., Ixodes acuminatus, Ixodes arboricola, Ixodes frontalis, Ixodes ricinus and Ixodes ventalloi. We found that I. frontalis and Hyalomma spp. were the most common ticks infesting birds of several species and that they were widespread in Portugal. Turdus merula was the bird species that presented the highest diversity of infesting ticks and had one of the highest infestation intensities. B. burgdorferi s.l. was detected in 7.3% (37/505) of Ixodidae ticks derived from birds. The most common genospecies was Borrelia turdi (6.9%), detected in ticks collected from Parus major, T. merula and Turdus philomelos, but Borrelia valaisiana (0.2%) and one Borrelia sp. (0.2%) similar to Borrelia bissettii (96% of similarity of the flaB gene in Blastn) were also detected. This study contributed to a better knowledge of the Ixodidae tick fauna parasitizing birds in Western Europe and to the assessment of the prevalence of B. burgdorferi s.l. associated with birds and their ticks.

Wastewater and greywater reuse on irrigation in centralized and decentralized systems--an integrated approach on water quality, energy consumption and CO2 emissions

Wastewater and greywater have different scales of end-uses in irrigation in Portugal. Wastewater is treated in a central wastewater treatment plant and reused in public/private large areas of irrigation, like agriculture, public gardens and golf courses. On the contrary, greywater reuse is generally applied in in situ small scales, treated and used in the same place, generally in the production site. The main aim of this paper is to compare the two types of systems: a wastewater centralized reuse system (WWCRS) and a greywater decentralized reuse system (GWDRS) in terms of water quality, energy consumption and CO2 emissions. In this paper, the main characteristics of both streams are presented and the degree of treatment required in each stream is analyzed. The advantages and disadvantages of its reuse in different scales, in terms of water quality, energy consumption and CO2 emissions are discussed. A methodology to calculate the energy consumptions and CO2 emissions related to wastewater treatment that may be applied in different cases is presented. A hypothetical example of the two systems: one referring to a WWCRS and the other to a GWDRS is presented. The energy consumption and the CO2 emissions are analyzed and compared. The WWCRS needs a higher degree of treatment and so it spends more energy and leads to more CO2 emissions to the environment than the GWDRS that consumed between 11.8 and 37.5% of the energy consumed in the WWCRS considering the same number of inhabitants served.

Imaging techniques for assessment of inflammatory bowel disease: joint ECCO and ESGAR evidence-based consensus guidelines

The management of patients with IBD requires evaluation with objective tools, both at the time of diagnosis and throughout the course of the disease, to determine the location, extension, activity and severity of inflammatory lesions, as well as, the potential existence of complications. Whereas endoscopy is a well-established and uniformly performed diagnostic examination, the implementation of radiologic techniques for assessment of IBD is still heterogeneous; variations in technical aspects and the degrees of experience and preferences exist across countries in Europe. ECCO and ESGAR scientific societies jointly elaborated a consensus to establish standards for imaging in IBD using magnetic resonance imaging, computed tomography, ultrasonography, and including also other radiologic procedures such as conventional radiology or nuclear medicine examinations for different clinical situations that include general principles, upper GI tract, colon and rectum, perineum, liver and biliary tract, emergency situation, and the postoperative setting. The statements and general recommendations of this consensus are based on the highest level of evidence available, but significant gaps remain in certain areas such as the comparison of diagnostic accuracy between different techniques, the value for therapeutic monitoring, and the prognostic implications of particular findings.

A pilot study of common health problems in smallholder pigs in Angónia and Boane districts, Mozambique

Apilot survey was conducted in 2 districts in Mozambique to determine the most important health problems facing smallholder pig producers. While African swine fever is the most serious disease that affects pigs at all levels of production in Mozambique, it is likely that productivity is reduced by the presence of mange and gastrointestinal parasites, while in traditional systems the conditions are favourable for the development of porcine cysticercosis caused by the pork tapeworm Taenia solium, which poses a health risk to communities. Results of the pilot survey confirmed that, with the exception of African swine fever, ecto- and endoparasites are probably the most important health risks for producers. Porcine cysticercosis is more prevalent among pigs in traditional, free-ranging systems, while mange becomes a serious factor when pigs are permanently confined.

Assessment of the pesticides atrazine, endosulfan sulphate and chlorpyrifos for juvenoid-related endocrine activity using Daphnia magna

The water flea Daphnia magna belongs to the cyclical parthenogenic species, which can reproduce by either parthenogenesis or sexual reproduction. Recent studies have reported the involvement of the methylfarnesoate hormone, in male sex determination of D. magna. The aim of this study was to evaluate the juvenoid and anti-juvenoid activity of atrazine, endosulfan sulphate, and chlorpyrifos. To assess the juvenoid activity we exposed maternal daphnids to several concentrations of the respective pesticides, using the percentage of male production as endpoint. Fenoxycarb (1microgL(-1)) was used as a positive control. The anti-juvenoid activity was assessed using a similar bioassay after the addition of fenoxycarb (1microgL(-1)) to all test solutions. Fenoxycarb is an insect growth regulator that mimics the action of methylfarnesoate, and promoted the production of 95% of male offspring at the given concentration. Weak juvenoid-agonist activity was detected for endosulfan sulphate, with a significant increase of the percentage of male daphnids detected through logistic regression. In addition, atrazine and endosulfan sulphate antagonized the juvenoid activity of fenoxycarb. These results also corroborate the hypothesis that weak juvenoid agonists can simultaneously act as juvenoid antagonists as it has been observed in other hormonal systems.

Effects of atrazine and endosulfan sulphate on the ecdysteroid system of Daphnia magna

The ecdysteroid system is used by crustaceans and other arthropods as the major endocrine signalling molecules, regulating processes such as molting and embryonic development. The aim of this study was to evaluate the ecdysteroid activity of two pesticides (atrazine and endosulfan sulphate), with distinct modes of action and which act in the juvenoid system of the crustacean Daphnia magna as weak juvenoid compounds. To assess the ecdysteroid activity, we first exposed maternal daphnids and embryos to nominal concentrations of the pesticides and determined the effect promoted by these pesticides on the molting frequency and on abnormalities in the embryos development. Furthermore, we evaluated if the toxic effects observed with the isolated pesticides were promoted or not by the disruption of the ecdysteroids system of the crustacean, by co-administrating of them with 20-hydroxyecdysone hormone. This hormone is the prime form of the invertebrate's ecdysteroids system and it is responsible for the crustacean molting process. Both pesticides induced an increase of embryo abnormalities development. Endosulfan sulphate promoted a delay in the molting process. The effects induced by atrazine were not altered by co-exposure to 20-hydroxyecdysone. In contrast, the co-administration of 20-hydroxyecdysone allowed the reversion of the effects on both the molting process and embryonic development elicited by endosulfan sulphate. These results suggest that atrazine promotes its toxicity without interfering with the ecdysteroid activity of the crustacean. On the contrary, endosulfan sulphate is an anti-ecdysteroidal compound for D. magna.

Fatty acid profile of human milk of Portuguese lactating women: prospective study from the 1st to the 16th week of lactation

BACKGROUND/AIMS

Fatty acid (FA) composition varies over the course of the day and during lactation. The aim of this study was to evaluate FA composition and its compositional stability in human milk, from day 7 to week 16 of lactation.

METHODS

Human milk was collected from all feedings over 24 h at day 7 and weeks 4, 8, 12 and 16 of lactation in 31 lactating women. FAs were analyzed through gas chromatography. Comparisons were made with analysis of variance.

RESULTS

Total monounsaturated FAs decreased from 33.04 +/- 2.58% wt/wt at day 7 to 31.48 +/- 3.32% wt/wt at week 16 of lactation, much at the expenses of the decrease in the major monounsaturated FA found in human milk, oleic acid. Main polyunsaturated FAs n-6 and n-3 showed fluctuations from day 7 up to week 16 of lactation, but with no statistical significance. Arachidonic acid significantly decreased from transitional to mature milk.

CONCLUSIONS

The FA profile obtained throughout the study time points presented very low levels of oleic acid and very high linoleic acid/alpha-linoleic acid ratios which reflect recent changes in Portuguese women's food patterns. Despite this, the arachidonic acid/docosahexaenoic acid ratio [corrected] remained constant during the study, suggesting a protective metabolic mechanism.

Pancreatic ductal system obstruction and acute recurrent pancreatitis

Acute recurrent pancreatitis is a clinical entity largely associated with pancreatic ductal obstruction. This latter includes congenital variants, of which pancreas divisum is the most frequent but also controversial, chronic pancreatitis, tumors of the pancreaticobiliary junction and sphincter of Oddi dysfunction. This review summarizes current knowledge about diagnostic work-up and therapy of these conditions.

The influence of HLA mismatches and immunosuppression on kidney graft survival: an analysis of more than 1300 patients

New immunosuppressive drugs used in kidney transplantation decreased the incidence of acute rejection. It was hypothesized that, with their power, the importance of HLA matching was decreased. To evaluate the influence of HLA matching, immunosuppression, and other possible risk factors, we analyzed data of 1314 consecutive deceased donor kidney transplantation. We divided the patient population into 4 cohorts, according to the era of transplantation: era 1, before 1990, azathioprine (Aza) and cyclosporine (Csa) no microemulsion; era 2, between 1990 and 1995, Csa microemulsion; era 3, between 1996 and 2000, wide use of mycophenolate mofetil (MMF) and anti-thymocyte globulin (ATG); and era 4, after 2000, marked by sirolimus and tacrolimus (TAC) use. Multivariate analysis compared death-censored graft survival. Using as reference the results obtained with 0 HLA mismatches, we verified, during era 1 and era 2, an increased risk of graft loss for all of the subgroups with HLA mismatch >0. However, during era 3 and era 4, the number of HLA mismatches did not influence graft survival. Although acute rejection and delayed graft function, which decreased in the later periods, remained as prognostic factors for graft loss. Considering the immunosuppressive protocol with Csa+Aza+Pred as reference, protocols used after 1995 with Pred+Csa+ATG, with Pred+Csa+MMF, and with Pred+Tac+MMF presented better survival results. Results showed that the significance of HLA matching decreased while the results improved with the new immunosuppressant drugs. These observations support the hypothesis that the weakened importance of HLA matching may be a consequence of the increasing efficacy of the immunosuppression.

MR cholangiography: what's new?

This article presents a brief overview of current and incoming MR imaging techniques for the diagnosis of diseases of the biliary system. It emphasizes the impressive amount of morphological and functional information that can be obtained with a non invasive technique.

Endoscopic therapy for chronic pancreatitis

When endoscopic therapy is used for the treatment of patients with painful chronic pancreatitis, extracorporeal shock wave lithotripsy (ESWL) can be proposed as a first-line approach when obstructive ductal stone(s) induce upstream dilation of the main pancreatic duct. Stone fragmentation by ESWL is followed by endoscopic ductal drainage using pancreatic sphincterotomy, fragmented stone(s) extraction, and pancreatic stenting in case of ductal stricture. After completion of endoscopic pancreatic ductal drainage, long-term clinical benefit can be expected for two thirds of the patients. Best clinical results are associated with absence or cessation of smoking and with early treatment in the course of chronic pancreatitis, while alcohol abuse increases the risks of diabetes, steatorrhea and mortality. The complications of chronic pancreatitis are mainly the development of pseudocyst secondary to the downstream ductal obstruction, and biliary obstruction caused by fibrotic changes in the head of the pancreas. Successful endoscopic pseudocyst drainage is currently obtained in most patients, and carries a low complication rate. Biliary stenting is a safe and effective technique for the short-term treatment of symptomatic bile duct stricture due to chronic pancreatitis, but permanent resolution is obtained in only 25% of cases. In conclusion, endoscopic management is now considered to be the preferred interventional treatment of chronic pancreatitis, for patients selected on the basis of the anatomical changes caused by the disease. This treatment is generally safe, minimally invasive, often effective for years, does not prevent further surgery, and can be repeated.

Quantification of pancreatic exocrine function with secretin-enhanced magnetic resonance cholangiopancreatography: normal values and short-term effects of pancreatic duct drainage procedures in chronic pancreatitis. Initial results

The aim of this study was to quantify pancreatic exocrine function in normal subjects and in patients with chronic pancreatitis (CP) before and after pancreatic duct drainage procedures (PDDP) with dynamic secretin-enhanced magnetic resonance (MR) cholangiopancreatography (S-MRCP). Pancreatic exocrine secretions [quantified by pancreatic flow output (PFO) and total excreted volume (TEV)] were quantified twice in ten healthy volunteers and before and after treatment in 20 CP patients (18 classified as severe, one as moderate, and one as mild according to the Cambridge classification). PFO and TEV were derived from a linear regression between MR-calculated volumes and time. In all subjects, pancreatic exocrine fluid volume initially increased linearly with time during secretin stimulation. In controls, the mean PFO and TEV were 6.8 ml/min and 97 ml; intra-individual deviations were 0.8 ml/min and 16 ml. In 10/20 patients with impaired exocrine secretions before treatment, a significant increase of PFO and TEV was observed after treatment (P<0.05); 3/20 patients presented post-procedural acute pancreatitis and a reduced PFO. The S-MRCP quantification method used in the present study is reproducible and provides normal values for PFO and TEV in the range of those obtained from previous published intubation studies. The initial results in CP patients have demonstrated non-invasively a significant short-term improvement of PFO and TEV after PDDP.

Pancréatites chroniques et inflammatoires : apport des techniques d’imagerie en coupe

The role of diagnostic imaging in chronic and inflammatory pancreatitis is to detect structural changes of the ducts and pancreatic parenchyma, to assess the functional integrity of the gland, to detect associated complications, and to assist in management. These goals may be achieved using helical CT and MR imaging with secretin stimulation. In this review, the advantages of each technique are discussed and illustrated.

[Rational use of MRI in abdominal diseases]

The use of magnetic resonance imaging (MRI) for patients with a variety of suspected abdominal and pelvic diseases continues to increase and the number of examinations performed is limited primarily by the number of MR scanners available. This text shortly reviews the rationale of MRI in the investigation of the abdomen and pelvis.

An outbreak of conjunctivitis caused by multiresistant Pseudomonas aeruginosa in a Brazilian Newborn Intensive Care Unit

We report an outbreak of conjunctivitis due to Pseudomonas aeruginosa involving seven infants admitted in the Neonatal Intensive Care Unit (NICU) of the Uberlândial Federal University Hospital between March and September 2001. Three infants developed systemic complications (01 sepsis and 02 pneumonias). Ten isolates were obtained from conjunctival cultures and all were resistant to ceftazidime and aminoglycosides. Fast identification of the organism and treatment with imipenem were important in containing the outbreak of P. aeruginosa.