From guidelines to current practices: Suboptimal hypertension management in France

In France, the prevalence of hypertension is higher than 30%. Although treatment guidelines have been well established over the last twenty years, the national blood pressure control rate is below the average of high-income countries. This observational study aimed to describe the antihypertensive prescription behaviours of primary care physicians (PCPs) in France and to assess their compliance with current French guidelines, focusing on three specific prescription issues and their potential repercussions on blood pressure control: treatment initiation, treatment renewal or change and type of triple therapy. Prescription data were retrieved using the IQVIA longitudinal patient database (LPD), which delivers real-world data insights from French primary care electronic medical records (EMR). The average number of prescribed therapeutic agents was 1.9 per patient, with 39.3% monotherapy prescriptions. Treatment initiation represented 7.2% of all antihypertensive prescriptions. At treatment initiation, 22.5% of patients were prescribed dual therapy. The proportion of treatment renewal in the same therapeutic class was 74.3% while the proportion of treatment change was 18.5%. Of these, only 6.3% of patients received an additional therapy. Lastly, 35.7% of triple therapies were consistent with the recommended combinations. In conclusion, this study provides evidence of therapeutic gaps in hypertension management in France. The low blood control rate may be attributed to PCPs' therapeutic inertia and lack of knowledge of treatment guidelines. All stakeholders should commit to rapid corrective action in order to provide patients with the best care.

Skin pigmentation as landmark for arteriovenous fistula cannulation in hemodialysis

BACKGROUND

The cannulation of the arteriovenous fistula (AVF) for hemodialysis (HD) has traditionally depended on the nurse's tactile sensation, which has been associated with suboptimal needle placement and detrimental effects on vascular access (VA) longevity. While the introduction of ultrasound (US) has proven beneficial in mapping the AVF outflow vein and assisting in cannulation planning, aneurysmal deformations remain a common occurrence resulting from various factors, including inadequate cannulation techniques. Within this context, the utilization of skin pigmentation as a clinical landmark has emerged as a potential approach to enhance cannulation planning in HD.

METHODS

A prospective longitudinal study was undertaken to investigate the correlation between the occurrence of venous morphological deformations and the cannulation technique guided by skin pigmentation after a 2-month period of implementation.

RESULTS

Thirty patients were enrolled in the study with 433 cannulations being described within the first 2 months of AVF use. The overall rate of cannulation-related adverse events was 21.9%. Comparative analysis demonstrated a statistically significant relationship (p < 0.001) between aneurysmal deformation and non-compliance with the proposed cannulation technique, resulting in cannulation outside the designated points. Non-compliance was primarily attributed to nurse's decision (57.1%).

CONCLUSION

The integration of US mapping of the AVF outflow vein and the utilization of skin pigmentation as a guiding tool have shown promising results in enhancing cannulation planning over time. Consistent adherence to a cannulation technique other than the area technique has been found to reduce the risk of AVF morphological deformation. These findings underscore the potential benefits of incorporating skin pigmentation as a clinical landmark in cannulation practices, highlighting its ability to impact positively cannulation outcomes.

Patients with laboratory criteria of anti-phospholipid syndrome and 'non-criteria' manifestations: a multicenter cohort

OBJECTIVES

Patients with laboratory criteria for anti-phospholipid syndrome (APS) but presenting only 'non-criteria' clinical manifestations are scarcely characterized in the literature. We aimed to analyse a cohort of these patients regarding the most prevalent manifestations, antibody profile, and treatments, while establishing a comparison with definite APS patients.

METHOD

A retrospective analysis was conducted of individuals fulfilling APS laboratory criteria assessed in two tertiary European hospitals between 2005 and 2020. Patients without clinical criteria but with non-criteria manifestations (termed 'clinical non-criteria') and age-/gender-matched controls were included.

RESULTS

Altogether, 75 clinical non-criteria patients were analysed, with haematological (thrombocytopenia, haemolytic anaemia) and 'mild' neurological manifestations (white-matter lesions, migraine) as the most prevalent non-obstetric involvements. These patients displayed more thrombocytopenia [odds ratio (OR) = 3.6, 95% confidence interval (CI) 1.7-7.6; p = 0.001] than controls with APS, but severe manifestations, such as valvular heart disease (p < 0.001), livedoid vasculopathy, seizures, chorea, transverse myelitis, bone necrosis, and alveolar haemorrhage, occurred only in definite APS patients. Corticosteroids were required by 40% of patients with thrombocytopenia. Manifestations in anticoagulated patients included white-matter lesions, nephropathy, superficial vein thrombosis, amaurosis fugax, and livedoid vasculopathy. Suspicion of progression towards systemic lupus erythematosus (SLE) occurred in 19% of non-SLE individuals.

CONCLUSION

'Clinical non-criteria' patients displayed significant treatment use, predominantly haematological involvement, and less severe manifestations than definite APS controls. Some patients may additionally progress to future SLE. The impact of certain manifestations flags them as potential future contributors to classifying individuals as definite APS.

T-type Ca2+ channels and their relationship with pre-neoplastic and neoplastic lesions in the human breast

The expression of T-type voltage-dependent Ca2+ channels (Cav3) has been previously observed in breast cancer, but their expression and subcellular localization were not evaluated in pre-neoplastic lesions. Therefore, this work aimed to evaluate protein expression and subcellular localization of T-type channel isoforms in human breast tissue samples. Protein expressions of CaV3.1, CaV3.2, and CaV3.3 were evaluated by immunohistochemistry in breast without alteration, in proliferative non-neoplastic lesions, and in neoplastic ductal epithelial lesions of the human breast. CaV3.1, CaV3.2, and CaV3.3 nuclear expressions were decreased in advanced stages of neoplastic transformation, whereas CaV3.1 and CaV3.2 cytoplasmic expression increased. Also, the decrease in nuclear expression was correlated with an increase in cytoplasmic expression for CaV3.1 isoform. The change in CaV3 protein expression and subcellular localization are consistent with the neoplastic transformation stages of mammary epithelial cells, evident in early neoplastic lesions, such as ductal carcinomas in situ. These results suggest a possible involvement of CaV3 in the carcinogenic processes and could be considered as a potential pharmacological target in new therapies for breast cancer treatment.

Impact of the COVID-19 pandemic on maternal mental health during pregnancy: The CONCEPTION study – Phase I

Introduction

Mental health regional differences during pregnancy through the COVID-19 pandemic is understudied.

Objectives

We aimed to quantify the impact of the COVID-19 pandemic on maternal mental health during pregnancy.

Methods

A cohort study with a web-based recruitment strategy and electronic data collection was initiated in 06/2020. Although Canadian women, >18 years were primarily targeted, pregnant women worldwide were eligible. The current analysis includes data on women enrolled 06/2020-11/2020. Self-reported data included mental health measures (Edinburgh Perinatal Depression Scale (EPDS), Generalized Anxiety Disorders (GAD-7)), stress. We compared maternal mental health stratifying on country/continents of residence, and identified determinants of mental health using multivariable regression models.

Results

Of 2,109 pregnant women recruited, 1,932 were from Canada, 48 the United States (US), 73 Europe, 35 Africa, and 21 Asia/Oceania. Mean depressive symptom scores were lower in Canada (EPDS 8.2, SD 5.2) compared to the US (EPDS 10.5, SD 4.8) and Europe (EPDS 10.4, SD 6.5) (p<0.05), regardless of being infected or not. Maternal anxiety, stress, decreased income and access to health care due to the pandemic were increasing maternal depression. The prevalence of severe anxiety was similar across country/continents. Maternal depression, stress, and earlier recruitment during the pandemic (June/July) were associated with increased maternal anxiety.

Conclusions

In this first international study on the impact of the COVID-19 pandemic, CONCEPTION has shown significant country/continent-specific variations in depressive symptoms during pregnancy, whereas severe anxiety was similar regardless of place of residence. Strategies are needed to reduce COVID-19’s mental health burden in pregnancy.

Disclosure

No significant relationships.

Rare case of interstitial nephritis in a young adult under IgG therapy

Immunoglobulin replacement therapy is an important therapeutic approach used in different diseases, such as immunodeficiency diseases. We report a case of a 19-year-old female patient with suspected common variable immunodeficiency who started replacement therapy with IgG. During the follow-up, she developed interstitial nephritis and the subsequent workup excluded other diseases or triggers except IgG therapy.

A Case of Acute Interstitial Nephritis After Two Doses of the BNT162b2 SARS-CoV-2 Vaccine

Background

The development of vaccines to prevent COVID-19 breakouts came with highly positive results but some unexpected side effects. Rare side effects have been seen with the BNT162b2 SARS-CoV 2 vaccine.

Case Presentation

We present the case of a 45-year-old female patient who developed an acute kidney injury needing urgent hemodialysis one week after the second administration of the BNT162b2 SARS-CoV 2 vaccine. She developed a macular rash on her lower limbs and palms as well. A kidney biopsy was performed 10 days after vaccine inoculation, diagnosing acute interstitial nephritis and acute tubular necrosis with cellular casts. The patient was treated with three corticosteroid pulses followed by daily prednisolone. We witnessed clinical improvement 4 days after the initial corticosteroid treatment with progressive recovery of kidney function and hemodialysis withdrawal. After 2 weeks, the patient had recovered her kidney function. Immunophenotyping was performed, diagnosing a hypersensitivity to the vaccine and the polyethylene glycol excipient.

Conclusion

Patients may develop acute reactions to vaccines. In this case, symptoms seem to correlate significantly with its inoculation and, although this case had a favourable outcome, these side effects must be made aware for clinicians and patients.

Evaluation of the immunomodulatory activity of thalidomide on tumor-associated macrophages in the 4T1 murine metastatic breast cancer model

ABSTRACT The present work evaluated the immunomodulatory effect of thalidomide (Thal) at different doses on tumor-associated macrophages (TAMs) using a mouse model of human breast cancer. Mice were inoculated with 4T1 cells in the left flank and treated with Thal once a day at concentrations of 50, 100, and 150mg/kg body weight from the 5th day until the 28th day of tumor inoculation. The tumors were sized, proliferation index and TAMs count were evaluated in primary tumors and metastatic lungs. In addition, the metastasis rate was evaluated in the lungs. Thal at 150mg/kg significantly decreased tumor growth, proliferation index, and TAMs infiltration in primary tumors. Conversely, a higher number of TAMs and lower proliferation index were observed in metastatic lungs in mice treated with 150mg/kg of Thal. Furthermore, Thal at 150mg/kg significantly decreased the metastatic nodules in the lungs. Our findings demonstrated that Thal treatment considerably decreased the primary tumor and lung metastasis in mice associated with different TAM infiltration effects in these sites.

Cutaneous mast cell tumor in a captive Bush dog (Speothos venaticus): pathological and immunophenotypical aspects - case report

ABSTRACT A senile male captive bush dog (Speothos venaticus) presented a small perianal cutaneous nodule. Histologically, there was an ulcerated round cell tumor composed of well differentiated mast cells with abundant intracytoplasmic purple Giemsa-positive granules, with a diffuse eosinophilic infiltrate. Immunohistochemistry revealed that 30% of the neoplastic cells were positive for Kit in the cytoplasm and cell membrane, and all neoplastic cells were negative for MAC and CD3. Less than 10% of the neoplastic cells were positive for Ki67. At necropsy other primary tumors were identified in this animal, including an intestinal adenoma, an adrenal cortex adenoma and a testicular interstitial cell tumor.

Expression of VCAN and its receptors in canine mammary carcinomas with or without myoepithelial proliferation

The proteoglycan versican (VCAN) plays a complex role in cancer. The expression of this molecule has been related to invasion and progression in malignant mixed tumors, such as carcinoma in mixed tumors (CMT) of the canine mammary gland. In addition, its interaction with surface cell receptors EGFR, HER-2 and CD44 in malignant epithelial cells may be responsible for proliferation and cellular motility in early stages of cancer. We comparatively evaluated the expression of this proteoglycan and its receptors in in situ and invasive areas of simple carcinomas (SC) and CMT to investigate similarities and differences between these histological types. Immunohistochemistry was performed with anti-VCAN, anti-CD44, anti-EGFR and anti-HER-2 antibodies in 32 cases of SC or CMT. VCAN was highly expressed in stroma adjacent to invasive areas in SC and CMT. CMTs presented comparatively higher expression of VCAN in stroma adjacent to in situ and in invasive areas than in corresponding areas in SCs. In CMT, EGFR and HER-2 expressions were higher in situ compared to invasive areas. In contrast, increased CD44 and EGFR expression was found in invasive areas in SC compared to CMT. These results indicate that versican expression is similarly associated with invasiveness in SC and CMT, however higher levels were seen in CMT suggesting that the presence of myoepithelial proliferation in this tumor type participates in stromal composition and promoting an increase in the expression of versican.

Universal API for wellness and fitness BLE sensors

Background

A number of Bluetooth wellness and fitness devices were analysed to explore ways to access their raw data, using Bluetooth and the Generic Attribute Profile specification, while developing a Rest API using the .Net Core framework to provide a way to easily access said data in real time, in order to provide it to other uses, like dashboards or data science applications.

Methods

Two Bluetooth Low Energy devices were chosen for this experiment for their ability to record and transmit heart rate data in real-time, and as such our primary focus during development would be in obtaining this raw data. After collecting all the services and characteristics of the device, a method was implemented to read a value from a particular characteristic uuid, in our case the heart rate measurement. The resulting values obtained from the API follows the format specified in the corresponding XML file of the Bluetooth-SIG specification.

Results

The developed API worked as expected and provided useful information to advance its development to cover more devices, services, and features. We were able to obtain data not only from Heart Rate Monitoring, but also from the Battery Service and Device Information.

Conclusions

With these results it will be possible to expand the compatibility of the API to other devices, and also to other services present on the devices analysed, which were not considered in this preliminary analysis. The ultimate goal is the integration of this API on a rehabilitation oriented device being developed for this project.

Extracapsular extension and tumor implants in lymph nodes with canine mammary carcinoma metastasis: Study of the impact on survival

Regional lymph node status impacts survival in dogs with malignant mammary tumors. However, few studies have evaluated extracapsular extension and tumor implants in regional lymph node metastases in dogs with mammary carcinoma. Therefore, 84 cases of mammary carcinomas with metastases in inguinal and/or axillary lymph nodes from female dogs of different breeds and a total of 139 metastatic lymph nodes were evaluated by routine histological staining. Clinical and pathological characteristics of primary tumors as well as the presence of extracapsular extension and tumor implants in the lymph nodes were analyzed, in addition to survival. One to 5 lymph nodes were evaluated in each case. Extracapsular extension and tumor implants were present in 17.9% and 39.3% of cases, respectively. The simultaneous presence of extracapsular extension and tumor implants were associated with an increased risk of death (hazard ratio 10.46). In addition, "special type carcinomas", high histological grade (grade III), and presence of extracapsular extension associated with tumor implants were related to a worse prognosis and shorter survival times (p < 0.05). Based on these results, we highlight the importance of identifying extracapsular extension and tumor implants in dogs with metastatic mammary carcinomas, as they are associated with a higher risk of death and shorter survival.

Anatomical and histological traits of Brycon amazonicus liver cultivated in a semi-intensive system

The work aimed to evaluate the weight-length relationship and the condition factor, characterizing the biometry, anatomy, histology and volumetric density of the liver of Brycon amazonicus, in different stages of body growth. The experiment used twenty specimens in four stages of body growth (PI, PII, PIII and PIV) harvested every 90 days, containing five specimens, each group. The livers were dissected, weighed (g) and processed routinely using the hematoxylin and eosin technique. The data were submitted to analysis of variance, Pearson's correlation test and linear regression. The equation that represented the weight-length relation was W = 0.05902 x L2.63, with negative allometric growth, but with a relative condition factor equal to 1.0. The liver was divided into three lobes with the gallbladder close to the right lobe and its color varied from light red to dark red, not varying in relation to other fish species. The hepatosomatic relationship followed body growth until the PII group stage and then declined, demonstrating the behavior of its development in Brycon amazonicus. The organ consists predominantly of hepatocytes, followed by sinusoidal vessels and capillaries, with histological morphology similar to that of many species of fish. Melanomacrophage centers were found only in the most developed animals, but in small quantities, prompting the development of new research on this cell, in this species. In this way, research of this nature allows the characterization of fish species, helping to improve breeding methods, understanding pathological processes caused by diseases, and obtaining better productive capacity, serving an increasingly demanding and prosperous market.

AB0340 PATIENTS WITH LABORATORY CRITERIA OF ANTIPHOSPHOLIPID SYNDROME AND “NON-CRITERIA” MANIFESTATIONS: A MULTICENTER STUDY

Background:

Patients with laboratory criteria for antiphospholipid syndrome (APS) and presenting only “non-criteria” clinical manifestations are scarcely described in the literature [1-3].

Objectives:

To describe a cohort of these patients, portraying potential associations between “non-criteria” manifestations, antiphospholipid antibodies (aPL) and treatments.

Methods:

Retrospective analysis of patients with aPL positivity fulfilling APS criteria assessed in two tertiary European hospitals between 2005 and 2020. Those without criteria clinical manifestations but with the presence of “non-criteria” manifestations were included.

Results:

A total of 75 patients were analyzed. The predominant non-obstetric involvements were hematologic (thrombocytopenia, hemolytic anemia) and “mild” neurological (white matter lesions, migraine), with an absence or near absence of cutaneous, cardiac, pulmonary and more severe neurologic manifestations (Table 1). In obstetric morbidity, two spontaneous abortions before 10 weeks and infertility were the more frequent manifestations. LA positivity was positively associated with non-obstetric manifestations (OR=4.2, 95% CI 1.5-11.9; p=0.007) while an aCL profile was associated with obstetric manifestations (OR 7.0, 95% CI 2.3-21.3; p=0.001). A suspicion of progression towards SLE was considered plausible in 13 (19%) of non-SLE individuals. Twelve (40.0%) of patients with thrombocytopenia as their only hematological involvement required corticosteroids. History of infertility (OR 6.1, 95% CI 1.3-28; p=0.02) and IVF recurrent failure (OR 6.5, 95% CI 1.2-36.3; p=0.032) were associated with pregnancy treatment with LMWH/LDA combination. Among patients under anticoagulation, clinical manifestations included brain white matter lesions, APS nephropathy, superficial vein thrombosis, amaurosis fugax, and livedoid vasculopathy. A higher value of GAPSS was observed in patients with non-obstetric (median 9, IQR 5-13) in comparison to those with obstetric manifestations (median 5, IQR 4-5.5).

Conclusion:

The present article stresses the clinical relevance of these patients, with an impression that at least some manifestations will contribute in the future to the classification of individuals as definite APS.

References:

[1]J. Alijotas-Reig et al., Comparative study of obstetric antiphospholipid syndrome (OAPS) and non-criteria obstetric APS (NC-OAPS): report of 1640 cases from the EUROAPS registry. Rheumatology (Oxford), (2019).

[2]M. Fredi et al., Risk Factors for Adverse Maternal and Fetal Outcomes in Women With Confirmed aPL Positivity: Results From a Multicenter Study of 283 Pregnancies. Front Immunol9, 864 (2018).

[3]E. Sevim et al., Characteristics of Antiphospholipid Antibody Positive Patients in AntiPhospholipid Syndrome Alliance for Clinical Trials and InternatiOnal Networking. Arthritis Care & Researchn/a.

Table 1.

“Non-criteria” clinical manifestations present in the analyzed population.

Clinical manifestationn (%)Non-obstetricn = 49Thrombocytopenia34 (69.4)Coombs´ positivity11 (22.4)Migraine11 (22.4)Hemolytic anemia5 (10.2)Brain MRI white matter lesions5 (10.4)Raynaud´s phenomenon5 (10.2)Superficial vein thrombosis4 (8.1)Evans syndrome4 (8.1)Amaurosis fugax3 (6.1)APS nephropathy2 (4.1)Livedo reticularis1 (2.0)Livedoid vasculopathy1 (2.0)Memory lapses1 (2.0)Pseudo-multiple sclerosis1 (2.0)Sensorineural hearing loss1 (2.0)Splinter hemorrhages1 (2.0)Obstetricn = 38Two spontaneous abortions <10 weeks16 (42.1)Infertility14 (36.8)≥ 2 or more IVF failures11 (28.9)Late IUGR (>34 weeks)7 (18.4)Premature birth between 34 and 37 weeks7 (18.4)Placental ischemia5 (13.1)Late preeclampsia (>34 weeks)3 (8.0)Placental abruption2 (5.3)Placental hematoma2 (5.3)

Abbreviations –aCL: anticardiolipin antibodies; AI: Autoimmune; AID: Autoimmune disease; aPL: Antiphospholipid antibodies; IUGR: Intrauterine growth restriction; IVF: in vitro fertilization; LA: Lupus anticoagulant.

Disclosure of Interests:

None declared

POS0767 CLINICAL MANIFESTATIONS, TREATMENT, AND OUTCOMES OF “NON-CRITERIA” ANTIPHOSPHOLIPID SYNDROME IN COMPARISON WITH DEFINITE ANTIPHOSPHOLIPID SYNDROME: A SYSTEMATIC REVIEW AND META-ANALYSIS

Background:

Patients with laboratorial or clinical manifestations suggestive of antiphospholipid syndrome (APS) but not fulfilling the classification criteria [1] constitute a challenge in clinical practice.

Objectives:

To establish a comparison between patients with “non-criteria” versus those with definite APS on the frequency of clinical manifestations, prescribed therapies and reported outcomes.

Methods:

A systematic review of observational studies comparing “non-criteria” with definite APS patients was performed searching 4 electronic databases. Data was extracted on clinical manifestations, therapies and outcomes. Studies were analyzed globally and, where possible, grouped under four potential “non-criteria” APS subsets. Random-effects meta-analyses were performed.

Results:

Fourteen studies were included, assessing a total of 3,238 participants (Table 1). In the meta-analysis, no difference was detected in the frequency of arterial events or thrombosis recurrence between “non-criteria” and definite APS. However, a lower frequency of venous events was observed in “non-criteria” patients (risk ratio [RR]=0.9; 95%CI 0.7-1.0; p-value=0.047, I2=0%; Q Cochran p-value=0.226). Regarding obstetric morbidity, no difference was observed in most outcomes, but previous history of intrauterine growth restriction was less frequent (RR=0.7; 95%CI=0.6-0.9; p-value=0.003, I2=0%; Q Cochran p-value=0.228) and the risk of prematurity in followed pregnancies lower in “non-criteria” patients. There was no significant difference in treatment frequency between groups, except for less use of hydroxychloroquine in “non-criteria” APS (RR=0.7; 95%CI=0.5-0.9; p-value=0.007, I2=46.5%; Q Cochran p-value=0.642). There was no significant difference in the risk of fetal loss between groups either with or without treatment (Figure 1). It should be noted that significant heterogeneity was observed in some outcomes across the studied categories. Most studies focused on “seronegative” and “incomplete laboratory” APS.

Table 1.

Description of studies included in the systematic review.

Author, year (reference)Number of PatientsDefinite APSNC-APS(global)Mekinian, 2012 [2]2553Rodriguez-Garcia, 2012 [3]8767Conti, 2014 [4]2524Ofer-Shiber, 2015 [5]126117Mekinian, 2016 [6]8396Omar, 2018 [7]3030Signorelli, 2017 [8]7713Fredi, 2018 [9]8581Litvinova, 2018 [10]4117Alijotas-Reig, 2019 [11]1000640Ferreira, 2020 [12]1521Liu, 2020 [13]19290Li, 2020 [14]3494Lo, 2020 [15]1224

Abbreviations – APS: Antiphospholipid Syndrome; NC-APS: Non-criteria antiphospholipid syndrome.

Conclusion:

This review suggests an absence of marked differences in most of the evaluated variables regarding clinical manifestations, treatment and outcomes between “non-criteria” and definite APS. These results should be interpreted with caution in light of the low-quality evidence available and heterogeneity observed in some outcomes.

References:

[1]S Miyakis et al., J Thromb Haemost 4 (2), 295 (2006).

[2]A Mekinian et al., Journal of Reproductive Immunology 94 (2), 222 (2012).

[3]JL Rodriguez-Garcia et al., Ann Rheum Dis 71 (2), 242 (2012).

[4]F Conti et al., J Immunol Res 2014, 389601 (2014).

[5]S Ofer-Shiber and Y Molad, Blood Coagul Fibrinolysis 26 (3), 261 (2015).

[6]A Mekinian et al., Semin Arthritis Rheum 46 (2), 232 (2016).

[7]G Omar et al., Egyptian Rheumatologist 40 (2), 111 (2018).

[8]F Signorelli et al., Annals of the Rheumatic Diseases 76, 887 (2017).

[9]M Fredi et al., Front Immunol 9, 864 (2018).

[10]E Litvinova et al., Front Immunol 9, 2971 (2018).

[11]J Alijotas-Reig et al., Rheumatology (Oxford) (2019).

[12]TG Ferreira et al., Clin Rheumatol 39 (4), 1167 (2020).

[13]T Liu et al., Arthritis Res Ther 22 (1), 33 (2020).

[14]X Li et al., Clinical Rheumatology (2020).

[15]HW Lo et al., Eur J Obstet Gynecol Reprod Biol 244, 205 (2020).

Figure 1.

Forest plot of studies included in the meta-analysis regarding pregnancy and treatment outcomes.

Acknowledgements:

The authors wish to thank Helena Donato, from the Documentation Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal, for her assistance performing the search for the systematic review.

Disclosure of Interests:

None declared

Social support, coping strategies and sociodemographic factors in women with breast cancer

INTRODUCTION

The aim of this study was to analyze the associations between perceived social support and sociodemographic variables on coping strategies.

METHODS

A prospective, cross-sectional, multicenter study was conducted in 404 women with resected, non-metastatic breast cancer. Participants completed questionnaires: perceived social support (MSPSS), coping strategies (Mini-MAC), and psychological distress (BSI-18).

RESULTS

Sociodemographic factors as age, education, and partnership status were associated with coping strategies. As for maladaptive strategies, hopelessness was more frequent in older people and lower educational level; fatalism in older and single people, and cognitive avoidance was associated with lower educational level. Suppor t from family, friends, and partners was associated with a greater fighting spirit. In contrast, high psychological distress (anxiety and depression) was associated with greater use of maladaptive strategies.

CONCLUSION

Young people, a high level of education, having a partner, low psychological distress, and seeking social support were associated with the use of adaptive cancer coping strategies.

Melanoma oral amelanótico metastático com acometimento neurológico e gonadal em um cão fêmea ˗ relato de caso

RESUMO Relata-se um caso de melanoma oral disseminado em uma cadela de dois anos, com protrusão de bulbo ocular unilateral e quadro convulsivo progressivo. Os exames de imagem revelaram aumento de volume nas regiões submandibular, maxilar e cerebral, padrão nodular pulmonar e aumento das dimensões ovarianas. A citologia da massa submandibular indicou proliferação epitelial maligna, enquanto a biópsia excisional foi sugestiva de melanoma amelanótico. Na necropsia, havia uma massa gengival localmente infiltrativa e nodulações brancas nos linfonodos, nos rins, no pulmão, no cérebro e nos ovários, indicativas de metástase. O diagnóstico histopatológico consistiu de neoplasia maligna metastática indiferenciada, indicativo de melanoma amelanótico. Células caracterizadas por núcleo com cromatina espessa, múltiplos nucléolos bem evidentes, mitoses atípicas e multinucleações consistiram nos principais critérios de malignidade. No espaço peritrabecular ósseo facial, havia rara diferenciação pigmentar melanocítica, confirmada histoquimicamente pela técnica de Fontana-Massom e Giemsa. Algumas células foram positivas pela imuno-histoquímica para PNL-2 e Melan-A, e o diagnóstico de melanoma amelanótico disseminado foi firmado. A indiferenciação neoplásica marcante, com disseminação metastática multissistêmica e acometimento mútuo de sítios anatômicos pouco comuns, conjuntamente com a ampla variação dos padrões celulares, foi responsável pelo desafio diagnóstico do presente caso, ressaltando o papel decisivo da imuno-histoquímica para confirmação diagnóstica. A importância clínica deste trabalho consiste ainda em alertar a comunidade clínica e científica acerca da dificuldade diagnóstica, devendo-se considerar o melanoma amelanótico como diferencial mesmo em casos de lesões orais menos perceptíveis e/ou desprovidas de pigmentação.

Cardiac arrest after a cerebral gas embolism. Case report

Cerebral arterial gas embolism is a serious and often iatrogenic fatal event associated with invasive procedures. It is a possible cause of a cardiac arrest and the diagnosis is challenging. We report a case of a cardiac arrest after a cerebral arterial gas embolism, in a 63-year-old male subjected to a Computed Tomography-guided Transthoracic Needle Aspiration Biopsy, which was successfully managed with hyperbaric oxygen therapy.

P1360ARTERIOVENOUS FISTULA MATURATION DELAY - ENDOVASCULAR TREATMENT IS A VALID APPROACH

Background and Aims

Arteriovenous fistula is the optimal vascular access for hemodialysis as it has the best long-term patency rate and the lowest complication rate among hemodialysis vascular accesses. However, its occasional delayed maturation poses a challenge. Surgery has been advocated as the best treatment option. We proposed to evaluate the results of endovascular approach of arteriovenous fistula’s maturation delay in our hospital.

Method

We conducted a retrospective study, selecting patients referenced to our diagnostic and therapeutic angiography unit due to arteriovenous fistula delayed maturation, between April 2017 and October 2019. Physical examination and echography were used to confirm arteriovenous fistula delayed maturation.

Results

Thirty patients were referenced. Nine were excluded as maturation delay was not confirmed. Three patients were excluded due to extensive outflow stenosis since they were proposed to new vascular access creation. The other 18 patients were subjected to percutaneous endovascular treatment. Mean patient’s age was 65 years old. Twelve patients (66,7%) had forearm fistulas and the remaining (33,3%) had arm fistulas. Fourteen patients (77,7%) had maturation delay due to peri-anastomotic stenosis. The mean follow-up time was 14 months, (minimum - 3 months; maximum - 33 months). Seventeen fistulas (94,4%) were salvaged, although 3 (16,7%) needed a second intervention. Primary and secondary patencies at 3, 6 and 12 months were 77,8% vs. 94,4%, 69,2% vs. 92,3% and 75% vs. 100%, respectively. Arm fistulas had 83,3% of primary and secondary patencies. Forearm fistula’s primary and secondary patencies were 66,7% vs. 91,6%, 57,1% vs. 100% and 60% vs. 100%, at 3, 6 and 12 months, respectively. When maturation failure was due to peri-anastomotic stenosis, primary and secondary patencies were 71,4% vs. 92,9%, 66,7% vs. 100% and 66,7% vs. 100% at 3, 6 and 12 months, respectively.

Conclusion

Even though we are still lacking consensus about the best treatment option for fistula’s maturation delay, current guidelines suggest that, at least in delayed maturation due to peri-anastomotic stenosis, surgery may be the best treatment. Our results point out that endovascular treatment is a good treatment option for arteriovenous fistulas with maturation delay, mainly in the arm fistulas. Even though surgical treatment appears to have better primary patency, a step by step approach seems to be a valid approach, as our secondary patency shows.

Biomarkers and genetic modulators of cerebral vasculopathy in sub-Saharan ancestry children with sickle cell anemia

We investigated biomarkers and genetic modulators of the cerebral vasculopathy (CV) subphenotype in pediatric sickle cell anemia (SCA) patients of sub-Saharan African ancestry. We found that one VCAM1 promoter haplotype (haplotype 7) and VCAM1 single nucleotide variant rs1409419_T were associated with stroke events, stroke risk, as measured by time-averaged mean of maximum velocity in the middle cerebral artery, and with high serum levels of the hemolysis biomarker lactate dehydrogenase. Furthermore, VCAM-1 ligand coding gene ITGA4 variants rs113276800_A and rs3770138_T showed a positive association with stroke events. An additional positive relationship between a genetic variant and stroke risk was observed for ENPP1 rs1044498_A. Conversely, NOS3 variants were negatively associated with silent cerebral infarct events (VNTR 4b_allele and haplotype V) and CV globally (haplotype VII). The -alpha^3.7kb-thal deletion did not show association with CV. However, it was associated with higher red blood cell and neutrophil counts, and lower mean corpuscular volume, mean corpuscular hemoglobin and red cell distribution width. Our results underline the importance of genetic modulators of the CV sub-phenotype and their potential as SCA therapeutic targets. We also propose that a biomarker panel comprising biochemical, hematological, imaging and genetic data would be instrumental for CV prediction, and prevention.

Dilemmas in primary spinal glioblastoma management during pregnancy

Primary spinal glioblastoma (GBM) is a clinically rare entity with rapid progression and a dismal outcome despite aggressive treatment. In a pregnant woman, this malignancy is particularly dramatic because the potential benefits to the mother offered by standard GBM treatment must be balanced against the risks to the fetus. There is little guidance in the literature on how to manage pregnant patients with malignant neuraxial tumours and, to the authors' knowledge, no reports have been published so far regarding this specific neoplasm in such population. This case report describes the management of a pregnant patient with a previously undiagnosed and rapidly progressive intramedullary GBM submitted to an elective caesarean delivery to allow subsequent onset of oncological treatment. Dilemmas faced by anaesthetists are discussed in hope to provide guidance for future decisions and optimize outcomes.

Hemodialysis Reliable Outflow graft: A valid option in patients with central venous stenosis

INTRODUCTION

Central venous stenosis can be the main obstacle to the creation of an autologous vascular access in the upper limbs. The Hemodialysis Reliable Outflow graft was developed to provide an upper limb vascular access option to such patients, avoiding alternative, less advantageous options, such as lower limb vascular accesses or central venous catheters. Its advantages include catheter avoidance and, in case of lower limbs accesses, reduction of the ischemic risk and iliac vein thrombosis, potentially compromising a future kidney transplant.

PATIENTS AND METHODS

Revision of the clinical files of the four patients who were placed a Hemodialysis Reliable Outflow device in our Center, including demographic variables, implantation technique characteristics, surgical complications, episodes of infection and thrombosis of the access, and need to place a transitory central venous catheter to undergo hemodialysis treatment.

RESULTS

Four Hemodialysis Reliable Outflow grafts were placed, which resulted in a significant improvement in the dialysis efficacy in all patients, with a median raise in the Kt/V of 36.7%. Two cases needed thrombectomy, one of which was unsuccessful. The actual time of patency varies between 3 and 28 months.

CONCLUSION

Our experience with the Hemodialysis Reliable Outflow device showed that it was a safe option for patients with central venous stenosis and was associated with good clinical and analytic outcomes.

Digestibilidade, comportamento ingestivo e desempenho de ovinos alimentados com resíduos de agroindústrias processadoras de frutas

RESUMO Objetivou-se avaliar o consumo, a digestibilidade e o desempenho de ovinos, arraçoados com dietas isoproteicas, contendo 75% de resíduos da agroindústria frutífera (abacaxi, acerola, maracujá e cupuaçu), uma dieta com feno de tifton e 25% de concentrado, em delineamento inteiramente ao acaso. A participação do resíduo de maracujá na dieta proporcionou os maiores níveis de consumo de matéria seca (1170,6g d-1) em relação aos resíduos de abacaxi (693,8g d-1), acerola (644,2g d-1), cupuaçu (452,9g d-1) e feno de tifton (962,7g d-1), o que se relaciona aos seus níveis de digestibilidade (77,8; 63,1; 59,1; 61,7 e 71,8%, respectivamente). Tal resultado gerou diferenças significativas, destacando-se o resíduo de maracujá quanto à conversão alimentar (8,3), e o ganho médio diário de peso (141,5g d-1). Apesar de ter tido a mesma conversão observada para o feno de tifton (13,2), apresentou maior ganho médio diário (75,6g d-1). Os demais resíduos apresentaram efeitos sobrepostos, contudo o resíduo de acerola ficou com a pior conversão (51,4) e o menor ganho médio diário (15,6g d-1), sendo esse sem diferença em relação ao cupuaçu (23,0g d-1). Os resíduos podem ser utilizados como alternativa para a alimentação de ovinos.

Genetic modulators of fetal hemoglobin expression and ischemic stroke occurrence in African descendant children with sickle cell anemia

Sickle cell anemia (SCA) is an autosomal recessive monogenic disease with significant clinical variability. Cerebrovascular disease, particularly ischemic stroke, is one of the most severe complications of SCA in children. This study aimed to investigate the influence of genetic variants on the levels of fetal hemoglobin (Hb F) and biochemical parameters related with chronic hemolysis, as well as on ischemic stroke risk, in ninety-one unrelated SCA patients, children of sub-Saharan progenitors. Our results show that a higher Hb F level has an inverse relationship with the occurrence of stroke, since the group of patients who suffered stroke presents a significantly lower mean Hb F level (5.34 ± 4.57% versus 9.36 ± 6.48%; p = 0.024). Furthermore, the co-inheritance of alpha-thalassemia improves the chronic hemolytic pattern, evidenced by a decreased reticulocyte count (8.61 ± 3.58% versus 12.85 ± 4.71%; p < 0.001). In addition, our findings have confirmed the importance of HBG2 and BCL11A loci in the regulation of Hb F expression in sub-Saharan African SCA patients, as rs7482144_A, rs11886868_C, and rs4671393_A alleles are significantly associated with a considerable increase in Hb F levels (p = 0.019, p = 0.026, and p = 0.028, respectively). Concerning KLF1, twelve different variants were identified, two of them novel. Seventy-three patients (80.2%) presented at least one variant in this gene. However, no correlation was observed between the presence of these variants and Hb F level, severity of hemolysis, or stroke occurrence, which is consistent with their in silico-predicted minor functional consequences. Thus, we conclude that the prevalence of functional KLF1 variants in a sub-Saharan African background does not seem to be relevant to SCA clinical modulation.

A Rare Manifestation of Tuberculosis in a Renal Transplant Patient: A Case Report

Cutaneous lesions in the presence of fever in patients undergoing immunosuppressive therapy are a diagnostic challenge and may represent manifestations of multiple diseases, such as fungal infections, nocardiosis, lymphoproliferative diseases, zoonosis, and tuberculosis. The authors report a case of a 66-year-old white man with chronic kidney disease since 2014 (chronic pyelonephritis) who had a renal transplant in the previous 6 months. Induction therapy was performed with thymoglobulin, and his current immunosuppression scheme included tacrolimus, mycophenolate mofetil, and prednisolone. The patient had no history of pulmonary tuberculosis. The patient presented with 2 cutaneous lesions, localized on the back and abdomen, that appeared to be firm, painful, subcutaneous, erythematous nodules with an approximately 5 cm diameter overlying an infected focus and purulent material inside. The patient also had a fever and fatigue. Blood analysis showed pancytopenia with an elevation of inflammatory markers and graft dysfunction. Tissue cultures and skin biopsy with histological analysis were performed. Histopathology of the lesion showed a nonspecific inflammatory infiltrate without granulomas, and acid-fast bacillus staining was negative. Nevertheless, serum QuantiFERON testing was positive. But polymerase chain reaction finally confirmed the presence of Mycobacterium tuberculosis, which confirmed the diagnosis of cutaneous tuberculosis. A chest computed tomography scan showed a lung pattern of miliary tuberculosis. The patient was treated with multidrug tuberculosis therapy, resulting in lesion clearance after 3 weeks. Tuberculosis is a serious infection, especially in high-risk patients, such as those in an immunocompromised state. The incidence of cutaneous tuberculosis is rare, but it should be considered in patients presenting with atypical skin lesions suggestive of an underlying infectious etiology.

Pretransplant Biopsy of Marginal Kidneys: Is It Necessary?

INTRODUCTION

Pretransplant kidney biopsy from marginal donors is used to guide the decision of whether to accept or discard organs for transplantation; however, there is controversy about this procedure, and the need for a pretransplant biopsy is still a debate. We sought to determine if histologic evaluation before implantation of marginal kidneys would influence the outcome.

METHODS

A retrospective observational cohort study of marginal donor transplants at Centro Hospitalar e Universitário de Coimbra was done. From 2009 to 2016, 650 marginal kidney transplants were analyzed. We evaluated long-term graft survival in a cohort of patients who received marginal kidneys. The recipients were divided into 2 groups based on whether a pretransplant donor biopsy was performed. Continuous variables were summarized by mean and standard deviation or median and range, as applicable. Categorical variables were summarized by relative and absolute frequencies. The survival analysis was obtained and plotted using the Kaplan-Meier method and compared with the log-rank test.

RESULTS

The median age of recipients and donors were statistically different between both groups (P < .001), with the donors and the recipients being younger in the group without a pretransplant biopsy. The median cold ischemia time was higher in the biopsy group (P = .01). The survival analysis showed that graft survival didn't differ between the groups (P = .2).

CONCLUSIONS

Selection of kidneys based on histological findings may not influence the graft survival and implies a higher cold ischemia time. More data are necessary to provide insight into which clinical, histologic, and biochemical parameters are necessary for decision making on kidney acceptance.

CLA-supplemented diet accelerates experimental colorectal cancer by inducing TGF-β-producing macrophages and T cells

Conjugated linoleic acid (CLA) has been shown to activate the nuclear receptor PPAR-γ and modulate metabolic and immune functions. Despite the worldwide use of CLA dietary supplementation, strong scientific evidence for its proposed beneficial actions are missing. We found that CLA-supplemented diet reduced mucosal damage and inflammatory infiltrate in the dextran sodium sulfate (DSS)-induced colitis model. Conditional deletion of PPAR-γ in macrophages from mice supplemented with CLA diet resulted in loss of this protective effect of CLA, suggesting a PPAR-γ-dependent mechanism mediated by macrophages. However, CLA supplementation significantly worsened colorectal tumor formation induced by azoxymethane and DSS by inducing macrophage and T-cell-producing TGF-β via PPAR-γ activation. Accordingly, either macrophage-specific deletion of PPAR-γ or in vivo neutralization of latency-associated peptide (LAP, a membrane-bound TGF-β)-expressing cells abrogated the protumorigenic effect of CLA. Thus, the anti-inflammatory properties of CLA are associated with prevention of colitis but also with development of colorectal cancer.

The two functionally distinct amino termini of chicken c-ets-1 products arise from alternative promoter usage

The chicken c-ets-1 locus gives rise to two distinct transcription factors differing by structurally and functionally unrelated N-termini. p54c-ets-1 shows a striking phylogenetic conservation from Xenopus to humans, while p68c-ets-1, the cellular counterpart of the E26-derived v-ets oncogene, is apparently restricted to avian and reptilian species. In the chick embryo, both mRNAs are expressed in a wide array of tissues of mesodermal origin; however, in the embryo and after hatching, p68c-ets-1 is excluded from lymphoid cells where p54c-ets-1 accumulates. In this report, we define the basis of the differential expression of the chicken c-ets-1 products to assess their different potentials as transcription factors. We demonstrate that the two distinct N-termini arise from alternative promoter usage within the chicken c-ets-1 locus. Examination of both promoters reveals that transcription initiates from multiple sites, consistent with the absence of TATA and CAAT elements. Of these two regulatory regions, only the one that initiates the p54c-ets-1 mRNA synthesis is of the G + C-rich type, and its organization is conserved in humans. The avian-specific p68c-ets-1 promoter activity was enhanced by its own product. In addition, we identify numerous potential binding sites for lymphoid-specific transcription factors that might contribute to a tight repressor effect in lymphoid tissues.

The cytosolic sensor STING is required for intestinal homeostasis and control of inflammation

STING (stimulator of interferon genes) is a cytosolic sensor for cyclic dinucleotides and also an adaptor molecule for intracellular DNA receptors. Although STING has important functions in the host defense against pathogens and in autoimmune diseases, its physiological relevance in intestinal homeostasis is largely unknown. In this study, we show that STING^-/- mice presented defective protective mechanisms of intestinal mucosa, including decreased number of goblet cells, diminished mucus production, and lower levels of secretory IgA, when compared with wild-type (WT) mice. Fecal content and microbiota DNA could activate STING, indicating a role of this molecule in gut. Microbiota composition was altered in STING^-/- mice toward a more inflammatory profile, evidencing a reduction in the Allobacolum and Bifidobacterium groups along with increase in Disulfovibrio bacteria. Absence of STING lead to decrease in induced intraepithelial lymphocytes (IEL) and to increase in group 1 innate lymphoid cell (ILC1) as well as ILC3 frequencies and decrease in ILC2 in the colon. Development and function of Foxp3+ and LAP+ regulatory T cells were also compromised in STING^-/- mice. Moreover, these mice were highly susceptible to dextran sodium sulfate-induced colitis, T-cell-induced colitis, and enteric Salmonella typhimurium infection when compared with WT animals. Therefore, our results identify an important role of STING in maintaining gut homeostasis and also a protective effect in controlling gut inflammation.

Harnessing extracellular vesicles to direct endochondral repair of large bone defects

Large bone defects remain a tremendous clinical challenge. There is growing evidence in support of treatment strategies that direct defect repair through an endochondral route, involving a cartilage intermediate. While culture-expanded stem/progenitor cells are being evaluated for this purpose, these cells would compete with endogenous repair cells for limited oxygen and nutrients within ischaemic defects. Alternatively, it may be possible to employ extracellular vesicles (EVs) secreted by culture-expanded cells for overcoming key bottlenecks to endochondral repair, such as defect vascularization, chondrogenesis, and osseous remodelling. While mesenchymal stromal/stem cells are a promising source of therapeutic EVs, other donor cells should also be considered. The efficacy of an EV-based therapeutic will likely depend on the design of companion scaffolds for controlled delivery to specific target cells. Ultimately, the knowledge gained from studies of EVs could one day inform the long-term development of synthetic, engineered nanovesicles. In the meantime, EVs harnessed from in vitro cell culture have near-term promise for use in bone regenerative medicine. This narrative review presents a rationale for using EVs to improve the repair of large bone defects, highlights promising cell sources and likely therapeutic targets for directing repair through an endochondral pathway, and discusses current barriers to clinical translation. Cite this article: E. Ferreira, R. M. Porter. Harnessing extracellular vesicles to direct endochondral repair of large bone defects. Bone Joint Res 2018;7:263-273. DOI: 10.1302/2046-3758.74.BJR-2018-0006.

Tuberculosis among the homeless: should we change the strategy?

BACKGROUND

Tuberculosis (TB) is a major concern among high-risk populations such as the homeless.

OBJECTIVES

To evaluate TB incidence and treatment outcomes among homeless patients in Portugal and to identify predictors of unsuccessful TB treatment outcomes among the homeless.

DESIGN

This was a retrospective cohort study of all TB patients notified in Portugal from 2008 to 2014. Characteristics of homeless TB patients were assessed and predictors of unsuccessful TB treatment were determined using logistic regression.

RESULTS

TB incidence among the homeless was 122/100,000 homeless persons and was positively correlated with TB incidence among non-homeless persons. Homeless TB patients had a higher prevalence of alcohol and/or drug use, human immunodeficiency virus (HIV) co-infection, cavitary TB and smear positivity. The rate of unsuccessful treatment outcomes among the homeless was 28.6%, and was significantly associated with increased age, injection drug use (IDU) and HIV co-infection.

CONCLUSION

TB incidence among homeless persons was five times that among the non-homeless, and higher in regions with greater TB incidence among non-homeless persons. The successful treatment outcome rate was lower. Predictors of unsuccessful treatment were age, IDU and HIV co-infection. Integrated TB programmes targeting homeless and non-homeless patients, with measures targeting specific characteristics, may contribute to TB elimination in Portugal.

Ultrasound Biomicroscopy Findings in Peripheral Vitreoretinal Toxocariasis

Purpose

To describe the morphologic alterations in ultrasound biomicroscopy (UBM) present in peripheral vitreoretinal toxocariasis.

METHODS

An observational prospective study of case series. Fifteen eyes of 15 patients with clinical and laboratory diagnosis of peripheral vitreoretinal toxocariasis were enrolled. The patients were submitted to UBM examination of the region corresponding to the pars plana of the affected eye.

Results

The most common morphologic alterations found by UBM in patients with peripheral vitreoretinal toxocariasis were as follows: vitreal membranes (13 cases), toxocara granuloma (11 cases), and pseudocysts (8 cases). Other less frequent findings were thickening of the ciliary body (6 cases), cystic formation (2 cases), peripheral retinal detachment (2 cases), rectification of the iris root (1 case), and posterior synechiae (1 case).

CONCLUSIONS

UBM allows detection of well-defined morphologic alterations associated with peripheral vitreoretinal toxocariasis, being useful to reinforce the clinical diagnosis

Long-Term Outcomes of Kidney Transplantation From Expanded-Criteria Deceased Donors: A Single-Center Experience

BACKGROUND

Organ shortage has prompted the use of expanded-criteria donors (ECDs). Our objective was to compare long-term outcomes of kidney transplants from ECDs with those from concurrent standard-criteria donors (SCDs). In addition, we evaluated variables associated with graft survival in both groups.

METHODS

We retrospectively reviewed all 617 deceased-donor kidney transplantations performed from 2005 to 2009 in our department. The population was divided according to donor status into ECD or SCD. Patients were followed until 5 years after transplantation, death, graft failure, or loss to follow-up.

RESULTS

We transplanted 150 deceased-donor kidneys from ECDs and 467 from SCDs. ECD were older, more frequently women, had a lower pre-retrieval glomerular filtration rate, and more frequently died due to cerebrovascular accident. ECD recipients were older, presented a lower proportion of black race, more frequently were on hemodialysis, and presented a higher rate of first kidney transplants. Mean glomerular filtration rate was consistently lower in the ECD group. Patient and graft survivals were lower in the ECD group, but statistical significance was present only in graft survival censored for death with a functioning graft at 3 years and graft survival noncensored for death with a functioning graft at 5 years. Younger recipient ages, longer time on dialysis, acute rejection episodes, and glomerular filtration rate at 1 year after transplantation were independent risk factors for lower graft survival.

CONCLUSIONS

Transplantation with the use of ECD kidneys provide quite satisfactory patient and graft survival rates despite their poorer long-term outcomes.

Polyomavirus Nephropathy: Ten-Year Experience

BACKGROUND

Polyomavirus nephropathy (BKVN) is an important cause of chronic allograft dysfunction (CAD). Recipient determinants (male sex, white race, and older age), deceased donation, high-dose immunosuppression, diabetes, delayed graft function (DGF), cytomegalovirus infection, and acute rejection (AR) are risk factors. Reducing immunosuppression is the best strategy in BKVN. The objective of our study was to evaluate CAD progression after therapeutic strategies in BKVN and risk factors for graft loss (GL).

METHODS

Retrospective analysis of 23 biopsies, from patients with CAD and histological evidence of BKVN, conducted over a period of 10 years. Glomerular filtration rate was <30 mL/min in 16 patients at the time of the BKVN diagnosis.

RESULTS

BKVN was histologically diagnosed in 23 recipients (19 men, 4 women). All patients were white, with age of 51.2 ± 12.1 years (6 patients, age >60 years), and 22 had a deceased donor. Diabetes affected 4 patients, DGF occurred in 3, cytomegalovirus infection in 2, and AR in 15. All patients were medicated with calcineurin inhibitors (CNI) (95.7% tacrolimus) and corticoids, and 16 also received an antimetabolite. One year after antimetabolite reduction/discontinuation and/or CNI reduction/switching and/or antiviral agents, graft function was decreased in 11 patients, increased/stabilized in 10, and unknown in 2. GL occurred in 9 patients. Older age (hazard ratio, 1.76; 95% confidence interval, 0.94-3.28) and DGF (hazard ratio, 2.60; 95% confidence interval, 0.54-12.64) were the main risk factors for GL. The lower GFR at the time of the BKVN diagnosis was associated with an increased risk of initiation of dialysis.

CONCLUSIONS

GL occurred in 39.1% of patients with BKVN and DGF; older age and lower GFR at the time of diagnosis were important risk factors. Early diagnosis of BKVN is essential to prevent GL.

Álcool para controle de cascudinho em cama de frangos de corte

O Brasil é o maior exportador e o terceiro maior produtor mundial de carne de frango, sendo a atividade geradora de grande quantidade de resíduo chamado de cama de frango. Este resíduo gera condições favoráveis para o desenvolvimento do besouro Alphitobius diaperinus (Panzer) (Coleoptera: Tenebrionidae), conhecido como cascudinho, sendo esse considerado a principal praga da avicultura, e afeta a produção avícola em todo o mundo. Seu controle é considerado difícil, sendo comumente empregadas substâncias piretróides e organofosforadas, apesar de não eficientes. Na busca pelo controle alternativo do inseto, vários métodos aditivos e inseticidas naturais vêm sendo testados. Contudo, na prática entomológica, substâncias com elevada pressão de vapor a fim de se produzir gases tóxicos são utilizadas para fixação dos insetos. Assim, em outubro de 2015, avaliou-se o álcool etílico PA para o controle de A. diaperinus em cama de frango. As unidades experimentais foram representadas por garrafas plásticas tipo “pet” cortadas, onde foram colocadas 100g de cama de frango, acrescidos de 20 insetos adultos e 135 larvas, cada uma. Os tratamentos foram constituídos pela aplicação de álcool no volume de 1, 2,5, 5, 7,5 e 10 mL e sua diluição com água (1:1) sendo aplicado igual volume. Simularam-se dois ambientes, sendo um aberto (com telas contendo os insetos) e um fechado (recipiente amostral fechado com a porção previamente cortada da garrafa “pet”). Nas parcelas foram mantidas a temperatura de 28,5 ± 2 ºC e UR de 51,0 ± 2%, feito seis repetições por tratamento. A quantidade de 2,5 mL (2,5% v/p) de álcool gerou 100% de mortalidade de adultos e larvas nas amostras fechadas, sendo necessário o dobro do volume no sistema aberto. Para a diluição álcool-água (1:1) o controle de 100% foi obtido com o dobro das quantidades relatadas anteriormente em relação aos respectivos tratamentos.

Risk factors that influence sexual and reproductive health in Portuguese university students

BACKGROUND

University students have unprotected sex and associate alcohol and/or drugs with sexual practices. These behaviours are risk factors for influencing sexual and reproductive health that can be targeted by nursing interventions.

AIM

The aim of this study was to determine the risk and protective factors influencing sexual and reproductive risk-taking behaviours in university students.

METHODS

We conducted a cross-sectional and correlational study in a sample of 1946 students. Data were collected using a self-report questionnaire on the individual, environmental, cognitive and psychosocial factors related to knowledge of sexually transmitted infections, attitude for sexual and reproductive health, subjective norms, Condom Use Self-Efficacy and Sexual Sensation Seeking scales.

RESULTS

Older male students were at higher risk for all risk behaviours studied. Students involved in committed relationships were at risk because of decreased condom use. Individuals who placed high importance on sexual sensation seeking were at increased risk. The higher the importance students placed on peers' opinion, the more protective their behaviours were.

CONCLUSION

The results of this study showed that university students are exposed to sexual risks. Individual, cognitive and psychosocial factors influence the risk-taking behaviours.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

The findings of this study should be further incorporated into health care with nurses' leadership, adapting healthcare services to the specific needs of this population and promoting educational programmes.

Polymorphism of mitochondrial DNA in the Brazilian Canindé goat breed

The success of the geographical distribution of goat populations around the world is a consequence of the adaptive potential of these breeds. Several relevant traits to the success of the species in colonizing different ecosystems (and use by man) evolved before domestication. These features were relevant for the selection of different breeds. Each breed represents a genetic heritage that may be unique and essential for maintaining the species. The objective of this study was to catalog the mtDNA haplotypes of the Brazilian autochthonous Canindé goat breed and to characterize the genetic diversity observed in subpopulations by sequencing a 481-bp fragment corresponding to the first portion of the control region in 178 individuals from 10 herds, sampled in six Brazilian states. The global population displays a total of 29 haplotypes and 56 polymorphic sites. About one-third (10) of the haplotypes were common to all subpopulations while the remaining (19) were exclusive to a single subpopulation. The population exhibited high average haplotype diversity (0.82), with maximum and minimum values of 0.90 and 0.56 in individual subpopulations, respectively. In contrast, nucleotide diversity was 0.014, with maximum and minimum values of 0.020 and 0.004, respectively. The spatial analysis of molecular variance did not detect structure within the Canindé goat breed, and analysis of molecular variance revealed that 88.4% of the variation observed in the population was due to differences among individuals in the same subpopulation. Only 11.4% of the genetic variation referred to differences among subpopulations. About one-third (33.1%) of the individuals within population shared the same haplotype, which may be due not only to the breed developing from a small number of matrilines. The Brazilian autochthonous Canindé breed was classified as haplogroup A, a haplotype predominant in the Europe region.

Demographic history, current expansion and future management challenges of wild boar populations in the Balkans and Europe

Wild boar (Sus scrofa), one of the most widespread wildlife species, has entered a stage of continuous growth in Europe, and could even be considered a pest species. We analysed microsatellite variability in 723 wild boars from across Europe, including the northern Dinaric Balkans. Our aims were: (1) to define the population structure of wild boars in the Balkans and its relation with other European populations; (2) to estimate effective populations sizes, levels of intra- and inter-population diversity, inbreeding migration and gene flow patterns; (3) to test subpopulations for bottlenecks; (4) to interpret these results in light of current knowledge about the demographic history of wild boars in Europe; and (5) to discuss the relevance of these findings for management and conservation. Strong population structuring was observed and 14 subpopulations were revealed. High genetic diversity was found, and besides the well-known identity of the Italian populations of Sardinia and Castelporziano, we bring new insights into other potential relevant, refugial populations such as Littoral Slovenia, South Portugal, North-western Iberia and an entire cluster in the Balkans. There was evidence of gene flow going from these refugial subpopulations towards less peripheral and more admixed subpopulations. Recent population bottlenecks and expansions were detected, mostly in the peninsular refuge subpopulations. The results are consistent with the fluctuations of wild boar numbers in Europe since the beginning of the twentieth century. These results should be taken into account in future conservation and management plans for wild boar populations in Europe.

Cytomegalic hepatitis in a patient receiving omalizumab

Cytomegalovirus is a double stranded DNA virus that can be present in nearly all organs and body fluids. The primary infection is usually asymptomatic in the immunocompetent host and it is common among adolescents and young adults. The symptomatic form appears, in the majority of cases, as a mononucleosis syndrome with full recovery without specific treatment. We report a case of a 25 years old woman who presented with hepatitis due to CMV infection and history of omalizumab administration one month earlier. This recombinant monoclonal antibody is used to control refractory asthma and chronic spontaneous urticarial as it inhibits human IgE. Despite that, the long course of the disease lead us to initiate treatment with valganciclovir. The improvement after that was rapid and complete.