The Risks of Self - Medication: Case Report of Familial Misuse of AM3 (Immunoferon®)

Over the last decades extended medical knowledge has been an important health care benefit in terms of disease prevention and management. However, probably with no exception, most pharmaceutical products are not devoid of adverse consequences. Immunomodulators are commonly considered a “benign” drug whose advantages bypass consequences. The immunomodulator AM3 (Immunoferon®) is a clinically used, orally administered compound whose active principle is stabilised in an inorganic matrix of calcium. We report the misuse of AM3 in three members of a family; father and two children. The drug was prescribed to the father who subsequently administered it to the children without seeking medical advice. Two months later, all subjects developed abdominal and/or flank colicky pain. Hypercalciuria was diagnosed in the children with different degrees of severity. It is likely that the calcium content of the inorganic matrix played an important role in the onset of symptoms. No adverse side effects related to the inorganic matrix of calcium of immunoferon® have been documented so far. This family case report calls attention to the risks of self -medication in a susceptible family. Paediatric patients are vulnerable as they rely on adults for the supply of medications. Concerning the use of drugs in family, especially nonprescription drugs, the quality of health care provided to the children depends on the health literacy of their parents

Prenatally Diagnosed Uropathies: Ten Years of Follow-Up

Introdução: As anomalias do tracto urinário são detectadas com uma frequência cada vez maior devido à sistematização da vigilância ecográfica durante a gravidez aliada à sofisticação técnica e à experiência dos ecografistas. Objectivo: Analisar os principais diagnósticos pós-natais investigados na sequência do estudo evolutivo prolongado das uropatias fetais seguidas no ambulatório da nefrologia pediátrica do Hospital de Dona Estefânia. Doentes e Métodos: Estudo retrospectivo dos 392 casos de uropatia fetal observados num período de dez anos e submetidos ao protocolo de investigação em uso na unidade. Resultados: O estudo inclui 362 casos; excluímos 30 processos que não completaram a investigação. A relação sexo masculino: feminino foi de 2: 1. O diagnóstico pré-natal foi realizado em média às 28.9 semanas e a idade média de admissão foi de 68 dias. No estudo evolutivo pós-natal verificou-se a formulação de um diagnóstico definitivo em 349 (96.4%) das crianças. Em 109 crianças (30%) a anomalia fetal foi transitória. Em 75 (20.7%) a dilatação era funcional. Confirmou-se a existência de uropatia em 165/362 crianças: refluxo vesico-ureteral 70/165 (42.4%), displasia multiquística 21%, síndroma da junção pielo-ureteral 16.4%, entre os principais. Nenhum caso evoluiu para insuficiência renal e há a registar, apenas, um caso de hipertensão arterial por poliquistose renal. Conclusão: A planificação da investigação pós-natal reveste-se ainda de alguma controvérsia e continua a evoluir principalmente no grupo das anomalias unilaterais e assintomáticas

A ara romana de Vila Velha de Mourão

Volta a estudar-se, do ponto de vista epigráfico, a ara romana, que fora encontrada, em reaproveitamento, na parede norte da igreja da Vila Velha de Mourão (distrito de Évora, Conventus Pacensis). A novidade prende-se com a nova interpretação dada à 1ª linha da epígrafe: D(iis) D(eabus) O(mnibus) S(acrum)

Neuromesodermal progenitors and the making of the spinal cord

Neuromesodermal progenitors (NMps) contribute to both the elongating spinal cord and the adjacent paraxial mesoderm. It has been assumed that these cells arise as a result of patterning of the anterior neural plate. However, as the molecular mechanisms that specify NMps in vivo are uncovered, and as protocols for generating these bipotent cells from mouse and human pluripotent stem cells in vitro are established, the emerging data suggest that this view needs to be revised. Here, we review the characteristics, regulation, in vitro derivation and in vivo induction of NMps. We propose that these cells arise within primitive streak-associated epiblast via a mechanism that is separable from that which establishes neural fate in the anterior epiblast. We thus argue for the existence of two distinct routes for making central nervous system progenitors

Localized redox relays as a privileged mode of cytoplasmic hydrogen peroxide signaling

Hydrogen peroxide (H2O2) is a key signaling agent. Its best characterized signaling actions in mammalian cells involve the early oxidation of thiols in cytoplasmic phosphatases, kinases and transcription factors. However, these redox targets are orders of magnitude less H2O2-reactive and abundant than cytoplasmic peroxiredoxins. How can they be oxidized in a signaling time frame? Here we investigate this question using computational reaction-diffusion models of H2O2 signaling. The results show that at H2O2 supply rates commensurate with mitogenic signaling a H2O2 concentration gradient with a length scale of a few tenths of μm is established. Even near the supply sites H2O2 concentrations are far too low to oxidize typical targets in an early mitogenic signaling time frame. Furthermore, any inhibition of the peroxiredoxin or increase in H2O2 supply able to drastically increase the local H2O2 concentration would collapse the concentration gradient and/or cause an extensive oxidation of the peroxiredoxins I and II, inconsistent with experimental observations. In turn, the local concentrations of peroxiredoxin sulfenate and disulfide forms exceed those of H2O2 by several orders of magnitude. Redox targets reacting with these forms at rate constants much lower than that for, say, thioredoxin could be oxidized within seconds. Moreover, the spatial distribution of the concentrations of these peroxiredoxin forms allows them to reach targets within 1 μm from the H2O2 sites while maintaining signaling localized. The recruitment of peroxiredoxins to specific sites such as caveolae can dramatically increase the local concentrations of the sulfenic and disulfide forms, thus further helping these species to outcompete H2O2 for the oxidation of redox targets. Altogether, these results suggest that H2O2 signaling is mediated by localized redox relays whereby peroxiredoxins are oxidized to sulfenate and disulfide forms at H2O2 supply sites and these forms in turn oxidize the redox targets near these sites.This work was funded by FEDER funds through the Operational Programme Competitiveness Factors - COMPETE and by national funds by FCT - Foundation for Science and Technology under the strategic projects UID/NEU/04539/2013 (AS) and UID/FIS/04564/ 2016 (RT,FSA), and under the grant FCOMP-01-0124-FEDER-020978 (Project PTDC/QUI-BIQ/119657/2010) (AS). RT also acknowledges FCT's support through the FCT Researcher Program

Lupus Myelopathy in a Child

A 5-year-old female developed, after a 7-month period of fever, anorexia, weight loss, and a transitory cutaneous erythematous eruption, a severe acute transverse myelopathy, with a partial recovery of motor and sensory function. She had positive antinuclear and antidouble-stranded DNA antibodies but no antiphospholipid antibodies. Six months later she had massive proteinuria and restarted treatment with steroids and cyclophosphamide. Our patient is one of the youngest reported with lupus myelopathy. We discuss the clinical presentation, the magnetic resonance imaging findings, and other relevant laboratory studies of this rare but serious complication of systemic lupus erythematosus

Hyperthermic isolated limb perfusion in the treatment of in-transit melanoma metastases

BACKGROUND: To evaluate our cases at the Skin Tumors Sector of Plastic Surgery Division at Federal University of São Paulo in relation to Isolated Limb Perfusion (ILP) for the treatment of in transit melanoma metastases, as well as the results, comparing them with international literature. METHODS: From May 1993 until April 2007, 41 patients with in transit metastases of skin melanoma were submitted to 44 ILP. Medical registry observations were evaluated in terms of regional and systemic toxicity and tumoral response after ILP. The obtained results were compared with international literature and posterior conclusions were done. RESULTS: We observed 43.2% of complete responses, 36.4% of partial responses and 20.4% of no responses after the procedures. Acute regional toxicity was in general restricted to slight erythema or edema, and there was no single case of serious systemic complication. CONCLUSION: The obtained data are in accordance with international literature demonstrating the importance and the possibility of ILP for locoregional control of in transit metastases of skin melanoma also in Brazilian reality.OBJETIVO: Avaliar a casuística do Setor de Tumores Cutâneos da Disciplina de Cirurgia Plástica da Escola Paulista de Medicina/ Universidade Federal de São Paulo (UNIFESP) em relação à Perfusão Isolada de Membro (PIM) para o tratamento das metástases em trânsito do melanoma cutâneo, bem como os resultados conseqüentes, comparando-os com a literatura internacional. MÉTODO: De maio de 1993 a abril de 2007, 41 pacientes portadores de metástases em trânsito do melanoma cutâneo submeteram-se a 44 PIM. Por meio da observação de seus prontuários, foram avaliados quanto à toxicidade regional e sistêmica, e resposta tumoral após a PIM. Após a coleta dos resultados, procedeu-se a comparação com a literatura internacional e as posteriores conclusões. RESULTADOS: Houve 43,2% de respostas completas, 36,4% de respostas parciais e 20,4% sem resposta ao tratamento proposto. A toxicidade regional aguda descrita foi, de modo geral, restrita a edema e eritema discretos, não havendo nenhum caso de complicação sistêmica grave. CONCLUSÃO: Os dados obtidos nessa casuística corroboram os descritos pela literatura internacional, demonstrando a importância e a possibilidade da PIM para o controle locoregional das metástases em trânsito do melanoma cutâneo também na realidade brasileira.Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM) Departamento de DermatologiaUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Programa de Pós-Graduação da Disciplina de Cirurgia PlásticaUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUNIFESP, EPM, Depto. de DermatologiaUNIFESP, EPM, Programa de Pós-Graduação da Disciplina de Cirurgia PlásticaUNIFESP, EPMSciEL