Anorectal Complications in Patients with Haematological Malignancies

Background: Anorectal complications are common in patients with haematological malignancies. Objectives: The objectives are to characterize anorectal complications in these patients, identify risk factors and shed light on treatment, morbidity and mortality rates. Patients and methods: A retrospective, observational study that included 83 inpatients with haematological malignancies and proctological symptoms from January 2010 to September 2015 was conducted. Clinical outcomes were obtained through a detailed review of medical records. Results: The median age was 56 years, and 52 (62.7%) patients were men. Fifty-six (67.5%) patients had nonseptic anorectal complications and 27 (32.5%) patients had septic anorectal complications. Risks factors: Patients with septic anorectal complications were more commonly male, older, and had lower absolute neutrophil counts, but the differences were not statistically significant (P=0.79, 0.67 and 0.89, respectively). In positive blood cultures [23/70 (32.9%)], Enterococcus faecium, Klebsiella pneumonia, and Escherichia coli were the most common isolated agents. Treatment: In nonseptic anorectal complications, conservative treatments/minor proctological procedures were adopted, and patients with septic anorectal complications were treated with antibiotics±major proctological procedures and/or surgical drainage/debridement. Results of treatment: Forty-eight (85.7%) patients in the nonseptic complications group improved compared with 23 (85.2%) patients in the septic complications group. The overall mortality rate was 2.4% (n=2), with one (1.2%) death related to perianal sepsis. Conclusion: Enterococcus spp. were more commonly identified in this study and can be increasing in this specific population. In contrast to other reports, we did not identify an association between septic anorectal complications and possible risk factors such as male sex, younger age or a low absolute neutrophil count. Most patients had nonseptic anorectal complications. A major proctological procedure/surgical debridement should always be applied in septic complications, which have better prognoses now than in the past.info:eu-repo/semantics/publishedVersio

Prolactin-producing pituitary carcinoma, hypopituitarism, and graves' disease-Report of a challenging case and literature review

Introduction: The diagnosis of pituitary carcinoma is very rare, requires the evidence of metastatic disease, and has a poor overall survival. Malignant prolactinoma frequently requires dopamine agonist therapy, pituitary surgery, radiotherapy, and even chemotherapy. Case description: A 19-year-old female presented with galactorrhea, primary amenorrhea, and left hemianopsia. Complementary study detected hyperprolactinemia and a pituitary macroadenoma with cavernous sinus invasion and suprasellar growth. She was treated with cabergoline and bromocriptine without clinical or analytical improvement. Resection of the pituitary lesion was programmed and a non-contiguous lesion of the nasal mucosa was detected during the approach. This metastasis led to the diagnosis of prolactin-producing pituitary carcinoma. After partial resection, the patient was submitted to radiotherapy for residual disease with persistent symptoms. She developed growth hormone deficiency, central hypothyroidism, hypogonadism, and permanent diabetes insipidus. Six years later she was admitted for the suspicion of secondary adrenal insufficiency and thyrotoxicosis. Physical findings, laboratory data, thyroid ultrasound, and scintigraphy achieved the diagnosis of Graves' disease and hypocortisolism. She was treated with hydrocortisone and methimazole, but central hypothyroidism recurred after antithyroid drug withdrawal. Nine years after the diagnosis of a pituitary carcinoma, she maintains treatment with bromocriptine, has a locally stable disease, with no metastases. Conclusion: This report highlights an unusual presentation of a prolactin-producing pituitary carcinoma in a young female. The patient had multiple hormone deficiencies due to a pituitary lesion and treatments. The posterior development of hyperthyroidism and adrenal insufficiency brought an additional difficulty to the approach

MOBP and HIP1 in multiple system atrophy: new α‐synuclein partners in glial cytoplasmic inclusions implicated in the disease pathogenesis

Aims: MSA is a fatal neurodegenerative disease. Similar to Parkinson’s disease (PD), MSA is an α‐synucleinopathy, and its pathological hallmark consists of glial cytoplasmic inclusions (GCIs) containing α‐synuclein in oligodendrocytes. We previously identified consistent changes in MOBP and HIP1 DNA methylation status in MSA. We hypothesized that if differential DNA methylation at these loci is mechanistically relevant for MSA, it should have downstream consequences on gene regulation. / Methods: We investigated the relationship between MOBP and HIP1 DNA methylation and mRNA levels in cerebellar white matter from MSA and healthy controls. Additionally, we analysed protein expression using western blotting, immunohistochemistry and proximity ligation assays. / Results: We found decreased MOBP mRNA levels significantly correlated with increased DNA methylation in MSA. For HIP1, we found a distinct relationship between DNA methylation and gene expression levels in MSA compared to healthy controls, suggesting this locus may be subjected to epigenetic remodelling in MSA. Although soluble protein levels for MOBP and HIP1 in cerebellar white matter were not significantly different between MSA cases and controls, we found striking differences between MSA and other neurodegenerative diseases, including PD and Huntington’s disease. We also found that MOBP and HIP1 are mislocalized into the GCIs in MSA, where they appear to interact with α‐synuclein. / Conclusions: This study supports a role for DNA methylation in downregulation of MOBP mRNA in MSA. Most importantly, the identification of MOBP and HIP1 as new constituents of GCIs emphasizes the relevance of these two loci to the pathogenesis of MSA

Heart failure with reduced ejection fraction: Should we submit patients without angina to coronary angiography?

Coronary artery disease (CAD) accounts for about two-thirds of cases of heart failure with reduced ejection fraction (HFrEF) [1]. Angina symptoms and cardiovascular risk factors (CVRF) are not sufficient to establish an ischemic etiology and according to recommendations coronary angiography (CA) is the gold standard [1–3]. There is a paucity of information on the performance of CA for detecting CAD in HFrEF without known CAD [4]. We aimed to determine the frequency of CAD in HFrEF patients of unknown etiology and without known CAD, and to identify variables associated with the presence and severity of CAD

Effect of Weight Loss after Bariatric Surgery on Thyroid-Stimulating Hormone Levels in Patients with Morbid Obesity and Normal Thyroid Function

Background: Several studies have reported that morbid obesity is associated with increased thyroid-stimulating hormone (TSH) levels. However, it is not clear what is the impact of bariatric surgery on postoperative thyroid function. The aim of this study was to evaluate the effect of weight loss after bariatric surgery on TSH levels in euthyroid patients with morbid obesity. Methods: We performed a retrospective observational study of 949 euthyroid patients (86.1% female; age 42.0 ± 10.3 years, BMI 44.3 ± 5.7 kg/m2) with morbid obesity submitted to bariatric surgery (laparoscopic adjustable gastric band, Roux-en-Y gastric bypass, or sleeve gastrectomy). Patients were subdivided in two groups: normal TSH group (TSH <2.5 mU/L) and high-normal TSH group (TSH ≥2.5 mU/L). The impact of anthropometric parameters, comorbidities, TSH, free thyroxine (FT4), free triiodothyronine (FT3), type of surgery, and excessive body weight loss (EBWL) on TSH variation 12 months after surgery was evaluated. Results: The high-normal TSH group (24.3% of patients) included more women, presented a higher BMI, higher systolic blood pressure, and higher FT3 levels. There was a significant decrease of TSH 12 months after surgery that was more marked in the high-normal TSH group (normal TSH group: 1.57 ± 0.49 to 1.53 ± 0.69 mIU/L, p = 0.063; high-normal TSH group: 3.23 ± 0.59 to 2.38 ± 0.86 mIU/L, p < 0.001). In a multivariate analysis, after adjusting for relevant covariates, EBWL, baseline BMI, and baseline FT3 were significantly associated with TSH decrease 12 months after bariatric surgery. Conclusion: Bariatric surgery promotes a decrease of TSH that is significantly greater in patients with high-normal TSH and is independently associated with EBWL after surgery

Comparison of cadmium binding by humic and fulvic acids extracted from compost samples of different feedstock

Compost is a bio-sustainable material produced by the controlled decomposition of the organic wastes. Composting can be employed for the urban organic waste treatment in alternative to incineration or landfill disposal [1]. The properties of compost are closely related to the presence of humic-like substances (HS). Both fulvic acids (FA) and humic acids (HA) contain a significant amount of carboxylic acids and phenolic groups that are responsible for some of their properties like solubility and ability to complex metal ions [2]. In the scope of the project Res2ValHum [3], composts produced from different feedstock were analysed and compared regarding the ability of the FA and the HA extracts to bind Cd2+. The free cadmium ion concentration was measured using the electroanalytical technique AGNES (absence of gradients and Nernstian equilibrium stripping) [4]. The cadmium binding by FA and HA extracts of two compost samples: compost of algae (CA) and compost of sludge sewage (CSS) is illustrated in Figure 1. Results indicate that the extent of the binding of cadmium by FA is similar despite the nature of the compost. In opposition, the HA extracts from the algae compost exhibit a larger capacity to bind cadmium ion in comparison to the extracted from the sludge sewage compost. These results indicate that the nature of the feedstock seem to affect more the structure of the HA (in comparison to the FA) formed during the composting process. The chemical characterization of these extracts by different analytical techniques are in course in order to fully understand the referred effect.0366_RES2VALHUM_1_P - Valorização de resíduos orgânicos: produção de substâncias húmicas, cofinanciada pelo Fundo Europeu de Desenvolvimento regional (FEDER) através do Programa INTERREG V-A Espanha-Portugal (POCTEP) 2014-202

Comparison of cadmium binding by humic and fulvic acids extracted from two composts of different origin

Composting has been proven to be an environmentally friendly process for urban organic waste, that can represent an opportunity for new uses under the circular economy framework. The binding of cadmium to fulvic-like and humic-like acids extracted from compost of algae and urban residues were evaluated, and the results show significant differences. The fulvic and humic acids from algae compost bind cadmium more efficiently than those from urban residues compost. Furthermore, data from humic acids from both composts display significantly higher ability to bind to cadmium than both their corresponding fulvic acids and the generic soil extracted humic matter.  Cooperation Program Interreg V-A Spain-Portugal (POCTEP) 2014-2020 and the European Union through the European Regional Development Fund -FEDER within the scope of the project «RES2VALHUM -Valorization of Organic Waste: Production of Humic Substances» (0366_RES2VALHUM_1_P).The authors want to thank LIPOR for the supply of COUR sample. Members of the USC are also grateful to CRETUS Strategic Partnership (ED431E 2018/01) co-funded by FEDER and the Galician Competitive Research Group GRC ED431C/12.Members of the Department of Chemistry are also grateful toCenter of Chemistrythrough projects UID/QUI/00686/2016 and UID/QUI/00686/2019 (CQUM) funded by Foundation for Science and Technology (FCT, Portugal

Characterization of organic matter at different stages of a composting process

The characterization of the organic matter from raw organic wastes, unmatured compost and maturated compost was performed by different techniques: gravimetric, FTIR-ATR, TGA and from the ability of their extracts to bind Cd2+ (evaluating the free cadmium ion by AGNES). Although the amount of humic-like and fulvic-like acids did not change significantly, the structure and properties of the organic matter changed with composting and maturation. These changes resulted in an increase of the stability of the organic material toward thermal decomposition and in an increase of the capacity to bind cadmium.0366_RES2VALHUM_1_P - Valorização de resíduos orgânicos: produção de substâncias húmicas, cofinanciada pelo Fundo Europeu de Desenvolvimento regional (FEDER) através do Programa INTERREG V-A Espanha-Portugal (POCTEP) 2014-2020

Degradation studies of hydrophilic, partially degradable and bioactive cements (HDBCs) incorporating chemically modified starch

The degradation rate in Hydrophilic, Degradable and Bioactive Cements (HDBCs) containing starch/cellulose acetate blends (SCA) is still low. In order to increase degradation, higher amounts of starch are required to exceed the percolation threshold. In this work, gelatinization, acetylation and methacrylation of corn starch were performed and assessed as candidates to replace SCA in HDBCs. Formulations containing methacrylated starch were prepared with different molar ratios of 2-hydroxyethyl methacrylate and methyl methacrylate in the liquid component and the amount of residual monomer released into water was evaluated. The concentration of reducing sugars, percentage of weight loss and morphologic analyses after degradation all confirmed increased degradation of HDBC with alpha-amylase, with the appearance of pores and voids from enzymatic action. Methacrylated starch therefore is a better alternative to be used as the solid component of HDBC then SCA, since it leads to the formation of cements with a lower release of toxic monomers and more prone to hydrolytic degradation while keeping the other advantages of HDBCs.The authors acknowledge to Foundation for Science and Technology (FCT), who supported this study through funds from project Concept2Cement (POCTI/CTM/60735/2004)