Nicolau Livedoid Dermatitis following intramuscular benzathine penicillin injection

We report the case of a 64-year-old male presenting with a rapidly enlarging painful violaceous plaque in the left buttock and posterior thigh, following a gluteal intramuscular injection of benzathine penicillin. Associated urinary incontinence and lower left limb paresis were consistent with sciatic and lower sacral nerve damage, as confirmed by electromyography. Additional underlying muscular damage was observed in ultrasound and computer tomodensitometry scans and supported by high serum levels of creatine kinase and lactate dehydrogenase. Aggressive treatment was performed with fluid expansion, intravenous steroid bolus, vasodilators and anticoagulation, resulting in slow improvement of cutaneous and muscular lesions. However, no significant effect was observed on neurologic dysfunction after 6 months of regular neuromuscular rehabilitation. Nicolau Livedoid Dermatitis is a rare and potentially fatal condition showing variable levels of tissue impairment and unpredictable course and prognosis. Specific treatment is not consensual and the efficacy of any particular treatment remains to be established

GH levels and insulin sensitivity are differently associated with biomarkers of cardiovascular disease in active acromegaly

Context: Acromegaly is characterized by GH excess and insulin resistance. It is not known which of these disorders is responsible for the increased atherogenic risk in these patients. Objective: To analyse the associations of GH and homoeostasis model assessment (HOMA) with biomarkers of cardiovascular disease and to compare the above-mentioned variables between patients with active acromegaly and controls. Design and setting: This open cross-sectional study was conducted at a University Hospital. Patients: Twenty-two outpatients were compared with sex- and age-matched control subjects. Main outcomes: Included clinical features, hormonal status, markers of insulin resistance, lipoprotein profile and biomarkers of cardiovascular disease. Results: Patients presented higher triglyceride (median [IQR]) (1·2[1·1-1·6] vs 0·9[0·6-1·1] mm, P < 0·05), low-density lipoprotein-cholesterol (LDL-C) (mean ± SD) (3·5 ± 0·9 vs 3·0 ± 0·7mm, P < 0·05), apoB (0·98 ± 0·23 vs 0·77 ± 0·22 g/l, P < 0·05), free fatty acid (0·69 ± 0·2 vs 0·54 ± 0·2 mM, P < 0·05), oxidized-LDL (120 ± 22 vs 85 ± 19 U/l, P < 0·05) and endothelin-1 (0·90 ± 0·23 vs 0·72 ± 0·17 ng/l, P < 0·05) levels, increased cholesteryl ester transfer protein (CETP) activity (179 ± 27 vs 138 ± 30%/ml/h, P < 0·01) and lower C reactive protein (CRP) (0·25[0·1-0·9] vs 0·85[0·4-1·4] mg/l; P < 0·05) levels than control subjects. Vascular cell adhesion molecule (VCAM-1) concentration was not different. By multiple linear regression analyses, HOMA explained the variability of triglycerides (25%), high-density lipoprotein-cholesterol (HDL-C) (30%) and CETP activity (28%), while GH independently predicted LDL-C (18%), oxidized-LDL (40%) and endothelin-1 levels (19%). Conclusions: In patients with active acromegaly, GH excess contributes to the development of insulin resistance, and the interaction between both disturbances would be responsible for the appearance of atherogenic pro-oxidative and pro-inflammatory factors. Insulin resistance would be preferably associated with an atherogenic lipoprotein profile and to high CETP activity, while high GH levels would independently predict the increase in LDL-C, ox-LDL and endothelin-1

Traffic Vertical Signposting: Materials Characterization and Structural Numerical Simulation

Aknowlegements: This work was supported by the project POCI-01-0247-FEDER-010797from the Agency for Competitiveness and Innovation (IAPMEI). In addition, the authors acknowledge the funding from the project UID/Multi/04044/2013 of the Portuguese Foundation for Science and Technology (FCT) and PAMI - ROTEIRO/0328/2013 (Nº 022158).The existing metallic solutions used for vertical traffic signs are associated with higher costs and environmental issues due to their manufacturing and degradation, when compared with polymeric solutions. Thus, the development of vertical signs considering the injection from polymeric materials in order to overcome problems related with sustainability, maintenance costs, and to achieve higher resistance to corrosion assumes nowadays an important role. The use of ecofriendly and innovative products considering the industrial waste combined with synthetic polymers performing the appropriate mechanical properties, can also be studied to find out new solutions that allow to solve the aforementioned problems. Additionally, these innovative vertical signs can contribute to avoid vandalism events related with theft and graffiti activities. This work presents the prior materials investigation and the structural design of vertical signs that are intended to be produced through polymer injection. Three main steps were considered: i) materials research, ii) materials characterisation through the analysis of polycarbonate resin isolated and in different sets of mixtures with different concentrations through tensile testing and static water contact angle measurements to find the optimal material composition; and iii) structural numerical simulation considering polycarbonate resin and using the current standard EN 12899-1 [1] to compute wind resistance, temporary and permanent deflections. Both experimental and numerical results led to an optimized proposal of the vertical signposting structural design.info:eu-repo/semantics/publishedVersio

Obesity by BMI and central obesity in adolescents from Comodoro Rivadavia, Patagonia Argentina

Antecedentes: La prevalencia de obesidad infantil y adolescente resulta relevante ya que con frecuencia el sobrepeso a esa edad persistirá en la vida adulta. Objetivo: Determinar sobrepeso y obesidad en una población adolescente de Comodoro Rivadavia, Patagonia Argentina. Métodos: Se utilizaron las tablas propuestas para el índice de masa corporal (IMC) y la circunferencia de cintura (CC) por los siguientes tres grupos: International Obesity Taskforce (IOTF), Centers for Disease Control and Prevention (CDC) y la Organización Mundial de la Salud (OMS). Se evaluó el grado de concordancia en las definiciones, en relación a las tablas empleadas. Se estudiaron por muestreo no probabilístico y consecutivo, 402 voluntarios (279 mujeres y 123 varones) de edades comprendidas entre 12 y 16 ± 0,5 años. Con consentimiento escrito de los padres y asentimiento de los voluntarios, se midió peso, talla presión arterial y CC. Se calcularon percentiles del IMC y de la CC. Resultados: Al utilizar tanto las tablas IOTF como CDC más del 40 % de la población presentó sobrepeso u obesidad según el IMC. No se evidenciaron diferencias estadísticamente significativas al evaluar sobrepeso según sexo mientras que los varones presentaron mayores índices de obesidad con ambas definiciones (p0,05). Conclusiones: La prevalencia de obesidad es elevada tanto al considerar percentiles tanto de IMC, como de CC. El grado de acuerdo de las definiciones es adecuado. Estos resultados aportan información regional inexistente hasta este momento y alertan sobre una situación que requiere una urgente intervención sanitaria.Background: The prevalence of overweight and obesity in childhood and adolescence is important because it will frequently persist in adult life. Objective: To determine overweight and obesity in a group of adolescents from Comodoro Rivadavia, Argentine Patagonia through the use of body mass index (BMI) and waist circumference. Methods: Obesity Taskforce (IOTF), Centers for Disease Control and Prevention (CDC) and Word Health Organization (WHO) tables were used. The agreement degree in the definitions was evaluated in relation with the tables used. 402 volunteers were studied, aged between 12 to 16 years old ± 0.5. Written parental consent and assent of volunteers were obtained. Anthropometry, blood pressure were measured, andbody mass index and waist circumference´s percentile (Pc) were calculated. Results: Over 40 % of the adolescents were obese or overweight (BMI equal or major 95 or 85, respectively). There weren´t significant statistic difference between overweight and gender while the males showed majors obesity index with both definitions (p0.05). Conclusions: The prevalence of obesity is high with both BMI, as waist circumference percentiles. The degree agreement of the definition is adequate. These results contribute regional information that actually it is non-existent up to now and it alert about a situation that requires an urgent sanitary intervention.Fil: Ponce, Graciela M.. Universidad Nacional de la Patagonia; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Quezada, Andrés O.. Universidad Nacional de la Patagonia; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Rodríguez, María A. Universidad Nacional de la Patagonia; ArgentinaFil: Boeri, Mónica P.. Universidad Nacional de la Patagonia; ArgentinaFil: Soto, Mariana S.. Universidad Nacional de la Patagonia; ArgentinaFil: Brites, Fernando Daniel. Universidad de Buenos Aires; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Prevalência de Obstrução numa População Exposta ao Fumo do Tabaco - Projecto PNEUMOBIL

A espirometria não atingiu ainda a divulgação que se justificaria em patologia respiratória, ou indivíduos que se encontram em risco relativamente a esta patologia, cujo diagnóstico é insuficiente, havendo um escasso conhecimento, e consequente controlo, dos custos atribuíveis a estas doenças, com destaque para a doença pulmonar obstrutiva crónica (DPOC). O PNEUMOBIL, iniciativa que visa esta divulgação entre fumadores e ex -fumadores, foi reactivado, após 10 anos de aplicação em Portugal, revelando agora, numa amostra de 5324 indivíduos, em que cerca de 50% ainda mantêm os hábitos tabágicos, sejam do sexo masculino ou feminino, que houve uma elevada prevalência de obstrução detectada por espirometria (30% e 25%, respectivamente) nas pessoas rastreadas perto de centros de saúde (grupo público) e em empresas (grupo privado). Este risco não se explica em regra por exposição ocupacional, nem se relaciona com a maioria dos sintomas respiratórios, muito frequentes nos rastreados. Apenas a dispneia (OR=1,28; p=0,02) e os episódios frequentes de expectoração (OR=1,21; p=0,008) ou de bronquite aguda (OR=1,31; p=0,05) revelam alguma relação com a obstrução. O reconhecimento prévio da DPOC é muito reduzido e a presença de obstrução não se correlaciona (p=0,204) com o assumir da condição de portador

Ultrasonography Reliability in the Detection of Inflammatory and Structural Abnormalities: An Exercise in Multiple Joints

Background Ultrasonography is an image technique that allows rheumatologists to visualize structural and inflammatory changes within a joint. The objective of this study was to assess the interobserver and intraobserver reliability of musculoskeletal ultrasound (US) in the detection of inflammatory and destructive joint changes in patients with polyarthritis. Methods A Delphi exercise was undertaken to standardize and adapt the EULAR-OMERACT elementary US definitions of inflammatory lesions (effusion, synovial hypertrophy, power Doppler, bone erosions, and synovitis) for each joint. Fifteen patients were analyzed, and video clips of 600 joints were collected. Each joint was scored for the presence of each elementary component, on 2 separate occasions, by 6 examiners. Interobserver and intraobserver agreement analysis was assessed through Fleiss κ coefficient (κ). Results Considering all patients and all joints, the interobserver values were highest for erosions and lowest for effusion (κ = 0.7314 and κ = 0.6044, respectively). When analyzing different regions, the highest interobserver agreement was for tibiotalar joint (κ = 0.8043) and the lowest for wrist (κ = 0.6767). Intraobserver reliability was excellent for each and all elementary components and anatomical region. Conclusions The present study showed either a good or excellent US interobserver and intraobserver reliability in elementary elements and anatomical region. This kind of US reliability exercises are important for standardization of exploration in everyday practice by reducing the variability associated with this imaging technique, and ensuring a greater degree of homogeneity and future comparability in the assessment of disease activity in polyarthritis patients.info:eu-repo/semantics/publishedVersio

RadioActive101-Learning through radio, learning for life: an international approach to the inclusion and non-formal learning of socially excluded young people

This article describes an original international approach to inclusion and non-formal learning of socially excluded young people, through participatory internet radio - RadioActive101. First, we critically discuss the social and digital exclusion of young people. We then describe our approach - that includes partic-ipatory action research methods that are influenced by the work of Dewey and Freire, and operate as a process of complex intervention. This supports the inclusive co-production of radio content in ways that support non-formal learning in two EU contexts – the UK and Portugal. We then summarise and compare a qualitative investigation of RadioActive101. This showed positive results, with important similarities and differences between the two contexts. Participants reported that RadioActive101 was motivating and contributed to the development of contemporary skills, and also stimulated improvements in psychosocial dimensions such as confidence (self-efficacy) and self-esteem. This investigation informed the development of an original recog-nition system for non-formal learning that maps EU Key Competences for Lifelong Learning to radio practic-es and activities that are recognised through electronic badges. Our final reflections emphasise that in order to support the non-formal learning of socially excluded young people we must foreground our attention to foster-ing psychosocial dimensions alongside developing contemporary competences

Aumento del riesgo de enfermedad cardiovascular en pacientes con enfermedad celíaca

En pacientes con enfermedad celíaca (EC), se ha observado mayor incidencia de eventos cardiovasculares que en controles, sin la presencia de factores de riesgo aterogénico clásicos. El objetivo de este estudio fue evaluar los factores de riesgo nóveles y biomarcadores de inflamación y enfermedad cardiovascular en pacientes con EC, con presentación típica y atípica. Fueron seleccionados 14 pacientes con EC sin tratamiento y controles pareados por sexo y edad. Se determinaron parámetros hematológicos, indicadores del metabolismo de los hidratos de carbono, proteína C reactiva ultrasensible (PCRus), per- fil lipoproteico y actividades de proteína transportadora de colesterol esterificado (CETP) y fosfolipasa A2 asociada a lipoproteínas (Lp-PLA2). Los pacientes con EC presentaron niveles plasmáticos mayores de insulina (7,2 mU/l vs. 4,4 mU/l; p<0,05) y mayor índice HOMA-IR (1,45 vs. 0,98; p<0,05) que los controles. Por otro lado, se observó menor concentración de colesterol-HDL (50 vs. 62 mg/dl; p<0,05), mayor cociente triglicéridos/colesterol-HDL y niveles de PCRus más altos (4,56 vs. 1,17 mg/l; p<0,05) en los pacientes que en los controles. Al comparar a los pacientes con presentación típica (n=8) y atí- pica (n=6), aquellos con presentación típica mostraron menores niveles de apo A-I (128 vs. 178 mg/dl; p<0,01) y aumento del cociente apo B/apo A-I (0,72 vs. 0,43; p<0,05), así como mayor actividad de LpPLA2 (7,9 umol/ml.h vs. 6,15 umol/ml.h; p<0,05). La interacción de las alteraciones descriptas durante períodos de tiempo prolongados en una condición patológica crónica como la EC constituirían un mayor riesgo de desarrollo de enfermedad cardiovascular aterosclerótica.In patients with celiac disease (CD), it has been reported higher incidence of cardiovascular events than in controls, without the presence of classical atherogenic risk factors. The aim of this study was to evaluate the novel risk factors and biomarkers of inflammation and cardiovascular disease in patients with CD, with typical and atypical presentation. We selected 14 patients with CD without treatment and 14 healthy sex and age-matched controls. Haematological parameters, indicators of carbohydrates metabolism, high sensitive C reactive protein (hsCRP), lipoprotein profile and the activities of cholesteryl ester transfer protein (CETP) and lipoprotein-associated phospholipase A2 (Lp-PLA2) were determined. CD patients presented higher insulin plasma levels (7.2 mU/l vs. 4.4 mU/l, p <0.05) and increased HOMA-IR index (1.45 vs. 0.98, p <0.05) than controls. On the other hand, lower HDLcholesterol concentration (50 vs. 62 mg/dl, p<0.05), higher TG/HDL-cholesterol ratio and increased hsCRP levels (4.56 vs. 1.17 mg / l, P <0.05) were observed in comparison with control subjects. When comparing patients with typical (n=8) and atypical (n=6) presentation, the former showed lower apo A-I levels (128 vs. 178 mg/dl, p<0.01), and higher apo B/apo A-I ratio (0.72 vs. 0.43, p<0.05) and LpPLA2 activity (7.9 umol/ml.h vs. 6.15 umol/ml.h, p<0.05). The interaction among the alterations above described during long periods of time in a chronic pathological condition such as CD could constitute higher risk of development of atherosclerotic cardiovascular disease.Fil: Menafra, Martín. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Departamento de Bioquímica Clínica; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Meroño, Tomás. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Departamento de Bioquímica Clínica; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Matoso, María Dolores. Hospital Italiano; ArgentinaFil: Boero, Laura Estela. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Departamento de Bioquímica Clínica; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Gomez Rosso, Leonardo Adrián. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Departamento de Bioquímica Clínica; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Saez, María Soledad. Hospital Italiano; ArgentinaFil: Sorroche, Patricia Beatriz. Hospital Italiano; ArgentinaFil: de Paula, P.. Hospital Italiano; ArgentinaFil: Brites, Fernando Daniel. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Departamento de Bioquímica Clínica; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin