PITYRIASIS LICHENOIDES - RELATO DE DOIS CASOS QUE EVIDENCIAM O VARIADO ESPECTRO DE APRESENTAÇÃO DESTA RARA DOENÇA

Pityriasis lichenoides is a rare skin disease of unknown etiology, whose spectrum of clinical presentation varies from an acute form, pityriasis lichenoides et varioliformis acuta (PLEVA) to a more insidious and recurrent one, pityriasis lichenoides chronica (PLC). PLEVA, or Mucha-Habermann disease, has an acute onset of papules on the trunk, buttocks and proximal extremities that rapidly progress to vesicles or form hemorrhagic crusts, and may leave depressed scars. PLC, by contrast, has small scaly papules, asymptomatic or pruritic, which can develop over days, on the same distribution. The lesions may continue appearing and disappearing over months, sometimes causing post-inflammatory hypopigmentation. The patient does not usually evolve from a clinical form to another, tending to spontaneous healing or the cure comes after treatment. It is believed that pityriasis lichenoides is a hypersensitivity reaction to various infectious agents and with self-limiting clonal proliferation of T cells, wherein the immune response to the clone leads to clinical and pathological manifestations. It has been detected T-cell receptor gamma gene rearrangement (TCR-gamma) by PCR. Pathological exam shows typical changes of each presentation. This paper presents two very representative cases of this uncommon disease, showing the main features of each form of pityriasis lichenoides. Both had resolution with the use of Doxycycline.Pityriasis lichenoides é uma dermatose rara, de etiologia desconhecida, cujo espectro de apresentações clínicas varia de uma forma aguda, a pityriasis lichenoides et varioliformis acuta (PLEVA) a uma forma mais insidiosa e recorrente, a pityriasis lichenoides chronica (PLC). A PLEVA, ou doença de Mucha-Habermann, tem um quadro abrupto de pápulas no tronco, nádegas e extremidades proximais que progridem rapidamente para vesículas ou formam crostas hemorrágicas, podendo deixar cicatrizes deprimidas. Já a PLC apresenta pequenas pápulas descamativas, assintomáticas ou pruriginosas, que podem se desenvolver ao longo de dias, também com distribuição ao tronco, nádegas e extremidades proximais. As lesões podem continuar surgindo e involuindo ao longo de meses, algumas vezes causando hipopigmentação pós-inflamatória. O doente não costuma evoluir de um polo de apresentação para outro, tendendo a cura espontânea ou após tratamento. Acredita-se que a pitiríase liquenóide seja uma reação de hipersensibilidade a agentes infecciosos diversos, com proliferação clonal autolimitada de células T, em que a resposta imunológica ao clone provoca as manifestações clínicas e histopatológicas. Já foi identificado rearranjo dos receptores do gene gama de células T (TCR-gama) por técnicas de PCR. O anatomopatológico mostra alterações típicas de cada forma de apresentação. O artigo apresenta dois casos bem representativos desta rara doença, evidenciando as principais características de cada um dos polos da pitiríase liquenóide. Ambos tiveram resolução com o uso de Doxiciclina

DERMATOSE COMUM NO PASSADO, MAS QUE AINDA DESAFIA OS DERMATOLOGISTAS - QUAL O SEU DIAGNÓSTICO?

This paper presents a case of Hebra’s prurigo, with the typical picture in a child under similar socioeconomic conditions and predisposing factors described by Hebra in Vienna, in the nineteenth century. This disease is an eruption of multiple extremely itchy small papules. Because of scratching, there are abrasions or lichenification, frequent secondary infection and progression to scars with dyschromia. Affected children are usually malnourished and have increased inguinal, axillary or cervical lymph nodes. They are generally atopic children with hypersensitivity to insect bite, in a context of inadequate hygiene and poor nutrition.Os autores apresentam um caso de prurigo de Hebra, com o quadro típico numa criança com o mesmo perfil socioeconômico e de fatores predisponentes descritos por Hebra em Viena no século XIX. Essa doença se manifesta por múltiplas pápulas pequenas e extremamente pruriginosas. Devido à escoriação, ocorrem erosões e liquenificação e infecções secundárias, evoluindo para cicatrizes hiper ou hipopigmentadas.. As crianças afetadas geralmente são desnutridas e têm adenomegalias inguinal, axilar ou cervical. Normalmente, são crianças atópicas com hipersensibilidade cutânea a picada de insetos, num contexto de higiene inadequada e má nutrição

ERMES: Design and preliminary simulations for an autonomous docking manoeuvre

In the last decades, small satellites have played an important role in space missions. Due to their reduced dimension and costs, they became affordable to smaller companies and research laboratories to conduct scientific experiments and technological demonstrations in space. In addition, the number of these satellites has considerably increased due to their wide use in technological, scientific and commercial domains. In this scenario, autonomous architectures, as well as miniaturized mechanical subsystems for small satellites, are continuously investigated. Experimental Rendezvous in Microgravity Environment Study (ERMES) is a student project that focuses on the simulation of an autonomous docking manoeuvres between two CubeSats mock-ups equipped with miniaturized Guidance Navigation and Control systems and mechanical docking interfaces. ERMES aims to integrate different subsystems for autonomous docking, to increase the Technology Readiness Level and to study possible applications for in-orbit servicing. This paper deals with the design and development of the tests for autonomous docking manoeuvres between two CubeSats mock-ups to be performed in a reduced-gravity environment during a parabolic flight. A Target-Chaser configuration has been selected, where the Chaser is fully active and the Target is cooperative. The Chaser is equipped with a miniaturized cold gas propulsion system with eight thrusters to control its attitude and position; in contrast, the Target has a set of three reaction wheels to control only its attitude. The tested miniaturized mechanical docking interfaces employs a probe-drogue configuration. The most demanding aspect of the development phase will be the dedicated software for the proximity navigation. The reduced-gravity conditions will be achieved during a campaign of parabolic flights thanks to the participation to the European Space Agency “Fly Your Thesis!” programme 2022

The proinflammatory cytokine interleukin 18 regulates feeding by acting on the bed nucleus of the stria terminalis

The proinflammatory cytokine IL-18 has central anorexigenic effects and was proposed to contribute to loss of appetite observed during sickness. Here we tested in the mouse the hypothesis that IL-18 can decrease food intake by acting on neurons of the bed nucleus of the stria terminalis (BST), a component of extended amygdala recently shown to influence feeding via its projections to the lateral hypothalamus (LH). We found that both subunits of the heterodimeric IL-18 receptor are highly expressed in the BST and that local injection of recombinant IL-18 (50 ng/ml) significantly reduced c-fos activation and food intake for at least 6 h. Electrophysiological experiments performed in BST brain slices demonstrated that IL-18 strongly reduces the excitatory input on BST neurons through a presynaptic mechanism. The effects of IL-18 are cell-specific and were observed in Type III but not in Type I/II neurons. Interestingly, IL-18-sensitve Type III neurons were recorded in the juxtacapsular BST, a region that contains BST-LH projecting neurons. Reducing the excitatory input on Type III GABAergic neurons, IL-18 can increase the firing of glutamatergic LH neurons through a disinhibitory mechanism. Imbalance between excitatory and inhibitory activity in the LH can induce changes in food intake. Effects of IL-18 were mediated by the IL-18R because they were absent in neurons from animals null for IL-18R\u3b1 (Il18ra-/-), which lack functional IL-18 receptors. In conclusion, our data show that IL-18 may inhibit feeding by inhibiting the activity of BST Type III GABAergic neurons

LEISHMANIOSE TEGUMENTAR AMERICANA - APRESENTAÇÃO ATÍPICA DIAGNOSTICADA COM TÉCNICA DE BIOLOGIA MOLECULAR

American cutaneous leishmaniasis is an infectious, not contagious disease, caused by a protozoa from genus Leishmania and affects skin and mucosal tissue. The clinical symptoms is varied and it is related with the Leishmania species and the immune response of the host; Most common symptoms are single or multiples ulcerated lesions, however, we will present an atypical case of the disease. The patient presented mainly verrucous lesions in lower limbs, the polymerase chain reaction confirmed American cutaneous leishmaniasis diagnosis. After meglumine antimoniate treatment, the patient evolved with clinical improvement of the lesions, which supports the diagnosis. This case relevance is the need of knowledge of the disease atypical forms, in order to establish an early diagnosis and also an appropriate therapy.Leishmaniose tegumentar Americana é uma doença infecciosa, não contagiosa, causada por protozoários do gênero Leishmania, que acomete pele e mucosa. A clínica é variada e relaciona-se com a espécie de Leishmania e a resposta imune do hospedeiro; o quadro clássico são lesões ulceradas únicas ou múltiplas, porém mostraremos um caso atípico da doença. Paciente apresentava lesões predominantemente verrucosas em membros inferiores, a reação em cadeia da polimerase confirmou o diagnóstico de leishmaniose tegumentar Americana. Este paciente, após inicio do antimoniato de meglumina, evoluiu com melhora clínica das lesões, corroborando para o diagnóstico. A importância se deve a necessidade do conhecimento das formas atípicas da doença, a fim de se estabelecer um diagnóstico precoce e uma terapêutica correta

The WaveDAQ integrated Trigger and Data Acquisition System for the MEG II experiment

The WaveDAQ is a newly-designed digitization Trigger and Data AcQuisition system (TDAQ) allowing Multi-gigasample waveform recording on a large amount of channels (up to 16384) by using the DRS4 analog switched capacitor array as downconverting ASIC. A high bandwidth, programmable input stage has been coupled with a bias generator to allow SiPM operation without need of any other external apparatus. The trigger generation is tightly coupled within the system to limit the required depth of the analog memory, allowing faster digitization speeds. This system has been designed for the MEG experiment upgrade but also proved to be highly scalable and already found other applications.Comment: This manuscript is for conference record of the 21st IEEE Real Time conference onl

Characteristics, comorbidities and laboratory measures associated with disease severity and poor prognosis in young and elderly patients with COVID-19 admitted to medical wards in Emilia-Romagna region, Italy: a multicentre retrospective study

Background and Objectives. A relatively small number of studies have investigated the characteristics, comorbidities and laboratory measures associated with prognosis in patients with COVID-19, admitted to Internal Medicine Units (IMU) in Italy. Therefore, we performed a retrospective multicentre study to identify baseline features, predisposing to severe disease and poor outcomes, in adult individuals with SARS-CoV2 infection, hospitalized in 5 IMUs in the Emilia-Romagna region (Italy). Materials and Methods. We included 129 consecutive patients (male 75, median age 68 years) from 1st March 2020 to 31st October 2021. Patients' baseline characteristics, comorbidities, laboratory measures, and outcomes were collected. Results. At admission, the factors significantly associated with a higher risk of in-hospital mortality included: age (median 68 vs. 83 years in survived vs. dead patients, P=0.000), diabetes [Odds Ratio (OR) 4.00, P=0.016], chronic obstructive pulmonary disease (OR 4.60, P=0.022), cancer (OR 5.81, P=0.021), acute- (OR 9.88, P=0.000) and chronicrenal failure (OR 6.76, P=0.004). During the study period, 16 individuals died (12.4%), all over 70 years old. In deceased vs. non-deceased patients were detected: i) more elevated white blood cells and neutrophils-counts and lower lymphocytes count; ii) higher levels of total/direct bilirubin, creatinine, C-reactive-protein, lactate-dehydrogenase, ferritin, but only a slight Interleukin-6 increase; iii) a trend of lower vitamin D values. Conclusions. We proposed a new I index, a modified form of the Age-Adjusted Charlson Comorbidity Index, by considering pO(2)/FiO(2) ratio, to better characterize the severity of COVID-19. Furthermore, we critically discuss our results with the current assumption which considers COVID-19 as a pathological condition associated with cytokine storm

Nodulose pelo Uso de Metotrexato em Doente com Artrite Reumatoide

Extra-articular manifestations in patients with rheumatoid arthritis are common. Subcutaneous nodules appear in almost 8% of users of methotrexate with rheumatoid arthritis. Methotrexate, one of the recommended drugs in this disease, may cause unwanted effects such as accelerated nodulosis. This complication is an important differential diagnosis in subcutaneous nodules rapidly evolving in rheumatoid arthritis patients on methotrexate and TNF inhibitors. Early diagnosis is essential for a forehand treatment. We describe a case of accelerated nodulosis associated with the use methotrexate and etanercept in patients with rheumatoid arthritis.As manifestações extra-articulares em pacientes com artrite reumatóide são comuns. Os nódulos subcutâneos aparecem em cerca de 8% dos usuários de metotrexato com artrite reumatoide. O metotrexato, uma das drogas de escolha nesta doença, pode acarretar o aparecimento de efeitos indesejados como a nodulose acelerada. Esta complicação é um importante diagnóstico diferencial de nódulos subcutâneos com evolução rápida em pacientes com artrite reumatoide e uso de metotrexato e inibidores de TNF. O diagnóstico precoce é fundamental para que seja instalado tratamento efetivo. Descreve-se um caso de nodulose acelerada associado ao uso de MTX e etanercept em paciente com artrite reumatoide