Pneumocéfalo Espontâneo Hipertensivo

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Extended-release niacin increases anti-apolipoprotein A-I antibodies that block the antioxidant effect of high-density lipoprotein-cholesterol: the EXPLORE clinical trial.

Extended-release niacin (ERN) is the most effective agent for increasing high-density lipoprotein-cholesterol (HDL-C). Having previously identified anti-HDL antibodies, we investigated whether ERN affected the antioxidant capacity of HDL and whether ERN was associated with the production of antibodies against HDL (aHDL) and apolipoprotein A-I (aApoA-I). METHODS: Twenty-one patients older than 18 years, with HDL-C ≤40 mg dl-1 (men) or ≤50 mg dl-1 (women) were randomly assigned to receive daily ERN (n = 10) or placebo (n = 11) for two sequential 12-week periods, with 4 weeks of wash-out before cross-over. Primary outcome was change of paraoxonase-1 (PON1) activity and secondary outcomes were changes in aHDL and aApoA-I antibodies. Clinical Trial Unique Identifier: EudraCT 2006-006889-42. RESULTS: The effect of ERN on PON1 activity was nonsignificant (coefficient estimate 20.83 U l-1 , 95% confidence interval [CI] -9.88 to 51.53; P = 0.184). ERN was associated with an increase in HDL-C levels (coefficient estimate 5.21 mg dl-1 , 95% CI 1.16 to 9.25; P = 0.012) and its subclasses HDL2 (coefficient estimate 2.46 mg dl-1 , 95% CI 0.57 to 4.34; P = 0.011) and HDL3 (coefficient estimate 2.73 mg dl-1 , 95% CI 0.47 to 4.98; P = 0.018). ERN was significantly associated with the production of aApoA-I antibodies (coefficient estimate 0.25 μg ml-1 , 95% CI 0.09-0.40; P = 0.001). aApoA-I titres at baseline were correlated with decreased PON activity. CONCLUSIONS: The rise in HDL-C achieved with ERN was not matched by improved antioxidant capacity, eventually hampered by the emergence of aApoA-I antibodies. These results may explain why Niacin and other lipid lowering agents fail to reduce cardiovascular risk.info:eu-repo/semantics/publishedVersio

Stress-Related Mucosal Disease: Incidence of Bleeding and the Role of Omeprazole in its Prophylaxis

BACKGROUND: Upper gastrointestinal bleeding is the severe complication of stress-related mucosal disease in hospitalized patients. In intensive care units (ICU), risk factors are well defined and only mechanical ventilation and coagulopathy proved to be relevant for significant bleeding. On the contrary, in non-ICU settings there is no consensus about this issue. Nevertheless, omeprazole is still widely used in prophylaxis of bleeding. The objective of our study was to evaluate the relevance of stress-related mucosal disease bleeding in patients admitted to an internal medicine ward, and the role of omeprazole in its prophylaxis. METHODS: We conducted a retrospective study in which we analysed consecutive patients who were admitted to our ward over a year. We recorded demographic characteristics of the patients, potential risk factors for stress-related mucosal disease (clinical data, laboratory, and medication), administration of prophylactic omeprazole, and total cost of this prophylaxis. Patients with active gastrointestinal bleeding on the admission were excluded. We recorded every upper gastrointestinal bleeding event with clinical relevance. RESULTS: Five hundred and thirty-five patients, mean age 70 years, mean length of stay 9.6+/-7.7 days; 140 (26.2%) patients were treated with 40 mg of omeprazole intravenously, 193 (36.1%) with 20mg of omeprazole orally, and 202 (37.8%) patients had no prophylaxis. There was only one episode (0.2%) of clinically relevant bleeding. CONCLUSION: In patients admitted to an internal medicine ward, incidence of upper gastrointestinal bleeding as a complication of stress-related mucosal disease is low. We found that there is no advantage in prophylaxis with omeprazole

Antibodies against HDL Components in Ischaemic Stroke and Coronary Artery Disease

Quantitative and qualitative defects of high-density lipoprotein (HDL) are important in atherogenesis. In this study, we investigated whether antibodies against HDL components had additional value to conventional cardiovascular risk factors for the diagnosis of ischaemic stroke (IS) and coronary artery disease (CAD). Cross-sectional study was conducted on 53 patients with IS, 51 with CAD and 55 healthy controls, and in vitro studies to validate findings of the clinical study. We determined serum immunoglobulin G (IgG) antibodies against HDL (aHDL), apolipoproteins (aApoA-I, aApoA-II and aApoC-I) and paraoxonase-1 (aPON1) as well as PON1 activity (PON1a), total antioxidant capacity and biomarkers of endothelial activation (serum nitric oxide metabolites, 3-nitrotyrosine, VCAM-1 and ICAM-1); in vitro assays tested the capacity of IgG aHDL purified from high titer patients to inhibit PON1a and to reverse protective effect of HDL on endothelial cells. IgG aHDL, aApoA-I and aPON1 were higher in IS and CAD than controls (p < 0.001), predicted negatively PON1a and positively VCAM-1 and ICAM-1. By adding IgG aHDL and aApoA-I to a traditional cardiovascular risk factors model for IS and by adding IgG aHDL in a similar model for CAD, we obtained better discrimination of IS and CAD from healthy controls. IgG aHDL purified from IS and CAD inhibited PON1a by 38% (p < 0.01) and abrogated the protective effect of HDL on VCAM-1 expression by 126% compared with non-specific human IgG (p < 0.001). IgG against HDL components interfere with the antioxidant and anti-inflammatory properties of HDL and may represent novel biomarkers for vascular disease that need to be investigated in prospective studies.info:eu-repo/semantics/publishedVersio

Radiation protection booth versus conventional radiological protection on pacemaker implantation

São bem conhecidos os efeitos nefastos que a exposição prolongada a radiação X tem no ser humano. Os programas de protecção surgiram como uma ferramenta de auxílio na exposição radiológica, no âmbito da implantação de dispositivos reguladores do ritmo cardíaco. Estes programas baseiam-se na utilização de métodos de protecção convencional e cabines de radioprotecção. Este estudo pretende avaliar a eficácia, em termos de diminuição da exposição à radiação X, de dois métodos de protecção radiológica, a convencional e a utilização de uma cabine de radioprotecção. Foram seleccionados dois grupos (protecção convencional e cabine de radioprotecção CATHPAX ® ), para análise da dose de radiação recebida pelo operador com cada um destes métodos de protecção. A amostra foi composta por 77 procedimentos de implantação de pacemaker no Hospital Fernando da Fonseca. O tempo médio por procedimento foi de 53,59 minutos para utilização da cabine e 62,2 minutos para a utilização da protecção convencional, não sendo estes estatisticamente diferentes. Pode constatar-se que existe uma forte correlação entre o tempo total de procedimento e o tempo total de fluoroscopia, salientando-se que essa correlação é mais forte com a utilização de cabine. Com a cabine de radioprotecção, a dose de radiação recebida foi sempre zero, o que não sucedeu com a utilização de métodos de protecção convencional. Em conclusão, a cabine de radioprotecção é uma mais-valia na protecção de todos os profissionais de saúde envolvidos em procedimentos com recurso à utilização de técnicas com radiação X

Etiologia, Tratamento e Prognóstico da Pericardite Aguda

Introduction: Acute pericarditis is a common inflammatory condition of the pericardium usually assumed to be viral or idiopathic. Despite recent treatment improvements, information is scarce regarding etiology and prognosis. Our aim was to determine the incidence of pericarditis with a known etiology and assess clinical prognostic predictors. Material and Methods: A clinical retrospective analysis of hospitalized patients with acute pericarditis was conducted from 2012 to 2016. Population was characterized according to etiology, clinical presentation, treatment and prognosis. Outcomes of interest, evaluated at one year after hospital discharge, were pericarditis recurrence, hospitalization, constriction and overall mortality. Results: A total of 94 patients were enrolled, median age 46 years (inter-quartile range 32-61), 65% were male. Idiopathic etiology was responsible for 68% of cases. A specific etiology was found in the remaining 32% of patients, being the most frequent autoimmune disease (12%) and malignancy (5%). Idiopathic pericarditis was associated with myopericarditis (p = 0.049) and a known etiology with pericardial effusion (p = 0.001) and cardiac tamponade (p = 0.027). Recurrence of pericarditis was found in 13% of patients. Corticosteroid treatment in patients with an identified etiology was not associated with an increase in recurrence (p = 0.220). Overall 1-year mortality was 9%. A defined etiology was the only independent predictor of mortality at multivariate analysis (OR 40.3; 95% CI 1.9 – 137.2; p = 0.016). Conclusion: Up to one third of hospitalized patients with acute pericarditis have an identified cause of pericarditis and these patients are at increased risk of mortality.Introdução: A pericardite aguda é uma síndrome frequente caracterizada pela inflamação do pericárdio e usualmente atribuído a etiologia viral/idiopática. Apesar dos avanços no tratamento, existe informação limitada em relação a etiologia e prognóstico. O objetivo do nosso trabalho foi identificar a prevalência de pericardite aguda com etiologia especifica e avaliar marcadores clínicos de prognóstico. Material e Métodos: Estudo retrospetivo de doentes hospitalizados por pericardite aguda entre 2012-2016. A população foi caracterizada quanto a etiologia, apresentação clínica, tratamento e prognóstico. Para avaliação de prognóstico foram avaliadas recorrência de pericardite, pericardite constritiva e mortalidade global um ano após alta hospitalar. Resultados: Foram incluídos 94 doentes com idade mediana 46 anos (IIQ 32-61), 65% eram do sexo masculino. A etiologia idiopática foi responsável por 68% dos casos. Etiologia especifica foi identificada em 32% dos doentes, sendo mais frequente doença autoimune (12%) e neoplasia (5%). A pericardite idiopática foi mais associada a miopericardite (p = 0,049), enquanto a etiologia específica se associou a derrame pericárdico (p = 0,001) e a tamponamento pericárdico (p = 0,027). A recorrência de pericardite ocorreu em 13% dos doentes. O tratamento com corticosteroides em doentes com etiologia definida não se associou com aumento de recorrência (p = 0,220). A mortalidade global a um ano foi de 9%. A etiologia definida de pericardite aguda revelou-se o único preditor independente de mortalidade na análise multivariada (OR 40,3; 95% CI 1,9 – 137,2; p = 0,016). Conclusão: Cerca de um terço dos doentes hospitalizados por pericardite aguda têm uma causa específica identificável de pericardite e estes doentes apresentam risco aumentado de mortalidadeinfo:eu-repo/semantics/publishedVersio

Nickel phytoextraction by a native population of Alyssum serpyllifolium subsp. lusitanicum on ultramafic soils (Portugal): prospects for phytomining

RESUMO: Este estudo teve os seguintes objetivos: (1) investigar a relação entre as concentrações de níquel (Ni) nos solos e na planta Alyssum serpyllifolium ssp. lusitanicum em regiões ultramáficas de Portugal; (2) avaliar o potencial da espécie como bio-minério, para fitomineração de Ni. Esta espécie é endémica dos solos serpentiníticos dos maciços de Bragança e Morais, sendo hiperacumuladora de Ni. Em condições de campo, os resultados mostram que, considerando as partes aéreas da planta, a biomassa varia entre 4,08 e 9,37 t ha–1, contendo entre 0,25% e 1,23% de Ni, permitindo uma extração entre 12,2 e 98,1 kg de Ni por hectare por cultura. A quantidade de Ni extraído pela planta é semelhante em ambas as regiões ultramáficas, correspondendo ao valor médio de 580 USD por hectare (preços de janeiro 2018). Os resultados indicam que alguns terrenos destas áreas ultramáficas são potenciais produtores de Ni a partir desta espécie endémica.ABSTRACT: The present study had the following objectives: (1) to investigate the relationship between nickel (Ni) concentration in the soil and the concentration in the plant (Alyssum serpyllifolium ssp. lusitanicum) in ultra mafic areas of Portugal; and (2) to assess the potential of this species for Ni phytomining as bio-ore. This species is endemic to serpentine soils of the Bragança and Morais massifs and is a Ni hyperaccumulator that can accumulate more than 12000 mg kg–1 (dry weight). Under natural condi tions, the results show that considering only the aerial parts of the plant, the biomass varies between 4.08-9.37 t ha–1, containing a range of 0.25-1.23% Ni, allowing a withdrawal of between 12.2-98.1 kg Ni ha–1 per crop under natural conditions. The amount of Ni extracted by the plant is similar in both ultramafic areas, having a mean value of approximately $US 580 per ha considering the January 2018 Ni prices. The results of this study indicate that some of the land in these ultramafic areas are potential producers of Ni from this endemic species.info:eu-repo/semantics/publishedVersio

Performance of aquatic plant species for phytoremediation of arsenic-contaminated water

This study investigates the effectiveness of aquatic macrophyte and microphyte for phytoremediation of water bodies contaminated with high arsenic concentration. Water hyacinth (Eichhornia crassipes) and two algae (Chlorodesmis sp. and Cladophora sp.) found near arsenic-enriched water bodies were used to determine their tolerance toward arsenic and their effectiveness to uptake arsenic thereby reducing organic pollution in arsenic-enriched wastewater of different concentrations. Parameters like pH, chemical oxygen demand (COD), and arsenic concentration were monitored. The pH of wastewater during the course of phytoremediation remained constant in the range of 7.3–8.4, whereas COD reduced by 50–65 % in a period of 15 days. Cladophora sp. was found to survive up to an arsenic concentration of 6 mg/L, whereas water hyacinth and Chlorodesmis sp. could survive up to arsenic concentrations of 2 and 4 mg/L, respectively. It was also found that during a retention period of 10 days under ambient temperature conditions, Cladophora sp. could bring down arsenic concentration from 6 to <0.1 mg/L, Chlorodesmis sp. was able to reduce arsenic by 40−50 %; whereas, water hyacinth could reduce arsenic by only 20 %. Cladophora sp. is thus suitable for co-treatment of sewage and arsenic-enriched brine in an algal pond having a retention time of 10 days. The identified plant species provides a simple and cost-effective method for application in rural areas affected with arsenic problem. The treated water can be used for irrigation

Distinct in vitro binding properties of the anti-CD20 small modular immunopharmaceutical 2LM20-4 result in profound and sustained in vivo potency in cynomolgus monkeys

Objectives. To characterize the in vitro binding and effector function properties of CD20-directed small modular immunopharmaceutical (SMIP) 2LM20-4, and to compare its in vivo B-cell depletion activity with the mutated 2LM20-4 P331S [no in vitro complement-dependent cytotoxicity (CDC)] and rituximab in cynomolgus monkeys

Potential toxic elements in stream sediments, soils and waters in an abandoned radium mine (central Portugal)

The Alto da Várzea radium mine (AV) exploited ore and U-bearing minerals, such as autunite and torbernite. The mine was exploited underground from 1911 to 1922, closed in 1946 without restoration, and actually a commercial area is deployed. Stream sediments, soils and water samples were collected between 2008 and 2009. Stream sediments are mainly contaminated in As, Th, U and W, which is related to the AV radium mine. The PTEs, As, Co, Cr, Sr, Th, U, W, Zn, and electrical conductivity reached the highest values in soils collected inside the mine influence. Soils are contaminated with As and U and must not be used for any purpose. Most waters have pH values ranging from 4.3 to 6.8 and are poorly mineralized (EC = 41-186 µS/cm; TDS = 33-172 mg/L). Groundwater contains the highest Cu, Cr and Pb contents. Arsenic occurs predominantly as H2(AsO4)- and H(AsO4)2-. Waters are saturated in goethite, haematite and some of them also in lepidocrocite and ferrihydrite, which adsorbs As (V). Lead is divalent in waters collected during the warm season, being mobile in these waters. Thorium occurs mainly as Th(OH)3(CO3)-, Th(OH)2(CO3) and Th(OH)2(CO3) 22- , which increase water Th contents. Uranium occurs predominantly as UO2CO3, but CaUO2(CO3) 32- and CaUO2(CO3)3 also occur, decreasing its mobility in water. The waters are contaminated in NO2-, Mn, Cu, As, Pb and U and must not be used for human consumption and in agricultural activities. The water contamination is mainly associated with the old radium mine and human activities. A restoration of the mining area with PTE monitoring is necessary to avoid a public hazard.Thanks are due to Prof. Joao Coutinho for the determination of organic matter and cation exchange capacity in samples of stream sediments and soils and A. Rodrigues for the water analyses, EDM for some information on the Alto da Varzea mine area. This study had the support of Portuguese Fundacao para a Ciencia e Tecnologia (FCT), through the strategic projects UID/GEO/04035/2013 and UID/MAR/04292/2013 (MARE).info:eu-repo/semantics/publishedVersio