Sinovite Vilonodular Pigmentada: um desafio diagnóstico. Revisão de 8 casos

OBJECTIVE: Pigmented Villonodular Synovitis (PVNS) is a benign and uncommon clinical entity, characterized by excessive proliferation of synovial membrane of joints, tendon sheaths and bursas. The objective of this study was to evaluate demographic and clinical parameters, diagnostic and treatment procedures and the outcome of 28 patients with PVNS. MATERIAL AND METHODS: Retrospective study of the histologically proven cases of PVNS, diagnosed between January 1998 and April 2010 in the Orthopaedics Department of Coimbra University Hospital. Clinical data were reviewed for each patient and the following parameters were evaluated: gender, age at diagnosis, initial clinical symptoms and site of onset, symptom duration, main imaging findings (x-ray and magnetic resonance imaging of the involved structure), histological features of the lesion, treatment, follow-up duration, evidence of recurrence and time between surgery and recurrence. RESULTS: A total of 28 patients with histologically proven PVNS were included. The majority of patients were female (53.6%) and the mean age at the time of diagnosis was 39.2 ± 19.1 years (mean ± SD). The time between onset of symptoms and diagnosis was un- known in one patient and, in the other 27 patients, mean delay in diagnosis was 24.4 ± 20.5 months (mean ± SD). The knee was the most frequently affected site (75% of the cases). Pain and progressive local swelling sensation were the most frequent symptoms at onset (in 82.1% and 71.4% of the cases, respectively). Joint x-ray identified abnormalities in only 17.8% of the patients. Magnetic resonance imaging (MRI) of the affected structure identified the presence of synovial membrane proliferation in all cases and extra-articular extension of the lesion and bone erosions in 39.1% and 34.8%, respectively. Diagnosis was histologically proven in all cases (27 with synovial joint origin and 1 with tenosynovial origin). Subtotal synovectomy, total synovectomy, local excision of the lesion, synovectomy associated with arthroplasty and synovectomy associated with arthrodesis were performed in 53.6%, 21.4%, 10.7%, 7.1% and 3.6% of the cases, respectively. Local recurrence occurred in 25% of the patients, with a mean time of recurrence of 60.8 months after surgery. CONCLUSION: In PVNS patients, the non-specific symptoms often contribute to a delay in establishing a diagnosis. As in the majority of the reported studies, in this study the knee was also the most commonly affected articular site. Although the x-ray of the affected joint revealed abnormalities in just a few number of patients,MRI identified the presence of synovial membrane proliferation in all cases, proving its value in the diagnostic approach to this entity. However, only the histological study of the lesion allows establishing a definitive diagnosis

The digital scribe.

Current generation electronic health records suffer a number of problems that make them inefficient and associated with poor clinical satisfaction. Digital scribes or intelligent documentation support systems, take advantage of advances in speech recognition, natural language processing and artificial intelligence, to automate the clinical documentation task currently conducted by humans. Whilst in their infancy, digital scribes are likely to evolve through three broad stages. Human led systems task clinicians with creating documentation, but provide tools to make the task simpler and more effective, for example with dictation support, semantic checking and templates. Mixed-initiative systems are delegated part of the documentation task, converting the conversations in a clinical encounter into summaries suitable for the electronic record. Computer-led systems are delegated full control of documentation and only request human interaction when exceptions are encountered. Intelligent clinical environments permit such augmented clinical encounters to occur in a fully digitised space where the environment becomes the computer. Data from clinical instruments can be automatically transmitted, interpreted using AI and entered directly into the record. Digital scribes raise many issues for clinical practice, including new patient safety risks. Automation bias may see clinicians automatically accept scribe documents without checking. The electronic record also shifts from a human created summary of events to potentially a full audio, video and sensor record of the clinical encounter. Digital scribes promisingly offer a gateway into the clinical workflow for more advanced support for diagnostic, prognostic and therapeutic tasks

Multilocus sequence analysis reveals multiple symbiovars within Mesorhizobium species

The genus Mesorhizobium includes species nodulating several legumes, such as chickpea, which has a high agronomic importance. Chickpea rhizobia were originally described as either Mesorhizobium ciceri or M. mediterraneum. However, rhizobia able to nodulate chickpea have been shown to belong to several different species within the genus Mesorhizobium. The present study used a multilocus sequence analysis approach to infer a high resolution phylogeny of the genus Mesorhizobium and to confirm the existence of a new chickpea nodulating genospecies. The phylogenetic structure of the Mesorhizobium clade was evaluated by sequence analysis of the 16S rRNA gene, ITS region and the five core genes atpD, dnaJ, glnA, gyrB, and recA. Phylogenies obtained with the different genes are in overall good agreement and a well-supported, almost fully resolved, phylogenetic tree was obtained using the combined data. Our phylogenetic analyses of core genes sequences and their comparison with the symbiosis gene nodC, corroborate the existence of one new chickpea Mesorhizobium genospecies and one new symbiovar, M. opportunistum sv. ciceri. Furthermore, our results show that symbiovar ciceri spreads over six species of mesorhizobia. To our knowledge this study shows the most complete Mesorhizobium multilocus phylogeny to date and contributes to the understanding of how a symbiovar may be present in different species. (c) 2012 Elsevier GmbH. All rights reserved

Unusual Rhythm Behind a Narrow Complex Tachycardia

info:eu-repo/semantics/publishedVersio

Novel bio-strategies for the detoxification of mycotoxins using lactic acid bacteria

A ocorrência de bolores micotoxigénicos pertencentes aos géneros Aspergillus, Penicillium e Fusarium em alimentos para consumo Humano e animal, tem um impacto importante sobre a saúde pública e constitui também um importante problema económico. Isto é devido à síntese por este tipo de fungos filamentosos de metabolitos altamente tóxicos conhecidos como micotoxinas. A maioria das micotoxinas são substâncias cancerígenas, mutagénicas, neurotóxicas e imunossupressoras, sendo a ocratoxina A (OTA) uma das mais importantes. A OTA é uma micotoxina, tóxica para os animais e Humanos principalmente devido às suas propriedades nefrotóxicas. Alguns grupos de bactérias gram positivas nomeadamente as bactérias do ácido láctico (BAL) são capazes de controlar o crescimento de fungos, melhorando e aumentando a vida útil de muitos produtos fermentados e, assim, reduzir os riscos para a saúde provocados pela exposição às micotoxinas. Algumas BAL são, também, capazes de destoxificar certas micotoxinas. Em trabalhos anteriores do nosso grupo foi observada a biodegradação da OTA por estirpes de Pediococcus parvulus isoladas de vinhos do Douro. Assim, com este trabalho, pretendeu-se compreender com maior detalhe o processo de biodegradação da OTA pelas referidas estirpes e identificar quais as enzimas que estão associadas à sua biodegradação. Para atingir este objetivo utilizaram-se algumas ferramentas ioinformáticas (BLAST, CLUSTALX2, CLC Sequence Viewer 7, Finch TV), desenharam-se primers específicos e realizaram-se PCR específicos para os genes envolvidos. Através da utilização de ferramentas de bioinformática, foi possível identificar várias proteínas que pertencem à família das carboxipeptidases e que podem eventualmente participar no processo da degradação da OTA, tais como D-Ala-D-Ala carboxipeptidase serínica e carboxipeptidase membranar. Estas BAL podem desempenhar um papel importante na destoxificação da OTA, sendo as carboxipeptidases uma das enzimas envolvidas na sua biodegradação.The occurrence of mycotoxigenic moulds such as Aspergillus, Penicillium and Fusarium in food and feed has an important impact on public health and also constitutes a major economic problem. This is due through the synthesis of highly toxic metabolites known as mycotoxins by these kind of moulds. Most of the mycotoxins are carcinogenic, mutagenic, neurotoxic and immunosuppressive, being ochratoxin A (OTA) one of the most important. OTA is toxic to animals and Humans, mainly due to its nephrotoxic properties. Some group of Gram-positive bacteria named lactic acid bacteria (LAB) are able to control moulds ́ growth, improving the shelf life of many fermented products and reducing health risks due to exposure to mycotoxins. Some LAB are capable of mycotoxin detoxification. From previous work of our group was observed OTA biodegradation by Pediococcus parvulus isolated from Douro wines. So, we wanted to have a better understanding of this OTA degradation process and identify which molecules where present in this process. For achieving our aim we used some bioinformatics tools (BLAST, CLUSTALX2, CLC Sequence Viewer 7, Finch TV), we designed specific primers and we did gene specific PCR. Through the employment of bioinformatics tools it was possible to identify several proteins belonging to the carboxypeptidase family that participate in the process of OTA degradation, such as serine type D-Ala-D-Ala carboxypeptidase and membrane carboxypeptidase. LAB can play an important role in the mycotoxins detoxification, being carboxypeptidase proteins one of the molecules present in the OTA degradation process.Agradecimentos: Este trabalho foi financiado por fundos FEDER através do Programa Operacional Factores de Competitividade - COMPETE e por fundos nacionais através da Fundação para a Ciência e a Tecnologia -FCT, ref. FCOMP-01-0124-FEDER-028029 e PTDC/AGR-TEC/3900/2012, respetivamente. Luís Abrunhosa recebeu apoio através da bolsa Incentivo/EQB/LA0023/2014 do ON.2 O Novo Norte

The Atrium in Atrial Fibrillation - A Clinical Review on How to Manage Atrial Fibrotic Substrates

Atrial fibrillation (AF) is the most common sustained arrhythmia in the population and is associated with a significant clinical and economic burden. Rigorous assessment of the presence and degree of an atrial arrhythmic substrate is essential for determining treatment options, predicting long-term success after catheter ablation, and as a substrate critical in the pathophysiology of atrial thrombogenesis. Catheter ablation of AF has developed into an essential rhythm-control strategy. Nowadays is one of the most common cardiac ablation procedures performed worldwide, with its success inversely related to the extent of atrial structural disease. Although atrial substrate evaluation remains complex, several diagnostic resources allow for a more comprehensive assessment and quantification of the extent of left atrial structural remodeling and the presence of atrial fibrosis. In this review, we summarize the current knowledge on the pathophysiology, etiology, and electrophysiological aspects of atrial substrates promoting the development of AF. We also describe the risk factors for its development and how to diagnose its presence using imaging, electrocardiograms, and electroanatomic voltage mapping. Finally, we discuss recent data regarding fibrosis biomarkers that could help diagnose atrial fibrotic substrates.info:eu-repo/semantics/publishedVersio

Addition of vinegar to extend the shelf-life of "Cabeça de Xara"

Cabeça de xara es un producto de carne listos para comer, cuya producción es muy característica en el Alentejo, una región de Portugal. Es una galantina que generalmente se moldea en forma de paralelepípedo. Se elabora con varias carnes obtenidas de la raza porcina Alentejana y criada en la misma región, cabezas de cerdo deshuesadas, lengua y tejido conectivo, a la que se le añade una serie de condimentos como sal, perejil, vino y pimienta. Este trabajo se pretende poner a prueba la viabilidad de añadir vinagre con el fin de aumentar la vida útil de la cabeça de xara, mediante la reducción de la microbiota contaminante responsables del deterioro, así como el control del patógeno Listeria monocytogenes. Tres lotes independientes fueron producidos y con composición proximal parecida, se evaluó pH, aw, parámetros microbiológicos y contenido de aminas biogénicas. El análisis sensorial se realizó también durante todo el período de almacenamiento. No se encontraron diferencias significativas entre las muestras control y vinagre en cuanto a la composición proximal de cabeça de xara. Como era de esperar, el pH fue menor en las muestras con vinagre, sin embargo se observaron diferencias en aw entre los dos tratamientos. L. monocytogenes estuvo presente desde el primer mes sólo en un lote, en el tratamiento control. Sin embargo, es inhibida por la adición de vinagre de vino hasta el tercer mes de almacenamiento, donde L. monocytogenes está presente pero por debajo del límite establecido en el Reglamento 2073/2005. La presencia de vinagre redujo significativamente el contenido de aminas biógenicas, en particular cadaverina, putrescina y tiramina, durante todo el período de almacenamiento. En cuanto a la evaluación sensorial, el sabor a vinagre fue evaluado por los panelistas de manera negativa

ADDITION OF VINEGAR TO EXTEND THE SHELF-LIFE OF CABEÇA DE XARA

Cabeça de xara is a ready-to-eat meat product, whose production is very characteristic in Alentejo, a particular region of Portugal. It is a galantine usually moulded into parallelepiped shape made with various meats obtained from the Alentejano pig breed reared in the same region, namely deboned pork heads, tongue and connective tissue to which a number of condiments like salt, parsley, wine and pepper, are added. This work intended to test the feasibility of adding vinegar in order to increase the shelf-life of cabeça de xara, by reducing the contaminating microbiota responsible for spoilage, as well as controlling the pathogen Listeria monocytogenes. Three independent batches were produced and proximate composition, pH, aw, microbiological parameters and biogenic amines content evaluated. A sensory analysis was also performed throughout the storage period. No significant differences between control and vinegar samples was found regarding the proximate composition of cabeça de xara. As expected, pH is lower in the vinegar samples, however no differences in aw were observed between the two treatments. L. monocytogenes was present from the first month on only in one batch in the control treatment. However, it is inhibited by the addition of vinegar until the third month of storage, where L. monocytogenes is present but below the limit established in the 2073/2005 regulation. The presence of vinegar significantly decreased the content in biogenic amines, particularly cadaverine, putrescine and tyramine, throughout the storage period. Concerning sensory evaluation, no vinegar taste was reported by the panellists in a depreciating way

Chickpea rhizobia symbiosis genes are highly conserved across multiple Mesorhizobium species

ABSTRACT Chickpea has been considered as a restrictive host for nodulation by rhizobia. However, recent studies have reported that several Mesorhizobium species may effectively nodulate chickpea. With the purpose of investigating the evolutionary relationships between these different species with the ability of nodulating the same host, we analysed 21 Portuguese chickpea rhizobial isolates. Symbiosis genes nifH and nodC were sequenced and used for phylogenetic studies. Symbiotic effectiveness was determined to evaluate its relationship with symbiosis genes. The comparison of 16S rRNA gene-based phylogeny with the phylogenies based on symbiosis genes revealed evidence of lateral transfer of symbiosis genes across different species. Chickpea is confirmed as a nonpromiscuous host. Although chickpea is nodulated by many different species, they share common symbiosis genes, suggesting recognition of only a few Nod factors by chickpea. Our results suggest that sequencing of nifH or nodC genes can be used for rapid detection of chickpea mesorhizobia