Primary Central Nervous System Lymphoma Mimicking the Presentation of Pituitary Apoplexy: A Case Report

Pituitary lymphoma is one of the rare variants of primary central nervous system lymphoma (PCNSL), mostly arising due to the metastatic spread of systemic lymphoma. We report the case of a 69-year-old woman who initially presented to her family physician with a headache but without any other symptoms. The MRI scan revealed a sellar mass consistent with a pituitary macroadenoma. When the patient was referred to our hospital, two weeks later, the symptoms had progressed, comprising complete right-sided ophthalmoplegia and ptosis, with left-sided amaurosis. A repeat MRI revealed an increased size of the sellar mass, consistent with pituitary apoplexy. A right pterional craniotomy with partial resection of the mass was performed and an intraoperative frozen section biopsy was carried out. The final pathology revealed diffuse large B-cell lymphoma. A systemic follow-up including a whole-body CT, bone marrow aspiration, and cerebrospinal fluid studies ruled out any systemic manifestation, and the patient was HIV-negative. The patient underwent treatment with methotrexate, cytarabine, thiotepa, and rituximab for PCNSL. Although rare, PCNSL can mimic pituitary apoplexy, which needs to be considered if conservative therapy or surgery is to be offered to a patient with a radiological and clinical diagnosis of pituitary apoplexy.info:eu-repo/semantics/publishedVersio

Vacuum-assisted closure therapy after resection of giant basal cell carcinoma of the scalp

Management of complicated wounds is a challenge in head and neck reconstruction. Although the negative pressure wound therapy or wound vacuum-assisted closure has been widely used in complicated wounds and shows promising results, its application in the head and neck region after reconstruction for the head and neck cancer is rarely presented. A 77-year-old woman underwent a radical resection of an extensive basal cell carcinoma of the scalp and forehead involving the periosteum, where classic reconstruction was difficult, but successfully treated with negative pressure wound therapy. Negative pressure wound therapy is an efficacious tool in cases of complex and extensive defects, when we expect immediate reconstruction with poor results, as would be probable with this scalp lesion.info:eu-repo/semantics/publishedVersio

Type B adverse drug reactions reported by an immunoallergology department

Objective: Characterization of the adverse drug reactions (ADR) reported by the immunoallergology department (IAD), Centro Hospitalar de São João (Porto), to the Northern Pharmacovigilance Centre (NPC). Methods: An observational, descriptive and retrospective study was conducted, based in a spontaneous report system. Participants were all the patients from the IAD, with suspected ADR, reported to NPC by specialists after the study was completed. Results: Studied population had a median age of 41 years, with the predominance of the female gender (73.2%). Allergic rhinitis and asthma were the most frequent comorbidities. All studied ADR were type B, 89.6% were serious, 86.4% unexpected and 2.6% associated with drugs that presented less than 2 years in the market. The most represented drug classes were the non-steroidal anti-inflammatory drugs (NSAIDs) (52.6%) and antibiotics (25.2%). Skin symptoms represented 61.2% of the reported complaints. About 52.9% of these ADR occurred in less than one hour after intake. The most frequent ADR treatment at the time of the reaction was drug interruption (86.2%), followed by the prescription of anti-histamines (42.2%). Conclusions: Reported ADR to NPC by the Drug Alert Unit were mainly serious, unexpected, associated with NSAIDs and antibiotics and related with marketing authorization medicines older than two years. These results could be very useful to develop strategies to prevent the clinical and economic consequences of ADR.publishe

Prevalência da Microalbuminúria em Doentes Hipertensos e/ou Diabéticos Tipo 2 nos Cuidados de Saúde Primários em Portugal: Estudo RACE (micRoAlbumin sCreening survEy)

Introdução e objetivos: Determinar a prevalência de microalbuminúria (MAU) em doentes hipertensos (HTA) e/ou diabéticos tipo 2 (DM2) e em normotensos não diabéticos (grupo controlo). Como objetivos secundários, analisar as diferenças de distribuição da MAU nas quatro subpopulações e observar a associação de variáveis clínicas e epidemiológicas diversas com a MAU. Métodos: O RACE (micRoAlbuminsCreeningsurvEy) é um estudo epidemiológico descritivo, observacional de corte transversal, multicêntrico, que incluiu doentes acompanhados nos Cuidados de Saúde Primários (CSP) em Portugal. Os doentes com causas potenciais de falsos positivos para MAU foram excluídos. As avaliações principais foram a frequência da MAU, determinada pelo teste da tira reativa Micral-Test®, a pressão arterial (PA), as variáveis demográficas, as doenças concomitantes, a medicação cardiovascular e antidiabética e as variáveis bioquímicas. Resultados: Um total de 9198 participantes (3769 hipertensos, 3100 diabéticos tipo 2 hipertensos, 423 diabéticos normotensos e 1906 controlos), 54,7% do sexo feminino, foram incluídos na análise primária. A prevalência de MAU foi de 58% nos doentes com HTA + DM2, 51% nos doentes com DM2, 43% nos doentes com HTA e de 12% no grupo controlo ( 2: p < 0,001 para todos os subgrupos). Numa análise multivariada, os preditores de MAU foram presenc¸a de DM2 ou de HTA, a HbA1c, o sexo masculino, a idade, a PA sistólica e o colesterol total. Conclusões: A MAU é extremamente frequente nos doentes em CSP com diabetes e/ou hipertensão, particularmente em doentes com HTA e DM2 com risco cardiovascular elevado. O rastreio da MAU poderá facilitar a identificação de indivíduos em risco e aumenta a atenção para a doença renal e as lesões nos órgãos alvo.info:eu-repo/semantics/publishedVersio

Decolourisation of Remazol Brilliant Blue R via a novel Bjerkandera sp. strain

A novel strain of Bjerkandera sp. (B33/3), with particularly high decolourisation activities upon Poly R-478 and Remazol Brilliant Blue R (RBBR) dyes, was isolated. The role of the ligninolytic extracellular enzymes produced by this strain on decolourisation of RBBR was studied in some depth. The basis of decolourisation is an enzyme-mediated process, in which the main enzyme responsible is a recently described peroxidase with capacity for oxidation of manganese, as well as veratryl alcohol and 2,6-dimethoxyphenol in a manganese-independent reaction

Digital pathology workflow implementation at ipatimup

The advantages of the digital methodology are well known. In this paper, we provide a detailed description of the process for the digital transformation of the pathology laboratory at IPATIMUP, the major modifications that operate throughout the processing pipeline, and the advantages of its implementation. The model of digital workflow implementation at IPATIMUP demonstrates that careful planning and adoption of simple measures related to time, space, and sample management can be adopted by any pathology laboratory to achieve higher quality and easy digital transformation

Genetic and environment interactions contribute to longevity : a case-control study with centenarians

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.Objective: Environmental or genetic factors, together with the interaction between them, may explain the increasing population of centenarians. This research aimed to understand these interactions that underlie centenarian’s phenotypes, namely gene-gene and gene-environment, particularly in relation to cardiovascular risk (CVR).info:eu-repo/semantics/publishedVersio

SRC inhibition prevents P-cadherin mediated signaling and function in basal-like breast cancer cells

BACKGROUND: Basal-like breast cancer (BLBC) is a poor prognosis subgroup of triple-negative carcinomas that still lack specific target therapies and accurate biomarkers for treatment selection. P-cadherin is frequently overexpressed in these tumors, promoting cell invasion, stem cell activity and tumorigenesis by the activation of Src-Family kinase (SRC) signaling. Therefore, our aim was to evaluate if the treatment of BLBC cells with dasatinib, the FDA approved SRC inhibitor, would impact on P-cadherin induced tumor aggressive behavior. METHODS: P-cadherin and SRC expression was evaluated in a series of invasive Breast Cancer and contingency tables and chi-square tests were performed. Cell-cell adhesion measurements were performed by Atomic Force Microscopy, where frequency histograms and Gaussian curves were applied. 2D and 3D cell migration and invasion, proteases secretion and self-renew potential were evaluated in vitro. Student's t-tests were used to determine statistically significant differences. The cadherin/catenin complex interactions were evaluated by in situ proximity-ligation assay, and statistically significant results were determined by using Mann-Whitney test with a Bonferroni correction. In vivo xenograft mouse models were used to evaluate the impact of dasatinib on tumor growth and survival. ANOVA test was used to evaluate the differences in tumor size, considering a confidence interval of 95%. Survival curves were estimated by the Kaplan-Meier's method, using the log-rank test to assess significant differences for mice overall survival. RESULTS: Our data demonstrated that P-cadherin overexpression is significantly associated with SRC activation in breast cancer cells, which was also validated in a large series of primary tumor samples. SRC activity suppression with dasatinib significantly prevented the in vitro functional effects of P-cadherin overexpressing cells, as well as their in vivo tumorigenic and metastatic ability, by increasing mice overall survival. Mechanistically, SRC inhibition affects P-cadherin downstream signaling, rescues the E-cadherin/p120-catenin complex to the cell membrane, recovering cell-cell adhesion function. CONCLUSIONS: In conclusion our findings show that targeting P-cadherin/SRC signaling and functional activity may open novel therapeutic opportunities for highly aggressive and poor prognostic basal-like breast cancer.This work was funded by Laço Grant 2014, by FEDER - Fundo Europeu de Desenvolvimento Regional funds through the COMPETE 2020 - Operacional Programme for Competitiveness and Internationalisation (POCI), Portugal 2020, and by FCT - Fundação para a Ciência e a Tecnologia/ Ministério da Ciência, Tecnologia e Ensino Superior under the projects PTDC/SAU-GMG/120049/ 2010-FCOMP-01-0124-FEDER-021209, PEst-C/SAU/LA0003/2013, NORTE-01- 0145-FEDER-000029 and POCI-01-0145-FEDER-016390. FCT funded the research grants of ASR (SFRH/BPD/75705/2011), ARN (SFRH/BD/100380/2014), BS (SFRH/ BPD/104208/2014), AFV (SFRH/BPD/90303/2012), as well as JP with Programa IFCT 2013 (FCT Investigator). IPATIMUP integrates the i3S Research Unit, which is partially supported by FCT in the framework of the project “Institute for Research and Innovation in Health Sciences” (POCI-01-0145-FEDER-007274)

Bacterioplankton Community Shifts during a Spring Bloom of Aphanizomenon gracile and Sphaerospermopsis aphanizomenoides at a Temperate Shallow Lake

Climate change is enhancing the frequency of cyanobacterial blooms not only during summer but also in spring and autumn, leading to increased ecological impacts. The bacterioplankton community composition (BCC), in particular, is deeply affected by these blooms, although at the same time BCC can also play important roles in blooms’ dynamics. However, more information is still needed regarding BCC during species-specific cyanobacterial blooms. The goal of this study was to assess BCC succession in a hypereutrophic shallow lake (Vela Lake, Portugal) during a warm spring using a metagenomic approach to provide a glimpse of the changes these communities experience during the dominance of Aphanizomenon-like bloom-forming species. BCC shifts were studied using 16S rRNA gene metabarcoding and multivariate analyses. A total of 875 operational taxonomic units (OTUs) were retrieved from samples. In early spring, the dominant taxa belonged to Proteobacteria (mainly Alphaproteobacteria—Rickettsiales) and Bacteroidetes (Saprospirales, Flavobacteriales and Sphingobacteriales). However, at the end of May, a bloom co-dominated by cyanobacterial populations of Aphanizomenon gracile, Sphaerospermopsis aphanizomenoides and Synechococcus sp. developed and persisted until the end of spring. This led to a major BCC shift favouring the prevalence of Alphaproteobacteria (Rickettsiales and also Rhizobiales, Caulobacteriales and Rhodospirillales) and Bacteroidetes (Saprospirales, followed by Flavobacteriales and Sphingobacteriales). These results contribute to the knowledge of BCC dynamics during species-specific cyanobacterial blooms, showing that BCC is strongly affected (directly or indirectly) by Aphanizomenon-Sphaerospermopsis blooms.publishe

Empagliflozin and the New Age in the Treatment of Type 2 Diabetes: Beyond Glycemic Control

A diabetes mellitus tipo 2 (DMT2) tem associado um risco aumentado de mortalidade, principalmente, por doença cardiovascular (DCV). Interessa ter disponíveis opções terapêuticas que permitam o controlo glicémico mas que considerem, igualmente, a atuação sobre fatores de risco cardiovascular e a redução de eventos micro e macrovasculares. Nos últimos anos foram desenvolvidos vários inibidores do transporte renal de glicose via cotransporte de sódio/glicose (iSGLT), nomeadamente a empagliflozina, para promover a excreção urinária de glicose filtrada pelo rim. A empagliflozina é um inibidor competitivo, reversível, altamente potente e seletivo dos SGLT2, indicada no tratamento da hiperglicemia da DMT2. O EMPA-REG OUTCOME®, um ensaio clínico de resultados cardiovasculares aleatorizado, em dupla ocultação, controlado com placebo, que incluiu 7020 indivíduos com DMT2 e DCV estabelecida, avaliou o efeito da empagliflozina versus placebo, associado ao tratamento standard, na ocorrência de um compósito de 3 pontos MACE (Major Adverse Cardiovascular Events) - morte por causa cardiovascular, acidente vascular cerebral não fatal ou enfarte agudo de miocárdio não fatal. Com os resultados do EMPA-REG OUTCOME®, a empagliflozina foi o primeiro iSGLT2 a demonstrar uma redução de morbilidade cardiovascular em indivíduos com DMT2 com elevado risco cardiovascular, adicionando a proteção cardiovascular ao efeito anti-hiperglicémico do fármaco e abrindo uma nova era no tratamento e gestão da DMT2.Type 2 diabetes mellitus (T2DM) has an increased risk of mortality, mainly due to cardiovascular disease (CVD). There should be available therapeutic options that allow glycemic control but also consider the action on cardiovascular risk factors and the reduction of micro and macrovascular events. Several inhibitors of renal glucose transport via sodium/glucose cotransport (iSGLT), namely empagliflozin, have been developed in recent years, to promote kidney urinary excretion of glucose. Empagliflozin is a highly potent and selective, competitive, reversible inhibitor of SGLT2, indicated for hyperglycemia treatment in T2DM. EMPA-REG OUTCOME®, a randomized, double-blind, placebo-controlled clinical trial of 7020 subjects with established T2DM and CVD, evaluated the effect of empagliflozin versus placebo, associated with standard treatment, on the occurrence of a 3-point composite MACE (Major Adverse Cardiovascular Events) - cardiovascular death, nonfatal stroke or nonfatal myocardial infarction. With the results of EMPA-REG OUTCOME®, empagliflozin was the first iSGLT2 to demonstrate a reduction in cardiovascular morbidity in subjects with T2DM at high cardiovascular risk, adding cardiovascular protection to the antihyperglycaemic effect of the drug and, opening a new era in the management of T2DM.info:eu-repo/semantics/publishedVersio