Persistence of Left Superior Vena Cava Associated to Esophageal Atresia: Presentation of 5 Cases

Objectivos: A atresia do esófago está associada a uma variedade de malformações congénitas de outros órgãos. A persistência da veia cava superior esquerda e uma das malformações venosas torácicas mais comuns, ocorrendo em 0,3% da população. O objectivo deste estudo é caracterizar a persistência da veia cava superior esquerda nos doentes com atresia do esófago tratados no Hospital Dona Estefânia. Métodos: Estudo retrospectivo dos doentes admitidos por atresia do esófago desde Janeiro 2002 a Dezembro 2013. As seguintes variáveis foram estudadas, considerando, idade gestacional, o peso à nascença, o sexo, tipo de atresia do esófago, ecocardiograma no pré-operatório, malformações associadas, abordagem cirúrgica, eventual ecocardiograma no pós-operatório e angioressonância. Resultados: De um total de 107 doentes, em cinco casos foi diagnosticada persistência da veia cava superior esquerda. Destes, apenas um tinha diagnostico pré-natal. A restante investigação revelou um doente com atresia duodenal e outro com malformação do aparelho urinário, coloboma e malformação bilateral dos pavilhões auriculares. Todos os cinco doentes foram submetidos a toracotomia, esofagoesofagostomia primária após laqueação da fístula traqueo-esofágica e angio-ressonância para caracterizar a malformação vascular. Não houve registo de complicações, quer intra-operatórias quer pós-operatórias. Conclusão: Apesar do estudo pré-operatório, apenas se diagnosticou persistência da veia cava superior esquerda num dos doentes. O diagnóstico é geralmente feito de forma incidental durante a colocação rotineira de catéteres venosos centrais à esquerda. É importante identificar estes doentes e caracterizar o seu padrão de retorno venoso cardíaco, pelo risco de complicações embó1icas paradoxais para o sistema arterial

Seroconversion Rate Following HBV Vaccination in Clinical Practice: The Role of Age and DMT Treatment

HBV screening and immunization is recommended in all MS patients and is mandatory before the start of some DMT. However, studies evaluating the immune response to HBV vaccine in MS patients are scarce. We aimed to evaluate the seroprotection rate following HBV immunization in MS patients and to assess if older age and DMT-treatment influenced seroprotection. We conducted a cohort study between 2016 and 2020 and compared the immune response to HBV vaccine in MS patients under different DMTs and in patients 50 years old or younger and older than 50. We found that patients under non-injectable DMT presented lower rates of seroprotection comparing to patients under injectable DMT's or without treatment. In patients older than 50, although the seroprotection rate was similar to the remaining patients, the antibody anti-HBV surface antigen titers following HBV immunization were lower and patients were more likely to require a 4th dose of the vaccine to achieve seroprotection. Our findings highlight to need to consider HBV immunization in MS patients early in the disease course, in order to ensure a proper immune response to the vaccine.info:eu-repo/semantics/publishedVersio

Multiple Sclerosis Patient Management During the COVID-19 Pandemic: Practical Recommendations From the Portuguese Multiple Sclerosis Study Group (GEEM)

The spread of the COVID-19 pandemic has imposed significant challenges on healthcare provision, requiring changes in the conventional patient management, particularly in chronic diseases like multiple sclerosis (MS). To increase patient safety and reduce the risk of infection, while ensuring an appropriate and regular follow-up, tele-medicine gained prominence as a valid alternative to face-to-face appointments. However, the urgency of the implementation and the lack of experience in most MS centers led to "ad hoc" and extremely diverse approaches, which now merit to be standardized and refined. Indeed, while tele-consultation cannot fully replace face-to-face visits, it certainly can, and will, be incorporated as part of the routine care of MS patients in the near future. Bearing this in mind, the Portuguese Multiple Sclerosis Study Group (GEEM) has developed a set of recommendations for the usage of tele-medicine in the management of MS patients, both during the pandemic and in the future. The consensus was obtained through a two-step modified Delphi methodology, resulting in 15 recommendations, which are detailed in the manuscript.info:eu-repo/semantics/publishedVersio

Grass and Olea Airborne Pollen Allergens in Outdoor Air Samples and its Correlation with Pollen Counts

RATIONALE: In Portugal, grass and Olea europaea pollen are certainly one of the main sources of athmospheric aeroallergens and as such, one of the main causes of respiratory allergy. For these reasons, it is useful the development of new strategies for prevention and treatment of these pathologies. The aim of this study was to evaluate the putative correlation between the concentration of some of the major allergens of and with their pollen counts. METHODS: On a meteorological platform at the town center of Evora (south Portugal), ambient air was sampled at 800L/min with a Chemvol high-volume cascade impactor equipped with stages PM>10μm, 10 μm>PM>2.5μm. The polyurethane impacting substrate was extracted with 0.1M NH4HCO3, pH8.1, supplemented with 0.1% BSA. The major pollen allergens from grass Phleum p 5 and olive Ole e 1 were determined with allergen specific ELISA's. Airborne pollen of and Olea europaea simultaneously monitored with a Burkard Seven Day Recording Volumetric Spore TrapÒ, between the 30th of April and the 8th of July of 2009. Both samplers were placed side-by-side with air input at the same level. RESULTS: During the pollen season of 2009, high values of grass pollen were recorded between May 2th and June 1 th. It was also observed that the air content of Phl p5 or Ole e1 aeroallergens were directly correlated with airborne pollen counts of Poaceae and Oleaceae, respectively. CONCLUSIONS: Results suggest that the directly quantification of aeroallergens may contribute, together with pollen counts of air samples, to define the allergic risk with higher precision

Sugarcane bagasse delignification with potassium hydroxide for enhanced enzymatic hydrolysis

The optimization of an alkaline pretreatment process for the delignification of sugarcane bagasse (SCB) to enhance the subsequent enzymatic hydrolysis was performed according to the Doehlert uniform shell design. In this experimental design, the effect of two factors—potassium hydroxide (KOH) concentration and autoclaving time at 121 C (1 atm)—on cellulose, hemicellulose, or the total polysaccharide and lignin content in SCB was evaluated. This response surface methodology revealed that KOH concentration is the factor that most influences the chemical characteristics of treated SCB (SCBt), with optimal conditions for the highest delignification being KOH in the range 5–10% (w/v) and an autoclaving time of 35 min, which provides an average of 97% total polysaccharides without inhibitor accumulation (furfural, 5-hydroxymethyl furfural) and #5% lignin. SCBt samples from two pretreatment conditions (KOH 3.25% – 13 min; KOH 10% – 35 min) were selected, based on the greatest delignification (70–74%) and polysaccharide availability (95–97%) after pretreatment, and further hydrolysed for fermentable sugar production. High sugar yields were obtained from both the pretreated samples (866 to 880 mg sugar per g biomass, respectively) in contrast with the 129 mg sugar per g raw biomass obtained from untreated SCB. These results demonstrate the effectiveness of KOH alkali pretreatments, which improves the overall digestibility of raw SCB polysaccharides from about 18% up to 91%. However, harsh alkali treatment (KOH 10%) is the most effective if the highest glucose/xylose ratio in the final sugar-rich hydrolysate is the aim. Hence, the use of sugar-rich hydrolysates obtained from SCBt as the carbon source for industrial purposes may provide a sustainable and economic solution for the production of bio-based added-value products, such as second generation (2G) bioethanol