Púrpura Fulminante numa Jovem de 20 Anos

A previously healthy 20-year-old female presented with extensive retiform purpura located at the face, upper and lower limbs, one week after an episode of acute tonsillitis. Despite the exuberance of the cutaneous findings and progression to skin necrosis she had no accompanying symptoms. Laboratory investigation revealed a heterozygous protein C mutation (exon 9, c.1332G> C, p.Trp444Cys), accounting for a partial deficiency of this anticoagulant protein. The patient was started on broad spectrum antibiotics, anticoagulation and systemic corticosteroids, with no lesional progression and complete resolution of cutaneous ulceration within 6 months. This is a singular case of purpura fulminans, since two different causative factors precipitated the events. The previous tonsillitis reported by the patient is significant, because the serum concentration of protein S may also decrease after an infectious event - post-infectious purpura fulminans. This case illustrates that purpura fulminans due to autoantibodies against protein S, although rare, should be considered, especially in the absence of a severe acute infection. It also illustrates how in a given patient different independent factors can act simultaneously, triggering potentially devastating clinical scenarios.Apresentamos o caso de uma jovem do sexo feminino, de 20 anos de idade, previamente saudável, que se apresentou com lesões muito extensas de púrpura retiforme localizadas na face, membros superiores e inferiores, uma semana após um episódio de amigdalite aguda. Apesar das lesões cutâneas exuberantes que evoluiram para necrose cutânea, a doente não apresentava qualquer sintomatologia associada. A investigação laboratorial revelou uma mutação em heterozigotia da proteína C (exon 9, c.1332G> C, p.Trp444Cys), condicionando um deficit parcial desta proteína anticoagulante. Iniciou antibioticoterapia de largo espectro, anticoagulação e corticoterapia sistémica, sem progressão das lesões no imediato, e resolução completa das ulcerações em 6 meses. Este é um caso singular de púrpura fulminante, visto que que dois fatores etiológicos diferentes precipitaram os eventos. A amigdalite prévia rela- tada pela doente é significativa, pois a concentração sérica da proteína S também pode diminuir após um evento infeccioso - purpura fulminans pós-infecciosa. Este caso ilustra que a púrpura fulminante decorrente de auto-anticorpos contra a proteína S, embora rara, deve ser considerada, principalmente na ausência de infecção aguda grave. Também evidencia como, em um determinado doente, diferentes fatores independentes podem atuar simultaneamente, desencadeando cenários clínicos potencialmente devastadores

Pityriasis Lichenoides et Varioliformis Acuta: Case Report and Review of the Literature

We report a case of a 63-year-old man hospitalized for a polymorphous generalized eruption consisting of maculopapules with peripheral scaling, vesicopustules, and ulceronecrotic and crusted lesions measuring 5–20 mm, localized on his trunk and extremities, particularly exuberant in the flexural area. Histopathology showed necrotic keratinocytes with exocytosis of red blood cells and lymphocytes and a dermal perivascular and periadnexal inflammatory infiltrate, composed of CD8+/CD4–/CD30– T cells, indicating the clinical diagnosis of pityriasis lichenoides et varioliformis acuta. He was treated with erythromycin and methylprednisolone reduced gradually over 5 months, with a slow but complete response; the patient was without lesions after 2 years of follow-up. The authors want to remind of this rare entity which may present difficulties in diagnosis and therapy

Patterns of European youngsters’ daily use of media

The mediatisation of young people daily lives constitutes a significant subject due to the expressive use of media in their daily routines. In this article, we resort to a representative sample of 3609 online respondents aged between 14 and 30 years old from nine European countries (Belgium, Croatia, Denmark, Germany, Hungary, Israel, Italy, Poland and Portugal), in order to perceive the impact new (and “old”) media have in these youngsters daily media consumption activities. The results of this online survey show complementary uses between networked and traditional media, but also highlight a gradual substitution of “old” by “new” networked individualized media when leisure and news-related activities are at stake.info:eu-repo/semantics/publishedVersio

Uma Revisão de Dermohipodermite Aguda Bacteriana: A Diabetes Mellitus Não Influencia a sua Frequência ou Prognóstico

Introduction: Acute bacterial dermo-hypodermatitis (DHAB) is an acute infection of the dermis and hypodermis that most often affects the lower limbs. Although diabetes mellitus has been identified as a risk factor for its development, recent studies have questioned this relationship. The aim of the present study was to compare clinical characteristics of inpatients with DHAB associated or not with diabetes mellitus. Material & Methods: Prospective study of patients hospitalized at the Dermatology Department of the Coimbra Hospital and University Center with the diagnosis of DHAB between January and June 2018. The following parameters were evaluated: 1) demographic / biometric data - gender, age; body mass index; 2) clinical and evolutionary aspects - location of infection, interval between initial symptoms and diagnosis, history of a previous episode; previous diagnosis of diabetes mellitus; 3) laboratory abnormalities - leukocytosis, C-reactive protein (CRP), microorganism screening (blood, abscess pus, wound exudate, blister content); 3) therapy - duration of antibiotic therapy, need for second line therapy, length of hospitalization; 4) local (abscess, necrosis) or systemic complications (bacteremia, drug rash, deterioration of underlying disease and death). Data were analyzed with the SPSS software, mainly looking for the influence of diabetes mellitus on the different parameters evaluated. Statistical significance was set at p <0.05. Results: We included 102 patients, 55 female (53.9%) and 47 male (46.1%), with a mean age of 68.6 ± 13.9 years. The lower limb was the most affected site (73.5%), followed by the upper limb (20.6%) and face (5.9%). In average there were 3.1 ± 2.5 days between initial symptoms and hospitalization. Twenty-four patients had a diagnosis of diabetes mellitus (23.5%), six under insulin treatment (25%). No statistically significant difference was found between the diabetic and non-diabetic group for gender, age, infection location, time from initial symptoms to hospitalization, neither in circulating leukocyte or CRP values. Microorganism screening (blood, abscess pus, wound exudate, blister content) was positive in 2/8 diabetics (25%) and 15/39 non-diabetics (38.5%) (p=0.138), with the same type of microorganism isolated in both groups. Initial antibiotic therapy - cefoxitin plus clindamycin in 64.7% - was replaced in one non-diabetic and 10 diabetic patients (p=0.451) and the total duration of antibiotic treatment and hospitalization between groups was similar. Local complications occurred in 3 diabetics (12.5%) and 15 non-diabetics (19.2%), and systemic complications in 4 diabetics (16.7%) and 12 non-diabetics (15.4%), p=0.553 and p=1.000, respectively. Conclusion: The present study shows that diabetes mellitus in hospitalized patients diagnosed with DHAB is not associated with a worse prognosis, namely in which concerns need for second line antibiotic therapy, longer hospitalization or local/systemic complications.Introdução: A dermo-hipodermite aguda bacteriana (DHAB) é uma infeção aguda da derme e hipoderme que mais frequentemente atinge os membros inferiores. Apesar de a diabetes mellitus (DM) ser frequentemente apontada como um fator de risco para o seu desenvolvimento, estudos recentes têm questionado tal relação. O objetivo do presente estudo foi comparar as características da DHAB em doentes com e sem diabetes mellitus. Material e Métodos: Estudo prospetivo dos doentes hospitalizados no Serviço de Dermatologia do Centro Hospitalar e Universitário de Coimbra com o diagnóstico de DHAB entre Janeiro e Junho de 2018. Foram avaliados os seguintes parâmetros: 1) dados demográficos / biométricos – género, idade; índice de massa corporal (IMC); 2) aspetos clínico-evolutivos – localização, tempo de evolução dos sintomas até ao diagnóstico, história de episódio prévio de DHBA; diagnóstico prévio de DM; 3) alterações laboratoriais – leucocitose, proteína-C reativa (PCR), pesquisa de microrganismo (sangue, pus de abcesso, exsudato de ferida, conteúdo de bolha); 3) terapêutica – duração da antibioterapia, necessidade de terapêutica de segunda linha, duração do internamento; 4) complicações locais (abcesso, necrose) ou sistémicas (bacteriémia, exantema medicamentoso, descompensação de doença subjacente e morte). Os dados foram analisados com o software SPSS, procurando sobretudo a influência da DM nos distintos parâmetros avaliados. A significância estatística foi definida para p< 0,05. Resultados: Foram incluídos 102 doentes, 55 do género feminino (53,9%) e 47 do masculino (46,1%), com idade média de 68,6 ± 13,9 anos. O membro inferior foi o local mais atingido (73,5%), seguido do membro superior (20,6%) e face (5,9%), tendo a DHBA uma média de 3,1 ± 2,5 dias de evolução dos sintomas à data da hospitalização. Vinte e quatro doentes tinham o diagnóstico de DM (23,5%), seis dos quais insulinotratados (25%). Não foi encontrada diferença estatisticamente significativa entre o grupo de diabéticos e não diabéticos para o género, idade, localização da infeção, tempo de evolução dos sintomas até à hospitalização, nem no valor dos leucócitos circulantes ou da PCR. A pesquisa de microrganismo (sangue, pus de abcesso, exsudato de ferida, conteúdo de bolha) foi positiva em 2/8 diabéticos (25%) e em 15/39 não diabéticos (38,5%) (p=0,138), tendo sido o mesmo o tipo de microrganismo isolado. A antibioterapia inicial – cefoxitina em associação a clindamicina em 64,7% - foi substituída num doente não diabético e em 10 doentes diabéticos (p=0,451) e a duração total do tratamento antibiótico e do internamento entre os grupos foi semelhante. Complicações locais ocorreram em 3 diabéticos (12,5%) e em 15 não diabéticos (19,2%), e complicações sistémicas em 4 diabéticos (16,7%) e em 12 não diabéticos (15,4%), p=0,553 e p=1,000, respetivamente. Conclusão: O presente estudo demonstra que a DM em doentes hospitalizados com diagnóstico de DHAB não se associa a prior prognóstico nomeadamente necessidade de antibioterapia de segunda linha, internamento mais prolongados ou complicações locais ou sistémicas

PIODERMA GANGRENOSO PUSTULOSO E DOENÇA INFLAMATÓRIA INTESTINAL – RESOLUÇÃO APÓS PROCTOCOLECTOMIA

We present the case of a 67-year-old patient observed with multiple painful violaceous plaques with central pustules on distal lower limbs, rapidly transforming into deep ulcers with infiltrated undermined borders and centrifuge progression, associated with mucous bloody diarrhea, oral erosions and hyperthermia in the previous three months. Histopathologic skin examination was consistent with the diagnosis of pyoderma gangrenosum (PG). Subtotal colonoscopy showed a severe continuous rectocolitis, consistent with unspecific inflammatory bowel disease (IBD). Due to colonic perforation, the patient was submitted to left colectomy, and afterwards to total proctocolectomy. Treatment with topical corticosteroids was performed and complete ulcer healing was observed three months after surgery, without recurrence in the following 2 years. Pustular PG is a rare condition; the relevance of this case is supported not only by the synergic evolution of severe pustular PG and IBD, but also by the prompt regression of the former after proctoco- lectomy.KEYWORDS – Pyoderma Gangrenosum; Inflammatory Bowel Diseases; Proctocolectomy.Relata-se o caso de doente de 67 anos de idade observada com placas eritematovioláceas dolorosas centradas por pústulas nas extremidades dos membros inferiores, com evolução de 1 mês, progredindo para lesões ulceradas de crescimento centrífugo, com bordos infiltrados e descolados, com análise histológica compatível com pioderma gangrenoso. Associava diarreia mucopiossanguinolenta, erosões orais e febre, com 3 meses de evolu- ção. A colonoscopia subtotal foi sugestiva de doença inflamatória intestinal com envolvimento contínuo da mucosa visualizada. Ao 10o dia de internamento foi submetida a colectomia esquerda na sequência de perfuração cólica, e posteriormente a proctocolectomia total por complicação pós-operatória. Observou-se cicatrização rápida das lesões nos 3 meses seguintes, sob tratamento com dermocorticóide, sem recidiva em follow-up de 2 anos. O pioderma gangrenoso pustuloso é uma entidade clínica rara; salienta-se neste caso a evolução sinérgica das do- enças intestinal e cutânea, e em particular a rápida resolução do quadro cutâneo após proctocolectomia.PALAVRAS-CHAVE – Pioderma Gangrenoso; Doença Inflamatória Intestinal; Proctocolectomia

PÊNFIGO VULGAR COM EVOLUÇÃO PARA PÊNFIGO VEGETANTE

A 76-year-old male presented with multiple painful bullae and erosive lesions scattered through the abdomen and back, and erosive lesions on oral mucosa. Histology and perilesional direct immunofluorescence following cutaneous biopsy led to the diagnosis of pemphigus vulgaris. The patient was submitted to treatment with oral corticosteroid and azathioprine with gradual improvement. After progressive dose reduction, corticotherapy was suspended, keeping treatment with azathioprine alone. After three months clinical deterioration was noticed and new vegetative cutaneous lesions arose in intertriginous areas and, to a smaller extent, in the oral cavity. Histopathologic examination supported the diagnosis of pemphigus vegetans and clinical remission was achieved following re-introduction of oral corticosteroid in association with azathioprine.Um doente do sexo masculino de 76 anos foi observado com múltiplas lesões bolhosas e erosivas dispersas pelo abdómen e dorso, bem como lesões erosivas na mucosa oral. O exame histológico de biopsia e a imunofluorescência directa de pele sã perilesional levaram ao diagnóstico de pênfigo vulgar. Realizou tratamento com corticóide oral e azatioprina com melhoria gradual. Após redução progressiva, o corticóide foi suspenso aos 18 meses, mantendo-se apenas a azatioprina. Três meses depois houve agravamento clínico com aparecimento de novas lesões cutâneas, em placas vegetantes nas regiões intertriginosas, e em menor grau, lesões na mucosa oral. O exame histológico de biopsia cutânea revelou tratar-se de pênfigo vegetante. Obteve-se remissão clínica após a reintrodução do corticóide sistémico em associação à azatioprina

Gemcitabine-Induced Bullous Acral Erythema

O eritema acral da quimioterapia é caracterizado por áreas eritematosas e dolorosas, envolvendo predominantemente as mãos e pés, com formação de bolhas em casos severos. A gemcitabina é responsável frequentemente por reacções adversas cutâneas, embora estas sejam habitualmente transitórias e ligeiras. Relatamos o caso de um doente sob quimioterapia paliativa com gemcitabina por adenocarcinoma ductal pancreático, que desenvolveu lesões bolhosas em ambos os pés, de maiores dimensões à esquerda. A histopatologia foi consistente com eritema acral. A variante bolhosa do eritema acral da quimioterapia é uma reacção rara e, embora descrita para agentes citotóxicos estruturalmente semelhantes, não tem sido associada à gemcitabina. No doente apresentado, os antecedentes pessoais de doença arterial periférica podem ter desempenhado um papel importante na apresentação clínica final.Chemotherapy-induced acral erythema is characterized by areas of painful erythema affecting predominantly hands and feet, and in severe cases bullous lesions may develop. Gemcitabine is frequently responsible for cutaneous side effects, but these are usually mild and transient. We report a patient under palliative chemotherapy for pancreatic ductal adenocarcinoma with gemcitabine, who presented large bullous lesions on both feet, but of larger size on the left. Histopathology was consistent with acral erythema. The bullous variant of chemotherapy-induced acral eythema is a rare reaction, and although described for structurally similar cytotoxic agents, it has not been reported in association with gemcitabine. In our case, the patient’s medical history of significant peripheral arterial disease may have also played an important role in the overall clinical presentation

Ultrafast Low-Temperature Crystallization of Solar Cell Graded Formamidinium-Cesium Mixed-Cation Lead Mixed-Halide Perovskites Using a Reproducible Microwave-Based Process

National Funds through FCT, Foundation for Science and Technology, under the projects ALTALUZ (PTDC/CTM-ENE/5125/2014) and SUPER SOLAR (PTDC/NAN-OPT/28430/2017). M.J.M. also acknowledges funding by FCT through the Grant SFRH/BPD/115566/2016.The control of morphology and crystallinity of solution-processed perovskite thin-films for solar cells is the key for further enhancement of the devices' power conversion efficiency and stability. Improving crystallinity and increasing grain size of perovskite films is a proven way to boost the devices' performance and operational robustness, nevertheless this has only been achieved with high-temperature processes. Here, we present an unprecedented low-temperature (<80 °C) and ultrafast microwave (MW) annealing process to yield uniform, compact, and crystalline FA 0.83 Cs 0.17 Pb(I (1-x) Br x ) 3 perovskite films with full coverage and micrometer-scale grains. We demonstrate that the nominal composition FA 0.83 Cs 0.17 PbI 1.8 Br 1.2 perovskite films annealed at 100 W MW power present the same band gap, similar morphology, and crystallinity of conventionally annealed films, with the advantage of being produced at a lower temperature (below 80 °C vs 185 °C) and during a very short period of time (∼2.5 min versus 60 min). These results open new avenues to fabricate band gap tunable perovskite films at low temperatures, which is of utmost importance for mechanically flexible perovskite cells and monolithic perovskite based tandem cells applications.authorsversionpublishe

Novel solar absorber surfaces with organic pigments

This paper presents results of application of natural and synthetic organic pigments in selective solar absorber coatings. Some of these photo excite pigments were tested like solar radiation absorber pigments in paint coatings and others as a form to increase the absorption of solar radiation in titanium oxide monolayer selective coatings produced by reactive magnetron sputtering. Morphologic aspects and optical properties are discussed as a function of deposition parameters and of formulation parameters. The main goal is to prepare solar absorber surfaces as a tandem of TiOx thin films, organic pigment using a conductive substrate or of paint with organic and/or inorganic pigments and conductive substrate, all reaching great photo thermal conversion efficiency, high durability and low costs to the ending product and stability at medium range temperatures (120-150ºC). The best optical properties for titanium oxide sputtered films were 88% for solar absorption, with 7% of emissivity for deposition parameters of: pulsed frequency 200kHz, reverse time of 0.4μs, discharge current of 0.7A, argon flow rate of 50ml/min and oxygen flow rate changing from 0 to 2.5ml/min. The results obtained with paints were not satisfactory. The best couple values for solar absorption and emissivity were respectively 94%, and 74