Diagnosis of giant cell arteritis

© The Author(s) 2020. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved.GCA is the most common form of primary systemic vasculitis affecting older people. It is considered a clinical emergency because it can lead to irreversible blindness in around 20% of untreated cases. High doses of glucocorticoids should be initiated promptly to prevent disease-related complications; however, glucocorticoids therapy usually results in significant toxicity. Therefore, correct diagnosis is crucial. For many years, temporal artery biopsy has been considered the diagnostic ‘gold standard’ for GCA, but it has many limitations (including low sensitivity). US has proven to be effective for diagnosing GCA and can reliably replace temporal artery biopsy in particular clinical settings. In cases of suspected GCA with large-vessel involvement, other imaging modalities can be used for diagnosis (e.g. CT and PET). Here we review the current evidence for each diagnostic modality and propose an algorithm to diagnose cranial-GCA in a setting with rapid access to high quality US.info:eu-repo/semantics/publishedVersio

Morte fetal - a urgência da observação psiquiátrica: Fetal death - the urgency of psychiatric observation

Introdução: A morte fetal é um acontecimento único porque envolve simultaneamente nascimento e morte, representando um acontecimento traumático e extremamente doloroso para a maioria dos pais1,2. Em obstetrícia, morte fetal corresponde à morte do feto com idade gestacional igual ou superior a 20 semanas de gestação, uma morte que ocorre antes ou durante o parto3,4,5,6,7. Estas perdas estão associadas a custos psicológicos e sociais substanciais, diretos e indiretos, na mulher, família, profissionais de saúde e sociedade1,8,9,10. Sendo situações de crise que, na maioria dos casos, desorganizam a estrutura interna dos envolvidos e desencadeiam intensa dor e sofrimento5,8,9,11,12,13.Os objetivos deste trabalho são reconhecer as características do luto perante a morte fetal e quais as intervenções que se mostraram efetivas na elaboração do luto, prevenindo complicações na saúde mental.Metodologia: Revisão não sistemática da literatura.Resultados: As reações do luto devem ser interpretadas individualmente, pois são determinadas de modo pessoal, subjetivo e de forma contextual por quem a vivencia além disso, são influenciadas por diversos fatores, como as circunstâncias da morte e outras experiências semelhantes no passado4,6,9,14. O apoio ao casal deve incluir suporte e validação emocional bem como comunicação clara da informação4,12.Conclusões: O luto fetal é um processo global, complexo e multifacetado3. É fundamental que os cuidados de saúde materna sejam prestados por uma equipa multidisciplinar, com o objetivo de diminuir o sofrimento vivido pelo casal e prevenir situações que possam levar à perpetuação do sofrimento psíquico e/ou desencadear quadros patológicos15. Reconstruir a vida sem o seu filho é uma das mais dantescas tarefas da morte fetal e, contudo, no meio deste processo, o crescimento pessoal pode acontecer4

HERA - Environmental Risk Assessment of a contaminated estuarine environment: a case study

Sado River estuary is located in the west coast of Portugal. Previous environmental studies identified industrial contamination, non-point anthropogenic sources and contamination coming from the river, all promoting accumulation of polluted sediments with known impacts on the ecological system. Surrounding human populations have intense economic fishery activities. Together with agriculture, estuary fishing products are available to local residents. Food usage previously characterized through ethnographic studies suggests exposure to estuarine products, farming products, and water in daily activities, as potential routes of contamination. It is well established that long term exposure to heavy metals are associated with renal and neurological diseases, most heavy metals are classified as carcinogenic and teratogenic.Instituição Financiadora: FCT; Instituições participantes: IMAR -Instituto do Mar (coord.)e PRÓ-INSA, Associação para a Promoção da Investigação em Saúde, Instituto Nacional de Saúde Doutor Ricardo Jorg

O efeito do metilglioxal na regulação da conexina43 em cardiomioblastos

Trabalho de Projeto do Mestrado Integrado em Medicina apresentado à Faculdade de MedicinaAs doenças cardiovasculares são uma das complicações mais frequentes e fatais da Diabetes Mellitus. Diabetes e hiperglicémia podem levar à acumulação de metilglioxal, um composto capaz de se associar e modificar a função de várias proteínas e levando a uma desregulação celular e consequentemente a uma destruição de determinados tecidos como o tecido cardíaco. Estas modificações, tais como SUMOilação e ubiquitinação, são responsáveis pela regulação de várias proteínas, nomeadamente da conexina43 que é o principal constituinte dos canais intercelulares - gap junctions. As gap junctions assumem uma função importante no coração, pois asseguram a propagação do impulso eléctrico e sincronização do miocárdio. Posto isto, as gap junctions e mais especificamente a conexina43 necessitam de ser cuidadosamente reguladas, por várias modificações pós-tradução, nomeadamente por SUMOilação e ubiquitinação.Com o intuito de explorar os efeitos da hiperglicémia nas modificações pós-tradução da conexina43 em células cardíacas, trataram-se cardiomioblastos H9c2 com diferentes concentrações de metilglioxal. O metilglioxal cria um ambiente semelhante ao diabético e os níveis de conexina43, ubiquitina, SUMO-1 e SUMO-2 foram analisados por western blot e imunofluorescência. Estes resultados evidenciaram que o metilglioxal induz alterações nos níveis de conexina43 e nos níveis totais de SUMOilação e ubiquitinação. Também se realizaram imunoprecipitações contra a conexina43 e observou-se que os tratamentos com metilglioxal podem provocar alterações na conexina43 modificada por SUMO-2 e ubiquitina. Estes resultados sugerem que, no nosso modelo de células cardíacas, a diabetes pode causar alterações na regulação da conexina43 por ubiquitinação e SUMOilação. Isto pode, por sua vez, prejudicar a comunicação intercelular entre células cardíacas e consequentemente deteriorar a função cardíaca.Assim, este estudo tem como objectivo esclarecer os efeitos de um ambiente semelhante ao da diabetes nos mecanismos que envolvem as modificações pós-tradução da conexina43 realizadas pela SUMOilação e ubiquitinação. No futuro, estas modificações da conexina43 poderão surgir como potenciais alvos terapêuticos da diabetes.Cardiovascular diseases (CVDs) are one of the most frequent and fatal complications of Diabetes Mellitus (DM). Diabetes and hyperglycemia can lead to the accumulation of methylglyoxal (MGO), which has been associated to alterations of several proteins and impairment of cell and tissues including the heart. Protein modifications, such as SUMOylation and ubiquitination, are responsible for the regulation of several proteins, namely connexin43 (Cx43) which is the main component of gap junctions (GJs). GJs play an important role in heart function as they assure the propagation of the electrical impulse and myocardium synchronization. Hence GJs, and more specifically Cx43, need to be carefully regulated, among others, by SUMOylation and ubiquitination.For the purpose of exploring the effects of hyperglycemia in post-translational modifications of Cx43 in cardiac cells, cardiomyoblasts H9c2 cells were treated with different concentrations of MGO to create a diabetes-like setting. The results, obtained by western blot and immunostaining, showed that MGO induced alterations on global levels of Cx43, SUMOylation and ubiquitination. Immunoprecipitations against Cx43 were also performed and it was observed that MGO can induce alterations on modifications of Cx43 by SUMO-2 and ubiquitin. This suggests that in our model of cardiac cells, a diabetic state can cause alterations on the regulation of Cx43, with subsequent impairment on cardiac intercellular communication and thus the normal heart function.Therefore, this study aimed to shed light on the effects of a diabetes-like setting on the mechanisms involving regulation of Cx43 carried out by the post translational modifications, SUMOylation and ubiquitination. In the future, these mechanisms may serve as potential therapeutic targets of diabetes

Localized forms of Vasculitis

© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2021Purpose of review: To provide an updated review on epidemiology, clinical manifestations, diagnostic assessment, treatment, and prognosis of localized vasculitis, following the 2012 Revised International Chapel Hill Consensus Conference Nomenclature on single-organ vasculitis. Recent findings: Localized, single-organ vasculitides encompass a group of rare conditions in which there is no evidence of concomitant systemic vasculitis. Most data on this topic derives from case reports and small case series. Although some aspects of these diseases, such as clinical manifestations and histologic findings, have already been extensively investigated, there is still a lack of robust data concerning the pathogenesis, epidemiology, and treatment. Localized vasculitides may have a wide range of clinical features depending on the organ affected. The inflammatory process may have a multifocal/diffuse or unifocal distribution. Diagnosis is usually based on histopathology findings and exclusion of systemic vasculitis, which may frequently pose a challenge. Further research on treatment is warranted.info:eu-repo/semantics/publishedVersio

The Mediterranean diet, and not dietary inflammatory index, is associated with rheumatoid arthritis disease activity, the impact of disease and functional disability

© The Author(s), under exclusive licence to Springer-Verlag GmbH Germany 2023.Purpose: To assess the relationship between adherence to the Mediterranean Diet (MD) /individual Dietary Inflammatory Index (DII) and disease activity, disease impact, and functional status in Rheumatoid Arthritis (RA) patients. Methods: RA patients followed at a hospital in Lisbon, Portugal, were recruited. DII was calculated using dietary intake data collected with a food frequency questionnaire (FFQ). Adherence to the MD was obtained using the 14-item Mediterranean Diet assessment tool. Disease Activity Score of 28 Joints (DAS28) and the DAS28 calculated with C-Reactive Protein (DAS28-CRP) were used to assess disease activity. Impact of disease and functional status were evaluated using the Rheumatoid Arthritis Impact of Disease (RAID) questionnaire and the Health Assessment Questionnaire (HAQ), respectively. Results: 120 patients (73.3% female, 61.8 ± 10.1 years of age) were included. Patients with higher adherence to the MD had significantly lower DAS28-CRP (median 3.27(2.37) vs 2.77(1.49), p = 0.030), RAID (median 5.65(2.38) vs 3.51(4.51), p = 0.032) and HAQ (median 1.00(0.56) vs 0.56(1.03), p = 0.013) scores. Higher adherence to the MD reduced the odds of having a higher DAS28 by 70% (OR = 0.303, 95%CI = (0.261, 0.347), p = 0.003). Lower adherence to MD was associated with higher DAS28-CRP (β = - 0.164, p = 0.001), higher RAID (β = - 0.311, p < 0.0001), and higher HAQ scores (β = - 0.089, p = 0.001), irrespective of age, gender, BMI and pharmacological therapy. Mean DII of our cohort was not significantly different from the Portuguese population (0.00 ± 0.17 vs - 0.10 ± 1.46, p = 0.578). No associations between macronutrient intake or DII and RA outcomes were found. Conclusions: Higher adherence to the MD was associated with lower disease activity, lower impact of disease, and lower functional disability in RA patients.info:eu-repo/semantics/publishedVersio

The Mediterranean diet, and not dietary inflammatory index, is associated with rheumatoid arthritis disease activity, the impact of disease and functional disability

Purpose: To assess the relationship between adherence to the Mediterranean Diet (MD) /individual Dietary Inflammatory Index (DII) and disease activity, disease impact, and functional status in Rheumatoid Arthritis (RA) patients. Methods: RA patients followed at a hospital in Lisbon, Portugal, were recruited. DII was calculated using dietary intake data collected with a food frequency questionnaire (FFQ). Adherence to the MD was obtained using the 14-item Mediterranean Diet assessment tool. The disease Activity Score of 28 Joints (DAS28) and the DAS28 calculated with C-Reactive Protein (DAS28-CRP) were used to assess disease activity. The impact of disease and functional status were evaluated using the Rheumatoid Arthritis Impact of Disease (RAID) questionnaire and the Health Assessment Questionnaire (HAQ), respectively. Results: 120 patients (73.3% female, 61.8 ± 10.1 years of age) were included. Patients with higher adherence to the MD had significantly lower DAS28-CRP (median 3.27(2.37) vs 2.77(1.49), p = 0.030), RAID (median 5.65(2.38) vs 3.51(4.51), p = 0.032) and HAQ (median 1.00(0.56) vs 0.56(1.03), p = 0.013) scores. Higher adherence to the MD reduced the odds of having a higher DAS28 by 70% (OR = 0.303, 95%CI = (0.261, 0.347), p = 0.003). Lower adherence to MD was associated with higher DAS28-CRP (β = - 0.164, p = 0.001), higher RAID (β = - 0.311, p < 0.0001), and higher HAQ scores (β = - 0.089, p = 0.001), irrespective of age, gender, BMI and pharmacological therapy. The mean DII of our cohort was not significantly different from the Portuguese population (0.00 ± 0.17 vs - 0.10 ± 1.46, p = 0.578). No associations between macronutrient intake or DII and RA outcomes were found. Conclusions: Higher adherence to the MD was associated with lower disease activity, lower impact of disease, and lower functional disability in RA patients.info:eu-repo/semantics/publishedVersio

Markers of neuroprotection of combined EPA and DHA provided by fish oil are higher than those of EPA (Nannochloropsis) and DHA (Schizochytrium) from microalgae oils in Wistar rats

Abstract Background To overcome the current overexploitation of fish rich in n-3 long chain polyunsaturated fatty acids (LCPUFA), microalgae have become a promising marine lipid source. The purpose of this study was to assess eicosapentaenoic acid (EPA, 20:5n-3) and docosahexaenoic acid (DHA, 22:6n-3), isolated or combined from distinct marine origins, on the promotion of neuroprotective effects. Methods The experiment lasted for 10 weeks and involved 32 Wistar rats, divided into 4 diets (n = 8): a diet rich in milk fat was taken as control (Milk Fat) and compared to n-3 LCPUFA enriched diets, either in EPA + DHA form through fish oil (Fish Oil), or EPA through Nannochloropsis oil (Nanno), or DHA through Schizochytrium oil (Schyzo), while maintaining Milk Fat incorporation. Results Plasma lipid profile and dopamine levels were more beneficial in Fish Oil diet. In addition, n-3 LCPUFA incorporation was found increased in liver and erythrocytes from Fish Oil fed rats, suggesting that fish oil is a better dietary source for fatty acids deposition in the organism than microalgae. The Forced Swimming Test revealed a positive behavioural action of EPA + DHA, in opposition to Milk Fat and Nanno diets, which had higher immobile times. mRNA levels of serotonin receptors, HT1A and HT2A along with CREB, the transmission factor for learning and memory, were higher in the hippocampus of rats fed n-3 LCPUFA diets comparative to Milk Fat. Conclusion Taken together, the combination of EPA and DHA from fish oil can counteract the undesirable health effects of saturated fat based diets and benefit, in the long run, neurological function

Predictors of Interstitial Lung Disease in Mixed Connective Tissue Disease

Interstitial lung disease (ILD) frequently complicates mixed connective tissue disease (MCTD) and contributes to increased mortality. We aimed to identify predictors of ILD in MCTD patients. This is a nationwide, multicentre, retrospective study including patients with an adult-onset MCTD clinical diagnosis who met Sharp’s, Kasukawa, Alarcón-Segovia, or Kahn’s diagnostic criteria and had available chest high-resolution computed tomography (HRCT) data. Univariate and multivariate analyses were conducted. We included 57 MCTD patients, with 27 (47.4%) having ILD. Among ILD patients, 48.1% were asymptomatic, 80.0% exhibited a restrictive pattern on pulmonary function tests, and 81.5% had nonspecific interstitial pneumonia on chest HRCT. Gastroesophageal involvement (40.7% vs. 16.7%, p = 0.043) and lymphadenopathy at disease onset (22.2% vs. 3.3%, p = 0.045) were associated with ILD. Binary logistic regression identified lymphadenopathy at disease onset (OR 19.65, 95% CI: 1.91–201.75, p = 0.012) and older age at diagnosis (OR 1.06/year, 95% CI: 1.00–1.12, p = 0.046) as independent ILD predictors, regardless of gender and gastroesophageal involvement. This study is the first to assess a Portuguese MCTD cohort. As previously reported, it confirmed the link between gastroesophageal involvement and ILD in MCTD patients. Additionally, it established that lymphadenopathy at disease onset and older age at diagnosis independently predict ILD in MCTD patients