Hand, foot, and mouth syndrome in an immunocompetent adult: a case report

BACKGROUND: Hand, foot, and mouth syndrome (HFMS) is a common acute illness. It is characterized by mild clinical symptoms including fever, blisters, and sores in the mouth and on the palms and soles following a 3- to 7-day incubation period. This syndrome is rarely seen in adults. CASE PRESENTATION: A 35-year-old male Caucasian patient had a history of multiple episodes of acute pharyngitis, hypertension, hypercholesterolemia, and occasional abdominal pain. He presented with polyarthralgia in the knees and hands and odynophagia, followed by fever, oral mucosal aphthous lesions, and vesicles on the palms and soles. Three weeks after presentation, he was admitted to the emergency room with acute myocarditis. The in-hospital evaluation revealed positive serology for coxsackie A9 (1:160), positive anti-transglutaminase and anti-gliadin antibodies, normal immunoglobulins, and human immunodeficiency virus negativity. CONCLUSION: We herein describe a case of HFMS that was associated with coxsackie A9 infection complicated by acute myocarditis. Although an association between celiac disease and HFMS has not been described, this patient’s immunologic disruption could have favored the development of infection and ultimately HFMS

Heterogeneous lupus‐specific lesions and treatment outcome, in a single patient, over a period of time

The report highlights the importance of strict clinico-histological correlations when skin biopsies are performed in diagnostic doubt in systemic lupus erythematosus. Furthermore, PUVA is never indicated in autoimmune conditions involving photosensitivity, due to high potential for internal and cutaneous aggravation of the disease, as the authors observed in this case.info:eu-repo/semantics/publishedVersio

Influência das mudanças agrícolas sobre as populações de Orthoptera

Na região de Trás-os-Montes, a diminuição da população e o seu envelhecimento, estão a conduzir ao abandono das práticas agrícolas tradicionais. Os lameiros são pastagens semi-naturais submetidas a maneio extensivo, que devido a estas mudanças agrícolas estão a perder grande parte da superfície que ocupavam anteriormente, sendo substituídos por explorações intensivas, florestas e, na maioria dos casos, abandonados. Estas alterações na vegetação são acompanhadas por mudanças nas comunidades de animais que lhes estão associadas, perdendo-se ainda quilómetros de potenciais corredores ecológicos que se mantêm verdes durante grande parte do ano. O presente trabalho pretende conhecer como se vêm afetadas as comunidades de gafanhotos e grilos do mato (Orthoptera) pelas mudanças no maneio dos lameiros

Clinical Presentation and Long-Term Outcomes of Systemic Sclerosis Portuguese Patients from a Single Centre Cohort: A EUSTAR Registration Initiative

Introduction: Systemic sclerosis is a complex disorder that requires systematic screening. Our objective is to report the European Scleroderma Trials and Research group centre affiliation and its impact in our clinical practice. Material and Methods: The European Scleroderma Trials and Research group affiliation process, database update and current patient evaluation, with respect to demographic and clinical features. Cumulative mortality was analysed. Results: We identified 19 female patients (which met all the American College of Rheumatology/ European League Against Rheumatism 2013 criteria for systemic sclerosis) under current follow-up, divided according to the LeRoy classification into diffuse cutaneous (n = 5), limited cutaneous (n = 11) and limited (n = 3) types, followed for a median period of 5, 12 and 6 years, respectively. Raynaud´s phenomenon and abnormal nailfold capillaries were universally present. Interstitial lung disease was absent in the limited cutaneous form but present in 100% of the diffuse subtype. Pitting scars were more common in the diffuse form. Active disease was also more frequent in the diffuse form, and most patients with active disease were treated with anti-endothelin receptor antagonists. Over 21 years (from 1994 to 2015) the mortality rate was 55% (n = 23/42). Age at time of death was significantly lower in the diffuse subtype. Discussion: Our single centre cohort shares many features with larger and international reports and more specifically is in accordance with patient characteristics described in the European Scleroderma Trials and Research group registries. Conclusion: The European Scleroderma Trials and Research group registration motivated our systematic patient characterization and may be used as a tool for homogenous disease registries

Erratum to “Clinical Presentation and Long-Term Outcomes of Systemic Sclerosis Portuguese Patients from a Single Centre Cohort: A EUSTAR Registration Initiative”

Article published with errors: https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/10658 On page 312, where the authors’ line reads as: Carolina VIDAL1, Carina RUANO2, Vera BERNARDINO3, Pedro LAVADO CARREIRA3, Ana LLADÓ3, Maria Céu SANTOS4, Heidi GRUNER3, António PANARRA3, Nuno RISO3, Maria Francisca MORAES-FONTESAC,1 It should read: Carolina VIDAL1,2, Carina RUANO3, Vera BERNARDINO1, Pedro LAVADO CARREIRA1, Ana LLADÓ1, Maria Céu SANTOS4, Heidi GRUNER1, António PANARRA1, Nuno RISO1, Maria Francisca MORAES-FONTESAC,1   On the same page, where the authors’ affiliation on the footer reads as: • Serviço de Medicina Interna. Hospital do Divino Espírito Santo de Ponta Delgada. São Miguel. Portugal. • Serviço de Radiologia. Hospital de Santa Marta. Centro Hospitalar de Lisboa Central. Lisboa. Portugal. • Unidade de Doenças Auto-Imunes/Serviço Medicina 7.2. Hospital de Curry Cabral. Centro Hospitalar de Lisboa Central. Lisboa. Portugal. • Laboratório de Imunologia. Centro Hospitalar de Lisboa Central. Lisboa. Portugal.  It should read: • Unidade de Doenças Auto-Imunes/Serviço Medicina 7.2. Hospital de Curry Cabral. Centro Hospitalar de Lisboa Central. Lisboa. Portugal. • Serviço de Medicina Interna. Hospital do Divino Espírito Santo de Ponta Delgada. São Miguel. Portugal. • Serviço de Radiologia. Hospital de Santa Marta. Centro Hospitalar de Lisboa Central. Lisboa. Portugal. • Laboratório de Imunologia. Centro Hospitalar de Lisboa Central. Lisboa. Portugal

Progressive skin fibrosis is associated with a decline in lung function and worse survival in patients with diffuse cutaneous systemic sclerosis in the European Scleroderma Trials and Research (EUSTAR) cohort.

Objectives To determine whether progressive skin fibrosis is associated with visceral organ progression and mortality during follow-up in patients with diffuse cutaneous systemic sclerosis (dcSSc). Methods We evaluated patients from the European Scleroderma Trials and Research database with dcSSc, baseline modified Rodnan skin score (mRSS) ≥7, valid mRSS at 12±3 months after baseline and ≥1 annual follow-up visit. Progressive skin fibrosis was defined as an increase in mRSS >5 and ≥25% from baseline to 12±3 months. Outcomes were pulmonary, cardiovascular and renal progression, and all-cause death. Associations between skin progression and outcomes were evaluated by Kaplan-Meier survival analysis and multivariable Cox regression. Results Of 1021 included patients, 78 (7.6%) had progressive skin fibrosis (skin progressors). Median follow-up was 3.4 years. Survival analyses indicated that skin progressors had a significantly higher probability of FVC decline ≥10% (53.6% vs 34.4%; p<0.001) and all-cause death (15.4% vs 7.3%; p=0.003) than non-progressors. These significant associations were also found in subgroup analyses of patients with either low baseline mRSS (≤22/51) or short disease duration (≤15 months). In multivariable analyses, skin progression within 1 year was independently associated with FVC decline ≥10% (HR 1.79, 95% CI 1.20 to 2.65) and all-cause death (HR 2.58, 95% CI 1.31 to 5.09). Conclusions Progressive skin fibrosis within 1 year is associated with decline in lung function and worse survival in dcSSc during follow-up. These results confirm mRSS as a surrogate marker in dcSSc, which will be helpful for cohort enrichment in future trials and risk stratification in clinical practice

Influence of agrarian management changes on populations of Orthoptera in north-eastern Portugal

El éxodo rural y la desaparición del manejo tradicional agrícola durante el siglo pasado tuvo consecuencias en el medio rural, como la pérdida de biodiversidad en un gran número de grupos de plantas y animales. Los lameiros, pastizales semi-naturales que acumulan una gran cantidad de agua, actuando como corredores ecológicos y refugio para determinadas especies, se han visto fuertemente influidos por esa regresión. El presente trabajo pretende determinar si el abandono de las prácticas tradicionales está teniendo un efecto sobre las comunidades de saltamontes (Orthoptera) que habitan estos lameiros. Fueron capturados, en lameiros con diferente tipo de gestión, un total de 164 adultos pertenecientes a 19 especies, entre ellas varios endemismos ibéricos o iberobaleares. Nuestros resultados sugieren que el abandono de las prácticas está conduciendo a un cambio progresivo de las comunidades de ortópteros, con la desaparición de las especies más dependientes de los manejos practicados durante décadas, siendo estas especies sustituidas por otras mas eurioicas, lo que implicaría una disminución de la diversidad gamma a nivel paisajístico.The rural exodus and the disappearance of traditional agricultural practices during the past century has had serious consequences for the rural space, like the loss of biodiversity in a large number of plants and animals. The lameiros, seminatural pastures which hold big quantities of water and act as habitat corridors and refuge for various species, have been deeply influenced by that regression. The present work aims to determine if the loss of traditional practices is having an effect on the grasshopper and bush cricket communities (Orthoptera) of the lameiros. We collected, at lameiros with different kinds of management, 164 adults belonging to 19 species, amongst them several Iberian and Iberian-Balearic endemics. Our results suggest that the loss of traditional agricultural practices in these pastures in north-eastern Portugal is progressively altering the orthopteran communities, with the disappearance of those species most heavily dependent on traditional uses and their replacement by more generalistic species, which would involve a decrease in gamma diversity at the landscape level.info:eu-repo/semantics/publishedVersio

Influência das mudanças agrícolas sobre as populações de Orthoptera

Na região de Trás-os-Montes, a diminuição da população em conjunto com o seu envelhecimento, está a conduzir ao abandono das práticas agrárias tradicionais. Os lameiros são pastagens semi-naturais submetidas a maneio extensivo, que devido a estas mudanças agrícolas estão a perder grande parte da superfície que ocupavam anteriormente, sendo substituídos por explorações intensivas, florestas e, na maioria dos casos, abandonados. Estas alterações na vegetação são acompanhadas por mudanças nas comunidades de animais que lhes estão associadas. Além disto, os lameiros encontram-se principalmente situados em talvegues, desenhando linhas dentro da paisagem que se mantêm verdes durante grande parte do ano. Desta forma podem ter a função de corredores naturais, em muitos casos de vários quilómetros de cumprimento. O desaparecimento dos lameiros implica não só a alteração das comunidades vegetais e animais que lhes estão associadas mas também a rutura destas linhas dentro da paisagem. O presente trabalho pretende conhecer como se vêm afetadas as comunidades de gafanhotos e grilos do mato (Orthoptera) pelas mudanças no maneio dos lameiros. Para isso fez-se a amostragem mensal das espécies presentes das famílias Acrididae, Tettigoniidae e Tetrigidae em vinte pontos com diferentes usos (pastados, ceifados, florestados, abandonados), entre os meses de julho e outubro, numa aldeia do planalto mirandês. Encontraram-se um total de 19 espécies. Posteriormente submeteram-se os dados a uma análise multivariante a fim de conhecer o grau de relação entre os usos dos lameiros e as espécies de insetos.Financiado pela Associacção AEPGA e Associação Palomba