Exploring the ways of “The great imitator”: a case report of Syphilitic Hepatitis

Introduction: Syphilis is a chronic infection caused by Treponema pallidum. Manifestations of this disease are vast, and syphilitic hepatitis is a rarely depicted form of secondary syphilis. Case Presentation: We report the case of a 63-year-old man with worsening jaundice, maculopapular rash and perianal discomfort. Proctological examination with anoscopy revealed a perianal gray/white area with millimetric pale granules along the anal canal. Liver function tests showed a mixed pattern. Venereal Disease Research Laboratory, T. pallidum hemagglutination assay and IgM fluorescent treponemal antibody absorbance were positive. The patient was successfully treated with a single dose of penicillin G. Discussion/Conclusion: Syphilitic hepatitis is scarcely reported in the literature. Secondary syphilis with mild hepatitis rarely leads to hepatic cytolysis and jaundice. Many signs of secondary syphilis including syphilitic hepatitis may be linked to immune responses initiated during early infection. Over the past decades, evidence has emerged on the importance of innate and adaptive cellular immune responses in the immunopathogenesis of syphilis. This report raises awareness to a clinical entity that should be considered in patients at risk for sexually transmitted diseases, who present with intestinal discomfort or liver dysfunction, as it is a treatable and fully reversible condition.info:eu-repo/semantics/publishedVersio

Comentário a “O papel da oxigenoterapia hiperbárica nas úlceras retais secundárias à terapêutica com árgon-plasma”

Dear Editor, We read with great interest the paper by Laranjo et al. [1] entitled “The Effect of Hyperbaric Oxygen Therapy on Rectal Ulcers after Argon Plasma Coagulation.” The authors reported the case of a patient with chronic radiation proctitis, who developed rectal ulcers after endoscopic treatment with argon plasma coagulation (APC) and was successfully treated with hyperbaric oxygen therapy (HBO). Although it is well established that HBO therapy is an effective alternative treatment for patients with radiation-induced rectal ulcers and severe chronic proctitis [2, 3], its application has not been described as a treatment option in APC-induced rectal ulcers. We acknowledge the authors’ awareness of HBO as an option for complications induced by conventional chronic proctitis treatments and we would like to share our experience on this particular matter. A 72-year-old female patient was admitted to our Emergency Department with rectal bleeding, acute anal pain, and iron deficiency anemia (hemoglobin 10.7 g/dL). She had a past medical history of endometrial carcinoma treated with radio- and brachytherapy 2 years before. Total colonoscopy revealed multiple bleeding rectal radiation-induced telangiectasias. Medical treatment with topical salicylates and sucralfate for 8 months was unsuccessful and APC therapy (45 W; 1.5 L/min gas flow) every 4 weeks was initiated. The patient was submitted to a total of 6 APC sessions, with an overall endoscopic improvement between the first and third sessions. However, amidst the fourth and sixth APC sessions, the patient developed multiple APC-induced ulcers and an ulcerated stenosis of the distal rectum.info:eu-repo/semantics/publishedVersio

Therapeutic drug monitoring of CT-P13: a comparison of four different immunoassays

Background: The commercialization of CT-P13, an infliximab (IFX) biosimilar, has the potential to decrease health-related costs and enhance access to biological therapies. This study aimed to address the accuracy and inter-assay agreement of the CT-P13 quantification using four different assays initially developed to assess IFX. Methods: The four different methods, one in-house method and three commercially available kits, were used to quantify exogenously-spiked samples and the sera from 185 inflammatory bowel disease (IBD) patients on CT-P13 therapy. Results: The quantification of the spiked samples unveiled a consistent and accurate behaviour of three of the tested methods, with average percentage recoveries of 90%, 102% and 109%. Results from the clinical samples demonstrated that these three assays were also highly correlated, both concerning Spearman's rank coefficients (range 0.890-0.947) and intraclass correlation coefficients (range 0.907-0.935). There were a few systematic deviations among them, but their impact in the clinical stratification of the patients using different cut-offs was minimal, particularly when these cut-offs were in the 3-4 mu g/ml range, for which the strength of agreement (as assessed by the Kappa statistics that ranged from 0.732 to 0.902) was substantial to almost perfect. Conclusions: Our results indicate that three of the tested IFX quantification methods can be used to accurately quantify CT-P13 without any adjustments.Portuguese IBD Group (GEDII, Grupo de Estudo da Doenca Inflamatoria Intestinal)Portuguese IBD Group (GEDII, Grupo de Estudo da Doença Inflamatória Intestinal

Tooth loss in middle-aged adults with diabetes and hypertension : social determinants, health perceptions, oral impact on daily performance (OIDP) and treatment need

This study aimed to explore the association between tooth loss and social determinants, health self-perceptions, OIDP and self-concept of dental treatment need in middle-aged adults with diabetes and hypertension. A cross-sectional study was developed with 212 hypertensive and diabetic middle-aged adults (50-65 years). Data were collected from clinical examinations (DMFT) and a questionnaire regarding socioeconomic status, dental health assistance, self-perceptions of oral and general health, OIDP, and the self-concept of dental treatment need. Tooth loss was dichotomized considering the cutoff point of 12 (Model I) or 24 missing teeth (Model II). Data were analyzed using Chi-square, Fisher?s exact test and logistic regression (p?0.05). Tooth loss was significantly associated with variables such as last dental visit, reason for dental visit, OIDP, perception of dental treatment need, and general self-perception (Model I). Schooling, last dental visit, oral health self-perception and perception of dental treatment need were significantly associated with tooth loss in the Model II. When Model 1 and 2 were adjusted, they demonstrated that last dental visit and perception of dental treatment need were predictor variables. The annual dental visit and the self-concept of dental treatment need were associated with tooth loss, demonstrating that these variables reduce the tooth loss prevalence

Influence of the dental prosthetic status on self-perceptions of health and treatment needs : a cross-sectional study of middle-aged adults with chronic disease

Background: Subjective aspects of dental prosthesis need in middle-aged adults are poorly explored, especially when the population presents chronic diseases. Objectives: To investigate if the use and necessity of dental prosthesis influence the self-perceptions of health and dental treatment need in middle-aged adults with chronic diseases. Material and Methods: A cross-sectional study was performed in 210 middle-aged adults. Socio-demographic aspects, dental services use, oral and general perceptions of health, dental treatment need and OIDP were assessed using a standardized questionnaire. One trained dentist evaluated the use and necessity of dental prosthesis. Data were analyzed using Chi-square and multivariate logistic regression ( p <0.05). Results: The use of dental prosthesis showed a proportion of 2.2:1 for upper to lower arch. Dental prosthesis need was largely prevalent (90 and 95% in upper and lower arch, respectively). The self-perceptions of dental treatment need and oral health were associated with the use and necessity of dental prosthesis ( p <0.05), which could not be observed in relation to the general self-perception. The adjusted model demonstrated that the subjective necessity of dental treatment was 16.04 (1.92-133.7) fold higher in individuals with necessity of rehabilitation in the lower arch. Besides, a positive self-perception of oral health (satisfied) was 2.59 (1.38-4.85) more expressive in individuals that used a dental prosthesis in upper arch. Conclusions: The self-perception of oral health was influenced by the use of maxillary dental prosthesis in individuals with chronic disease. Moreover, individuals were more likely able to perceive treatment need when the lower jaw was affected by tooth loss

As Características de Governo Societário versus Estrutura de Capital das Empresas Portuguesas

This study analyzes the relationship between Corporate Governance and the level of leverage of Portuguese companies. The sample consists in 9,170 Portuguese non-financial companies corresponding to 100,870 observations, over a period from 2008 to 2018. The data for this study were collected by consulting the SABI database and were analyzed using random effects regression models, considering the data model in panel, by using the integrated development software program for R – RStudio, version 1.2.5001. The analysis of the results provides evidence that Corporate Governance influence the choice of capital structure of Portuguese companies.O presente estudo analisa a relação existente entre as características de Governo Societário  e o nível de endividamento das empresas portuguesas. A amostra é constituída por 9.170 empresas, não financeiras e corresponde a 100.870 observações, no período de 2008 a 2018. Os dados foram recolhidos por consulta da base SABI e foram analisados através de modelos de regressão de efeitos aleatórios, considerando o modelo de dados em painel, com recurso ao programa de software de desenvolvimento integrado para R – RStudio, versão 1.2.5001. A análise dos resultados fornece evidências no sentido de concluirmos que as características de governo influenciam a escolha da estrutura de capital das empresas portuguesas. Este estudo visa contribuir para o debate e o enriquecimento da discussão sobre as características de Governo e a estrutura de capitais e pode ser muito útil para accionistas, administradores, credores e outros investidores, assim como para académicos e reguladores. 

Soluble human Suppression of Tumorigenicity 2 is associated with endoscopic activity in patients with moderate-to-severe ulcerative colitis treated with golimumab

Suppressor of Tumorigenicity 2 (ST2) is an IL33 receptor detected in the mucosa and serum of ulcerative colitis (UC) patients. We evaluated soluble ST2 (sST2) as a surrogate biomarker of disease outcome and therapeutic response, in moderate-to-severe UC patients treated with golimumab.Agência financiadora Merck Sharp and Dohme, Lda, Portugal MK8259-22info:eu-repo/semantics/publishedVersio

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Preservation of bovine preantral follicle viability and ultra-structure after cooling and freezing of ovarian tissue

Bovine preantral follicles within ovarian fragments were exposed and cryopreserved in absence or presence of 1.5 M glycerol (GLY), ethylene glycol (EG), propanediol (PROH) or dimethyl sulfoxide (DMSO), undergoing a previous cooling at 20 °C for 1 h (protocol 1) or at 4 °C for 24 h (protocol 2) in 0.9% saline solution. At the end of each treatment, preantral follicles were classified as non-viable/viable when they were stained/not stained with trypan blue, respectively. To confirm viability staining, ultra-structure of the follicles was evaluated by transmission electronic microscopy (TEM). Data were compared by Chi-square test (P < 0.05). The storage of the ovaries at 20 °C for 1 h (78%) and 4 °C for 24 h (80%) did not reduce significantly the percentage of viable preantral follicles when compared to the control (75%). Similar results were obtained when ovarian fragments, respectively, for protocols 1 and 2, were exposed to MEM (78 and 77%), 1.5 M EG (78 and 71%), as well as frozen in 1.5 M EG (74 and 77%). Percentages of viable follicles in control were similar to those observed after exposure (75%) and freezing (76%) in presence of 1.5 M DMSO only when protocol 1 was used. The increase of the concentration from 1.5 to 3.0 M, for all cryoprotectants, reduced significantly the percentage of viable preantral follicles after freezing. Ultra-structural analysis has confirmed trypan blue results, showing that not only basement membrane, but also organelles, were intact in viable preantral follicles. In conclusion, ovarian tissue cooling at 4 °C for 24 h before cryopreservation (protocol 2) does not affect the viability of bovine preantral follicles when 1.5 M EG is present in the cryopreservation medium