Severe Isolated Thrombocytopenia After Clopidogrel and Pentoxifylline Therapy: a Case Report

INTRODUCTION: Clopidogrel is frequently associated with thrombotic thrombocytopenic purpura, however this drug is rarely related to severe isolated thrombocytopenia. Pentoxifylline has previously been associated with thrombocytopenia only once. To the best of our knowledge, this is the first report of severe isolated thrombocytopenia after therapy with both clopidogrel and pentoxyfilline. CASE PRESENTATION: We report the case of a 79-year-old Caucasian man who presented to our facility with intermittent claudication. He had obliterative arterial disease and started therapy with clopidogrel and pentoxifylline. His basal platelet count was 194 × 109 cells/L. At three days after the start of treatment, our patient had lower limb petechia and stopped taking clopidogrel and pentoxifylline. His platelet count lowered to 4 × 109 cells/L and our patient was admitted to hospital. Our patient had purpura with no other hemorrhages or splenomegaly. Results of a blood smear were normal, and a bone marrow study showed dysmegakaryopoiesis. Antiplatelet antibody test results were negative, as were all viral serology tests. Imaging study results were normal. Our patient was given immunoglobulin but there was no sustained platelet increase, so corticotherapy was started as the next treatment step. At five months after clopidogrel and pentoxifylline were discontinued, his platelet count continued increasing even after prednisolone was tapered. CONCLUSIONS: Severe isolated thrombocytopenia may appear as a side effect when using clopidogrel and pentoxifylline. These drugs are widely used by general physicians, internists, cardiologists and vascular surgeons. We hope this report will raise awareness of the need to monitor the platelet count in patients taking these drugs

Reflexões na mediação da coleção do Museu de Anatomia Prof. Nuno Grande – ensinar através de objetos museais

University museums and their collections, as they are embedded in an atmosphere of teaching, learning and research, are excellent educational resources for the academic community. The article presents a research supported by the study of the origins of the university museums observed as places of production and convergence of scientific knowledge. Based on a qualitative approach to research in education, I try to understand how university museums have established pedagogical conditions of collection objects, analyzing issues related to the mediation of museum objects, focusing in particular on the Museum of Anatomy Prof. Nuno Grande of the Abel Salazar Institute of Biomedical Sciences at the University of Porto (ICBAS-UP).Os museus universitários e as suas coleções, por estarem inseridos numa atmosfera de ensino, aprendizagem e investigação, constituem-se como excelentes recursos de educação para a comunidade académica. O presente artigo apresenta uma pesquisa sustentada no estudo das origens dos museus universitários observados como lugares de produção de conhecimento e de convergência de saberes científicos. Baseado numa abordagem qualitativa de investigação em educação, procuro compreender como os museus universitários têm estabelecido condições pedagógicas dos objetos da coleção, analisando questões relacionadas com a mediação de objetos museais, focando de modo particular, o Museu de Anatomia Prof. Nuno Grande do Instituto de Ciências Biomédicas Abel Salazar da Universidade do Porto (ICBAS-UP)

Certificação Energética do Teclabs

Tese de mestrado integrado, Engenharia da Energia e do Ambiente, Universidade de Lisboa, Faculdade de Ciências, 2020Currently, there is a great concern among representatives from all countries of the world about the objectives to be defined in order to mitigate the emission of greenhouse gases and their impact on our planet. In the European Union, the buildings sector represents more than 41% of the final energy consumed and in Portugal it represents almost 30%. The energy certification of buildings introduced in Europe through the Energy Performance of Buildings Directive (EPBD) was an important measure that recognized the active role that the building sector has in the emissions of each country. This master's thesis consists of the energy certification of a service building, applying the Energy Performance Regulation of Commercial and Service Buildings (RECS) in effect in Portugal. The evaluation of the building's energy performance was carried out by dynamic multi-zone simulation using the EnergyPlus® simulation software. The Energy Efficiency Class attributed to the building was B, as it presented an RIEE of 0.55. Potential improvement measures were evaluated, through their cost of implementation in comparison with the benefit they would bring to the energy bill. The replacement of lighting equipment allows an annual saving always higher than € 657 with a maximum return period of less than 2 years and 8 months. The installation of a 10kWp photovoltaic system allows an annual saving of more than 2200 € with a maximum payback period of 5 years and 7 months. Even when applied separately, each measure allows the improvement of the building's Class to Category A, which allows the building to obtain a reduction of the Municipal Property Tax (IMI) of up to 25%. This dissertation recommends the implementation of both measures in order to obtain greater annual savings after the return period of both investments.Atualmente existe uma grande preocupação entre os representantes de todos os países do mundo sobre quais os objetivos a definir para mitigar a emissão de gases de efeito estufa e o seu impacte no nosso planeta. Na União Europeia o sector dos edifícios representa mais de 41% da energia final consumida e em Portugal representa quase 30%. A certificação energética dos edifícios introduzida na Europa através da Energy Performance of Buildings Directive (EPBD) foi uma importante medida que reconheceu o papel ativo que o sector dos edifícios tem nas emissões de cada país. Esta dissertação de mestrado consiste na certificação energética de um edifício de serviços, aplicando o Regulamento de Desempenho Energético dos Edifícios de Comércio e Serviços (RECS) em vigor em Portugal. A avaliação do desempenho energético do edifício foi realizada por simulação dinâmica multizona recorrendo ao software de simulação EnergyPlus®. A Classe de Eficiência Energética atribuída ao edifício foi B, pois este apresentou um RIEE de 0.55. Foram avaliadas potenciais medidas de melhoria, através do seu custo de implementação em comparação com o benefício que trariam à fatura energética. A substituição de equipamentos de iluminação permite uma poupança anual nunca inferior a 654€ possuindo um período de retorno máximo inferior a 2 anos e 8 meses. A instalação de um sistema fotovoltaico de 10kWp permite uma poupança anual superior a 2200€ possuindo um período de retorno máximo de 5 anos e 7 meses. Isoladamente, cada medida permite o melhoramento da Classe do edifício para a categoria A, o que coloca o edifício apto a obter uma redução do Imposto Municipal sobre Imóveis (IMI) de até 25%. A presente dissertação recomenda a implementação de ambas as medidas visando obter uma poupança anual maior após o período de retorno de ambos os investimentos

Neurosyphilis versus Herpes Encephalitis in a Patient with Confusion, Memory Loss, and T2-Weighted Mesiotemporal Hyperintensity

Acute confusion and memory loss associated with asymmetrical mesiotemporal hyperintensity on T2-weighted MRI are characteristic of herpes encephalitis. The authors report the case of a patient with these symptoms and MRI presentation who had neurosyphilis. Recently clinical and imaging patterns usually associated with herpes simplex encephalitis have been seen in patients with neurosyphilis. Because syphilis is “The Great Pretender” not only clinically but also in imaging and because its numbers are rising, it must be sought as a differential diagnosis

Gene Expression Profiling and Association Studies Implicate the Neuregulin Signaling Pathway in Behçet's Disease Susceptibility

Behçet's disease (BD) is a complex disease with genetic and environmental risk factors implicated in its etiology; however, its pathophysiology is poorly understood. To decipher BD's genetic underpinnings, we combined gene expression profiling with pathway analysis and association studies. We compared the gene expression profiles in peripheral blood mononuclear cells (PBMCs) of 15 patients and 14 matched controls using Affymetrix microarrays and found that the neuregulin signaling pathway was over-represented among the differentially expressed genes. The Epiregulin (EREG), Amphiregulin (AREG), and Neuregulin-1 (NRG1) genes of this pathway stand out as they are also among the top differentially expressed genes. Twelve haplotype tagging SNPs at the EREG-AREG locus and 15 SNPs in NRG1 found associated in at least one published BD genome-wide association study were tested for association with BD in a dataset of 976 Iranian patients and 839 controls. We found a novel association with BD for the rs6845297 SNP located downstream of EREG, and replicated three associations at NRG1 (rs4489285, rs383632, and rs1462891). Multifactor dimensionality reduction analysis indicated the existence of epistatic interactions between EREG and NRG1 variants. EREG-AREG and NRG1, which are members of the epidermal growth factor (EGF) family, seem to modulate BD susceptibility through main effects and gene–gene interactions. These association findings support a role for the EGF/ErbB signaling pathway inBD pathogenesis that warrants further investigation and highlight the importance of combining genetic and genomic approaches to dissect the genetic architecture of complex diseases

IL10 Low-Frequency Variants in Behçet's Disease Patients

To explain the missing heritability after the genome-wide association studies era, sequencing studies allow the identification of low-frequency variants with a stronger effect on disease risk. Common variants in the interleukin 10 gene (IL10) have been consistently associated with Behçet's disease (BD) and the goal of this study is to investigate the role of low-frequency IL10 variants in BD susceptibility

Mechanisms of dyadic coping : implications for interventions=Mecanismos de coping diádico : implicações para intervenções

Tese de doutoramento, Psicologia Clínica (Psicologia da Família e Intervenção Familiar), Universidade de Lisboa, Faculdade de Psicologia, Universidade de Coimbra, Faculdade de Psicologia e Ciências da Educação, 2014This dissertation aims to expand on the current knowledge regarding stress and dyadic coping (DC) in intimate relationships, given the crucial role both play for couples functioning, well-being and health. Our core aim was to fill and link important contextual (Portuguese culture context), intrapersonal (love styles), interpersonal (we-ness) and relational outcomes (relationship satisfaction) empirical gaps related with the way couples support each other and jointly cope with stress (i.e., DC); within a systemic-transaction model (STM; Bodenmann, 2005) framework of stress and DC. Apart from the literature review and theoretical model proposal made for we-ness, three empirical studies were conducted to test the above-identified gaps. Findings support that: (1) DC is a valid construct in the Portuguese context, which can have important implications since Portugal is one of the European countries with one of the highest divorce rates and faces a multitude of stressors; (2) love styles (romantic, altruistic and ludic) are relevant interpersonal motivational factors affecting different DC forms, and these coping behaviors partially explain the association between the former styles and RS; thus both the field of psychology of love and DC were expanded as well as linked; and, (3) DC was found to have a relationship enhancement mediation role via we-ness in promoting RS, which enlarged our knowledge about the STM as well as the new and important field of we-ness. Our findings have important research implications as well as interventional implications by hinting that it may be advisable to incorporate love styles, DC and we-ness related methods into preventive and clinical approaches. In view of the interplay between these factors, and how partners mutually influence each other, helping couples in enhancing their coping capabilities regarding stress, while attending to their love attitudes and fostering we-ness, may be crucial for promoting more satisfying and hopefully, more resilient relationships

Multiplicity patterns of minimal zero sequences of Zp x Zp

If G is a nite abelian group, let MZS(G k) denote the set of all minimal zero sequences of G with length k. In the class of groups G = Zp Zp, where p is an odd prime, this thesis discusses the structure of the elements in MZS(G k) with maximal length k, known as the Davenport constant. The multiplicity pattern of the minimal zero sequences of maximal length over Zp Zp are also determined. Furthermore, additional results which strengthen a known theorem about the multiplicity pattern of such sequences are presented