Rosacea with extensive extrafacial lesions

Rosacea is a very common skin disorder in the clinical practice that primarily affects the convex areas of the face. Extrafacial rosacea lesions have occasionally been described, but extensive involvement is exceptional. In the absence of its typical clinical or histological features, the diagnosis of extrafacial rosacea may be problematic. We describe an unusual case of rosacea with very exuberant extrafacial lesions, when compared with the limited involvement of the face

Diagnóstico Pré-Natal de Uropatia: Importância do Desenvolvimento Embriológico Renal

As uropatias malformativas constituem a principalcausa de anomalia neonatal nao letal. Estas anomalias do desenvolvimento devem ser interpretadas com base no conhecimento da morbilidade e, em alguns casos, a mortalidade associada a este tipo de patologia 1,2. As malformações congénitas devem ser pensadas com base no conhecimento da dinâmica do normal desenvolvimento embrionário e dos múltiplos factores reguladores intervenientes, so assim será possivel estabelecer estratégias eficazes de investigação e terapêutica

CIDP na Idade Pediátrica - Desafio Diagnóstico

Introdução: A polirradiculoneuropatia desmielinizante inflamatória crónica (CIDP) é uma patologia auto-imune caracterizada pela desmielinização dos nervos periféricos e raízes espinhais, rara na idade pediátrica. Apresenta-se de forma progressiva ou mais raramente recorrente, tornando-se por vezes difícil o seu diagnóstico e o diagnóstico diferencial com Síndrome de Guillain-Barré. Caso Clínico: Criança de 3 anos, com quadro de dor nos membros superiores e inferiores, proximal, simétrica, de agravamento nocturno, associada a recusa ou dificuldade no início da marcha e com 5 dias de evolução, sem outra sintomatologia acompanhante. Refere 2 episódios semelhantes nos 6 meses precedentes, com resolução espontânea em alguns dias. Nas 4 semanas prévias ao actual episódio, apresentou uma gastroenterite aguda sem agente isolado. Objectivamente salienta-se ausência de sinais inflamatórios locais, dor à mobilização dos membros (com possível sinal de Lasègue), diminuição da força muscular (grau 4) proximal e distal nos membros superiores e inferiores, tremor postural e intencional nos membros superiores, reflexos miotáticos presentes nos membros superiores mas ausentes nos inferiores e instabilidade na marcha. Não havia história de exposição a drogas ou tóxicos nem história familiar de neuropatia. Avaliação analítica para doenças auto-imunes e ecografias articulares não revelaram alterações. O estudo electromiográfico (EMG) demonstrou aumento das latências distais, com diminuição das velocidades de condução e atraso/dispersão das ondas F em múltiplos nervos. A análise do LCR revelou dissociação albumino-citológica. Estudo etiológico do LCR, sangue e fezes com resultados negativos. Em D9 de doença pela persistência das queixas álgicas, repetiu o EMG demonstrando agravamento da polineuropatia. Fez Imunoglobulina intravenosa (0,4 g/Kg/dia) durante 5 dias, com melhoria progressiva da sintomatologia e recuperação parcial da capacidade funcional. Discussão: O diagnóstico de CIDP baseia-se em elementos clínicos (interpretamos como episódios recorrentes de neuropatia num período de cerca de 6 meses, embora a nossa observação da criança seja apenas a actual) e no estudo electrofisiológico (reúne critérios de diagnóstico). Está planeada biópsia de nervo para confirmação diagnóstica embora nem todas as guidelines considerem necessária esta investigação. É importante diagnosticar precocemente a CIDP de forma a instituir a terapêutica mais adequada, determinante para o prognóstico

Urotensin II-Induced Increase in Myocardial Distensibility Is Modulated by Angiotensin II and Endothelin-1

Endogenous regulators, such as angiotensin-II (AngII), endothelin-1 (ET-1) and urotensin-II (U-II) are released from various cell types and their plasma levels are elevated in several cardiovascular diseases. The present study evaluated a potential crosstalk between these systems by investigating if the myocardial effects of U-II are modulated by AngII or ET-1. Effects of U-II (10(-8), 10(-7), 10(-6) M) were tested in rabbit papillary muscles in the absence and in the presence of losartan (selective AT, receptor antagonist), PD-145065 (nonselective ET-1 receptors antagonist), losartan plus PD-145065, AngII or ET-1. U-II promoted concentration-dependent negative inotropic and lusitropic effects that were abolished in all experimental conditions. Also, U-II increased resting muscle length up to 1.008 +/- 0.002 L/L(max). Correcting it to its initial value resulted in a 19.5 +/- 3.5 % decrease of resting tension, indicating increased muscle distensibility. This effect on muscle length was completely abolished in the presence of losartan and significantly attenuated by PD-145065 or losartan plus PD-145065. This effect was increased in the presence of AngII, resulting in a 27.5 +/- 3.9 % decrease of resting tension, but was unaffected by the presence of ET-1. This study demonstrated an interaction of the U-II system with the AngII and ET-1 systems in terms of regulation of systolic and diastolic function

Hereditary Neuropathy with Liability to Pressure Palsy Presenting with Hand Drop in a Young Child

Hereditary neuropathy with liability to pressure palsy (HNPP) results from the deletion of the PMP22 gene in chromosome 17p11.2. Clinically, it presents with painless pressure palsies, typically in the 2nd and 3rd decades of life, being a rare entity in childhood. We present the case study of a six-year-old male child who presented with left hand drop that he kept for over four weeks. Electrophysiological studies suggested HNPP and genetic studies confirmed it. With this paper, we pretend to create awareness to this entity as a diagnosis to be considered in a child with painless monoparesis and to emphasize the importance of electrophysiological studies in the diagnosis

Parental health literacy and the use of pediatric emergency services

A literacia em saúde pode ser definida, entre outras, como o nível da capacidade dos indivíduos para obter, processar e perceber informação de saúde básica e os serviços necessários para realizar decisões apropriadas sobre a sua saúde. Neste sentido, o objetivo deste estudo é identificar qual a literacia em saúde dos pais e cuidadores das crianças utilizadoras dos serviços de urgência pediátrica (SUP). Para tal, realizou-se uma revisão integrativa da literatura nas bases de dados CINAHL, MEDLINE e PUBMED, para artigos com menos de cinco anos, com a seguinte equação de pesquisa: [(health literacy OR parental education OR caregiver education) AND (child* OR adolesc* OR paediatric) AND (emergency department OR emergency room OR emergency unit)]. Após aplicação dos critérios de inclusão e exclusão obteve-se uma amostra final de sete artigos. Da análise realizada verificou-se uma elevada prevalência de baixa literacia em saúde, representando em média 63,71% dos inquiridos, com IC 95% ]61-66[. Outros determinantes sociais da saúde, como o nível de rendimento, a etnia e o tipo de seguro de saúde estão também descritos como fatores adjacentes à reduzida literacia em saúde. A baixa literacia em saúde está presente em grande parte dos cuidadores das crianças utilizadores do SUP sendo que esta problemática pode influenciar fenómenos como a recorrência aos serviços de saúde e/ou a incorreta compreensão do tratamento necessário.info:eu-repo/semantics/publishedVersio

Modulation of Myocardial Stiffness by beta-Adrenergic Stimulation Its Role in Normal and Failing Heart

The acute effects of ß-adrenergic stimulation on myocardial stiffness were evaluated. New-Zealand white rabbits were treated with saline (control group) or doxorubicin to induce heart failure (HF) (DOXO-HF group). Effects of isoprenaline (10 -10-1 -5 M), a non-selective ß-adrenergic agonist, were tested in papillary muscles from both groups. In the control group, the effects of isoprenaline were also evaluated in the presence of a damaged endocardial endothelium, atenolol (ßi-adrenoceptor antagonist), ICI-118551 (ßz-adrenoceptor antagonist), KT-5720 (PKA inhibitor), L-NNA (NO-synthase inhibitor), or indomethacin (cyclooxygenase inhibitor). Passive length-tension relations were constructed before and after adding isoprenaline (10 -5 M). In the control group, isoprenaline increased resting muscle length up to 1.017±0.006 L/L max. Correction of resting muscle length to its initial value resulted in a 28.5±3.1% decrease of resting tension, indicating decreased muscle stiffness, as confirmed by the isoprenaline-induced right-downward shift of the passive lengthtension relation. These effects were modulated by ßr and ß 2adrenoceptors and PKA. In DOXO-HF group, the effect on myocardial stiffness was significantly decreased. We conclude that ß-adrenergic stimulation is a relevant mechanism of acute neurohumoral modulation of the diastolic function. Furthermore, this study clarifies the mechanisms by which myocardial stiffness is decreased. (c) 2011 Institute of Physiology v.v.i., Academy of Sciences of the Czech Republic, Prague, Czech Republic

Echocardiographic evaluation including tissue Doppler imaging in New Zealand white rabbits sedated with ketamine and midazolam

Limited data are available on the use of more recent echocardiographic parameters in the rabbit. Echocardiographic examination, including conventional echocardiography and tissue Doppler imaging (TDI), was performed on 26 male New Zealand white rabbits under ketamine-midazolam sedation. Particular emphasis was placed on the more recent systolic and diastolic parameters, such as myocardial performance index (Tei index) and mitral annular motion (from septal and lateral sides of the left ventricle) obtained using pulsed TDI. Parameters that assessed systolic and diastolic function (fractional shortening, Tei index, and maximal mitral E- and A-wave velocities) were comparable to those reported in the literature for rabbits in the awake state. The less cardiodepressive anaesthetic protocol could offer a good alternative in performing echocardiographic evaluation whenever such caution is necessary. TDI is feasible in healthy rabbits and potentially suitable for the investigation of left ventricle systolic and diastolic function

Reliability Loss with Sampling Rate Reduction

High sampling frequency is not usually available in hospital monitoring systems, what can limit the usefulness of the data, namely for repolarization measures. In this work the reliability of beat-to-beat measures using low sampling frequency is quantified with respect to the original high sampling rate. ECG recordings originally at 1000 Hz, including intensive care patients data, were downsampled to 500 Hz and to 250 Hz. Automatic delineation was applied to extract beat-to-beat intervals. The reliability was measured considering concordance correlation coefficient (CCC) and intraclass correlation coefficient (ICC); the Information-based measure of disagreement (IBMD) was used for agreement quantification. High reliability and low disagreement were generally found. Using the conventional interpretation excellent consistency was found at 250 HZ for more than 68%, 50%, 50% and 58% of the cases for RR, RT QT and QT(c), respectively. Results indicate that at 250 Hz RR, RT QT and QT(c) measures are still reliable compared with the values at 1000 Hz