PARAGANGLIOMA E ANGIOEDEMA

Paragangliomas or extra-adrenal pheochromocytomas are rare tumors that arise from chromaffin tissues and tend to occur either sporadically or in the context of complex genetic disorders. They are clinically heterogeneous in nature - symptoms deriving either from the secretory profile of the tumor or from the mass effect of the neoplasm. Dermatologic symptoms are quite seldom described in the literature and have been classified in acute or chronic. The case of a 40 YO Caucasian female that had been enduring for the last 2 years recurring self-limited episodes of angioedema, diarrhoea, chest pain, hypertension or hypotension, dyspnoea and anxiety is reported. Biochemical studies and further imagiologic work up and, later on, pathologic exam allowed to identify a paraganglioma that drained to the left renal artery. Upon surgery, during tumor manipulation, the patient developed an additional systemic crisis that required active life support. Recovery was regular, with a quick and sustained normalization of lab results as well as on the clinical side, with no further episode for the last 17 years.Paragangliomas ou Feocromocitomas extra-suprarrenais são tumores raros derivados do tecido cromafim que tendem a ocorrer esporadicamente ou no contexto de doenças genéticas complexas. São tumores com apresentação clínica variada, dependente do seu perfil secretório ou do efeito de massa determinado pela neoplasia. Sintomas dermatológicos são raros, tendo sido classificados como agudos/paroxísticos ou crónicos. É apresentado caso de uma Eurocaucasiana de 40 anos de idade que referia, nos últimos 2 anos, episódios auto-limitados de angioedema, diarreia, toracalgia, hiper ou hipotensão arterial, dispneia e ansiedade. Estudos laboratoriais e, posteriormente, avaliação imagiológica e exame patológico permitiram identificar um paraganglioma drenante para a veia renal esquerda, o qual foi extirpado com sucesso. Durante a cirurgia, a manipulação do tumor desencadeou uma nova crise grave, a qual exigiu, com carácter de emergência, a instituição de medidas de suporte avançado de vida. A recuperação decorreu sem incidentes, tendo-se verificado uma rápida regularização dos valores laboratoriais a par de uma remissão clínica completa, sem novos episódios verificados durante 17 anos

FARELO DO MESOCARPO DE BABAÇU NA TERMINAÇÃO DE TOURINHOS: CARACTERÍSTICAS DA CARCAÇA E CORTES SECUNDÁRIOS DO TRASEIRO ESPECIAL

We evaluated carcass characteristics, weight and percentage of prepared commercial cuts of the primal pistol cut (PC) of 30 young crossbred bulls fed diets which included replacement levels (0, 25, 50, 70 and 100% of the dry matter, DM) of corn by babassu mesocarp bran (BMB). The experiment was a completely randomized design with six replicates. Slaughter weight was not affected by treatments. Hot and cold carcass weights decreased linearly (P<.05) at 230 g and 250 g, respectively, for each 1 kg of replacement, and hot carcass yield (HC) decreased by 3.2 g/kg of HC for each 1 kg of DM of BMB in the diet (P<0.05). Subcutaneous fat thickness presented a quadratic (P<.05) response with maximum point estimated by the regression equation of 4.29 mm with 33.3% substitution. The proportion of PC of the carcass increased linearly as levels of BMB in the diet increased (P<.05). The percentage of side cut showed a quadratic response (P<.05), with maximum point estimated with 33.3% substitution. The weight of the prepared commercial cuts of the PC, striploin, knuckle and eye round, and the percentage of tenderloin, topside and shank, were influenced by the diet (P<0.05). There was no change in prepared meat cuts yields of PC (73.22%) (P<.05). The use of babassu mesocarp bran to replace corn in cattle finishing diets does not affect the weight and meat yield of the pistol cut, but decreases linearly hot carcass weight, and subcutaneous fat thickness at replacement levels above 33.3%

PHEOCHROMOCYTOMA AND NEUROFIBROMATOSIS 1

Introdução: Feocromocitomas são tumores originários de células cromafins do sistema simpato-adrenal. As suas manifestações clínicas são múltiplas e diversificadas, função do perfil secretório variável de múltiplos compostos, incluindo catecolaminas, neuropéptidos e outros compostos vasoactivos. A Neurofibromatose 1 (D de von Recklinghausen), a mais prevalente das variantes das neurofibromatoses, é genodermatose transmitida segundo padrão mendeliano autossómico dominante. O diagnóstico de NF1 assenta em critérios diagnósticos, entre os quais as alterações cutâneas, oculares e esqueléticas são as mais relevantes, embora múltiplas neoplasias envolvendo diversos orgãos e sistemas não possam ser esquecidas ou sub-valorizadas já que é bem conhecido que o produto genético do gene alterado da NF1 – a neurofibromina – é uma proteina de supressão tumoral. Feocromocitomas ocorrem em menos de 1% dos doentes com NF1; por outro lado, apenas 5% dos casos reportados de feocromocitoma estão associados com a NF I. No entanto, entre doentes hipertensos com NF1, a prevalência de feocromocitoma pode atingir os 50%.Caso clínico: É relatado caso de eurocaucasiana de 27 A de idade, com diagnóstico de NF1 com história de 4 meses de cólicas abdominais, hiperhidrose generalizada, dispneia e hipertensão arterial paroxística. As catecolaminas e metanefrinas urinárias estavam aumentadas e a exploração topográfica levada a cabo (RMN e I-MIBG) permitiram detectar uma massa na glândula suprarrenal direita, a qual, após adrenalectomia confirmou o diagnóstico de feocromocitoma. Conclusão: O caso apresentado enfatiza a necessidade de uma abordagem multissistémica, multidisciplinar a doentes com NF1, tendo em conta as manifestações sistémicas associadas, na base de um prognóstico por vezes fechado da doença.Introduction: Pheochromocytomas are tumours arising from chromaffin cells in the sympathetic nervous system. Clinical manifestations are protean, function of the variable secretory profile of several compounds including catecolamines, neuropeptides and other vasoactive molecules. Neurofibromatosis I (von Recklinghausen`s disease), a prevalent autosomal dominant disorder, is the most prevalent type among the neurofibromatoses. Among the diagnostic criteria proposed by the NIH Consensus Conference on Neurofibromatosis (1987), cutaneous, ocular and skeletal alterations are most relevant, although neoplastic disease involving a number of distinct organs cannot be overlooked as the altered NF I - gene product -neurofibromin - is a tumour supressor protein. Pheochromocytoma is a tumour that occurs in less than 1% of NF I patients; only 5% of pheochromocytoma reported cases are related to NF I. Nevertheless, among hypertensive NF I patients, the prevalence of pheochromocytoma may account for about 50%.Case report: The case of a 27 YO Caucasian NF I female patient, with a 4 month history of episodes of colicky abdominal pain, hyperhidrosis, dyspnoea and paroxystic hypertension is reported. Urinary catecholamines and metanephrines were raised and the topographic work up (RMN and I-MIBG) disclosed a right adrenal mass that, upon adrenalectomy, confirmed the diagnosis of Pheochromocytoma.Conclusion:  This case report intends to re-emphasize the relevance of a multisystem, multidisciplinary approach to NF I patients, bearing in mind the systemic, often ominous nature of the associated com plications

Reserva estratégica do medicamento – uma ferramenta (in)vulgar

Como têm respondido as Forças Armadas à emergência COVID-19? Que impactos tem esta crise na organização e nas missões militares? Em que medida afetará os recursos que lhes são alocados, ou o peso relativo de diferentes serviços ou áreas internamente? Que lições para a articulação com outras forças de segurança e organizações civis? Estas são algumas das questões que colocámos aos especialistas convidados neste IDN Brief. Para além de participantes nacionais desafiámos também analistas de França, Reino Unido, Holanda, Canadá e África do Sul que nos trazem reflexões a partir da experiência dos seus países. Os desafios que enfrentamos exigem cada vez mais partilha de informação, aprendizagem cruzada e respostas cooperativas.info:eu-repo/semantics/publishedVersio

Identification of clusters of asthma control: A preliminary analysis of the inspirers studies

This work was funded by ERDF (European Regional Development Fund) through the operations: POCI- -01-0145-FEDER-029130 (“mINSPIRERS—mHealth to measure and improve adherence to medication in chronic obstructive respiratory diseases - generalisation and evaluation of gamification, peer support and advanced image processing technologies”) co-funded by the COMPETE2020 (Programa Operacional Competitividade e Internacionalização), Portugal 2020 and by Portuguese Funds through FCT (Fundação para a Ciência e a Tecnologia).© 2020, Sociedade Portuguesa de Alergologia e Imunologia Clinica. All rights reserved. Aims: To identify distinct asthma control clusters based on Control of Allergic Rhinitis and Asthma Test (CARAT) and to compare patients’ characteristics among these clusters. Methods: Adults and adolescents (≥13 years) with persistent asthma were recruited at 29 Portuguese hospital outpatient clinics, in the context of two observational studies of the INSPIRERS project. Demographic and clinical characteristics, adherence to inhaled medication, beliefs about inhaled medication, anxiety and depression, quality of life, and asthma control (CARAT, >24 good control) were collected. Hierarchical cluster analysis was performed using CARAT total score (CARAT-T). Results: 410 patients (68% adults), with a median (percentile 25–percentile 75) age of 28 (16-46) years, were analysed. Three clusters were identified [mean CARAT-T (min-max)]: cluster 1 [27(24-30)], cluster 2 [19(14-23)] and cluster 3 [10(2-13)]. Patients in cluster 1 (34%) were characterised by better asthma control, better quality of life, higher inhaler adherence and use of a single inhaler. Patients in clusters 2 (50%) and 3 (16%) had uncontrolled asthma, lower inhaler adherence, more symptoms of anxiety and depression and more than half had at least one exacerbation in the previous year. Further-more, patients in cluster 3 were predominantly female, had more unscheduled medical visits and more anxiety symp-toms, perceived a higher necessity of their prescribed inhalers but also higher levels of concern about taking these inhalers. There were no differences in age, body mass index, lung function, smoking status, hospital admissions or specialist physician follow-up time among the three clusters. Conclusion: An unsupervised method based on CARAT--T, identified 3 clusters of patients with distinct, clinically meaningful characteristics. The cluster with better asthma control had a cut-off similar to the established in the validation study of CARAT and an additional cut-off seems to distinguish more severe disease. Further research is necessary to validate the asthma control clusters identified.publishersversionpublishe

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

Effect of water aerobics on the functional autonomy of the elderly population

OBJECTIVE: To assess the effect of water aerobics exercise on the functional autonomy of the elderly. METHODS: Thirty-eight elderly subjects (aged 60-75 years) were randomly selected and divided into two groups: sedentary elderly subjects (GIS N = 19) and elderly subjects who practiced water aerobics three times a week, 50 minutes per session, for six months (GIH; N = 19). The subjects in GIS did not participate in any activity during this period. Physical aptitude was assessed using a battery of tests from the Latin American Development Group for the Elderly (LADGE), which measure activities of daily life: a 10-min walk (10mW), getting up from a seated position (GSP), getting up from the prone position (GPP), getting up from a chair and moving around (GCM), and putting on/taking off a shirt (PTS). All data are expressed in seconds. Differences between groups were analyzed using descriptive and inferential statistics (SPSS software, version 16.0 for Windows). RESULTS: The level of functional autonomy was higher in G1 than in G2 (p &lt; 0.05). CONCLUSION: We found that practice of water aerobics contributes to the improvement and maintenance of functional autonomy of the elderly. Increased autonomy positively affects self-esteem and ultimately enhances the quality of life of the elderly.</p

CARCASS CHARACTERISTICS OF NELORE X LIMOUSIN BULLS FED WITH DIETS CONTAINING CORN GERM MEAL CARACTERÍSTICAS DA CARCAÇA DE TOURINHOS NELORE X LIMOUSIN ALIMENTADOS COM DIETAS CONTENDO GÉRMEN DE MILHO INTEGRAL

&lt;p class="western" style="margin-bottom: 0cm; line-height: 150%" align="justify"&gt;Quantitative characteristics of the carcass of feedlot finished Nelore X Limousin bulls, receiving diets containing 0%, 15%, 30% and 45% corn germ meal (CGM) were evaluated. The initial average weight and age were 321.25 kg and 20 months, respectively. The experimental diets were composed by 25% of roughage and 75% of concentrate. Each 1% CGM inclusion provided the increase of 0.62 kg in the slaughter weight. The CGM addition to the diets provided linear increases in the weights of the hot and cold carcasses. There were no differences for hot and cold carcasses dressing percentages and chilling loss for the different diets. Observed averages were 55.21%; 54.42% and 0.78%, respectively. The hindquarter (pistol) (48.53%), spare ribs (11.66%) and forequarter (39.8%) cuts did not alter with the CGM inclusion in the diets. The weights and percentages of the commercial cuts of the hindquarter were, also not influenced by the CGM addition. Diets containing up to 45% of CGM can be supplied to feedlot finishing bovine, providing higher body and carcass weights, without affecting carcass yields. &lt;br /&gt;&lt;br /&gt;KEY WORDS: By-products, commercial cuts, carcass evaluation, carcass yield.&lt;/p&gt;&lt;p class="western" style="margin-bottom: 0cm; line-height: 150%" align="justify"&gt; &lt;/p&gt; Foram avaliadas as características quantitativas das carcaças de 24 tourinhos Nelore X Limousin submetidos a dietas contendo 0%, 15%, 30% e 45% de gérmen de milho integral (GMI), terminados em confinamento, com peso e idade média inicial de 321,25 kg e vinte meses, respectivamente. A dieta total conteve 25% de volumoso e 75% de concentrado. Cada 1% de inclusão de GMI às dietas proporcionou ganhos de 0,62 kg no peso de abate dos animais. Os pesos da carcaça quente e carcaça fria mostraram comportamento linear crescente (p&lt;0,05) à medida que foi incluído GMI às dietas. Contudo, as adições de GMI às dietas não influenciaram os rendimentos de carcaça fria e quente ou quebra pelo resfriamento, observando-se médias de 55,21%; 54,42% e 0,78%, respectivamente. Os cortes traseiro especial (48,53%), ponta-de-agulha (11,66%) e dianteiro (39,80%) não alteraram com a inclusão de GMI às dietas. Os cortes comerciais do traseiro especial e seu rendimento não foram influenciados pelos tratamentos. Conclui-se que o GMI pode ser adicionado às dietas de bovinos machos Nelore X Limousin inteiros em até 45% da dieta, proporcionando maiores pesos de abate e carcaças mais pesadas, sem afetar as características de rendimento da carcaça. &lt;br /&gt;&lt;br /&gt;PALAVRAS-CHAVES: Avaliação de carcaças, cortes comerciais, rendimento de carcaça, subprodutos agroindustriais.&lt;p class="western" style="margin-bottom: 0cm; line-height: 150%" align="justify"&gt; &lt;/p&gt