Desmoid tumors are the main extraintestinal manifestation of FAP, presenting high morbidity and mortality. It is a neoplasia without metastasis capacity, but with infiltrative growth and with a high ...rate of recurrence. In familial forms, these tumors are associated with a germinal mutation in the APC gene, with a genotype–phenotype correlation influenced by other risk factors.
A review of articles published since the year 2000 in Portuguese, English or Spanish on desmoid tumors in patients with FAP was carried out. A total of 49 publications were included.
The site of the mutation in the APC gene is related to the severity of FAP and to the frequency of desmoid tumor. Mutations located distally to codon 1309 are associated with a more attenuated polyposis, but with higher frequency of desmoid tumors. Clinically, these tumors may or may not be symptomatic, depending on their size and location. In their treatment, priority should be given to medical therapy, especially in intra-abdominal tumors, with surgery being the last option if there are no other complications.
These tumors are associated with certain risk factors: genetic (mutation site), hormonal (estrogenic environment) and physical (surgical trauma) ones. In young women, a later prophylactic colectomy is suggested. Moreover, the laparoscopic approach to prophylactic surgery seems to be an option that reduces surgical trauma and consequently the appearance of desmoid tumors.
The step-up medical approach has been shown to be valid in the treatment of intra-abdominal desmoid tumors, and medical treatment should be the first therapeutic option.
Os tumores desmóides são a principal manifestação extraintestinal da PAF, apresentando elevada morbimortalidade. É uma neoplasia sem capacidade de metastização, mas com crescimento infiltrativo e com alta taxa de recorrência. Nas formas familiares associa-se a uma mutação germinativa no gene APC, havendo uma correlação genótipo-fenótipo influenciada por outros fatores de risco.
Foi efetuada uma revisão de artigos publicados desde o ano 2000, em português, inglês ou espanhol, acerca de tumores desmóides em doentes com PAF. Foram incluídas, no total, 49 publicações.
O local da mutação no gene APC relaciona-se com a gravidade da PAF e frequência de tumor desmóide. Mutações localizadas distalmente ao codão 1309 associam-se a uma polipose mais atenuada, mas a maior frequência de tumor desmóide. Clinicamente podem ser, ou não, sintomáticos, dependendo do seu tamanho e localização. No seu tratamento deve ser dada prioridade à terapêutica médica, sobretudo nos tumores intra-abdominais, colocando a cirurgia como última opção, caso não hajam outras complicações.
Estes tumores associam-se a determinados fatores de risco: genéticos (local da mutação), hormonais (ambiente estrogénico) e físicos (trauma cirúrgico). Nas mulheres jovens sugere-se a realização de colectomia profilática mais tardiamente. Além disso, a abordagem laparoscópica para a cirurgia profilática parece ser uma opção que diminui o trauma cirúrgico e consequentemente o aparecimento de tumores desmóides.
A abordagem médica em step-up mostrou ser válida no tratamento de tumores desmóides intra-abdominais, devendo o tratamento médico ser a primeira opção terapêutica.
This work aimed to investigate the chemical composition, antimicrobial, antinociceptive, acute toxicity and antioxidant activity of the essential oil of Algrizea minor (EOAm). The essential oil ...presented as the major constituents β-Pinene (56.99%), α-Pinene (16.57%), Germacrene D (4.67%), Bicyclogermacrene (4.66%), (E)-Caryophyllene (3.76%) and Limonene (1.71%). It was verified that the essential oil did not show acute toxicity in the maximum dose of 5,000 mg/kg. In the evaluation of the antinociceptive activity it was verified that the essential oil reduced in 65.84% the number of writhing in the mice, reducing the pain in 59.17%, and the mechanism of action in pain reduction was opioid, similar to morphine. The essential oil also presented significant antimicrobial against Gram positive and Gram-negative bacteria and fungi, and the antioxidant activity was relevant. Therefore, these results demonstrate the great potential for the future development of pharmaceutical products with the essential oil of Algrizea minor (EOAm).
INTRODUCTIONThis study investigated the genetic environment of bla KPC-2 in Klebsiella pnemoniae multi-drug resistant clinical isolates. METHODSFour carbapenemase gene isolates resistant to ...carbapenems, collected from infected patients from two hospitals in Brazil, were investigated using polymerase chain reaction and plasmid DNA sequencing. RESULTSThe bla KPC-2 gene was located between ISKpn6 and a resolvase tnpR in the non-Tn4401 element (NTEKPC-IId). It was detected on a plasmid belonging to the IncQ1 group. CONCLUSIONSTo our knowledge, this is the first report of the presence of the bla KPC-2 gene in the NTEKPC-IId element carried by plasmid IncQ1 from infections in Brazil.
Bilateral diaphragm paralysis due to bilateral isolated phrenic neuropathy (BIPN) is a very rare cause of unexplained respiratory failure. We present a 65-year-old patient with no relevant previous ...medical history who presented in the Pulmonology Clinic with mMRC1 dyspnoea and orthopnoea. After the medical work-up, diaphragmatic paresis was diagnosed. Inspiratory muscle training resulted in mild symptomatic improvement and treatment with noninvasive mechanical ventilation (NIV) was initiated. This condition is generally chronic and has a poorer prognosis, compared to other cases of phrenic nerve involvement. In this case, NIV restored near-normal daily function.
Besides being a rare cause of dyspnoea, diaphragmatic dysfunction should be considered in the medical evaluation.Noninvasive mechanical ventilation is the mainstay of treatment for symptomatic patients.Neurologic and electrodiagnostic evaluation is essential, since the differential diagnosis of phrenic nerve dysfunction may imply different treatment strategies.
This study aimed to evaluate the response of bacteria, in terms of microbial community structure, from constructed wetland (CW) microcosms exposed to two veterinary antibiotics, enrofloxacin (ENR) ...and ceftiofur (CEF), alone or in a mixture, identifying which bacterial groups were dominant in CWs substrate during livestock wastewater treatment. Wastewater, not-doped or doped with ENR and/or CEF (100 µg/L each), was treated during 18 one-week cycles. Systems showed removal percentages > 85% for the added antibiotics, showing also high removal percentages for nutrients and organic matter and confirming CWs systems were working properly. However, both time of exposure and presence of antibiotics influenced significantly CWs substrate bacterial community structure. Pyrosequencing results showed bacterial communities were dominated by phyla Proteobacteria (38–48%), Firmicutes (20–27%), Bacteroidetes (12–15%) and Actinobacteria (4–9%), and that their relative abundance was clearly affected by the presence of the antibiotics. Results suggest the applicability of CWs for the removal of veterinary antibiotics from livestock wastewaters and provide new knowledge about the bacteria within the system, which can potentially be involved in removal processes. This information could in the future be used to improve CWs removal rates of pharmaceuticals from livestock wastewaters.
•Time of exposure influenced significantly substrate bacterial community structure.•Relative abundance of bacterial communities phyla clearly affected by antibiotics presence.•Despite this, constructed wetlands showed antibiotics removals higher than 90%.
Hymenaea cangaceira Pinto, Mansano & Azevedo (Fabaceae) is a Brazilian medicinal plant widely known as “Jatobá”. In folk medicine, it is used to treat infections, respiratory problems, rheumatism, ...antitumoral, inflammation and pain, however, no activity has been scientifically validated.
This study investigated chemical composition of essential oil from Hymenaea cangaceira (EOHc), antimicrobial, antinociceptive and antioxidant activities besides protection against DNA damage and hemolysis.
The essential oil was obtained by hydrodistillation, and characterized by GC-MS and GC-FID. The evaluation of antimicrobial activity was performed by microdilution method. The evaluation of the antioxidant activity was performed using the radicals DPPH, ABTS, O2- and OH-, and the protection of DNA damage using plasmid pBR322. Different experimental models were used to evaluate the antinociceptive effect (acetic acid and formalin), and evaluate the mechanisms of action involved with pharmacological antagonists (naloxone, atropine and gibenclamide) in mice. The essential oil was evaluated for hemolysis on human erythrocytes.
The extraction of EOHc showed a yield of 0.18% on a dry basis, presenting high content of hydrocarbon sesquiterpenes (79.04%), high antioxidant activity and protect DNA from damage, besides presenting antifungal and antibacterial activity against Gram-positive and Gram-negative bacteria in vitro. It was found that the essential oil had no acute toxicity in mice up to 5000 mg/kg oral administration (o.a.), in addition to no hemolysis on human erythrocytes. The reduction of antinociceptive activity was 75%, with the opioid system as the mechanism of action.
Our results validate the main activities by the traditional use attributed to H. cangaceira for antimicrobial and analgesic activity. In addition, the oil has a potent antioxidant activity, protecting the body against oxidative stress damage, adding new value to an endemic species not known to the industry.
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Autologous bone remains the gold standard grafting substrate for bone fusions used for small gaps and critical defects. However, significant morbidity is associated with the harvesting of autologous ...bone grafts and, for that reason, alternative bone graft substitutes have been developed. In the present case series, a glass-reinforced hydroxyapatite synthetic bone substitute, with osteoinductive and osteoconductive proprieties, was applied. This synthetic bone substitute comprises the incorporation of P
O
-CaO glass-based system within a hydroxyapatite matrix, moulded into spherical pellets with 250-500 μm of diameter. A total of 14 veterinary clinical cases of appendicular bone defects and maxillary / mandibular bone defects are described. In all clinical cases, the synthetic bone substitute was used to fill bone defects, enhancing bone regeneration and complementing the recommended surgical techniques. Results demonstrated that it is an appropriate synthetic bone graft available to be used in veterinary patients. It functioned as a space filler in association with standard orthopaedic and odontological procedures of stabilization, promoting a faster bone fusion without any local or systemic adverse reactions. This procedure improves the animals' quality of life, decreasing pain and post-operative recovery period, as well as increasing bone stability improving positive clinical outcomes.
ISO 9001 European Scoreboard: an instrument to measure macroquality Sampaio, Paulo Alexandre da Costa Araújo; Saraiva, Pedro Manuel Tavares Lopes de Andrade; Gomes, Ana Catarina Ribeiro
Total quality management & business excellence,
02/2014, Letnik:
25, Številka:
3-4
Journal Article
Recenzirano
Odprti dostop
Purpose: ISO 9001 certification is nowadays considered to be one of the most effective tools that can be adopted for guiding the management of Quality Systems. The stunning growth observed by these ...standards all over the world confirms a strong polarisation of enterprises' interest in this practice. Owing to the wide incidence of this phenomenon, a deep investigation of ISO 9001 diffusion over time is mandatory and of importance. In line with our previous publications, this paper derives from a research project that we are conducting in Portugal in order to develop the 'ISO 9001 European Scoreboard', aimed at studying and ranking European Union (EU) countries based on the diffusion of quality management systems. Methodology/approach: In order to achieve such a goal, the authors have performed a set of statistical analyses over public data sets. Findings: Based on the model developed and the analyses performed, we were able to identify clusters of countries with different ISO 9001 evolution stages, derived from the ISO 9001 per 1000 inhabitants' scores and countries' growth indexes. Originality: With this scoreboard, we are able to categorise and rank countries based on the quality management systems evolution (growth rates) over the past few years. Ultimately, such an 'ISO 9001 European Scoreboard' will be an instrument to provide a comparative assessment of quality management practices over the EU states, leading to the dynamic evaluation of their 'macroquality' levels achieved, according to such a standard. We believe that such results provide an additional important contribution to the study of management systems diffusion/evolution, aimed at providing more fact-based insights and understandings.
Low Back Pain: A Pain That May Not Be Harmless Lucas, Catarina; Costa, Joana; Paixão, Joana ...
European journal of case reports in internal medicine,
2018, Letnik:
5, Številka:
3
Journal Article
Recenzirano
Odprti dostop
Abdominal aortic aneurysms are defined as vascular dilatations greater than 50% of the normal proximal segment or those that have a maximum diameter above 3 cm. Risk factors include male gender, age ...over 75 years, history of vascular pathology, hypertension and arteriosclerosis. The Authors describe a case of a 74-year-old man, evaluated in an emergency setting for right lumbar pain lasting 4 days. The pain did not respond to analgesia and became progressively worse. Due to the severity of symptoms, CT angiography was performed, which showed an active rupture of a partially contained aneurysm associated with aortic dissection. Early diagnosis and timely management of aortic aneurysms are essential in preventing complications, namely rupture (50-83% patients die after rupture and before receiving medical care). Acute aortic dissection is a surgical emergency and the risk of rupture is proportional to the size of the aneurysm and its rate of growth.
This article shows how difficult it is sometimes to make the right diagnosis in an emergency department.Although a very common symptom, low back pain should not be regarded as harmless.
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