Allergic sensitization to storage dust mites: a prospective study of patients with respiratory allergy

Summary

Objectives. To describe the prevalence of allergic sensitization to Storage Dust Mites (SDM), access whether the place of living and occupational exposure were determinants for SDM sensitization and study association between Lepidoglyphus destructor and other SDM sensitization. Methods. Prospective analysis of patients evaluated for suspected allergic rhinitis and/or asthma that performed Skin Prick Tests (SPT) to SDM between January and December 2018 in our Department. Results. Two hundred consecutive patients were evaluated for rhinitis and/or asthma in our outpatient consultation: 123 (61.5%) presented positivity for at least one SDM, 68.3% were female and the mean age was 33.1 ± 12.12. Lepidoglyphus destructor (69.9%) was the most prevalent, followed by Tyrophagus putrescentiae (50.4%), Blomia tropicalis and Glycyphagus domesticus (48.8%) and Acarus siro (24.4%). Living in a rural place was not associated with a higher prevalence of sensitization to SDM, except for Acarus siro (p = 0.032), and working in a place with storage areas was not associated with sensitization to any of SDM. Sensitization to Lepidoflyphus destructor was associated with sensitization to Blomia tropicalis, Glycyphagus domesticus and Tyrophagus putrescentiae (p less than 0.005), but not with Acarus siro. Conclusions. Our study suggests that our population, independently of their occupational exposure and place of residency, are sensitized to SDM and that evaluation of sensitization to SDM should be considered as standard practice.

A cohort study among 402 patients with penile cancer in Maranhão, Northeast Brazil with the highest worldwide incidence

Objective

Maranhão State—Northeast Brazil–has the world’s highest incidence of penile cancer. This study describes the epidemiological, histopathological and clinical profile of patients stricken across that Brazilian state. The study is aimed at providing new data on neoplasia.

Data description

402 men stricken with penile cancer were studied from January 2004 to December 2018. A retrospective stage was developed with collection of physical and electronic records. A prospective stage was performed with collection of clinical and epidemiological information through a questionnaire. The surgical material was looked into by a uropathologist, and the lesions were evaluated for macroscopic characteristics and various microscopic parameters. Three articles using this data have already been published.

A silent “shipyard eye”: lessons from an epidemic keratoconjunctivitis outbreak in Portugal

Issue

Adenoviral conjunctivitis is the most common cause of conjunctivitis. Its most severe form is epidemic keratoconjunctivitis (EKC). This highly contagious disease is the only form to significantly involve the cornea and may cause visual impairing sequelae that persist for years.

Description

On January 2020, staff members at a childcare facility (CCF) alerted the Public Health Unit of Loures-Odivelas to a suspected conjunctivitis outbreak. The CCF was responsible for 57 children, separated in different rooms: a nursery (4-12 months), a pre-school (1-3 years) and a kindergarten (4-5 years). At the initial assessment, 4 cases of active disease were identified, all of which were at home and under treatment. CCF staff had previously identified 33 cases. Symptom onset of the index case had occurred more than 5 weeks before the alert. Infection control and epidemiological investigation were initiated. CCF staff was instructed to implement preventive measures, including careful disinfection of surfaces and toys, as well as frequent handwashing. Information about the disease and recommendations were sent to the children's caretakers.

Results

A total of 87 cases distributed in 8 weeks were identified: 28 at the CCF (25 children and 3 workers) and 59 close contacts (50 adults and 9 children). Average duration of disease was 14.1 days. In total, 43.9% of the children attending the CFF were affected. The highest attack rate was observed at the pre-school (69.2%, against 38.9% and 17.6% at the nursery and the kindergarten, respectively). 88.0% of the CCF children's households were affected. The average number of affected close contacts per affected child attending the CCF was 2.63. Corneal involvement was observed in 17,4% of cases.

Lessons

EKC outbreaks may go unnoticed by public health services, despite its high contagiousness and impact. Improvement of communication with organizations in the community is essential to secure future early detection and intervention.

Key messages

Epidemic keratoconjunctivitis is a highly contagious disease with potential long-term consequences. Early detection and intervention by public health services are essential to mitigate the impact of outbreaks and depend on well-established communication lines with institutions in the community.

HIV infection and AIDS reported cases in two municipalities near Lisbon between 2015 and 2019

Background

In the WHO European Region, in 2018, there were 16.2 newly diagnosed HIV infections per 100,000. In Portugal, there were 9.5 new cases per 100,000 population. The aim of this study is to analyse HIV/AIDS's notifications in the group of primary healthcare centres of Loures-Odivelas (ACES LO), with 340,000 inhabitants, between 2015 and 2019.

Methods

An observational, descriptive, retrospective, quantitative study was performed. Data was collected in March 2020, from the National System of Epidemiological Surveillance Database. Variables included were age, sex, HIV's presentation, country of probable origin of infection, probable form of transmission, partner characteristics, pregnancy at diagnosis, reason for testing/consultation, anti-retroviral therapy (ART) before diagnostic of AIDS. Descriptive analysis was performed for all variables.

Results

In ACES LO, there were 83 notified cases of HIV infection/AIDS between 2015 and 2019, with 36.1% of cases notified in 2019. The male to female ratio was 1.4. The average age was 41.7 years old. At time of notification, 56.6% of cases were asymptomatic and 25.3% had clinical criteria for AIDS. Guinea-Bissau was the probable origin of infection in 43.0% of cases (n = 23). Men having sex with men (MSM) was the probable form of transmission in 19.3% of cases. In 19.6% of cases of heterosexual contact, the partner was known to have HIV infection. Six women were pregnant at time of diagnosis. Testing was done on a routine basis in 22.2% of cases (n = 54). Among those with clinical criteria for AIDS (n = 21), 5 cases had previously taken ART.

Conclusions

There was an increase in notified cases of HIV infection/AIDS from 2015 to 2019 in ACES LO. The male to female ratio was lower than for Portugal in 2018.The proportion of cases with AIDS at time of notification was higher than for Portugal in 2018. Preventive strategies should be reinforced for people with partners diagnosed with HIV infection and perhaps for people.

Key messages

More than one third of cases were notified in 2019. Preventive strategies should be reinforced for people with partners diagnosed with HIV infection.

Notification of sexually transmitted infections: the tip of the iceberg?

Background

Sexually transmitted infections (STIs) are a major public health problem in Europe and in Portugal, their incidence has been increasing since the 90s. Although STIs are among the most frequently reported infections globally, they still go often underdiagnosed. Their under notification is also a problem in Portugal. The aim of this study is to describe STIs' notifications in the area of the groups of primary healthcare centers of Loures-Odivelas (ACES LO), between 2015-2019.

Methods

An observational, descriptive, quantitative study was performed. Data was collected in January 2020, from the National System of Epidemiological Surveillance Database. Variables included for each STIs notification were age and sex. Univariate descriptive analysis and evolution trends were performed for each variable.

Results

A total of 638 cases of STIs were reported from 2015 to 2019. The number of reported cases increased from 87 to 197 cases (126.4%). The annual mean incidence of HBV and HCV notifications were 8 and 4, respectively. There was an increase in reported cases of syphilis (33 to 57), HIV (13 to 29), chlamydia (13 to 46) and gonorrhea (18 to 51). In 2019, 30.9% of the notified cases were syphilis infections, 23.5% gonorrhea infections, 22.1% chlamydia infections and 13.2% HIV infections.Males comprised 460 cases (72.1%), and, in patients aged between 15 and 44 years old, 484 cases (75.9%) were reported. From 2015 to 2019, the co-infections of gonorrhea and chlamydia increased from 2 to 10 cases (25.0%). In 2019, 17.5% of the notified cases of gonorrhea were co-infections.

Conclusions

The modification of risk behaviors and the appropriate treatment of infected people, including infected partners, are determinant to prevent recurrent infections and to interrupt the transmission cycle. Increasing notification should facilitate the monitoring of STIs' trends, contributing to the implementation of appropriate interventions and for better decision-making in public health.

Key messages

Campaigns about sexual health promotion are important to increase safer sexual health practices. More notifications contribute to better data quality and more robust decision-making.

A retrospective study of an International Vaccination Centre in the Lisbon Metropolitan Area

Background

Vaccination is one of the most cost-effective disease prevention strategies. Trips from Portugal to other countries have increased in the past 5 years. Depending on the destination, certain vaccines are advised to travellers in order to reduce travel-related risk. We analyzed the data of an International Vaccination Centre (IVC) in the Public Health Unit of the Primary Care Centres Group (ACES) of Loures-Odivelas.

Methods

A retrospective observational study comprising data from an IVC database between 2014 and 2018. Variables included were sex, age, destination, purpose, referral, and prescriptions. Descriptive analyses were performed for all variables.

Results

Between 2014 and 2018, there was a total of 4,873 users. Regarding individual characteristics, 51% were female, 80% had between 15 and 64 years of age, and 51% were referred by general practitioners of the ACES. Africa was the leading destination (66% average for all years) with a downward trend (from 82% in 2014 to 47% in 2018) followed by South America (12%) with an upward trend (from 4% to 16% in the same period). The primary purpose of travelling was tourism (74%) followed by work (15%). A total of 7,323 vaccines were administered, with an annual increase from 1,250 administrations in 2014 to 1,862 in 2018. The yellow fever vaccine accounted for 36,9% of all administrations, followed by typhoid fever vaccine (32,3%) and hepatitis A vaccine (10,2%).

Conclusions

African countries are still the most common destination for Portuguese travellers, but changing trends might influence the vaccination strategies in the IVC. Information provided in the IVC can be optimized to suit individual profiles better.

Key messages

As travelling increases, the International Vaccination Centre has an essential role in the prevention of disease. Africa remains the most common destination, requiring pre-travel health counselling and vaccine prophylaxis.

A retrospective study of a pre-travel consultation in the Lisbon Metropolitan Area, Portugal

Background

Travel from Portugal to other countries has increased in the past 5 years. A pre-travel health consultation is advised to all travellers to raise awareness and reduce travel-related risk. We describe the experience of a pre-travel consultation centre in the public health service.

Methods

A retrospective observational study about consultations in an international vaccination centre between 2014-2018. Variables included were: sex, age, destination, purpose, referral, and prescriptions. Descriptive analyses were performed for all variables.

Results

Between 2014 and 2018, there were 1,546 consultations. Regarding individual characteristics, 54% were female, and 80% had between 15 and 64 years of age. There was no referral in 66% of the consultations, followed by 16% from general practitioners in the Primary Care Centres Group. The leading destination was Africa (54%), in a downward trend (74% in 2015 and 32% in 2018) followed by Asia (18%) with an upward trend (12% to 28% in the same period). The primary purpose was tourism (83%), followed by work (9%). In total, 3,287 vaccines were prescribed with typhoid fever vaccine accounting for 26%, hepatitis A vaccine 22%, and yellow fever vaccine 15%. Mefloquine was the primary therapeutic drug prescribed for destinations with risk for malaria (41%). Regarding destinations with low risk for malaria, in 42% of the consultations, personal protective measures were the only recommendation.

Conclusions

Our data show that pre-travel consultations seem to be valued and actively asked for by travellers, but medical referral is still insufficient. Regarding health promotion and prevention of diseases, tracking trends in the most common destinations allows to optimize the information provided in the consultation, effectively capacitating the traveller to recognize and act on the most common travel-related health risks. In further studies, a post-travel follow-up should be carried out to determine the impact of the consultation.

Key messages

Pre-travel consultation is an actively sought-after service by the community, but awareness should be promoted in the medical community. Pre-travel consultation can have an important role in the health literacy of travellers.

Tuberculosis’ surveillance in a group of primary healthcare centres of Lisbon district

Background

Tuberculosis (TB), a communicable disease, is the leading cause of death from a single infectious agent and one of the top 10 causes of death worldwide. Its burden varies among different countries. In the 31 European Economic Area member states, in 2017, the TB notification rate was 10.7/100,000 population; in Portugal, this rate was 17.5/100,000 population and the majority of the notified cases occurred in two districts: Lisbon and Oporto. The aim of this study is to analyse TB's notifications in a group of primary healthcare centres of Loures-Odivelas (ACES LO), between 2015 and 2019.

Methods

An observational, descriptive, retrospective, quantitative study was performed. Data was collected in January 2020, from the National System of Epidemiological Surveillance Database. Variables included were: age, sex, TB's presentation, antimicrobial susceptibility testing, HIV testing. Descriptive analysis was performed for all variables.

Results

In ACES LO, notified cases of TB dropped 18.0% between 2015 and 2017, having since increased by 54.8% (n = 113), a notification rate of 32.3/100,000 population in 2019. The male to female ratio was 1.7 and the most affected age group was the 30-40 year old group (n = 25). Notified cases in children <10 years old have increased from 0 in 2016 to 7 in 2019. Pulmonary TB was reported in 73.5% (n = 83) of the notified cases; in 56.6% (n = 64), antimicrobial susceptibility testing revealed that first-line treatment would be effective; HIV testing was positive in 10.6% (n = 12).

Conclusions

Surveillance is the first step towards taking action to control and eliminate TB. ACES LO has a high notification rate of TB, therefore effort should be made in order to reduce TB's incidence. More investigation should be performed in order to evaluate the possibility of reintroduction of Bacille Calmette-Guérin (BCG) vaccine to the general population, instead of only risk groups, as it happens in ACES LO since 2016.

Key messages

Surveillance is one of the ten essential Public Health operations, allowing us to measure and analyse health problems in a certain population. Tuberculosis’ incidence is still high in some populations; it is a critical issue to raise awareness about.

Do long-term care services meet the minimal requirements for the elderly?

Background

As the percentage of elderly people (aged over 65) is expected to rise, from 16.0% of the population in 2010 to 29.3% in 2060 in Europe, a quality long-term care system is of increasing priority for governments. The aim of this study is to analyse long-term care services (LTCS) in the geographical area of the group of primary healthcare centres of Loures-Odivelas.

Methods

A retrospective, observational, descriptive study comprising data from public health inspections to LTCS between 2015 and 2019. Variables included were the number of residents, nurses, orderly, cooks, kitchen helpers and medical doctors; licensing status, public health inspection results and the presence of air conditioning. Descriptive analysis was performed for all variables.

Results

Between 2015 and 2019, a total of 200 public health inspections were carried out in 106 LTCS. Only 41 (38.7%) LTCS were licensed. The total number of residents was 2,803, 168 (6.0%) of which were bedridden. Concerning the staff ratio, 79 (74.5%) LTCS fulfilled the ratio of nurse to resident of 1:40 and 67 (63.2%) the ratio of orderly to resident of 1:8. On the first inspection, 11 LTCS (10.4%) complied with the minimal requirements for health care, hygiene, food preparation and facilities conditions. After the implementation of corrective measures proposed by the Public Health Unit, the number of LTCS which had complied for the same criteria was 64 (60.4%).

Conclusions

Society needs to adapt to a growing ageing population. LCTS, while part of the solution, still have deficiencies. In this sample, the majority were illegal and lacked the appropriate conditions. Public Health interventions can contribute to improving these services.

Key messages

In an ageing society, long-term care services are essential but the majority lack the appropriate conditions. Public Health intervention is crucial in implementing corrective measures that will result in better conditions for the elderly.

Lung function in wind instrument players of philharmonic bands

Introduction In order to play a wind instrument one must have a good breathing control with rhythm variation, control of inspiratory and expiratory volume as well as a good control of the airflow transmitted by the musician through the different mouthpieces. The pulmonary function of the different wind instrument players has been scarcely studied generating divergent conclusions.

Objectives To characterize and compare lung function and functional capacity of musicians of different wind instruments.

Methodology One hundred and one individuals from five philharmonic bands from Aveiro and Porto districts were studied. Smokers or ex-smokers for less than one year, respiratory pathology, history of chronic pulmonary or cardiac disease were exclusion criteria. The sample was divided into three groups: "Air reed", "Reeds" and "Metals". Pulmonary function was assessed by spirometry: forced vital capacity (FVC), forced expiratory volume in first second (FEV1), Tiffeneau index (TI), peak expiratory flow (PEF) and maximal voluntary ventilation (MVV). Functional capacity was assessed using the six-minute walk test (6-MWT). Data analysis was performed in the Statistical Package for the Social Sciences with a 95% confidence interval. Chi-square test, Mann-Whitney U test, ANOVA test and Kruskal-Wallis test were used.

Results All spirometric parameters with the exception of TI were increased in "Metals" group with significant decrease in the "Air reed" parameters of FEV1 (p = 0.045) and MVV (p = 0.004). A negative correlation between FEV1 and 6-MWT was noticed in male musicians (r=-0.291; p = 0.022).

Conclusion Musicians from the “Metals” group showed better lung function when compared to other groups. There was no positive correlation between lung function and functional capacity of the studied musicians. However, there was a weak negative correlation between FEV1 of male musicians and their functional capacity.

Profile of patients with penile cancer in the region with the highest worldwide incidence

To determine the epidemiological, histopathological, and clinical characteristics of patients diagnosed with penile cancer in the Brazilian state of Maranhão, the region with the highest incidence worldwide. One hundred and sixteen penile cancer patients were interviewed from July 2016 to October 2018. The majority of patients lived in a rural area (57%), worked in farming (58%), had a low level of schooling or no schooling (90%), and were married or in a stable relationship (74%). The mean age was 60.4 ± 16.51 years (range, 23–93 years). Phimosis (66%), poor/moderate genital hygiene (73%), history of sexually transmitted infections (55%), and zoophilia (60%) were found in the majority of patients. Most patients had their first sexual encounter at 16.2 ± 2.8 years (range, 10–25 years), and 75% had >6 sexual partners. The most common initial symptom was pruritus (37%), and most patients waited to seek treatment (average time to treatment, 18.9 months; range, 2–84 months). Human papillomavirus (HPV)-related histologies were observed in 62% of patients. Most patients had histological grades II or III (87%), stage ≥T2 disease (84%), and lymphadenopathy at admission (42%). Penectomy was performed in 96% of patients. The population with penile cancer in the region of highest incidence in the world is marked by low socioeconomic status, high prevalence of HPV infection, and phimosis. The delay in seeking treatment is related to a very high rate of advanced cancer and aggressive surgical treatment. The high prevalence of young patients was also a striking feature.

Targeted sequencing of plasmacytoid urothelial carcinoma reveals frequent TERT promoter mutations

Activating mutations in the promoter of the telomerase reverse transcriptase (TERT) gene are the most common genetic alterations in urothelial carcinoma (UC) of the bladder and upper urinary tract. Although the cadherin 1 (CDH1) gene is commonly mutated in the clinically aggressive plasmacytoid variant of urothelial carcinoma (PUC), little is known about their TERT promoter mutation status. A retrospective search of our archives for PUC and UC with plasmacytoid and/or signet ring cell features (2007-2014) was performed. Ten specimens from 10 patients had archived material available for DNA analysis and were included in the study. Intratumoral areas of nonplasmacytoid histology were also evaluated when present. Samples were analyzed for TERT promoter mutations with Safe-SeqS, a sequencing error-reduction technology, and sequenced using a targeted panel of the 10 most commonly mutated genes in bladder cancer on the Illumina MiSeq platform. TERT promoter mutations were detected in specimens with pure and focal plasmacytoid features (6/10). Similar to conventional UC, the predominant mutation identified was g.1295228C>T. In heterogeneous tumors with focal variant histology, concordant mutations were found in plasmacytoid and corresponding conventional, glandular, or sarcomatoid areas. Co-occurring mutations in tumor protein p53 (TP53, 2 cases) and kirsten rat sarcoma (KRAS) viral proto-oncogene (1 case) were also detected. TERT promoter mutations are frequently present in PUC, which provides further evidence that TERT promoter mutations are common events in bladder cancer, regardless of histologic subtype, and supports their inclusion in any liquid biopsy assay for bladder cancer.

P2X7 receptor drives Th1 cell differentiation and controls the follicular helper T cell population to protect against Plasmodium chabaudi malaria

A complete understanding of the mechanisms underlying the acquisition of protective immunity is crucial to improve vaccine strategies to eradicate malaria. However, it is still unclear whether recognition of damage signals influences the immune response to Plasmodium infection. Adenosine triphosphate (ATP) accumulates in infected erythrocytes and is released into the extracellular milieu through ion channels in the erythrocyte membrane or upon erythrocyte rupture. The P2X7 receptor senses extracellular ATP and induces CD4 T cell activation and death. Here we show that P2X7 receptor promotes T helper 1 (Th1) cell differentiation to the detriment of follicular T helper (Tfh) cells during blood-stage Plasmodium chabaudi malaria. The P2X7 receptor was activated in CD4 T cells following the rupture of infected erythrocytes and these cells became highly responsive to ATP during acute infection. Moreover, mice lacking the P2X7 receptor had increased susceptibility to infection, which correlated with impaired Th1 cell differentiation. Accordingly, IL-2 and IFNγ secretion, as well as T-bet expression, critically depended on P2X7 signaling in CD4 T cells. Additionally, P2X7 receptor controlled the splenic Tfh cell population in infected mice by promoting apoptotic-like cell death. Finally, the P2X7 receptor was required to generate a balanced Th1/Tfh cell population with an improved ability to transfer parasite protection to CD4-deficient mice. This study provides a new insight into malaria immunology by showing the importance of P2X7 receptor in controlling the fine-tuning between Th1 and Tfh cell differentiation during P. chabaudi infection and thus in disease outcome.

Malaria still causes the death of approximately half a million people yearly despite efforts to develop vaccines. The ability of Plasmodium parasites to survive the immune effector mechanisms indicates how suitable the immune response must be to eliminate the infection. CD4 T cells have a dual role in protection against blood-stage malaria by producing IFNγ and helping B cells to secrete antibodies. Infected erythrocytes release adenosine triphosphate (ATP), a damage signal that can be recognized by purinergic receptors. Among them, the P2X7 receptor senses extracellular ATP and induces CD4 T cell activation and death. Here, we evaluated the role of P2X7 receptor in the CD4 T cell response during blood-stage Plasmodium chabaudi malaria. We observed that the selective expression of P2X7 receptor in CD4 T cells was required for T helper 1 (Th1) cell differentiation, contributing to IFNγ production and parasite control. In contrast, we found an increase in follicular T helper (Tfh) cell population, germinal center reaction and anti-parasite antibody production in the absence of the P2X7 receptor. Our findings provide mechanistic insights into malaria pathogenesis by demonstrating the importance of damage signals for the fine-tuning between Th1 and Tfh cell populations and thus for the outcome of the disease.

Pre-treatment neutrophil to lymphocyte ratio (NLR) association with curative intent metastasectomy (MSX) in metastatic renal cell carcinoma (RCC)

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Background: NLR is a marker of inflammation and when elevated is associated with poor outcome in many tumors, including RCC. Hereby we evaluate the association of NLR with the likelihood of curative intent MSX. Methods: We retrospectively studied 846 patients diagnosed with metastatic RCC between 2007 and 2016. 116 patients fulfilled inclusion criteria: previous nephrectomy, no sarcomatoid features and available tumor specimens from metastatic site. Regression tree for censored data method was used to find the best NLR cut-off value. NLR was examined baseline – prior to MSX or targeted therapy. Chi-square test was used to evaluate associations between variables. We estimated overall survival (OS) using Kaplan-Meier curves. Cox proportional hazards regression models were fitted to evaluate the prognostic significance of NLR in univariable and multivariable analysis. Results: The median OS for the whole cohort was 45 months (95% CI, 27.6 to 62.4 months), and the median follow-up was 78.2 months. The best cut-off NLR value was 4.07. Higher NLR was associated with shorter OS when compared to the lower NLR cohort (11.5 months vs 68.3 months HR = 0.26, 95% CI: 0.15 – 0.97, p ≤ 0.0001, respectively). Univariate analysis revealed that bone metastasis and poor IMDC criteria were associated with worse OS and that MSX and lower NLR were associated with better OS. On multivariate analysis MSX, lower NLR and favourable/intermediate group on IMDC criteria were associated with a decreased risk of death (HR = 0.41, 95% CI 0.19-0.85, p = 0.018 and HR = 0.45, 95% CI 0.22-0.90, p = 0.025, HR = 0.35, 95% CI 0.16-0.79, p = 0.012, respectively). We found a positive association of lower NLR and curative intent MSX (p = 0.002). Conclusions: NLR is a prognostic marker in metastatic RCC and a ratio ≤ 4,07 is associated with a higher likelihood of curative intent MSX.

High prevalence of TERT promoter mutations in micropapillary urothelial carcinoma

Somatic activating mutations in the promoter of the telomerase reverse transcriptase (TERT) gene are the most common genetic alterations in urothelial carcinoma (UC) of the bladder and upper urinary tract. Little is known, however, about TERT-mutation status in the relatively uncommon but clinically aggressive micropapillary (MPC) variant. We evaluated the presence of TERT promoter mutations in MPC of the bladder and upper urinary tract. A retrospective search of our archives for MPC and UC with micropapillary features (2005-2014) was performed. All slides were reviewed to confirm the histologic diagnosis. Thirty-three specimens from 31 patients had FFPE blocks available for DNA analysis and were included in the study. Intratumoral areas of non-micropapillary histology were also evaluated when present. Samples were analyzed with Safe-SeqS, a sequencing error reduction technology, and sequenced using the Illumina MiSeq platform. TERT promoter mutations were detected in all specimens with pure MPC (18 of 18) and UC with focal micropapillary features (15 of 15). Similar to conventional UC, the predominant mutations identified occurred at positions -124 (C228T) (85 %) and -146 (C250T) (12 %) bp upstream of the TERT ATG start site. In heterogeneous tumors with focal variant histology, intratumoral concordant mutations were found in variant (MPC and non-MPC) and corresponding conventional UC. We found TERT promoter mutations, commonly found in conventional UC, to be frequently present in MPC. Our finding of concordant intratumoral mutational alterations in cases with focal variant histology lends support to the common oncogenesis origin of UC and its variant histology.

Detection of TERT promoter mutations in primary adenocarcinoma of the urinary bladder

TERT promoter mutations (TERT-mut) have been detected in 60% to 80% of urothelial carcinomas. A molecular urine-based screening assay for the detection of TERT-mut is currently being pursued by our group and others. A small but significant number of bladder carcinomas are adenocarcinoma. The current study assesses the incidence of TERT-mut in primary adenocarcinomas of urinary bladder. A retrospective search of our institutional pathology records identified 23 cystectomy specimens with a diagnosis of adenocarcinoma (2000-2014). All slides were reviewed by a senior urologic pathologist to confirm tumor type and select a representative formalin-fixed, paraffin-embedded block for mutational analysis. Adequate material for DNA testing was available in 14 cases (7 enteric type and 7 not otherwise specified). TERT-mut sequencing analysis was performed using previously described SafeSeq technique. Overall, 28.5% of primary adenocarcinoma harbored TERT-mut. Interestingly, 57% of nonenteric adenocarcinomas were mutation positive, whereas none of the enteric-type tumors harbored mutations. Similar to urothelial carcinoma, we found a relatively higher rate of TERT-mut among nonenteric-type adenocarcinomas further supporting the potential utility of TERT-mut urine-based screening assay for bladder cancer.

Electroconvulsive therapy in elderly - a preliminary study

Introduction

Studies with electroconvulsive therapy (ECT) in elderly focus mainly on the assessment of possible side effects on the cognitive functioning; there are few studies that evaluate the effectiveness.

Objective

Evaluate the effectiveness of this treatment in the population over 65 years.

Aims

Perform a preliminary study to evaluate the response to ECT of ≥ 65 years patients with depression.

Methods

We carry out a descriptive study based on patients treated in the last 10 years in the ECT Unit of Centro Hospitalar Psiquiátrico de Lisboa.

Results

Our initial sample consisted of 457 patients. We select patients aged ≥ 65 years with depression, and with complete data, including electroconvulsive parameters, and initial and final Hamilton Rating Scale for Depression (HRSD) scores (n = 59). Of this, 81.36% (n = 48) had unipolar depression, and 18.64% (n = 11) had bipolar depression. In the first group, the mean variation between the initial and final scores in HRSD was 13.88 points, and 27.10% (n = 13) of the patients ended the treatment in the normal range of HRSD score. In the second group, the mean variation was 12.82, and 63.60% (n = 7) ended the treatment in the normal range of HRSD. Considering the initial and final HRSD scores, it appears that unipolar depression group presents higher values (severe depression) (P < 0.05). When we compare the mean variation between the initial and final HRSD scores, we didn’t observe a statistically significant difference between the two groups. There was a clinical improvement in both.

Conclusions

The acute treatment with ECT appears to improve depressive symptoms in bipolar and unipolar depression, when considering an elderly population.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

STAT-3 and Β-catenin expression in metastatic clear cell renal cell carcinoma (mRCC)

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Background: In mRCC, there are no prospectively validated biomarkers to guide the treatment and therapy decision is based on prognostic scores and histology. STAT-3 and Wnt/b-cateninare cell proliferation pathways and have already been related to prognostic in renal cell carcinoma. Objective: to evaluate the role of STAT-3 and b-catenin expression as prognostic biomarkers in clear cell mRCC. Methods: 684 medical records of renal cell carcinoma patients treated at AC Camargo Cancer Center from 2007 to 2015 were reviewed. 86 out of 684 patients fulfilled the study criteria: metastatic clear cell carcinoma, no sarcomatoid features, previous systemic therapy, previous nephrectomy and available tumor specimens from metastatic site. Pathological samples were arranged in a TMA. The number of positive stainings cells for each antibody in each core was categorized as low positive or negative versus highly positive expression. Results: We had available tissue blocks from 47 tumors. 32/45 patients (71,1%) had highly positive membrane b-catenin and none of the patients was positive for nuclear b-catenin. 27 /45 (60%) were categorized as low positive or negative STAT-3. There was no statistically significant association between STAT-3 and b-catenin expression with clinical prognostic criteria (MSKCC and Heng criteria). In the multivariate analysis, KPS < 80% (p = 0.02; HR: 2.7), time from nephrectomy to metastasis < 1 year (p = 0.04; HR: 2.1), no hypothyroidism (p = 0.05; HR: 2.4) and MSKCC criteria (p = 0.02; HR: 2.5) were confirmed as negative prognostic factors. Associative analysis showed that none of the patients with negative membrane b-catenin had response to systemic therapy (p=0.02). OS was 35.5 months (IC 22.2-48.8) and PFS was 12.5 months (IC 10.0-14.0). Conclusions: in our cohort, STAT-3 and B-catenin expression are not associated with the prognostic criteria (MSKCC and Heng). The loss of B-catenin expression is associated to a worse response rate to antiangiogenic therapy in metastatic clear cell renal cancer. [Table: see text]

Tophaceous Gout: a tragic course for a preventable disease

A 66-year-old man, with a history of chronic tophaceous gout since the age of 30, presented with multiple tophi and significant deformity of all fingers that caused substantial function loss. Due to osteomyelitis refractory to antimicrobial therapy, he underwent disarticulation of several fingers. Finally, both his hands were amputated.

Baastrup's Disease: a poorly recognised cause of back pain

A 56-year-old male complained about progressive mechanical back pain for more than 10 years, which worsened with prolonged orthostatism and spine extension and improved in fetal position. His lumbar spine radiography revealed enlargement and sclerosis of the spinous processes which was confirmed by computed tomography, suggesting Baastrup's disease. This condition is characterized by enlargement, close approximation and impingement of one spinous process on another ("kissing spines"). There are few studies on Baastrup´s disease epidemiology and their results are inconsistent. Patients often complain of back pain, typically increased with extension and relieved by flexion. Radiographically, spinous process impingement leads to reactive sclerosis, enlargement, flattening, and remodeling of the involved vertebral spines. Physicians frequently miss it on radiographs due to lack of knowledge and overexposure of spinous processes in most X rays. Both conservative and surgical options are available for treatment. Baastrup's disease should be considered in differential diagnosis of back pain, although one must be aware the typical radiographic changes appear to be common with aging and may not be the cause of patient's symptoms.

Effects of the PPARα agonist WY-14,643 on plasma lipids, enzymatic activities and mRNA expression of lipid metabolism genes in a marine flatfish, Scophthalmus maximus

Fibrates and other lipid regulator drugs are widespread in the aquatic environment including estuaries and coastal zones, but little is known on their chronic effects on non-target organisms as marine fish. In the present study, turbot juveniles were exposed to the PPARα model agonist WY-14,643 for 21 days by repeated injections at the concentrations of 5mg/kg (lo-WY) and 50mg/kg (hi-WY), and samples taken after 7 and 21 days. Enzyme activity and mRNA expression of palmitoyl-CoA oxidase and catalase in the liver were analyzed as first response, which validated the experiment by demonstrating interactions with the peroxisomal fatty acid oxidation and oxidative stress pathways in the hi-WY treatment. In order to get mechanistic insights, alterations of plasma lipids (free cholesterol, FC; HDL associated cholesterol, C-HDL; triglycerides, TG; non-esterified fatty acids, NEFA) and hepatic mRNA expression of 17 genes involved in fatty acid and lipid metabolism were studied. The exposure to hi-WY reduced the quantity of plasma FC, C-HDL, and NEFA. Microsomal triglyceride transfer protein and apolipoprotein E mRNA expression were higher in hi-WY, and indicated an increased formation of VLDL particles and energy mobilization from liver. It is speculated that energy depletion by PPARα agonists may contribute to a higher susceptibility to environmental stressors.

[Psoriatic Arthritis concomitant with Paget's Disease - a case report]

Paget disease of bone is a focal disorder of bone metabolism; it is characterized by an accelerated rate of bone remodeling, with profound changes in the bone structure, making it fragile. This condition affects approximately 2% to 5% of the population older than 40. The main clinical manifestations of Paget's disease are pain and bone deformity, although the majority of patients are asymptomatic. Psoriatic Arthritis is a spondyloarthritis with a prevalence of about 0,1%. It is characterized by the presence of arthritis, enthesitis and/or dactylitis associated with a familiar or personal history of psoriasis. Several clinical patterns of joint involvement in psoriatic arthritis have been identified, namely, the polyarticular pattern, similar to rheumatoid arthritis. Arthritis precedes skin disease in approximately 13 to 17 % of the cases. The authors report a clinical case of a 60 years old patient with polyarthritis and dactylitis who was diagnosed with psoriatic arthritis and Paget's disease of bone. The concomitance of the two entities, in the same individual, with so different pathogenesis and clinical features, have never been described on literature. Because of the complexity on the clinical and imaging evaluation as the result of the coexistence of both pathologies, the authors consider relevant to publish this singular case.

Sexuality in spondyloarthritis--the impact of the disease

INTRODUCTION

The impact of rheumatic diseases on patients' sexual life has been gathering the attention of the scientific community over the last decade. The existing studies are scarce, especially related to spondyloarthritis, and particularly to psoriatic arthritis. Several factors associated with the disease may condition sexual function: pain, stiffness, decreased range of motion, joint swelling and extraarticular features such as fatigue, enthesopathy and cutaneous lesions in psoriatic arthritis.

OBJECTIVES

To assess sexual satisfaction and limitations in sexual activity in a cohort of patients with spondyloarthritis.

METHODS

An anonymous questionnaire was performed, consisting in two parts. One part consisted in a questionnaire filled by the doctor with data on the disease; the other part was filled by the patient, with demographic data, multiple choice questions and questions to be answered through a visual analogic scale, including items approached in some validated indexes of sexual function and satisfaction assessment. Statistical treatment was performed using SPPS system, version 17.0.

RESULTS

76 patients with the diagnosis of spondyloarthritis were enrolled; 31 had psoriatic arthritis, 30 had ankylosing spondylitis, 9 had undifferentiated spondyloarthritis and 6 had inflammatory bowel disease spondyloarthritis. In a visual analogic scale, the perception of conditioning in the conjugal relationship was 33.68±31.56 mm; limitation on sexual activity was 32.72±31.06 mm; limitation imposed by pain, joint swelling, fatigue, stiffness, decreased range of motion, decreased libido and cutaneous lesions ranged from 29.17±28.51 mm (swelling) to 46.94±32.31 mm (fatigue); there was no significant difference between sexes, diagnose and type of involvement. A strong correlation was identified between some analysed factors and ASQoL and HAQ values, but only moderate between them and disease function and activity indexes. Most of patients did not talk about their sexual limitations with their partners or with health professionals.

CONCLUSION

This work highlights the impact of spondyloarthritis on patients' sexual function. The type of disease and joint involvement didn't imply statistically significant differences on the analyzed parameters in this cohort. This work also emphasizes the unawareness of health professionals towards this subject, whose approach is equally difficult to the patients, and might deserve greater attention.

Tissue expression of PPAR-α isoforms in Scophthalmus maximus and transcriptional response of target genes in the heart after exposure to WY-14643

Peroxisome proliferator-activated receptors (PPARs) are involved in the regulation of lipid and carbohydrate metabolism and can be activated either by natural ligands as fatty acids or by synthetic ligands including several environmental chemicals. In this study, two PPARα isoforms (α1 and α2) were analyzed in turbot (Scophthalmus maximus) for a different tissue distribution. PPARα1 was ubiquitously expressed, while the PPARα2 was predominantly expressed in the heart. Following this result, turbot juveniles were exposed by injection to a synthetic selective PPARα agonist, WY-14643, for 14 days. Suppression subtractive hybridization (SSH) was performed with pools of heart samples of control and exposed fish to get insights into PPARα-regulated genes in the heart of juvenile turbot. Four genes were positively identified in the forward-subtracted and 12 genes in the reverse-subtracted cDNA SSH library, corresponding to the down-regulated and up-regulated genes in response to the WY-14643 treatment, respectively. The confirmation of these results in individual samples of juvenile turbot exposed to WY-14643 revealed a statistically significant mRNA induction of two cardiac muscle proteins (myosin light chain 2 and tropomyosin 4), which were shown to be involved in heart contraction and heartbeat regulation in other teleost species. Herewith, we showed for the first time that PPARα2 is predominantly expressed in the heart and that a PPARα agonist can induce the mRNA expression of cardiac muscle proteins in teleosts.

Abstract 5296: Evaluation of HER2 and topoisomera II alpha (TOP2a) expression and gene number in penile carcinoma according to HPV status

BACKGROUND: Penile squamous cell carcinoma (PSCC) is a rare tumor. In specific regions of developing countries, however, it may represent one the most frequent male tumors. Presence of lymph node metastasis (LNM) is the main factor significantly associated with reduced survival, and molecular markers to predict it have been extensively pursued. HER2 is an oncogene part of the EGFR family, often overexpressed in PSCC. HER2 overexpression is associated with poor prognosis and presence of LNM in breast tumors, and it is generally coamplified with topoisomerase IIα (TOP2A), a neighboring gene that is a target for anthracyclines.

MATERIAL AND METHODS: We evaluated the frequency of HPV infection in 84 PSCC samples.The presence or absence of HPV DNA was established using generic primers (GP5+/GP6+) specific for the L1 gene of several HPVs. Genotyping of positive samples was done by dot blot hybridization using radioactive probes. Expression of HER2 and TOP2a was evaluated through immunohistochemistry and automatedly quantified using ScanScope XT, Aperio. Sixty cases were also submitted to a triple-color fluorescence in situ hybridization (FISH) assay using probes for the genes of HER2 and TOP2a, and also for the chromosome 17 centromere. Cases showing two signals of each probe were considered non-altered, those showing more than two signals of each probe were considered polysomy and those showing more HER2 or TOP2a signals compared to centromere signals were considered amplified.

RESULTS: HPV infection, characterized by detection of viral DNA on the samples, was observed in 22.6% (19) of the cases. Among the positive HPV samples, 51.3% were infected by HPV16, 21.6% by HPV18, and 2.7% by both subtypes concomitantly. In agreement with studies that showed better prognosis of tumors with HPV infection, 5-year and 10-year survival of HPV-positive patients was, respectively, 79.1% and 70.8%, whereas of HPV-negative patients was 60.2% and 38.7% (p=0,018). Immunohistochemistry showed nuclear positivity for TOP2a in 74.2% (106) cases and cytoplasmic expression of HER2 was seen in 20,3% (29) of cases, which was associated with higher histologic grade (p &lt;0,001) and lower overall survival in multivariate analysis (RR=2,966; IC 95% [1,6-5,2]; p&lt;0,001). No membrane staining for HER2 was observed. There was not an association between expression of HER2 and TOP2a (p=0.970), nor with these markers and HPV infection (p=0.177 and p=0.336, respectively). FISH analysis revealed 55 out of 60 cases without gene alterations (91.7%), and five cases (8,3%) presenting polysomy of chromosome 17. No amplification of HER2 or TOP2a genes was observed.CONCLUSIONS: Overexression of TOP2a was frequent and cytoplasmic HER2 associates with poor outcome of PSCC patients. HPV infection seem to have a positive impact in patients’ survival, as reported for other tumors.

Citation Format: Alice M. Silva, Lara Termini, Jose Ivanildo Neves, Isabela Cunha, Ademar Lopes, Gustavo Guimaraes, Fernando A. Soares. Evaluation of HER2 and topoisomera II alpha (TOP2a) expression and gene number in penile carcinoma according to HPV status. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 5296. doi:10.1158/1538-7445.AM2013-5296

Normalization strategies for gene expression studies by real-time PCR in a marine fish species, Scophthalmus maximus

Thorough evaluation of normalization approaches is a fundamental aspect in real-time quantitative RT-PCR experiments to avoid artificial introduced intergroup variations. In our study, we tested three normalization strategies in an experimental data set derived from a toxicological exposure of Scophthalmus maximus to the peroxisome proliferator-activated receptor alpha (PPARα) agonist WY-14643. Juvenile turbots were exposed by repeated injections to 5 mg or 50 mg WY-14643/kg, and liver samples were taken at day 1, 7 and 21. Specifically, the mRNA expression of peroxiredoxin 5 (prdx5) was normalized to the cDNA content, to the mRNA expression of single reference genes (b-actin, b-act; elongation factor 1 α, ef1a; glyceraldehyde-3-phosphate dehydrogenase, gapdh; ribosomal protein L8, rpl8; tata-box binding protein, tbp; tubulin beta 2C chain, tubb2c; ubiquitin-conjugating enzyme E2L 3, ub2l3) or to a combination of multiple reference genes using geNorm, BestKeeper or NormFinder algorithms. Four single reference genes (ef1a, rpl8, tubb2c, tbp) did not show any significant differences between the treatment groups over time, while significant intergroup variations were observed for cDNA content, gapdh, b-act and ub2l3. The normalization of prdx5 to the valid (not altered) single reference genes led to significant up-regulated (prdx5/rpl8), not-regulated (prdx5/ef1a; prdx5/tbp) or down-regulated (prdx5/tubb2c) mRNA expression pattern. The multiple reference gene approaches resulted in different rankings and combinations of the most stable expressed reference genes (geNorm: ef1a>rpl8>b-act; BestKeeper: ub2l3>gapdh>ef1a; NormFinder: b-act>ef1a). However, the normalization with the three multiple reference gene procedures demonstrated consistent expression pattern with a significant up-regulation of prdx5 in response to the higher concentration after 21 days. Concluding, even if not yet established as "gold" standard for expression profiling in environmental toxicology or physiology using freshwater or marine fish models, the multiple reference gene approach is recommended, since it eliminates any biased results, which represented the major flaw of single reference genes.

Dynamics of PPARs, fatty acid metabolism genes and lipid classes in eggs and early larvae of a teleost

Dietary long chain polyunsaturated fatty acids (FA) have been recognized of crucial importance in early development of vertebrates, contributing to the impressive morphological and physiological changes both as building blocks and to energy production. The importance of lipids along development depends on ontogenetic, phylogenetic and environmental parameters. The expression patterns of FA metabolism genes have not been characterized in developing fish embryos nor compared to lipid class profiles. Full lipid metabolism only occurred after hatching, as revealed by alterations in lipid profiles and FA gene expression. Nonetheless, transcriptional changes of some FA genes were already present in embryos at notochord formation. Many genes displayed an expression profile opposed to the decrease of lipids along the development, while others responded solely to starvation. Transcription of most genes involved in FA metabolism had a strong correlation to PPARs' mRNA levels (α1, α2, β, γ). The comparison of mRNA expression of the genes with the lipid profiles produced new insights into the FA metabolism and regulation during the development of turbot larvae, providing the basis for future studies including comparative approaches with other vertebrate species.

Analysis of treatment results in the electroconvulsive therapy unit of centro hospitalar psiquiatrico de lisboa (CHPL)

Introduction

Electroconvulsive therapy is widely used for treatment-resistant psychiatric patients, with remission rates close to 50% and response rates between 60–70%. Post ictal suppression index (PISI) has been positively correlated with clinical outcome.

Objectives

Characterize the treatment results of the electroconvulsive therapy unit of CHPL; find a correlation between improvement on HAM-D, PANSS and PSAS and PISI.

Methods

The patient data was collected and divided according to ICD-10 diagnosis. Evaluation scales were applied at the beginning and end of treatment: depressed patients (F31.3–5; F33; F20.4; F25.1) - HAM-D; schizophrenic/ schizoaffective/ bipolar-manic or mixed patients (F20.X, F25.X, F31.0, F31.6) - PANSS; with any of these diagnosis - PSAS. A correlation between the points of improvement on each scale and PISI was investigated using the Pearson product-moment correlation coefficient.

Results

Of 101 depressed patients, 33,7% showed remission and 49,5% showed response, over 11 sessions (average). The reduction on HAM-D score was significantly greater for patients with initial HAM-D score > 18 versus HAM-D ≤ 18 (52,9% versus 37,75%). Patients with unipolar depression (N = 72) and bipolar depression (N = 22) showed comparable results (response:47,2% versus 52,4%; remission: 30,6% versus 40,1%). Schizophrenic patients (N = 43) had higher response rates: 88%. No correlation was found between PISI and HAM-D, PANSS or PSAS improvement (r = -0,1;-0,01;-0,07).

Conclusion

Response and remission rates in depressed patients were inferior to other ECT studies, except in patients with higher severity. Those rates were comparable for schizophrenic patients. PISI did not correlate with clinical outcome.

Continuation and Maintenance ECT: An Update

The efficacy of electroconvulsive therapy (ECT) is widely recognized and indications are well defined for acute treatments. Surprisingly, the use of continuation and maintenance ECT (M-ECT) is uncommon after acute remission. This is partly because of the scarcity of scientific evidence. Indications are poorly defined and the practice is based on case reports and small open studies. Recent data suggest that M-ECT is a viable treatment option in severe affective and psychotic illnesses, especially in recurring, drug-resistant or medically compromised patients who suffer toxic effects with psychotropics.

Studies regarding the duration and frequency of treatment sessions are laking. The time interval between sessions and duration of treatment vary according to clinical requirements, and should be individualized. The length of treatment and deciding when to stop it are still uncertain. Controversial data about the relation between the frequency of sessions and diagnostic is found. An inverse relation between good prognostic factors for each patient and the frequency of M-ECT was described. During continuation and maintenance ECT, seizure threshold increases until a plateau not being clear when the plateau is reached and if it depends on other treatment variables.

The risk of cognitive dysfunction following M-ECT is one major concern. A transient memory and attention dysfunction are described after acute ECT. Recent studies seem to suggest that M-ECT is cognitively safe.

Effects of copper and cadmium on cholinesterase and glutathione S-transferase activities of two marine gastropods (Monodonta lineata and Nucella lapillus)

With the view of using Nucella lapillus and Monodonta lineata as bioindicators in biomonitoring programs in the NW coast of Portugal, the sensitivity to copper and cadmium of these two common species in Atlantic coasts of Europe was investigated. Assays based on mortality and on the activity of the enzymes cholinesterases (ChE) and glutathione S-transferases (GST) were used, as these biomarkers have been used in biomonitoring studies in the area. ChEs present in foot muscle of both species were characterised and found to show properties of both typical acetylcholinesterase and pseudocholinesterase. Cadmium LC50s for N. lapillus and M. lineata were 2.64 and 2.44 mg/L, respectively, while the lowest observed effect concentration (LOEC) was 1.53 mg/L for both species. LOEC value for cooper was 0.075 mg/L for both. Cadmium in vivo exposure increased ChE activity of N. lapillus, but had no effects on M. lineata ChE. No in vitro effects of cadmium on ChE activity of any of the tested species was observed. Copper had no significant in vivo effects on ChE activity, although it inhibited the ChE of both species in vitro, the IC50s being 5.87 and 12.17 mg/L for N. lapillus and M. lineata, respectively. Cadmium had no significant effects on GST activity of either species, while copper caused a significant reduction of N. lapillus GST (LOEC=0.044 mg/L) but had no effect on M. lineata GST. Results indicate that (i) N. lapillus and M. lineata have a similar acute sensitivity to cadmium and copper; (ii) ChE and GST of these species are sensitive to cadmium (iii) ChEs of both species are inhibited by copper at concentrations in the mg/L range and therefore, its use is limited to heavily polluted sites; (iv) N. lapillus GST does not seem to be a suitable biomarker for copper, at least in the range of concentrations tested, since it was inhibited by copper, but no clear concentration-response relationship was observed.

[Hajdu-Cheney Syndrome: a case of acroosteolysis]

Acroosteolysis is a rare clinical manifestation characterized by bone resorption of the terminal phalanges. It can occur in association with the variety of systemic diseases or be idiopathic. The authors describe a case of 47-year-old woman with acroosteolysis of distal phalanges since childhood, congenital amaurosis, premature loss of teeth and mal perforans. Because of the rate and exuberant manifestations found, with no etiological cause identified, the authors diagnosed Hajdu-Cheney Syndrome. Hajdu-Cheney is a rare, autosomal dominant disorder, with sporadic cases, apparently representing new mutations. Based on this case the authors review the differential diagnoses of acroosteolysis and the clinical manifestation of the Hajdu-Cheney syndrome

[Ossifying arachnoiditis in spondyloarthropathy patient]

A 52-year-old man, with the diagnosis of Ankylosing Spondylitis, since the age of 22, was admitted due to progressive neurological symptoms that had started two years before: paresthesias, impaired sensation and muscle weakness of the lower limbs; burning abdominal and lumbar pain; together with bladder, bowel and sexual dysfunction. Imaging investigations revealed severe lesions from D1 to L5: epidural calcification; spinal cord compression and syringomyelia. Based on this case, the authors review the neurological complications of Ankylosing Spondylitis.

[Prevalence of antibodies against hepatitis A virus in a population from northern Portugal]

AIM

To find the prevalence of antibody to hepatitis A virus in the population of the North of Portugal.

MATERIAL AND METHODS

Ten General Practitioners were asked to provide blood samples from patients who would need blood tests for any reason other than acute hepatitis, during January and February 1996. In this way, 381 samples were obtained for assessment of anti hepatitis A virus antibodies using a commercial radioimmunassay ELISA. All subjects gave their informed consent and answered to a protocol regarding age, sex, geographic area, number of people per household and sewage systems. The statistics were performed using SPSS.

RESULTS

The 381 subjects were distributed into eight age groups: I (1-4 years)--57; II (5-9 years)--57; III (10-14 years)--26; IV (15-19 years)--41; V (20-29 years)--55; VI (30-39 years)--51; VII (40-49 years)--41; VIII--(equal or more than 50 years)--53. The prevalence of anti HAV antibodies per group-percentage (number), (confidence intervals), were: I--7.0% (4) (3-17%); II--15.8% (9), (9-27%); III--26.9% (7) (14-46%); IV--51.2% (21) (37-66%); V--85.5% (47) (74-92%); VI--72.5% (37) (59-83%); VII--87.8% (36) (75-95%); VIII--88.7% (47) (80-93%).

CONCLUSION

The comparison with previous data (Lecour et al.) shows improvement in sanitary conditions of population, with associated lower prevalence of anti hepatitis A virus antibody.

Preliminary report on the effects of propolis on wound healing in the dental pulp

The purpose of this investigation was to determine the antimicrobial and healing potential of propolis on direct dental pulp exposures. This study used 25 adult male rats. Pulp exposures were performed and animals were allocated to propolis and calcium hydroxide (Ca(OH)2 groups. Animals were killed on days 5, 7, 10, and 14. The teeth were routinely processed for histological evaluation. Non-parametric tests were employed to analyze the data. No significant differences were found between study groups on the wound healing of the dental pulp. Both substances were comparable in exhibiting normal reorganization of the pulp and no increased vascularity, and were equally efficacious in maintaining a low inflammatory and microbial cell population as well as in stimulating the formation of reparative dentin.

Bone marrow transplantation with major ABO incompatibility. Experience of the Bone Marrow Transplantation Unit--Francisco Gentil Portuguese Institute of Oncology, Lisbon Centre

Thirteen patients submitted to bone marrow transplantation (BMT), HLA A and B identical, with mixed negative lymphocyte culture and major ABO incompatibility were retrospectively evaluated. Gravity sedimentation by hydroxyethyl starch was used in almost all cases to deplete erythrocytes from bone marrow (12/13): a removal rate of 90%--corresponding to an erythrocyte residual volume of 27,4 rate ml--and a nucleated cell recovery of 76% (mean values) were obtained. All patients underwent a hyperhydration regimen and received corticosteroid prophylaxis before bone marrow infusion. Considering the most important immunohematological problems associated to this type of transplant, we verified that seven patients developed minor complications and among them only one had long term consequences. In comparison with the control group, ABO identical and with minor incompatibility, the study group had delayed onset of erythropoiesis and needed greater erythrocyte transfusion support. We concluded that major ABO incompatibility does not constitute a drawback to BMT success in most patients.

[Bone marrow transplantation with major ABO incompatibility. Experience at the bone marrow transplantation unit of the Center of Lisbon at the IPOFG]

Thirteen patients submitted to major ABO incompatible, HLA A and B identical, mixed lymphocyte culture negative bone marrow transplantation (BMT) were retrospectively evaluated. Gravity sedimentation by hydroxyethyl starch was used in almost all cases to deplete erythrocytes from bone marrow (12/13): a removal rate or 90%--corresponding to an erythrocyte residual volume of 27.4 rate ml--and a nucleated cell recovery of 76% (mean values) were obtained. All patients underwent a hyperhydration regimen and received corticosteroid prophylaxis before bone marrow infusion. Considering the most important immunohematological problems associated to this type of transplant we verified that seven patients developed minor complications, and among them only one had long term consequences. In comparison with the control group, ABO identical and with minor incompatibility, the study group had delayed onset of erythropoiesis and needed greater erythrocyte transfusion support. We concluded that major ABO incompatibility does not constitute a drawback to BMT success in most patients.