Atypical hypertrophy of retinal pigment epithelium manifesting as the first sign of familial adenomatous polyposis

A female patient in her 20s presented to a routine ophthalmology appointment. Medical history was unremarkable. Family history was notable for intestinal cancer of a second-degree relative, diagnosed in her late 60s. Fundus examination revealed bilateral, multiple, flat, oval, pigmented lesions with an irregular halo of atrophy. The patient was diagnosed with atypical congenital hypertrophy of retinal pigmented epithelium. Investigation of extraocular associations was performed, including upper and lower endoscopy, which revealed 500-1000 colonic polyps with a maximum size 25 mm. Pathology did not reveal submucosal invasion. Genetic testing detected an adenomatous polyposis coli mutation (heterozygotic variant c.3183_3187delACAAA p.(Gln1062*)).

Application of optical coherence tomography angiography for microvascular changes in patients treated with hydroxychloroquine: a systematic review and meta-analysis

BACKGROUND

Retinal toxicity with long-term hydroxychloroquine (HCQ) treatment is a major concern. This systematic review aims to assess the application of optical coherence tomography angiography (OCTA) to detect microvascular alterations in patients under HCQ.

METHODS

PubMed, Scopus, Web of Science, and Cochrane Library databases were systematically searched until January 14, 2023. Studies using OCTA as a primary diagnostic method to evaluate the macular microvasculature of HCQ users were included. Primary outcomes were macular vessel density (VD) and foveal avascular zone (FAZ) at the superficial (SCP) and deep (DCP) capillary plexus. Meta-analysis was performed using a random-effects model.

RESULTS

Of 211 screened abstracts, 13 were found eligible, enrolling 989 eyes from 778 patients. High-risk patients due to longer duration of treatment presented lower VD in the retinal microvasculature than those with low-risk in SCP (P = 0.02 in fovea; P = 0.004 in parafovea) and in DCP (P = 0.007 in fovea; P = 0.01 in parafovea). When compared with healthy controls, HCQ users had lower VD in both plexus-no quantitative synthesis was presented.

CONCLUSIONS

Microvascular changes were found in autoimmune patients under HCQ treatment without any documented retinopathy. However, the evidence produced so far does not allow to draw conclusion concerning the effect of drug as studies were not controlled for disease duration.

Influence of the river flow pulse on the maturity, resilience, and sustainability of tropical coastal ecosystems

Coastal marine ecosystems have structural and functional features usually connected by the seasonal transfer of nutrients and organisms. These environments can utilize inter-ecosystem subsidies to increase resilience and maturity and support human activities like fishing. However, the importance of the connection and the role of the seasonal pulse of energy flows to enhance maturity are still poorly understood and reported. Our objective in this paper is to assess the effect of seasonal hydrological pulses on two tropical coastal interconnected ecosystems. Thus, we made four Ecopath models for estuarine and neritic environments considering the dry and rainy seasons, with a similar sampling design that allowed them to be compared. Our results provide evidence for the occurrence of the pulsed ecosystems since both environments seem driven by the river flow. Estuary presents more and more substantial differences (measured by ecosystem attributes) in both seasons because it is directly affected by river floods than the neritic environment. The neritic is affected indirectly by the movement of species from the estuary and by a weaker river flow. In the dry season, the differences between ecosystems are lower because the dry season trend to homogenize cycling, maturity, homeostasis, and resilience. We found that the seasonal river flow (pulse) forces the variability of biomass, flows, and ecosystem features, and this variance creates the required stability for both ecosystems. Still, these environments benefit through the exchange of components that relieve the pressures of predation on specific groups and maintain the energy flow necessary for the functioning of their trophic webs. The pulse by the rainfall favors connectivity and equalizes the two systems, increasing the connectivity between them and the exchange of subsidies that strengthens the trophic structures, contributing to the increase in maturity. In these ecosystems, seasonal changes become a key factor for exchanging flows that will promote sustainability, the accumulation of more biomass (growth), and the optimization of reserve energy (development) in both systems. This efficient joint strategy of perpetuation is what promotes resistance and resilience to these ecosystems, which together can reach different states of equilibrium, translated into maturity to withstand new environmental changes.

The 2021 Portuguese Society of Ophthalmology joint guidelines with Paediatric Rheumatology on the screening, monitoring and medical treatment of juvenile idiopathic arthritis-associated uveitis

AIM

To develop the first Ophthalmology joint guidelines with Paediatric Rheumatology with recommendations on the screening, monitoring and medical treatment of juvenile idiopathic arthritis-associated uveitis (JIA-U), endorsed by the Portuguese Society of Ophthalmology (SPO).

METHODS

A systematic literature review was conducted to include publications up to July 14th 2020, with no language restrictions, in order to include all the international position papers/guidelines concerning the medical management of JIA-U and randomised clinical trials assessing the efficacy and safety of medical treatment in this field. We searched through MEDLINE (PubMed), Scopus, Web of Science and Cochrane Library. The Delphi modified technique to generate consensus was used. Preliminary evidence statements were subject to an anonymous agreement assessment and discussion process using an online survey, followed by further discussion and update at a national meeting. A draft of the manuscript with all recommendations was then circulated among all participants and suggestions were incorporated. The final version was again circulated before publication.

RESULTS

Twenty-six recommendations were developed focusing on the following topics: general management (3), screening and follow-up of uveitis (4), treatment (17) and health education in JIA-U among patients and families (2).

CONCLUSION

These guidelines were designed to support the shared medical management of patients with JIA-U and emphasize the need for a multidisciplinary approach between Ophthalmology and Paediatric Rheumatology regarding the comprehensive care of JIA-U. We acknowledge that updating these recommendations will be warranted in the future, as more evidence becomes available.

KEY-WORDS

juvenile idiopathic arthritis, uveitis, biological treatment, conventional immunosuppressive treatment, multidisciplinary management, guidelines, consensus, review, Delphi Technique.

Fatigue Is Not Associated with Phase Angle in Hemodialysis Patients

PURPOSE

The aim of this study was to investigate the association between fatigue and phase angle (PA) in patients with chronic kidney disease (CKD) on hemodialysis (HD).

METHODS

A cross-sectional study with older patients than 18 years diagnosed with CKD undergoing HD. From 160 (58.36±15.05 years) patients, (n=96; 60%) are men. Body mass and height were assessed using a portable scale and stadiometer, followed by body mass index (BMI) calculus. The bioimpedance electrical analysis was performed using the Bodystat QuadScan 4000. The sample size was dichotomized in two groups, using the median of our sample, either normal when PA ≥5.4º, or low when the PA <5.4º. The Chalder fatigue questionnaire was used the assess the fatigue. The multiple regression was applied to assess the association between fatigue questionnaire and PA.

RESULTS

Were considered normal PA≥5.4º (n=78, 48.8%) and low PA<5.4º (n=82, 51.2%). The patients of the PA<5.4º group are older compared to the PA≥5.4º group (63.1±15.1 vs. 53.3±13.4 years, p<0.001). There was no association between PA and fatigue score in the crude model (OR: 1.02, 95%CI: 0.96-1.08, p=0.47) and after confounding variables (OR: 1.03, CI: 0.95-1.12, p=0.43).

CONCLUSIONS

In HD patients, we found that patients with lower PA values are older. In addition, we did not find association between fatigue and PA.

Novel KMT2B mutation causes cerebellar ataxia: Expanding the clinical phenotype

Hereditary cerebellar ataxias comprise a heterogeneous group of neurodegenerative disorders affecting the cerebellum and/or cerebellar pathways. Next-generation sequencing techniques have contributed substantially to the expansion of ataxia-causing genes, including genes classically described in alternative phenotypes. Herein, we describe a patient with adult-onset cerebellar ataxia, minor dystonia, neuropathy, seizure and ophthalmological pathology, who bears a novel variant in KMT2B (NM_014727.2:c.3334 + 1G > A). Bioinformatic analysis suggested this variant completely abolished the splice-site at exon 8/intron 8, which was confirmed through analysis of mRNA extracted from fibroblasts. Exon 8 skipping would ultimately translate as an in-frame deletion at the protein level, corresponding to the loss of 91 aminoacids [p.(Gly1020_Asn1111del)]. So far, KMT2B disease causing variants have been described in patients with dystonia or neurodevelopmental delay, with no reports of a cerebellar predominant phenotype. Our findings highlight the possible role of KMT2B as a gene involved in hereditary cerebellar ataxias.

25OH Vitamin D Is No Associated with Muscle Function Loss in Adults and Elderly Patients Undergoing Hemodialysis

OBJECTIVES

In patients with chronic kidney disease, sarcopenia is associated with dialysis treatment, accelerated protein catabolism, and high energy demand. Thus, this study aimed to assess the association between 25-OH vitamin D concentrations and muscle function in patients undergoing hemodialysis.

DESIGN

A cross-sectional study.

SETTING

Performed in a hemodialysis clinic.

PARTICIPANTS

79 adult and elderly patients undergoing hemodialysis.

MEASUREMENTS

The sample was divided according to the SARC-F definition, being 55 patients allocated in the SARC-F <4 group and 24 in the SARC-F ≥4 group. Normal 25-OH vitamin D concentrations was considered when ≥30 ng/dL.

RESULTS

Vitamin D concentrations and number of patients with low or normal muscle function did not differ between the groups. There was no correlation between SARC-F and 25-OH vitamin D levels (r: -0.09, p=0.42).

CONCLUSIONS

25-OH vitamin D has no association with muscle function loss in adults and elderly patients undergoing hemodialysis.

Multimodal imaging of exudative maculopathy associated with hand-foot-mouth disease

A 31-year-old man presented with acute unilateral visual loss secondary to hand-foot-mouth disease (HFMD). Ophthalmic examination demonstrated best corrected visual acuity (BCVA) of 6/24 and a macular neurosensory detachment. He was diagnosed with unilateral acute idiopathic maculopathy (UAIM), and multimodality imaging was performed. No treatment was warranted. At 3 months, BCVA was 6/5 and funduscopy revealed a juxtafoveal scar. Based on the evidence of the association between HFMD and UAIM, the authors refer to this condition as exudative maculopathy associated with HFMD. Multimodality imaging during acute and convalescent phases is useful to study this disorder and raises questions about choroidal and bilateral involvement. Ophthalmologists should be aware of this and query about systemic signs and symptoms.

[Smoking prevalence in Portuguese school-aged adolescents by gender: can we be optimistic?]

INTRODUCTION

According to the MPOWER approach adopted in 2008 by the WHO, monitoring smoking epidemics is necessary in order to assess the effectiveness of the preventive measures used in smoking control in adolescents and adults.

OBJECTIVES

To determine the prevalence of smoking in Portuguese school-aged adolescents by region.

MATERIAL AND METHODS

The sample is made up of 8764 students, 4060 boys and 4704 girls, and is representative of the Portuguese students in regular public education. The data was collected in the 2008/2009 academic year, through a quantitative self-report questionnaire.

RESULTS

In the total sample, 10.2% of boys and 9.1% of girls are regular smokers. Smoking increases with age. At 15 years old 12.3% of the boys and 8.6% of the girls are regular smokers and 6.1% of the boys and 4.0% of the girls are occasional smokers. Looking at prevalence by region, the highest prevalence of regular smoking is found in Alentejo (14.7%), followed by Azores (11.8%) and the lowest is found in Algarve (4.1%).

CONCLUSIONS

The prevalence of smokers among Portuguese school-aged adolescents varies within the several regions of the country, similar to what happens in the adult Portuguese population.

Study of density of interstitial cells of cajal in the terminal intestine of rats with anorectal malformation

INTRODUCTION

Intestinal constipation is one of the most commonly occurring complaints in the postoperative period after correction of anorectal malformation (ARM). An abnormal density of interstitial cells of Cajal (ICC) is one potential cause. The objective of this study was to analyze the density of ICC in the terminal intestine of fetuses of rats with anorectal anomaly induced by ethylenethiourea (ETU).

MATERIAL AND METHODS

The fetuses were distributed into three groups: Group A--normal fetuses obtained from pregnant female rats that did not receive ETU; Group B--fetuses with no ARM, obtained from pregnant rats that received ETU, and Group C--fetuses with ARM, obtained from pregnant rats that received ETU. ETU was administered on the 11th day of pregnancy at a dose of 125 mg/kg. The fetuses were extracted by means of laparotomy on the 21st day of pregnancy. The terminal intestine of the fetuses was removed and analyzed by immunohistochemistry to evaluate ICC.

RESULTS

Statistically significant differences were found between groups A, B and C regarding the density of ICC. Group A presented with the highest density, followed by groups B and C.

CONCLUSION

There is a lower density of ICC in the terminal intestine of rats with ARM.

Antithrombin activity of medicinal plants of the Azores

A chromogenic bioassay was utilized to determine the antithrombin activity of methylene chloride and methanol extracts prepared from 50 plants of Azores. Extracts of the six plants Hedychium gardneranum, Tropaeolum majus, Gunnera tinctoria, Hedera helix, Festuca jubata and Laurus azorica demonstrated activity of 78% or higher in this bioassay system.

[Unusual procedures used in reconstructive surgery and/or revascularization of the aorta]

Since the advent of arterial surgery, four decades of development have evolved, characterized not only by a remarkable evolution of concepts, but also by the improvement of technics, means and methods utilized for arterial reconstructive surgery. This progress led to the promotion and improvement of the conventional surgical methods dedicated to the treatment of the most common aortic disorders, obstructive or aneurysmal. Endarterectomy, revascularization using synthetic bypasses or interposition of arterial prosthesis are the most common and standardized procedures which are used worldwide, giving gratifying and long lasting results, involving low or negligible risks. In clinical practice however one sometimes, faces rare conditions, poorly understood due to their rarity, in which the conventional methods may be regarded as inappropriate, unfit or even formally contraindicated. Some unusual or uncommon methods were devised to deal with such conditions, which are less popular due to their rarity, but may also be considered just as valid and reliable as conventional methods, bearing satisfactory and rewarding results. Among them we stress the bypass originated in the ascending aorta, the bypass from the descending thoracic aorta and the bypass arising from the supraceliac aorta. The main features of these procedures as well as the personal experience of their utilization obtained by the senior author constitute the essence of this presentation.