IgA Vasculitis with scrotal involvement - a rare presentation in adults.

IgA vasculitis (IgAV) is a small-vessel vasculitis common in children but rare in adults. It is usually an auto-limited disease in children but has a more severe course and worse prognosis in adults. The classical manifestations are non-thrombocytopenic purpura, arthralgias, gastrointestinal involvement and renal involvement. Herein we report a case of a 39-year-old man with a rash of the lower limbs associated with testicular and lower abdominal pain. The initial study revealed increased inflammatory biomarkers and enlarged left testis with bilateral ischemic areas on doppler ultrasound. A cutaneous biopsy later revealed leukocytoclastic vasculitis, confirming the diagnosis of IgAV with scrotal involvement. The patient started prednisolone, with improvement in the first week and sustained remission after two years of follow-up. This case report describes an adult with IgAV and scrotal involvement, which is rarely reported in adults and appears to be different from the one in children. The prevalence of scrotal involvement is presumably underestimated. In all men with IgAV, a scrotal examination should be performed and ultrasonography accordingly since it affects the treatment and follow-up. Recommendations for IgAV diagnosis and treatment in adults are still lacking and more research is needed.

Hypomagnesaemia - One Cause To Remember!

A 71-year-old female presented with 5 days of diarrhoea and asthenia. Past medical history of rheumatoid arthritis, arterial hypertension, hypertrophic cardiomyopathy and chronic gastritis was treated with leflunomide, deflazacort, esomeprazole, carvedilol and spironolactone. At admission, the patient's physical examination showed signs of dehydration. Lab results revealed leucocytosis, increased C-reactive protein, hypomagnesaemia, hypocalcaemia and hypokalaemia. A presumption of acute infectious diarrhoea causing hypomagnesaemia with hypocalcaemia and hypokalaemia was made. She was started on ciprofloxacin, IV hydration and electrolyte supplementation with an adequate response. However, magnesium levels fell repeatedly. After excluding other causes for hypomagnesaemia, chronic use of proton pump inhibitors (PPIs) was considered a plausible cause therefore PPI was discontinued, with normalisation of magnesium levels. Hypomagnesaemia is a common disturbance, mainly caused by diarrhoea, gastrointestinal malabsorption, medications, alcoholism and volume expansion. Clinical manifestations include neuromuscular symptoms, cardiovascular manifestations, hypokalaemia and changes in calcium metabolism. PPI-related hypomagnesaemia has been described in later years particularly in chronic use cases, with a medium prevalence of 27%, but further studies remain necessary to clarify its pathophysiologic mechanism. Since PPIs are widely used, it is essential to be aware of hypomagnesaemia as a possible side effect, particularly in refractory cases and after excluding other common causes. LEARNING POINTS: PPIs-related hypomagnesaemia should be a concern, especially in cases with refractory hypomagnesaemia and after excluding other common causes.Formal indication for PPIs use should be revised in most patients.

Near-infrared techniques for fraud detection in dairy products: A review.

The dairy products sector is an important part of the food industry, and their consumption is expected to grow in the next 10 years. Therefore, the authentication of these products in a faster and precise way is required for the sake of public health. This review proposes the use of near-infrared techniques for the detection of food fraud in dairy products as they are faster, nondestructive, environmentally friendly, do not require sample preparation, and allow multiconstituent analysis. First, we have described frequent forms of food fraud in dairy products and the application of traditional techniques for their detection, highlighting gaps and counterproductive characteristics for the actual global food chain, as longer sample preparation time and use of reagents. Then, the application of near-infrared spectroscopy and hyperspectral imaging for the detection of food fraud mainly in cheese, butter, and yogurt are described. As these techniques depend on model development, the coverage of different dairy products by the literature will promote the identification of food fraud in a faster and reliable way.

The Profile of Bicycle Users, Their Perceived Difficulty to Cycle, and the Most Frequent Trip Origins and Destinations in Aracaju, Brazil.

The objective of this study was to describe the profile of bicycle users, their perceived difficulty to cycle, and the most frequent trip origins and destinations in Aracaju, Northeast Brazil. Our cross-sectional study sampled 1001 participants and we collected information through structured interviews. Aged ≥15 years, participants were residents of all Aracaju's neighborhoods and used a bicycle for commuting to work or for leisure. We observed that bicycle users in Aracaju are predominantly employed male subjects, aged between 18 and 40 years, and were the heads of their households. Most of the them reported "work" as the main reason for their bicycle trips and, "health" and "practicality" aspects as their main motivations for using bicycles. In general, the neighborhoods in the north and center of the city were identified as the most difficult for cycling, and the easiest trips occurred in places with cycle paths. As a conclusion of this study, we reaffirm the need for intersectoral actions that create favorable environments for active commuting and more sustainable cities.