RESUMO
The fruit processing industry is responsible for disposing of huge amounts of byproducts, especially fruit peels (FPs), which are often discarded in landfills. Using FPs in biotechnological processes contributes to a circular economy, reducing the environmental burden of FPs and increasing the revenue of the fruit processing industry. This study was focused on upgrading the nutritional value of orange (OPs) and banana (BPs) peels by solid-state fermentation (SSF) with filamentous fungi. SSF factors (moisture, fermentation time, inoculum size, ammonium sulfate (AS), and corn steep liquor (CSL)) and fungi species (Aspergillus ibericus and Rhizopus oryzae) were studied by a variable screening Plackett-Burman design. Both fungi grew on untreated FPs, increasing their protein content and antioxidant activity. Moisture, AS, and CSL were further studied by a Box-Behnken design with A. ibericus. Fermented OPs at 70% moisture and 0.005 g/g AS increased their protein content by 200%, whereas BPs at 70% moisture and 0.005 g/g CSL increased by 123%. Fermented peels were enriched in protein, fiber, and minerals, with a low content of carbohydrates and soluble sugars. Fermented OPs and BPs showed higher antioxidant activity than unfermented peels. The SSF of these FPs is an innovative approach that contributes to obtaining rich nutrient-fermented peels for food.
Assuntos
Fermentação , Frutas , Valor Nutritivo , Rhizopus oryzae , Frutas/microbiologia , Frutas/química , Frutas/metabolismo , Rhizopus oryzae/metabolismo , Aspergillus/metabolismo , Musa/microbiologia , Antioxidantes/metabolismo , Citrus sinensis/microbiologia , Citrus sinensis/químicaRESUMO
Onychomatricoma is a slow-growing, benign neoplasm of the nail matrix with several histological variants. With only 2 cases previously reported, the term "myxoid onychomatricoma" has been used by some authors to describe a rare variant, known to have a fibromixoid component. We present a case of a 51-year-old Caucasian woman with a 1-year history of thickening and discoloration of the right thumbnail, who was initially misdiagnosed as onychomycosis. After performing a magnetic resonance imaging that showed a tumor with several filamentous projections, an onychomatricoma was suspected and a total distal plaque avulsion was performed. Histology revealed a biphasic tumor with an epithelial component and a prominent myxoid stroma. Immunohistochemical staining was then used, confirming the diagnosis. Considering these findings, we believe that our case meets the diagnostic description of "myxoid onychomatricoma" and is, therefore, a new case of this rare histological variant.
Assuntos
Doenças da Unha/patologia , Neoplasias Cutâneas/patologia , Erros de Diagnóstico , Feminino , Humanos , Pessoa de Meia-Idade , Onicomicose/diagnósticoRESUMO
Debridement is essential for the optimal care of venous leg ulcers. Several debridement methods with different limitations may be deployed. Trichloroacetic acid (TCA) is used for several dermatological purposes. Its application as a chemical debridement method for leg ulcers has never been explored. We designed a prospective study to determine the role of 80% TCA solution as a chemical debridement method for leg ulcers, regarding efficacy and procedure-associated pain. Chronic venous leg ulcers were treated with 3 cycles of 80% TCA solution or curettage over 1 week. Pain and the mean percentage of fibrin and devitalized tissue covering wound bed were evaluated. At the end of the study, a trend towards larger fibrin mean reduction among the TCA treated ulcers was observed, although this difference was not statistically significant (P = .35). The mean pain score after TCA application was significantly reduced compared to pain after curettage alone (P < 0.001). TCA presented several advantages over mechanical debridement: it is a more selective debridement method, has haemostatic properties, and a simpler and faster application. The 80% TCA solution may be a cheap, simple, and considerably less-painful chemical debridement method for venous leg ulcers compared to classical mechanical debridement.
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Cáusticos/uso terapêutico , Desbridamento/métodos , Úlcera da Perna/terapia , Dor Processual/prevenção & controle , Ácido Tricloroacético/uso terapêutico , Úlcera Varicosa/terapia , Idoso , Doença Crônica , Desbridamento/efeitos adversos , Humanos , Úlcera da Perna/patologia , Dor Processual/etiologia , Projetos Piloto , Estudos Prospectivos , Úlcera Varicosa/patologiaAssuntos
Queilite/etiologia , Lábio/patologia , Lúpus Eritematoso Discoide/complicações , Idoso , Anticorpos Antinucleares/imunologia , Antirreumáticos/administração & dosagem , Antirreumáticos/uso terapêutico , Queilite/diagnóstico , Queilite/tratamento farmacológico , Feminino , Humanos , Hidroxicloroquina/administração & dosagem , Hidroxicloroquina/uso terapêutico , Lúpus Eritematoso Discoide/diagnóstico , Lúpus Eritematoso Discoide/tratamento farmacológico , Lúpus Eritematoso Discoide/imunologia , Fator de Proteção Solar/métodos , Resultado do TratamentoAssuntos
Carcinoma in Situ , Imunoterapia/efeitos adversos , Infecções por Mycobacterium , Mycobacterium bovis , Doenças do Pênis , Neoplasias Uretrais , Idoso , Carcinoma in Situ/microbiologia , Carcinoma in Situ/terapia , Humanos , Masculino , Infecções por Mycobacterium/etiologia , Infecções por Mycobacterium/microbiologia , Infecções por Mycobacterium/patologia , Doenças do Pênis/etiologia , Doenças do Pênis/microbiologia , Doenças do Pênis/patologia , Neoplasias Uretrais/microbiologia , Neoplasias Uretrais/patologia , Neoplasias Uretrais/terapiaRESUMO
INTRODUCTION: Sit-to-stand (SitTS) and stand-to-sit (StandTS) are very important functional tasks that become compromised in stroke patients. As in other voluntary movements, they require an adequate postural control (PC) involving the generation of anticipatory postural adjustments (APAs). In order to give clues for more efficient and directed rehabilitation programs, a deeper knowledge about APAs during challenging and daily life movements is essential. PURPOSE: To analyze the activation timing of tibialis anterior (TA) and soleus (SOL) muscles during SitTS and StandTS in healthy subjects and in post-stroke patients. METHODS: Two groups participated in this study: one composed of ten healthy subjects and the other by ten subjects with a history of stroke and increased H-reflex. Electromyographic activity (EMGa) of SOL and TA was analyzed during SitTS and StandTS in the ipsilateral (IPSI) and the contralateral (CONTRA) limb to the side lesion in stroke subjects, and in one limb in healthy subjects. A force plate was used to identify the movement onset. RESULTS: In both sequences, in the stroke group SOL activation timing occurred prior to movement onset, contrary to the pattern observed in the healthy subjects. Statistically significant differences were found in SOL activation timings between each lower limb of the stroke and healthy groups, but no significant differences were found between the IPSI and the CONTRA limb. The TA activation timing seems to be delayed in the CONTRA limb when compared to the healthy subjects and showed a better organization of TA timing activation in StandTS when compared to SitTS. CONCLUSION: Compared to healthy subjects, APAs seem to be altered in both limbs of the post-stroke subjects, with the SOL activation timing being anticipated in both SitTS and StandTS.
Assuntos
Reflexo H/fisiologia , Músculo Esquelético/fisiologia , Equilíbrio Postural/fisiologia , Acidente Vascular Cerebral/complicações , Adulto , Estudos de Casos e Controles , Eletromiografia/instrumentação , Eletromiografia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estatísticas não Paramétricas , Acidente Vascular Cerebral/fisiopatologiaAssuntos
Corantes/efeitos adversos , Dermatite Alérgica de Contato/etiologia , Dermatite Ocupacional/etiologia , Dermatoses da Mão/induzido quimicamente , Idoso , Compostos Azo/efeitos adversos , Humanos , Masculino , Testes do Emplastro , Fenilenodiaminas/efeitos adversos , Indústria Têxtil , Têxteis , p-Aminoazobenzeno/efeitos adversosAssuntos
Vacina Quadrivalente Recombinante contra HPV tipos 6, 11, 16, 18/efeitos adversos , Vacinas contra Papillomavirus/efeitos adversos , Pseudolinfoma/induzido quimicamente , Dermatopatias/induzido quimicamente , Adulto , Betametasona/análogos & derivados , Betametasona/uso terapêutico , Feminino , Vacina Quadrivalente Recombinante contra HPV tipos 6, 11, 16, 18/administração & dosagem , Humanos , Injeções Intralesionais , Injeções Intramusculares , Imageamento por Ressonância Magnética , Pseudolinfoma/diagnóstico , Pseudolinfoma/tratamento farmacológico , Doenças Raras , Dermatopatias/diagnóstico , Dermatopatias/tratamento farmacológicoRESUMO
INTRODUCTION: The interaction of antiseizure medication with contraceptives, its potential teratogenicity and implications in pregnancy and breastfeeding are aspects to consider in the neurological care of women with epilepsy of childbearing age. To ensure the commitment in therapeutic decisions and the appropriate planning of maternity, it is essential that women are informed about the implications of their disease in these domains. The main aim of this study was to assess the knowledge of women of childbearing age with epilepsy concerning the impact of epilepsy in contraception, pregnancy and breastfeeding. As secondary aims we defined (1) the demographic, clinical and therapeutic characterization of this group of patients, (2) the identification of variables that correlated with the level of knowledge of women with epilepsy, and (3) the identification of preferential methods to acquire new knowledge about epilepsy. MATERIAL AND METHODS: The study was observational, cross-sectional and multicentric, and was carried out in five hospitals of the Lisbon metropolitan area. After identifying all women of childbearing age with epilepsy followed in the epilepsy clinic of each center, we applied an electronic questionnaire based on a non-systematic review of the literature. RESULTS: One hundred and fourteen participants were validated, with a median age of 33 years. Half of the participants were on monotherapy, and the majority had no seizures in the last six months. We identified important gaps in the participants' knowledge. Sections about complications and administration of antiseizure medication during pregnancy were the ones with the worst results. None of the clinical and demographic variables correlated with the final questionnaire score. Having had a previous pregnancy and the desire to breastfeed in a future pregnancy were positively correlated with the performance in breastfeeding section. Face-to-face discussion during medical outpatient visits was selected as the preferential method to learn about epilepsy, and the internet and social media were the least preferred ones. CONCLUSION: The knowledge of women of childbearing age with epilepsy in the Lisbon metropolitan area concerning the impact of epilepsy in contraception, pregnancy and breastfeeding seems to have significant gaps. Medical teams should consider engaging in patient education particularly during outpatient clinics.
Introdução: A interação dos fármacos anticrise epilética com os métodos contracetivos, a sua potencial teratogenicidade e as implicações na gravidez e amamentação são aspetos a considerar no acompanhamento de mulheres com epilepsia em idade fértil. Para o seu desejado envolvimento nas decisões terapêuticas e o adequado planeamento da maternidade, é essencial que as mulheres estejam corretamente informadas acerca das implicações da sua doença. O objetivo principal do presente estudo foi avaliar o conhecimento das mulheres com epilepsia em idade fértil sobre o impacto da epilepsia na contraceção, gravidez e amamentação. Como objetivos secundários definiram-se (1) a caracterização demográfica, clínica e terapêutica deste grupo de doentes, (2) a identificação de variáveis correlacionadas com o nível de conhecimento das mulheres com epilepsia, e (3) a identificação de meios e suportes preferenciais para aquisição de novos conhecimentos sobre epilepsia. Material e Métodos: O estudo foi observacional, transversal e multicêntrico, tendo decorrido em cinco centros hospitalares da região metropolitana de Lisboa. Após identificação das mulheres com epilepsia em idade fértil seguidas na Consulta de Epilepsia de cada centro, aplicou-se um questionário eletrónico construído após revisão não sistemática da literatura. Resultados: Foram validadas 114 participantes, com uma idade mediana de 33 anos. Metade das participantes apresentavam-se sob monoterapia, tendo a maioria a epilepsia controlada há pelo menos seis meses. Identificaram-se importantes lacunas no conhecimento das participantes. Conceitos sobre complicações dos fármacos anticrise epilética e a sua administração durante a gravidez motivaram piores resultados. Não houve correlação entre variáveis clinico-demográficas e o resultado no questionário. A ocorrência de gravidez prévia e o desejo de amamentar numa gravidez futura correlacionaram-se com o desempenho na secção sobre amamentação. A discussão oral na consulta foi a forma preferencial para aquisição de novos conhecimentos sobre epilepsia, tendo a internet e as redes sociais sido os meios menos escolhidos. Conclusão: O conhecimento das mulheres com epilepsia em idade fértil na área metropolitana de Lisboa sobre o impacto da sua doença na contraceção, gravidez e amamentação parece apresentar lacunas importantes. A educação para a saúde deste grupo deverá constituir uma preocupação por parte das equipas médicas, devendo privilegiar-se a consulta como local de ensino.
Assuntos
Aleitamento Materno , Epilepsia , Feminino , Gravidez , Humanos , Adulto , Estudos Transversais , Anticonvulsivantes/efeitos adversos , Anticoncepção , Epilepsia/tratamento farmacológico , Conhecimentos, Atitudes e Prática em Saúde , Estudos Multicêntricos como AssuntoRESUMO
INTRODUCTION: The beginning of the movement sequence from standing to sitting requires the modulation of plantar flexors activity, including the soleus muscle (SOL), to allow the forward translation of the tibia in relation to the foot, preserving its antigravity function. PURPOSE: To analyze the SOL activity during the initial phase of standing to sitting in stroke subjects. METHODS: Two groups of ten subjects each participated in this study, one composed of healthy subjects and the other with subjects with a history of stroke. Electromyographic activity (EMGa) of SOL was analyzed in the ipsilateral (IPSI) and contralateral (CONTRA) limb to side lesion in stroke subjects, and in one limb in healthy subjects during the initial phase of standing to sitting. A force plate was used to identify the movement sequence phase. RESULTS: The mean values of SOL EMGa were higher in healthy subjects than the ones obtained in the IPSI and CONTRA limb in stroke subjects. Significant differences were only observed between the IPSI and healthy limb (p=0.035). CONCLUSION: When compared to the healthy subjects, stroke subjects showed a decreased SOL EMGa in the IPSI limb, which suggests that therapeutic decisions must consider the need to promote a better postural control also in the IPSI limb.
Assuntos
Transtornos dos Movimentos/fisiopatologia , Movimento/fisiologia , Músculo Esquelético/fisiopatologia , Postura/fisiologia , Acidente Vascular Cerebral/fisiopatologia , Adulto , Idoso , Avaliação da Deficiência , Eletromiografia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos dos Movimentos/diagnóstico , Transtornos dos Movimentos/etiologia , Músculo Esquelético/inervação , Recuperação de Função Fisiológica/fisiologia , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnósticoRESUMO
Scleredema of Buschke is a rare connective tissue disease with a poorly understood pathogenesis. Three types of scleredema have been distinguished according to its association with preceding or underlying conditions. Type 1 is usually secondary to a febrile infection, type 2 is mostly associated with paraproteinemia and type 3, usually named scleredema diabeticorum, has a strict association with Diabetes mellitus. A diffuse, non-pitting swelling and induration of the skin define this disease. The skin histology is characterized by a normal or slightly thinned epidermis, and the dermis containing a decreased number of elastic fibers and thick large swollen collagen bundles separated by mucopolysaccharide deposits in the deep reticular dermis. In this report we present a 58-year-old man with scleredema diabeticorum controlled with a topical steroid cream and an optimization of glycemic control. We reviewed clinical, histopathological characteristics and the various possible treatments.
RESUMO
BACKGROUND: Persistent headache attributed to past stroke (PHAPS) is a controversial entity, recently included in the third edition of the International Classification of Headache Disorders (ICHD-3) despite being described only in retrospective studies. OBJECTIVE: To determine the frequency and characteristics of PHAPS in patients admitted with acute stroke. METHODS: We selected all patients with headache associated with acute stroke (HAAS) from a prospective, single-center registry of patients with acute stroke admitted to a Neurology ward between November 2018 and December 2019. We analyzed demographic, clinical, and neuroimaging data. We assessed the follow-up with a phone call questionnaire at 6 to 12 months. RESULTS: Among 121 patients with acute stroke, only 29 (24.0%) had HAAS. From these, 6 (5.0%) were lost to follow-up. In total, 23 (20.0%) patients answered the 6- to 12-month follow-up questionnaire and were included in this study. The median age of the sample was 53 years (interquartile range [IQR]: 38-78 years), and there was no sex predominance. Of the 10 patients (8,3%) that had persistent headache, 8 (6.6%) suffered from previous chronic headaches; however, they all mentioned a different kind of headache, and 1 (0,8%) probably had headache secondary to medication. CONCLUSIONS: In the present study, only 10 out of 121 stroke patients (8.3%) referred persistent headache at the 6- to 12-month follow-up, but the majority already suffered from previous chronic headache, which raises the question that the actual prevalence of PHAPS may be lower than previously reported.
ANTECEDENTES: A cefaleia persistente atribuída a acidente vascular cerebral (AVC) prévio é uma entidade controversa, recentemente incluída na terceira edição da Classificação Internacional de Transtornos da Cefaleia (International Classification of Headache Disorders, ICHD-3), apesar de descrita apenas em estudos restrospectivos. OBJETIVO: Determinar a frequência e as características do acidente vascular cerebral prèvio em doentes admitidos com AVC agudo. MéTODOS: Selecionamos todos os doentes com cefaleia associada a AVC agudo de um registro unicêntrico e prospectivo de doentes admitidos no serviço de Neurologia entre novembro de 2018 e dezembro de 2019. Analisamos dados demográficos, clínicos e imagiológicos. Reavaliamos aos 6 a 12 meses por questionário telefónico. RESULTADOS: Entre os 121 doentes admitidos com AVC agudo, apenas 29 (24,0%) tinham cefaleia associada a AVC agudo. Destes, 6 (5,0%) perderam-se no seguimento. Ao todo, 23 (20,0%) responderam ao questionário e foram incluídos. A idade mediana foi de 53 anos (intervalo interquartílico [IIQ]: 3878 anos), e não houve predominância de gênero. Dos 10 doentes (8,3%) que apresentam cefaleia persistente, 8 (6,6%) tinham histórico de cefaleia; no entanto todos mencionaram um tipo diferente de cefaleia, e 1 (0,8%) provavelmente tinha cefaleia secundária a medicação. CONCLUSõES: Neste estudo, apenas 10 em 121 doentes (8,3%) mencionaram cefaleia persistente aos 6 a 12 meses de seguimento, mas a maioria sofria de cefaleia prévia, pelo que a real prevalência de acidente vascular cerebral prèvio pode ser inferior à descrita nos estudos realizados até a data.
Assuntos
Transtornos da Cefaleia , Acidente Vascular Cerebral , Humanos , Adulto , Pessoa de Meia-Idade , Idoso , Estudos Retrospectivos , Estudos Prospectivos , Cefaleia/complicações , Acidente Vascular Cerebral/complicaçõesRESUMO
Dermatitis Cruris Pustulosa et Atrophicans (DCPA) was first described in 1952 in Nigeria and is nowadays regarded as a type of chronic folliculitis of tropical areas. It is often limited to the lower limbs of young adults, mostly in the second to third decades, with a unique clinical picture characterized by chronicity, relentless progression, therapy refractoriness, and permanent cicatricial changes. Trauma, occlusion, and microorganism selection contribute for its etiopathogenesis, which is deemed multifactorial but still incompletely understood. Despite its conspicuous clinical features, awareness of DCPA is apparently low, hence probably overlooked. We herein summarize the current state of knowledge regarding this distinct entity, and further present the first report in a patient from Bangladesh, and concurrently the first in Europe. Paucity of data, and unraveled definite etiology and treatment, highlight the need for further studies.
RESUMO
Onychomycosis is one of the most common nail disorders and may be difficult to distinguish from other causes of nail dystrophy, based on clinical grounds alone. With this study, we aimed to describe the use of fungal testing by dermatologists and family physicians in their daily current practice, analyze their respective familiarity with nail disease diagnosis, and ultimately treatment decision-making by both groups. An online survey was distributed among Portuguese dermatologists, trainees, and family physicians by email. The survey focused on the diagnostic impression, use of diagnostic methods to confirm a fungal infection, and the subsequent assessment of treatment. One hundred fifty-one responses were obtained, 60 (39.7%) from dermatologists and 91 (60.3%) from family physicians; 98.3% of dermatologists mentioned usually requesting a fungal testing at their local institution or outside, while this percentage was 50.5% among family physicians (p < 0.001). Regarding the diagnosis, the median of correct diagnosis by the dermatologist group was higher (10/15) than the family physicians (6/15). Considering the treatment strategy, we observed that in the dermatologists' group it would result in unnecessary treatment in a median of 2 cases, while in the family physicians' group, in a median of 4 cases.
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BACKGROUND: Considering the potential COVID-19 impact on pwMS health and the importance of vaccination for this population, we decided to assess: (a) pwMS' beliefs and knowledge on COVID-19 pandemic; (b) their acceptance towards COVID-19 vaccination and (c) pwMS' opinions on general vaccination. METHODS: Observational study, based on a cross-sectional (10-20th September 2020) online survey, conducted in a cohort of pwMS' followed at two Portuguese hospitals. The survey included measures to characterize the sample and a questionnaire designed to assess the topics defined for this study. RESULTS: 270 respondents completed the full survey (response rate 58.2%). pwMS greatest concern during the pandemic was an aggravation of MS, especially by patients older than 50 years old. Almost 40% of the patients older than 50 felt that the pandemic negatively affected their MS related medical assistance. Most patients believed they would recover from COVID-19 infection. More than half of the responders feared a MS aggravation if they got COVID-19; this was more pronounced in patients with progressive MS. About 12% of the participants did not want to be vaccinated and almost 40% was unsure. Regarding vaccines in general, almost a third of the participants feared their side effects or MS related complications. CONCLUSION: Having knowledge of pwMS' opinions on COVID-19 pandemic impact and vaccination is useful to better address these issues. Fears and expectations towards vaccination must be discussed with pwMS.