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Introduction: Acquired angioedema (AAE), a rare cause of adult-onset non-urticarial mucocutaneous angioedema, can present as acute abdomen, a frequent complaint in the emergency room (ER), often leading to unnecessary and potentially harmful procedures. Case Presentation: We report a 47-year-old hypertense male, controlled with an angiotensin converting enzyme inhibitor (ACEI), who presented in the ER with progressively worsening abdominal pain, nausea, and vomiting, and a radiologic workup revealing small intestine thickening, initially diagnosed with ACEI-induced angioedema. However, further investigation revealed low serum levels of C4, C1q, and C1 inhibitors, with an abnormal function of the latter, favoring the diagnosis of AAE instead. The frequent association of this condition with lymphoproliferative disorders encouraged further studies, which unveiled a monoclonal gammopathy IgM/Kappa, representing an increased risk of Waldenström macroglobulinemia, non-Hodgkin lymphoma, and multiple myeloma. Discussion: AAE should be regarded as an important differential diagnosis in patients presenting with acute abdomen in the ER, especially when more common causes are excluded. A correct and early diagnosis may represent a chance for a better prognosis of underlying diseases.
Introdução: O angioedema adquirido (AA), causa rara de angioedema mucocutâneo não urticariforme de início tardio, pode ter como apresentação inicial abdómen agudo, motivo frequente de admissão no serviço de urgência (SU), promovendo frequentemente procedimentos desnecessários e potencialmente prejudiciais. Apresentação do caso: Um homem de 47 anos, hipertenso e controlado com um inibidor da enzima conversora de angiotensina (IECA), recorreu ao SU por um quadro de dor abdominal com agravamento progressivo, náuseas e vómitos. A investigação radiológica inicial revelou espessamento do intestino delgado, culminando num diagnóstico preliminar de angioedema induzido por IECA. No entanto, uma investigação mais aprofundada em regime ambulatório revelou níveis séricos reduzidos de C4, C1q e de inibidor de C1, com função anormal deste último, favorecendo o diagnóstico de AA. A associação frequente desta condição com distúrbios linfoproliferativos incentivou investigação adicional, que revelou uma gamopatia monoclonal IgM/Kappa, representando um risco aumentado de macroglobulinemia de Waldenström, linfoma não-Hodgkin e mieloma múltiplo. Discussão: O AA deve ser considerado um diagnóstico diferencial de abdómen agudo, principalmente após exclusão de causas mais frequentes. Um diagnóstico precoce pode contribuir para um melhor prognóstico da patologia subjacente.
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Phytophotodermatitis, a condition that results from sequential skin exposure to phototoxic chemicals contained within plants, followed by exposure to solar ultraviolet radiation, has been described with several plants and plant-based foods, namely members of the Moraceaefamily, which include Ficus carica L. This tree's branches, leaves, and fruit skin exude a milky sap or latex containing proteolytic enzymes and furocoumarins known to be photoirritants, easily absorbed upon skin contact. Oxygen-dependent and independent toxic reactions subsequent to sun exposure promote cell membrane damage and oedema, consequently leading to cell death. The diagnosis is confirmed with a detailed anamnesis, and photopatch testing is often useful to rule out a differential diagnosis. It is typically a self-limited condition, with few cases requiring treatment with topical or systemic corticosteroids. We report on a 55-year-old male patient who, following picking figs and pruning a fig tree while exposed to sunlight, developed erythematous and pruritic maculopapular lesions that progressed to blisters with residual hyperpigmentation. The diagnosis was further corroborated through photopatch testing, and the patient was recommended to avoid this recreational activity without symptoms' relapse. This case highlights the importance of considering phytophotodermatitis as a differential diagnosis when evaluating cases of dermatitis on exposed body surfaces and the importance of an exhaustive anamnesis. Identification of specific plant triggers and the performance of photopatch tests are essential to help confirm the diagnosis and guide avoidance recommendations.
Asunto(s)
Angioedema , Angioedemas Hereditarios , Embarazo , Femenino , Humanos , Angioedemas Hereditarios/complicacionesRESUMEN
BACKGROUND: Obesity is a growing epidemic worldwide. Evidence so far demonstrates that the bacteria that are commonly found in the human gastrointestinal tract affect nutrient acquisition and energy regulation. This suggests that an important role is played by gut microbiota in the development of obesity. OBJECTIVES: Our main goal was to assess if a probiotic diet leads to a significant difference in weight change in non-obese and obese people, and in experimental models. METHODS: Search was undertaken in PubMed, Scopus, ISI Web of knowledge, Cochrane Central Register of Controlled Trials, Google scholar, meta-Register of Controlled Trials, ClinicalTrials.gov and by scanning reference lists of articles, without publication date imposed, for randomised clinical trials studying the administration of probiotics to obese or overweight patients and experimental studies in experimental models and healthy humans. Search terms included probiotics, obesity, weight, BMI, weight gain, weight loss, weight change, probiotic diet and probiotic therapy. In an unblended standardized manner, 2 reviewers analysed the searched studies, using the defined inclusion and exclusion criteria, and performed extraction of data, in an independent way, using predefined data fields. RESULTS: We've identified, through searching databases specified in methods, 269 records. A total of 4 clinical trials and 14 experimental studies were included in the systematic review. Among the 4 randomized clinical trials only one showed statistically significant results. L. rhamnosus CGMCC 1.3724 was efficient in reducing weight in females, but not in males - Mean weight loss 12 week/24 week (kg): Males-probiotic: 4/5.4; Males-placebo: 3.05/4.43; Females-probiotic: 4.4/5.2; Females- placebo: 2.6/2.5 (P<0.05 only on females). CONCLUSIONS: In our systematic review, we found that probiotic effect in body weight is specie and strain specific. L. gasseri BNR17, reduced the weight gain compared to controls; L. gasseri L66-5 promoted weight gain, L. rhamnosus GGMCC is the only one that had a positive effect in weight loss in humans. Probiotic effect in body weight was species and strain specific. On the other hand L. plantarum LG42, L. gasseri SBT2055 and L. plantarum co-therapy with KY103 and L. curvatus HY7601 had an anti-obesity effect in animal models.
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Introdução: Actualmente os estudos realizados tendo em conta a qualidade de vida (QDV) dos pais de crianças autistas são escassos. O que reforça a necessidade de novas investigações para que se consiga perceber o real impacto que uma criança autista provoca no seio familiar, para posteriormente se conseguirem desenvolver novas estratégias de actuação. Neste pressuposto, o presente estudo teve como objectivos: conhecer a QDV dos pais de crianças autistas e determinar variáveis o efeito de variáveis de contexto sociodemográfico, familiar e psicossocial nos diferentes domínios desta mesma QDV. Métodos: Realizou-se um estudo transversal, descritivo-correlacional, de natureza analítica e quantitativa, no qual participaram 56 pais de crianças autistas pertencentes à APPDA-Viseu, com idades entre 26 e 47 anos. Para a mensuração das variáveis utilizaram-se os seguintes instrumentos: uma ficha sóciodemográfica, escala de Apgar Familiar, escala de avaliação da QDV WHOQOL-Bref, Escala de Satisfação com o Suporte Social (ESSS) e o Inventário da Personalidade de Eysenck. Resultados: Relativamente à QDV dos pais de crianças autistas concluímos que os homens apresentam melhor QDV face às mulheres com uma ordenação média de 34.50 vs 24.62 respectivamente. Os dados revelam que existem influências significativas das variáveis sóciodemográficas: género, zona de residência e estado civil sobre a QDV dos pais de crianças autistas. Obtêm-se também a existência de influências significativas das variáveis sóciofamiliares: género do filho, tempo de institucionalização do filho e funcionalidade familiar e por fim influências significativas tanto da variável suporte social como da personalidade (em relação às variáveis psicossociais). Conclusão: As evidências encontradas neste estudo convidam-nos para a elaboração e reflexão sobre novas estratégias que possibilitem a obtenção de um melhor conhecimento que facilite o desenho de programas de intervenção formativos e informativos, visando a promoção da QDV destes sujeitos.
Introduction: Currently studies regarding the quality of life (QOL) of parents of autistic children are scarce. This reinforces the need for further investigations in order to realize the real impact of an autistic child in the family environment. So our objectives are to understand the QOL of parents of autistic children and to establish whether there is any kind of connection between the different domains of QOL and socio-demographic, psychosocial and social-familial aspects. Method: We conducted a cross-sectional study, descriptive-correlational, analytical and quantitative, attended by 56 parents of autistic children belonging to APPDA-Viseu, aged between 26 and 47 years. To measure the variables we used the following instruments: a socio-demographic data sheet, family Apgar scale, WHOQOL-Bref scale, Satisfaction with Social Support scale and the Eysenck Personality Inventory. Results: we found that men have better QOL compared to women with an average ranking of 34,50 vs. 26,72 respectively. The data reveal that there are significant influences of socio-demographic variables: gender, area of residence and marital status on QOL of parents of autistic children. We also obtained a significant influence of social-familial variables: child's gender, Length of institutionalization of the child and family functioning and ultimately we also obtain significant influences of both the variable of Social Support and personality (in relation to psychosocial). Conclusion: Evidences found in this study invite us to create and reflect on strategies to achieve a better knowledge to facilitate the design of intervention programs and training information aiming at promoting QOL of parents of autistic children.