Renal Doppler Ultrasound - a Late Diagnosis of Aortic Coarctation.

Aortic coarctation is characterized by a segmental narrowing of the aortic lumen, usually diagnosed and treated in the neonatal period or early childhood, but can remain undiagnosed until adulthood. It manifests as a broad spectrum of signs and symptoms, ranging from mild to severe, of which arterial hypertension is one of the most common. In this article, the authors describe the clinical case of a 9-year-old child under investigation in the Pediatric Department for secondary causes of arterial hypertension. A renal Doppler ultrasound study revealed the presence of bilateral parvus et tardus waveform morphology in renal and intrarenal arteries and the proximal abdominal aorta. These findings were suspicious for diagnosing aortic coarctation, which thoracic CTangio confirmed.

Reactivation of Tumor-like Chagas Disease in the Central Nervous System in Cardiac Transplant Patients: A Case Series and Literature Review / Reativação pseudotumoral da doença de Chagas no sistema nervoso central em pacientes transplantados cardíacos: Série de casos e revisão de literatura

Introduction Chagas disease is an important public health problem in Latin American countries, affecting 6 million people within the region. In patients with chronic Chagas disease who undergo some type of immunosuppression reactivation of the acute form may occur, and manifestations involve many organs, including the central nervous system. Tumor-like brain reactivations are well described in patients with acquired immunodeficiency syndrome; however, this is a very rare event among Chagasic patients immunosuppressed after a heart transplantation. Case Report We describe three cases of cardiac transplant patients who had a tumor-like intracranial lesion, whose biopsies were compatible with Chagas disease. All 3 patients were treated with benznidazole, and 2 of them presented parameters of cure after 60 days of treatment, while 1 required a 2nd cycle of treatment. Discussion A tumor-like Chagas disease reactivation in the central nervous system may happen in heart-transplant patients and, due to the multiple differential diagnoses, we believe that brain biopsies should be considered when feasible

Introdução A doença de Chagas é um problema de saúde pública relevante nos países da América Latina, afetando aproximadamente 6 milhões de pessoas na região. Em pacientes com a forma crônica da doença submetidos a algum tipo de imunossupressão, a reativação da forma aguda pode ocorrer e cursar com manifestações que envolvem vários órgãos, incluindo o sistema nervoso central. A reativação cerebral pseudotumoral é bem descrita em pacientes imunossuprimidos pela síndrome de imunodeficiência adquirida; contudo, é um evento raro entre os pacientes imunossuprimidos após transplante cardíaco. Relato de caso São relatados três casos de transplantados cardíacos que apresentavam uma lesão tumoral intracraniana, cujas biópsias eram compatíveis com a doença de Chagas. Todos os 3 pacientes foram tratados com benznidazol, e 2 deles apresentaram parâmetros de cura após 60 dias de tratamento, enquanto 1 exigiu um 2° ciclo de tratamento. Discussão A reativação pseudotumoral da doença de Chagas no sistema nervoso central pode acontecer em pacientes submetidos ao transplante cardíaco e, devido aos múltiplos diagnósticos diferenciais, acreditamos que a biópsia cerebral deve ser considerada quando viável.

Measurement of arterial stiffness and vascular aging in community pharmacies-The ASINPHAR@2action project.

The ASINPHAR@2action project aims at raising awareness to arterial stiffness (AS) and early vascular aging (EVA) through a community pharmacy-based intervention. This preliminary analysis is focused on the analysis of the proportion of participants with increased AS and the identification of its main determinants. We performed an observational cross-sectional study of participants enrolled in 11 community pharmacies in Portugal, between April and November 2017. Blood pressure (BP) and arterial function parameters were measured with a validated device. Clinical and demographic information was gathered, as well as the estimation of global cardiovascular risk, health-related quality of life, and dietary profile. Cholesterol and glycaemia were taken from a recent laboratory bulletin. The cohort includes 658 participants with a mean age of 57.3 ± 16.3 years, 66% women. Brachial BP was 126.6 ± 16.4 mm Hg and 79.9 ± 11.5 mm Hg, and central BP was 115.8 ± 15.4 mm Hg and 81.2 ± 11.6 mm Hg, respectively, for systolic and diastolic BP. Mean pulse wave velocity (PWV) was 8.5 ± 2.3 m/s, and the augmentation index was 23.6 ± 15.6%. The proportion of participants with increased AS was 19.8%. The overall best-fitting model for AS included age, gender, aortic PP, visceral fat, HDL cholesterol, AIx@75, total vascular resistance, hypertension, and diabetes, corresponding to an AUC of 0.910 (CI: 0.883, 0.937; P < 0.001) in the ROC curve analysis. The preliminary results of this pioneering large-scale study measuring arterial function in community pharmacies provide the grounds for the operationalization of subclinical target organ damage screening in pharmacies, as a strategy to improve cardiovascular risk monitoring and to promote adherence to treatment.

Influence of Food Characteristics and Food Additives on the Antimicrobial Effect of Garlic and Oregano Essential Oils.

Utilization of essential oils (EOs) as antimicrobial agents against foodborne disease has gained importance, for their use as natural preservatives. Since potential interactions between EOs and food characteristics may affect their antimicrobial properties, the present work studies the influence of fat, protein, pH, aw and food additives on the antimicrobial effect of oregano and garlic EOs against Salmonella spp. and Listeria monocytogenes. Results showed that protein, pH, aw, presence of beef extract, sodium lactate and nitrates did not influence their antimicrobial effect. In contrast, the presence of pork fat had a negative effect against both EOs associated with their dilution of the lipid content. The addition of food phosphates also exerts a negative effect against EOs probably associated with their emulsification properties as observed with the addition of fat. The results may help the food industry to select more appropriate challenges to guarantee the food safety of foodstuffs.

Synergistic Activity of Essential Oils from Herbs and Spices Used on Meat Products against Food Borne Pathogens.

Essential oils (EOs) could be utilized as natural agents to improve the safety of meat products. However, the high concentration required to achieve an antimicrobial effect in foods might be incompatible with their sensory acceptance. To avoid this problem, combinations of EOs provide an effective approach reducing the odds of sensory rejection. In our study, 13 EOs of herbs and spices commonly used in the seasoning of meat products were assessed for their antimicrobial activity against Salmonella spp., Listeria monocytogenes, Escherichia coli and Staphylococcus aureus. However, only 7 of them were selected to study their synergistic effect based on their antimicrobial activity and minimum inhibitory concentration (MIC) against foodborne pathogens. EOs of thyme and cinnamon presented the largest antibacterial activity against foodborne pathogens. Combinations of selected EOs displayed a synergic effect against foodborne pathogens and also an important decrease in their individual MIC. Thyme EO presented the lowest individual MIC, but its utilization in combination decreased the MIC of the other EOs. Utilization of cinnamon EO also improved the reduction of the individual MICs of the EOs of cumin and parsley. Our results suggest the potential use of EO mixtures to control foodborne pathogens in meat products. Although the individual MIC values of selected EOs decreased, the sensory impact on meat products needs to be assessed.

Characterization of anti-Listeria bacteriocins isolated from shellfish: potential antimicrobials to control non-fermented seafood.

This work had as main objectives to characterize two bacteriocins produced by lactic acid bacteria (LAB) previously isolated from non-fermented seafood, in order to evaluate their potential as new food protective agents. The two bacteriocinogenic isolates were identified by Polymerase Chain Reaction (PCR) using genus- and species-specific primers, and confirmed by 16S rDNA sequencing, as Enterococcus faecium and Pediococcus pentosaceus. The antimicrobial spectrum of each strain included several indicator microorganisms, some of them also isolated from seafood. Growth of Listeria innocua, L. monocytogenes, Staphylococcus aureus, Bacillus cereus and other LAB species were inhibited, although no inhibition of Gram-negative microorganisms was observed. Proteolytic, but not lipolytic or glycolytic enzymes, completely inactivated the antimicrobial effect of both cell-free supernatants confirming the proteinaceous nature of the inhibitors. The antimicrobial activity was maintained after treatment with NaCl, SDS, Triton X-100, Tween 20, Tween 80 and EDTA after 2 h or 5 h of exposure and both bacteriocins were stable over a wide range of pH and temperatures. Production of bacteriocin by E. faecium (bacALP7) was detected initially at exponential phase and reached a maximum activity of 25,600 AU/ml in the early stationary phase, whereas bacteriocin production by P. pentosaceus ALP57 (bacALP57) reached the maximum at exponential phase with 12,800 AU/ml. The bacteriocins did not kill L. monocytogenes ESB54 nor L. innocua 2030c however, cellular growth was reduced. The partially purified bacteriocins, bacALP7 and bacALP57, were below 6.5 kDa in size as determined by Tricine-SDS gel electrophoresis. E. faecium and P. pentosaceus contained DNA fragments corresponding in size to those recorded for enterocin B and pediocin PA-1, respectively. Sequencing of the fragments from both bacteriocins confirmed the homology. To our knowledge, for the first time two LAB producing bacteriocins similar to pediocin PA-1 and enterocin B, were isolated from non-fermented shellfish. The adaptation of the cultures to seafood matrices may be advantageous in terms of application as a biopreservation strategy for reduction of L. monocytogenes levels in seafood products.