[Rheumatic expression of secondary syphilis]. / Manifestações reumáticas da Sífilis Secundária.

Syphilis is a disease caused by Treponema pallidum infection with protean clinical manifestations. Musculoskeletal complaints are however uncommon and most of the time mild. Occasionally they can dominate the clinical picture and simulate a variety of rheumatic diseases. The authors present the clinical case of a 33-year-old woman who developed a lupus-like syndrome in the postpartum, characterized by polyarthritis, elevated acute phase reactants and positive antinuclear antibodies (ANA). Physical examination revealed a macular non-pruriginous skin rash involving the trunk, upper limbs and palms. The Rapid Plasma Reagin (RPR) and Treponema Pallidum Hemaglutination (TPHA) tests gave a positive result and the patient was diagnosed as secondary syphilis and medicated with 2.4 MU of benzathine penicillin intramuscular weekly for 3 weeks, with complete resolution of clinical signs and ANA negativation. The association of rash and arthritis may occur in several rheumatic diseases but in the presence of palmoplantar involvement, the possibility of syphilis infection should not be overlooked.

[Mixed cryoglobulinemia]. / Crioglobulinémia mista.

The authors describe two clinical cases of cryoglobulinemia. A 70 years old woman, having skin ulcers on lower limbs, arthralgias, paresthesias and constitutional symptoms, for about 10 months. Exams revealed mild anemia, elevation of the biological parameters of inflammation and aminotransferases, positive cryoglobulin and rheumatoid factor in serum, and a severe reduction in C4 complement fraction. Hepatitis C virus (HCV) serology was negative. Idiopathic mixed cryoglobulinemia was diagnosed and corticosteroid therapy started. Given the lack of response, cyclophosphamide and plasmapheresis were added. Two weeks later the patient died in septic shock. The second case refers to a 41 years old female, with untreated hepatitis C who developed over a 6 month period petechiae and livedoid lesions on the lower limbs, peripheral neuropathy, and constitutional symptoms and was admitted with intestinal necrosis. Exams were consistent with the diagnosis of mixed cryoglobulinemia associated, with HCV. She started therapy with ribavirin and pegylated interferon-alpha, with improvement.

Body composition phenotypes in systemic lupus erythematosus and rheumatoid arthritis: a comparative study of Caucasian female patients.

OBJECTIVES: The amount and distribution of fat and lean mass have important implications for health and systemic inflammation may represent a risk for altered body composition. The aim of this study was to analyse whether changes in body composition are similarly associated with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA), two inflammatory conditions of different pathogenesis. METHODS: Body mass index (BMI), waist circumference, fat mass (FM) and fat-free mass (FFM) were measured in 92 women with SLE, 89 with RA and 107 controls. Results were compared among the 3 groups and correlations of FM percentage were explored within SLE and RA. RESULTS: Abnormal body composition was more frequent in women with SLE and RA than in non-inflammatory controls, despite having a similar BMI. RA diagnosis was significantly associated with overfat (OR=2.782, 95%CI 1.470-5.264; p=0.002) and central obesity (OR=2.998, 95%CI 1.016-8.841; p=0.04), while sarcopenia was more common among SLE (OR=3.003; 95%CI 1.178-7.676; p=0.01). Sarcopenic obesity, i.e. the coexistence of overfat with sarcopenia, was present in 6.5% of SLE and 5.6% of RA women, but no controls. Independent correlations of FM percentage in women with SLE included smoking, disease activity and CRP. In RA, education, disease activity and cumulative corticosteroid dose were identified as independent predictors of FM percentage. CONCLUSIONS: Women with SLE or RA diagnosis are more likely to have abnormal body composition phenotype, with some differences existing between these two conditions. Changes in body composition are partly explained by the inflammatory burden of disease and its treatment.

Omni-wedge technique for increased dose homogeneity in head and neck radiotherapy.

Dose homogeneity in head and neck tumour irradiation is a challenging task for conventional radiotherapy due to large anatomic contour irregularities and tissue heterogeneities in irradiation volumes. We present a simple technique based on the omni-wedge concept which uses superimposed fields, orthogonally wedged, to improve target-volumes homogeneity in head and neck tumour irradiation. The routine implementation of this technique is straightforward and easy to achieve with standard radiotherapy equipment and treatment planning software. Our five-year experience in the clinical implementation of this technique is presented.

Assessment of salivary gland function in Sjögren's syndrome: the role of salivary gland scintigraphy.

Salivary gland scintigraphy (SGS) is a non invasive method of salivary gland function assessment. This technique is easy to perform, reproducible and well tolerated by patients. Additionally, an abnormal salivary gland scintigraphy result is accepted by the American-European consensus group as a criterion for the diagnosis of Sjögren's syndrome. Scintigraphic evaluation of salivary gland function also plays an important role in therapeutic decision and patient follow-up. Schall's categorical classification is usually considered the standard method for salivary scintigraphy interpretation, though subjective and with limited capacity to discriminate borderline results. In order to improve the diagnostic accuracy of SGS, there has been an increasing interest in the quantification of glandular function. However, the debate on the most reliable and suitable parameters for the diagnosis of SS persists.

[Salivary gland scintigraphy in the evaluation of patients with sicca complaints]. / Cintigrafia das glândulas salivares major na avaliação de doentes com queixas secas.

UNLABELLED: Salivary gland scintigraphy is a non invasive method widely accepted as an objective assessment of salivary gland function and a diagnostic criterion of primary Sjögren's Syndrome. In this study we evaluated the performance of qualitative and semi--qualitative salivary gland scintigraphy in primary Sjögren's Syndrome. Additionally we aimed to identify the scintigraphic patterns of salivary gland involvement in this condition. PATIENTS AND METHODS: Observational study of fifty--six women with suspected primary Sjögren's Syndrome (pSS). Investigation included clinical history and observation, ophtalmologic examination, autoantibodies (SSA and SSB) determination, minor salivary gland biopsy and salivary gland scintigraphy interpreted according to Schall classification, visual quality of radioactivity uptake, morphology of time-activity curves and semi-quantitative parameters of uptake and excretion. RESULTS: Twenty patients fulfilled diagnostic criteria for pSS. Submandibular glands showed more pronounced functional impairment. In pSS patients, all scintigraphic parameters were significantly lower on these glands: a) qualitative evaluation ' visual quality of uptake (p=0,003), morphology of time-activity curves (p=0,001) and Schall classification (p<0,001); b) semi-quantitative parameters ' maximum counts (p=0,005), maximum counts/second/MBq administered (p=0,01), index of maximum counts versus counts at first minute (p=0,002) and excretion index (p=0,006). CONCLUSIONS: Despite being qualitative and observer-dependent, Schall classification is valuable for the diagnosis of primary Sjögren's Syndrome. Nevertheless, semi-quantitative evaluation of salivary gland scintigraphy reveals significant differences in pSS patients and may have incremental value for the interpretation of salivary gland scintigraphy results.

Members of the ethylene signalling pathway are regulated in sugarcane during the association with nitrogen-fixing endophytic bacteria.

Nitrogen-fixing bacteria have been isolated from sugarcane in an endophytic and beneficial interaction that promotes plant growth. In this work, for the first time, the involvement of ethylene signalling in this interaction was investigated by molecular characterizing members of this pathway in sugarcane. The expression pattern of a putative ethylene receptor (SCER1) and two putative ERF transcription factors (SCERF1 and SCERF2) show exclusive modulation in plants inoculated with the diazotrophic endophytes. The gene expression profile of SCER1, SCERF1, and SCERF2 is differentially regulated in sugarcane genotypes that can establish efficient or inefficient associations with diazotrophic micro-organisms, exhibiting high or low biological nitrogen fixation (BNF) rates, respectively. In addition, SCER1, SCERF1, and SCERF2 expression is different in response to interactions with pathogenic and beneficial micro-organisms. Taken together, that data suggest that SCER1, SCERF1, and SCERF2 might participate in specific ethylene signalling cascade(s) that can identify a beneficial endophytic association, modulating sugarcane responses toward the diazotrophic endophytes.

SHR5: a novel plant receptor kinase involved in plant-N2-fixing endophytic bacteria association.

Endophytic nitrogen-fixing bacteria have been isolated from graminaceous plants such as maize, rice, and sugarcane. They are thought to promote plant growth, not only by fixing nitrogen, but also by the production of plant hormones. The molecular mechanisms involved in this interaction are not yet clear. In this work, the identification of a receptor-like kinase (RLK), named SHR5, which may participate in signal transduction involved in the establishment of plant-endophytic bacteria interaction is described for the first time. SHR5 seems to be part of a novel subclass of RLKs present in a wide range of plant species. The expression of this gene is down-regulated in sugarcane plants associated exclusively with beneficial endophytic bacteria and is not a general response caused by micro-organisms or abiotic stress. In addition, more successful sugarcane-endophytic bacteria associations have a more pronounced decrease in SHR5 expression, suggesting that SHR5 mRNA levels in plant cells are inversely related to the efficiency of the association.

Trace element levels in whole blood samples from residents of the city Badajoz, Spain.

Copper, lead, cadmium, and zinc were determined by anodic stripping voltammetry after sample digestion and potentiometric stripping analysis was used for Pb and Cd determination in original samples. Selenium was determined by cathodic stripping voltammetry or hydride generation AAS. Element levels found in the whole blood sample in a group of 82 people are for Cd: 0.98 +/- 0.94 ng/ml; for Pb: 46.7 +/- 28.6 ng/ml; for Cu: 1.07 +/- 0.12 micrograms/ml; for Zn: 6.95 +/- 1.08 micrograms/ml, and for Se: 116 +/- 25 ng/ml. Analytical data have been correlated to age, sex, smokers or non-smokers, drinking and food habits.

Application of adsorptive stripping voltammetry to the study of immunoglobulin A and its interaction with benzodiazepine drugs.

The adsorptive stripping voltammetric behaviour of immunoglobulin A has been optimised with respect to accumulation time, accumulation potential, scan rate and drop size and its interaction with benzodiazepine drugs in 0.05 M phosphate buffer (pH 7.4) has been studied. Immunoglobulin A was observed to form a strongly reducible complex with diazepam and a labile non-reducible complex with flurazepam.