As síndromes mielodisplásicas (SMD) são um grupo heterogéneo de neoplasias mielóides caracterizadas por citopenias decorrentes de hematopoiese ineficaz e por risco aumentado de progressão para leucemia mieloide aguda. Afetam 5/100 000 pessoas por ano em Portugal, dos quais mais de 60% se tornará dependente de transfusões ao longo do curso de doença. As citopenias podem levar a uma morbilidade significativa, sendo a sua gestão um dos pontos-chave para a melhoria da qualidade de vida destes doentes. Este documento compila o resultado do debate promovido pelo Anemia Working Group Portugal com peritos reconhecidos sobre a abordagem de suporte dos doentes com SMD de risco mais baixo, focando os efeitos a médio e longo prazo das transfusões recorrentes e da sobrecarga de ferro. Para o diagnóstico das SMD, recomenda-se a aplicação da classificação da Organização Mundial de Saúde 2016. O score International Prognosis Scoring System continua a ser a referência para definição de prognóstico e estratégia terapêutica. A terapêutica de suporte é um pilar fundamental do tratamento dos doentes em qualquer estádio da sua doença e inclui antibióticos, transfusão de concentrado eritrocitário e plaquetas, fatores de crescimento hematopoiético, agentes antifibrinolíticos e terapêutica quelante. Em doentes transfundidos com = 20 unidades de concentrado eritrocitário ou com ferritina sérica =1 000 ng/mL, deve-se considerar terapêutica com quelantes de ferro. Os doentes candidatos a terapêutica quelante devem fazer ressonância magnética ao fígado e pâncreas com periodicidade semestral ou anual. As opções terapêuticas devem ter em conta as características da doença e a qualidade de vida do doente, de acordo com as linhas orientadoras internacionais.

Myelodysplastic syndromes (MDS) are a diverse group of myeloid neoplasias, characterized by cytopenias stemming from ineffective hematopoiesis and by an increased risk of progression to acute myeloid leukemia. They affect 5/100 000 people per year in Portugal, among which more than 60% will become transfusion-dependent during the course of the disease. Cytopenias may lead to significant morbidity and their correct management is the key to maintain these patients’ quality of life. This document gathers the result of the debate promoted by the Anemia Working Group Portugal with experts on the management of patients with lower risk MDS, addressing the medium- and long-term effects of recurrent transfusion and iron overload. For the diagnosis of MDS, the group recommends the use of World Health Organization classification published in 2016. The International Prognosis Scoring System score is still the reference score to define both the prognosis and the therapeutic strategy. Support therapy is a fundamental cornerstone in the management of MDS patients at any stage of the disease, and includes antibiotics, transfusion of erythrocytes and platelets, hematopoietic growth factors, antifibrinolytic agents and chelators. Chelation therapy should be considered in patients transfused with = 20 units of erythrocytes or with serum ferritin = 1000 ng/mL. Patients who are candidates to chelation should be submitted to periodic magnetic resonance imaging to the liver and the pancreas. Therapeutic options should take into account the individual characteristics of the disease for every patient and preserve the quality of live, in accordance with international guidelines.

Relato de caso de oftalmomiíase externa em uma paciente de 82 anos, diabética e hipertensa, residente na zona rural, que inicialmente apresentava um quadro sugestivo de celulite pré-septal e hordéolo, com dor, edema, eritema e nodulação localizada na pálpebra superior e bulbo ocular normal. Foi então tratada com antibiótico e corticóide local, que levou a redução do processo inflamatório, possibilitando a realização de adequado exame físico, com a eversão da pálpebra superior, sendo estabelecido o diagnóstico de oftalmomiíase externa. Após tentativa frustrada de retirada ambulatorial da larva, foi indicado o procedimento cirúrgico por uma incisão vertical no tarso, a qual possibilitou a remoção de larva de 6mm de comprimento, com características da espécie Dermatobia hominis. Diante do exposto, é importante destacar, os vários diagnósticos diferenciais de oftalmomiíase, a particularidade de cada agente, as formas possíveis de tratamento, os fatores de risco e aspectos profiláticos.

A 82 years old women reported an external opthalmomyiasis. She was a diabetic and with high blood pressure carrier, living in rural area. Initially a she had pain with swelling, erythema and nodulation located on the upper eyelid and normal eye and a pre-septal cellulitis was suspected and antibiotic and local steroid were introduced, which led to a reduction of inflammatory process and to perform an appropriate physical examination with the eversion of the upper eyelid, which established the diagnosis of an external opthalmomyiasis. After the unsuccessful attempt to outpatient withdrawal of the worm, was appointed the surgical procedure by a vertical incision in the tarsus, which allowed the removal of a larva 6 mm long, with characteristics of the species Dermatobia hominis. Considering the foregoing, it is important to emphasize, the various differencial diagnostics of opthalmomyiasis, the particularity of each agent, possible forms of treatment, the risk factors and prophylaxis of this disease.

O vírus do amarelo letal do mamoeiro (Papaya lethal yellowing virus, PLYV) é responsável por uma das principais doenças do mamoeiro (Carica papaya) no Nordeste brasileiro. O PLYV pode ser transmitido através do solo, água, instrumento de corte e mãos contaminadas. A presente pesquisa teve como objetivo estudar as características biológicas, sorológicas e físicas de um isolado do vírus e avaliar sua sobrevivência em tecido seco infetado. O PLYV foi detectado por "Enzyme linked immunosorbent assay" (ELISA) indireto e isolado em mudas de mamoeiro, através da inoculação mecânica. A sobrevivência do PLYV em folhas e raízes secas de mamoeiro infetado foi avaliada por sorologia e inoculação em plantas sadias. A presença do vírus foi detectada em folhas e raízes de mamoeiro secas, indicando que o vírus pode permanecer ativo em restos de cultura por até 120 dias. A purificação do PLYV permitiu a obtenção de 309.5 mg de vírus/kg de folha e o anti-soro obtido mostrou-se altamente específico, com títulos de 1:128 em dupla difusão em Agar e 1:1.024.000 em Elisa indireto. Estudos das propriedades físicas do PLYV em mamoeiro revelaram um ponto de inativação térmica (PIT) em torno de 80 ºC, um ponto máximo de diluição (PMD) de ac. 10-6 e uma longevidade in vitro (LIV) acima de 50 dias.

The Papaya lethal yellowing virus (PLYV) is responsible for one of the most important disease of papaya (Carica papaya) in the Northeast of Brazil. The PLYV can be transmitted through the soil, irrigation water, agriculture tools and contaminated hands. The present research had the objective to characterize biologically, serologically and physically a PLYV isolate and evaluates how long it survives in infected dried tissues. The PLYV was identified by indirect enzyme linked immunoabsorbent assay (ELISA), isolated in young papaya plants by mechanical inoculations and maintained at green house conditions for virus purification. Approximately 309.5 mg of virus was purified per kg of infected papaya leaves and a polyclonal antiserum was obtained from an immunized rabbit. The antiserum obtained was shown to be highly specific to PLYV with a titer of 1:128 in double immune-diffusion and a titer of 1:1.024.000 in indirect ELISA. The virus was detected in dried roots and leaves maintained at room temperature up to 120 days, confirming its high stability within nonliving plant tissues, which could explain its dissemination by contaminated hands, tools, water and soil. The physical properties determined for the virus revealed a thermal inactivation point of 80 ºC, longevity in vitro over 50 days and dilution end point ac. of 10-6.

Os autores definem mastalgia cíclica pré-menstrual, (MCPM), repassam os principais mecanismos do ciclo celular da mama, e com base nestes conhecimentos propõem a sua classificação em três tipos, segundo a fisiologia do ciclo mamário: tipo 1 - caracterizado pela distensão localizada de ductos e adensamento do tecido conjuntivo em volta de pequenas dilatações. tipo II - caracterizado pelo edema intersticial, e tipo III - caracterizado pela combinação dos dois processos etiopatogênicos. OBJETIVO: Por meio de estudo prospectivo, aleatório, triplo cego e controlado, comparar a ação de placebo com associação de vitaminas A-D-E e doses baixas de ácido acetilsalicílico. MÉTODOS: Foram observadas 259 portadoras de MCPM, acompanhadas durante seis meses para estudo comparativo das drogas empregadas no alívio da dor. Destas, foram selecionadas 81 pacientes por critérios rigorosos, divididas em três grupos de 27, que receberam, respectivamente, aspirina, associação de vitaminas e placebo. A dor foi classificada em grau I (sem dor), grau II (dor moderada) e grau III (dor intensa). Os métodos estatísticos realizados mostraram que o número de pacientes em cada grupo era satisfatório. Foi empregado o teste de Tukey para comparação dos resultados e significância a 5%. RESULTADOS: As características clínicas, idade, peso, altura e IMC, antecedentes obstétricos e duração da amamentação foram semelhantes nos três grupos. Houve redução de intensidade da dor nos três grupos, principalmente naquele que recebeu placebo. CONCLUSÃO: O estudo realizado, segundo metodologia aceitável, porque foi prospectivo, controlado, triplo cego e aleatório, não mostrou diferenças significativas no tratamento da mastalgia cíclica pré-menstrual entre aspirina e associação de vitaminas, mas revelou superioridade do placebo.

OBJECTIVES: To compare therapeutic effects of placebo with intake of low doses of acetyl-salysilic acid (aspirin) and a compound of retinol, pyridoxine chlorhydrate and tocopherol acetate. METHODS: The study is a prospective, controlled, triple blinded, randomized trial. From 259 patients, 81 were selected in order to follow rigid criteria of inclusion. They were divided into three groups of 27 patients, taking aspirin, vitamins or placebo respectively. The number of patients in each group was considered satisfactory for statistical analysis. Pain was scored as Grade 1 (without pain), Grade II (moderate pain) and Grade III (severe pain). The Tukey test was applied for comparison of results (statistical significance 5%). RESULTS: Clinical parameters, age, weight, BMI, parity and lactation period were similar for each group. There was a decrease of pain intensity in all groups, that was even more pronounced for the placebo group. DISCUSSION: Emphasis was given to symptomatic treatment of cyclic premenstrual mastalgia with symptoms considered to be the expression of a physiological process that can be treated with simple drugs or placebo. Usual therapeutic approaches with several drugs are criticized, including results and contraindications. CONCLUSION: This study based upon acceptable trial methodology (randomized, triple blinded, placebo controlled, prospective) did not show significant differences in the treatment of cyclic mastalgia.

OBJECTIVE: To assess the association between microalbuminuria with ambulatory blood pressure monitoring in normotensive individuals with insulin-dependent diabetes mellitus. METHODS: Thirty-seven patients underwent determination of the rate of urinary excretion of albumin through radioimmunoassay and ambulatory blood pressure monitoring. Their mean age was 26.5±6.7 years, and the mean duration of their disease was 8 (1-34) years. Microalbuminuria was defined as urinary excretion of albumin > or = 20 and <200µg/min in at least 2 out of 3 urine samples. RESULTS: Nine (24.3%) patients were microalbuminuric. Ambulatory blood pressure monitoring in the microalbuminuric patients had higher mean pressure values, mainly the systolic pressure, during sleep as compared with that in the normoalbuminuric patients (120.1±8.3 vs 110.8±7.1 mmHg; p=0.007). The pressure load was higher in the microalbuminuric individuals, mainly the systolic pressure load during wakefulness [6.3 (2.9-45.9) vs 1.6 (0-16%); p=0.001]. This was the variable that better correlated with the urinary excretion of albumin (rS=0.61; p<0.001). Systolic pressure load >50% and diastolic pressure load > 30% during sleep was associated with microalbuminuria (p=0.008). The pressure drop during sleep did not differ between the groups. CONCLUSION: Microalbuminuric normotensive insulin-dependent diabetic patients show greater mean pressure value and pressure load during ambulatory blood pressure monitoring, and these variables correlate with urinary excretion of albumin.

PURPOSE: To determine the frequency of coronary artery disease, microalbuminuria and the relation to lipid profile disorders, blood pressure and clinical and metabolic features. METHODS: Fifty-five type 2 diabetic patients (32 females, 23 males), aged 59.9±9 years and with known diabetes duration of 11±7.3 years were studied. Coronary artery disease (CAD) was defined as a positive history of myocardial infarction, typical angina, myocardial revascularization or a positive stress testing. Microalbuminuria was defined when two out of three overnight urine samples had a urinary albumin excretion ranging 20 - 200µg/min. RESULTS: CAD was present in 24 patients (43,6%). High blood pressure (HBP) present in 32 patients (58.2%) and was more frequent in CAD group (p=0.05) HBP. Increased the risk of CAD 3.7 times (CI[1.14-12]). Microalbuminuria was present in 25 patients (45.5%) and tended to associate with higher systolic blood pressure (SBP) (p = 0.06), presence of hypertension (p = 0.06) and know diabetes duration (p = 0.08). In the stepwise multiple logistic regression the systolic blood pressure was the only variable that influenced UAE (r = 0.39, r² = 0.14, p = 0.01). The h ypertensive patients had higher cholesterol levels (p = 0.04). CONCLUSION: In our sample the frequency of microalbuminuria, hypertension, hypercholesterolemia and CHD was high. Since diabetes is an independent risk factor for cardiovascular disease, the association of others risk factors suggest the need for an intensive therapeutic intervention in primary and in secundary prevention.

Do cruzamento entre a cultivar "sempre verde" de semente de tegumento creme e a cultivar "TVu 59", de sementes de cor marrom, selecionou-se a cultivar "Setentão". O método utilizado foi o genealógico com teste de capacidade produtiva nas gerações F3 e F4, sendo as melhores linhas submetidas a seleção massal em blocos isolados e separados por fileiras de milho na geração F5, na geração F5 foi realizada seleção individual dentro de cada linha, iniciando-se na geração F7 os ensaios de produção com 14 linhas. A seleção 010.061 (05) (01) (03) além da excelente qualidade da semente, apresenta boa capacidade produtiva, resistência ao CpSMV e CMV, respectivamente. Esta seleção agora cognominada de "Setentão" apresenta hábito de crescimento indeterminado, porte semi-ramador e boa produtividade.

A cultivar of cowpea, Vigna unguiculata, named "Setentão" was obtained from a cross between "Sempre Verde" with seeds with cream integument and "TVu 59" with seeds with brown integument. The genealogical method with productive capacity test was used in the selection for F3 and F4 generations, with the best lines submitted to a bulk selection in isolated blocks (with lines separated by maige) in the F5 generation. Individual selection was carried out within each line and the assay productions with 14 lines were initiated at the F7. The selected line 010.061 (05) (01) (03) presented excellent seed quality together with good productive capacity and resistance to cowpea severe mosaic virus and cucumber mosaic virus isolated in Ceará from cowpea. The selected line named "Setentão" has indeterminate growth with semi-climbing habit and good productivity.