The antifouling booster biocides are frequently studied for toxic effects on the aquatic ecosystems. The present investigation proposes passive silicone rubber samplers as a collection method for biocides, once these methods can concentrate substances in aqueous matrices at very low levels. Through the passive sampler-water partition coefficient (Ksw) and the analyte chemical nature, we can optimize their extraction from the membrane to apply in the sample medium. We used the co-solvent method to determine the Ksw of three third-generation antifouling biocides, chlorothalonil, dichlofluanid, and dichlorooctylisothiazolinone (DCOIT), with log Ksw = 2.24, 4.01, and 2.38, respectively. Improving extraction also led to a recovery range higher than 70%, determinations were carried out by gas chromatography with an electron capture detector. Biocides concentration in seawater samples from Itaqui port (São Marcos Bay, northern Brazil) ranged from 0.058 to 0.72 µg L-1 for chlorothalonil, 0.001 to 0.008 µg L-1 for dichlofluanid, and 0.018 to 0.64 µg L-1 for DCOIT. ecosystems levels samplerwater sampler water (Ksw nature medium cosolvent co solvent thirdgeneration third generation chlorothalonil dichlofluanid DCOIT, DCOIT , (DCOIT) 224 2 24 2.24 401 4 01 4.01 238 38 2.38 respectively 70 70% detector São Bay Brazil 0058 0 058 0.05 072 72 0.7 L1 L 1 L- 0001 001 0.00 0008 008 0018 018 0.01 064 64 0.6 (DCOIT 22 2.2 40 4.0 23 3 2.3 7 005 05 0.0 07 0. 000 00 06 6 2. 4.

ABSTRACT This research aimed to suggest practical strategies for Mexico's economic development through the trend of nearshoring. It involved identifying, analyzing, and organizing the causes of the conflict between China and the USA over international trade and exploring the opportunities that nearshoring to Mexico can offer. Qualitative research methods were applied, and documentary research techniques were used based on two study objects: a) the Sino-American dispute over international trade and b) nearshoring to Mexico. Nearshoring to Mexico is driven by various factors, including tariff benefits from Free Trade Agreements, low labor costs in manufacturing companies, and a stable exchange rate. Therefore, Mexico needs to encourage the development of industrial parks, implement an effective Public Security Policy, offer tax incentives to attract Foreign Direct Investment and improve port, road, and air infrastructure to take full advantage of this trend.

RESUMEN Esta investigación tuvo como objetivo sugerir estrategias prácticas para el desarrollo económico de México a través de la tendencia del nearshoring. Implicó identificar, analizar y organizar las causas del conflicto entre China y Estados Unidos sobre el comercio internacional y explorar las oportunidades que puede ofrecer el nearshoring a México. Se aplicaron métodos de investigación cualitativos y se utilizaron técnicas de investigación documental basadas en dos objetos de estudio: a) la disputa chino-estadounidense sobre el comercio internacional y b) el nearshoring a México. El nearshoring a México está impulsado por varios factores, incluidos los beneficios arancelarios de los Tratados de Libre Comercio, los bajos costos laborales en las empresas manufactureras y un tipo de cambio estable. Por lo tanto, México necesita fomentar el desarrollo de parques industriales, implementar una Política de Seguridad Pública efectiva, ofrecer incentivos fiscales para atraer Inversión Extranjera Directa y mejorar la infraestructura portuaria, vial y aérea para aprovechar al máximo esta tendencia.

ABSTRACT Introduction Vesicovaginal fistula (VVF) is the most common urogenital fistula due to iatrogenic cause, primarily associated with gynecologic surgery (1). Although both conservative and surgical management may be considered, the optimal treatment is still uncertain and several studies were published using different techniques (open, laparoscopic or robotic) and approaches (extravesical, transvesical or transvaginal) (2–5). In this context, we aim to report our initial experience repairing VVF with Single-Port (SP) Transvesical (TV) access. Materials and Methods Four patients with a diagnosis of VVF underwent SP-TV VVF repair between May 2022 and December 2023. Diagnosis was confirmed by cystoscopy, cystogram and in two cases by CT Urogram. Under general anesthesia, before robotic time, patients were placed in lithotomy position and a preliminary cystoscopy was performed. Fistula was noted and a 5fr stent was placed through the fistulous tract. Two ureteral stents were placed. Then, with patient supine, a transverse suprapubic 3cm incision and 2cm cystotomy were made for SP access. First step was to mark and remove fistula tract to the vagina. The edges of the vagina and bladder were dissected in order to have a closure free of tension and to create three different layers to close: vagina, muscularis layer of the bladder and mucosal layer of the bladder. A bladder catheter was placed, and the two ureteral stents were removed at the end of procedure. Results Mean age was 53 years old and three out of 4 patients developed VVF after gynecologic surgery. Two patients underwent VVF repair 6 and 8 months after total hysterectomy. One patient developed VVF after total hysterectomy and oophorectomy followed by radiation therapy. Last patient developed VVF after previous urological procedure. Fistula diameter was between 11 and 15mm. Operative time was 211 min, including preliminary cystoscopy, stents placement and SP-access. All patients were discharged on the same day with a bladder catheter, successfully removed between post-operative day 14-18 after negative cystogram. Only in one case a ureteral stent was left because the fistula was closed to the ureteral orifice and we reported one case of UTI twelve days after surgery, treated with outpatient antibiotics. Mean follow-up was 8 months, patients were scheduled for regular follow-up visits and no recurrence was reported. All patients have at least 3 months of post-operative follow-up. Conclusions Our experience suggests that SP Transvesical VVF repair may be considered as a safe and feasible minimally invasive treatment for small/medium fistulae (10-15mm). (VVF cause 1. 1 . (1) open, open (open extravesical, extravesical (extravesical transvaginal 2–5. 25 2–5 2 5 (2–5) context SinglePort Single Port (SP TV (TV access SPTV 202 2023 Urogram anesthesia performed fr Then supine cm close procedure therapy 15mm mm 21 min SPaccess. SPaccess SP-access postoperative post operative 1418 14 18 14-1 antibiotics followup follow up followup. up. smallmedium small medium 1015mm. 1015mm 10 (10-15mm) (1 2– (2–5 20 141 14- (10-15mm ( (2– (2

Abstract Objective: This study aimed to assess the efficacy of a combination therapy involving NB-UVB phototherapy, bFGF-related decapeptide, and fractional CO2 laser in stable non-segmental vitiligo cases. Method: A prospective interventional study was conducted on clinically stable, non-segmental vitiligo patients. The combination therapy was administered for 16 weeks, and patients were followed up for 12 weeks. Data analysis was performed using SPSS version 23.0, with statistical significance set at p < 0.05. Results: Twenty patients aged 12-60 years were enrolled. After 16 weeks, 65% of patients showed good to excellent repigmentation (> 50%) with perifollicular repigmentation being commonly observed. The time for initial repigmentation was as early as 4 weeks. Adverse effects were mild and transient, with no recurrence observed during the follow-up period. Conclusion: This novel combination therapy demonstrated significant repigmentation rates in stable non-segmental vitiligo and presents a potential safe and efficacious therapeutic option in clinical settings.

Resumo Objetivo: Este estudo teve como objetivo avaliar a eficácia de uma terapia combinada envolvendo fototerapia NB-UVB, decapeptídeo relacionado a bFGF e laser de CO2 fracionado em casos estáveis de vitiligo não segmentar. Métodos: Um estudo intervencionista prospectivo foi conduzido em pacientes com vitiligo não segmentar, clinicamente estáveis. A terapia combinada foi administrada por 16 semanas e os pacientes foram acompanhados por 12 semanas. A análise dos dados foi realizada no SPSS versão 23.0, com significância estatística definida como valor p < 0.05. Resultados: Vinte pacientes com idades entre 12 e 60 anos foram incluídos. Após 16 semanas, 65% dos pacientes apresentaram repigmentação boa a excelente (> 50%), sendo comumente observada repigmentação perifolicular. O tempo para repigmentação inicial foi de 4 semanas. Os efeitos adversos foram leves e transitórios, sem recorência observada durante o período de acompanhamento. Conclusão: Esta nova terapia combinada demonstrou taxas de repigmentação significativas no vitiligo não segmentar estável e apresenta uma opção terapêutica potencialmente segura e eficaz em ambientes clínicos.

Abstract Dowling-Degos disease (DDD) is an uncommon genodermatosis. The most closely associated disorder is Galli-Galli disease (GGD). Both conditions are considered on the same disease spectrum, with the differentiating factor being the presence of acantholysis in GGD. A 51-year-old female with a 21-year history of pruritic eruption in flexural areas progressing to the trunk and limbs presented to our dermatology consult. Physical examination revealed reddish-to-dark brown hyperkeratotic papules and reticulated confluent macules. Dermoscopy showed irregular star-shaped brown mottled areas and yellow-brown polygonal structures. Histopathology confirmed features consistent with GGD. Genetic screening identified a mutation in the POGLUT1 gene. Treatment with topical clobetasol propionate 0.05% and oral antihistamines decreased pruritus, but the skin eruption persisted. We present a rare case of GGD describing clinical, genetic, dermoscopy, and histopathological features. Clinicopathological correlation and good cooperation between dermatologists and histopathologists are essential to make the correct diagnosis of GGD.

Resumo A doença de Dowling-Degos (DDD) é uma genodermatose rara, associada à doença de Galli-Galli (GGD). O fator de diferenciação entre as duas doenças é um critério histopatológico com a presença de acantólise no caso da GGD. Mulher de 51 anos, fototipo de Fitzpatrick II, recorreu à consulta de Dermatologia por uma dermatose generalizada e pruriginosa com 21 anos de evolução, com início nas pregas e progressão o tronco e membros. Ao exame objetivo observaram-se máculas e pápulas, castanho-alaranjadas, confluentes, de aspecto reticulado que predominavam no tronco e membros. A dermatosocopia das lesões mostrou áreas irregulares em estrela de coloração castanha e estruturas poligonais amareloacastanahdas, circundadas por halos esbranquiçados. A biópsia cutânea foi compatível com GGD. O estudo genético identificou uma mutação no gene POGLUT1. Este artigo ilustra um caso raro de GGD, descrevendo suas características clínicas, genéticas, dermatoscópicas e histopatológicas. A correlação clinicopatológica é essencial para o diagnóstico de GGD.

Abstract Objective: Acute telogen effluvium (ATE) is a scalp hair disorder featured by diffuse, non-scarring shedding with higher female predilection. In general, the disorder is perceived as extremely frightening and urges the patient to visit a physician immediately. We retrospectively analyzed the 3-month prognosis of the female patients with hair loss complaint. Methods: Two-hundred and sixty-six female patients who were referred to our hospital with ATE were retrospectively recruited. The patients were analyzed for serum iron, iron-binding capacity, vitamin B12, folate, thyroid-stimulating hormone, and prolactin values. All were prescribed standard zinc and vitamin E supplements in addition to needed medications and invited to a second visit after 3 months. Results: All of the mean values for all parameters were found in normal ranges. Two hundred and nine patients came to the second visit after the 3-month treatment period. Of these patients, 9.1% stated hair shedding ceased completely, 74.6% diminished to some extent, and 16.3% continued as before. Conclusions: Mainly due to normal mean values, none of the analyzed parameters can be accused as the cause of hair sheddings. The frustrations of the patients are so great that it is reasonable to prescribe some supplements, at least for their placebo effects. Treatment for ATE is primarily reassurance and counseling.

Resumo Objetivo: O deflúvio telogênico agudo (DTA) é uma condição do couro cabeludo caracterizada por uma queda difusa e não cicatricial, com maior incidência no sexo feminino. Geralmente, a doença é percebida como altamente alarmante, levando os pacientes a buscar imediatamente assistência médica. Neste estudo, analisamos retrospectivamente o prognóstico de tês meses em mulheres com queixa de queda de cabelo. Método: Duzentos e sessenta e seis pacientes do sexo feminino encaminhados ao nosso hospital com DTA foram recrutados retrospectivamente. As pacientes foram submetidas à análise dos níveis séricos de ferro, capacidade de ligação do ferro, vitamina B12, folato, hormônio estimulante da tireoide e prolactina. Todas receberam prescrição de suplementos padrão de zinco e vitamina E, além dos medicamentos necessários, e foram convidadas para uma segunda consulta após tês meses. Resultados: Todos os valores médios dos parâmetros analisados estavam dentro da faixa normal. Dentre os 209 pacientes que compareceram à segunda consulta após o tratamento de tês meses, 9,1% relataram cessação completa da queda de cabelo, 74,6% experimentaram diminuição em alguma medida, e 16,3% mantiveram o quadro como antes. Conclusões: Principalmente devido aos valores médios normais, nenhum dos parâmetros analisados pode ser atribuído como causa da queda de cabelo. As frustrações dos pacientes são tão significativas que é razoável prescrever alguns suplementos, ao menos pelos efeitos placebo que podem proporcionar. O tratamento do DTA consiste essencialmente em tranquilizar e aconselhar os pacientes.

Abstract Our case focuses on a 34-year-old woman, pregnant, with a history of allergic rhinitis treated with antihistamines as needed. She had no documented history of medication allergies. At 38 weeks she went into labor. Three days after delivery, she received intravenous hydrocortisone for postpartum pain management. During administration, the patient developed generalized urticaria, dysphonia, and dyspnea. She was brought to the emergency room and received intramuscular adrenaline and antihistamines with clinical improvement. Prick tests for methylprednisolone succinate 10 mg/ml and hydrocortisone succinate 10 mg/mL and 100 mg/ml were positive. In challenge testing, the patient tolerated dexamethasone and budesonide. A diagnosis of anaphylactic reaction to group A corticosteroids was made. The patient was instructed to avoid hydrocortisone, methylprednisolone, and prednisolone. Although rare, corticosteroid allergy has very important therapeutic consequences; therefore it is necessary to be alert and to offer a safe alternative to these patients demonstrating tolerance to other corticosteroids.

Resumo O nosso caso foca-se numa mulher de 34 anos, grávida, com antecedentes de rinite alérgica tratada com anti-histamínicos em SOS. Não tinha histórico documentado de alergias a medicamentos. Às 38 semanas, entrou em trabalho de parto. Tês dias após o parto, foi medicada com hidrocortisona intravenosa para o controlo da dor pós-parto. Durante a administração, a doente desenvolveu anafilaxia. Foi levada para a sala de emergência, tendo sido tratada com adrenalina intramuscular e anti-histamínicos, com melhoria clínica. Os testes cutâneos prick para succinato de metilprednisolona 10 mg/ml e succinato de hidrocortisona 10 mg/mL e 100 mg/ml foram positivos. Posteriormente foram realizadas provas de provocação com dexametasona e budesonida, com boa tolerância. Foi feito o diagnóstico de reação anafilática a corticosteróides do grupo A. A doente foi recomendada a evitar totalmente o uso de hidrocortisona, metilprednisolona e prednisolona. Apesar de rara, a alergia a corticosteróides tem consequências terapêuticas muito importantes; por isso é necessário estar alerta e oferecer uma alternativa segura a estes pacientes que demonstram tolerância a outros corticosteróides.

Abstract Congenital nail matrix nevi (NMN) are a rare cause of melanonychia that may present with irregularity, asymmetry, and multicomponent pigmentation posing diagnostic challenges with subungual melanoma. We report a case of a 49-year-old female with longitudinal melanonychia and a 1-month recent pigmentation in the proximal nail fold. This sign is traditionally associated with malignancy, which further complicates the differentiation from acral melanoma. Therefore, a nail matrix biopsy was performed. Histopathologic examination revealed a nail matrix nevus. This procedure is crucial in suspicious cases, despite the risk of nail dystrophia. The evolution of these nevi into adulthood and their potential malignancy remains unclear, emphasizing the need for continued research and surveillance. This case highlights that congenital NMN often present with clinical and dermoscopic features of concern, mirroring those observed in subungual melanoma.

Resumo Os nevos congénitos da matriz ungueal são uma causa rara de melanoníquia que pode apresentar-se com irregularidade, assimetria e pigmentação multicomponente, o que dificulta o diagnóstico diferencial com melanoma subungueal. Descrevemos o caso de uma mulher de 49 anos com melanoníquia longitudinal que progrediu com pigmentação na prega ungueal proximal. O sinal de Hutchinson está frequentemente associado a malignidade, o que dificulta ainda mais a diferenciação com o melanoma acral. Realizou-se uma biópsia da matriz ungueal, cujo exame histopatológico foi compatível com nevo da matriz ungueal. Esta abordagem é crucial em casos suspeitos, apesar do risco de distrofia ungueal. A evolução destes nevos até à idade adulta e o seu potencial de malignidade permanecem pouco claros, enfatizando a necessidade de vigilância contínua. Este caso realça que os nevos congénitos da matriz ungueal se apresentam frequentemente com características clínicas e dermatoscópicas suspeitas, que podem mimetizar as observadas no melanoma subungueal.

Abstract Objective: The use of dupilumab in children with atopic dermatitis (AD) demonstrated clinical efficacy in clinical trials. Nevertheless, real-world evidence is still limited. We aim to provide data on this matter regarding a Portuguese pediatric population. Methods: Retrospective analysis of patients with AD below the age of 18 treated with dupilumab in two Portuguese hospitals. Data regarding previous therapies, activity scores, and adverse reactions were collected. Results: Thirty patients were included in the analysis (19 male patients, 63%), with a median age of 14 years (2-17 years). The median follow-up after starting treatment was 80 weeks. The median baseline Eczema Area and Severity Index (EASI) score was 32.3. Sixty percent of patients achieved EASI-90 and 77% EASI-75 at week 16 (n = 30); 79% EASI-90 and 92% EASI-75 at week 52 (n = 24); 64% EASI-90 and 82% EASI-75 at week 104 (n = 11); and 75% EASI-90 and 100% EASI-75 at week 132 (n = 4). Regarding adverse reactions, four patients (12%) presented facial erythema and two patients had eosinophilia above 2000/μL and conjunctivitis. In five patients (17%), there was a need for a dose increase, with treatment failure occurring in two patients (7%). Conclusion: Our data corroborated the evidence from clinical trials, highlighting the maintained efficacy and adequate safety profile of dupilumab in this age group.

Resumo Objetivo: O uso de dupilumab em crianças com dermatite atópica (DA) demonstrou eficácia clínica em ensaios clínicos. No entanto, a evidência do mundo real é ainda limitada. Este trabalho pretende fornecer dados relativos a este domínio, numa população pediátrica portuguesa. Métodos: Análise retrospetiva de doentes com DA com idade inferior a 18 anos, tratados com dupilumab, em dois hospitais portugueses. Foram recolhidos dados sobre terapêuticas prévias, scores de atividade e reações adversas. Resultados: Trinta doentes foram incluídos na análise (19 doentes do sexo masculino, 63%), com uma mediana de idades de 14 anos (2-17 anos). O seguimento mediano após o início do tratamento foi de 80 semanas. O score EASI basal mediano foi de 32,3. Sessenta por cento dos doentes alcançaram EASI-90 e 77% EASI-75 na semana 16 (n = 30); 79% EASI-90 e 92% EASI-75 na semana 52 (n = 24); 64% EASI-90 e 82% EASI-75 na semana 104 (n = 11); 75% EASI-90 e 100% EASI-75 na semana 132 (n = 4). Em relação a reações adversas, 4 doentes (12%) apresentaram eritema facial e 2 doentes eosinofilia superior a 2000/μL e conjuntivite. Em 5 doentes (17%), houve necessidade de aumento de dose, com falência do tratamento em 2 doentes (7%). Conclusão: O tratamento com Dupilumab na DA em idade pediátrica num ambiente de mundo real corroborou os dados dos ensaios clínicos, destacando a eficácia mantida e o perfil de segurança adequado neste grupo etário.

Abstract This article reviews the dermatological manifestations that frequently arise in endocrine disorders, encompassing conditions such as diabetes mellitus, acromegaly, polycystic ovary syndrome, hypothyroidism, Addison’s disease, among others. It explores the interactions between the endocrine system and the skin, highlighting how hormonal imbalances can result in a variety of skin symptoms. With a comprehensive approach, it offers important clinical insights for dermatologists and endocrinologists, aiming at a better understanding and an accurate diagnosis of these conditions.

Resumo Este artigo revisa as manifestações dermatológicas que frequentemente surgem em distúrbios endócrinos, abrangendo condições como diabetes mellitus, acromegalia, síndrome dos ovários policísticos, hipotireoidismo, doença de Addison, entre outras. Explora as interações entre o sistema endócrino e a pele, destacando como desequilíbrios hormonais podem resultar em uma variedade de sintomas cutâneos. Com uma abordagem abrangente, oferece insights clínicos importantes para dermatologistas e endocrinologistas, visando uma melhor compreensão e diagnóstico preciso dessas condições.

Abstract Tungiasis is a skin parasitosis caused by a flea. It is very prevalent in underdeveloped countries and rare in developed countries, particularly in Europe. The disease is acquired through direct contact with infected soil, mainly on the feet after the host has been barefoot. The disease is typically self-limited and its diagnosis is essentially clinical due to its typical clinical presentation. This report presents a case of imported tungiasis in Portugal, in a 21-year-old male patient after returning from a vacation in a country with a high prevalence of this parasite. The patient had three typical tungiasis lesions, with no associated complications. The parasites were surgically excised without complications. The aim of this report is to contribute to knowledge of this pathology, which is largely unknown to the majority of the medical community. Its identification is essential due to the increase in globalization, tourism, and the importation of this pathology.

Resumo A tungíase é uma parasitose cutânea causada por uma pulga, sendo prevalente em países subdesenvolvidos, sendo rara a sua apresentação em países desenvolvidos, nomeadamente na Europa. A doença é adquirida através contacto direto com o solo infetado, sendo adquirida principalmente nos pés após o hospedeiro ter andado descalço. A doença é tipicamente autolimitada e o seu diagnóstico é essencialmente clínico devido à sua apresentação clínica típica. Neste relato apresenta-se um caso de importação de tungíase em Portugal num utente masculino de 21 anos após regressar de férias num país com alta prevalência deste parasita. O utente apresentava tês lesões típicas de tungíase, sem complicações associadas. Foi realizada a excisão cirúrgica dos parasitas sem intercorências. Com este relato pretende-se contribuir para o conhecimento desta patologia muito desconhecida pela maioria da comunidade médica, sendo essencial a sua identificação devido ao aumento da globalização, do turismo e da importação desta patologia.

Abstract The VEXAS syndrome (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic), which has recently been described, is a monogenic autoinflammatory syndrome that primarily affects males and has its onset in adulthood. The disease is caused by somatic mutations in the UBA1 gene (ubiquitin-like modifier activating enzyme 1), which is responsible for cellular processes, particularly in maintaining protein homeostasis. It presents with severe and progressive systemic inflammation that is resistant to therapy. Common symptoms include fever and constitutional syndrome, along with hematological manifestations such as macrocytic anemia, other cytopenias, myelodysplastic syndrome, and characteristic vacuolization of myeloid and erythroid cells. Additional symptoms may involve the skin (neutrophilic dermatosis), lungs, chondritis, and vasculitis. Thus, in a case where a male patient presents with recurrent neutrophilic dermatosis unresponsive to treatment, macrocytic anemia, and systemic autoinflammatory manifestations, it is important to suspect this newly identified condition and proceed with a confirmatory genetic test.

Resumo A síndrome VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic), recentemente descrita, consiste numa síndrome autoinflamatória monogénica de início na idade adulta que afecta quase exclusivamente o sexo masculino. A doença é causada por mutações somáticas no gene UBA1 (ubiquitin-like modifier activating enzyme 1), responsável por processos celulares, principalmente pela manutenção da homeostase proteica. Manifesta-se com inflamação sistémica, muitas vezes grave, progressiva e refractária à terapêutica. Cursa frequentemente com febre e síndrome constitucional associada a alterações hematológicas (anemia macrocítica e outras citopenias, além de síndrome mielodisplásico e vacuolização característica de células mielóides e eritróides), cutâneas (dermatose neutrofílica), pulmonares, condrite e vasculite. Deste modo, e qual como se verificou neste caso, na presença de um doente do sexo masculino, com dermatose neutrofilica recidivante e refratária ao tratamento, anemia macrocitica e com manifestações autoinflamatórias e sistémicas, devemos suspeitar desta nova entidade e realizar o teste genético confirmatório.