RESUMEN La cactáceas son plantas emblemáticas, su comercio, aprovechamiento irracional, destrucción del hábitat, y lento crecimiento estan ocasionado que muchas esten en alta vulnerabilidad. Oreocereus psudofossulatus, es un cactus endémico, distribuido en los Valles Xéricos Interandinos de la Puna del norte de Bolivia. La presente investigación tiene como objetivo evaluar el comportamiento germinativo y describir morfológicamente el desarrollo inicial de O. psudofossulatus en condiciones in vitro. Así mismo, determinar el porcentaje de germinación con pruebas pre-germinativas de remojo en agua en sustratos de papel en cajas Petri. Al igual que, cuantificar el porcentaje de germinación en sustratos de arena, tierra negra y humus de lombriz (ex situ). Además, comparar las características morfométricas de brotes procedentes de cultivo in vitro y de cajas Petri. Las semillas fueron sembradas en diferentes técnicas, una en medio de cultivo MS/2, en sustratos de papel en cajas Petri y en sustrato de tierra negra, arena y humus de lombriz, esta última en dos tratamientos T1 (1:1:1) y T2 (1:1:2). Las variables evaluadas fueron porcentaje de viabilidad y geminación. Las semillas de O. psudofossulatus presentaron un 83 % de germinación en el medio MS/2; 72.7 % en sustrato de papel (cajas petri) y con un 95.6 % de viabilidad. El tratamiento de sustratos que presentó mayor porcentaje de germinacion (35 %) fue en el T-2 (1:1:2). In vitro desde la emergencia de la radícula pasaron por cuatro fases hasta la conversión de plantas (70 %) en 42 días, con esta técnica se reduce el tiempo de cultivo lo que no sucederia en condiciones naturales, ya que las semillas están expuestas a climas aridos con deficit de agua por encontrarse en hábitat Xéricos.

ABSTRACT Cactaceae are emblematic plants, their trade, irrational exploitation, habitat destruction, and slow growth are causing many of them to be highly vulnerable. Oreocereus psudofossulatus, is an endemic cactus, distributed in the Xeric Inter-Andean Valleys of the Puna of northern Bolivia. The present research aims to evaluate the germination behavior and morphological description of the initial development of O. psudofossulatus under in vitro conditions. Likewise, to determine the germination percentage with pre-germination tests of soaking in water on paper substrates in Petri boxes. Also, to quantify the percentage of germination in substrates of sand, black soil and earthworm humus (ex situ). In addition, to compare the morphometric characteristics of sprouts from in vitro culture and Petri dishes. Seeds were sown in different techniques, one in MS/2 culture medium, in paper substrates in Petri boxes and in substrate of black soil, sand and earthworm humus, the latter in two treatments T1 (1:1:1) and T2 (1:1:2). The variables evaluated were percentage viability and gemination. O. psudofossulatus seeds showed 83 % germination in MS/2 medium; 72.7 % in paper substrate (petri boxes) and 95.6 % viability. The substrate treatment that presented the highest germination percentage (35 %) was T-2 (1:1:2). In vitro, from radicle emergence through four phases until plant conversion (70 %) in 42 days, with this technique the cultivation time is reduced, which would not happen under natural conditions, since the seeds are exposed to arid climates with water deficit because they are in Xeric habitat.

A prevalência da Diabetes Mellitus tipo 1 tem vindo a aumentar nos últimos anos. O tratamento intensivo através de Sistema de Perfusão Subcutânea Contínua de Insulina é o método mais fisiológico de administração de insulina atualmente disponível. Para que este seja eficaz é fundamental ter conhecimentos sobre a composição dos alimentos, particularmente os Hidratos de Carbono. O presente estudo teve como objetivos avaliar e caracterizar o controlo metabólico, compará-lo antes e depois do Sistema de Perfusão Subcutânea Contínua de Insulina, avaliar os conhecimentos de contagem de Hidratos de Carbono e relacioná-los com o controlo metabólico. Trata-se de um estudo observacional, analítico e retrospetivo, com uma amostra de conveniência constituída pelos utentes com consulta entre novembro 2017 e março de 2018 no Hospital Garcia de Orta. A avaliação do controlo metabólico foi realizada através da HbA1c. Na avaliação dos conhecimentos sobre contagem de Hidratos de Carbono utilizou-se uma adaptação do questionário PedCarbQuiz. Avaliaram-se 60 indivíduos com uma média de idades 21,3 ± 14,27 anos [2 - 57]. Aquando a colocação do Sistema de Perfusão Subcutânea Contínua de Insulina, apenas 23,6% da amostra se encontrava com a HbA1c dentro dos valores recomendados. Três meses após a colocação do Sistema de Perfusão Subcutânea Contínua de Insulina verificou-se uma diminuição significativa da HbA1c, que estabilizou após os 6 primeiros meses. Relativamente aos conhecimentos sobre contagem de HC, 78,3% possuíam nível muito bom e os restantes nível bom. Não foi detetada correlação significativa entre a HbA1c e os conhecimentos de contagem de Hidratos de Carbono, ou seja, ter mais conhecimentos não demonstrou ter influência no controlo metabólico da amostra.

The prevalence of type 1 diabetes mellitus has been increasing in recent years. Intensive treatment through Continuous Subcutaneous Insulin Perfusion System is the most physiological method of insulin administration currently available. For this to be effective it is essential to have knowledge about the composition of the food, particularly about its content in carbohydrates. The aim of the present study was to evaluate and characterize metabolic control, to compare it before and after Continuous Subcutaneous Insulin Perfusion System, to evaluate the carbohydrates count knowledge and to relate it to metabolic control. This is an observational, analytical and retrospective study, with a convenience sample of patients consulted between November 2017 and March 2018 at the Garcia de Orta Hospital. The evaluation of metabolic control was performed through HbA1c. In the evaluation of the knowledge about carbohydrates count, an adaptation of the PedCarbQuiz questionnaire was used. Sixty individuals with a mean age of 21.3 ± 14.27 years were evaluated [2-57]. At the Subcutaneous Insulin Perfusion System, placement, only 23.6% of the sample was HbA1c within the recommended values. 3 months after Continuous Subcutaneous Insulin Perfusion System placement there was a substantial decrease in HbA1c, which stabilized after the first 6 months. Regarding the knowledge about carbohydrates count, 78.3% had “very good” level and the remaining “good” level. No significant correlation was detected between HbA1c and carbohydrates counting knowledge. Having more knowledge has not been shown to influence the metabolic control of the sample.

Chronic kidney disease is highly prevalent in patients with diabetes mellitus. There are many specific aspects in the treatment of diabetes that have to be taken into account when there is concomitant nephropathy. All antihyperglycemic drugs can be used in earlier stages of chronic kidney disease. With worsening nephropathy, most will require dose adjustments (some eventually suspension) and increased monitoring of adverse events and kidney function. New treatment options that are safe and effective are now available for more advanced stages of disease. Moreover, findings from large clinical trials suggest that some drugs, namely GLP-1 receptor agonists and SGLT2 inhibitors, might potentially have kidney and cardiovascular protective effects, although clinical significance and putative mechanisms are not yet fully understood. The aim of this review is to provide an updated overview of relevant data to guide clinical practice in the use of antihyperglycemic agents in chronic kidney disease patients, including older drugs and also the most recently available treatment options.

Introdução: A tiroidite subaguda, ou tiroidite de De Quervain, é uma patologia incomum. Uma das possíveis apresentações clínicas é a dor cervical anterior, com irradiação à orofaringe, condicionando odinofagia, sintoma este muito frequente nos cuidados de saúde primários. Este caso demonstra a importância de conhecer esta entidade como diagnóstico diferencial de odinofagia, sobretudo na presença de sintomas e sinais sugestivos de tirotoxicose. Descrição do caso: Senhora de 36 anos, que iniciou quadro de febre, odinofagia e tumefação cervical, com três dias de evolução, inicialmente tratada como infeção das vias aéreas superiores. Uma vez que não se observou melhoria, foi novamente avaliada tendo sido identificada clínica sugestiva de doença tiroideia. O diagnóstico de tiroidite subaguda teve por base a presença de parâmetros analíticos de inflamação e de tirotoxicose, bem como a exclusão de patologia autoimune e bacteriana. O plano terapêutico envolveu o controlo sintomático e terapêutica anti-inflamatória, com boa evolução dos sintomas ao longo de semanas. Posteriormente, a doente desenvolveu hipotiroidismo, tendo sido controlada com terapêutica com levotiroxina. Comentário: O diagnóstico precoce da tiroidite subaguda poderá não ser fácil pela sua apresentação inicial, podendo sugerir tratar-se de uma faringite comum. Apesar de ser um diagnóstico incomum, na presença de odinofagia/desconforto cervical e febre é essencial considerá-lo e pesquisar outros sintomas/sinais sugestivos desta doença. Diagnosticando precocemente, é possível minimizar o desconforto do doente e o consumo de recursos em saúde.

Introduction: Subacute thyroiditis, or De Quervain's thyroiditis, is an uncommon condition. It can manifest itself as an anterior neck pain with radiation into the oropharynx, leading to odynophagia, a very common symptom in primary care. This case report demonstrates the importance of being aware of this clinical entity as a differential diagnosis of odynophagia, particularly when in presence of symptoms and signs of thyrotoxicosis. Case description: 36-years old female, presenting with fever, odynophagia sore throat and swollen neck, initially treated as an upper respiratory tract infection. Since no clinical improvement was observed, the patient was re-assessed and clinical signs of thyroid pathology were identified. The diagnosis of subacute thyroiditis was based on biochemical markers of inflammation and thyrotoxicosis, as well as on the exclusion of autoimmune and bacterial causes. The treatment plan included symptomatic control with anti-inflammatory drugs, with improvement of symptoms over the following weeks. Subsequently, the patient developed an hypothyroidism and was treated with levothyroxine therapy. Comment: The early diagnosis of subacute thyroiditis may not be easy due its initial presentation, and may suggest a common pharyngitis. Although being an uncommon diagnosis, this diagnosis should be considered when in presence of odynophagia / neck pain and fever and other symptoms/signs should be searched, in order to minimise patient discomfort and healthcare resources' spending.

Los agricultores dedicados al cultivo de frutilla indican que los rendimientos son bajos en comparación con otros países, este efecto es consecuencia de que siembran plantines que proceden de estolones ya que las frutillas se propagan vía asexual. Esta forma de reproducción convencional presenta desventajas como: la disminución del rendimiento, la pérdida de la calidad del fruto. Una alternativa para solucionar este problema es la micropropagación. La presente investigación evaluó el comportamiento in vitro de dos variedades de frutilla (Oso Grande y Sweet Charlie) a partir de segmentos foliares con diferentes grados de maduración (juvenil y adulto) en dos épocas de introducción. Para inducir a la propagación in vitro, los medios de cultivo fueron suplementados con reguladores de crecimiento, utilizando dos concentraciones 4.54 y 9.08 µM de tidiazuron con la combinación de tres concentraciones 0, 0.98 y 2.5 µM de ácido indolbutírico. Los explantes de segmentos de hojas que presentaban tejidos juveniles (mayo) llegaron a formar brotes. No ocurrió lo mismo con aquellas que procedían de tejido adulto (junio), por lo que se puede señalar que las que provinieron de tejido juvenil presentaron una mejor respuesta in vitro. Se determinó que la combinación de 9.08 µM de tidiazuron con 0.98 µM de ácido indolbutírico, fue la más adecuada para la propagación in vitro de secciones foliares de hojas de frutilla en ambas variedades, ya que en este medio se obtuvo mayor formación de agregados celulares, para la formación de brotes en comparación con los demás tratamientos.

Strawberry farmers indicate that yields are low compared to other countries. This effect is due to the fact that they plant seedlings that come from stolons since the strawberries are propagated asexual. This conventional form of reproduction has disadvantages such as: decreased yield, loss of fruit quality. An alternative to solve this problem is micropropagation. The present research evaluated the in vitro behavior of two varieties of strawberry (Oso Grande and Sweet Charlie) from leaf segments with different degrees of maturation (juvenile and adult) in two periods of introduction. To induce in vitro propagation, the culture media were supplemented with growth regulators, using two concentrations 4.54 and 9.08 μM of thidiazuron with the combination of three concentrations of 0, 0.98 and 2.5 μM of acid Indolebutyric acid. Explants of leaf segments showing juvenile tissues (May) came to form buds. The same did not occur with those that came from adult tissue (June), so it can be noted that those that came from juvenile tissue had a better response in vitro. It was determined that the combination of 9.08 μM thidiazuron and 0.98 μM indolbutyric acid was the most suitable for the in vitro propagation of leaf sections of strawberry leaves in both varieties, since in this medium more formation was obtained Of cell aggregates, for the formation of outbreaks compared to the other treatments.

X-linked adrenal hypoplasia congenita typically manifests as primary adrenal insufficiency in the newborn age and hypogonadotropic hypogonadism in males, being caused by mutations in NR0B1 gene. We present the clinical and follow-up findings of two kindreds with NR0B1 mutations. The proband of kindred A had a diagnosis of primary adrenal insufficiency when he was a newborn. Family history was relevant for a maternal uncle death at the newborn age. Beyond 2 year-old steroid measurements rendered undetectable and delayed bone age was noticed. Molecular analysis of NR0B1 gene revealed a previously unreported mutation (c.1084A>T), leading to a premature stop codon, p.Lys362*, in exon 1. His mother and sister were asymptomatic carriers. At 14 year-old he had 3 mL of testicular volume and biochemical surveys (LH < 0.1 UI/L, total testosterone < 10 ng/dL) concordant with hypogonadotrophic hypogonadism. Kindred B had two males diagnosed with adrenal insufficiency at the newborn age. By 3 year-old both siblings had undetectable androgen levels and delayed bone age. NR0B1 molecular analysis identified a nonsense mutation in both cases, c.243C>G; p.Tyr81*, in exon 1. Their mother and sister were asymptomatic carriers. At 14 year-old (Tanner stage 1) hypothalamic-pituitary-gonadal axis evaluation in both males (LH < 0.1UI/L, total testosterone < 10 ng/dL) confirmed hypogonadotropic hypogonadism. In conclusion, biochemical profiles, bone age and an X-linked inheritance led to suspicion of NR0B1 mutations. Two nonsense mutations were detected in both kindreds, one previously unreported (c.1084A>T; p.Lys362*). Mutation identification allowed the timely institution of testosterone in patients at puberty and an appropriate genetic counselling for relatives.

A tireoidite de Hashimoto (TH) foi caracterizada durante muitos anos como uma entidade clinicopatológica bem definida, mas é atualmente considerada uma patologia heterogênea. A TH associada a IgG4 apresenta-se como um novo subtipo, sendo caracterizada por inflamação da tireoide com numerosos plasmócitos IgG4-positivos e fibrose extensa. É possível que pertença ao espectro da doença sistêmica associada a IgG4. Relatamos o caso de um homem português de 56 anos que se apresentou com aumento progressivo do volume cervical e disfagia, com um mês de evolução. A avaliação laboratorial revelou elevação dos parâmetros inflamatórios, hipotireoidismo subclínico e níveis muito elevados de autoanticorpos tireoidianos. Por ultrassonografia cervical demonstrou-se tireoide aumentada, heterogênea, com dois nódulos hipoecoicos. Foi realizada citologia aspirativa com agulha fina guiada por ultrassom, compatível com tireoidite linfocítica. O doente foi submetido à tireoidectomia total e o exame histológico revelou achados típicos de TH, extensa fibrose localizada dentro da cápsula tireoidiana e infiltrado linfoplasmocitário, com >50 plasmócitos IgG4-positivos por campo de grande ampliação e uma relação IgG4/IgG >40%. Após cirurgia, a concentração sérica de IgG4 encontrava-se no limite superior do normal. Ocorreu melhoria sintomática e redução dos parâmetros inflamatórios. A função tireoidiana foi controlada com levotiroxina. Relatamos o primeiro caso de TH associada a IgG4 num indivíduo não asiático. Além disso, realizamos uma revisão da literatura sobre doença associada a IgG4 e TH associada a IgG4. Este caso destaca uma nova variante da TH e permite aos médicos reconhecerem suas principais características clínicas, proporcionando diagnóstico e tratamento adequados.

Hashimoto’s thyroiditis (HT) has been characterized for many years as a well-defined clinicopathologic entity, but is now considered a heterogeneous disease. IgG4-related HT is a new subtype characterized by thyroid inflammation rich in IgG4-positive plasma cells and marked fibrosis. It may be part of the systemic IgG4-related disease. We report a case of a 56-year-old Portuguese man who presented with a one-month history of progressive neck swelling and dysphagia. Laboratory testing revealed increased inflammatory parameters, subclinical hypothyroidism and very high levels of thyroid autoantibodies. Cervical ultrasound (US) demonstrated an enlarged and heterogeneous thyroid gland and two hypoechoic nodules. US-guided fine needle aspiration cytology was consistent with lymphocytic thyroiditis. The patient was submitted to total thyroidectomy and microscopic examination identified typical findings of HT, marked fibrosis limited within the thyroid capsule and lymphoplasmacytic infiltration, with >50 IgG4-positive plasma cells per high-power field and an IgG4/IgG ratio of >40%. After surgery, serum IgG4 concentration was high-normal. Symptoms relief and reduction in laboratory inflammatory parameters were noticed. Thyroid function is controlled with levothyroxine. To our knowledge we report the first case of IgG4-related HT in a non-Asian patient. We also perform a review of the literature regarding IgG4-related disease and IgG4-related HT. Our case highlights this new variant of the well known HT, and helps physicians in recognizing its main clinical features, allowing for proper diagnosis and treatment.

Paciente de 82 anos apresentando-se com nódulo tireoidiano de crescimento progressivo e ptose palpebral esquerda. O exame oftalmológico revelou ainda miose ipsilateral e achados diagnósticos de síndrome de Horner. A tomografia computadorizada mostrou massa tireoidiana de 7,5 cm infiltrando os grandes vasos do pescoço. Apesar dos dados clínicos e imagiológicos sugestivos de um carcinoma pouco diferenciado da tireoide, a citologia aspirativa foi diagnóstica de carcinoma papilar. Em função do estádio avançado da neoplasia e das comorbilidades significativas, foi proposta para terapêutica paliativa. A síndrome de Horner é uma manifestação clínica infrequente em tumores tireoidianos, estando as condições benignas maioritariamente implicadas. As neoplasias malignas da tireoide representam uma causa rara de síndrome de Horner. Contudo, um diagnóstico adequado e expedito é fundamental para o tratamento atempado nos raros casos de malignidade da tireoide.

An 82-year-old patient presented a progressively growing hard thyroid nodule, and left ptosis. Additionally, ophthalmologic evaluation revealed ipsilateral miosis, diagnostic findings of Horner syndrome. Computerized tomography revealed a 7.5-cm thyroid mass infiltrating the main neck vessels. Although clinical and imaging data were suggestive of poorly differentiated thyroid carcinoma, fine-needle aspiration led to the diagnosis of papillary carcinoma. Paliative care was proposed to the patient due to the advanced stage of the neoplasm and to significant comorbidities. Horner syndrome is an infrequent manifestation of thyroid disorders and benign etiologies are more often implied. Malignant thyroid neoplasms represent a rare cause of Horner syndrome. However, an appropriate and prompt diagnosis is paramount for timely treatment of rare thyroid malignancies.