Postpartum Onset of Multiple Sclerosis: A Case Report.

A breastfeeding 29-year-old woman who gave birth to her first child three months ago presented at the family doctor's appointment with a diverse array of symptoms, including vertigo, blurred vision, right lower limb weakness, and abdominal allodynia. She has a history of obesity and anxiety. The patient had a pre-pregnancy history of several visits to the family doctor. She takes folic acid, vitamin B12, iodine, and omega-3 supplements. The diverse symptomatology, the patient's insistence on seeking medical care, and the history of anxiety pose significant hurdles in arriving at a timely diagnosis. Magnetic resonance imaging showed signs compatible with primary demyelinating lesions of the central nervous system, which elicited a referral to neurology. The clinical and imagiological findings were suggestive of multiple sclerosis (MS), for which a conservative approach was taken. MS is a chronic inflammatory autoimmune disease with a mean age of onset of 20-30 years, more common in females. Stressful life events, viral infections, vaccination, physical trauma, previous anesthesia, excessive physical activity, and puerperium have all been described as trigger factors. This case underscores the importance of vigilance in postpartum healthcare and the importance of conducting a comprehensive diagnostic assessment. Early diagnosis has a positive impact on the prognosis of the disease.

Hand, Foot, and Mouth Disease in Adults.

Hand, foot, and mouth disease (HFMD) is a viral infection primarily affecting children, but it can occur in individuals of all ages. In this article, we present the atypical case of a 36-year-old male with no significant medical history who recurred to the emergency department with a three-day history of fever, sore throat, and a maculopapular rash. After an extended evaluation with normal blood tests, he was discharged home with a diagnosis of HFMD. This case underscores the importance of considering HFMD when evaluating adult patients with rashes, and patients should be reassured about the self-limiting nature of the disease.

Curae de mim ­ A Prática Especializada de Enfermagem de Saúde Mental e Psiquiátrica na Intervenção com Cuidadores Familiares / Curae from me - The Specialised Practice of Mental Health and Psychiatric Nursing in Intervention with Family Caregivers

Cuidar é viver em função de quem é cuidado, é dirigir toda a atenção, entrega e dedicação a outro que depende de si. A vida do cuidador familiar passa a organizar-se em função do cuidado ao outro, em função do bem-estar do outro. Ser cuidador familiar de uma pessoa com doença de Alzheimer está associado a sobrecarga na prestação de cuidados, bem como ao risco de doença mental. As pessoas com doença de Alzheimer necessitam de cuidados a longo prazo, requerendo dos seus cuidadores familiares uma dedicação e cuidado também a longo prazo. O Enfermeiro Especialista em Enfermagem de Saúde Mental e Psiquiátrica pode ter um papel determinante no acompanhamento dos cuidadores familiares, nomeadamente na capacitação para o desenvolvimento de estratégias de gestão da sobrecarga e de promoção de saúde mental. O presente relatório inclui o exercício de análise reflexiva do processo de aquisição de competências de Enfermeira Especialista em Enfermagem de Saúde Mental e Psiquiátrica, mas também o processo de confirmação das competências comuns de Enfermeiro Especialista. O relatório reflete um percurso pautado por uma prática baseada na evidência, alicerçada em modelos de enfermagem, que se traduziu no desenvolvimento de intervenções especializadas em contexto de um Serviço de Internamento de Psiquiatria, de uma Unidade de Cuidados na Comunidade e de uma Equipa Comunitária. A prática especializada, nos diferentes contextos, decorreu da identificação das necessidades encontradas, do planeamento e da implementação, com base nos Padrões de Qualidade dos Cuidados de Enfermagem de Saúde Mental, e com o propósito de ganhos em saúde mental na pessoa/grupos/comunidade. O desenho, planeamento e operacionalização de um projeto de melhoria contínua da qualidade no meu contexto da prática dirigido a cuidadores familiares de pessoa com doença de Alzheimer permitiu responder ao problema identificado, falta de estratégias face à sobrecarga dos cuidadores familiares. Com a aplicação do programa a 14 participantes, verificou-se a alteração do status do diagnóstico de sobrecarga do cuidador familiar, de intensa para ligeira e/ou moderada. Os participantes expressaram reconhecimento e satisfação através de narrativas que permitiram a identificação de indicadores do impacto do programa. A prática especializada dirigida aos cuidadores evidenciada neste programa reforça o contributo do Enfermeiro Especialista de Saúde Mental e Psiquiátrica no desenvolvimento de estratégias promotoras de saúde mental.

Communicating Bad News: Using Role-Play to Teach Nursing Students.

Receiving bad news can have a profound impact on a patient's physical, psychological and social well-being. Therefore, communication of bad news is an essential skill required for health professionals. A good interpersonal relationship based on trust, empathy, and respect can help the psychological adjustment to end-of-life losses. This study presents a simulation-based learning experience designed to teach communication skills to nursing students who care for palliative patients and their family members. The authors suggest adopting Gibbs' reflective cycle during structured debriefing that enables the students to move logically through the reflective process. A student-centered learning approach can promote responsibility and success in achieving the expected learning outcomes.

Identification and relative quantification of 3-nitrotyrosine residues in fibrinogen nitrated in vitro and fibrinogen from ischemic stroke patient plasma using LC-MS/MS.

Ischemic stroke is one of the leading causes of death and disability worldwide. This acute vascular event interferes with blood supply to the brain and induces a burst of free radicals such as nitric oxide and superoxide, producing peroxynitrite, a precursor of strong nitrating agents. Fibrinogen is one of the most abundant plasma proteins; it plays a role in the hemostatic system, mediating clot formation, which can be affected by nitrotyrosine formation. We hypothesized that nitration of fibrinogen by ONOOH and ONOOCO2- radical products could be one of the early events of the ischemic stroke, and protein-bound 3-nitrotyrosine could be a potential biomarker for diagnosis and/or prognosis of this condition. A targeted mass spectrometry approach was developed to analyze the nitration of fibrinogen and its association with ischemic stroke. First, a comprehensive mapping of 3-nitrotyrosine locations and their relative quantification was performed by LC-MS/MS, using in vitro nitrated fibrinogen samples. Twenty different 3-nitrotyrosine residues were identified on fibrinogen nitrated in vitro, varying with the peroxynitrite tofibrinogen molar ratio used. Nine tyrosine residues that were consistently modified at different treatment ratios were chosen to perform a targeted LC-MS/MS analysis in clinical samples. Enriched fibrinogen fractions from clinical samples from 24 ischemic stroke and 12 patients with non-inflammatory conditions were analysed with this method. Three of the nine tyrosine residues analysed (ßY452, ßY475 and γY380) showed a significant difference between the ischemic stroke and non-inflammatory disease groups. ROC curve analysis suggested an association of these residues either individually or in combination with ischemic stroke. Different tyrosine nitration patterns were also observed in fibrinogen modified in vitro and in vivo, suggesting differences in the nitration process in these situations. This is the first study showing a putative association between the nitration profile of specific tyrosine residues in human fibrinogen and ischemic stroke.

Spontaneous rupture of an intercostal artery.

Spontaneous rupture of an intercostal artery is exceptionally rare. It can be complicated by haemothorax, haematoma and/or retroperitoneal haemorrhage, which contributes to its morbidity and mortality. The authors report a case of a 76-year-old patient who was referred to the emergency department for pain associated with the appearance of a mass with progressive growth for 2 days in the right subscapular region. The patient had no previous history of trauma, ecchymosis or noticeable skin changes. History included the use of acetylsalicylic acid and a history of heart failure, as well as haemodialysis due to stage 5 chronic renal disease. CT scan showed an active haemorrhage from an artery in the fifth intercostal space. Embolisation was performed with microspheres and microcoils. No complications or recurrent bleeding was observed. Spontaneous rupture of an intercostal artery is rare, but it is an emergency requiring immediate diagnosis and intervention.

Evaluation of air oxidized PAPC: A multi laboratory study by LC-MS/MS.

Oxidized LDL (oxLDL) has been shown to play a crucial role in the onset and development of cardiovascular disorders. The study of oxLDL, as an initiator of inflammatory cascades, led to the discovery of a variety of oxidized phospholipids (oxPLs) responsible for pro-inflammatory actions. Oxidized 1-palmitoyl-2-arachidonoyl-sn-glycero-3-phosphocholine (PAPC) is frequently used by the scientific community as a representative oxPL mixture to study the biological effects of oxidized lipids, due to the high abundance of PAPC in human tissues and the biological activities of oxidized arachidonic acids derivatives. Most studies focusing on oxPAPC effects rely on in-house prepared mixtures of oxidized species obtained by exposing PAPC to air oxidation. Here, we described a multi-laboratory evaluation of the compounds in oxPAPC by LC-MS/MS, focusing on the identification and relative quantification of the lipid peroxidation products (LPPs) formed. PAPC was air-oxidized in four laboratories using the same protocol for 0, 48, and 72 h. It was possible to identify 55 different LPPs with unique elemental composition and characterize different structural isomeric species within these. The study showed good intra-sample reproducibility and similar qualitative patterns of oxidation, as the most abundant LPPs were essentially the same between the four laboratories. However, there were substantial differences in the extent of oxidation, i.e. the amount of LPPs relative to unmodified PAPC, at specific time points. This shows the importance of characterizing air-oxidized PAPC preparations before using them for testing biological effects of oxidized lipids, and may explain some variability of effects reported in the literature.

Splenomesenteric bypass as revascularisation technique after iatrogenic injury of the superior mesenteric artery during radical nephrectomy: A case report.

INTRODUCTION: Iatrogenic vascular injuries during radical nephrectomy are rarely reported. In the case of an injury of the superior mesenteric artery, the consequences for the patient are potentially catastrophic. It occurs more frequently in patients with large renal tumors, due to the presence of bulky perihilar adenopathies, or in cases of pyelonephritis. In most cases, the inadvertent injury of the artery occurs due to the difficulty in distinguishing it from the left renal artery. CASE: 69-year-old male, with a malignant neoplasm of the left kidney with the involvement of the tail of the pancreas, tumor thrombus in the left renal vein and multiple left para-aortic adenopathies, whose histological examination revealed to be a renal sarcomatoid carcinoma pT4N1M0G3. A radical nephrectomy was performed with caudal splenopancreatectomy and left paraaortic lymphadenectomy, with an iatrogenic injury of the superior mesenteric artery at its origin. A terminoterminal anastomosis was performed from the proximal stump of the splenic artery. The postoperative period went uneventfully. Control imaging in the follow-up showed permeability of the celiac trunk and the superior mesenteric artery. CONCLUSIONS: Intra-operative superior mesenteric artery injury should be promptly identified and repaired to prevent gut ischemia and all its dire consequences. There are different repair options, and the technique should be chosen according to the degree of injury. The splenomesenteric bypass has numerous advantages.

Contacts in Death: The Role of the ER-Mitochondria Axis in Acetic Acid-Induced Apoptosis in Yeast.

Endoplasmic reticulum-mitochondria contact sites have been a subject of increasing scientific interest since the discovery that these structures are disrupted in several pathologies. Due to the emerging data that correlate endoplasmic reticulum-mitochondria contact sites function with known events of the apoptotic program, we aimed to dissect this interplay using our well-established model of acetic acid-induced apoptosis in Saccharomyces cerevisiae. Until recently, the only known tethering complex between ER and mitochondria in this organism was the ER-mitochondria encounter structure (ERMES). Following our results from a screening designed to identify genes whose deletion rendered cells with an altered sensitivity to acetic acid, we hypothesized that the ERMES complex could be involved in cell death mediated by this stressor. Herein we demonstrate that single ablation of the ERMES components Mdm10p, Mdm12p and Mdm34p increases the resistance of S. cerevisiae to acetic acid-induced apoptosis, which is associated with a prominent delay in the appearance of several apoptotic markers. Moreover, abrogation of Mdm10p or Mdm34p abolished cytochrome c release from mitochondria. Since these two proteins are embedded in the mitochondrial outer membrane, we propose that the ERMES complex plays a part in cytochrome c release, a key event of the apoptotic cascade. In all, these findings will aid in targeted therapies for diseases where apoptosis is disrupted, as well as assist in the development of acetic acid-resistant strains for industrial processes.

Lipoproteins as targets and markers of lipoxidation.

Lipoproteins are essential systemic lipid transport particles, composed of apolipoproteins embedded in a phospholipid and cholesterol monolayer surrounding a cargo of diverse lipid species. Many of the lipids present are susceptible to oxidative damage by lipid peroxidation, giving rise to the formation of reactive lipid peroxidation products (rLPPs). In view of the close proximity of the protein and lipid moieties within lipoproteins, the probability of adduct formation between rLPPs and amino acid residues of the proteins, a process called lipoxidation, is high. There has been interest for many years in the biological effects of such modifications, but the field has been limited to some extent by the availability of methods to determine the sites and exact nature of such modification. More recently, the availability of a wide range of antibodies to lipoxidation products, as well as advances in analytical techniques such as liquid chromatography tandem mass spectrometry (LC-MSMS), have increased our knowledge substantially. While most work has focused on LDL, oxidation of which has long been associated with pro-inflammatory responses and atherosclerosis, some studies on HDL, VLDL and Lipoprotein(a) have also been reported. As the broader topic of LDL oxidation has been reviewed previously, this review focuses on lipoxidative modifications of lipoproteins, from the historical background through to recent advances in the field. We consider the main methods of analysis for detecting rLPP adducts on apolipoproteins, including their advantages and disadvantages, as well as the biological effects of lipoxidized lipoproteins and their potential roles in diseases.

A mass spectrometry approach for the identification and localization of small aldehyde modifications of proteins.

Lipids containing polyunsaturated fatty acids are primary targets of oxidation, which produces reactive short-chain aldehydes that can covalently modify proteins, a process called lipoxidation. Improved mass spectrometry (MS) methods for the analysis of these adducts in complex biological systems are needed. Lysozyme and human serum albumin (HSA) were used as model proteins to investigate lipoxidation products formed by two short-chain aldehydes, acrolein and pentanal, which are unsaturated and saturated aldehydes respectively. The adducts formed were stabilized by NaBH4 or NaBH3CN reduction and analysed by MS. Analysis of intact modified lysozyme showed a pentanal modification resulting from Schiff's base formation (+70 Da), and up to 8 acrolein adducts, all resulting from Michael addition (+58 Da). Analysis of tryptic digests identified specific histidine, cysteine and lysine residues modified in both lysozyme and HSA, and determined characteristic amino acid-specific fragmentations. Eight different internal fragment ions were found that could be used as general diagnostic ions for pentanal- and acrolein-modified amino acids. The combined use of intact protein analysis and LC-MS/MS methods provided a powerful tool for the identification and localization of aldehyde-protein adducts, and the diagnostic ions will facilitate the development of targeted MS methods for analysis of adducts in more complex samples.

European contribution to the study of ROS: A summary of the findings and prospects for the future from the COST action BM1203 (EU-ROS).

The European Cooperation in Science and Technology (COST) provides an ideal framework to establish multi-disciplinary research networks. COST Action BM1203 (EU-ROS) represents a consortium of researchers from different disciplines who are dedicated to providing new insights and tools for better understanding redox biology and medicine and, in the long run, to finding new therapeutic strategies to target dysregulated redox processes in various diseases. This report highlights the major achievements of EU-ROS as well as research updates and new perspectives arising from its members. The EU-ROS consortium comprised more than 140 active members who worked together for four years on the topics briefly described below. The formation of reactive oxygen and nitrogen species (RONS) is an established hallmark of our aerobic environment and metabolism but RONS also act as messengers via redox regulation of essential cellular processes. The fact that many diseases have been found to be associated with oxidative stress established the theory of oxidative stress as a trigger of diseases that can be corrected by antioxidant therapy. However, while experimental studies support this thesis, clinical studies still generate controversial results, due to complex pathophysiology of oxidative stress in humans. For future improvement of antioxidant therapy and better understanding of redox-associated disease progression detailed knowledge on the sources and targets of RONS formation and discrimination of their detrimental or beneficial roles is required. In order to advance this important area of biology and medicine, highly synergistic approaches combining a variety of diverse and contrasting disciplines are needed.