Colonic polypoid arteriovenous malformation - An unexpected cause of haematochezia.

A 70-year-old male was admitted with severe haematochezia and lipothymia. His medical history was relevant for coronary artery disease and radiation proctopathy. During hospitalization, was hemodynamically stable with persistent haematochezia. Laboratory examination revealed continuous haemoglobin fall, despite erythrocyte reposition, with administration of 11 units since admission. Colonoscopy showed an 8mm fibrinous lesion with an adherent clot, at 40cm from the anal verge. During exploration, a heavy spurting haemorrhage developed, with haemostasis being achieved with 4 clips, followed by site tattoo. Considering the risk of severe bleeding relapse in a high-risk patient, the patient underwent emergent Hartmann type colectomy. Histopathology report revealed a vascular lesion with arterial and venous vessels, protruding through the submucosa, muscular and subserosa, with a focal mucosal erosion, without neoplastic disease, compatible with an arteriovenous malformation (AVM).

Current Approach to Dysphagia: A Review Focusing on Esophageal Motility Disorders and Their Treatment.

Background: Dysphagia is a prevalent condition which may severely impact the patient's quality of life. However, there are still lacking standardized therapeutic options for esophageal motility disorders. Summary: Dysphagia is defined as a subjective sensation of difficulty swallowing which can result from oropharyngeal or esophageal etiologies. Regarding esophageal dysphagia, after excluding structural causes and esophageal mucosal lesions, high-resolution manometry (HRM) is the gold standard for the diagnosis of esophageal motility disorders. HRM has not only improved the sensitivity for detecting achalasia but has also expanded our understanding of spastic and hypomotility disorders of the esophageal body. The Chicago Classification v4.0 uses a hierarchical approach and provides a standardized diagnosis of esophageal motility disorders, allowing a tailored therapeutic approach. Dysphagia is often a long-term health problem that broadly impacts health and well-being and leads to physical and psychosocial disability, namely, malnutrition and aspiration pneumonia, as well as social isolation, depression, and anxiety. Apart from achalasia, most esophageal motility disorders tend to have a benign long-term course with symptoms of dysphagia and noncardiac chest pain that can improve significantly over time. Patient-reported outcomes (PROs) are self-assessment tools that capture the patients' illness experience and help providers better understand symptoms from the patients' perspective. Therefore, PROs have a critical role in providing patient-centered care. Key Messages: Motility disorders should be ruled out in the presence of nonobstructive esophageal dysphagia, and treatment options should be considered according to the severity of symptoms reported by the patient.

Contexto: A disfagia é uma condição prevalente que poderá ter impacto negativo na qualidade de vida dos doentes. No entanto, a abordagem terapêutica dos distúrbios da motilidade esofágica não está ainda padronizada. Sumário: A disfagia define-se como uma sensação subjetiva de dificuldade de deglutição que pode resultar de uma etiologia orofaríngea ou esofágica. Na disfagia esofágica, após exclusão de causas estruturais e lesões da mucosa esofágica, o estudo por manometria de alta resolução (MAR) está indicado como avaliação por excelência para o diagnóstico de distúrbios da motilidade esofágica. A implementação da MAR aumentou a sensibilidade para o diagnóstico de acalásia, como também melhorou a nossa compreensão dos distúrbios espásticos e de hipomotilidade do corpo esofágico. A Classificação de Chicago v4.0 utiliza uma abordagem hierárquica fornecendo um diagnóstico padronizado dos distúrbios da motilidade esofágica, o que permite uma abordagem terapêutica adaptada às diferentes condições. Frequentemente manifesta-se como uma condição clínica crónica com amplo impacto na saúde e bem-estar dos afetados, dada as suas consequências físicas e psicossociais. Pode estar associada a complicações graves, incluindo desnutrição e pneumonia por aspiração, bem como isolamento social, depressão e ansiedade, com redução acentuada da qualidade de vida. A maioria dos distúrbios da motilidade esofágica, à exceção da acalásia, tende a ter um curso benigno a longo prazo com sintomas de disfagia e de dor torácica não cardíaca que podem melhorar significativamente ao longo do tempo. Os outcomes reportados pelo doente (PRO) são ferramentas de autoavaliação que captam a experiência da doença dos afetados e ajudam os profissionais a entender melhor os sintomas na perspetiva dos doentes. Portanto, os PROs têm um papel crítico na prestação de cuidados centrados no doente. Mensagens-Chave: Doenças motoras deverão ser excluídas na presença de disfagia esofágica não obstrutiva. A terapêutica instituída deverá ser definida mediante a gravidade dos sintomas reportados pelo doente.

Aglaomorpha quercifolia (L.) Hovenkamp & S. Linds a Wild Fern Used in Timorese Cuisine.

Aglaomorpha quercifolia (L.) Hovenkamp & S. Linds is an extensively used species in traditional medicinal systems in several areas of the world due to some important medicinal properties such as antioxidant, antibacterial, analgesic, and anti-inflammatory activities. In East Timor, different parts of this fern are used either as remedies or as food. The ingestion of a broth made from its rhizome improves lactation, and young fronds of this fern are boiled and eaten with rice by the locals. Nevertheless, its chemical profile is far from being established. The present work aims to establish the chemical profile of both rhizomes and leaves n-hexane extracts by Gas Chromatography- Mass Spectrometry (GC-MS). The results showed the leaves richness in fatty acids with interesting nutritional values (ω-6/ω-3 = 0.68, AI = 0.59, TI = 0.30), being linolenic acid (253.71 ± 0.93 mg/g dry leaves) and palmitic acid (237.27 ± 0.59 mg/g dry leaves) the significant compounds in the extract. Whereas the rhizome extract is mostly rich in terpenoids, such as steroid, cycloartane, and hopanoid derivatives, being hop-16-ene (166.45 ± 0.53 mg/g dry rhizome) and ß-sitosterol (50.76 ± 0.11 mg/g dry rhizome) the major compounds. Several compounds are reported for the first time in the species, and the data herein reported contributes to confirming the species nutritional value.

Rhinoscleroma in a 5-year-old Portuguese Child.

Rhinoscleroma is a chronic granulomatous infectious disease that is rare in Western Europe. We report the case of a 5-year-old Portuguese boy diagnosed with rhinoscleroma in the context of recurrent epistaxis. He had a 6-month course of antibiotic (amoxicillin plus clavulanate) therapy with full recovery.

First seizure as late presentation of velo-cardio-facial syndrome.

Congenital hypoparathyroidism caused by velo-cardio-facial syndrome (VCFS) typically presents with hypocalcemia in the neonatal period associated with other characteristic findings. We report the case of an 8-year-old boy presenting a hypocalcemic seizure (ionized calcium, 0.65 mM); he had a history of velopharyngeal insufficiency and late development with language impairment; at presentation, minor dysmorphic features were noticed. Laboratory evaluation revealed a parathormone level of <1.0 pg/mL. VCFS was confirmed by fluorescence in situ hybridization study revealing the 22q11.2 deletion. High levels of calcium administration were needed to normalize serum calcium. In this case, signs of hypoparathyroidism only developed in late childhood, and the patient, despite the minor clinical signs of VCFS, remained symptom-free. He presented no cardiac malformations, immunologic abnormalities, or renal dysfunction often associated with this diagnosis. In a child with hypocalcemia, considering the hypothesis of VCFS, even if there are no other manifestations, is important both for clinical diagnosis and management and for genetic counseling.