Mechanical Characterization of the Erythrocyte Membrane Using a Capacitor-Based Technique.

Pathological processes often change the mechanical properties of cells. Increased rigidity could be a marker of cellular malfunction. Erythrocytes are a type of cell that deforms to squeeze through tiny capillaries; changes in their rigidity can dramatically affect their functionality. Furthermore, differences in the homeostatic elasticity of the cell can be used as a tool for diagnosis and even for choosing the adequate treatment for some illnesses. More accurate types of equipment needed to study biomechanical phenomena at the single-cell level are very costly and thus out of reach for many laboratories around the world. This study presents a simple and low-cost technique to study the rigidity of red blood cells (RBCs) through the application of electric fields in a hand-made microfluidic chamber that uses a capacitor principle. As RBCs are deformed with the application of voltage, cells are observed under a light microscope. From mechanical force vs. deformation data, the elastic constant of the cells is determined. The results obtained with the capacitor-based method were compared with those obtained using optical tweezers, finding good agreement. In addition, P. falciparum-infected erythrocytes were tested with the electric field applicator. Our technique provides a simple means of testing the mechanical properties of individual cells.

Higher frequency of gastric neoplasia in advanced chronic liver disease patients: Impact of screening endoscopy in an intermediate-high risk country.

BACKGROUND: The Baveno VII guidelines were proposed to identify which patients could safely avoid screening esophagogastroduodenoscopy (EGD) for gastroesophageal varices. We aimed to evaluate the frequency of gastric neoplasia in compensated advanced chronic liver disease (cACLD) patients who underwent EGD for screening of gastroesophageal varices (GOEV) compared to a healthy population. METHODS: Retrospective study that enrolled all cACLD patients who underwent EGD for GOEV screening (January 2008-June 2018) in a tertiary reference center. cACLD patients were compared with asymptomatic healthy individuals who underwent EGD in a private hospital setting (April 2017-March 2018). RESULTS: We evaluated 1845 patients (481 cACLD patients, 1364 healthy individuals). A significantly higher frequency of gastric neoplasia was observed in patients with cACLD compared to healthy individuals (4.0% vs. 1.0 %; p < 0.001). Rare histopathological subtypes (WHO Classification) accounted for 28.7 % of gastric carcinoma cases in the cACLD cohort. Seven cases of gastric neoplasia (36.8 % of gastric neoplasia cases in the cACLD patients) were diagnosed in patients who, according to the Baveno VII criteria, would have not been submitted to EGD. CONCLUSION: We found an increased frequency of gastric neoplasia in patients with cACLD in comparison with healthy individuals. In countries with intermediate-high risk for GC, continuing to perform EGD could be beneficial.

P. falciparum Invasion and Erythrocyte Aging.

Plasmodium parasites need to find red blood cells (RBCs) that, on the one hand, expose receptors for the pathogen ligands and, on the other hand, maintain the right geometry to facilitate merozoite attachment and entry into the red blood cell. Both characteristics change with the maturation of erythrocytes. Some Plasmodia prefer younger vs. older erythrocytes. How does the life evolution of the RBC affect the invasion of the parasite? What happens when the RBC ages? In this review, we present what is known up until now.

A review of starch-based biocomposites reinforced with plant fibers.

Renewable and biodegradable resources have gained increasing attention as promising alternatives to synthetic plastics. Among the diverse raw materials employed in bioplastics production, starch emerges as an attractive, low-cost, and largely available source. However, the inherent properties of starch-based materials often limit their utility across various applications, necessitating strategic modifications to enhance their performance. A common approach to boost these materials involves incorporating natural fillers into biopolymer matrices. Incorporating natural fibers within starch matrices enables the development of biocomposites with improved properties while retaining their renewable and biodegradable characteristics. This review briefly addresses fundamental aspects of starch structure, obtention, and processing, as well as the main pre-treatments of natural fibers and processing methods currently applied to produce starch-based composites. It also highlights the most recent advances in this field, elucidates the effect of the incorporation of fibers on the biocomposite properties, and discusses the critical parameters affecting the synergic combination between starch and fibers.

Can 3-dimensional cranial ultrasound be used to successfully reconstruct a 2-dimensional image without compromising on image quality in a neonatal population?

BACKGROUND: Cranial ultrasound is frequently performed in neonatal intensive care units and acquiring 2-dimensional (D) images requires significant training. Three-D ultrasound images can be acquired semi-automatically. OBJECTIVE: This proof-of-concept study aimed to demonstrate that 3-D study image quality compares well with 2-D. If this is successful, 3-D images could be acquired in remote areas and read remotely by experts. MATERIALS AND METHODS: This was a prospective study of 20 neonates, who underwent both routine 2-D and 3-D cranial ultrasounds. Images were reconstructed into standard views extracted from the 3-D volume and evaluated by three radiologists blinded to the acquisition method. The radiologists assessed for the presence of anatomical landmarks and overall image quality. RESULTS: More anatomical structures were identified in the 3-D studies (P<0.01). There was a trend that 3-D ultrasound demonstrated better image quality in the coronal plane, and 2-D in the sagittal plane, only reaching statistical significance for two coronal views and two sagittal views. CONCLUSION: Overall, this study has demonstrated that 3-D cranial ultrasound performs similarly to 2-D and could be implemented into neonatal practice.

Limonene and its derived oligomer as bioactive additives in starch/coffee husks biocomposites for food packaging applications.

In this study, antioxidant, and antimicrobial starch-based biocomposite films reinforced with coffee husks (S/CH) were developed by incorporating either limonene (LM) (S/CH/LM) or its oligomer derivative, poly(limonene) (PLM) (S/CH/PLM), at different concentrations (5-10 % w/w of starch). Through a comprehensive assessment of film properties, morphology, and structure, a comparative analysis between the two additives was proposed. Scanning electron microscopy (SEM) revealed some defects throughout the polymer matrix after additive incorporation. The tensile strength (TS) and modulus of elasticity (ME) showed a decrease upon the inclusion of both LM and PLM, while the elongation at break (E) increased. Notably, PLM exhibited outstanding antioxidant capacity, enhancing the films by 108 % over control samples. Additionally, at just 5 % concentration, PLM effectively inhibited the growth of Escherichia coli ATCC 11775 (35.33 ± 2.52 mm) and demonstrated an impressive UV-Vis barrier, comparable to the highest amount of LM incorporated. Therefore, this research highlights the potential of coffee husk-reinforced starch biocomposites with limonene-derived additives as a promising solution for food packaging applications. The comparative analysis sheds light on the advantages of using the PLM in terms of antioxidant and antimicrobial properties, contributing to the advancement of active packaging technologies.

Alternative flexible plastic packaging for instant coffees.

Instant coffees are consumed worldwide and their packages must protect them mainly from moisture gain. Flexible packaging stand-up pouches made by PET/Al foil/LDPE are currently used but, the look for alternative materials is interesting to replace the aluminum foil with reducing costs and focusing on sustainability. Therefore, the aim of this study was to evaluate the quality loss of freeze-dried and spray-dried (agglomerated and powder) instant coffees during 365 days at 25 °C/75% RH, packaged in five plastic structures: PET (polyethylene terephthalate)/Al (aluminum) foil/LDPE (low density polyethylene), LDPE/HDPE (high density polyethylene)/LDPE, BOPP (biaxially oriented polypropylene)/BOPP met (metallized)/PP, PET/PET met/LDPE and PET/BOPP met/LDPE. The results were compared with the shelf-life estimated by modeling the moisture sorption isotherms of the products by mathematical models. Results indicated that the lower the barrier to water vapor of the packaging material, the greater the gains in moisture and water activity of the instant coffees and in addition to being thermally less stable. After 365 days of storage, the three soluble coffees still had acceptable characteristics in the five packaging structures, indicating that it is possible to replace the currently used laminate, which contains aluminum foil, with recyclable structures. However, the greatest stability for the coffees was obtained using the alternative structures: BOPP/BOPP met/PP and LDPE/HDPE/LDPE, a result that was in concordance with that obtained by mathematical modeling.

Protein-Losing Enteropathy Resolved by Helicobacter pylori Eradication.

Protein-losing enteropathy (PLGE) is an uncommon condition with a multifactorial origin, that is characterized by excessive loss of serum proteins into the gastrointestinal tract, resulting in hypoproteinaemia and oedema. The authors present the case of a 24-year-old man admitted to hospital for a 2-month history of lower extremity oedema and diarrhoea with a secretory pattern. Blood analysis revealed hypoalbuminaemia and iron deficiency anaemia. Liver disease and severe proteinuria were excluded as possible aetiologies. Upper gastrointestinal endoscopy revealed signs of chronic Helicobacter pylori gastritis. After completion of H. pylori eradication, the patient had complete resolution of clinical and laboratory abnormalities. The results suggest the need to consider less frequent aetiologies for peripheral oedema and hypoproteinaemia, such as PLGE, especially those caused by prevalent bacterial agents like H. pylori. LEARNING POINTS: Protein-losing enteropathy may be related to Helicobacter pylori infection.Protein-losing enteropathy and its associated symptoms may be resolved by H. pylori eradication.

Biopolymer-Based Films from Sodium Alginate and Citrus Pectin Reinforced with SiO2.

Blend films based on sodium alginate (SA) and citrus pectin (P) reinforced with different concentrations of SiO2 (0-10% w/w) were developed in this study. From the morphological (SEM) and structural (FT-IR) evaluation, it was verified that the incorporation of the reinforcing agent did not drastically modify the microstructure of the films, nor did new chemical bonds form. However, the XRD results suggested a slight reduction in the crystallinities of the blends by the incorporation of SiO2. Among the formulations prepared, the addition of a 5% reinforcing agent was responsible for the simultaneous improvement of mechanical and barrier properties. Comparing the control sample (SA/P) with the SA/P/5.0%SiO2 film, the tensile strength increased from 27.7 ± 3.7 to 40.6 ± 4.5 MPa, and the water-vapor transmission rate decreased from 319.8 ± 38.7 to 288.9 ± 23.5 g m-2 day-1. Therefore, SiO2, as a reinforcing agent in SA/P blends, represents a simple and effective strategy for improving the properties of biopolymer-based films in applications, such as packaging.

Improving the mechanical properties and thermal stability of sodium alginate/hydrolyzed collagen films through the incorporation of SiO2.

Biopolymer-based films have become leading alternatives to traditional fossil-based packaging plastics. Among the countless types of biopolymers with potential for such applications, films containing hydrolyzed collagen in their composition were scarcely explored. This study determined the effect of different loads of nano-SiO2 (0, 2, 6, 8 and 10% w/w of sodium alginate) in the sodium alginate (SA) and hydrolyzed collagen (HC) blend films in terms of structure, thickness, mechanical properties, and thermal stability. The results indicated an improvement in the general mechanical and thermal behavior. Tensile strength increased from 18.2 MPa (control sample) to 25.4 MPa for the SA/HC film incorporated with 10% nano-SiO2. In the same condition, the film's elongation at break improved impressively (from 19.5 to 35.8%). Thermal stability improved slightly for all proportions of nano-SiO2. Therefore, the addition of nano-SiO2 can be an easy and simple strategy to improve crucial properties of SA/HC blend films, increasing its performance for future application as sustainable packaging.

Intraocular Lymphoma: When to Suspect a Sinister Cause of Ocular Haemorrhage.

Intraocular lymphoma (IOL) is a rare and life-threatening condition whose aetiology is unclear. Blurred vision, reduced vision, and floaters are common initial symptoms. Posterior vitreous detachment and haemorrhage rarely occur. The authors present the case of a 79-year-old man who initially presented with a 3-month history of fever, night sweats, significant weight loss, bilateral peri-orbital haematoma, red eyes and retro-orbital headache. Physical examination revealed fever, bilateral peri-orbital haematoma, subconjunctival haemorrhage and palpable cervical lymphadenopathy. CT scans detected conical intra-orbital lesions, cervical adenomegalies, expansive lesions in the adrenal glands, and thrombosis of the splenomesenteric confluent and posterior segment of the right branch of the portal vein. These findings were suggestive of a lymphoproliferative disorder. Aspiration cytology of the adrenal mass and inguinal adenopathies was compatible with diffuse large B-cell lymphoma with areas of transformation to Burkitt's lymphoma. We describe a rare form of lymphoma, and a very unusual presentation of primary intraocular lymphoma with atypical symptoms. LEARNING POINTS: Intraocular lymphoma is a rare disease and can mimic common infectious or non-infectious uveitis.Bleeding or periocular haematoma are suggestive of intraocular lymphoma.

Congenital Heart Disesase: A Retrospective Analysis from a Tertiary Referral Centre in Portugal

Abstract Background: Congenital heart disease is the leading cause of mortality among all congenital malformations. Objectives: To evaluate the incidence of congenital heart diseases in a central maternity hospital in Portugal from January 2003 to December 2018 and to determine survival in the first year of life. Methods: Retrospective analysis of newborns diagnosed with congenital heart diseases within 72 hours after birth. Malformations were divided according to pathophysiology. Cumulative survival analysis was performed by the Kaplan-Meier test. Stastical significance was set at p <0.05. Results: A total of 297 newborns with cardiac malformation was recorded among 47,198 live births (incidence of 6:1000), 16% associated with extra-cardiac disease. The most frequent congenital heart diseases were left-to-right shunt lesions (n = 216), followed by cyanotic (n = 41), acyanotic obstructive (n = 31) and miscellaneous (n = 9). Seventy (24%) patients had prenatal diagnosis, 88% of them cyanotic defects, and a positive association was found between prenatal diagnosis and mortality (p <0.001). Coarctation of the aorta was associated with gestational diabetes (p = 0.014). Atrial septal defect was more common in females (p = 0.02). Mortality rate due to heart disease was 3.4%. Patients with cyanotic disease, 99%, 97%, 97%, respectively, for patients with left-to-right shunt lesions, and 97%, 97%,97% for those with obstructive lesion cases. Conclusion: The incidence of congenital heart disease was 6:1000, mostly left-to-right shunt lesions. Heart disease accounted for only half of deaths, and cyanotic diseases have a high nonspecific mortality rate.

O-ATRP synthesized poly(ß-pinene) blended with chitosan for antimicrobial and antioxidant bio-based films production.

Antioxidant and antimicrobial activities are important characteristics of active film packaging designed to extend food preservation. In this study, functional bio-based films were produced using different concentrations of antioxidant poly(ß-pinene) bio-oligomer synthesized via organocatalyzed atom transfer radical polymerization (O-ATRP) and blended with chitosan of different molecular weights. The structural, mechanical, thermal, solubility, antioxidant, and antimicrobial properties of the films were investigated. The poly(ß-pinene)-chitosan blends presented significant pores and irregularities with the increase of poly(ß-pinene) concentration over 30%. Chitosan molecular weight did not show any important influence in the physical properties of the blends. Poly(ß-pinene) load decreased the materials' tensile strength and melting temperature, exhibiting a plasticizing effect on chitosan chains. The antioxidant and antimicrobial activities of the films were improved by poly(ß-pinene) incorporation and mainly depended on its concentration. Therefore, the incorporation of poly(ß-pinene) in chitosan films can be an alternative for active packaging production.

Effect of low concentrations of SiO2 nanoparticles on the physical and chemical properties of sodium alginate-based films.

This work investigated the effect of adding low concentrations of nano-SiO2 (0.5, 1.0 and 1.5%) in the properties of films based on sodium alginate, to identify lower thresholds in the proportion of the reinforcing agent. It was found that, even in the smallest proportion, thermal stability of the nanocomposites improved significantly (with degradation onset increased by almost 15% compared with the control film). The surface morphology showed pronounced roughness at nano-SiO2 concentrations greater than 1.0%, indicating agglomeration of part of the nanomaterial. Mechanical properties were reduced for the samples with concentrations equal to 1.0 and 1.5%, however, without significant differences between them. Conversely, water vapor and light barrier properties have not undergone significant changes in any formulation. Therefore, the use of 0.5% nano-SiO2 in alginate films would be an easy and economically interesting way to improve thermal stability, without significantly reducing mechanical properties of the pure material.

Breast cancer survival in Great Cuiaba, Brazil: a population-based study.

OBJECTIVE: To analyze ten-year specific survival of women with breast cancer in Great Cuiaba, Mato Grosso, Brazil. METHODS: A population-based cohort of 61 women diagnosed with breast cancer in 2008 and 2009, in Great Cuiabá, Mato Grosso, followed by 2018 in the regional mortality database. Specific survival was analyzed through the Kaplan-Meier curve, with adjustment of the Weibull model and Log-Weibull Regression. The survival curves of the variables were compared using the log-rank test which were statistically significance (p<0.05). RESULTS: The mean time to death is approximately 51.1 months. Women aged ≤ 50 years and of white race/color presented the worst survival. CONCLUSION: We found out that age, race/color affect specific survival and there is a need for reviewing the control plan for breast cancer in order to increase the survival of women diagnosed with this pathology.

Normal head and neck lymph nodes in the paediatric population.

AIM: To determine the normal range of head and neck lymph nodes in a paediatric population. MATERIALS AND METHODS: A retrospective review was undertaken of 200 brain magnetic resonance imaging (MRI) examinations in patients aged between 5 months to 16 years. Exclusion criteria included possible causes for lymphadenopathy. Studies were reported previously as normal. Eight regions were assessed for the presence of nodes, short and long axis of the largest node measured, and the ratio was calculated. RESULTS: Most commonly identifiable nodes were the deep cervical, submandibular, and posterior cervical in 100%, 99.5%, and 92.5% of studies. In the long axis, the three largest were the submandibular, deep, and posterior cervical with mean values of 19.7, 18.1, and 15.4 mm, respectively. For the S/L ratio, the three with the most oval shape were the pre-auricular, occipital, and submental with ratios of 0.64, 0.63, and 0.6, respectively. A positive correlation between the occipital and deep cervical lymph node groups with age was found to be stronger than the rest of localisations. CONCLUSION: This study characterises the normal distribution, size, and shape of head and neck lymph nodes in a healthy paediatric population, demonstrating that rounder and larger lymph nodes may be a normal finding, depending on their location and patient age.

Patent ductus arteriosus closure: experience from a tertiary referral center / Experiência de uma maternidade terciária no fechamento do canal arterial patente

ABSTRACT Objective: To characterize the number and methods of closure of Persistent Ductus Arteriosus (PDA) over a span of 16 years in a third level maternity hospital. Methods: Retrospective study of neonates born between January 2003 and Deccember 2018, who underwent ductus arteriosus closure by pharmacological, surgical and/or transcatheter methods. Gestational age, birth weight, number and methods of closures per year were evaluated. The success rate of the pharmacologic method was calculated, as well as the mortality rate. The association between mortality and birthweight, treatment used and treatment failure was explored. Results: There were 47,198 births, 5,156 were preterm, 325 presented PDA and 106 were eligible for closure (median gestational age - 27 weeks, birthweight <1000 g - 61%). Frequency of PDA closure decreased during the study period, especially starting in 2010. Success rate with pharmacologic treatment was 62% after the first cycle and 74% after the second. After drug failure, 12 underwent surgical ligation and two underwent transcatheter closure. Exclusive surgical ligation was indicated in four infants. Ibuprofen replaced indomethacin in 2010, and acetaminophen was used in three infants. Among the 106 infants, hospital mortality was 12% and it was associated with birthweight <1000 g (13/65 <1000 vs. 0/41 >1000 g; p=0.002) and with failure in the first pharmacologic treatment cycle (13/27 with failure, vs. 0/75 without failure; p<0.001). Conclusions: The national consensus published in 2010 for the diagnosis and treatment of PDA in preterm infants led to a decrease in the indication for closure. Pharmacological closure was the method of choice, followed by surgical ligation. Birthweight <1000 g and first cycle of pharmacologic treatment failure were associated with higher mortality.

RESUMO Objetivo: Caraterizar o número e métodos de fechamento de canal arterial durante 16 anos numa maternidade de nível terciário. Métodos: Estudo retrospetivo de nascidos entre 01 de janeiro de 2003 a 31 de dezembro de 2018 submetidos a fechamento do canal arterial por métodos farmacológico, cirúrgico e/ou percutâneo. Avaliaram-se idade gestacional, sexo, peso ao nascimento, número de fechamentos por ano e método utilizado. Aferiram-se as taxas de sucesso de método farmacológico e de mortalidade e sua associação com peso ao nascer, fármaco utilizado e insucesso do fechamento. Resultados: Verificaram-se 47.198 recém-nascidos, 5.156 prematuros, dos quais 325 com canal arterial patente, sendo 106 com indicação para fechamento (idade gestacional mediana 27 semanas, peso <1000 g em 61%). Verificou-se diminuição do número de fechamentos ao longo dos anos, sobretudo a partir de 2010. O fechamento ocorreu em 62% após primeiro ciclo de tratamento farmacológico e em 74% após segundo. Após insucesso farmacológico, 12 realizaram ligadura cirúrgica e dois, fechamento percutâneo. Houve indicação de ligadura cirúrgica exclusiva em quatro. O ibuprofeno substituiu a indometacina em 2010. O acetaminofen foi usado em três doentes. A mortalidade nos 106 pacientes foi de 12%, associando-se ao peso ao nascer (13/65 <1000 vs. 0/41 >1000 g; p=0,002) e à falha do primeiro ciclo de tratamento farmacológico (13/27 com falha vs. 0/75 com sucesso; p<0,001). Conclusões: Consenso nacional de 2010 para diagnóstico e tratamento do canal arterial nos prematuros levou à diminuição do número de fechamentos desse canal. O fechamento farmacológico foi o método mais utilizado, seguido da ligadura cirúrgica. Peso <1000 g e falha no primeiro ciclo de fechamento farmacológico se associaram à maior mortalidade.

Breast cancer survival in Great Cuiaba, Brazil: a population-based study / Supervivencia para el cáncer de mama en el Gran Cuiabá, Brasil: estudio poblacional / Sobrevida para o câncer de mama na grande Cuiabá, Brasil: estudo de base populacional

ABSTRACT Objective: To analyze ten-year specific survival of women with breast cancer in Great Cuiaba, Mato Grosso, Brazil. Methods: A population-based cohort of 61 women diagnosed with breast cancer in 2008 and 2009, in Great Cuiabá, Mato Grosso, followed by 2018 in the regional mortality database. Specific survival was analyzed through the Kaplan-Meier curve, with adjustment of the Weibull model and Log-Weibull Regression. The survival curves of the variables were compared using the log-rank test which were statistically significance (p<0.05). Results: The mean time to death is approximately 51.1 months. Women aged ≤ 50 years and of white race/color presented the worst survival. Conclusion: We found out that age, race/color affect specific survival and there is a need for reviewing the control plan for breast cancer in order to increase the survival of women diagnosed with this pathology.

RESUMEN: Objetivo: Analizar la supervivencia específica en 10 años de las mujeres con cáncer de mama en el Gran Cuiabá, Mato Grosso, Brasil. Método: Cohorte poblacional de 61 mujeres diagnosticadas con cáncer de mama en los años de 2008 y 2009, en el Gran Cuiabá, Mato Grosso, seguidas hasta 2018 en el banco regional de mortalidad. La supervivencia específica se analizó utilizando curvas de Kaplan-Meier, con ajuste del modelo Weibull y Regresión Log-Weibull. Las curvas de supervivencia de las variables que fueron estadísticamente significativas (p <0.05) se compararon mediante la prueba de log-rank. Resultados: El tiempo promedio hasta la muerte es de aproximadamente 51.1 meses. Las mujeres de ≤ 50 años y de raza/blanca presentaron peor supervivencia. Conclusión: Descubrimos que la edad y la raza/color afectan la supervivencia específica y que es necesario revisar el Plan de control del cáncer de mama para aumentar la supervivencia de las mujeres diagnosticadas con esta enfermedad.

RESUMO Objetivo: Analisar a sobrevida específica em 10 anos para o câncer de mama feminino na Grande Cuiabá, Mato Grosso, Brasil. Métodos: Coorte de base populacional composta por 61 mulheres diagnosticadas com câncer de mama, período 2008-2009, na Grande Cuiabá, Mato Grosso, seguidas até 2018 no banco de mortalidade regional. A sobrevida foi analisada por meio das curvas de Kaplan-Meier, com ajuste do modelo Weibull e Regressão Log-Weibull. Compararam-se as curvas de sobrevida por meio do teste log-rank e as diferenças estatísticas foram significantes com p<0,05. Resultados: O tempo médio até a morte por câncer de mama foi de aproximadamente 51,1 meses. Apresentaram pior sobrevida as mulheres com idade ≤ 50 anos e raça/cor branca. Conclusão: Evidenciou-se que a idade e a raça/cor afetaram a sobrevida específica para este câncer. Há necessidade de revisão da política oncológica do estado para aumentar a sobrevida das mulheres com essa patologia.

PATENT DUCTUS ARTERIOSUS CLOSURE: EXPERIENCE FROM A TERTIARY REFERRAL CENTER.

OBJECTIVE: To characterize the number and methods of closure of Persistent Ductus Arteriosus (PDA) over a span of 16 years in a third level maternity hospital. METHODS: Retrospective study of neonates born between January 2003 and Deccember 2018, who underwent ductus arteriosus closure by pharmacological, surgical and/or transcatheter methods. Gestational age, birth weight, number and methods of closures per year were evaluated. The success rate of the pharmacologic method was calculated, as well as the mortality rate. The association between mortality and birthweight, treatment used and treatment failure was explored. RESULTS: There were 47,198 births, 5,156 were preterm, 325 presented PDA and 106 were eligible for closure (median gestational age - 27 weeks, birthweight <1000 g - 61%). Frequency of PDA closure decreased during the study period, especially starting in 2010. Success rate with pharmacologic treatment was 62% after the first cycle and 74% after the second. After drug failure, 12 underwent surgical ligation and two underwent transcatheter closure. Exclusive surgical ligation was indicated in four infants. Ibuprofen replaced indomethacin in 2010, and acetaminophen was used in three infants. Among the 106 infants, hospital mortality was 12% and it was associated with birthweight <1000 g (13/65 <1000 vs. 0/41 >1000 g; p=0.002) and with failure in the first pharmacologic treatment cycle (13/27 with failure, vs. 0/75 without failure; p<0.001). CONCLUSIONS: The national consensus published in 2010 for the diagnosis and treatment of PDA in preterm infants led to a decrease in the indication for closure. Pharmacological closure was the method of choice, followed by surgical ligation. Birthweight <1000 g and first cycle of pharmacologic treatment failure were associated with higher mortality.

Pleural Sarcoidosis and Occult Lymphatic Anthracosis: An Unusual Symptomatic Association.

Sarcoidosis is a chronic multisystemic inflammatory disease of unknown aetiology. Virtually any organ or system can be involved, resulting in a wide range of clinical presentation. Pleural sarcoidosis is rare. Pleural effusion can only be attributed to pleural sarcoidosis in the presence of pleural non-caseating epithelioid granulomas and after excluding other granulomatous diseases. Anthracosis is a pneumoconiosis associated with thoracic adenopathies and bronchial disease, and it is usually asymptomatic. The authors present a case of a middle-aged man hospitalized due to cough, right-sided pleuritic chest pain and trepopnoea. LEARNING POINTS: To pursue a systematic and exhaustive investigation of pleuraleffusion until a definitive diagnosis is established.To recognize atypical presentations of sarcoidosis with a high degree of suspicion whenever the initial investigation is inconclusive.