Xantomatose cerebrotendínea: uma doença rara e multissistêmica ainda pouco conhecida. Quando devemos suspeitar? / Cerebrotendinous xanthomatosis: a rare and multisystemic disease still little known. When should we suspect?

Xantomatose cerebrotendínea (XCT) é uma doença congênita autossômica recessiva rara multissistêmica do me-tabolismo do ácido biliar que leva ao acúmulo de intermediários do colesterol em diversos tecidos. A principal ma-nifestação da doença é o acometimento neurológico progressivo e irreversível, que inicia na infância e evolui com disfunção neurológica grave na fase adulta. Sintomas não neurológicos característicos como xantomas tendíneos, cataratas de início na infância e diarreia crônica infantil também podem estar presentes. No Brasil, não existe te-rapia medicamentosa para a doença. A principal abordagem terapêutica para retardar a progressão do quadro é o acompanhamento multidisciplinar com o objetivo de melhorar a qualidade de vida. Apesar dos sintomas iniciarem na infância, a maioria dos pacientes demora em média 16 anos para receber o diagnóstico, fase na qual o dano neurológico já é extenso e as abordagens terapêuticas não são mais eficazes. Neste estudo é relatado o caso de paciente de 47 anos com XCT que iniciou os sintomas na infância, com piora neurológica aos 38 anos e diagnóstico aos 44 anos, fase na qual a neurodegeneração já era grave e irreversível. Os testes laboratoriais e Imagem de Res-sonância Magnética indicaram alterações características da doença. Ressalta-se a importância de ter a XTC como diagnóstico diferencial na presença de um quadro neurológico progressivo, amplo e variado, associado com xanto-mas tendíneos e outros sinais e sintomas específicos. Por tratar-se de doença crônica e degenerativa, o diagnóstico precoce é essencial para que se possa instituir medidas que melhorem a qualidade de vida (AU)

Cerebrotendinous xanthomatosis (CTX) is a rare, multisystemic autosomal-recessive disease of biliary acid me-tabolism that leads to accumulation of cholesterol intermediates in multiple tissues. Its primary presentation is progressive and irreversible neurological damage, beginning in childhood and progressing to neurological dys-function in adulthood. There also are characteristic non-neurological symptoms, including tendinous xanthomas, cataracts beginning in childhood, and chronic infantile diarrhea. In Brazil, there is no available treatment for CTX. The primary therapeutic approach to slow disease progression is a palliative one, with multidisciplinary team. While CTX symptoms begin in childhood, most patients are diagnosed at approximately age 16, when neurological damage is extensive and therapeutic approaches are no longer effective. Here, we report a case of a 47-year-old female patient with CTX with symptoms beginning in childhood, with neurological worsening at the age of 38 and diagnosis at 44, at which neurodegeneration was already severe and irreversible. Laboratory tests and magnetic resonance imaging indicated characteristic symptoms. It is important to consider CTX as a differential diagnosis in the presence of a progressive, wide, and varied neurological picture, with tendinous xanthomas and other specific symptoms. Because it is a chronic and degenerative disease, early diagnosis is essential to establish measures to improve the quality of life (AU)

Chemical Composition and Antioxidant, Antinociceptive, and Anti-inflammatory Activities of Four Amazonian Byrsonima Species.

Species of the Byrsonima genus are widely used in Brazil, especially for the treatment of gastrointestinal disorders. However, species from the Amazonian region are still poorly studied. Thus, we studied the antioxidant, antinociceptive, and anti-inflammatory activities of for Amazonian species, Byrsonima crispa, Byrsonima duckeana, Byrsonima garcibarrigae, and Byrsonima incarnata. Phenolic composition was determined by chemical and chromatographic methods. The aqueous extracts were evaluated in DPPH• , ABTS+• , and superoxide (O2•- ) tests, LPS-activated macrophage assay, and formalin test. All species contained a high phenolic and flavonoid content. We identified 15 phenolic compounds, including phenolic acids, hydroxycinnamic acids, flavonoids, and catechins. The extracts showed high antioxidant activity and were more active than quercetin at inhibiting nitric oxide release in the LPS-activated macrophage assay. B. duckeana and B. garcibarrigae showed higher in vivo antinociceptive and anti-inflammatory activities. B. garcibarrigae presented significant effect on the early phase of the formalin test, pointing to an antinociceptive mechanism distinct from traditional anti-inflammatory medicines. In conclusion, the pharmacological potential of these species is closely related to their flavonoid-rich chemical composition, which seems to act through antioxidant mechanisms. Copyright © 2017 John Wiley & Sons, Ltd.