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  • ISSN: 2373-9819
    Volume 8, Issue 1
    Case Report
    Irene Verdasca, Susana Franco, Luis Melo, João Torres, Susana Peres, Fernando Borges, and Kamal Mansinho
    Autoimmune hepatitis (AIH) remains a major diagnostic and therapeutic challenge. In addition to being a relatively rare disease, early recognition may be difficult due to its heterogeneous clinical picture and the absence of a specific laboratory finding. Female patient, 67 years old, with human immunodeficiency virus infection under antiretroviral therapy with stable immune status and suppressed viral load. Reported asthenia, yellowish mucosa and nausea for one month. Lived in a rural area with direct contact with unvaccinated animals, consumed unpasteurized food and had occasional contact with rat poison. Laboratory evaluation showed liver biochemical and function tests highly elevated and the autoimmune study positive antinuclear antibody (ANA) and anti-smooth muscle antibody (ASMA). Other causes of inflammatory liver diseases were excluded. Abdominal ultrasound showed no abnormal findings. Liver biopsy (Figure 1) was preceded and revealed chronic hepatitis with marked activity that could be compatible with autoimmune or toxic etiology (Figure 2). By the use of simplified AIH score, diagnosis of AIH was likely (7 points) and probable by using the revised original score for AIH (14 points). The patient started prednisolone 1mg / kg / day and azathioprine 25mg / day with rapid remission. The simplified diagnostic criteria have a high sensitivity and specificity for the diagnosis of AIH. Its application in clinical practice led to the diagnosis of HAI after the result of a non-definitive liver histology and the initiation of immunosuppressive therapy, in this case with remission of the disease.
    Irene Verdasca*, Miguel Ferreira, Pedro Mota, and Nuno Cardim
    A 34-year-old woman, from Argentina, with history of positive serology for Trypanosoma cruzi (T. cruzi) is referred to cardiology consultation for symptoms of palpitations. Cardiovascular assessment with chest x-ray, electrocardiogram (ECG) and 24-hour Holter monitoring was normal. Attending to the epidemiologic context of an immigrant patient from an endemic area for Chagas' disease echocardiographic evaluation was performed and documented left ventricle cavity at the upper limit for normal and inferolateral hypokinesia with decreased regional longitudinal strain. Cardiac magnetic resonance imaging (MRI) detected dilated left ventricle (LV) with segmental alterations (lower wall and apex), dilated right ventricle (RV) and increased T1 and T2 native left ventricle. These findings were suggestive of chronic Chagas' myocardiopathy, an early form (indeterminate phase).
    New imagining modalities, like strain echochardiography and MRI, helped this patient to start pharmacological treatment earlier and is now a good way to improve clinical care and follow-up of a "forgotten disease".
    Zhanfen Chen*, Yixuan Wu, Qiang Zhang and Yumin Zhang
    A novel mononuclear platinum(II) complex, [PtLCl]Cl (1, where L N-(4-(benzo[d]thiazol-2-yl)phenyl)-2-(bis(pyridine-2-ylmethyl)-amino)acetamide), was synthesized by covalently tethering a benzothiazole derivative 2-(4-aminophenyl)benzothiazole to the 2,2’-dipicolylamine (DPA) chelating PtII center by an amidic bond. The complex showed a cytotoxicity comparable to that of cisplatin against MCF-7 cell lines, and more potent activities against HeLa and A-549 cell lines. Investigations of the reaction of 1 with 5’-GMP display that 1 could coordinate with N7-GMP to form the Pt-GMP adduct. Thus 1 has potential to form Pt-DNA adducts in vivo. Similarly, the glutathione (GSH) ligand could also coordinate to the Pt(II) center to form a monodentatePt-GS complex. The competition experiments of 1 with 5’-GMP and GSH showed that the coordination binding of 1 with GSH did not prevent the formation of a certain amount of the Pt-GMP adduct in the reaction process. DNA binding experiments displayed that 1 could bind to DNA through multiple binding modes involving non-covalent interaction and monofunctionalplatination of the platinum(II) moiety, and induce a visible conformational change of DNA. The evaluation of the protein binding ability showed that complex 1 could bind to human serum albumin (HSA) with a moderate binding affinity, quench the intrinsic fluorescence of HSA, and destroy the tertiary structure of HSA.
    Marta Reia*, Carlos Quintana and Carlos Penalva Santos
    Sarcomas are an uncommon diversified group of neoplasms, which affects soft tissue: muscle, fatty tissue, lymphatics, blood vessels and nerves.
    Soft tissue sarcomas (STS) accound for approximately 1% of all adults' malignancies. They are hard to diagnose, requiring image exams, and imuno-hystochemical and molecular tests to confirm the diagnosis. The treatment is multidisciplinary, involving surgery, radiotherapy, chemotherapy, and monoclonal therapy, depending on the
    Presenting stage of the disease.
    This article reports a clinical case of a fusocellular fibrosarcoma in a 20-year-old female, presenting with a cervical indolent mass. The histologic exam revealed an incomplete excision of the lesion (R1) and it showed aspects related to a undifferentiated fusocellular fibros sarcoma, (G3).
    This case was discussed in multidisciplinary consultation and the patient was referred to a Sarcoma Group in a terceary center, where a new surgery was performed for excision of the remaining disease. The anatomo-pathologic review showed a complete excision (R0), but with an insufficient margin, so that the patient was reoperated to obtain larger margins. The pathological exam of this new sample was negative for atypia. After surgical treatment, it was decided by the multidisciplinary team adjuvant treatment with radiotherapy. Follow-up: without evidence of disease relapse until today, eight years after diagnosis.
    This case is relevant regarding the rarity of this tumors and the importance of obtaining sufficient margin to avoid relapse. We may remain unnoticed because of its indolent presentation, which can delay the diagnosis, several times presenting with advanced disease, reducing therapeutic options and survival.
    Jacques M, Christophe Jl and Willems T
    We present a case of acute HELLP (Haemolysis, Elevated Liver enzymes, Low Platelets) syndrome at 28 gestational weeks. Shortly after delivery, all parameters initially improved. At 48 hours postpartum, we observed a resurgence of complete HELLP syndrome with a platelet drop to 17.000/mm3 requiring frozen platelet transfusion. With this case report, we want to draw attention on the risk of resurgence of HELLP syndrome in postpartum even after initial improvement.
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