Cleberson Lima dos Santos

Períodos de interferência de plantas daninhas na cultura do feijoeiro-comum (Phaseolus vulgaris L.)

Objetivou-se nesta pesquisa determinar os periodos de interferencia de plantas daninhas no feijoeiro-comum (Phaseolus vulgaris L.) cultivado em plantio direto, em Rolim de Moura-RO. Dois ensaios foram conduzidos simultaneamente; no primeiro a cultura permaneceu livre da competicao com plantas daninhas desde a emergencia ate os 7; 14; 21; 28; 35; 42; 49 e 64 dias; no segundo a cultura permaneceu em competicao com a comunidade infestante pelos periodos citados no primeiro ensaio. O delineamento utilizado foi de blocos ao acaso, com quatro repeticoes. A Digitaria horizontalis e Zea mays foram as especies que apresentaram maior importância. A D. horizontalis atingiu altas frequencias relativas, dominância relativa e densidade de ate 95,3%. A Z. mays apesar dos baixos indices de densidade e frequencia relativa, apresentou alta dominância relativa pelo grande acumulo de massa seca. O rendimento de graos do feijoeiro foi afetado pela convivencia com as plantas daninhas. Assumindo perdas de 5% no rendimento de graos do feijoeiro pela interferencia da comunidade infestante o periodo anterior a interferencia foi de quatro dias, onde nao foi necessaria a realizacao do controle. O periodo total de prevencao da interferencia foi de dezoito dias apos a emergencia (DAE) e o periodo critico de prevencao da interferencia situou-se entre os quatro e os dezoito DAE. Neste periodo ate 18 DAE a convivencia do feijoeiro com plantas daninhas ocasionou diminuicao no rendimento da cultura por competirem pelos recursos do meio, onde houve necessidade de serem controladas.

Anti-vgkc Antibody-associated Limbic Encephalitis Presenting with Recurrent Catatonia

Introduction Limbic encephalitis is an inflammatory disorder, commonly characterized by psychiatric features and cognitive impairment. It used to be considered a rare disease, usually paraneoplastic, with poor prognosis. Recent findings of membrane-surface directed antibodies, including anti-VGKC (Voltage-Gated Potassium Channels) antibodies, showed a substantial proportion of cases with no association with any malignancy and better prognosis. Case presentation A 56-year-old woman was admitted to the psychiatric ward in Nov/2007, with an acute onset of psychomotor retardation and agitation periods, apathy and nihilistic symptoms. She improved very slowly with lorazepam, clomipramine and quetiapine. In Jun/2014, she was admitted again to the psychiatric ward with acute onset of intense headache, confusion, insomnia, agitation and prejudice ideas. There was a clinical deterioration with mnesic deficits, catatonic stupor, autonomic dysfunction and seizures. Complementary exams revealed: ESR>120mm; hyponatraemia; acelular CSF with slightly elevated protein; EEG with slow base activity; Brain MRI with diffuse cortical atrophy and multiples subcortical hyperintensities of frontoparietal regions on FLAIR and T2 sequences; and positive anti-VGKC antibodies. Initially there was a poor transitory improvement with high-dose steroids and intravenous immunoglobulins. After 5 months, she did plasmapheresis with relevant clinical improvement. Discussion and Conclusions About 80% of anti-VGKC encephalitis patients have clinical improvement following prompt treatment. In this case, there was not as good improvement as initially expected probably because of the prolonged duration of disease prior to effective treatment. Given the good prognostic outcome with prompt initiation of immunotherapy, early recognition and diagnosis of this rare neuropsychiatric syndrome is crucial.

AB0500 Treatment of digital ulcers in systemic sclerosis: a review of ten patients from a single center and discussion on outcome

Background In systemic sclerosis (SSc), digital ulcers (DU) are debilitating and sometimes recurrent complications. Treatment of DU is not dissociable from that of Raynaud’s phenomenon (RF), both express the same microvascular disfunction at different stages. Objectives Our goal is clinical characterization of a population of SSc patients with DU, its treatment, complications and outcome. Methods Retrospective analysis of 46 consecutive SSc patients between 1999-2012, meeting ACR or Le Roy classification criteria, from our department in a general hospital serving approximately 200.000 inhabitants. Clinical data were obtained from patient files. Results DU were detected in 10 patients: three males and 7 females, with a mean age of 60,2 years (range 48-76 years). Nine patients had limited type SSc (two had digital calcinosis) and one had diffuse type scleroderma. Anticentromere autoantibodies (ACA) were positive in 8 patients, anti-topoisomerase antibodies were present in one patient. Antiphospholipid antibodies were determined in six patients and were positive in one. All 10 patients were treated with calcium channel blockers (CCB) for RF. Healing of DU was made with intravenous prostanoid in 9 patients, four patients required repeated treatment with prostanoid for DU healing, one of these has a very slowly healing ulcer and positive antiphospholipid autoantibodies (APLA). After DU healing, there was persistent RF in three patients, two of them required repeated prostanoid infusions. Nine patients were later treated with bosentan, one of which experienced recurrence of DU. Alteration of liver function tests (LFT) was present in three patients: persistent in one patient with a history of alcohol intake, so bosentam was stopped; two were previously exposed to methotrexate, and LFT improved after folinic acid theraphy. Antiaggregant therapy was prescribed in nine patients and oral anticoagulants in two patients. Two patients had digital loss and two other patients healed with scars. Patients with digital loss were late presenters. The only patient that required hospitalization presented at diagnosis with pulmonary arterial hypertension (PAH), DU and digital loss; PAH normalized after treatment with bosentan. Two patients are dead: one died with massive digestive bleeding; the other died of liver failure, he had a history of alcohol intake. One patient is lost to follow-up. Three patients are still professionally active. Conclusions DU are serious manifestations of vasculopathy, a sign of target-organ damage; they are associated with increased morbidity (hand disability, reduced quality of life) and mortality. Treatment of DU comprises detection of complications, promotion of healing and preventing recurrence. Patients with SSc and DU have a worse prognosis, but there is sufficient evidence to support recommendations on standard of care and the most effective drugs available. Intravenous prostanoids and CCB have the highest level of evidence. Bosentan is recommended to prevent recurrence of DU, improving outcome. In this small series, patients with worse outcome were older, had longer follow-up and late diagnosis, already with organ damage. Younger and more recent patients have better results, probably mirroring improvement in quality of care. Disclosure of Interest None Declared