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Apolipoprotein E epsilon4 allele is a risk factor for Alzheimer's disease: the central region of portugal (Coimbra) as a case study

Fernandes, MA; Oliveira, CR; Oliveira, LM; Nogueira, AJ; Santiago, B; Santana, I
Fonte: Karger Publicador: Karger
Tipo: Artigo de Revista Científica
Publicado em //1999 Português

Frontotemporal dementia and mitochondrial DNA transitions

Grazina, M; Silva, F; Santana, I; Santiago, B; Mendes, C; Simões, M; Oliveira, M; Cunha, L; Oliveira, CR
Fonte: Elsevier Publicador: Elsevier
Tipo: Artigo de Revista Científica
Publicado em //2004 Português
Frontotemporal dementia (FTD) is the second most common type of primary degenerative dementia. Some patients present an overlap between Alzheimer's disease (AD) and FTD both in neuropathological and clinical aspects. This may suggest a similar overlap in physiopathology, namely an involvement of mitochondrial DNA (mtDNA) in FTD, as it has been associated to AD. To determine if mtDNA is involved in FTD, we performed a Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP) analysis, specific to mtDNA NADH Dehydrogenase subunit 1 (ND1) nucleotides 3337-3340, searching for mutations previously described in Parkinson's and AD patients. We could identify one FTD patient with two mtDNA transitions: one already known (3316 G-to-A) and another unreported (3337 G-to-A). Additionally, mitochondrial respiratory chain complex I activity was reduced in leukocytes of this patient (36% of the control mean activity). To our knowledge, this is the first report of mtDNA variants in FTD patients.

Extracção Percutânea de Corpos estranhos do Sistema Cardiovascular; Percutaneous retrieval of foreign bodies from the cardiovascular system

Rodrigues, D; Sá e Melo, A; Marinho da Silva, A; Carvalheiro, VM; Manuel, O
Fonte: Sociedade Portuguesa de Cardiologia Publicador: Sociedade Portuguesa de Cardiologia
Tipo: Artigo de Revista Científica
Publicado em //2007 Português
We report our experience of seven patients referred to our hospital with foreign bodies embolized in the cardiovascular system, namely fragmented catheters and devices used in interventional techniques, which were retrieved by a percutaneous approach. The patients' ages ranged from 2 to 29 years, with a mean age of 17. The majority (57%) were male. The retrieval equipment used included a pigtail catheter, multipurpose catheter with hand-prepared snare, Amplatz gooseneck snare, nitinol multisnare set and basket catheter. The foreign bodies were successfully removed percutaneously in all cases, with no complications.

Linear psoriasis - a case report.

Brinca, A; Santiago, F; Serra, D; Andrade, P; Vieira, R; Figueiredo, A
Fonte: Centro Hospitalar e Universitário de Coimbra Publicador: Centro Hospitalar e Universitário de Coimbra
Tipo: Artigo de Revista Científica
Publicado em //2011 Português
A 56-year-old woman presented with a 3-month history of erythematous plaques covered by scales and limited to the right side of her body. The plaques were arranged along Blaschko's lines with a marked mid-line cutoff. The histopathologic analysis of a skin biopsy in conjunction with the anamnesis allowed the diagnosis of linear psoriasis. Our patient showed a good clinical response to antipsoriatic treatment.

Both structural damage and inflammation of the spine contribute to impairment of spinal mobility in patients with ankylosing spondylitis

Machado, P; Landewé, R; Braun, J; Hermann, KG; Baker, D; van der Heijde, D
Fonte: BMJ Group Publicador: BMJ Group
Tipo: Artigo de Revista Científica
Publicado em //2010 Português
OBJECTIVE: To study the relationship between spinal mobility, radiographic damage of the spine and spinal inflammation as assessed by MRI in patients with ankylosing spondylitis (AS). METHODS: In this subanalysis of the Ankylosing Spondylitis Study for the Evaluation of Recombinant Infliximab Therapy cohort, 214 patients, representing an 80% random sample, were investigated. Only baseline data were used. MRI inflammation was assessed by the AS spinal MRI activity (ASspiMRI-a) score, structural damage by the modified Stoke AS Spine Score (mSASSS) and spinal mobility by the linear definition of the Bath Ankylosing Spondylitis Metrology Index (BASMI). Univariate correlations were calculated on baseline values using Spearman rank correlation. Independent associations between the variables of interest were investigated by multivariate linear regression analysis. Associations with clinical disease activity, C-reactive protein, disease duration, age, gender, body mass index and HLA-B27 status were also investigated. Subanalyses were performed according to disease duration. RESULTS: BASMI correlated moderately well with mSASSS (Spearman's rho=0.6) and weakly with ASspiMRI-a (rho=0.3). A best-fit model for BASMI included both mSASSS (regression coefficient (B)=0.865...

Estudo experimental do impacto da clampagem selectiva da veia porta na função hepatocelular; The impact of selective clamping of portal vein in hepatocellular function. An experimental study

Tralhão, JG; Abrantes, AM; Gonçalves, C; Carvalho, C; Portela, I; Laranjo, M; Oliveiros, B; Cardoso, D; Ribeiro, AB; Botelho, MF; Castro e Sousa, F
Fonte: Centro Hospitalar e Universitário de Coimbra Publicador: Centro Hospitalar e Universitário de Coimbra
Tipo: Artigo de Revista Científica
Publicado em //2009 Português
The influence of selective clamping of the elements of hepatic pedicle in the hepatocellular function and viability were evaluated in our department. AIM: Study the effect of selective clamping of the portal vein (CPV) in hepatocellular function in an animal model with normal liver. METHOD: Three groups of Wistar rats (males, 2 months) were subjected a CPV for 60 min: group A (n=21) submitted to a continuous inflow occlusion; group B (n=12) underwent to a CPV for 30 min with 5 min of reperfusion; group C (n=10) underwent a CPV for 15 min with 5 min of reperfusion. The group D (n=9) was not subjected to a CPV. A hepatic biopsy was done at the end of surgery. The degree of tissue injury was evaluated using: 1) blood markers: AST, ALT, total bilirubin (TB), GGT alkaline-phosphatase, LDH and hepatic extraction fraction (HEF) by radioisotopic methods three days before laparotomy (BS) and after surgery (AS); 2) apoptosis, necrosis were investigated after collagenase cell isolation from hepatectomy pieces by flow-cytometry using the followed probes: propidium-iodide and annexin-V. Statistical analysis: variance analysis, post-hoc comparisons by Turkey-test (p<0.05). RESULTS: 1) Mortality: Group A - 62%, Group B - 17%, Group C - 30%...

Low preoperative plasma cholinesterase activity as a risk marker of postoperative delirium in elderly patients.

Cerejeira, J; Batista, P; Nogueira, V; Vaz-Serra, A; Mukaetova-Ladinska, EB
Fonte: Oxford University Press Publicador: Oxford University Press
Tipo: Artigo de Revista Científica
Publicado em //2011 Português
BACKGROUND: delirium is a frequent neuropsychiatric syndrome affecting medical and surgical elderly patients. Cholinergic dysfunction has been implicated in delirium pathophysiology and plasmatic acetylcholinesterase (AChE) and butyrylcholinesterase (BuChE) activities are suppressed in patients with delirium. In this cohort study, we investigated whether these changes emerge during delirium or whether they are present before its onset. METHODS: plasma activities of AChE and BuChE were measured pre- and postoperatively in consecutive patients ≥60 years old undergoing elective total hip replacement surgery. In addition to a comprehensive clinical and demographic baseline evaluation, venous blood samples were collected from each subject in the morning of hospital admission's day and in the morning of the first postoperative day. Delirium was screened daily with confusion assessment method (confirmed with diagnostic and statistical manual of mental disorders (DSM-IV)-TR). RESULTS: preoperatively, plasma esterase activity was significantly lower in patients who developed delirium compared with the remaining subjects. Following surgery BuChE activity was lower in the delirium group but this difference disappeared after controlling for preoperative values. Plasma cholinesterase activity correlated positively with calcium and haemoglobin and negatively with total bilirubin and international normalised ratio. CONCLUSION: plasma cholinesterase activity can be a useful candidate biomarker to identify subjects at greater risk of developing postoperative delirium.

Hiperplasia Congénita da Suprarrenal de Expressão Tardia por Deficiência de 21-Hidroxilase; Late onset congenital adrenal hyperplasia due to 21-hydroxylase deficiency: revision of literature and preconception genetic study of five couples

Vieira, A; Paiva, S; Baptista, C; Ruas, L; Silva, J; Gonçalves, J; Carrilho, F; Carvalheiro, M
Fonte: Centro Editor Livreiro da Ordem dos Médicos Publicador: Centro Editor Livreiro da Ordem dos Médicos
Tipo: Artigo de Revista Científica
Publicado em //2011 Português
The deficiency of the enzyme 21-hydroxylase (21-HO) is responsible for about 90% to 95% of all cases of congenital adrenal hyperplasia (HCSR). This disorder is one of the most frequent hereditary illnesses of autosomal recessive trait. The illness can be presented in two clinical forms: 1 - classic, subdivided in saltwasting form and simple virilizing form; 2 - nonclassic or late-onset. The severity of the illness is correlated with the degree of enzymatic activity of 21-HO, which depends on the type of mutation that occurs in gene CYP21A2. The late onset congenital adrenal hyperplasia is that one where the enzymatic blockade is less intense. The clinical is variable: precocious pubarche, polycystic ovaries, hirsutism, oligoamenorrhea, acne and infertility. Gold standard for the diagnosis of late onset congenital adrenal hyperplasia consists on the test of the tetracosactide, considering itself diagnostic positive when 17-hidroxiprogesterona (17-OHP) is higher of 10-15 ng per mL. Many patients don't need treatment; however, if necessary, such a treatment essentially consists on the Administration of glucocorticoids and antiandrogens. Considering that affected individuals and the carriers may have a severe mutation in CYP21A2, they can have descendents with the classic form (if their partner is also a carrier of a severe mutation)...

Trombose Venosa Cerebral: Análise Retrospectiva de 49 Casos; Cerebral venous thrombosis: retrospective analysis of 49 cases

Santos, GR; André, R; Pereira, SL; Parreira, T; Machado, E
Fonte: Centro Editor Livreiro da Ordem dos Médicos Publicador: Centro Editor Livreiro da Ordem dos Médicos
Tipo: Artigo de Revista Científica
Publicado em //2011 Português
Introduction: Cerebral Venous Thrombosis (CVT) is a rare and potentially life-threatening disease, accounting for about 0.5% of stroke cases. However, it is believed to be an underdiagnosed condition. Early diagnosis requires a high degree of suspicion and appropriate use of imaging modalities. Objectives: Imagiological and clinical characterization of CVT cases diagnosed at our hospital from 2004 to 2007. Methods: This study was a retrospective, cross-sectional analysis from 2004 to 2007, using our institution database. We reviewed hospital discharge data to assess the incidence of CVT. The study population consisted of 49 patients. Retrospective review of the clinical data and imaging studies of these patients was then performed. Results: Of the 49 patients with confirmed CVT, 38 were female. Patient age varied between 16 and 75 years, with an average of 42.6 years. Thrombotic risk factors were found in 43 patients; the most frequent was dyslipidemia (n = 22) followed by oral contraceptive use (n = 18). Initial head Computerized Tomography (CT) was normal in six cases. Diagnosis was made by Magnetic Resonance (MR) in 38 cases, Cerebral CT-Venography in 10 cases and Digital Subtraction Angiography in one case. Average time from onset of symptoms to diagnosis was nine days; this was not significantly different when comparing the group diagnosed by MR with the group diagnosed by CT-Venography. Right transverse sinus was the most frequent location of thrombosis (n = 36). Only in four cases thrombosis did not involve the lateral sinuses. Conclusions: Lateral sinus thrombosis is a frequent variety of CVT...

Hodgkin's lymphoma and late onset egg allergy: is there a causal relationship?

Calado, G; Machado, D; Ribeiro, C; Loureiro, G; Tavares, B; Pereira, C; Cunha, R; Chieira, C
Fonte: Elsevier Publicador: Elsevier
Tipo: Artigo de Revista Científica
Publicado em //2011 Português

Necrotizing external otitis on a Crohn's disease patient treated with infliximab

Duque, G; Portela, F; Migueis, MC
Fonte: Elsevier Publicador: Elsevier
Tipo: Artigo de Revista Científica
Publicado em //2010 Português

Case for diagnosis; Caso para diagnóstico

Santiago, F; Reis, JP
Fonte: Centro Hospitalar e Universitário de Coimbra Publicador: Centro Hospitalar e Universitário de Coimbra
Tipo: Artigo de Revista Científica
Publicado em //2011 Português
This report describes a patient with clinical and histopathological findings compatible with angiolymphoid hyperplasia with eosinophilia. This benign vascular hyperplasia should be recognized and differentiated from Kimura's disease.

Neurorradiologia da síndroma de Kallmann; Neuroradiology of Kallmann's syndrome

Melo Freitas, P; Carvalho, S; Ribeiro, F; Marnoto, D; Martins, F
Fonte: Centro Hospitalar e Universitário de Coimbra Publicador: Centro Hospitalar e Universitário de Coimbra
Tipo: Artigo de Revista Científica
Publicado em //2001 Português
The present study refers to the magnetic resonance characteristics observed in a group of three patients with clinical and laboratory evidence of Kallmann's Syndrome. This disease, also named olfactogenital dysplasia, affects the normal gonadal and olfactory development and is clinically characterized by the association of hypogonadotrophic hypogonadism and anosmia/hyposmia. The study protocol, which included the attainment of sagittal and coronal T1-weighted MPRAGE (Multiplanar Rapid Acquisition Gradient Echo) volumetric sequences, showed defective rhinocephalon development in all patients, expressed by the aplasia/hypoplasia of the olfactory bulbs/tracts and/or of the olfactory sulci. The changes observed corroborate the predictable imaging of this genetic disorder and have been mainly visible in the coronal slices obtained. The results shown are more clear evidence that magnetic resonance is an effective method to show the abnormalities in the olfactory region that are invariably found in this syndrome.

Reclassificação do carcinoma broncopulmonar: Diferenciação do tipo histológico em biópsias por imuno -histoquímica; Reclassifying bronchial-pulmonary carcinoma: Differentiating histological type in biopsies by immunohistochemistry

Carvalho, L
Fonte: Sociedade Portuguesa de Pneumologia Publicador: Sociedade Portuguesa de Pneumologia
Tipo: Artigo de Revista Científica
Publicado em //2009 Português
The current state of molecular knowledge on lung cancer demands a histological classification which goes beyond small-cell and non-small-cell carcinoma to provide support for tailored therapy in aiding in understanding of the drugs currently available. As diagnosis and follow-up in the vast majority of lung cancer cases is based on biopsies and cytology samples, Immunohistochemical Bronchial Pulmonary Carcinoma Classification (IBPCC) is necessary to reveal the raft of characteristics available. This provides morphological support for the WHO's 1999/2004 classification, in addition to an understanding of carcinogenesis. The immunohistochemical panel clarifies the main morphology and cytology characteristics to maintain the leading histological types as squamous cell carcinoma (high weight molecular cytokeratins/HWMC), adenosquamous carcinoma (CK7, TTF1, HWMA), neuroendocrine carcinoma (Chrg, Syn, CD56, TTF1, Ki67), adenocarcinoma (CK7, CK20, TTF1) and bring the polymorphic and pleomorphic carcinomas under a single banner of pleomorphic carcinoma (Ck7, TTF1, HWMC, VMT, Desmin, Actin) which shelters large cell carcinomas and sarcomatoid carcinomas. Lung cancer chemotherapy will still be based on platinum and gemcitabine for the near future and the IBPCC is a simple and efficient tool for streamlining the registration of lung cancer histological characteristics in biopsies and other reduced samples to support clinical evidence and trials.

p-Phenylenediamine sensitization is more prevalent in central and southern European patch test centres than in Scandinavian: results from a multicentre study

Thyssen, JP; Andersen, KE; Bruze, M; Diepgen, T; Giménez-Arnau, AM; Gonçalo, Margarida; Goossens, A; Le Coz, C; McFadden, J; Rustemeyer, T; White, IR; White, JM; Johansen, JD
Fonte: John Wiley & Sons Publicador: John Wiley & Sons
Tipo: Artigo de Revista Científica
Publicado em //2009 Português
BACKGROUND: Positive patch test reactions to p-phenylenediamine (PPD) are common. PPD is used in oxidative hair dyes and is also present in dark henna temporary 'tattoos'. Cross-sensitization to other contact allergens may occur. Because subjects sensitized to PPD are at risk of clinically severe reactions upon hair dyeing, there is a need for 'current' prevalence data on PPD sensitization. OBJECTIVES: To compare PPD patch test results from dermatitis patients tested between 2003 and 2007 in 10 European patch test centres and to analyse the causes and determine relevance of positive PPD patch test reactions. MATERIALS: Patch testing was performed using PPD (1% free base in petrolatum from Trolab (Almirall Hermal GmbH, Reinbeck, Germany) or Chemotechnique (Malmö, Sweden), equivalent to 0.090 mg/cm(2) in the TRUE test from MEKOS Laboratories AS). Statistical analysis was performed using the chi-squared test. RESULTS: The weighted average prevalence was 4.6% among 21 515 patients. PPD sensitization occurred more often in centres located in Central and Southern Europe than in Scandinavian centres (odds ratio = 2.40; 95% confidence interval = 2.07-2.78). The overall proportion of positive patch test reactions to PPD that were registered as being of either current or 'past' relevance was high (weighted average 53.6% and 20.3%...

Assessment of strategies to increase chondrocyte viability in cryopreserved human osteochondral allografts: evaluation of the glycosylated hydroquinone, arbutin.

Rosa, SC; Gonçalves, J; Judas, F; Lopes, C; Mendes, AF
Fonte: Elsevier Publicador: Elsevier
Tipo: Artigo de Revista Científica
Publicado em //2009 Português
OBJECTIVE: Allogeneic cartilage is used to repair damaged areas of articular cartilage, requiring the presence of living chondrocytes. So far, no preservation method can effectively meet that purpose. Identification of more effective cryoprotective agents (CPAs) can contribute to this goal. The aim of this study was to determine whether the glycosylated hydroquinone, arbutin, alone or in combination with low concentrations of other CPAs, has cryoprotective properties towards human articular cartilage. MATERIAL AND METHODS: Human tibial plateaus were procured from multi-organ donors, with the approval of the Ethics Committee of the University Hospital of Coimbra. The tibial plateaus were treated with or without arbutin (50 or 100mM), alone or in combination with various concentrations of dimethyl sulfoxide (DMSO) and glycerol, for 0.5-1.5h/37 degrees C, then frozen at -20 degrees C and 24h later transferred to a biofreezer at -80 degrees C. Two to 3 months later, thawing was achieved by immersion in cell culture medium at 37 degrees C/1h. Chondrocyte viability was assessed before and after freeze-thawing using a colorimetric assay based on the cell's metabolic activity and fluorescent dyes to evaluate cell membrane integrity. RESULTS: Before freezing...

Mitochondrial-dependent apoptosis in Huntington's disease human cybrids

Ferreira, IL; Nascimento, MV; Ribeiro, MH; Almeida, S; Cardoso, SM; Grazina, M; Pratas, J; Santos, MJ; Januário, C; Oliveira, CR; Rego, AC
Fonte: Elsevier Publicador: Elsevier
Tipo: Artigo de Revista Científica
Publicado em //2010 Português
We investigated the involvement of mitochondrial-dependent apoptosis in Huntington's disease (HD) vs. control (CTR) cybrids, obtained from the fusion of human platelets with mitochondrial DNA-depleted NT2 cells, and further exposed to 3-nitropropionic acid (3-NP) or staurosporine (STS). Untreated HD cybrids did not exhibit significant modifications in the activity of mitochondrial respiratory chain complexes I-IV or in mtDNA sequence variations suggestive of a primary role in mitochondrial susceptibility in the subpopulation of HD carriers studied. However, a slight decrease in mitochondrial membrane potential and increased formation of intracellular hydroperoxides was observed in HD cybrids under basal conditions. Furthermore, apoptotic nuclei morphology and a moderate increase in caspase-3 activation, as well as increased levels of superoxide ions and hydroperoxides were observed in HD cybrids upon 3-NP or STS treatment. 3-NP-evoked apoptosis in HD cybrids involved cytochrome c and AIF release from mitochondria, which was associated with mitochondrial Bax translocation. CTR cybrids subjected to 3-NP showed increased mitochondrial Bax and Bim levels and the release of AIF, but not cytochrome c, suggesting a different mode of cell death...

Familial Sneddon's syndrome

Mascarenhas, R; Santo, G; Ferro, MA; Tellechea, O; Gonçalo, Margarida; Figueiredo, A
Fonte: Centro Hospitalar e Universitário de Coimbra Publicador: Centro Hospitalar e Universitário de Coimbra
Tipo: Artigo de Revista Científica
Publicado em //2003 Português
A syndrome associating Livedo Reticularis (LR) with Cerebrovascular disease (CVD) was described, in 1965, by Sneddon. It occurs sporadically, but a few familial cases of Sneddon's Syndrome (SS) have been reported, like these 3 cases that represent one of the largest number among siblings. We studied three male brothers, aged 28, 37 and 42 years, with CVD (ischaemic stroke in 2 patients and cerebral haemorrhages in the third) and their sister with no CVD. All patients presented with long lasting Livedo Reticularis, extending beyond the lower limbs. Skin biopsy on the centre of the reticular pattern showed, only in the second patient, partial endothelium detachment in dermo-hypodermic blood vessels. The males also had accesses of Livedoid Vasculitis (LV), in which a skin biopsy showed obliteration of several upper dermal vessels with hialin thrombi and a very scarce inflammatory infiltrate. Complementary studies, with an extensive investigation on pro-coagulation/pro-thrombotic features including antiphospholipid antibodies, were repeatedly negative. Their non-consanguineous parents were not affected, but among these kindred of 9 individuals, apart from the 4 patients reported above, LR and LV were present in two other brothers and also in an aunt and uncle...

Gitelman syndrome

Cotovio, P; Silva, C; Oliveira, N; Costa, F
Fonte: BMJ Publicador: BMJ
Tipo: Artigo de Revista Científica
Publicado em //2013 Português
Hypokalaemia is a common clinical disorder, the cause of which can usually be determined by the patient's clinical history. Gitelman syndrome is an inherited tubulopathy that must be considered in some settings of hypokalaemia. We present the case of a 60-year-old male patient referred to our nephrology department for persistent hypokalaemia. Clinical history was positive for symptoms of orthostatic hypotension and polyuria. There was no history of drugs consumption other than potassium supplements. Complementary evaluation revealed hypokalaemia (2.15 mmol/l), hypomagnesaemia (0.29 mmol/l), metabolic alkalosis (pH 7.535, bicarbonate 34.1 mmol/l), hypereninaemia (281.7 U/ml), increased chloride (160 mmol/l) and sodium (126 mmol/l) urinary excretion and reduced urinary calcium excretion (0.73 mmol/l). Renal function, remainder serum and urinary ionogram, and renal ultrasound were normal. A diagnosis of Gitelman syndrome was established. We reinforced oral supplementation with potassium chloride and magnesium sulfate. Serum potassium stabilised around 3 mmol/l. The aim of our article is to remind Gitelman syndrome in the differential diagnosis of persistent hypokalaemia

A case of infliximab-induced lupus in a patient with ankylosing spondylitis: is it safe switch to another anti-TNF-α agent?

Santiago, T; Santiago, MG; Rovisco, J; Duarte, C; Malcata, A; Pereira da Silva, ja
Fonte: Springer Publicador: Springer
Tipo: Artigo de Revista Científica
Publicado em //2013 Português
Anti-TNF-α therapies are the latest class of medications found to be associated with drug-induced lupus, a distinctive entity known as anti-TNF-α-induced lupus (ATIL) (Williams et al., Rheumatology (Oxford) 48:716-20, 2009; De Rycke et al., Lupus 14:931-7, 2005; De Bandt et al., Clin Rheumatol 22:56-61, 2003). With the widespread use of these agents, it is likely that the incidence of ATIL will increase. The onset of ATIL in patients with rheumatoid arthritis and Crohn's disease has been described, but the literature regarding the occurrence of this entity in patients with ankylosing spondylitis (AS) is scarce (De Bandt et al., Clin Rheumatol 22:56-61, 2003; Ramos-Casals et al., Autoimmun Rev 9:188-93, 2010; Perez-Garcia et al., Rheumatology 45:114-116, 2006). To our knowledge, few reports of switching anti-TNF-α therapy after ATIL in AS have been reported (Akgül et al., Rheumatol Int, 2012). Therefore, it is not clear whether the development of ATIL should prohibit switch to another therapy, since patients may respond to another anti-TNF-α agent (Akgül et al., Rheumatol Int, 2012; Bodur et al., Rheumatol Int 29:451-454, 2009; Mounach et al., Clin Exp Rheumatol 26:1116-8, 2008; Williams and Cohen, Int J Dermatol 50:619-625, 2011; Ye et al....