In contrast, G8, G6, and G9 were among the genotypes with the lowest stability and with higher (G8) and lower (G6 and G9) mean yield performances than the overall mean. The yield, stability and yield–stability ranks for 20 tested genotypes in 24 environments based on each of the statistical methods mentioned above are given in Table 3. Comparison of the statistical methods Everolimus in vitro based on the yield ranks showed that the methods generally gave similar results in the ranking of genotypes. For example, the five top-ranked

genotypes based on AMMI were G4, followed by G10, G19, G1, and G17; based on the GGE biplot were G4 followed by G10, G1, G19, and G17; based on JRA were G8, G4, G1 = G12, and G10; and based on the YSi statistic were G4, G10, G19, G1, and G17. With respect to stability ranks, genotypes G2, G15, G12, G11, and G17 were found to be stable based IWR-1 supplier on AMMI distance, whereas the five top-ranked genotypes based on the GGE biplot were G18 = G12 = G2, G14, and G3, showing that AMMI and the GGE biplot gave similar results in identifying two of the five top-ranking genotypes as stable. According to JRA the most desirable genotypes based on stability ranks were G2, G17, G10,

G16, and G3, and based on the YSi statistic the most stable genotypes were G2, G17, G3, G16, and G18. Similar stability ranks were assigned by the JRA method and YSi statistic, as they identified four of the five top-ranking genotypes as stable. For yield–stability, the AMMI analysis identified G10 followed by G17, G3, G15, and G12 as the top-ranking high-yielding and stable genotypes; whereas G18 followed by G17 = G12 and G4 = G10 were characterized

by the GGE biplot as high-yielding and stable. According to JRA, the top-ranking high-yielding and stable genotypes were G10, followed by G4, G12, G17, and G3, and based on the Fludarabine in vitro YSi statistic the highest-ranking genotypes were G4 = G10, G17, G19, and G1 = G18. All four methods identified G10 and G17 as among the five top-ranking high-yielding and stable genotypes. Significant rank correlations were found between the statistical methods in the ranking of genotypes for yield, stability and yield–stability (Table 4). With respect to yield, the statistical methods were significantly correlated (P < 0.01) in the ranking of genotypes. The correlations varied from 0.72 (JRA–YSi; P < 0.01) to 0.99 (GGE–AMMI; P < 0.01) indicating that AMMI and the GGE biplot agreed most closely in ranking genotypes for yield. The statistical methods were positively correlated in identifying stable genotypes. The Spearman’s rank correlations for stability indices ranged from 0.53 (GGE–YSi; P < 0.05) to 0.97 (JRA–YSi). The AMMI distance (AMMID) was highly correlated with the stability indices in JRA (r = 0.83; P < 0.01) and YSi (r = 0.86; P < 0.01).

In addition to liver toxicity, isoniazid is associated OTX015 chemical structure with toxicity to the nervous system.70 Vitamin B6 reduces central and peripheral effects of isoniazid and should

be given to individuals with a history of alcoholism, diabetes, pregnant, postpartum, infants, malnourished, HIV-positive, people with active liver disease, cancer or history of pre-existing peripheral neuropathy.71 In case of choosing rifampicin-based regimens, interactions with other drugs should be considered, since this drug is a potent inducer of CYP450.72 Besides patient education and clinical monitoring, baseline and monthly (or biweekly) laboratory testing of liver enzymes is recommended for people older than 35 years, chronic alcohol abusers, HIV-infected persons, females during pregnancy and within selleck chemical 3 months after delivery and for those with chronic liver disease or taking potentially hepatotoxic concomitant medications. Transient transaminase elevations are common and may reflect the process of hepatic adaptation. However, isoniazid and/or rifampicin should be withheld as recommended if the serum transaminase level is higher than three times the upper limit

of normal in a symptomatic patient or five times the upper limit of normal in the absence of symptoms.60 and 61 A change of the therapeutic regimen for a less hepatotoxic one (as 4R, at the expense of effectiveness) should be considered when serious hepatotoxicity is limiting LTBI treatment with isoniazid. Patients should be re-screened for LTBI if the previous screen had been negative and the patient had not started biologicals, to exclude possible infection in the meantime (in the absence of a

known contact with a TB patient, the screen would be valuable for 6 months). In the event of contact with active TB, TB screening should be promptly performed and in the absence of disease and LTBI, chemoprophylaxis should be guaranteed.19 Annual testing is recommended for patients, who live, travel or work in environments where TB exposure is likely, while they continue treatment with biologic agents. Patients who tested positive for TST and IGRA should only be monitored for clinical signs of TB. 1. All candidates for biologic therapy Amylase should be screened for TB. “
“A albumina humana é um expansor plasmático derivado do plasma sanguíneo. Promove o aumento da pressão oncótica em 70% e causa mobilização de líquido intersticial para o espaço intravascular, levando à expansão de volume intravascular e à manutenção do débito cardíaco1. A albumina deve ser administrada com precaução em doentes com insuficiência renal ou hepática devido ao seu conteúdo proteico. Infusões rápidas devem ser evitadas devido ao risco de desencadear quadros de sobrecarga volémica1.

Other toxins acting on Sodium channel site III, as Tx2-6, fail to induce priapism possibly by pharmacokinetic reasons but this should still be investigated experimentally. The question whether IDH signaling pathway these other toxins that act on Sodium channel site III interfere with NO/NOS/cGMP system was never addressed and could eventually explain why these other toxins don’t induce priapism. The cascade of events triggered by the toxin is currently under investigation

in our laboratory. It is clear though, that more investigations are needed to identify the ultimate mechanism of action involved in the erectogenic effect as well as the local consequences of a long-term use of this toxin. We conclude that crude venom and pure Tx2-6 toxin seem to produce identical effects on the organs examined suggesting that the possible cause of death is lung intra alveolar hemorrhage; toxin and crude venom seem to exert mild to moderate effects on brain tissue as suggested by our previous results (Troncone et al., 2011). In addition, the observed edema could be alternatively

attributed to the respiratory impairment caused by the severe lung hemorrhage. We gratefully acknowledge Dr. Daniel Pimenta and Dr. Isabel F. C. Correia (Biochemistry Laboratory – I. Butantan) for mass spectrometry of fractions and amino acid sequencing and the technical support of Mr. Wilson B. D’Ávila. Supported by research grants from FAPESP No. 98/02039-0 PD-1/PD-L1 activation to LRPT and 06/57922-3 to MS. “
“The Methocarbamol skin of fish constitutes a pivotal immunological protection against the external environment. The layer of mucus on the fish surface, considered the first line of defence, participates in a number of functions including disease resistance, respiration, ionic and osmotic regulation, locomotion, reproduction, communication, feeding

and nest building (Negus, 1963, Ingram, 1980, Shephard, 1994 and Zhao et al., 2008). The mucus, such as that produced by the skin of the stingrays, has a complex set of components, which may include amino acid residues, peptides, complex carbohydrates, glycopeptides, glycolipids and other chemicals (Klesius et al., 2008, Alexander and Ingram, 1992 and Birkemo et al., 2003). Fish epidermal mucus was found to display antimicrobial activity against broad range of infectious pathogens (Mozumder, 2005 and Hellio et al., 2002). We recently described the antimicrobial activity of catfish Cathorops spixii mucus ( Ramos et al., 2012). Moreover, histone H2B and two ribosomal proteins are examples of proteins with antimicrobial activity that have been isolated from epidermal mucus of Atlantic cod ( Bergsson et al., 2005). Members of some families of antimicrobial peptides (AMPs) were also found to be important innate defence components in the epidermal mucosal layer of Moses sole fish (Pardachirus marmoratus) ( Oren and Shai, 1996), winter flounder (Pleuronectes americanus) ( Cole et al.

, 2008 and Svendsen, 2006). Furthermore, due to similarities to human biochemistry and drug elimination, the Gottingen minipig has become an increasingly important EPZ-6438 purchase model species for pharmacological and toxicological studies (Soucek et al., 2001, Svendsen, 2006 and Forster et al., 2010a). The large size of the species has several further advantages including: a longer, and more clinically relevant, time course of study for most diseases; repeated sampling of blood and of the gas exchanging regions of the lung using bronchoalveolar lavage; and the use of readily available clinical equipment to measure physiology and for imaging. The EPA/WHO Class II ‘moderately toxic’ insecticide dimethoate is a major clinical problem

(Eddleston et al., 2005) with a case fatality of 20.6% in one large prospective case series (Dawson et al., 2010); it is likely to become more widely used following the Food and Agriculture Organization (FAO)’s advice to withdraw the more toxic Class I OP pesticides

from agricultural practice (Food and Agriculture Organization of the United Nations, 2002) and recent favourable reviews by the EPA and FAO (FAO, 2005 and US, 2008). The EC40 formulation contains cyclohexanone, xylene, and a surfactant, as well as dimethoate (Table 1). Human poisoning with dimethoate EC40 is characterised by respiratory failure, distributive shock, cardiovascular collapse, and neuromuscular dysfunction (Eddleston et al., 2005 and Davies et al., 2008). We aimed to determine whether the dimethoate AI alone was responsible for the mammalian Alectinib datasheet toxicity of agricultural dimethoate EC40 or whether other

components of the formulation were necessary. The study was performed under Home Office Licence after institutional ethics review in 27 adult male Göttingen minpigs (Ellegaard Minipigs ApS, Dalmose, Denmark) with mean weight 20.1 (SD 3.3) kg. Animals were drug-naïve and barrier bred, and shown to be free of infections before shipment to Edinburgh. Animals were kept in pens with free access to food scattered in their bedding and water under the care of institutional veterinary surgeons. Food was withheld for one night before a study. The animals were treated in accordance with Cyclin-dependent kinase 3 the Animals (Scientific Procedures) Act of 1986. The study involved three experiments: a comparison of dimethoate EC40 poisoning with saline placebo, a comparison of dimethoate AI and/or cyclohexanone with the results of this previous study, and a study of the experimental dimethoate EC35 formulation. See Table 2 for numbers of animals in each group. Each study was carried out separately in an intensive care laboratory, starting between 07:00 and 08:00. The individual animal was the experimental unit. Bias was minimised by randomly allocating animals to study groups using a random number list. Allocation could not be predicted before allocation; the study was an open study but the outcomes were robust and not likely to be affected by bias (Wood et al., 2008).

Incubation with d-Tc

produced the characteristic blockade that could be reversed by washing and there was no effect on the contractures to exogenous ACh and KCl (data not shown). In preparations pretreated with d-Tc followed by incubation with venom, subsequent washing partially restored the muscle twitch-tension (to 81 ± 7% of control; n = 3), in contrast to preparations treated with venom alone in which washing did not restore twitch-tension. In contrast, d-Tc did not affect the responses to exogenous agonists since there was still marked attenuation of the contractures to exogenous ACh (∼94% inhibition) and KCl (∼60% inhibition). The PLA2 activity of B. alcatraz venom was 0.06 ± 0.02 U/mg and was lower (p < 0.05) than that of Crotalus durissus terrificus (South American

LGK-974 research buy rattlesnake) venom (0.2 ± 0.03 U/mg, n = 4 each). There was a progressive increase in CK release by venom-treated preparations throughout the experiment, although the responses to the two venom concentrations tested (10 μg/ml and 100 μg/ml) were not significantly different (Fig. 1C). Control muscle incubated with Krebs solution showed normal morphology with regular diameter muscle fibers (Fig. 2A). Both of the venom concentrations analyzed (10 and 100 μg/ml) caused mild muscle fiber damaged that involved fiber hypercontraction and delta lesions (10 μg/ml; Fig. 2B) and edema formation, oxyclozanide seen as fiber swelling

(100 μg/ml; Fig. 2C). The percentage of damaged fibers in venom-treated preparations was 18.1 ± 1.5% (10 μg/ml) and 24.7 ± 6.6% (100 μg/ml) compared Natural Product Library nmr to 7.9 ± 2.4% in control preparations. Pre-incubation of B. alcatraz venom (10 and 100 μg/ml) with commercial bothropic antivenom (BAV) at a venom:antivenom ratio of 1:5 (10 μg venom:2 μl antivenom) recommended by the manufacturer did not neutralize the neuromuscular blockade. However, when 10 μg of venom was pre-incubated with 30 μl of antivenom the blockade was attenuated by 81 ± 4%. In contrast, when 100 μg of venom was incubated with 300 μl of antivenom (same venom:antivenom proportion as used for 10 μg of venom) only partial protection was observed, with the blockade at t50 and t90 increasing from 20 ± 3 min and 38 ± 5 min ( Fig. 1A) to 45 ± 3 min and 66 ± 4 min ( Fig. 2E), respectively. Greater volumes of antivenom (≥1 ml) were not tested with this higher quantity of venom because they tended to have a deleterious effect on the preparations. Histological analysis of preparations incubated with the lower venom:antivenom concentrations revealed a normal muscle appearance, indicating effective protection by the antivenom ( Fig. 2D). Various Bothrops venoms, including Bothrops erythromelas ( Zamunér et al., 2004), Bothrops insularis ( Cogo et al., 1993, Cogo et al.

5% reduction in C. albicans and C. glabrata CFU/mL. Non-parametric statistics found significant differences between the P+L+ and control groups (p < 0.001). PIT presented no statistical differences irrespective of the Cur concentration

tested. For C. albicans, the use of 1 and 10 min of PIT resulted in similar CFU/mL values among the three Cur concentrations tested (p > 0.05). buy SB203580 However, when the PIT time intervals of 5 and 20 min were considered, 20 μM Cur promoted the highest reduction in cell counts, while 5 μM Cur presented the lowest reductions (p < 0.05). The concentration-dependence was also observed for C. glabrata and C. dubliniensis since 20 μM Cur always promoted the highest reduction in cell counts, and 5 μM Cur always Sorafenib manufacturer presented the lowest reductions, irrespective of the pre-irradiation

period (p < 0.05). Fig. 2, Fig. 3 and Fig. 4 present mean values and 95% confidence intervals of the absorbance values (XTT) obtained for C. albicans, C. glabrata and C. dubliniensis (respectively) after experimental procedures with the biofilm cultures irradiated for 4 and 8 min. All the control groups presented significantly higher mean absorbances than the P+L+ groups, demonstrating that PDT in association of Cur and LED light had a significant effect on diminishing cell metabolism of all species evaluated. The mean absorbance values for both 4 and 8 min irradiation groups were calculated and compared using the Student's-t test (p < 0.05). The results are presented in Fig. 5. In general, the use of 8 min of illumination resulted in lower absorbance values in comparison with those of the 4 min samples, but in some cases the difference was not statistically significant. For C. albicans biofilms, the two-way analysis of variance of the P+L+ groups (irradiated for 4 and 8 min) indicated the significant effect of PIT (p < 0.001) and Cur concentration (p < 0.001), but no significant effect of the interaction

of these factors (p > 0.05). Therefore, PIT Glycogen branching enzyme and Cur concentration had independent effect on cell metabolism. Fig. 5 and Fig. 6 present details of the multiple comparisons obtained by Tukey’s test, separately exhibiting comparisons among each PIT within the same Cur concentration ( Fig. 5), and among each Cur concentrations within the same PIT ( Fig. 6). For C. albicans, analysis of the data allowed the observation that after either 4 or 8 min of illumination, as the PIT increased, the cell viability diminished proportionally, irrespectively of the concentration. The lowest absorbance values were reached in 20 min of PIT and 40 μM Cur. For C. glabrata, the analysis of variance of the P+L+ group irradiated for 4 and 8 min indicated significant effect of the PIT and Cur-concentration interaction (p = 0.001 and p = 0.015, respectively). To detect this interaction, Tukey’s test was performed, and the results are presented in Fig. 5 and Fig. 6.

For tuning of the MSD in EI mode perfluorotributylamine (PFTBA) was used as tuning compound. Mass spectra were taken at 2235 EMvolts Selleck Luminespib and fragments from 40 to 550. Interpretation of the mass spectrum of GC-MS was conducted using the database of National Institute Standard and Technology (NIST) which consists of more than 62,000 patterns. The spectrum of the unknown component was compared with the spectrum of the known component inherent in the NIST library. The name, molecular weight and structure of the components of the test materials were ascertained. Data are represented by Mean ± S.E.M. Significance of mean values

of different parameters between the treated groups were analysed using one way analysis of variances (ANOVA) after ascertaining the homogeneity of variances between the treatments. Paired comparisons were done by calculating the least significance. Statistical selleck kinase inhibitor tests were performed using Microcal Origin 7.0 for Windows. Each experiment was repeated at least three times with different rats. Figure 1 shows that aqueous curry leaf extract provides protection to the gastric

mucosa against piroxicam induced damage in a dose-dependent manner. Aqueous curry leaf extract pre-administered at 100 mg/kg body weight dose reduced ulcer index by 86.7% against piroxicam fed animal group (**P≤ 0.001), but almost complete protection was rendered when 200 mg/kg BW and 300 mg/kg BW doses were administered. This is clearly indicating that the extract at 200 mg/kg BW dose is sufficient to provide protection against piroxicam induced gastric ulceration in rats. Figure 1A and 1B are representative photographs Tyrosine-protein kinase BLK of macroscopic and microscopic

changes in the rat stomach clearly indicating ulcerative damages on feeding rats with piroxicam at 30 mg/kg BW dose orally. Haematoxylin–eosin stained sections reveal that mucosal bleeding occurred on piroxicam feeding, which was protected when graded doses of the aqueous extract was administered before piroxicam feeding. Photographs of the inner surface of stomach show no ulcer spots in the rats fed 200 mg/kg BW and 300 mg/kg BW doses of the aqueous extract. Biomarkers of oxidative stress altered in piroxicam induced gastro-toxicity. Lipid peroxidation level and reduced glutathione content were also protected in a dose dependent manner by aqueous curry leaf extract. In figure 1D and 1E curry leaf extract shows reduction in lipid peroxidation level by 53.7% (**P≤0.001 Vs piroxicam fed group) and 1.4 fold increase (**P≤0.001 Vs piroxicam fed group) in reduced glutathione content on administration of 200 mg/kg BW dose prior to oral administration of 30 mg/kg body weight dose of piroxicam.

2 μl/injection site) into the LPBN. They were then deeply anaesthetised with sodium thiopental (CRISTALIA, Itapira, SP, Brazil, 80 mg/kg of b.w.) and perfused transcardially with saline followed by 10% formalin. The brains were removed, fixed in 10% formalin, frozen, cut coronally into 60 μm sections and stained with Giemsa stain. Only animals with injections into the LPBN were considered for statistical analysis. The results are reported as means ± standard error of the mean (SEM). Statistical analysis was performed using two-way analysis of variance (ANOVA) with repeated measures followed by Student–Newman–Keuls post hoc tests to determine significant differences between

groups. IL-6 and TNF-α levels and alveolar bone loss were analysed by the Student Torin 1 ic50 t-test. Differences were considered significant at P < 0.05. The software used to analyse the data was SigmaStat

learn more for Windows, version 2.03 from SPSS Inc. Alveolar bone analysis revealed that rats with periodontal disease had more bone loss than rats in the control group (1.29 ± 0.04 vs. CN group: 0.50 ± 0.02 mm, P < 0.001, Fig. 1), showing that the induction of periodontal disease was effective. There were no statistically significant differences between the ingestion (ml/24 h) of water and 0.3 M NaCl for both groups (control and PD rats) in any of the evaluation periods (3 and 16 days) after ligature-induced periodontal disease (Fig. 2). ANOVA showed significant differences among treatments and times for water intake (F(18,126) = 17.4; P < 0.001, Fig. 3C and D) and 0.3 M NaCl intake (F(18,126) = 5.4; P < 0.001, Fig. 3A and B) when fluid-replete rats had simultaneous access to water and 0.3 M NaCl. Compared with saline injections into the LPBN, the cumulative ingestion of 0.3 M NaCl and water significantly increased after injections of muscimol (0.5 nmol/0.2 μl at each site, n = 8) into the LPBN after 120 min until the end of the test in control and PD rats ( Fig. 3A and

C). Post all hoc tests showed that ligature-induced PD attenuated the effects of muscimol on water intake ( Fig. 3C and D) without changing 0.3 M NaCl intake ( Fig. 3A and B). ANOVA showed significant differences among treatments and times for water intake (F(18,126) = 6.9; P < 0.001, Fig. 4C and D) and 0.3 M NaCl intake (F(18,126) = 4.7; P < 0.001, Fig. 4A and B) when FURO + CAP-treated rats (control and PD) that received muscimol or saline in the LPBN had simultaneous access to water and 0.3 M NaCl. In control rats, the cumulative ingestion of 0.3 M NaCl after injections of muscimol (0.5 nmol/0.2 μl at each site, n = 8) into the LPBN was significantly different from ingestion after saline injections into the LPBN from 90 to 180 min of the test, with P values ranging from P < 0.05 at 90 min to P < 0.005 from 120 to 180 min (Newman–Keuls post hoc test) ( Fig. 4A and B).

In order to ensure benefits to the local economy, the Raja Ampat

regency government developed a tourism entrance fee system in 2007 that requires every guest visiting the regency to pay Rp. 500,000 (approximately USD $55) for a waterproof tag valid for the calendar year. Thirty percent of the tag revenues are utilized by the government for tourism selleck compound management, while 70% fund conservation and community development programs in all 135 villages of Raja Ampat. Since its inception, the fee system has accrued nearly USD $1,000,000 and has funded a nutrition program for pregnant and nursing mothers and MPA enforcement and turtle rookery guarding programs. Kaimana Regency and the Cendrawasih Bay National Park have recently commenced their own entrance fee systems. The Raja Ampat government enacted legislation in July 2011 to establish the first marine tourism licensing

system in Indonesia, setting an upper limit of 40 liveaboard dive vessel and 20 dive resort licenses for the regency while also stipulating strong requirements for environmentally-sensitive construction of resorts and employment of local community members in tourism operations. Both the West Papua provincial government and the Raja Ampat regency selleck chemical government have now explicitly recognized marine tourism as one of the main sectors for economic development of the regency, and increasingly this sector is providing benefits to local communities not only through entrance fee revenues, but also through direct employment in resorts and on dive vessels as well as through providing important markets for sale of handicrafts and PtdIns(3,4)P2 of fish, fruits and vegetables harvested by community members. The largest mariculture industry in the BHS is pearl oyster farming. There are currently two large pearl farms in Kaimana and seven pearl farms in Raja Ampat. The pearl farms focus exclusively on silver and gold pearls from the oyster Pinctada maxima. The industry operates in sheltered bays with unpolluted

waters, low sedimentation, high dissolved nutrient levels, good water exchange and relatively stable cool water temperatures. Pearl farming companies enter into private lease agreements with local Papuan communities over large areas of water, generally have low environmental impact and can provide strong socioeconomic benefits for local communities. Cendana Indopearls for example, employs around 200 staff, provides training and livelihoods for many members of the community, and supplies electricity, transportation, medical services and schooling for the two local communities in Raja Ampat with whom they have their lease agreements. While the overall contribution of pearl farms to the local economy is not known, it is estimated that Cendana Indopearls invests nearly USD $3 million per annum into the local economy in the form of operational costs, salaries, rents, royalties and taxes (J. Taylor, personal communication).

Os autores declaram não haver selleck inhibitor conflito de interesses. “
“A Doença de Wilson (DW), descrita pela primeira vez em 1912 por Kinnear Wilson1, é uma doença rara, hereditária, de transmissão autossómica recessiva, caracterizada por acumulação de cobre no fígado, cérebro, rins e córnea2. A prevalência da DW é de cerca de 1:30 000 e a idade de apresentação varia entre os 3 e os 55 anos de idade3. Em Portugal, estima-se

que, entre 2005 e 2008, tenham surgido 10 novos casos, conforme registo na base de dados internacional «eurowilson». As manifestações clínicas da DW podem atingir múltiplos órgãos e são extremamente variáveis, pelo que é necessário um elevado GPCR Compound Library supplier índice de suspeição para o seu diagnóstico. Os autores apresentam um caso clínico de DW num adulto jovem, cuja primeira manifestação foi sob a forma de doença hepática crónica descompensada, sem diagnóstico prévio. Doente do sexo masculino de 25 anos de idade, sem antecedentes pessoais relevantes, nomeadamente hábitos alcoólicos ou toxicofílicos. O doente recorreu ao Serviço de Urgência por um quadro clínico de febre e tosse com expetoração muco-purulenta com uma semana de evolução. À entrada encontrava-se febril, hemodinamicamente estável e apresentava diminuição do murmúrio vesicular na

base do hemitórax direito. Analiticamente salientava-se aumento dos parâmetros inflamatórios, trombocitopenia (plaquetas

de 65 000), prolongamento do tempo de protrombina com INR de 1,94, AST:116 U/L (valor de referencia (v.ref): 15-39 U/L), ALT: 96 U/L (v.ref: 8-37 U/L), bilirrubina total: 1,3 mg/dL (v.ref: 0-1 mg/dL), albumina:1,6 mg/dL (v.ref: 3,4-5,0 mg/dL) e função renal sem alterações. Na radiografia de tórax apresentava condensação na base do hemitórax direito. O doente foi internado no Serviço de Pneumologia com a hipótese diagnóstica de pneumonia hipoxemiante. Iniciou antibioterapia empírica e houve necessidade de ventilação não invasiva por insuficiência respiratória parcial, com melhoria do quadro. Durante o internamento, Celecoxib por apresentar epigastralgias e vómitos, realizou endoscopia digestiva alta, que revelou no terço distal do esófago, variz grande sem manchas vermelhas ou ponto de rotura (fig. 1) e mucosa do fundo e corpo com padrão em mosaico (fig. 2). Paralelamente, verificou-se agravamento clínico com aumento do volume abdominal e edema marcado dos membros inferiores. Realizou ecografia abdominal, que revelou fígado pequeno de ecoestrutura heterogénea, compatível com cirrose, esplenomegalia de 17 cm e ascite em moderada quantidade (fig. 3).