IntroductionSleep related breathing disorders (SRBD) cause sleep fragmentation, intermittent hypoxia or a combination of both leading to homeostasis perturbations, including in the immune system. We investigated whether SRBD patients with or without intermittent hypoxia show substantial differences in perforin and granzyme-B positive peripheral blood lymphocytes.MethodsA total of 87 subjects were included and distributed as follows: 24 controls (C), 19 patients with respiratory effort related arousals due to increased upper airway resistance (UAR) without hypoxic events, 24 obese patients with obstructive sleep apnea (OSA) (oOSA), and 20 without obesity (noOSA). After polysomnographic recording, we analyzed in fasting blood samples routine hematologic and biochemical parameters and the percentage of lymphocytes containing the proteins perforin and granzyme-B (GrB). Kruskal-Wallis tests and a posteriori multiple comparisons were applied for statistical analysis of results.ResultsPerforin-positive γδ-cells revealed significant differences between groups (p = 0.017), especially between the Control group and the oOSA (p-value = 0.04); the remaining SRBD groups also showed differences from the control (C vs UAR: p = 0.08; C vs noOSA = 0.09), but they did not raise to statistical significance. There were no differences among the SRBD groups. Granzyme-B cells were decreased in SRBD patients, but the differences were not statistically significant. No additional statistical significant result was found in the other investigated lymphocyte subsets.ConclusionsObstructive sleep-disordered breathing is associated with a decrease in perforin-positive CD3+γδ-T cells. Although this finding was detected in lean patients without intermittent hypoxia, the reduction was only statistically significant in obese patients with severe OSA. Because CD3+γδ-T cells play an important role in the control of tumor cells, our findings are directly relevant for the study of the association of OSA and cancer.Electronic supplementary materialThe online version of this article (10.1007/s11325-017-1602-6) contains supplementary material, which is available to authorized users.

INTRODUÇÃO A infeção por Helicobacter pylori (H. pylori) é certamente a mais comum a nível global, prevendo-se que metade da população mundial esteja infetada. 1 A sua tendência para causar doença e morte é uma preocupação ao nível da saúde pública em todo o mundo. 1-2 É a principal causa de gastrite crónica, úlcera péptica, adenocarcinoma gástrico e linfoma MALT gástrico. 3 O principal objetivo terapêutico na infeção por H. pylori é a sua erradicação completa. Por conseguinte, a eficácia do regime terapêutico deve ser o principal fator decisivo aquando da sua prescrição. 1 As principais guidelines ainda recomendam a terapêutica tripla (TT) convencional [inibidor da bomba de protões (IBP) + claritromicina + amoxicilina ou metronidazol, durante 7-14 dias] como tratamento de 1. a linha. 2,4-6

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WHEN A COMMON COMPLAINT REVEALS AN UNCOMMON DIAGNOSIS -THE EAGLE SYNDROMEIntroduction: The Eagle syndrome is characterized by the elongation of styloid process. This provides attachment for many important neurovascular structures and can lead to a broad spectrum of symptoms. The most common symptoms include odynophagia and a sensation of a foreign body. It can also cause dysphagia, headache, syncope, or even transient ischemic attacks. The diagnosis is difficult as the symptoms may be attributed to other diseases. Case report: We describe the case of a 35-year-old female with persistent odynophagia for 8 months, with multiple consultations with her family doctor and the local emergency department. Physical examination revealed oropharyngeal erythema. Endoscopy and pharyngeal exudate were normal. The patient was referred to an otolaryngology consultation, but no cause was found. With persistent odynophagia and anxiety due to a lack of a diagnosis, computerized tomography of the pharynx was requested. This revealed asymmetry of the styloid process and the Eagle syndrome was diagnosed. Conservative management was suggested, but due to refractory symptoms, the patient was referred to stomatology. After consultation in hospital, the complaints of pain improved with anti-inflammatory therapy. The patient is currently followed in hospital with annual monitoring. Comment: Although the Eagle syndrome is rare, it should be considered in patients with chronic cervicofacial pain, especially when this is refractory to treatment. Otherwise, it may lead to incorrect diagnosis, to consumption of health resources, and to physical and emotional stress for the patient. The family doctor has a role to play in recognition this syndrome since the symptoms are commonly encountered in daily clinical practice.Artigo escrito ao abrigo do novo acordo ortográfico.

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