Non Palpable Implanon Rod - Strategies for their Localization and Removal

Overview and Aims: The contraceptive implant is frequently used to provide contraceptive protection over three years. The implant is inserted into the subcutaneous tissue of the upper arm, and should be palpable and easily removed. We evaluated the best imaging strategy for non-palpable implant (Implanon®) localization and removal. Study Design: Retrospective study. Population: A total of 11 women referred to a tertiary care hospital, between October 2009 and January 2012, for localization and removal of their non-palpable implants. Methods: Different localization methods (ultrasound and magnetic resonance imaging) were evaluated for non-palpable rod. Results: Seven of the nonpalpable implants were inserted in a health care center, three in a district hospital and one in a private clinic. In three women, the reasons for requesting removal were the end of the implant validity, two wanted to become pregnant, two had weight gain, one had weight loss, one referred irregular bleeding, one had two implants and one did a hysterectomy. In 81.8% (9) of the women, the implants were identified and localized by ultrasound, and successfully removed. In two patients the implant was not found and therefore not removed. Conclusions: In our study, high resolution ultrasound proved to be a sensitive method in implants localization, being the primary choice for determining the location of nonpalpable implants

Magnetic Resonance Imaging and Gynecological Devices

Background: Performing magnetic resonance imaging (MRI) on women with gynecological devices is a completely accepted practice. The goal of our review is to assess how safe it is to perform MRI on women using contraceptive implants or devices. Study Design: Literature review, searching in PubMed-Medline/Ovid for the following keywords: magnetic resonance imaging, intrauterine devices, Implanon® and Essure®. Results: Though plastic devices do not represent a contraindication to the use of the technique, those including metallic components have been submitted to several tests, after which they were classified as MR Conditional (devices presenting no risks in MR-specific environments) by the Food and Drug Administration. Thus, the use of MRI can be safely advised to women with this type of device as long as the magnetic resonance equipment is ≤3.0 T. Conclusions: Presently, there is no scientific evidence that contraindicates performing MRI on women with any kind of gynecological device. Therefore, this procedure is safe as long as it is performed under previously tested conditions

Efetividade do Dispositivo Intra-Uterino de Levonorgestrel no Tratamento de Hemorragia Uterina Anómala em Mulheres Obesas

Objective:We aimed to identify if there was any difference in Levonorgestrel-releasing intrauterine system (LNG-IUS) efficacy or weight gain when used in heavy menstrual bleeding (HMB) treatment, between obese and non-obese women. Population and methods: This was a case-controlled retrospective study undertaken between 2002-2007. 194 women with HMB were treated with LNG-IUS and stratified into two groups accordingly with body mass index (BMI): Obese Group – BMI ≥ 30 (n=53) and Non-obese Group – BMI < 30 (n=141). Age, weight, days of spotting and days of menses were analyzed at 1, 3 and 6 months after insertion and then annually until 2 years. Analytic parameters of anemia (hemoglobin, serum ferritin, mean corpuscular volume) were reviewed at pre-insertion, at 6 months and then annually until 2 years. Results: During the 2-year follow-up there was a similar improvement in two groups regarding duration of menses, spotting and in analytic parameters of anemia. A statistically significant improvement was observed in obese group after 2 years of treatment regarding analytic parameters of anemia and menstrual characteristics, without weight gain. Conclusion: In obese women, the LNG-IUS is an effective treatment for heavy menstrual bleeding, without being associated to weight gain

Female Sterilization: Comparative Study of Hysteroscopic versus Laparoscopic Sterilization

Overview and Aims: Female sterilization is increasingly requested as a contraceptive method. Hysteroscopic sterilization by transcervical placing of Essure® micro-inserts in the initial portion of the tubes is a recent alternative to laparoscopic sterilization. The objective of this study is to evaluate the safety and effectiveness of hysteroscopic versus laparoscopic sterilization. Study Design: Retrospective cohort study. Population: A total of 98 women undergoing sterilization in an outpatient clinic between July 2005 and July 2009. Methods: Patients’ age, associated diseases, anesthesic risk, procedure time, discomfort, adverse events and success rate were evaluated. Results: Mean age at surgery was 37.8 years (19-49), and there were no statistically significant differences between the groups regarding this parameter. Women in the hysteroscopic group had a significant number of associated diseases (98% versus 47%), obesity (31% versus 6%), and anesthesic risk (ASA III- 31% versus 0%). The mean duration of the procedure was the same for both techniques (laparoscopy 28 minutes and hysteroscopy 26 minutes). All laparoscopic sterilizations were successfully completed. In the hysteroscopic group 4% failed to complete the technique. There were no cases of severe pain. Women in the hysteroscopy group reported pain less frequently (40% versus 57%, χ2 p<0.05). Long term success rate was similar in both groups (96% for hysteroscopy and 98% for laparoscopy). Conclusions: In spite of a higher incidence of associated diseases, obesity and anesthetic risks in the hysteroscopy group, there were no significant differences in the duration of the procedure, adverse events and success rate. The hysteroscopic approach can therefore be considered an alternative to laparoscopy, eliminating the need for incisional surgery and for general anaesthesia. If women with high surgical risk and several associated diseases can safely undergo this procedure, it could well become the preferred method for women who want a permanent and irreversible contraceptive method

Intra-urban variation in tuberculosis and community socioeconomic deprivation in Lisbon metropolitan area: a Bayesian approach

Background: Multidrug resistant tuberculosis (MDR-TB) is a recognized threat to global efforts to TB control and remains a priority of the National Tuberculosis Programs. Additionally, social determinants and socioeconomic deprivation have since long been associated with worse health and perceived as important risk factors for TB. This study aimed to analyze the spatial distribution of non-MDR-TB and MDR-TB across parishes of the Lisbon metropolitan area of Portugal and to estimate the association between non-MDR-TB and MDR-TB and socioeconomic deprivation. Methods: In this study, we used hierarchical Bayesian spatial models to analyze the spatial distribution of notification of non-MDR-TB and MDR-TB cases for the period from 2000 to 2016 across 127 parishes of the seven municipalities of the Lisbon metropolitan area (Almada, Amadora, Lisboa, Loures, Odivelas, Oeiras, Sintra), using the Portuguese TB Surveillance System (SVIG-TB). In order to characterise the populations, we used the European Deprivation Index for Portugal (EDI-PT) as an indicator of poverty and estimated the association between non-MDR-TB and MDR-TB and socioeconomic deprivation. Results: The notification rates per 10,000 population of non-MDR TB ranged from 18.95 to 217.49 notifications and that of MDR TB ranged from 0.83 to 3.70. We identified 54 high-risk areas for non-MDR-TB and 13 high-risk areas for MDR-TB. Parishes in the third [relative risk (RR) = 1.281, 95% credible interval (CrI): 1.021–1.606], fourth (RR = 1.786, 95% CrI: 1.420–2.241) and fifth (RR = 1.935, 95% CrI: 1.536–2.438) quintile of socioeconomic deprivation presented higher non-MDR-TB notifications rates. Parishes in the fourth (RR = 2.246, 95% CrI: 1.374–3.684) and fifth (RR = 1.828, 95% CrI: 1.049–3.155) quintile of socioeconomic deprivation also presented higher MDR-TB notifications rates. Conclusions: We demonstrated significant heterogeneity in the spatial distribution of both non-MDR-TB and MDR-TB at the parish level and we found that socioeconomically disadvantaged parishes are disproportionally affected by both non-MDR-TB and MDR-TB. Our findings suggest that the emergence of MDR-TB and transmission are specific from each location and often different from the non-MDR-TB settings. We identified priority areas for intervention for a more efficient plan of control and prevention of non-MDR-TB and MDR-TB. Graphical Abstract: [Figure not available: see fulltext.] © 2022, The Author(s).This work has been funded by National funds, through the Foundation for Science and Technology (FCT)—project UIDB/50026/2020, UIDP/50026/2020 and PTDC/SAU-PUB/29521/2017. This study was also supported by FEDER through the Operational Programme Competitiveness and Internationalization and national funding through the Foundation for Science and Technology—FCT (Portuguese Ministry of Science, Technology and Higher Education) under the Unidade de Investigação em Epidemiologia—Instituto de Saúde Pública da Universidade do Porto (EPIUnit) (UIDB/04750/2020). Ana Isabel Ribeiro was supported by National Funds through FCT, under the programme of ‘Stimulus of Scientific Employment—Individual Support’ within the contract CEECIND/02386/2018

Cefaleia e Hormonas

As hormonas desempenham um papel fundamental na modulação e exacerbação da cefaleia. A revisão da literatura apresentada descreve e diferencia os vários tipos de cefaleias hormonais, sendo igualmente abordados os mecanismos fisiopatológicos assim como as diversas opções terapêuticas. Dado o maior atingimento no sexo feminino e em idade reprodutiva várias questões se colocam no que concerne ao uso de contraceção hormonal. Por último será discutido o risco vascular na presença de enxaqueca o qual contraindica o uso de estrogénios em mulheres com aura.info:eu-repo/semantics/publishedVersio

Comparing the cost-effectiveness of two screening strategies for latent tuberculosis infection in Portugal

Introduction and objectives: Screening for latent tuberculosis infection (LTBI) in close contacts of infectious TB cases might include Tuberculin Skin Test (TST) and Interferon-Gamma Release Assays (IGRA), in combination or as single-tests. In Portugal, the screening strategy changed from TST followed by IGRA to IGRA-only testing in 2016. Our objective was to compare the cost-effectiveness of two-step TST/IGRA with the current IGRA-only screening strategy in immunocompetent individuals exposed to individuals with respiratory TB. Materials and methods: We reviewed clinical records of individuals exposed to infectious TB cases diagnosed in 2015 and 2016, in two TB outpatient centers in the district of Porto. We estimated medical, non-medical and indirect costs for each screening strategy, taking into account costs of tests and health care personnel, travel distance from place of residence to screening site and employment status. We calculated the incremental cost-effectiveness ratio (ICER) as the cost difference between the two screening strategies with the difference number of LTBI diagnosis as a measure of cost-effectiveness, assuming that treating LTBI is a cost-effective intervention. We also calculated adjusted odds-ratios to test the association between diagnosis of LTBI and screening strategy and estimated the total cost for averting a potential TB case. Results: We compared 499 contacts TST/IGRA screened with 547 IGRA-only. IGRA-only strategy yielded a higher screening effectiveness for diagnosing latent tuberculosis infection (aOR 2.12, 95%CI: 1.53 - 2.94). ICER was €106 per LTBI diagnosis, representing increased effectiveness with a slightly increased cost of IGRA-only screening strategy. Conclusions: Our data suggests that in Portugal LTBI screening with IGRA-only is more cost-effective than the two-step TST/IGRA testing strategy, preventing a higher number of cases of TB cases

Maturação Cervical com Sonda de Foley: Experiência de um Centro Terciário

Overview and Aims: In the presence of an unfavorable cervix, pre-induction cervical ripening is an important part of the labour induction process. Both mechanical and pharmacological methods are available for this purpose, with Foley catheter being the most commonly used mechanical method. We intend to describe the efficacy of Foley catheter for cervical ripening and to describe maternal and neonatal outcomes. Furthermore, we analyze the same results in high risk subgroups. Study Design: Retrospective observational study Population: 44 women with a singleton pregnancy, live fetus, cephalic presentation, intact membranes, with medical indication for labour induction and Bishop score ≤6. Methods: Medical records were reviewed and analyzed. Foley catheter was introduced until expulsion or for a maximum of 24 hours. Cervical ripening was considered effective when Bishop score after catheter was ≥8. Maternal outcomes considered were tachysystole, chorioamnionitis, post-partum bleeding and uterine rupture. Neonatal outcomes assessed were Apgar score, need for hospitalization in neonatal care unit and days of hospitalization. In the subgroup analysis, we divided the risk population in two subgroups: Group 1- Fetal growth restriction and/or oligohydramnios; Group 2- Previous caesarean section. Results: 72.7% of the labour inductions were indicated by maternal or fetal disease. The efficacy of cervical ripening was 65.9% and vaginal delivery rate was 63.6%. Regarding maternal and neonatal outcomes, there were only two cases (4.5%) of clinical chorioamnionitis. In subgroup analysis, the efficacy of cervical ripening and vaginal delivery rates were, respectively, 60.9% and 69.6% in Group 1 and 72.2% and 50% in Group 2.There was one case of chorioamnionitis in each subgroup. Conclusions: Foley catheter is an effective and safe method for cervical ripening. Due to its low association with adverse outcomes, it appears to be a good alternative for high-risk populations.info:eu-repo/semantics/publishedVersio

Portuguese Prevalence of Pediatric Chronic Intestinal Failure

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Blood Pressure Variability in Acute Ischemic Stroke: The Role of Early Recanalization

We performed a retrospective study with the aim of investigating the association between blood pressure (BP) variability in the first 24 h after ischemic stroke and functional outcome, regarding arterial recanalization status. A total of 674 patients diagnosed with acute stroke and treated with revascularization therapies were enrolled. Systolic and diastolic BP values of the first 24 h after stroke were collected and their variation quantified through standard deviation. Recanalization state was evaluated at 6 h and clinical outcome at 3 months was assessed by modified Rankin Scale. In multivariate analyses systolic BP variability in the first 24 h post-stroke showed an association with 3 months clinical outcome in the whole population and non-recanalyzed patients. In recanalyzed patients, BP variability did not show a significant association with functional outcome.info:eu-repo/semantics/publishedVersio