Two Gestational Sacs, Two Locations - Heterotopic Pregnancy - Case Report

Introduction: Heterotopic pregnancy (HP) is defined as two gestational sacs simultaneously present in two different locations, being the uterus and the fallopian tubes the more common. Sporadic HP is a very rare condition (1:30,000 pregnancies). With the use of medically assisted reproduction the prevalence is significantly higher(1:7,000). Considering spontaneous pregnancy, HP is associated with risk factors, being prior inflammatory pelvic disease the most common. The clinical presentation is similar to that of ectopic pregnancy or spontaneous miscarriage although it is usually a more late diagnosis. Case report: 25 year-old pregnant woman, OI 0000, previously healthy; admitted at the Emergency Department (ED) with acute pelvic pain mainly at the right iliac fossa and moderate vaginal bleeding confirmed by speculum examination. She was hemodynamically stable and the bimanual palpation was painful; no prior medically assisted reproduction technique had been performed. The haemoglobin value was within normal range and the serum β-hCG was 2,763mUI/mL. The ultrasonography at the ED showed an in uterus gestational sac and another one inside the right fallopian tube; in both gestational sacs cardiac activity was absent. HP diagnosis was then established and the patient was admitted at the Obstetrics Ward for surveillance and ultrasonographic/laboratorial reassessment; complete miscarriage of the uterine pregnancy occurred but methotrexate was necessary for the treatment of persistent tubarian pregnancy. Conclusion: When evaluating a pregnant woman with pelvic pain and vaginal bleeding one should always be aware of several differential diagnosis amongst which HP should be considered. If the patient has in uterus viable pregnancy the treatment of the ectopic concomitant gestational sac should be as conservative as possible; methotrexate should not be used in that situation as it leads to uterine pregnancy miscarriage in about one third of the patients

Mercapturate Pathway in the Tubulocentric Perspective of Diabetic Kidney Disease

BACKGROUND: The recent growing evidence that the proximal tubule underlies the early pathogenesis of diabetic kidney disease (DKD) is unveiling novel and promising perspectives. This pathophysiological concept links tubulointerstitial oxidative stress, inflammation, hypoxia, and fibrosis with the progression of DKD. In this new angle for DKD, the prevailing molecular mechanisms on proximal tubular cells emerge as an innovative opportunity for prevention and management of DKD as well as to improve diabetic dysmetabolism. SUMMARY: The mercapturate pathway (MAP) is a classical metabolic detoxification route for xenobiotics that is emerging as an integrative circuitry detrimental to resolve tubular inflammation caused by endogenous electrophilic species. Herein we review why and how it might underlie DKD. Key Messages: MAP is a hallmark of proximal tubular cell function, and cysteine-S-conjugates might represent targets for early intervention in DKD. Moreover, the biomonitoring of urinary mercapturates from metabolic inflammation products might be relevant for the implementation of preventive/management strategies in DKD.info:eu-repo/semantics/publishedVersio

Report Card on Physical Activity for Children and Youth

Background: This article describes the procedures and development of the rst Portuguese Report Card on Physical Activity in Children and Adolescents. Methods: Comprehensive searches for data related to indicators of physical activity (PA) were completed by a committee of physical activity and sports specialists. Grades were assigned to each indicator consistent with the process and methodology outlined by the Active Healthy Kids Canada Report Card model. Results: Nine indicators of PA were graded. The following grades were assigned: Overall Physical Activity Levels, D; Organized Sport Participation, B; Active Play, D; Active Transportation, C; Sedentary Behaviors, D; Family and Peers, C; Schools, B; Community and the Built Environment, D; and Government, C. Conclusions: Portuguese children and adolescents do not reach suf cient physical activity levels and spend larger amounts of time spent in sedentary behaviors compared with recommendations. Effective policies of PA promotion and implementation are needed in different domains of young people’s daily lives

Doença meningocócica oculta

Introdução: A doença meningocócica inclui entidades com diferentes graus de gravidade. A bacteriemia oculta, muitas vezes subdiagnosticada, pode cursar com bom prognóstico. Caso clínico: Criança de três anos, de origem africana, com febre (38,7ºC), gonalgia e claudicação da marcha com 24 horas de evolução sem sensação de doença grave. Os exames imagiológicos osteoarticulares eram normais. Apresentava leucocitose (27300/mL) com neutrofilia (21000/mL) e proteína C reactiva (PCR) 10,8 mg/dl. Realizou hemocultura e teve alta com diagnóstico de sinovite da anca. No dia seguinte encontrava-se apirético, assintomático, mantendo leucocitose (19300/mL), neutrofilia (10400/mL) e PCR 18,2 mg/dl. Optou-se por uma atitude expectante. Isolou-se Neisseria meningitidis na hemocultura inicial, pelo fez ceftriaxona e apesar de assintomático e com exames laboratoriais normais. Não se verificaram complicações. Discussão: A bacteriemia meningocócica oculta pode manifestar-se por sintomas sugestivos de infecção viral. A resolução espontânea, na ausência de antibioticoterapia é rara mas, atendendo ao caso descrito, discutem-se atitudes a seguir em casos semelhantes

Results from Portugal’s 2018 Report Card on Physical Activity for Children and Youth

Available evidence indicates that there are still a large proportion of Portuguese children and adolescents that are not sufficiently active and that exceed the recommended levels of screen-time. In Portugal, virtually all students, enrolled in formal education, attain regular Physical Education classes, which is of significance

Genetic Evidence of African Slavery at the Beginning of the Trans-Atlantic Slave Trade

An archaeological excavation in Valle da Gafaria (Lagos, Portugal), revealed two contiguous burial places outside the medieval city walls, dating from the 15th–17th centuries AD: one was interpreted as a Leprosarium cemetery and the second as an urban discard deposit, where signs of violent, unceremonious burials suggested that these remains may belong to slaves captured in Africa by the Portuguese. We obtained random short autosomal sequence reads from seven individuals: two from the latter site and five from the Leprosarium and used these to call SNP identities and estimate ancestral affinities with modern reference data. The Leprosarium site samples were less preserved but gave some probability of both African and European ancestry. The two discard deposit burials each gave African affinity signals, which were further refined toward modern West African or Bantu genotyped samples. These data from distressed burials illustrate an African contribution to a low status stratum of Lagos society at a time when this port became a hub of the European trade in African slaves which formed a precursor to the transatlantic transfer of millions

Response Regarding: Endoscopic Management of Sigmoid Volvulus in a Debilitated Population: What Relevance?

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