Linfangioleiomiomatose pulmonar inicial provável e linfangioleiomioma mediastinal

A 68 year old woman was submitted to a mediastinal lymphangioleiomyoma resection found in a follow-up study of lower left lung resection due to bronchiectasis complicated by chylothorax. This led to a revaluation of the pulmonary specimen that revealed, in addition to inflammatory bronchiectasis, small spindle cell nodules in the lung parenchyma, similar to minute pulmonary meningothelial-like nodules, but with smooth muscle actin immunohistochemical positivity. The possibility of initial pulmonary development of lymphangioleiomyomatosis is discussed

Educação pós-graduada em cuidados paliativos pediátricos – experiência de uma instituição de ensino superior

Introdução: O desenvolvimento de serviços de Cuidados Paliativos Pediátricos (CPP) é uma prioridade atual dos sistemas de saúde desenvolvidos. Em Portugal o seu reconhecimento tem crescido desde 2013, quando foram constituídos grupos de trabalho na pediatria e nos cuidados paliativos. Nesse mesmo ano, antecipando as necessidades formativas, uma instituição de ensino superior decidiu criar um curso de pós-graduação (PG) em CPP. Objetivos: Avaliar, desde o 1º ano letivo (2013/14 –2018/19), a diversidade dos formandos e a adequação da sua distribuição por área geográfica nacional e respetiva estimativa de crianças com necessidades paliativas (CcNP). Métodos: Revimos a base de dados das inscrições dos alunos, excluindo aqueles que não concluíram a PG; para as omissões contactámos os alunos por email. Consultámos a base de dados do INE para obter a população pediátrica (0-17 anos) no último ano disponível(2017). Para calcular as CcNP utilizámosos dados publicados no relatório do ObservatórioPortuguês de CP sobre a estimativa decrianças com doença crónica complexa.Resultados: Desde a sua criação esta PG contacom 130 alunos –N=121;93% do génerofeminino; idade mediana 37 anos (22-61). Amediana anual é de 20 alunos (entre 14 em2013 e 42 em 2016, anoem que uma organizaçãoatribuiu 20 bolsas). A maioria cuida decrianças (96;74%). A área mais representadaé a enfermagem (54;42%), seguida da medicina(51;39%), da psicologia (12;9%) e doserviço social (6;5%); outros alunos vieram daeducação (3), voluntariado (2), terapia musical(1) e fisioterapia (1). A região com mais alunosé a ARS LVT (83;64%), seguida da ARS Norte(25;19%), Centro (11;8%), Alentejo (5;4%) eAlgarve (1). Dos Açores vieram 2 alunos e daMadeira 1; no corrente ano temos 1 aluno doBrasil e 1 de Angola (este online). Utilizando aestimativa do OPCP (45:10000 crianças residentes),verificámos que em 2017 o númerode CcNP variou entre 360 (Algarve) e 2639(Norte), resultando num rácio profissionais formados:CcNP entre 1:29 (área metropolitanade Lisboa) e 1:360 (Algarve).Conclusão: Nestes 6 anos letivos, a PG emCPP educou profissionais da saúde (sobretudoda Pediatria, Enfermagem e Medicina) e áreasafins, indo ao encontro das necessidades formativasnacionais. Predominam os formandosda ARS LVT, onde é lecionada a PG. Face aocrescente reconhecimento das necessidadesem CPP, é premente estimular a formação deprofissionais das outras zonas do país.info:eu-repo/semantics/publishedVersio

Universal vs. risk-factor-based screening for gestational diabetes-an analysis from a 5-Year Portuguese Cohort

PURPOSE: The criteria to screen for Gestational Diabetes Mellitus are not internationally consensual. In opposition to the universal screening performed in Portugal, certain countries advocate a risk-factor-based screening. We aim to compare obstetric and neonatal outcomes in pregnant women with and without risk factors treated for Gestational Diabetes Mellitus. METHODS: Retrospective and multicentric study of 12,006 pregnant women diagnosed with Gestational Diabetes Mellitus between 2011 and 2015, in Portugal. Gestational Diabetes Mellitus was diagnosed according to the International Association of the Diabetes and Pregnancy Study Groups criteria. RISK FACTORS: body mass index > 30kg/m2, history of Gestational Diabetes Mellitus, history of macrossomic newborn (birth weight > 4000 g) or first-degree relatives with Type 2 Diabetes Mellitus. EXCLUSION CRITERIA: lack of data concerning risk factors (n = 1563). RESULTS: At least one risk factor was found in 68.2% (n = 7123) pregnant women. Pregnant women with risk factors were more frequently medicated with insulin (p < 0.001), caesarean section was more commonly performed (p < 0.001), their newborns were more frequently large-for-gestational-age (p < 0.001) and neonatal morbidity was higher (p = 0.040) in comparison to pregnant women without risk factors. The Diabetes Mellitus reclassification test showed an increased frequency of intermediate hyperglycaemia and Diabetes Mellitus in women with risk factors (p < 0.001). CONCLUSION: Almost one-third of pregnant women would have remained undiagnosed if risk-based-factor screening were implemented in Portugal. Women without risk factors presented fewer obstetric and neonatal complications. However, more than one third required insulin therapinfo:eu-repo/semantics/publishedVersio

Iron Deficiency and Obesity - Are we Diagnosing with Appropriate Indicators?

INTRODUCTION: We aim to define the iron deficiency prevalence and eventual differences between obese patients with and without metabolic syndrome. MATERIAL AND METHODS: Analysis of patients evaluated at multidisciplinary consultation of obesity in our institution between 2013 and 2015 (n = 260). Iron deficiency: ferritin levels < 15 ng/mL. EXCLUSION CRITERIA: prior bariatric surgery; lack of ferritin or hemoglobin determinations. RESULTS: We analyzed data from 215 patients (84.2% female) with a mean age of 42.0 ± 10.3 years. The median body mass index was 42.5 (40.0 - 46.8) kg/m2 and 52.1% had metabolic syndrome. Iron deficiency was present in 7.0%, with no differences between genders or between patients with or without metabolic syndrome. Hypertension was associated with lower prevalence of iron deficiency. Type 2 diabetes and hypertension patients had higher levels of ferritin. The multivariate analysis showed that metabolic syndrome and increasing body mass index were predictive of higher risk of iron deficiency while hypertension predicted lower odds of iron deficiency. DISCUSSION: The prevalence of iron deficiency was similar in other published studies. Iron deficiency may be underdiagnosed if based only on ferritin concentrations. In our study, diabetes and hypertension appear to contribute to the increase in ferritin levels described in obesity. CONCLUSION: Ferritin may not be a reliable index for evaluating iron stores in obese patients, particularly when associated with comorbidities such as type 2 diabetes and hypertension. Further studies are needed to guide the diagnosis and iron supplementation in these patients.info:eu-repo/semantics/publishedVersio

Orofacial Injuries in Children and Adolescents (2009-2013): A 5-Year Study In Porto, Portugal

The aim of this study was to verify the prevalence of acts of aggression to the head, face and neck towards victims of Physical Violence against Children and Adolescents (PVCA) who were examined at the National Institute of Legal Medicine and Forensic Sciences Delegation North (INMLCF-DN) in Porto, Portugal. A study was carried out on 2,148 complaints of physical aggression against children and adolescents (0 to less than 18 years old) occurred between 2009 and 2013 and which were retrieved from information about violence held on INMLCF-DN data files. Continuous variables were described and the association between them was verified by Chi-square or Fischer’s Exact tests with 5% significance level. Within the 5-year timespan, 1,380 cases were identified with clinical relation with physical aggression. Most subjects evaluated were male adolescents and the most affected body region was the face, to which 747 injuries (24.7%) were recorded, with statistically significant association between sex and region (head and face). Victims in 15-17-year-old age group are more susceptible to violence than those in the 0-14-year-old age range. Dentists routinely examine the face, neck and skull, which make them the most appropriate health professionals to identify cases of aggression early.The authors thank the INMLCF-DN (Instituto Nacional de Medicina Legal e Ciências Forenses - Delegação do Norte, Portugal) for technical support and CAPES(Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, Brazil) for scholarship

Using technology to deliver cancer follow-up : a systematic review

Peer reviewedPublisher PD

Migrations and habitat use of the smooth hammerhead shark (Sphyrna zygaena) in the Atlantic Ocean

The smooth hammerhead shark, Sphyrna zygaena, is a cosmopolitan semipelagic shark captured as bycatch in pelagic oceanic fisheries, especially pelagic longlines targeting swordfish and/or tunas. From 2012 to 2016, eight smooth hammerheads were tagged with Pop-up Satellite Archival Tags in the inter-tropical region of the Northeast Atlantic Ocean, with successful transmissions received from seven tags (total of 319 tracking days). Results confirmed the smooth hammerhead is a highly mobile species, as the longest migration ever documented for this species (> 6600 km) was recorded. An absence of a diel vertical movement behavior was noted, with the sharks spending most of their time at surface waters (0-50 m) above 23 degrees C. The operating depth of the pelagic long-line gear was measured with Minilog Temperature and Depth Recorders, and the overlap with the species vertical distribution was calculated. The overlap is taking place mainly during the night and is higher for juveniles (similar to 40% of overlap time). The novel information presented can now be used to contribute to the provision of sustainable management tools and serve as input for Ecological Risk Assessments for smooth hammerheads caught in Atlantic pelagic longline fisheries.Oceanario de Lisboa through Project "SHARK-TAG: Migrations and habitat use of the smooth hammerhead shark in the Atlantic Ocean"; Investigador-FCT from the Portuguese Foundation for Science and Technology (FCT, Fundacao para a Ciencia e Tecnologia) [Ref: IF/00253/2014]; EU European Social Fund; Programa Operacional Potencial Human