Que Urgência?

Objectivo: Caracterizar a população que utiliza o serviço de urgência, as circunstâncias que determinam a procura de um médico e as razões porque recorrem a um serviço de urgência hospitalar. Material e métodos: Numa amostra aleatória de 1000 utentes recolhem-se os dados relativos à idade/sexo/residência/classe social/tipo de assistência médica/patologia e razões da ida ao Hospital. Registam-se depois o diagnóstico, exames complementares e, a necessidade de atendimento num serviço hospitalar é avaliada. Resultados: Esta série (n = 1000) foi constituída por 533 (53,3%) crianças do sexo masculino e 467 (46,7%) do sexo feminino, com idades compreendidas entre os três dias de vida e os 15 anos (média de 3,4 anos), 92,4% provenientes da área da grande Lisboa. A grande maioria (94,2%) recorre por iniciativa própria, 46,7% nas primeiras 24 horas de doença e 26,3% já tinham consultas prévias pela mesma doença. Das várias razões apontadas como causa de consulta há a salientar 26,5% de utilizadores habituais. A patologia respiratória foi predominante (39,6%). Apenas 24,6% das situações foram consideradas urgentes, embora nem todas necessitassem do nível de cuidados de um hospital central. Não se verificaram diferenças relativamente ao grupo etário e ao estrato sócio económico, entre o grupo referenciado e o que recorreu por iniciativa própria, sendo contudo significativa a diferença destes grupos quanto à percentagem de internamentos e ao número de urgências. Conclusão: Após análise dos resultados, propõem-se algumas soluções possíveis para o grande afluxo de crianças ao serviço de urgência, por motivos não urgentes

Risk factors for human papillomavirus infection among women in Portugal: the CLEOPATRE Portugal Study

OBJECTIVE: To investigate demographic, socioeconomic, lifestyle, and medical factors that might predispose women to cervical human papillomavirus (HPV) infection. METHOD: A cross-sectional population-based study was performed. Women aged 18-64 years who attended selected obstetrics and gynecology or sexually transmitted disease (STD) clinics in mainland Portugal between February 2008 and March 2009 were recruited, according to an age-stratified sampling strategy. Liquid-based cytology samples were analyzed centrally for HPV genotype and for cytologic features. Univariate and multivariate logistic regression analyses identified risk factors for HPV infection. RESULTS: Among the 2326 women evaluated, the crude prevalence of HPV infection was 19.4%. Lifetime number of sexual partners was a strong predictor of HPV infection (odds ratio 5.44 for 5-10 partners versus 1 partner; P<0.001). Other risk factors were young age (particularly among women aged 20-24 years; P<0.001); country of birth other than mainland Portugal (P=0.002); education up to secondary school level (P=0.010); smoking history (≤ 10 years; P=0.004); and any STD in the past 12 months (P=0.052). CONCLUSION: Data from the present study may aid identification of women at increased risk of HPV infection and target prevention strategies. TRIAL REGISTRATION: National Commission of Data Protection (CNPD) registration number 5346/2007; Sanofi Pasteur MSD study number HPV-E05.info:eu-repo/semantics/publishedVersio

Seroepidemiological survey of transmissible infectious diseases in a portuguese prison establishment

A cross-sectional study was conducted in 151 (71.6%) of 211 male inmates of a regional Portuguese prison in order to establish the seroprevalence for viral hepatitis (HAV, HBV, HCV), human immunodeficiency virus (HIV), syphilis and herpes simplex virus (HSV-1 and HSV-2) and to analyze some psychosocial and criminal characteristics. Mean age was 34 years. Anti-HAV was positive in 69.5% (n = 105) and in 34.4% (n = 52) for anti-HCV. One (0.7%) person had HBsAg and 29 (19.2%) had laboratory markers of past HBV infection. Non-immune inmates for HBV were 40.4% (n = 61). Syphilis was diagnosed in 6.0% (n = 9). The rate of HIV infection was 6.6% (n = 10; all HIV-1). The seropositivity of HSV-2 was 19.9% (n = 30) and of HSV-1 was 82.1% (n = 124). Alcohol dependence was reported by 26.5% (n = 40). Excluding tobacco and prescription medication, 73.5% (n = 111) reported drug use in prison. The most commonly used drugs were: cannabis (100%; n = 111) followed by heroin (56.7%; n = 63). Anti-HCV rate was noteworthy. The HIV infection rate (6.6%) in this regional prison is at least 13 to 22 times greater than in general population. As the inmate return to the community increases the risk of disease exposure for the general population, early detection and counseling is urgently needed for prisoners

Risk factors for human papilomavirus infection among women in Portugal: the CLEOPATRE Portugal Study

OBJECTIVE: Human papillomavirus (HPV) is responsible for a range of diseases, including cervical cancer. The primary objectives of the CLEOPATRE Portugal study were to estimate the overall and age-stratified prevalence of cervical HPV infection and to assess HPV prevalence and type-specific distribution by cytological results among women aged 18 to 64 years, who reside in mainland Portugal. MATERIALS AND METHODS: This cross-sectional population-based study recruited women aged 18 to 64 years, according to an age-stratified sampling strategy, who attended gynecology/obstetrics or sexually transmitted disease clinics across the 5 regional health administrations in mainland Portugal between 2008 and 2009. Liquid-based cytology samples were collected and analyzed centrally for HPV genotyping (clinical array HPV 2 assay) and cytology. Prevalence estimates were adjusted for age using 2007 Portuguese census data. RESULTS: A total of 2326 women were included in the study. The overall prevalence of HPV infection in the study was 19.4% (95% confidence interval, 17.8%-21.0%), with the highest prevalence in women aged 18 to 24 years. High-risk HPV types were detected in 76.5% of infections, of which 36.6% involved multiple types. The commonest high-risk type was HPV-16. At least 1 of the HPV types 6/11/16/18 was detected in 32.6% of infections. The HPV prevalence in normal cytology samples was 16.5%. There was a statistically significant association between high-risk infection and cytological abnormalities (P < 0.001). CONCLUSIONS: This is the first population-based study to quantify and describe cervical HPV infection in mainland Portugal. This study provides baseline data for future assessment of the impact of HPV vaccination programs

Through the looking glass: leader personhood and the intersubjective construction of institutions

Institutions have been mainly understood in a dualistic way: as abstract, macro cultural logics, or as inhabited socio-cultural sites. This form of dualism divided people into cognitive cultural dopes or persons with a heart. Scholars are now trying to overcome dualistic modes of thinking about people in institutions, through the consideration of the persons as whole human beings. In this new theoretical approach, it is crucial to understand how institutions frame individual action and how individuals shape institutions. We study this duality by considering the lived experience of Colombia’s presidential transition period from Uribe to Santos in the decade of the 2010s

Rede Nacional de Cuidados Continuados Integrados – o seu impacto no funcionamento de um Serviço de Urologia

info:eu-repo/semantics/publishedVersio

Incontinentia Pigmenti in the Neonatal Period

Incontinentia pigmenti (IP) is a rare multisystem disease, X linked dominant disorder. As all X linked dominant diseases, it is usually male-lethal. Female newborn admitted to the neonatal intensive care unit on the fi rst day of life was diagnosed as having probable herpetic infection with vesicular skin lesions distributed on upper right limb and inferior limbs. Family history showed that her 22-year-old mother had hypopigmented lesions on the lower limbs and her 13-month-old sister had hyperpigmented lesions on the trunk and limbs. In newborns, herpes infection emerges as the principal diagnosis of vesicular rash, due to the importance of precocious diagnosis and treatment. Other hypothesis must be considered in a newborn with vesicobullous rash, such as IP

A polymorphic microsatellite from the Squalius alburnoides complex (Osteichthyes, Cyprinidae) cloned by serendipity can be useful in genetic analysis of polyploids

A new microsatellite locus (SAS1) for Squalius alburnoides was obtained through cloning by serendipity. The possible usefulness of this new species-specific microsatellite in genetic studies of this hybrid-species complex, was explored. The polymorphism exhibited by SAS1 microsatellite is an important addition to the set of microsatellites previously used in genetic studies in S. alburnoides complex, that mostly relied in markers described for other species. Moreover, the SAS1 microsatellite could be used to identify the parental genomes of the complex, complementing other methods recently described for the same purpose.

Phylogenetic relationships of cone snails endemic to Cabo Verde based on mitochondrial genomes

Background: Due to their great species and ecological diversity as well as their capacity to produce hundreds of different toxins, cone snails are of interest to evolutionary biologists, pharmacologists and amateur naturalists alike. Taxonomic identification of cone snails still relies mostly on the shape, color, and banding patterns of the shell. However, these phenotypic traits are prone to homoplasy. Therefore, the consistent use of genetic data for species delimitation and phylogenetic inference in this apparently hyperdiverse group is largely wanting. Here, we reconstruct the phylogeny of the cones endemic to Cabo Verde archipelago, a well-known radiation of the group, using mitochondrial (mt) genomes. Results: The reconstructed phylogeny grouped the analyzed species into two main clades, one including Kalloconus from West Africa sister to Trovaoconus from Cabo Verde and the other with a paraphyletic Lautoconus due to the sister group relationship of Africonus from Cabo Verde and Lautoconus ventricosus from Mediterranean Sea and neighboring Atlantic Ocean to the exclusion of Lautoconus endemic to Senegal (plus Lautoconus guanche from Mauritania, Morocco, and Canary Islands). Within Trovaoconus, up to three main lineages could be distinguished. The clade of Africonus included four main lineages (named I to IV), each further subdivided into two monophyletic groups. The reconstructed phylogeny allowed inferring the evolution of the radula in the studied lineages as well as biogeographic patterns. The number of cone species endemic to Cabo Verde was revised under the light of sequence divergence data and the inferred phylogenetic relationships. Conclusions: The sequence divergence between continental members of the genus Kalloconus and island endemics ascribed to the genus Trovaoconus is low, prompting for synonymization of the latter. The genus Lautoconus is paraphyletic. Lautoconus ventricosus is the closest living sister group of genus Africonus. Diversification of Africonus was in allopatry due to the direct development nature of their larvae and mainly triggered by eustatic sea level changes during the Miocene-Pliocene. Our study confirms the diversity of cone endemic to Cabo Verde but significantly reduces the number of valid species. Applying a sequence divergence threshold, the number of valid species within the sampled Africonus is reduced to half.Spanish Ministry of Science and Innovation [CGL2013-45211-C2-2-P, CGL2016-75255-C2-1-P, BES-2011-051469, BES-2014-069575, Doctorado Nacional-567]info:eu-repo/semantics/publishedVersio

Complicações Intracranianas na Mastoidite: É Possível Melhorar o Prognóstico

A otomastoidite é a complicação supurativa mais comum da otite média aguda. Pode cursar com complicações intracranianas em 17% dos casos, como a meningite ou trombose venosa do seio lateral (TVSL). A abordagem nem sempre é consensual e a hipertensão craniana secundária pode ser uma complicaçãoN/