Avaliação da Satisfação Sexual a Longo Prazo de Doentes Submetidas a Sacropexia Laparoscópica: Estudo Retrospectivo de um Centro Terciário

Introduction: Traditional treatments for apical compartment prolapse and multicompartment prolapse, such as open sacrocolpopexy, have been associated with concerns regarding sexual function. In recent years, laparoscopic or robotically assisted sacrocolpopexy has emerged as an alternative with potential benefits, including enhanced visualization, symptom relief, and comparable anatomical results. However, the impact of laparoscopic sacrocolpopexy (LSP) on long-term sexual satisfaction in women remains an important area of investigation. This retrospective tertiary center study aimed to evaluate the long-term sexual satisfaction in women who underwent LSP for the treatment of POP. The objective was to assess postoperative sexual satisfaction among patients with a history of active sexual life before the surgery. Methods: A total of 30 patients who underwent laparoscopic sacrocolpopexy between August 2014 and December 2016 were included in the analysis. The patients’ sexual satisfaction was assessed using The New Sexual Satisfaction Scale, a validated questionnaire in the Portuguese language with a mean follow-up of 7 years. Baseline characteristics, surgical and function outcomes were also evaluated. Results: Among the participants, 70% remained sexually active after the surgery. The mean score on The New Sexual Satisfaction Scale was 75.1, indicating a moderate to very satisfied level of sexual satisfaction. Out of the patients who reported a change in their sexual satisfaction after surgery, 69.2% would still recommend the procedure to others. The mean rate of global satisfaction with the surgery was 6.97 out of 10, with 83.3% of the patients recommending the surgery to someone else. Conclusion: The study provides valuable insights into the impact of laparoscopic sacrocolpopexy on sexual well-being in women with POP. Despite potential changes in sexual function, the majority of patients remained sexually active and perceived the procedure as beneficial, expressing overall satisfaction and recommending it to others. The findings highlight the importance of considering sexual function in the management of POP and suggest that LSP can be an effective treatment option that preserves sexual activity. However, further studies with larger sample sizes and comprehensive assessments are warranted to better understand the complex relationship between pelvic organ prolapse surgery, sexual function, and patient outcomes.Introdução: O tratamento tradicional para o prolapso apical e multicompartimental, como a sacrocolpopexia aberta, tem sido associado a preocupações relacionadas à função sexual. Nos últimos anos, a sacrocolpopexia laparoscópica ou assistida por robot tem surgido como uma alternativa com potenciais benefícios, incluindo melhor visualização, alívio de sintomas e resultados anatómicos comparáveis. No entanto, o impacto da sacrocolpopexia laparoscópica (LSP) na satisfação sexual de longo prazo em mulheres é uma área de investigação importante. Este estudo retrospectivo num centro terciário teve como objetivo avaliar a satisfação sexual a longo prazo de mulheres submetidas a LSP para o tratamento do POP. O objetivo foi avaliar a satisfação sexual pós-operatória em doentes com vida sexual ativa antes da cirurgia. Métodos: Foram incluídas na análise 30 pacientes submetidas a sacrocolpopexia laparoscópica entre agosto de 2014 e dezembro de 2016. A satisfação sexual das pacientes foi avaliada através do questionário The New Sexual Satisfaction Scale, um questionário validado em língua portuguesa, com uma média de follow-up de 7 anos. Características demográficas, resultados cirúrgicos e funcionais foram avaliados. Resultados: Entre as participantes, 70% permaneceram sexualmente ativas após a cirurgia. A pontuação média em The New Sexual Satisfaction Scale foi de 75,1, indicando um nível moderado a muito satisfeito de satisfação sexual. Entre as pacientes que relataram uma mudança na sua satisfação sexual após a cirurgia, 69,2% ainda recomendariam o procedimento a outras pessoas. A taxa média de satisfação global com a cirurgia foi de 6,97 em 10, e 83,3% das pacientes recomendaram a cirurgia a outras pessoas. Conclusão: O estudo oferece insights valiosos sobre o impacto da sacrocolpopexia laparoscópica no bem-estar sexual em mulheres com POP. Apesar das possíveis mudanças na função sexual, a maioria das pacientes permaneceu sexualmente ativa e reconheceu o procedimento como benéfico, expressando satisfação geral e recomendando-o a outras pessoas. Os resultados destacam a importância de considerar a função sexual no tratamento do POP e sugerem que a LSP pode ser uma opção de tratamento eficaz que preserva a atividade sexual. No entanto, estudos adicionais com tamanhos de amostra maiores e avaliações abrangentes são necessários para compreender melhor a relação complexa entre a cirurgia de prolapso de órgãos pélvicos, função sexual e resultados do paciente

Traumatismo Renal: Análise Retrospetiva de 5 Anos de um Centro de Trauma de Nível 1

Introduction: Renal trauma accounts for about 1% to 5% of all trauma patients, the majority of which are due to blunt trauma. Based on the American Association for the Surgery of Trauma (AAST) classification we can classify renal trauma into five grades of injury, which can help choosing the adequate treatment and anticipate the outcome. Management of renal trauma is evolving to a more conservative approach, avoiding surgery when it is possible.Our objective was to analyse our 5-year experience of renal trauma at a level 1 trauma center and report the patterns of injury, management and complications.   Methods: Retrospective analysis of patients diagnosed with renal trauma at a level 1 trauma center between January 2017 and December 2021. Data were collected from electronic patient records.   Results: During this period of time, we identified 29 patients, 93.1% male, admitted due to renal trauma. Median age was 48 years old. The majority had a blunt trauma (89.7%). The distribution of injury grade according to the AAST classification was: 6.9% grade I, 13.8% grade II, 41.4% grade III, 31% grade IV and 6.9% grade V. No patient died due to this trauma. A percentage of 43.3% of patients were treated conservatively, 6.7% with embolization by interventional radiology, 30.0% with a double J ureteral stent and 20.0% with nephrectomy. Early complications were observed in 34.4% of the patients.   Conclusion: The vast majority of renal injuries were due to blunt trauma, as expected. At this moment, management of renal trauma is trending to a more conservative approach, but in our sample, half of the patients needed intervention, mainly due to urinary extravasation but also because active bleeding and unfavourable clinical evolution. Nephrectomies were performed almost exclusively in grade 4 or 5 of injury. Early complications were more frequent than expected, mainly due to infection, in spite of empiric antibiotic therapy have been done in all patients.Introdução: O trauma renal compreende entre 1% a 5% de todos os doentes de trauma, a maioria por trauma contuso. Baseada na classificação da American Association for the Surgery of Trauma (AAST), podemos classificar o trauma renal em 5 graus, o que ajuda a escolher o melhor tratamento e a prever o desfecho de cada caso. Cada vez mais, o tratamento do trauma renal está a evoluir para um tratamento mais conservador, evitando a cirurgia sempre que possível. O nosso objetivo foi analisar os doentes com trauma renal durante 5 anos no nosso centro e reportar quais os padrões de lesão, o seu tratamento e complicações. Método: Análise retrospetiva dos doentes diagnosticados com trauma renal no Centro Hospitalar Universitário de Lisboa Central, entre Janeiro de 2017 e Setembro de 2021. Os dados foram obtidos através do processo clínico dos doentes. Resultados: Durante este período de tempo, foram identificados 29 doentes, 93,1% do sexo masculino, admitidos por trauma renal. A idade média foi de 48 anos e a grande maioria apresentava um trauma contuso (89,7%). A distribuição dos graus de trauma de acordo com a AAST foi: 6,9% grau I, 13,8% grau II, 41,4% grau III, 31% grau IV e 6,9% grau V. Não se registaram óbitos devido a trauma renal. Foram tratados conservadoramente 43,3%, com embolização pela radiologia de intervenção 6,7%, com a colocação de um stent duplo J 30,0% e com nefrectomia 20,0%. Apresentaram complicações precoces, 34,4%. Conclusão: Tal como expectável, a maioria dos doentes foram admitidos devido a trauma contuso. Atualmente, o tratamento é tendencialmente mais conservador, apesar de na nossa amostra metade dos doentes terem necessitado de uma intervenção, maioritariamente devido a extravasão urinária mas também por hemorragia ativa ou uma evolução clínica desfavorável. As nefrectomias ocorreram quase exclusivamente em lesões de grau IV ou V. As complicações precoces, principalmente infeciosas, foram mais frequentes que o expectável, apesar de todos os doentes terem realizado antibioterapia empírica

Constitutive deficiency of the neurogenic hippocampal modulator AP2γ promotes anxiety-like behavior and cumulative memory deficits in mice from juvenile to adult periods

The transcription factor activating protein two gamma (AP2γ) is an important regulator of neurogenesis both during embryonic development as well as in the postnatal brain, but its role for neurophysiology and behavior at distinct postnatal periods is still unclear. In this work, we explored the neurogenic, behavioral, and functional impact of a constitutive and heterozygous AP2γ deletion in mice from early postnatal development until adulthood. AP2γ deficiency promotes downregulation of hippocampal glutamatergic neurogenesis, altering the ontogeny of emotional and memory behaviors associated with hippocampus formation. The impairments induced by AP2γ constitutive deletion since early development leads to an anxious-like phenotype and memory impairments as early as the juvenile phase. These behavioral impairments either persist from the juvenile phase to adulthood or emerge in adult mice with deficits in behavioral flexibility and object location recognition. Collectively, we observed a progressive and cumulative impact of constitutive AP2γ deficiency on the hippocampal glutamatergic neurogenic process, as well as alterations on limbic-cortical connectivity, together with functional behavioral impairments. The results herein presented demonstrate the modulatory role exerted by the AP2γ transcription factor and the relevance of hippocampal neurogenesis in the development of emotional states and memory processes.H2020 -“la Caixa” Foundation(101003187

A National Wide Collaborative Study

INTRODUCTION: Even though the risk of COVID-19 in pregnancy may be increased, large-scale studies are needed to better understand the impact of the infection in this population. The aim of this study is to describe obstetric complications and the rate of vertical transmission in pregnant women with SARS-CoV-2 infection. MATERIAL AND METHODS: Detected cases of SARS-CoV-2 infection in pregnancy were registered in Portuguese hospitals by obstetricians. Epidemiological, pregnancy and childbirth data were collected. RESULTS: There were 630 positive cases in 23 Portuguese maternity hospitals, most at term (87.9%) and asymptomatic (62.9%). The most frequent maternal comorbidity was obesity. The rates of preterm birth and small-to-gestational-age were 12.1% and 9.9%, respectively. In the third trimester, 2.9% of pregnant women required respiratory support. There were eight cases (1.5%) of fetal death, including two cases of vertical transmission. There were five cases of postpartum respiratory degradation, but no maternal deaths were recorded. The caesarean section rate was higher in the first than in the second wave (68.5% vs 31.5%). RT-PCR SARS-CoV-2 positivity among newborns was 1.3%. CONCLUSION: SARS-Cov-2 infection in pregnancy may carry increased risks for both pregnant women and the fetuses. Individualized surveillance and the prophylaxis of this population with vaccination. is recommended in these cases.publishersversionepub_ahead_of_prin

Alterações musculares e esqueléticas cervicais em mulheres disfônicas

Termo clínico, a disfonia envolve a todas as transformações e dificuldades durante a emissão vocal, as quais resultam no impedimento da produção normal da voz. Pacientes como esse problema, podem apresentar desequilíbrio da musculatura crâniocervical e laríngea e lesão orgânica subjacente. A disfonia resulta em modificações fonatórias, limitando atividades diárias relacionadas ao uso da voz, impactando na vida social e na qualidade de vida do indivíduo. Este estudo teve como objetivo analisar alterações musculares e esqueléticas cervicais em mulheres com disfonia, conforme identificado na literatura científica sobre o tema. Para isso, realizou-se uma revisão integrativa de literatura, selecionando estudos nas bases de dados Literatura Latino-americana e do Caribe em Ciências da Saúde (Lilacs) e Medical Literature Analysis and Retrieval System Online (Medline). A partir da análise qualitativa dos resultados, concluiu-se que dor intensa na região posterior do pescoço e na laringe se manifestam em mulheres disfônicas. Contribuem para isso a função prejudicada da articulação cervical e alterações da amplitude de movimento cervical. Com isso, compreende-se que o abuso vocal e o mau uso da voz como fatores mais comuns para a disfonia

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Photography-based taxonomy is inadequate, unnecessary, and potentially harmful for biological sciences

The question whether taxonomic descriptions naming new animal species without type specimen(s) deposited in collections should be accepted for publication by scientific journals and allowed by the Code has already been discussed in Zootaxa (Dubois & Nemésio 2007; Donegan 2008, 2009; Nemésio 2009a–b; Dubois 2009; Gentile & Snell 2009; Minelli 2009; Cianferoni & Bartolozzi 2016; Amorim et al. 2016). This question was again raised in a letter supported by 35 signatories published in the journal Nature (Pape et al. 2016) on 15 September 2016. On 25 September 2016, the following rebuttal (strictly limited to 300 words as per the editorial rules of Nature) was submitted to Nature, which on 18 October 2016 refused to publish it. As we think this problem is a very important one for zoological taxonomy, this text is published here exactly as submitted to Nature, followed by the list of the 493 taxonomists and collection-based researchers who signed it in the short time span from 20 September to 6 October 2016

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

A Gencitabina como Alternativa Terapêutica na Ausência de BCG: A Experiência do CHLC (Hospital S. José)

Introduction: The non-muscle invasive bladder tumors should be stratified into risk groups so the adjuvant treatment after surgery can be suited to each patient. The high risk tumors should be treated with one to three-year maintenance intravesical bacillus Calmette-Guérin (BCG). It has been reported shortages of intravesical BCG and our hospital center was affected in 2014/2015, leading to a treatment change of the patients who had indication to BCG. Gemcitabine could be a valid alternative because some studies show it may have a role in intermediate-risk patients, as an alternative to mitomycin C, and in high risk, BCG-refractory patients, with a better toxicity profile. Material and Methods: This is a descriptive, retrospective study that included patients with non-muscle invasive bladder tumors of high risk with onset of disease in 2013/2014, affected by the BCG shortage period at the Hospital Center. Results: At CHLC, 11 high-risk patients were treated with gemcitabine, only two exclusively, and the others sequentially with BCG. Only two patients, treated with both gemcitabine and BCG, had tumoral recurrence. However, a significant number (6 out of 11) had adverse events, two of whom had to stop treatment. Conclusion: Apparently, gemcitabine seems to be a good adjuvant treatment choice during the shortage of the gold standard treatment, due to the low number of recurrence, although adverse events reported were high.Introdução: Os tumores não músculo invasivos da bexiga devem ser estratificados em grupos de risco de forma a adequar o tratamento após cirurgia a cada doente. Nos tumores de alto risco deve ser realizada terapêutica adjuvante com bacilo de Calmette-Guérin (BCG) intravesical durante 1 a 3 anos. Têm sido reportadas roturas de stock de BCG intravesical, tendo sido o Centro Hospitalar de Lisboa Central (CHLC) afectado nos anos 2014 e 2015, o que obrigou a uma reformulação no tratamento dos doentes que tinham indicação para realização desta terapêutica. A gencitabina poderá ser uma alternativa válida, dado que alguns estudos mostram que poderá ter um papel nos doentes de risco intermédio, como alternativa à mitomicina C, e nos de alto risco, refractários à BCG, com um perfil de toxicidade mais favorável. Material e Métodos: Trata-se de um estudo retrospectivo descritivo que incluiu doentes com tumores da bexiga não musculo-invasivos de alto risco, com início da doença em 2013/2014, afectados pelo período de escassez de BCG no Centro Hospitalar. Resultados: No CHLC, 11 doentes com tumores de alto risco foram submetidos a terapêutica com gencitabina, apenas dois exclusivamente, os restantes sequencialmente com BCG. Apenas dois doentes, tratados com BCG e gencitabina, apresentaram recidiva tumoral. No entanto, um número significativo (6 em 11) sofreram efeitos adversos, dois dos quais que levaram à interrupção da terapêutica. Conclusão: Aparentemente, a gencitabina foi uma boa alternativa de terapêutica adjuvante na ausência do tratamento gold standard (BCG), dada a existência de baixo número de recidivais tumorais, apesar do elevado número de efeitos adversos reportados