Postimplantation Syndrome after Endovascular Aneurysm Repair

Endovascular aneurysm repair is associated, in a significant proportion of patients, to a systemic inflammatory response denominated postimplantation syndrome (PIS). PIS is characterized by fatigue, fever, and a rise in inflammatory biomarkers after the operation. However, the exact definition is still a matter of debate. There are several proposed definitions for PIS in the literature resulting in significant variability of PIS incidence (ranging from 2% to 100%). The etiology of PIS is not entirely clear. Endograft composition, aortic thrombus, intestinal bacterial translocation, and contrast media may contribute to PIS but the first seems to be the most important determinant. This clinical entity may have clinical consequences in length of hospital stay, readmissions, renal function, cardiovascular events, endoleak rate, and quality of life, but current data are insufficient for definitive conclusions. Despite of absence of stablished treatment for PIS, non-steroid and steroid anti-inflammatory drugs are currently advocated when clinical suspicion arises. Prevention may be achieved with perioperative administration of a steroid drug. Since it may have adverse effects, further knowledge of the real incidence of PIS and its clinical consequences is imperative

Isolated Superior Mesenteric Artery Dissection, A Rare Cause Of Abdominal Pain

A 42-year-old previously healthy male presented with 5 days of spontaneous mid-epigastric intense abdominal pain and mild epigastric tenderness on palpation. CT angiography revealed a Sakamoto type 2 isolated superior mesenteric artery dissection (SMA) with a "cul-de-sac" shaped false lumen (B- C: large arrow), side branch perfusion from both lumens, and compression of the true (A-D: small arrow) by the false lumen (A-D: large arrow). Dissection flap presented just distal to an aberrant right hepatic artery arising from the SMA (B.D: star). CT, clinical and analytic findings did not suggest visceral compromise and was successfully treated with bowel rest and anticoagulation. He is now on close clinical and imaging follow-up.publishersversionpublishe

Plano de comunicação integrada de marketing para a Aracira Group

Tendo em conta a crescente instabilidade do mercado e os seus inúmeros desafios, o marketing e a comunicação são fatores decisivos para o sucesso das organizações e devem ser parte integrante da sua estratégia. Terem uma boa imagem e serem reconhecidas irá permitir que se posicionem melhor. As empresas precisam de estar atentas aos seus competidores e aos seus atuais clientes, procurando fidelizá-los, bem como angariar novos. Uma boa alocação dos recursos irá aumentar a sua atratividade perante os consumidores e facilitar a sua diferenciação perante a concorrência. O principal objetivo da investigação consistiu em realizar um plano de Comunicação Integrada de Marketing para a Aracira Group. Foi utilizada uma abordagem metodológica de recolha de dados preexistentes, através da análise de documentos provenientes de fontes secundárias. O plano inclui uma análise abrangente do mercado, a identificação dos objetivos e dos públicos-alvo, tal como o conjunto de estratégias e táticas definidas. Os resultados desta pesquisa possibilitam que a organização melhore as suas práticas de comunicação de marketing, de modo a que aumente também a sua notoriedade e carteira de clientes, atingindo assim os seus objetivos

Intervenção psicoterapêutica, depressão pós-parto e vivência psicológica da gravidez

Para a maioria dos casais, a gravidez é um período de vivências positivas, embora tal nem sempre aconteça, sendo a depressão um problema bastante comum durante a mesma (Bowen, Bowen, Butt, Rahman, & Muhajarine, 2012; Evans, Heron, Francomb, Oke, & Golding, 2001). O presente estudo tem como objectivo contribuir para a avaliação do impacto de um programa de intervenção psicoterapêutica, centrado na interacção de casal, em associação com uma intervenção de orientação cognitiva-narrativa, na prevenção da depressão gestacional e na vivência psicológica da gravidez. Pretende também perceber quais os níveis de depressão baseline dos participantes, se existem diferenças entre homens e mulheres e de que modo os elementos das díades vivenciam psicologicamente a gravidez. No estudo participaram seis casais grávidos, divididos equitativamente em três grupos: o grupo de controlo; o grupo experimental 1, que apenas beneficiou da intervenção cognitiva-narrativa; e o grupo experimental 2, que foi sujeito à intervenção cognitivanarrativa, em associação com a intervenção de casal baseada na vinculação. A sintomatologia depressiva foi avaliada em dois momentos, na 20ª-23ª e na 32ª semana de gestação, através do Beck Depression Inventory (BDI) e a vivência psicológica da gravidez, através da Escala de Atitudes sobre a Gravidez e a Maternidade (EAGM) e a Escala de Atitudes sobre a Gravidez e a Paternidade (EAGP), conforme se tratasse do elemento feminino ou masculino da díade. Os resultados permitem perceber que a adaptação à parentalidade é experienciada de forma muito diversa, nomeadamente no que respeita ao desenvolvimento de sintomatologia depressiva. Quanto à vivência psicológica da gravidez, os homens parecem obter mais ganhos do que as mulheres ao beneficiar da intervenção, embora os resultados por estas obtidos no pós-intervenção possam reflectir uma percepção mais realista da transição para a parentalidade.Pregnancy, for most couples, is a period of positive experiences, although this isn’t always the case, and depression is fairly common (Bowen, Bowen, Butt, Rahman, & Muhajarine, 2012; Evans, Heron, Francomb, Oke, & Golding, 2001). The study at hand has as an objective to contribute to the evaluation of the impact of a psychotherapeutic intervention program, focused on couple interaction, in association with a cognitive-narrative intervention orientation in the prevention of gestational depression and the psychological experience of pregnancy. Furthermore it is intended to understand the baseline depression levels of the participants, if any differences occur between men and women and in what form the elements of the dyads experience the pregnancy psychologically. Six pregnant couples took part in the study, and they were divided in the following manner: the control group; experimental group 1, that only benefited from cognitive-narrative intervention; and the experimental group 2, that was subject to cognitive-narrative intervention, in association with the attachment based couple intervention. The depressive symptomatology was evaluated twice, in the 20th-23rd and the 32nd week of gestation, by means of the Beck Depression Inventory (BDI) and the psychological experience of pregnancy, through the Escala de Atitudes sobre a Gravidez e a Maternidade (EAGM) and the Escala de Atitudes sobre a gravidez e a paternidade (EAGP), depending on whether it was with respect to the male or female element of the dyad. The results allow us to understand that adaptation to parenthood is experienced diversely, namely in terms of depressive symptomatology development. In terms of psychological experiences of pregnancy, men seem to obtain more from it than women as they benefit from the intervention,although the obtained results for the female category may reflect a more realistic perspective of the transition to parenthood

Reflectance confocal microscopy for the diagnosis of skin infections and infestations

Reflectance confocal microscopy (RCM) is a noninvasive real-time imaging technique that has been widely used for the diagnosis of skin cancer. More recently, it has been reported as a useful tool for the diagnosis and management of several inflammatory and infectious skin disorders. This article provides an overview of the current available applications of RCM use in cutaneous infections and infestations. PubMed was used to search the following terms in various combinations: reflectance confocal microscopy, skin, hair, nail, infection, parasitosis, mycosis, virus, bacteria. All papers were accordingly reviewed. In most cutaneous infections or infestations, the main alterations are found in the epidermis and upper dermis, where the accuracy of confocal microscopy is nearly similar to that of histopathology. The high resolution of this technique allows the visualization of most skin parasites, fungi, and a few bacteria. Although viruses cannot be identified because of their small size, viral cytopathic effects can be observed on keratinocytes. In addition, RCM can be used to monitor the response to treatment, thereby reducing unnecessary treatments

Fatores relacionados a adesão ao uso de Insulinas em pacientes atendidos na Atenção Básica, Marialva, Paraná / Factors related to adherence to the use of Insulins in patients attending Basic Care, Marialva, Paraná

Introdução: Apesar de todas as consequências para o portador de diabetes, este nem sempre adere ao tratamento com insulina. Objetivo: efetuar levantamento em uma farmácia municipal de um município do noroeste do Paraná afim de avaliar o total de usuários que fazem uso de insulina para Diabetes, bem como conhecer o perfil desta população e os fatores relacionados a adesão a insulinoterapia. Metodologia:  estudo seccional do tipo transversal desenvolvido com 30 pacientes diabéticos insulinodependentes que fazem tratamento na atenção básica em um município do noroeste do Paraná. Aplicou-se instrumento de entrevista estruturado em dois módulos: o primeiro com dados sociodemográfico e o segundo sobre o tratamento com insulina e os fatores relacionados a adesão ao tratamento. Utilizou-se estatística descritiva por meio do uso de frequências relativas e absolutas. Normas éticas foram observadas. Resultados: Os pacientes eram na sua maioria mulheres (66,7%), brancos, de 41 a 70 anos (60%), casados (53,3%), com educação Fundamental Incompleta (53,3%), com renda até dois salários mínimos (46,7%), que convive com cônjuge ou companheiro (56,7%). Com relação aos fatores de risco observou-se que 6,7% fumam, 26,7% consumem bebidas alcoólicas, 50% estão com sobrepeso ou são obesos, 16,7% consideram sua saúde ruim ou péssima e 36,7% ficaram internados no último ano. Parcelas significativas dos diabéticos tinha comorbidades como doenças cardiovasculares, neurológicas, renais, hepáticas, autoimunes e gastrointestinais. Conclusão: na amostra em tela observou-se boa adesão ao tratamento com a insulinoterapia, no entanto, haja vista as características etárias e o perfil de comorbidades supõe-se que a adesão não seja ótima e direcionam o usuário para necessidade de ações educativas e tratamentos não farmacológicos para melhor cuidados da saúde

Novel insights in Erdheim-Chester disease using in vivo reflectance confocal microscopy

© 2020 by the American Academy of Dermatology, Inc. Published by Elsevier, Inc. This is an open access article under the CC-BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).A 61-year-old man presented with a 3-year history of slowly progressive yellowish plaques involving both eyelids (Fig 1). He also complained of intermittent retro-orbital headache, bilateral lower extremity pain, and increasing fatigue over the preceding year. His medical history was other-wise unremarkable.info:eu-repo/semantics/publishedVersio

Clarifying changes in student empathy throughout medical school: a scoping review

Despite the increasing awareness of the relevance of empathy in patient care, some findings suggest that medical schools may be contributing to the deterioration of students' empathy. Therefore, it is important to clarify the magnitude and direction of changes in empathy during medical school. We employed a scoping review to elucidate trends in students' empathy changes/differences throughout medical school and examine potential bias associated with research design. The literature published in English, Spanish, Portuguese and French from 2009 to 2016 was searched. Two-hundred and nine potentially relevant citations were identified. Twenty articles met the inclusion criteria. Effect sizes of empathy scores variations were calculated to assess the practical significance of results. Our results demonstrate that scoped studies differed considerably in their design, measures used, sample sizes and results. Most studies (12 out of 20 studies) reported either positive or non-statistically significant changes/differences in empathy regardless of the measure used. The predominant trend in cross-sectional studies (ten out of 13 studies) was of significantly higher empathy scores in later years or of similar empathy scores across years, while most longitudinal studies presented either mixed-results or empathy declines. There was not a generalized international trend in changes in students' empathy throughout medical school. Although statistically significant changes/differences were detected in 13 out of 20 studies, the calculated effect sizes were small in all but two studies, suggesting little practical significance. At the present moment, the literature does not offer clear conclusions relative to changes in student empathy throughout medical school.info:eu-repo/semantics/publishedVersio

Enhancing communication strategies in portuguese Public Administration: challenges, best practices, and a replicable model for the INA – Instituto Nacional de Administração, I.P. and Beyond

Comunicação apresentada a 6 de Setembro de 2023 - Enhancing Communication Strategies in Public Administration: Challenges, Best Practices, and a Replicable Model for the INA – Instituto Nacional de Administração, I.P. and Beyond, European Group of Public Administration (EGPA) Conference, Zagreb.Effective communication is a critical component for the success of public administration organizations. This study aims to analyse the challenges and identify best practices in communication strategies within a set of Public Administration organizations, with the goal of developing a communication strategy model that can be replicated in other Portuguese public entities and public services, specifically focusing on the Portuguese National Institute of Administration, I.P. (INA) experience. The research methodology employed involve data collection, document analysis, targeting professionals and stakeholders within the selected Public Administration organizations. Through rigorous analysis, the study identified several best practices in communication strategies employed by Public Administration organizations. These practices encompassed clear goal setting, stakeholder segmentation, tailored message development, utilization of multiple communication channels, fostering a culture of transparency, and leveraging modern technologies and platforms. Based on the identified challenges and best practices, a comprehensive communication strategy model was developed and applied specifically to INA. The model incorporates adaptable frameworks and guidelines to address the unique needs and goals of the organization. It emphasizes the importance of strategic planning, resource allocation, performance measurement, and continuous improvement. Furthermore, transcending a purely academic perspective, this study recognizes the critical importance of connecting theory and practice. By proposing an analysis based on real examples and relevant case studies, the study aims to provide valuable insights not only for academics but also for public sector professionals. This approach emphasizes the applicability of discussions in the practical context of contemporary public administration. Through this lens, the study explores how communication strategies can be effectively implemented and adapted to the challenging dynamics of the sector. The developed model can serve as a valuable blueprint for other public entities and public services seeking to enhance their communication strategies. By following the guidelines outlined in the model, organizations can overcome common challenges and implement effective communication strategies that facilitate transparency, engagement, and the delivery of public services. The main preliminary findings of this study provide a significant contribution to the field of public administration, offering practical insights and a replicable communication strategy model in times of institutional identity reframing. Implementing these recommendations can help Public Administration organizations establish robust communication channels, strengthen relationships with stakeholders, and ultimately improve their overall effectiveness and efficiency in serving the public interest