Priapismo na Criança - Caso Clínico e Revisão da Literatura

Reporta-se um caso clínico de uma criança de 10 anos, com anemia de células falciformes que recorre ao serviço de urgência por priapismo com 12h de evolução. A propósito deste caso clínico fez-se uma revisão da literatura sobre priapismo na criança: definição, etiologia mais frequente, diagnóstico e tratamento

Bacterial meningitis in an urban area: etiologic study and prognostic factors

Objectives: The study of clinical features, diagnostic methods and prognostic factors of bacterial meningitis, in an urban area. Patients and Methods: All patients admitted between June 2001 and July 2004 in the emergency departments of a few hospitals, with the diagnosis of bacterial meningitis were included. CSFand blood cultures were performed in every case. Phenotypic characterization of strains of 5treptococcus pneumoniae and Neisseria meningitidis identified by culture were performed. In order to detect the three most common agents it was done a PCRassay in culture negative CSFsamples. Results: Bacterial meningitis was diagnosed in 201 patients. Etiologic definition was based on culture in 142 patients (70.6%), done by CSFPCRassay in 33 (16.4%) other patients and exclusively by latex agglutination test results in two cases. Thus, an etiologic diagnosis was established in 177 (88%) cases. Antigenic characterization showed a slight prevalence of N. meningitidis phenotype C:2b:P1; the 5. pneumoniae serotype characterization showed that 43.8% of identified serotypes are not included in any of the available vaccines. Eighteen patients died (8.9%). The statistic analysis found that factors associated with an adverse outcome were age older than 50 years (aR 7.07; IC 95% 1.1-27.4), the presence of comorbidities (aR 3.3; IC 95% 1.1-9.6) and the occurrence of systemic complications (aR 5.8; IC 95% 2.1-16.0). Conclusions: This epidemiologic pattern is similar to that found in other countries after the introduction of Haemophilus influenzae b conjugated vaccine. The association of culture and noncultural methods of diagnosis had a better performance in defining the etiology. Comparing to other series, in-patients mortality rate was lower (8.9%) than usually referred to, being considered unfavourable prognostic factors the age more than 50 years, the presence of comorbidities and of systemic complications

Different kidney function trajectory patterns before dialysis in elderly patients: clinical implications and outcomes

Background. Identifying trajectories of kidney disease progression in chronic kidney disease (CKD) patients may help to deliver better care. We aimed to identify and characterize trajectories of renal function decline in CKD patients and to investigate their association with mortality after dialysis.Methods. This retrospective cohort study included 378 CKD patients who initiated dialysis (aged 65 years and over) between 2009 and 2016. Were considered mixed models using linear quadratic and cubic models to define the trajectories, and we used probabilistic clustering procedures. Patient characteristics and care practices at and before dialysis were examined by multivariable multinomial logistic regression. The association of these trajectories with mortality after dialysis was examined using Cox models.Results. Four distinct groups of eGFR trajectories decline before dialysis were identified: slower decline (18.3%), gradual decline (18.3%), early rapid decline (41.2%), and rapid decline (22.2%). Patients with rapid eGFR decline were more likely to have diabetes, more cognitive impairment, to have been hospitalized before dialysis, and were less likely to have received pre-dialysis care compared to the patients with a slower decline. They had a higher risk of death within the first and fourth year after dialysis initiation, and after being more than 4 years in dialysis.Conclusions. There are different patterns of eGFR trajectories before dialysis initiation in the elderly, that may help to identify those who are more likely to experience an accelerated decline in kidney function, with impact on pre ESKD care and in the mortality risk after dialysis

Multiparty Mediation as Solution for Urban Conflicts: A Case Analysis from Brazil

Social conflicts are becoming more complex every day and, therefore, the development of alternative forms of conflict resolution is necessary in view of the limited role of the Judiciary. With this, mediation gains more space in Brazil and in the world through the 2019 Singapore Convention on Mediation. Mediation is beneficial in the urban context to stimulate the population’s participation and guarantee legitimacy at different levels of power. It enables public and private convergences, better public interest comprehension about the best way of life in cities and enhanced democratic management due to better dialogue and cooperation with the public administration. Mediation focuses on the interventions’ reasons, the role of those involved in the process, welcoming the urban conflict with its peculiarities. It promotes the constitutional principles of democracy, pacification, solidarity, dignity, autonomy of will, speed and popular participation in the administration of Justice. However, in urban conflicts, which involve public administration and a multiplicity of parts, it is often necessary to apply collective or multiparty mediation. Thus, the article’s main objective is to address the effectiveness of multiparty mediation as a solution to urban conflicts through the analysis of 5 (five) concrete cases mediated at the Judicial Dispute Resolution Centers – CEJUSC of the Rio Grande State Court of Justice of the South in Brazil. In the first step, a theoretical-descriptive analysis of multiparty mediation in Brazil and the mediator’s role is carried out. In a second step, we will perform the analysis of practical cases to reach the appropriate conclusions

The population impact of rheumatic and musculoskeletal diseases in relation to other non-communicable disorders: comparing two estimation approaches

The aim of this study was to quantify the population impact of rheumatic and musculoskeletal diseases (RMDs) with other non-communicable diseases (NCDs), using two complementary strategies: standard multivariate models based on global burden of disease (GBD)-defined groups vs. empirical mutually exclusive patterns of NCDs. We used cross-sectional data from the Portuguese Fourth National Health Survey (n = 23,752). Six GBD-defined groups were included: RMDs, chronic obstructive pulmonary disease or asthma, cancer, depression, diabetes or renal failure, and stroke or myocardial infarction. The empirical approach comprised the patterns “low disease probability”, “cardiometabolic conditions”, “respiratory conditions” and “RMDs and depression”. As recommended by the outcome measures in rheumatology (OMERACT) initiative, health outcomes included life impact, pathophysiological manifestations, and resource use indicators. Population attributable fractions (PAF) were computed for each outcome and bootstrap confidence intervals (95% CI) were estimated. Among GBD-defined groups, RMDs had the highest impact across all the adverse health outcomes, from frequent healthcare utilization (PAF 7.8%, 95% CI 6.2–9.3) to negative self-rated health (PAF 18.1%, 95% CI 15.4–20.6). In the empirical approach, patterns “cardiometabolic conditions” and “RMDs and depression” had similar PAF estimates across all adverse health outcomes, but “RMDs and depression” showed significantly higher impact on chronic pain (PAF 8.9%, 95% CI 7.6–10.3) than the remaining multimorbidity patterns. RMDs revealed the greatest population impact across all adverse health outcomes tested, using both approaches. Empirical patterns are particularly interesting to evaluate the impact of RMDs in the context of their co-occurrence with other NCDs.This study received no specific funding. The funding for EPI Unit is obtained from the National Foundation for Science and Technology (FCT UID/DTP/04750/2013/002). FAA is supported by Grant FCT SFRH/BD/85398/2012, TM by Grant FCT SFRH/BD/92370/2013 and RL by Grant FCT SFRH/BPD/88729/2012

Histoplasmose pulmonar aguda e primeiro isolamento do Histoplasma capsulatum do solo do Rio Grande do Sul, Brasil

A case of acute pulmonary histoplasmosis, where the clinical histoiy and epidemiological data led to the identification of H. capsulatum natural source, is described. Specimens of spleen and liver, obtained after intraperitonial inoculation in mice, grew H. capsulatum in culture from the soil of rural area of General Câmara, by the first time in Rio Grande do Sul.Apresenta-se um caso de histoplasmose pulmonar aguda, onde a história clinica orientada levou a Identificação da fonte natural do Histoplasma capsulatum. O fungo foi obtido em cultivo a partir de fragmentos de baço e fígado de ratos inoculados intraperitonealmente com solo da zona rural de General Câmara, pela primeira vez no Rio Grande do Sul

Leiomioma da Uretra Feminina - Revisão da Literatura a Propósito de Caso Clínico

Oleiomioma da uretra é uma patologia rara, estando descritos cerca de uma centena de casos na literatura. São tumores benignos, constituídos por músculo liso e surgem mais frequentemente na idade fértil.Otratamento é cirúrgico com excisão da massa, existindo contudo possibilidade de recidiva local. Apresenta-seumcaso clínico de leiomioma da uretra e realizou-se revisão da literatura

Protocolo para determinação de umidade de farinha de trigo em analisador halógeno de umidade Ohaus.

Orientadora: Martha Zavariz de Miranda

Potential role of age, sex, body mass index and pain to identify patients with knee osteoarthritis

Aim: To evaluate the potential role of age, sex, body mass index (BMI), radiographic features and pain in knee osteoarthritis (OA) case ascertainment. Methods: A cross‐sectional study was performed using information from the EPIPorto cohort; social, demographic, behavioral and clinical data was obtained. Pain was assessed using a pain frequency score (regarding ever having knee pain, pain in the last year, in the last 6 months and in the last month). Knee radiographs were classified using the Kellgren–Lawrence scale (0–4). Path analysis was used to assess the plausibility of the causal assumptions and a classification tree to identify characteristics that could improve the identification of patients with radiographic OA. Results: Higher age and higher BMI were associated with higher radiographic score, but sex had no statistical association. Females, higher age, higher BMI and higher radiographic score were statistically associated with higher pain scores. For both genders, the classification tree estimated age as the first variable to identify individuals with knee radiographic features. In females older than 56 years, pain frequency score is the second discriminator characteristic, followed by age (> 65 years) and (BMI > 30 kg/m2). Higher pain frequency and BMI > 29 kg/m2 were relevant for identifying OA in men with ages between 43.5 and 55.5 years. Conclusions: Age, BMI and pain frequency are independently associated with radiographic OA and the use of information on these characteristics can improve the identification of patients with knee OA. Beyond age, pain complaints are particularly relevant but the level of pain is different by sex

Trajectories of Anxiety and Depression Symptoms over Five Years since Breast Cancer Diagnosis: Results of the NEON-BC Prospective Study

Anxiety and depression symptoms are frequent among patients with breast cancer (BCa) and may last after initial treatments. We aimed to identify five-year trajectories of anxiety and depression symptoms among women with BCa. Neuro-oncological complications of BCa (NEON-BC) cohort included 506 patients admitted at the Portuguese Institute of Oncology of Porto in 2012, who were evaluated with the Hospital Anxiety and Depression Scale before cancer treatment and after one, three, and five years (7.9% attrition rate). Mixed-effect models were used to model anxiety and depression scores over time and model-based clustering to identify the different trajectories. Three trajectories of anxiety symptoms were identified: (1) high scores at baseline and increasing over time (21.7%); (2) consistently low scores over time (63.6%); (3) mid-range scores at baseline, decreasing over time (14.6%). Three trajectories were identified for depression symptoms: (1) high scores at baseline and increasing over time (21.1%); (2) mid-range scores at baseline, which decreased afterward (58.7%); (3) consistently low levels over time (20.2%). Age, education, baseline, and one-year anxiety/depression status predicted the worst five-year trajectories. These results show that assessing anxiety and depression symptoms before treatment and after one year may contribute to identifying the patients who could benefit the most from psychological support. © 2022 by the authors. Licensee MDPI, Basel, Switzerland.This research was funded by the European Regional Development Funds (POCI-01-0145-FEDER016867) and Fundação para a Ciência e a Tecnologia (FCT), under the project “A five-year prospective cohort study on the neurological complications of breast cancer: frequency and impact in patient-reported outcomes” (PTDC/DTP-EPI/7183/2014), and by FCT under EPIUnit-Instituto de Saúde Pública da Universidade do Porto (UIDB/04750/2020) and Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (LA/P/0064/2020). NA receives funding from FCT under the project NeurodegCov19-Neurological Complications after COVID-19 (PTDC/SAU-EPI/6275/2020) and C.L., from FCT under the project NEON-PC: neuro-oncological complications of prostate cancer-longitudinal study of cognitive decline (POCI-01-0145-FEDER-032358, Ref. PTDC/SAU-EPI/32358/2017). Data management activities up to the first year of follow-up were supported by the Chair on Pain Medicine of the Faculty of Medicine, University of Porto, and the Grünenthal Foundation—Portugal