Hepatocellular Neoplasm of Uncertain Potential of Malignancy or Well-Differentiated Hepatocellular Carcinoma Arising within Hepatocellular Adenoma.

Background: Hepatocellular adenoma (HCA) is an uncommon solid, solitary, benign liver lesion that develops in an otherwise normal-appearing liver. Hemorrhage and malignant transformation are the most important complications. Risk factors for malignant transformation include advanced age, male gender, use of anabolic steroids, metabolic syndrome, larger lesions, and beta-catenin activation subtype. The identification of higher risk adenomas enables the selection of patients most suitable for aggressive treatment and those who benefit with surveillance, minimizing the risks for these predominantly young patients. Case Presentation. We present the case of a 29-year-old woman with a history of oral contraceptive intake for 13 years, which was sent to evaluation in our Hepato-Bilio-Pancreatic and Splenic Unit because of a large nodular lesion in segment 5 of the liver, compatible with HCA, and was proposed to surgical resection. Histological and immunohistochemical investigation revealed an area with atypical characteristics, suggesting malignant transformation. Conclusions: HCAs share similar imaging characteristics and histopathological features with hepatocellular carcinomas; therefore, immunohistochemical and genetic studies assumes great importance to discriminate adenomas with malignant transformation. Beta-catenin, glutamine synthetase, glypican-3, and heat-shock protein 70 are promising markers to identify higher risk adenomas.

Análise de casos e óbitos por covid-19 emprofissionais da enfermagem amazonense / Analysis of cases and deaths from covid-19 in nursing professionals from amazonas / Análisis de casos y muertes por covid-19 en profesionales de enfermería de amazonas

Objetivo: Analisar os casos confirmados e óbitos pela doença de coronavírus 2019 em profissionais de enfermagem do estado do Amazonas. Métodos: Trata-se de um estudo epidemiológico, que se valeu dos dados obtidos no Observatório da Enfermagem do Conselho Federal de Enfermagem, analisando-se os números de casos e óbitos no período de abril de 2020 a abril de 2021. Foi implementada análise estatística do tipo descritiva e utilizado o teste qui-quadrado. Resultados: Foram notificados 286 casos suspeitos, 148 confirmados e 79 óbitos, com taxa de prevalência de 278,31, mortalidade de 148,55 e letalidade de 53,4%. A categoria de técnicos de enfermagem foi a mais acometida, 62,8% (n = 93), a faixa etária mais relevante variou de 41 a 50 anos e o gênero feminino representou 74,3% (n = 110). Somente a variável faixa etária esteve significativamente associada aos óbitos pela doença. Foram evidenciadas oscilações entre as series temporais de incidência e mortalidade. Conclusão: Os profissionais de enfermagem do Amazonas se encontram em uma situação de alto risco para a doença e óbito, o que requer uma atenção mais criteriosa por parte dos gestores, Conselho Federal e Conselho Regional de Enfermagem ao campo laboral e suporte ao exercício da enfermagem. (AU)

Objective: To analyze confirmed cases and deaths from coronavirus 2019 disease in nursing professionals in the state of Amazonas. Methods: This is an epidemiological study, which used data obtained from the Nursing Observatory of the Federal Council of Nursing, analyzing the numbers of cases and deaths in the period from April 2020 to April 2021. Statistical analysis was implemented descriptive type and used the chi-square test. Results: 286 suspected cases were reported, 148 confirmed and 79 deaths, with a prevalence rate of 278.31, a mortality rate of 148.55 and a mortality rate of 53.4%. The category of nursing technicians was the most affected, 62.8% (n = 93), the most relevant age group ranged from 41 to 50 years and the female gender represented 74.3% (n = 110). Only the age group variable was significantly associated with deaths from the disease. Oscillations between the temporal series of incidence and mortality were evidenced. Conclusion: Nursing professionals in Amazonas are at high risk for disease and death, which requires more careful attention from managers, the Federal Council and Regional Council of Nursing to the labor field and support for the practice of nursing. (AU)

Objetivo: Analizar casos confirmados y defunciones por enfermedad por coronavirus 2019 en profesionales de enfermería del estado de Amazonas. Métodos: Se trata de un estudio epidemiológico, que utilizó datos obtenidos del Observatorio de Enfermería del Consejo Federal de Enfermería, analizando el número de casos y defunciones en el período de abril de 2020 a abril de 2021. Se implementó un análisis estadístico de tipo descriptivo y se utilizó la chi -Prueba cuadrada. Resultados: se notificaron 286 casos sospechosos, 148 confirmados y 79 defunciones, con una tasa de prevalencia de 278,31, una tasa de mortalidad de 148,55 y una tasa de mortalidad del 53,4%. La categoría de técnicos de enfermería fue la más afectada, 62,8% (n = 93), el grupo de edad más relevante osciló entre 41 y 50 años y el sexo femenino representó el 74,3% (n = 110). Solo la variable del grupo de edad se asoció significativamente con las muertes por la enfermedad. Se evidenciaron oscilaciones entre la serie temporal de incidencia y mortalidad. Conclusión: Los profesionales de enfermería en Amazonas se encuentran en alto riesgo de enfermedad y muerte, lo que requiere una mayor atención por parte de los administradores, el Consejo Federal y el Consejo Regional de Enfermería al campo laboral y el apoyo a la práctica de la enfermería. (AU)

Validity and Reliability of The Smart Groin Trainer for Measuring Hip Adduction Strength.

We analyzed the Smart Groin Trainer device's validity and reliability to measure the isometric hip adduction strength during the adductor squeeze strength test. Fifteen professional soccer players (25.33±4.06 years) and fifteen university students (21.60±1.76 years) participated in this study. All participants performed the squeeze strength test using two portable dynamometers: Smart Groin Trainer and Globus Ergometer. Three maximal isometric hip adduction contractions lasting 5s, interspersed by 3min rest intervals, were performed. Reliability was analyzed with intraclass correlation coefficients, standard error of measurements, and minimal detectable change. The absolute percent error and inter-device accuracy were also analyzed. Correlation analysis assessed the inter-device concurrent validity. The results found no significant differences (p>0.05) between devices in the squeeze strength test values in soccer players and university students. Inter-device comparisons revealed excellent levels of reliability and accuracy in soccer players. Concurrent validity measures revealed strong inter-device relationships in soccer players (r=0.89) and very strong relationships in university students (r=0.99). Intra-device analysis using the Smart Groin Trainer showed excellent relative and absolute reliability in tested soccer players. Our data demonstrated excellent levels of agreement between both dynamometers during the squeeze strength test, suggesting the Smart Groin Trainer as a valid, reliable, and accurate device to measure isometric hip adduction strength.

A Rare Case of a Migrating Inguinal Hernia Mesh Presenting as Acute Appendicitis.

Acute appendicitis is a very common event. Migration of hernia mesh is rare, especially intraluminal migrations. We aim to report a case of a migrated inguinal mesh presenting as an acute appendicitis. A 58-year-old male previously submitted to ONSTEP right inguinal hernia repair with a PolySoft™ hernia patch eight years before, was admitted in the emergency department with acute appendicitis, and submitted to laparoscopic appendectomy. Intraoperatively, the "recoil ring" from the inguinal hernia patch was extended from the anterior abdominal wall to the appendix, perforating it and progressing intraluminally. Appendectomy was performed, as well as removal of the mesh by an anterior approach. Hernia mesh migration to an intraluminally position is extremely rare with only a few cases described in literature. Pathogenesis of migration is still poorly understood. Clinicians should consider hernia mesh migration in their differential diagnosis for causes of acute appendicitis, in the right clinical setting, when a previous hernia defect correction is present. To the best of our knowledge, this is the first reported case of inguinal hernia mesh migration to the appendix, presenting as acute appendicitis.

Immunogenicity in Oreochromis niloticus vaccinated with sonicated antigens against streptococcosis.

Streptococcosis causes great economic losses in intensive culture of tilapia. Vaccination is the most effective and safest way to tackle infectious diseases. Thus, this study sought the more effective and safer antigenic fraction after sonication of Streptococcus agalactiae to elaborate a vaccine against streptococcosis in Nile tilapia. For this, twenty-one days after vaccination with different fractions (soluble and insoluble) of S. agalactiae, the fish were challenged with the homologous strain (LD50). Then, samples were taken at zero, 14, 28, 60 and 90 days post-vaccination (DPV, n = 7). Blood and organs (cranial kidney, spleen and liver) were collected from vaccinated and unvaccinated fish. Finally, insoluble fraction vaccine presented the best effect, resulting in a 100% relative percent of survival (RPS) and without clinical manifestations. In view of the results, it was to evaluate the role of the insoluble fraction of the antigen in the protective immunity against streptococcosis. The results indicate that the spleen might be the main organ in the vaccine response in Nile tilapia due to the great morphological and immunological differences in vaccinated fish, evidenced by the greater of melanomacrophage centers (MMC) and IgM + lymphocytes in relation to the non-vaccinated fish. At 60 DPV, it was observed the peak of the protective immunity related to the maximum concentration of proteins, circulating leukocytes, antibody titers in the serum and tissue changes with greater expression of IgM + and MMC number in the spleen and kidney of Oreochromis niloticus. Vaccination with insoluble fraction of S. agalactiae was safe and provided effective protection against streptococcosis with maximum protective response at 60 DPV.

Analysis of cases and deaths from COVID-19 in nursing professionals from Amazonas / Análisis de casos y muertes por COVID-19 en profesionales de enfermería de Amazonas / Análise de casos e óbitos por COVID-19 em profissionais da enfermagem amazonense

This article aimed to carry out an analysis of confirmed cases and deaths from COVID-19 in nursing professionals in the state of Amazonas. This is an epidemiological study, which used data obtained from the Nursing Observatory of the Federal Council of Nursing (COFEN), analyzing the number of cases and deaths in the period from April 2020 to April 2021. An analysis was implemented. descriptive statistics and the chi-square test was used. A total of 286 suspected cases, 148 confirmed and 79 deaths were reported, with an incidence rate of 278.31, a mortality rate of 148.55 and a fatality rate of 53.4%. The category of nursing technicians was the most affected, 62.8% (n = 93), the most relevant age group ranged from 41 - 50 years and the female gender represents 74.3% (n = 110). Only the gender variable was significantly associated with deaths from COVID-19. Oscillations between the temporal series of incidence and mortality were evidenced. It is concluded that nursing professionals in Amazonas are at a high risk of illness and death, which requires more careful attention from managers, COFEN and Regional Council to the labor field and support for the practice of nursing.

Este artículo tuvo como objetivo realizar un análisis de casos confirmados y defunciones por COVID-19 en profesionales de enfermería del estado de Amazonas. Se trata de un estudio epidemiológico, que utilizó datos obtenidos del Observatorio de Enfermería del Consejo Federal de Enfermería (COFEN), analizando el número de casos y defunciones en el período de abril de 2020 a abril de 2021. Se implementó un análisis. Se utilizó la prueba de chi-cuadrado. Se notificaron un total de 286 casos sospechosos, 148 confirmados y 79 defunciones, con una tasa de incidencia de 278,31, una tasa de mortalidad de 148,55 y una tasa de letalidad del 53,4%. La categoría de técnicos de enfermería fue la más afectada, 62,8% (n = 93), el grupo de edad más relevante fue de 41 a 50 años y el sexo femenino representa el 74,3% (n = 110). Solo la variable de género se asoció significativamente con las muertes por COVID-19. Se evidenciaron oscilaciones entre la serie temporal de incidencia y mortalidad. Se concluye que los profesionales de enfermería en Amazonas tienen un alto riesgo de enfermedad y muerte, lo que requiere una mayor atención por parte de los directivos, COFEN y Consejo Regional al campo laboral y apoyo para la práctica de la enfermería.

Este artigo objetivou realizar uma análise dos casos confirmados e óbitos por COVID-19 em profissionais de enfermagem do estado do Amazonas. Trata-se de um estudo epidemiológico, que se valeu dos dados obtidos no Observatório da Enfermagem do Conselho Federal de Enfermagem (COFEN), analisando-se os números de casos e óbitos no período de abril de 2020 a abril de 2021. Foi implementada análise estatística do tipo descritiva e utilizados o teste qui-quadrado. Foram notificados 286 casos suspeitos, 148 confirmados e 79 óbitos, com taxa de incidência de 278,31, mortalidade de 148,55 e letalidade de 53,4%. A categoria de técnicos de enfermagem foi a mais acometida, 62,8% (n = 93), a faixa etária mais relevante variou de 41 - 50 anos e o gênero feminino representa 74,3% (n = 110). Somente a variável gênero esteve significativamente associada aos óbitos por COVID-19. Foi evidenciado oscilações entre as series temporais de incidência e mortalidade. Conclui-se que os profissionais de enfermagem do Amazonas se encontram em uma situação de alto risco para a doença e óbito, o que requer uma atenção mais criteriosa por parte dos gestores, COFEN e Conselho Regional ao campo laboral e suporte ao exercício da enfermagem.

Podemos falar de segurança do paciente durante uma pandemia? Uma experiência portuguesa / Can we talk about patient safety during a pandemia? A portuguese experience / ¿Podemos hablar sobre seguridad del paciente durante una pandemia? Una experiencia portuguesa

Objetivo: enumerar medidas governativas e de saúde pública implementadas em Portugal decorrentes da pandemia pelo vírus SARS-CoV-2 e descrever a atuação do Gabinete de Segurança do Paciente do Centro Hospitalar Universitário de Lisboa Central (CHULC), referência nacional na resposta à situação de emergência de saúde pública. Métodos: utilizou-se como método a análise normativa, documental, além de relato de caso por pesquisa-ação. Resultados: em Portugal, documentaram-se os primeiros casos de infeção por SARS-CoV-2 a 2 de março de 2020. Os processos assistenciais são geridos pelo Ministério da Saúde e Direção Geral da Saúde, abrangendo o Sistema Nacional de Saúde (universal) e o sector privado. O Gabinete de Segurança do Doente do CHULC, participou na redefinição dos processos, criação de vias alternativas de informação entre as várias estruturas, implementação de inovações no uso de tecnologias e vigilância clínica, gestão dos equipamentos de proteção, motivação e suporte emocional dos profissionais e na consolidação das principais metas de segurança do doente (ex. identificação do doente, medicação e cirurgia segura). A aprendizagem feita com os erros contribui para a melhoria contínua dos processos. Conclusão: em Portugal e no mundo a pandemia por COVID-19 não terminou. Compreendemos que é tempo de refletir e voltar aos princípios básicos da segurança, como a higiene das mãos, a etiqueta respiratória e o controlo ambiental. Na gestão do risco e segurança do paciente em situação de crise, é necessário, mais do que nunca, inovar e aprender com os erros.

Objective: to enumerate governmental and public health measures implemented in Portugal resulting from the SARS-CoV-2 virus pandemic and describe the work of the Patient Safety Office of the Centro Hospitalar Universitário de Lisboa Central (CHULC), a national reference in the response to the situation of public health emergency. Methods: normative, documentary analysis was used as a method, in addition to case reports by action research. Results: in Portugal, the first cases of SARS-CoV-2 infection were documented on March 2, 2020. Assistance processes are managed by the Ministry of Health and the General Directorate of Health, covering the National Health System (universal) and the private sector. The CHULC Patient Safety Office, participated in the redefinition of processes, creation of alternative information routes between the various structures, implementation of innovations in the use of technologies and clinical surveillance, management of protective equipment, motivation and emotional support from professionals and consolidating the main patient safety goals (eg patient identification, medication and safe surgery). Learning from mistakes contributes to the continuous improvement of processes. Conclusion: In Portugal and in the world, the COVID-19 pandemic has not ended. We understand that it is time to reflect and return to the basic principles of safety, such as hand hygiene, respiratory etiquette and environmental control. In the management of risk and safety of patients in crisis situations, it is necessary, more than ever, to innovate and learn from mistakes.

Objetivo: enumerar las medidas gubernamentales y de salud pública implementadas en Portugal como resultado de la pandemia del virus SARS-CoV-2 y describir el trabajo de la Oficina de Seguridad del Paciente del Centro Hospitalar Universitário de Lisboa Central (CHULC), una referencia nacional en la respuesta a la situación de emergencia de salud pública. Métodos: se utilizó como método el análisis documental, normativo, además de los reportes de casos por investigación-acción. Resultados: en Portugal se documentaron los primeros casos de infección por SARS-CoV-2 el 2 de marzo de 2020. Los procesos de atención son gestionados por el Ministerio de Salud y la Dirección General de Salud, abarcando el Sistema Nacional de Salud (universal) y el privado. sector. La Oficina de Seguridad del Paciente del CHULC, participó en la redefinición de procesos, creación de rutas alternativas de información entre las distintas estructuras, implementación de innovaciones en el uso de tecnologías y vigilancia clínica, manejo de equipos de protección, motivación y apoyo emocional de los profesionales y consolidando las principales objetivos de seguridad del paciente (por ejemplo, identificación del paciente, medicación y cirugía segura). Aprender de los errores contribuye a la mejora continua de los procesos. Conclusión: En Portugal y en el mundo, la pandemia de COVID-19 no ha terminado. Entendemos que es hora de reflexionar y volver a los principios básicos de seguridad, como la higiene de manos, la etiqueta respiratoria y el control ambiental. En la gestión del riesgo y la seguridad de los pacientes en situaciones de crisis, es necesario, más que nunca, innovar y aprender de los errores.

Exosomal glypican-1 for risk stratification of pancreatic cystic lesions: A case of pathological progression in the absence of any suspicious imaging finding.

The clinical management of patients with pancreatic cystic lesions is of utmost importance to identify those at high risk for pathological progression. Current recommendations are guided by clinical presentation and radiologic criteria, but the results fall short for a disease that the only curative option is surgical resection. There is an urgent need for the introduction of biomarkers that can help in risk assessment of such lesions. We report a case of a pancreatic cystic lesion without imagiological findings suggestive of advanced disease, and high levels of a circulating biomarker, glypican-1 (GPC-1), which parallel those of patients with pancreatic cancer. One year after, the patient revealed malignant progression at follow-up. Our report is unprecedented in the literature. It describes a clinical case in which a biomarker was positive for a patient that only showed progression one year after its detection. This clinical information goes beyond the current knowledge in the field because it shows that the introduction of liquid biopsy and biomarkers is a highly promising clinical tool for the non-invasive assessment of pancreatic cancer precursor lesions, ultimately increasing the rate of patients eligible for surgical resection.

Can Interpersonal Behavior Influence the Persistence and Adherence to Physical Exercise Practice in Adults? A Systematic Review.

Objective: Motivation seems to be a fundamental indicator of long-term physical exercise adherence. Self-Determination Theory (SDT) argues that social environment plays a central role in the satisfaction of basic psychological needs, which might directly affect the quality of one's motivation. Individuals who appear to be more self-determined tend to persist longer at certain behaviors. Therefore, this body of work intends to analyze the relationship between motivational variables and behavioral outcomes in the exercise context, having as theoretical background the Self-Determination Theory. Methods: This systematic review was conducted through an electronic search on Web of Science, PubMed, SPORTDiscus, and PsycINFO. Data such as instruments, main predictors and results were collected from studies published between 1985 and 2018. A total of 35 empirical studies were considered for a detailed analysis. Results: Results showed the relevance of autonomy support performed by exercise professionals, as well as the major contribution that these behaviors have toward the satisfaction of basic psychological needs, besides the inherent benefits of developing more autonomous regulations. According to the literature, few studies have analyzed interpersonal thwarting behavior and the way this relates to basic psychological needs' frustration. Nether less, there seems to be a negative relationship between less self-determined regulations and exercise practice. Conclusion: Despite the existence of numerous cross-sectional studies that demonstrate positive correlations between SDT and behavioral outcomes in the exercise context, longitudinal research that analyzes all six dimensions of interpersonal behaviors and their relationship with persistence and adherence to exercise proves to be crucial. However, according to this review, interventions based on SDT appear to be fundamental when it comes to promote the maintenance of a long-term exercise practice.

Meckel's diverticulum perforation by a fish bone: A case report.

INTRODUCTION: Meckel's diverticulum is the most common congenital abnormality of the gastrointestinal tract. The perforation of a Meckel's diverticulum by a foreign body is a very rare complication. CASE PRESENTATION: A 61-year-old male presented to the Emergency Department with complaints with abdominal pain and fever, and abdominal rebound tenderness on physical examination. An intestinal perforation by a foreign body was diagnosed by CT scan. The patient was submitted to a diagnostic laparoscopy and a perforation of a Meckel's diverticulum by a foreign body was identified. The foreign body was removed and a stapled diverticulectomy was performed. DISCUSSION: Meckel's diverticulum is asymptomatic in most of the affected individuals, with a 4.2-16.9% probability of symptomatic presentations. The clinical presentation ranges from intestinal obstruction, to bleeding, inflammation and perforation. While children with Meckel's diverticulum present more often with gastrointestinal bleeding, intestinal obstruction is the most common presentation in adults. Foreign body perforation of a Meckel's diverticulum is an extremely rare event. There is general agreement that a symptomatic Meckel's diverticulum should be resected. Laparoscopy is a safe diagnostic and therapeutic tool that can decrease diagnostic time and theoretically avoids the morbidity and mortality of a delayed diagnosis. CONCLUSION: The perforation of a Meckel diverticulum by a foreign body is an extremely rare event and may have a bad prognosis in case of a delayed diagnosis.

Adenoma-carcinoma sequence in intrahepatic cholangiocarcinoma.

INTRODUCTION: Cholangiocarcinoma is a rare tumor but recent data report a worldwide increase in incidence and mortality. There are several risk factors associated with cholangiocarcinoma, and chronic inflammation of billiary tree seems to be implied in the cholangiocarcinogenesis, but little is known about this process. PRESENTATION OF CASE: We present a 56-year-old female with a bile duct adenoma incidentally discovered in the follow up of breast cancer that 18 months later progress to intrahepatic cholangiocarcinoma. DISCUSSION: This is a rare presentation of intrahepatic cholangiocarcinoma that suggests the classic adenoma-carcinoma sequence in cholangiocarcinogenesis. Furthermore this case gives rise to some questions about the possible common ground on intrahepatic cholangiocarcinoma and breast cancer. CONCLUSION: Cholangiocarcinogenesis is a complex multi-step mechanism and further investigations are needed to fully understand this process.