Diffuse dermal angiomatosis: a rare cause of painful ulceration in renal insufficiency.

Diffuse dermal angiomatosis is a rare, benign, reactive cutaneous vascular proliferation that has been reported in the context of end-stage renal failure and can rarely be associated with arteriovenous fistulas. We report a striking clinical resolution following prompt diagnosis and subsequent arteriovenous fistula reversal. This case further demonstrates that accurate diagnosis is particularly rewarding since correct therapeutic approach can be curative.

Mixed Cryoglobulinaemia Vasculitis after Persistent Hepatitis C Virus Eradication.

Mixed cryoglobulinaemia vasculitis (MCV) is a systemic vasculitis of the small and medium-size vessels caused by active hepatitis C (HCV) infection in >80% of cases. Beuthien et al. presented the first case of MCV with undetectable HCV after 10 months of therapy. In the last few years, more authors have described other cases of symptomatic MCV after 1 year of persistent HCV eradication. Here, we present a case report of a 57-year-old man who developed MCV with renal involvement after 3 years of HCV eradication with interferon therapy. LEARNING POINTS: Mixed cryoglobulinaemia can occur after persistent hepatitis C virus eradication.Most cases described in the literature presented mixed cryoglobulinaemia vasculitis (MCV) after 1 year of HCV eradication compared with after 3 years of persistent eradication in our case.The exact mechanism linking HCV and B-cells is not fully understood, but the main factor seems to be the sustained HCV antigenic stimulation of the B-cell compartment.

A new formula for managing family doctors' patient list in Portugal.

In Portugal, family doctors work with a well-defined list of patients to whom they provide healthcare throughout their lives. Several studies showed that larger list sizes are associa- ted with poorer health outcomes and compromise the quality of care. A significant increase in the average list size has been observed in recent years due to the Portuguese unfavorable socioeconomic context and the lack of family doctors. In 2017, the Portuguese Association of General and Fa- mily Medicine (APMGF) developed technical and scientific research that ultimately typified a set of different clinical practice contexts. It considers the geographic and socioeconomic characteristics and a set of population-based indicators, adjusting the list size according to the population's specific needs. Such adjustments ensure health care services with better quality, safety, efficacy, and personalized to their features. In this paper, a brief review is made on this topic, focusing on the work developed by APMGF and its main results.

A new formula for managing family doctors' patient list in Portugal / Uma nova fórmula para a gestão das listas de utentes dos médicos de família em Portugal

Abstract In Portugal, family doctors work with a well-defined list of patients to whom they provide healthcare throughout their lives. Several studies showed that larger list sizes are associa- ted with poorer health outcomes and compromise the quality of care. A significant increase in the average list size has been observed in recent years due to the Portuguese unfavorable socioeconomic context and the lack of family doctors. In 2017, the Portuguese Association of General and Fa- mily Medicine (APMGF) developed technical and scientific research that ultimately typified a set of different clinical practice contexts. It considers the geographic and socioeconomic characteristics and a set of population-based indicators, adjusting the list size according to the population's specific needs. Such adjustments ensure health care services with better quality, safety, efficacy, and personalized to their features. In this paper, a brief review is made on this topic, focusing on the work developed by APMGF and its main results.

Resumo Em Portugal, os médicos de família trabalham com uma lista bem definida de utentes, aos quais prestam cuidados de saúde ao longo da vida. Vários estudos mostraram que as dimensões maiores das listas estão associadas a piores resultados de saúde comprometedoras da qualidade do atendimento prestado. Devido ao contexto socioeconómico português desfavorável e à falta de médicos de família, tem-se verificado um aumento significativo da dimensão média das listas de utentes atribuídas aos médicos de família nos últimos anos. A Associação Portuguesa de Medicina Geral e Familiar (APMGF) desenvolveu, em 2017, uma investigação técnico-científica que acabou por tipificar diferentes contextos do exercício clínico. Este trabalho considerou as características geográficas e socioeconómicas, bem como um conjunto de indicadores demográficos, visando ajustar a dimensão das listas de acordo com as necessidades específicas da população. Com os ajustamentos propostos na gestão da dimensão das listas de utentes, será possível prestar serviços de saúde com mais qualidade, segurança, eficácia e obter ganhos decorrentes da maior personalização na prestação de cuidados. Neste artigo uma breve revisão é feita sobre este tópico, direcionando o enfoque para os resultados do trabalho desenvolvido pela APMGF.

Staphylococcus-induced glomerulonephritis: potential role for corticosteroids.

Staphylococcus aureus is a troublesome pathogen, responsible for a broad range of clinical manifestations, ranging from benign skin infections to life-threatening conditions such as endocarditis and osteomyelitis. The kidney can be affected through a rapidly progressive glomerulonephritis mediated by an inflammatory reaction against a superantigen deposited in the glomerulus during the infection's course. This glomerulopathy has a poor prognosis, often leading to chronically impaired kidney function, eventually progressing to end-stage renal disease. Treatment rests on antibiotherapy. Despite the inflammatory role in this disease's pathophysiology, most authors discourage a simultaneous immunosuppressive approach given the concomitant infection. However, there are some reports of success after administration of systemic corticosteroids in these patients. We present a 66-year-old man with a staphylococcus-induced glomerulonephritis brought on by a vascular graft infection, with rapidly deteriorating kidney function despite extraction of the infected graft and 3 weeks of antibiotherapy with achievement of infection control. Kidney function improved after the introduction of corticosteroids. This case highlights the potential role of corticosteroids in selected cases of staphylococcus-induced glomerulonephritis, particularly those in which the infection is under control.

Incidence of Antibiotic Treatment Failure in Patients with Nursing Home-Acquired Pneumonia and Community Acquired Pneumonia.

PURPOSE: Nursing home-acquired pneumonia (NHAP) patients are at higher risk of multi-drug resistant infection (MDR) than those with community-acquired pneumonia (CAP). Recent evidence suggests a single risk factor for MDR does not accurately predict the need for broad-spectrum antibiotics. The goal of this study was to compare the rate antibiotic failure between NHAP and CAP patients. METHODS: Demographic characteristics, co-morbidities, clinical and laboratory variables, antibiotic therapy, and mortality data were collected retrospectively for all patients with pneumonia admitted to an Internal Medicine Service between April 2017 and April 2018. RESULTS: In total, 313 of 556 patients had CAP and 243 had NHAP. NHAP patients were older, and were more likely to be dependent, to have recent antibiotic use, and to experience treatment failure (odds ratio (OR) 1.583; 95% CI 1.102-2.276; p = 0.013). In multivariate analysis, patient's origin did not predict treatment failure (OR 1.083; 95% CI 0.726-1.616; p = 0.696). DISCUSSION: Higher rates of antibiotic failure and mortality in NHAP patients were explained by the presence of other risk factors such as comorbidities, more severe presentation, and age. Admission from a nursing home is not a sufficient condition to start broader-spectrum antibiotics.

RENA Study: Cross-Sectional Study to Evaluate CKD Prevalence in Portugal.

INTRODUCTION: Chronic kidney disease (CKD) is a major global public health problem associated with increased risk of cardiovascular morbidity, premature mortality, and decreased quality of life. In Portugal, the PREVADIAB study showed a prevalence of CKD stages 3-5 of 6.1%. To overcome the limitations of the PREVADIAB study, the RENA study aimed to provide an estimate of the prevalence of CKD at a national level and to characterize CKD patients. METHODS: This was a cross-sectional study including users of Primary Health Care Units aged 18 or more. After obtaining written informed consent, sociodemographic and clinical data were recorded through a structured questionnaire, anthropometric measurements were taken, and blood and urine samples were collected. All participants initially meeting the criteria for CKD were contacted at least 3 months after the initial assessment for confirmation of the analytical results. RESULTS: A total of 3,135 individuals were included, 65.4% were female, and the mean age was 56.7 ± 15.9 years. The prevalence of hypertension, dyslipidemia, and diabetes was 38, 32, and 16%, respectively, and 31% were obese. After data adjustment by gender, age group, and geographical region, the global prevalence of CKD was 20.9% (95% CI: 6.5-35.3%), with no differences between genders and a significant increase with the advance of the age groups. CONCLUSION: Our study showed a CKD prevalence above the worldwide and Europe average. Despite the study limitations, it has become clear that it is urgent to identify CKD patients earlier and to develop awareness and educational programs to prevent CKD and its associated diseases.

The management of bilateral cryptorchidism in the adult man: report of two cases.

OBJECTIVE: Undescended testis or cryptorchidism is a pathology usually presenting in the newborn or during childhood, rarely diagnosed in the adult man. This article pretends to perform a review of its management in the adulthood. METHODS: We present two cases of man with bilateral congenital cryptorchidism diagnosed in the adult. We made a review of the management of this condition in the adult male, based in a research performed in PubMed database. CONCLUSIONS: With the use of laparoscopy in the management of men with cryptorchidism, the diagnostic and therapeutic approach in this pathology doesn't differ from that used in childhood. Surgical management is based in the localization of the testis in physical exploration, the risk of testicular cancer and the viability of the gonad in its exploration. Hormonal replacement therapy and fertility preservation techniques should be offered in selected cases to optimize patient health and desires.

Tratamiento de la criptorquidia bilateral en el adulto: revisión, a propósito de dos casos clínicos / The Management of Bilateral Cryptorchidism in the Adult Man. Report of Two Cases

OBJETIVO: La criptorquidia es una patología característica del recién nacido y la infancia, siendo raramente identificada en el hombre adulto. En el articulo hacemos una revisión del diagnostico y tratamiento de la patología en el hombre adulto. MÉTODOS: Se presentan los casos de dos hombres adultos con criptorquidia bilateral congénita con diagnostico tardío en la consulta de urología. Realizamos una revisión del manejo diagnóstico y terapéutico de esta patología de la diferenciación genital masculina, en la edad adulta, con base en la búsqueda bibliográfica en Pubmed. CONCLUSIONES: Con la cirugía laparoscópica, el riesgo quirúrgico del diagnóstico y tratamiento de la criptorquidia en el adulto no difiere del de la infancia. El manejo quirúrgico es determinado por la localización del testículo en la palpación inguinal, el riesgo de tumor testicular y por la presencia ó no de una gónada atrófica a la exploración. El manejo de los hombres se complementa con la optimización del status hormonal y de la preservación de la fertilidad

OBJECTIVE: Undescended testis or cryptorchidism is a pathology usually presenting in the newborn or during childhood, rarely diagnosed in the adult man. This article pretends to perform a review of its management in the adulthood. METHODS: We present two cases of man with bilateral congenital cryptorchidism diagnosed in the adult. We made a review of the management of this condition in the adult male, based in a research performed in PubMed database. Coclusions: With the use of laparoscopy in the management of men with cryptorchidism, the diagnostic and therapeutic approach in this pathology doesn't differ from that used in childhood. Surgical management is based in the localization of the testis in physical exploration, the risk of testicular cancer and the viability of the gonad in its exploration. Hormonal replacement therapy and fertility preservation techniques should be offered in selected cases to optimize patient health and desires

[Strangulated urethral prolapse. Case report]. / Prolapso uretral encarcerado. A propósito de un caso clínico.

OBJECTIVE: We report a case of strangulated urethral prolapse. METHOD/RESULTS: A 62-year-old female patient presents to the emergency department with complaints of a bleeding vaginal mass, pain referred to the vaginal introitus and dysu-ria. After being diagnosed with a strangulated urethral pro-lapse, surgical excision of the prolapsed urethra was performed. Pathologically, vascular proliferation of the angioma-tous type with thrombosis and focal recanolization (Masson) and inclusion of rare muscular fibers were recognized. Her postoperative course was uneventful, without any recurrence or abnormal micturition. CONCLUSION: For the treatment of strangulated urethral prolapse, surgical excision has been widely applied with successful results.

[Bladder adenocarcinoma. Case report]. / Adenocarcinoma vesical. Aportación de un caso clínico.

OBJECTIVE: Primary bladder adenocarcinoma is a rare entity. We performed a review of the literature on this subject and present a clinical case. METHOD/RESULTS: A 74 year old female patient presents to the emergency department with complaints of gross hematúria not accompanied by lower urinary tract symptoms. Diagnostic work-up included renal and bladder ultrasound, cistoscopy and abdomino-pelvic C. T. scan. Metastatic disease was excluded. Trans-urethral resection revealed an invasive adenocarcinoma. A gynaecologic origin was excluded by further gynaecologic examination and an anterior pelvic exanteration was performed. The bladder specimen showed primary bladder adenocarcinoma, pT3aNO. At 6 months of follow-up, the patient does not present disease progression or surgical complications. CONCLUSION: Primary bladder adenocarcinoma is rare. Unlike urothelial carcinoma, it responds poorly to chemotherapy or radiotherapy Radical Cistectomy offer the best chance of long-term survival.

Prolapso uretral encarcerado. A propósito de un caso clínico / Strangulated urethral prolapse. Case report

Objetivo: Presentar un caso clínico de prolapso de la mucosa uretral encarcerado. Métodos/Resultados: Paciente del sexo femenino de 62 años de edad. Acude al Servicio de urgencias por masa vaginal sangrante acompañada de dolor, localizada en el introioto vaginal y disuria. Después del diagnóstico de prolapso de la mucosa uretral encarcerado, se sometió a exéresis quirúrgica del mismo. El examen histológico reveló uretra con proliferación vascular de tipo angiomatoso con trombosis y recanalización focal (Masson) e inclusión de raros fascículos de fibras musculares. El postoperatorio recorre sin incidencias, no recurrencias o problemas miccionales. Conclusión: Para el tratamiento del prolapso uretral encarcerado, la exéresis quirúrgica es el «gold stardard» (AU)

Objective: We report a case of strangulated urethral prolapse. Method/Results: A 62 year old female patient presents to the emergency department with complaints of a bleeding vaginal mass, pain referred to the vaginal introitus and dysuria. After being diagnosed with a strangulated urethral prolapse, surgical excision of the prolapsed urethra was performed. Pathologically, vascular proliferation of the angiomatous type with thrombosis and focal recanalization (Masson) and inclusion of rare muscular fibers were recognized. Her postoperative course was uneventful, without any recurrence or abnormal micturition. Conclusion: For the treatment of strangulated urethral prolapse, surgical excision has been widely applied with successful results (AU)

Adenocarcinoma vesical. Aportación de un caso clínico / Bladder adenocarcinoma. Case report

Objetivo: El adenocarcinoma primario de vejiga es una entidad rara. Realizamos una revisión de la literatura y presentamos un caso clínico. Métodos/Resultados: Se trata de una paciente del sexo femenino de 74 años de edad que acude al servicio de urgencias por hematuria macroscópica, sin otra sinto matología acompañante. Se sometió a varios exámenes auxiliares de diagnóstico, incluyendo ecografía renal y vesical, cistoscopia y TAC abdominal y pélvico. Después de la realización de resección transuretral de pólipo vesical y frente al diagnóstico de adenocarcinoma músculo invasivo, se somete a una evaluación ginecológica completa, excluyendo enfermedad ginecológica. Se procede a exanteración pélvica anterior. El informe anatomo patológico muestra un adenocarcinoma vesical primario, pT3aN0, con ganglios linfáticos regionales negativos. Después de 6 meses de seguimiento, la paciente no presenta complicaciones resultantes de la cirugía o evidencia de evolución de su enfermedad. Conclusión: El Adenocarcinoma vesical primario es una entidad rara. Al contrario del carcinoma urotelial, responde mal a la quimioterapia y radioterapia, por lo que el único tratamiento eficaz es la cirugía radical (AU)

Objective: Primary bladder adenocarcinoma is a rare entity. We performed a review of the literature on this subject and present a clinical case. Method/Results: A 74 year old female patient presents to the emergency department with complaints of gross hematúria not accompanied by lower urinary tract symptoms. Diagnostic work-up included renal and bladder ultrasound, cistoscopy and abdomino-pelvic C.T. scan. Metastatic disease was excluded. Trans-urethral resection revealed an invasive adenocarcinoma. A gynaecologic origin was excluded by further gynaecologic examination and an anterior pelvic exanteration was performed. The bladder specimen showed primary bladder adenocarcinoma, pT3aN0. At 6 months of follow-up, the patient does not present disease progression or surgical complications. Conclusion: Primary bladder adenocarcinoma is rare. Unlike urothelial carcinoma, it responds poorly to chemotherapy or radiotherapy. Radical Cistectomy offer the best chance of long-term survival (AU)

Stability of triglyceride liquid films on hydrophilic and hydrophobic glasses.

Wetting and dewetting of solid surfaces by oily fluids were investigated in terms of the stability of the liquid film formed between an air bubble and the solid surface. With the objective of understanding how molecules with low polarity but relatively complex molecular structure behave at the solid/liquid interface, three liquid triglycerides with different chain length and saturation were chosen, namely, tributyrin, tricaprylin, and triolein. Tributyrin and tricaprylin exist in milkfat while triolein is present in vegetable oils. The stability of the liquid films may be inferred from the shape of the disjoining pressure isotherms, which represent the dependence of the disjoining pressure on the film thickness. Disjoining pressure isotherms for films of the three triglycerides on hydrophilic and hydrophobic glasses were obtained using a recently developed apparatus, based on the interferometric technique. The experimental curves are compared with the theoretical predictions of London-Hamaker. The deviations between theory and experiment are interpreted in terms of a structural component of the disjoining pressure. All triglycerides form metastable films on both hydrophilic and hydrophobic glasses which means that for disjoining pressures higher than a critical value, pi(c), a wetting transition occurs and the film ruptures. The mechanisms for film rupture are discussed and a correlation between film stability and the apolar (Lifshitz-van der Waals) and the polar components of the spreading coefficient is proposed.

A new method for bidimensional analysis of interferometric patterns of liquid films.

A new method for bidimensional analysis of interferometric patterns of wetting liquid films obtained with the captive bubble technique is described. This method replaces one-dimensional analysis along various intensity profiles with analysis of one average intensity profile. The advantage is to concentrate the surface characteristics of the whole film image into a single intensity profile.

Wetting films of polar and nonpolar liquids.

Disjoining pressure isotherms for water and n-octane films on glass obtained using a recently developed apparatus, based on the interferometric technique, are compared with other values reported in the literature. Our method, including a simple cleaning procedure, yields experimental results in excellent agreement both with other experimental results and with theoretical predictions. An error analysis was made which quantifies the uncertainty of our results and simultaneously allows the minimization of the errors.

Médico de família / The family doctor

O autor ressalta o papel do médico de família em termos da qualidade do relacionamento médico-paciente e da alta resolubilidade no tocante à maioria dos problemas de saúde. Enfatiza que tanto o serviço público quanto o privado ressentem-se da carência desse profissional, o primeiro por näo valorizá-lo e, o segundo, sufocado pela maré montante de especializaçöes e pedidos de exames, mesmo para atos simples, resolvíveis pelo médico de família