Whipple's Disease: A Challenging Diagnosis.

Whipple's disease (WD) is a chronic multisystemic infection caused by Tropheryma whipplei. It is a rare condition with a wide spectrum of clinical presentations, necessitating a high clinical suspicion to arrive at the diagnosis. We present the case of a 65-year-old woman who experienced chronic, intermittent, and migratory polyarthralgia, weight loss, anorexia, and pyrosis. She was admitted due to bilateral deep vein thrombosis (DVT). She exhibited lymphadenopathy without hepatosplenomegaly, and lymph node biopsy revealed reactive lymphadenitis with intrahistiocytic bacilli that reacted positively to periodic acid-Schiff staining. This led to the suspicion of WD, which was subsequently confirmed through small bowel biopsies. She initiated treatment with ceftriaxone and experienced rapid clinical improvement. WD poses a diagnostic challenge. The signs and symptoms are often nonspecific and can result in misdiagnosis as a rheumatic or neoplastic disease. The presentation with DVT, while unusual, has been reported as a manifestation of WD.

A Case Report of Whipple's Disease: A Challenging Diagnosis.

Whipple's disease is caused by a ubiquitous Gram-positive bacillus, Tropheryma whipplei. The disease is extremely rare, with only 1,000 cases reported worldwide. Classic Whipple's disease is characterized by a multisystemic involvement with joint (arthralgias) and gastrointestinal (abdominal pain, diarrhea, and weight loss) symptoms.  We present a case of a 48-year-old male who had a constitutional syndrome associated with an exuberant bilateral pleural effusion. The small bowel biopsy identified a rod-shaped bacterial cologne in the macrophage cytoplasm, positive for periodic acid-Schiff (PAS) staining, and the polymerase chain reaction (PCR) exam identified the DNA of Tropheryma whipplei. The patient was medicated with two weeks of endovenous antibiotherapy with ceftriaxone 2 g per day, followed by one year of oral trimethoprim 160 mg and sulfamethoxazole 800 mg twice daily. He presented good evolution with total resolution of symptoms.

Stability and Change in Adolescents' Sense of Agency: Contributions of Sex, Multiple Risk, Pandemic Stress, and Attachment to Parents.

Although literature states that individual, relational, and contextual factors contribute to adolescents' sense of agency, more research is needed to clarify and understand how adolescents develop this belief over time. The current study examined the stability/change trajectories of the sense of agency during adolescence, specifically across high school, analyzing whether attachment to parents over time, adolescents' sex, cumulative risk in baseline, and pandemic-related stress explained these trajectories. The sample included 467 Portuguese adolescents (40.7% were males; Mage = 15.58 years, SD = 0.80), evaluated three times across 18 months. This work yielded three significant findings. First, adolescents' sense of agency significantly increased over time, with significant between-subject variance at the initial levels but not at the growth rate. Second, attachment to parents consistently links to adolescents' sense of agency across time, despite the differential contributions from attachment to mothers and fathers. Third, boys reported greater growth in the sense of agency than girls. Adolescents' cumulative risk at T1 predicted lower initial levels of sense of agency, whereas higher pandemic-related stress predicted less growth of the sense of agency. These findings emphasize the contributions of individual and family characteristics and the role of the broader social context in shaping the development of adolescents' sense of agency. The findings underline the need to consider further the differential influences of adolescents' relationships with mothers and fathers to understand changes in adolescents' sense of agency.

Eagle's Syndrome Presenting as Peripheral Facial Palsy.

Eagle's syndrome (ES) is the elongation of the ossified styloid process that causes symptoms such as foreign body sensation, neck pain, and odynophagia. A styloid process greater than 25 mm in length should be considered abnormal. Facial palsy is a condition that affects the facial nerve and results in weakness or total paralysis of the facial muscles that control expression. Here, we describe a rare presentation of ES presenting as facial palsy. We present the case of a 62-year-old female who was admitted to the emergency department with right peripheral facial palsy. A computed tomography (CT) scan of the neck confirmed the diagnosis. The patient underwent conservative management and physical therapy, which resulted in good evolution with an improvement of symptoms. She was referred to the otorhinolaryngologist for surgical evaluation.

Parental meta-emotion, attachment to parents, and personal agency in adolescents.

Guided by attachment theory, we explored in the present study the links between parental emotion-coaching, attachment to parents, and adolescent's sense of agency. Further, we examined a possible mediating role of adolescent's attachment to parents in the association between parental emotion-coaching and sense of agency. All models control for cumulative psychosocial risk, and adolescents' sex and age, and take into account the reports of both mothers and fathers. The sample included 501 Portuguese families comprising adolescents, their mothers, and their fathers. Adolescents (ages ranged from 15 to 18) reported on their attachment to parents, personal agency, and cumulative psychosocial risk, whereas mothers and fathers independently completed a questionnaire assessing their meta-emotion skills. The results indicate that both mothers' and fathers' emotional-coaching are positively associated with the quality of adolescent's attachment to parents. Nonetheless, parental emotion-coaching are not directly associate with sense of agency. The quality of emotional bond with father is linked to a more positive sense of agency, while relationships characterized by mother's inhibition of adolescent's exploration are associated with less positive perceptions of agency. Parental emotion-coaching seems to be associated with the sense of personal agency through the quality of attachment to parents. These results are discussed according to attachment theory taking into account the parents' importance to adolescents' development. Our findings provide a first attempt to unravel the possible links between parental emotion-coaching, attachment to parents, and sense of agency; nevertheless, they need to expand. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Case Report: Pure Red Cell Aplasia due to Angioimmunoblastic T-Cell Lymphoma.

Pure red cell aplasia (PRCA) is a rare bone marrow failure characterized by a progressive normocytic anemia and reticulocytopenia without leukopenia and thrombocytopenia. It can be associated with various hematological disorders but exceedingly rarely with angioimmunoblastic T-cell lymphoma (AITL). We report the case of a 72-year-old woman with PRCA associated with AITL. The patient presented with severe anemia (hemoglobin 2.6 g/dL) and a low reticulocyte count 0.7%. Direct and indirect Coombs tests were positive. A CT scan of the chest, abdomen, and pelvis revealed multiple lymphadenopathies. A cervical lymph node biopsy was compatible with AITL. A bone marrow biopsy showed medullary involvement by AITL and a severe erythroid hypoplasia with a myeloid:erythroid ratio of 19.70. The patient was started on CHOP and after 6 cycles the PET scan confirmed complete remission.

Complicaciones neonatales a corto plazo de los partos por ventosa. Estudio caso-control / Short-term neonatal outcomes of vacuum-assisted delivery. A case-control study

Introducción: El objetivo fue comparar la morbimortalidad neonatal de los partos vaginales por ventosa con los restantes partos vaginales e identificar los factores de riesgo. Material y métodos: Realizamos un estudio caso-control, retrospectivo, en un hospital con servicios de neonatología y cuidados intensivos neonatales, entre 2012 y 2016, con inclusión de 1.802 partos vaginales con ventosa, 1.802 partos eutócicos y 909 partos con fórceps. Se consideraron complicaciones menores (traumatismo de tejidos blandos, cefalohematoma, ictericia, fototerapia doble, lesión transitoria del plexo braquial) y mayores (encefalopatía hipóxico-isquémica, hemorragia intracraneal y subgaleal, convulsión, fractura craneal, lesión permanente del plexo braquial), ingreso en la Unidad de Cuidados Intensivos Neonatales y fallecimiento. Resultados: El riesgo de traumatismo de los tejidos blandos (ORa 2,4; p < 0,001), cefalohematoma (ORa 5,5; p < 0,001), ictericia (ORa 4,4; p < 0,001), fototerapia doble (ORa 2,1; p < 0,001) y lesión transitoria del plexo braquial (ORa 2,1; p = 0,006) fue mayor en los partos con ventosa en comparación con los eutócicos. El ingreso en la Unidad de Cuidados Intensivos Neonatales también fue mayor en los partos con ventosa que en los eutócicos (OR 1,9; p = 0,001). En comparación con los partos con fórceps, también se ha comprobado un mayor riesgo de traumatismo de los tejidos blandos (OR 2,1; p = 0,004), cefalohematoma (OR 2,2; p = 0,046) e ictericia (OR 1,4; p = 0,012) en los partos con ventosa. Los partos con ventosa presentaron mayor incidencia de complicaciones mayores que los restantes partos vaginales, pero la diferencia no fue significativa. Las 2 muertes ocurrieron en partos con ventosa (1,1 por 1.000). Conclusión: Las tasas de complicaciones neonatales menores fueron más altas en el parto con ventosa. Aunque las complicaciones mayores y la muerte también fueron más frecuentes, fueron poco comunes y no mostraron diferencias significativas. El parto con ventosa es una técnica con indicación obstétrica, pero que debe alertar sobre la necesidad de vigilancia de posibles complicaciones neonatales

Introduction: The purpose of this study was to assess the neonatal morbidity and mortality associated with vacuum-assisted vaginal deliveries compared to all other vaginal deliveries, and to identify the associated risk factors. Material and methods: We conducted a retrospective case-control study in a level iii maternity hospital between 2012 and 2016, including 1,802 vacuum-assisted vaginal deliveries and 2 control groups: 1802 spontaneous deliveries and 909 forceps-assisted deliveries. We considered minor complications (soft tissue trauma, cephalohaematoma, jaundice, intensive phototherapy, transient brachial plexus injury) and major complications (hypoxic-ischaemic encephalopathy, intracranial and subgaleal haemorrhage, seizures, cranial fracture, permanent brachial plexus injury), admission to the neonatal intensive care unit and death. Results: The risk of soft tissue trauma (aOR, 2.4; P < .001), cephalohaematoma (aOR, 5.5; P < .001), jaundice (aOR, 4.4; P < .001), intensive phototherapy (aOR, 2.1; P < .001) and transient brachial plexus injury (aOR; 2.1, P = .006) was higher in vacuum deliveries compared to spontaneous deliveries. Admission to the neonatal intensive care unit was also higher in vacuum deliveries compared to spontaneous deliveries (OR, 1.9; P = .001). When we compared vacuum with forceps deliveries, we found a higher risk of soft tissue trauma (OR, 2.1; P=.004), cephalohaematoma (OR, 2.2, P = .046) and jaundice (OR, 1.4; P = .012). Major complications were more frequent in the vacuum group comparing with the control groups, but the difference was not significant. The 2deaths occurred in vacuum deliveries (1.1 per 1000). Conclusion: The proportion of minor neonatal complications was higher in the vacuum-assisted delivery group. Although major complications and death were also more frequent, they were uncommon, with no significant differences compared to the other groups. There are obstetrical indications for vacuum delivery, but it should alert to the need to watch for potential neonatal complications

[Short-term neonatal outcomes of vacuum-assisted delivery. A case-control study]. / Complicaciones neonatales a corto plazo de los partos por ventosa. Estudio caso-control.

INTRODUCTION: The purpose of this study was to assess the neonatal morbidity and mortality associated with vacuum-assisted vaginal deliveries compared to all other vaginal deliveries, and to identify the associated risk factors. MATERIAL AND METHODS: We conducted a retrospective case-control study in a level iii maternity hospital between 2012 and 2016, including 1,802 vacuum-assisted vaginal deliveries and 2control groups: 1802 spontaneous deliveries and 909 forceps-assisted deliveries. We considered minor complications (soft tissue trauma, cephalohaematoma, jaundice, intensive phototherapy, transient brachial plexus injury) and major complications (hypoxic-ischaemic encephalopathy, intracranial and subgaleal haemorrhage, seizures, cranial fracture, permanent brachial plexus injury), admission to the neonatal intensive care unit and death. RESULTS: The risk of soft tissue trauma (aOR, 2.4; P<.001), cephalohaematoma (aOR, 5.5; P<.001), jaundice (aOR, 4.4; P<.001), intensive phototherapy (aOR, 2.1; P<.001) and transient brachial plexus injury (aOR; 2.1, P=.006) was higher in vacuum deliveries compared to spontaneous deliveries. Admission to the neonatal intensive care unit was also higher in vacuum deliveries compared to spontaneous deliveries (OR, 1.9; P=.001). When we compared vacuum with forceps deliveries, we found a higher risk of soft tissue trauma (OR, 2.1; P=.004), cephalohaematoma (OR, 2.2, P=.046) and jaundice (OR, 1.4; P=.012). Major complications were more frequent in the vacuum group comparing with the control groups, but the difference was not significant. The 2deaths occurred in vacuum deliveries (1.1 per 1000). CONCLUSION: The proportion of minor neonatal complications was higher in the vacuum-assisted delivery group. Although major complications and death were also more frequent, they were uncommon, with no significant differences compared to the other groups. There are obstetrical indications for vacuum delivery, but it should alert to the need to watch for potential neonatal complications.

A LysM Domain Intervenes in Sequential Protein-Protein and Protein-Peptidoglycan Interactions Important for Spore Coat Assembly in Bacillus subtilis.

At a late stage in spore development in Bacillus subtilis, the mother cell directs synthesis of a layer of peptidoglycan known as the cortex between the two forespore membranes, as well as the assembly of a protective protein coat at the surface of the forespore outer membrane. SafA, the key determinant of inner coat assembly, is first recruited to the surface of the developing spore and then encases the spore under the control of the morphogenetic protein SpoVID. SafA has a LysM peptidoglycan-binding domain, SafALysM, and localizes to the cortex-coat interface in mature spores. SafALysM is followed by a region, A, required for an interaction with SpoVID and encasement. We now show that residues D10 and N30 in SafALysM, while involved in the interaction with peptidoglycan, are also required for the interaction with SpoVID and encasement. We further show that single alanine substitutions on residues S11, L12, and I39 of SafALysM that strongly impair binding to purified cortex peptidoglycan affect a later stage in the localization of SafA that is also dependent on the activity of SpoVE, a transglycosylase required for cortex formation. The assembly of SafA thus involves sequential protein-protein and protein-peptidoglycan interactions, mediated by the LysM domain, which are required first for encasement then for the final localization of the protein in mature spores.IMPORTANCEBacillus subtilis spores are encased in a multiprotein coat that surrounds an underlying peptidoglycan layer, the cortex. How the connection between the two layers is enforced is not well established. Here, we elucidate the role of the peptidoglycan-binding LysM domain, present in two proteins, SafA and SpoVID, that govern the localization of additional proteins to the coat. We found that SafALysM is a protein-protein interaction module during the early stages of coat assembly and a cortex-binding module at late stages in morphogenesis, with the cortex-binding function promoting a tight connection between the cortex and the coat. In contrast, SpoVIDLysM functions only as a protein-protein interaction domain that targets SpoVID to the spore surface at the onset of coat assembly.

SpoVID functions as a non-competitive hub that connects the modules for assembly of the inner and outer spore coat layers in Bacillus subtilis.

During sporulation in Bacillus subtilis, a group of mother cell-specific proteins guides the assembly of the coat, a multiprotein structure that protects the spore and influences many of its environmental interactions. SafA and CotE behave as party hubs, governing assembly of the inner and outer coat layers. Targeting of coat proteins to the developing spore is followed by encasement. Encasement by SafA and CotE requires E, a region of 11 amino acids in the encasement protein SpoVID, with which CotE interacts directly. Here, we identified two single alanine substitutions in E that prevent binding of SafA, but not of CotE, to SpoVID, and block encasement. The substitutions result in the accumulation of SafA, CotE and their dependent proteins at the mother cell proximal spore pole, phenocopying a spoVID null mutant and suggesting that mislocalized SafA acts as an attractor for the rest of the coat. The requirement for E in SafA binding is bypassed by a peptide with the sequence of E provided in trans. We suggest that E allows binding of SafA to a second region in SpoVID, enabling CotE to interact with E and SpoVID to function as a non-competitive hub during spore encasement.

Parenting Styles and Dimensions Questionnaire - Adaptação da Versão Portuguesa de Heterorrelato / Parenting Styles and Dimensions Questionnaire - Adaption of the Observer Reporting Version to the Portuguese Population / Parenting Styles and Dimensions Questionnaire - Adaptación de la Versión Portuguesa de Heteroinforme

Resumo O presente estudo procura analisar as propriedades psicométricas do Parenting Styles and Dimension Questionnaire (PSDQ) e adaptar para a população portuguesa a sua versão de heterorrelato. A amostra foi constituída por 604 adolescentes com idades entre os 15 e os 18 anos (M=15.99, DP=.97). A confiabilidade foi avaliada através do alfa de Cronbach, que revelou índices de .86/.81 para a totalidade do instrumento na versão do pai e da mãe respetivamente, e índices que variaram entre .48A85 para as respetivas subescalas. A análise fatorial confirmatória evidenciou que os índices de ajustamento apresentaram valores desajustados. Confirmou-se a estrutura original do instrumento organizada em três fatores mediante as análises de componentes principais que revelaram a presença de um item do estilo permissivo a saturar noutro fator. Através da análise semântica deste item e da sua respetiva reorganização, verificaram-se índices de ajustamento adequados. Propõe-se a nova estrutura fatorial do PSDQ por se considerar que é mais ajustada à cultura portuguesa.

Abstract This study aimed to analyze the psychometric properties of the Parenting Styles and Dimensions Questionnaire (PSDQ) and adapts its observer reporting version to the Portuguese population. The sample consisted of 604 adolescents 15 to 18 years old (M=15.99, SD=.97). Reliability as measured by Cronbach's alpha revealed indices of .86/.81 for the totality of the instrument in the father and mother version respectively, with indices that varied between .48A85 for the respective subscales. The Confirmatory Factor Analysis indicated mismatched values for the goodness of fit indices. The analysis of principal components study confirmed the original structure of the instrument organized in three factors that revealed the presence of a permissive item saturating into another factor. Semantic analysis of this item and its respective reorganization verified adequate goodness of fit indices. The new factor structure of the PSDQ is proposed as more adjusted to the Portuguese culture.

Resumen El presente estudio busca analizar las propiedades psicométricas del Parenting Styles and Dimensions Questionnaire (PSDQ) y adaptar su versión de heterorrelato a la población portuguesa. La muestra se constituyó por 604 adolescentes con edades entre los 15 y los 18 años (M=15.99,dP=.97). La fiabilidade se evaluó por medio del alfa de Cronbach, que reveló índices de .86/.81 para la totalidad del instrumento en la versión del padre y de la madre respectivamente, e índices que variaron entre .48A85 para las respectivas subescalas. El análisis factorial confirmatorio evidenció que los índices de ajustamiento presentaron valores desajustados. Se confirmó la estructura original del instrumento organizada en tres factores mediante los análisis de componentes principales que revelaron la presencia de un ítem del estilo permisivo a saturar en otro factor. Por medio del análisis semántico de este ítem y su respectiva reorganización, se verificaron índices de ajustamiento adecuados. Se plantea la nueva estructura factorial del PSDQ porque se considera que es más ajustada a la cultura portuguesa.

Informação médica e consentimento de pessoas com câncer / Medical information and consent for cancer patients / La información médica y el consentimiento de las personas con cáncer

Resumo A forma como pessoas com câncer acedem à informação de saúde e o impacto deste conhecimento na tomada de decisão constituem questão de interesse fulcral para este grupo. Esta pesquisa objetiva promover reflexão crítica sobre valores de natureza pessoal, profissional e da sociedade em geral; identificar princípios éticos subjacentes à tomada de decisão; analisar a relação profissional-pessoa doente; caracterizar a tomada de decisão; e quantificar a informação fornecida aos usuários. Trata-se de estudo quantitativo e exploratório, realizado mediante aplicação de questionário Easy-Care e QLQ - INFO25 em amostra de 20 pessoas com câncer. Verificou-se déficits na informação adequada às necessidades das pessoas com câncer nas áreas da autogestão da doença, do uso de determinados serviços (fisioterapia, psicologia) e da influência da doença/tratamento nos ambientes social e familiar.

Abstract The way people with cancer access health information and the impact such knowledge has on decision-making is a matter of crucial interest in this group. This research intends to promote a critical reflection on personal, professional values and of society in general; to identify underlying ethical principles to decision making; to analyze the professional relationship with the sick person; to characterize the decision making and quantify the information provided to users. It is a quantitative, exploratory study with application of Easy-Care questionnaire, and QLQ - INFO25 in a sample of 20 people with cancer. It was observed deficits in adequate information to the needs of people with cancer in the fields of self-management of the disease; use of certain services (physical therapy, psychology) and the influence of the disease/treatment in social and family environment.

Resumen La forma en que las personas con cáncer acceden a la información sobre la salud y el impacto que este conocimiento tiene en la toma de decisiones constituyen un asunto de interés fundamental para este grupo. Esta investigación tiene como objetivo promover la reflexión crítica sobre valores de índole personal, profesional y de la sociedad en general; identificar los principios éticos subyacentes a la toma de decisiones; analizar la relación entre el profesional y el paciente; caracterizar la toma de decisiones y cuantificar la información facilitada a los usuarios. Se trata de un estudio cuantitativo, exploratorio, realizado por medio de la aplicación del cuestionario Easy-Care y QLQ - INFO25 en una muestra de 20 personas con cáncer. Se verificó un déficit en la información adecuada a las necesidades de las personas con cáncer en las áreas de la autogestión de la enfermedad, de la utilización de ciertos servicios (fisioterapia, psicología) y de la influencia de la enfermedad/tratamiento en el entorno social y familiar.

The role of ultrasound in the prediction of birth weight discordance in twin pregnancies: are we there yet?

OBJECTIVE: To analyze the accuracy of ultrasound prediction of birth weight discordance (BWD) and the influence of chorionicity and fetal growth restriction (FGR) on ultrasound performance. METHODS: Retrospective analysis of 176 twin pregnancies at a Portuguese tertiary center, between 2008 and 2014. Last ultrasound biometry was recorded. Cases with delivery before 24 weeks, fetal malformations, interval between last ultrasound and deliver >3 weeks, twin-to-twin transfusion syndrome and monoamniotic pregnancies were excluded. The accuracy of prediction of BWD was assessed using the area under the receiver-operating characteristics curve (AUC). RESULTS: BWD ≥20% was present in 21.6% of twin pregnancies. EBW had the best predictive performance for BWD (AUC 0.838, 95%CI 0.760-0.916), with a negative predictive value of 86.9% and a positive predictive value of 51.3%. Chorionicity did not influence ultrasound performance. None of the biometric variables analyzed was predictive of BWD in pregnancies without FGR. CONCLUSION: The accuracy of ultrasound in the prediction of BWD is limited, particularly in pregnancies without fetal growth restriction. Clinical decisions should not rely on BWD alone.

Contraception in adolescents with intellectual disability.

OBJECTIVES: The aims of the study were to investigate the reasons for first gynaecological consultation in adolescents with intellectual disability (ID) and assess how contraception is prescribed with regard to the different contraceptive methods, their medical indications, adverse effects and compliance, in comparison with a group of adolescents without ID. METHODS: A retrospective case-control study was conducted among 200 adolescents with ID (group A) and a control group of 200 adolescents without ID (group B). RESULTS: The main reasons for gynaecological consultation in group A were 'need for contraception' (46.5% in group A vs 32.0% in group B, p = .003) and abnormal uterine bleeding (42.0% in group A vs 27.0% in group B, p = .002). Contraception was prescribed in 80.0% of the adolescents in both groups. Combined oral contraception was prescribed in 83.1% in group A vs. 91.3% in group B (p = .03). The transdermal patch was more prevalent in group A (6.3% vs. 0.6% in group B, p = .006). Other contraceptive methods were similar between the two groups. In group B there were 5.0% unintended pregnancies vs no cases in group A (p = .001). Sexual abuse occurred similarly in both groups (2.5% in group A vs 2.0% in group B, p = not significant). CONCLUSION: The need for contraception in adolescents with ID is a frequent reason for gynaecological consultation, despite their younger age and lower number who are sexually active. Combined oral contraception is the most prescribed method in adolescents with ID; however, the transdermal patch also plays an important role in this group.

Induction of labour vs. spontaneous vaginal delivery in twin pregnancy after 36 weeks of gestation.

Time for delivery and delivery pathway in twin pregnancies are still in great debate. Our study goal was to compare the characteristics of delivery and maternal-foetal outcome in uncomplicated near-term twin pregnancies undergoing labour induction and those with spontaneous labour. We found no statistical differences in patients with twin pregnancies who underwent labour induction and those with spontaneous labour regarding the history of previous caesarean delivery, parity, pregnancy achieved by assisted reproductive techniques (ART), chorionicity and cervical dilation at the admission as well as maternal and neonatal morbidity, and admission to the neonatal intensive care unit. There were significant differences in the caesarean section rate (60.6 vs. 33.3%, p < .05) and the time interval between delivery of the first and second foetus (9.8 vs. 11.7 min, p = .024). There was an increased incidence of caesarean section after the induction of labour. However, it appears to be a safe option.

Vinculação aos pais, competências sociais e ideação suicida em adolescentes / Attachment to parents, social skills and suicidal ideation in adolescents / Vinculación a los padres, habilidades sociales e ideación suicida en adolescentes

O presente estudo, de natureza quantitativa, teve como principal objetivo analisar o papel da vinculação aos pais e das competências sociais no desenvolvimento de ideação suicida em adolescentes. A amostra foi constituída por 604 indivíduos, com idades entre os 15 e os 18 anos de idade. Para a recolha dos dados, recorreu-se ao Questionário de Vinculação ao Pai e à Mãe (QVPM), ao Social Skills Questionnaire (SSQ) e ao Questionário de Ideação Suicida (QIS). Os resultados apontam para uma predição negativa da qualidade do laço emocional ao pai e da assertividade face à ideação suicida, assim como para a predição positiva da inibição da exploração da individualidade da mãe face à ideação suicida. Os resultados foram discutidos à luz da teoria da vinculação, assumindo a relevância das figuras de afeto na forma como os jovens desenvolvem competências sociais e estão mais capazes de ultrapassar as dificuldades, prevenindo o desenvolvimento de ideações suicidas

This study, of quantitative nature, had as main objective analyze the role of attachment to parents and social skills in the development of suicidal ideation in adolescents. The sample comprised 604 individuals, aged between 15 and 18 years old. For data collection we resorted to the Questionário de Vinculação ao Pai e à Mãe (QVPM), Social Skills Questionnaire and Questionário de Ideação Suicida. The results suggest a negative prediction of the quality of emotional bond to father and assertiveness in relation to suicidal ideation, as well as for the positive prediction of inhibiting mother's exploration of individuality to suicide ideation. The results were discussed based on attachment theory, assuming the relevance of affection figures in the way how adolescents develop social skills, and are more able of overcome the difficulties, preventing suicidal ideation

Este estudio, de naturaleza cuantitativa, tuvo como principal objetivo analizar el papel de la vinculación a los padres y de las habilidades sociales en el desarrollo de ideación suicida en los adolescentes. La muestra se constituyó con 604 individuos, con edades comprendidas entre 15 y 18 años de edad. Para la recolección de los datos, se utilizó el Questionário de Vinculação ao Pai e à Mãe (QVPM), el Social Skills Questionnaire (SSQ) y el Questionário de Ideação Suicida (QIS). Los resultados apuntan a una predicción negativa de la calidad del vínculo emocional con su padre y la asertividad en relación a la ideación suicida, así como para la predicción positiva de la inhibición de la exploración de la individualidad de la madre en la ideación suicida. Los resultados fueron discutidos a luz de la teoría de la vinculación, asumiendo la relevancia de los cuidadores en la forma cómo los jóvenes desarrollan habilidades sociales y están más capaces de superar las dificultades, evitando el progreso de las ideaciones suicidas

Monochorionic versus dichorionic twins: Are obstetric outcomes always different?

This prospective cohort study compared obstetric, perinatal and postpartum outcomes of monochorionic diamniotic (n = 228) versus (vs.) dichorionic (n = 598) twin pregnancies. Statistical analysis was performed using software SPSS® v19.0.0.2. Chi square, Fischer's exact, Student's t and Mann-Withney tests were applied. Obstetrical complications rates were 85.5% vs. 75.1% (p < 0.01). Differences were found in preterm premature rupture of membranes (26.3% vs. 19.3%, p < 0.05) and intrauterine growth restriction (19.7% vs. 10.5%, p < 0.01). Twin-to-twin transfusion syndrome (TTTS) occurred in 7.9% of monochorionic pregnancies. Vaginal delivery occurred in 47.4% vs. 43.1%. Monochorionic pregnancies had earlier gestational ages at delivery and subsequently lower birthweights (p < 0.01). There was no difference in Apgar scores. Admission rate of at least one of the newborns in intensive care unit (NICU) was 50% vs. 38.9% (p < 0.05). Postpartum complications were similar. These results were the same excluding TTTS cases, except for admission in NICU (46.8% vs. 34.9%, p > 0.05). Analysing only the uncomplicated pregnancies (33 vs. 149), there were no differences in perinatal outcomes. We conclude that monochorionic pregnancies had higher rates of obstetrical complications, which were independent of TTTS occurrence in our sample. However, considering only the uncomplicated pregnancies till delivery, there were no significant differences in perinatal outcomes.

Hirsutismo pós-menopausa: caso clínico raro de hipertecose ovárica / Post-menopausal hirsutism: a rare case of ovarian hyperthecosis

Durante o climatério podem ocorrer sinais clínicos de hiperandroginismo. Contudo quadros de virilização exigem investigação para exclusão de uma fonte produtora de androgênios. Doente de 66 anos, com menopausa espontânea aos 50, referenciada à consulta de ginecologia por hirsutismo após a menopausa, com agravamento no último ano e episódios demetrorragia que não valorizava. Ao exame objetivo tinha masculinização da voz, alopécia androgênica, aumento da pilosidade na face, tronco e membros e hipertrofia do clitóris.Feita ecografia endovaginal que revelou espessamento endometrial e ovários aumentados de volume para a idade; estudo analítico que demonstrou um valor de testosterona total elevado (225ng/dL); tomografia computadorizada da suprarrenal e ressonância magnética crânio-encefálica que não revelaram alterações; e histeroscopia com remoção de pólipo endometrial, associado a hiperplasia endometrial simples sem atipia. Submetida a histerectomia total com anexectomia bilateral. O estudo histológico concluiu tratar-se de hipertecose ovárica. Seis meses após a cirurgia apresentava normalização da testosterona sérica, acentuada redução do hirsutismo e melhoria da alopécia.O diagnóstico de hiperandrogenismo em mulheres na pós-menopausa constitui um desafio. Os meios complementares de diagnóstico nem sempre permitem detectar a origem da hiperandrogenemia. O tratamento da hipertecose ovárica melhora o hirsutismo e pode reduzir o risco de patologia maligna hormonodependente.

tMild clinical signs of hyperandrogenism such as hirsutism may arise during the menopausal transition as part of the aging process. However, development of virilization may be interpreted as the presence a specific source of androgen excess. 66 year-old menopausal woman, with a record of progressive hirsutism since menopausal age (50 years-old) exacerbated over the past year. Episodes of metrorrhagia were not valued by the patient. Physical examination showed deepening of voice, frontotemporal alopecia, hirsutism in face, trunk and limbs and hypertrophy of the clitoris. A transvaginal ultrasound revealed a thickened endometrium and enlarged ovaries considering her age and analytical study showed an increase of total testosterone (225ng/dL). No changes were detected at computerized tomography of adrenals and cerebral magnetic resonance. Performed an hysteroscopy with removal of endometrial polyp, associated to simple endometrial hyperplasia without atypia. The histological diagnosis after hysterectomy and bilateral salpingo-oophorectomy, revealed a ovarian hyperthecosis. Six months after surgery it was observed a testosterone within the normal range, marked hirsutism reduction and alopecia improvement.Diagnosis of hyperandrogenism in postmenopausal is a challenging task. Imaging techniques do not always reveal the source of excess androgens. The ovarian hyperthecosis treatment effectively improves hirsutism and reduces the risk of hormone-dependent tumors.

Cross-cultural adaptation and validation of the Quebec Back Pain Disability Scale to European Portuguese language.

STUDY DESIGN: Cross-cultural adaptation and psychometric testing. OBJECTIVE: To conduct the cross-cultural adaptation of the Quebec Back Pain Disability Scale (QBPDS) and investigate its reliability and validity in patients with chronic low back pain (CLBP). SUMMARY OF BACKGROUND DATA: The QBPDS is one of the most commonly used scales to evaluate functional incapacity resulting from low back pain. Although measuring disability is an important outcome in physiotherapy care, there is no previous research relating to the cultural adaptation and psychometric testing of the QBPDS in the Portuguese-speaking population. METHODS: The questionnaire was first translated and back-translated in accordance with the published guidelines. The Portuguese version of the QBPDS was then pilot tested in a Portuguese sample of 40 patients with CLBP. Psychometric properties were evaluated in a new sample of 132 patients with CLBP. Exploratory factor analysis was performed to confirm its unidimensionality. Reliability was evaluated through internal consistency and reproducibility, using the Cronbach α and intraclass correlation coefficient, respectively. Construct validity was assessed with correlations between the QBPDS and the Roland-Morris Disability Questionnaire and between the QBPDS and the visual analogue pain scale for convergent validity and pain localization for discriminative validity, using the Spearman correlation analysis and the Mann-Whitney test. RESULTS: Exploratory factor analysis revealed the existence of one major factor that explains 52.1% of the variance. One-week test-retest reliability was 0.7, and internal consistency was 0.95. The QBPDS correlated strongly with the Roland-Morris Disability Questionnaire (0.62; P < 0.001), moderately with pain (0.38; P < 0.001), and shows capability to discriminate between patients with localized and referred pain (U = 1218; P < 0.0005). CONCLUSION: The reliability and construct validity of the Portuguese version of the QBPDS are acceptable to assess functional status of Portuguese-speaking patients with CLBP. .

Physical interaction between coat morphogenetic proteins SpoVID and CotE is necessary for spore encasement in Bacillus subtilis.

Endospore formation by Bacillus subtilis is a complex and dynamic process. One of the major challenges of sporulation is the assembly of a protective, multilayered, proteinaceous spore coat, composed of at least 70 different proteins. Spore coat formation can be divided into two distinct stages. The first is the recruitment of proteins to the spore surface, dependent on the morphogenetic protein SpoIVA. The second step, known as encasement, involves the migration of the coat proteins around the circumference of the spore in successive waves, a process dependent on the morphogenetic protein SpoVID and the transcriptional regulation of individual coat genes. We provide genetic and biochemical evidence supporting the hypothesis that SpoVID promotes encasement of the spore by establishing direct protein-protein interactions with other coat morphogenetic proteins. It was previously demonstrated that SpoVID directly interacts with SpoIVA and the inner coat morphogenetic protein, SafA. Here, we show by yeast two-hybrid and pulldown assays that SpoVID also interacts directly with the outer coat morphogenetic protein, CotE. Furthermore, by mutational analysis, we identified a specific residue in the N-terminal domain of SpoVID that is essential for the interaction with CotE but dispensable for the interaction with SafA. We propose an updated model of coat assembly and spore encasement that incorporates several physical interactions between the principal coat morphogenetic proteins.