First-trimester uterine artery Doppler and hypertensive disorders in twin pregnancies: Use of twin versus singleton references.

OBJECTIVE: To determine the association of first-trimester uterine artery Doppler with hypertensive disorders of pregnancy in twin pregnancies. METHODS: This was a retrospective cohort study of twin pregnancies followed at the University Hospital Center of Central Lisbon, Portugal, between January 2010 and December 2022. First-trimester uterine artery pulsatility index (UtA-PI) was determined and compared between twin pregnancies (n = 454) and singleton pregnancies (n = 908), matched to maternal and pregnancy characteristics. Maternal characteristics and mean UtA-PI were analyzed for gestational age, birth weight, gestational hypertension, early- and late-onset pre-eclampsia, HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome, and preterm birth. Univariable and multivariable logistic regression models were used. RESULTS: The mean first-trimester UtA-PI was significantly lower in dichorionic twins than in singletons (P < 0.001). To study hypertensive disorders of pregnancy in twins, 390 pregnancies were included: 311 (79.7%) dichorionic and 79 (20.3%) monochorionic twins. The observed rates of early- and late-onset pre-eclampsia, gestational hypertension, and HELLP syndrome were 1.0%, 4.4%, 7.4%, and 1.5%, respectively. We achieved a 100% detection rate for early-onset pre-eclampsia using the UtA-PI 90th centile for twins. However, when singleton references were considered, the detection rate decreased to 50%. UtA-PI at or above the 95th centile was associated with increased odds for preterm birth before 32 weeks (adjusted odds ratio 4.1, 95% confidence interval 1.0-16.7, P = 0.043). CONCLUSIONS: Unless other major risk factors for hypertensive disorders are present, women with low UtA-PI will probably not benefit from aspirin prophylaxis. Close monitoring of all twin pregnancies for hypertensive disorders is still recommended.

Conservative management of a pregnancy complicated by preeclampsia and postpartum spontaneous hepatic rupture: A case report and review of the literature.

INTRODUCTION AND OBJECTIVES: Most spontaneous hepatic rupture cases are associated with a pregnancy-induced hypertensive disorder like preeclampsia and HELLP syndrome. Although it is a rare complication, it is still associated with high maternal and fetal morbidity and mortality rates. With this study, we aim to present a case report and review the available literature on hepatic rupture associated with hypertensive disorders of the pregnancy. METHODS: We present a case report and a review of the literature of the last 20 years on hepatic rupture associated with pregnancy-induced hypertensive disorders. The selected cases were reviewed to collect information on maternal characteristics, clinical presentation, diagnostic studies, therapeutic modalities and maternal and fetal outcomes. RESULTS: Our review has found 57 publications describing a total of 93 cases of hepatic hemorrhage with capsule rupture associated with pregnancy-induced hypertensive disorders. Most of the patients were less than 35 years old and primiparous and the first symptoms of hepatic rupture included epigastric and right upper abdominal pain. Most of the diagnoses were made during surgery without previous diagnosis and, in the majority of cases, a surgical approach was necessary to achieve hemostasis. Perihepatic packing was the most used surgical method. DISCUSSION/CONCLUSION: Our clinical case and literature review reinforces the importance of closely monitoring all pregnancies complicated with hypertensive disorders, including in the postpartum period. Although hepatic rupture accounts for high maternal and fetal morbidity and mortality rates, it is possible to keep a conservative approach with good maternal and fetal outcomes, with a high index of suspicious, an early diagnosis and a multidisciplinary approach.

Conservative Management of Asymptomatic Adnexal Masses Classified as Benign by the IOTA ADNEX Model: A Prospective Multicenter Portuguese Study.

This prospective multicentric study aiming to determine the incidence of complications (malignant transformation, torsion or rupture) during conservative management of adnexal masses was performed in two Portuguese tertiary referral hospitals. It included ≥18-year-old, non-pregnant patients with asymptomatic adnexal masses (associated IOTA ADNEX risk of malignancy < 10%) sonographically diagnosed between January 2016 and December 2020. Conservative patient management consisted of serial clinical and ultrasound assessment up to 60 months of follow-up, spontaneous resolution of the formation or surgical excision (median follow-up: 17.8; range 9-48 months). From the 573 masses monitored (328 premenopausal and 245 postmenopausal adnexal masses), no complications were observed in 99.5%. The annual lesion growth rates and increases in morphological complexity were similar in the premenopausal and postmenopausal patients. Spontaneous resolution, evidenced in 16.4% of the patients, was more common in the premenopausal group (p < 0.05). Surgical intervention was performed in 18.4% of the cases; one borderline and one invasive FIGO IA stage cancer were diagnosed. There was an isolated case of ovary torsion (0.17%). These data support conservative management as a safe option for sonographically benign, stable and asymptomatic adnexal masses before and after menopause and highlight the need for expedite treatment of symptomatic or increased-morphological-complexity lesions.

Are Soccer and Futsal Affected by the Relative Age Effect? The Portuguese Football Association Case.

A better understanding of the relative age effect (RAE) in youth will increase the awareness of the need for reducing the bias of (de)selection. Thus, we investigated the RAE in youth female and male soccer and futsal players in Portugal, using nationwide data. Birthdates of 5,306 female and 126,285 male soccer players, and 2,437 female and 23,988 male futsal players (U7-U19), registered in Portugal during the season 2019-2020, and Portuguese National teams (from U15 to AA soccer teams and from U17 to AA futsal teams) were analyzed. Data were categorized into age groups and certification levels [no certification, basic football training center, football school, and training institution] of the respective clubs/academies. Birthdates were stratified from the start of the selection year using quartiles (Q) and semesters (S). Differences between the observed and expected birthdate distributions were analyzed using chi-square statistics, and RAEs were calculated using odds ratios (OR). In both soccer and futsal, female players, in the age category U9, RAEs were found (Q1 vs. Q4, OR: 1.49 and 1.84, respectively). In male soccer, differences in the birthdate distribution were observed in all age categories (U7-U19) with significant OR between all comparisons (Q and S). In contrast, an over-representation of young male futsal players (Q1 vs. Q4) was observed only in the age categories U7 and U9 (OR: 1.54 and 1.34, respectively). The stratification by certification level showed a significant RAE for all certification levels in male soccer players. In contrast, in male futsal players, the RAE was significant only in clubs and academies with the highest level. For National teams, the RAE was more pronounced in male soccer, particularly in the U16 and U17 (OR: 9.84 and 12.36, respectively). Data showed a RAE in female and male youth soccer and futsal, particularly in male, younger age categories, and in clubs and academies having a higher certification level, which could be accompanied by a loss of valuable elite players during the youth phase of their careers. Thus, adjustments in the systems and structure of talent identification are recommended to prevent RAE-related discrimination in youth soccer and futsal.

The Female Athlete Triad/Relative Energy Deficiency in Sports (RED-S).

In a healthy athlete, the caloric intake is sufficient for sports energy needs and body physiological functions, allowing a balance between energy availability, bone metabolism, and menstrual cycle. On the other hand, an imbalance caused by low energy availability due to a restrictive diet, eating disorders or long periods of energy expenditure leads to multisystemic deregulation favoring the essential functions of the body. This phenomenon, described as the female athlete triad, occurs in a considerable percentage of high-performance athletes, with harmful consequences for their future. The present review was carried out based on a critical analysis of the most recent publications available and aims to provide a global perception of the topic relative energy deficit in sport (RED-S). The objective is to promote the acquisition of more consolidated knowledge on an undervalued theme, enabling the acquisition of preventive strategies, early diagnosis and/or appropriate treatment.

Em uma atleta saudável, o aporte calórico é suficiente para a necessidade energética esportiva e para as funções fisiológicas corporais, permitindo um equilíbrio entre disponibilidade energética (DE), metabolismo ósseo e função menstrual. Por outro lado, um desequilíbrio devido à baixa disponibilidade energética (BDE) por dieta restritiva, perturbações alimentares ou grandes períodos de gasto energético conduz a uma desregulação multissistêmica priorizando as funções essenciais do corpo. Este fenômeno, descrito inicialmente como tríade da mulher atleta e, atualmente, como défice energético relativo no esporte (RED-S, na sigla em inglês) tem como pilares a BDE, disfunção menstrual e alterações na densidade mineral óssea (DMO), estando presente em uma percentagem considerável de atletas de alta competição, com consequências nefastas para o seu futuro a curto, médio e longo prazo. A presente revisão foi realizada a partir da análise crítica das publicações mais recentes disponíveis e pretende proporcionar uma percepção global do tema RED-S. O objetivo é promover a aquisição de um conhecimento mais consolidado sobre uma temática subvalorizada, possibilitando a aquisição de estratégias preventivas, diagnóstico precoce e/ou tratamento adequado.

The Female Athlete Triad/Relative Energy Deficiency in Sports (RED-S) / A tríade da atleta feminina/déficit energético relativo no esporte (RED-S)

Abstract In a healthy athlete, the caloric intake is sufficient for sports energy needs and body physiological functions, allowing a balance between energy availability, bone metabolism, andmenstrual cycle.Onthe other hand, an imbalance causedby low energy availability dueto a restrictive diet, eating disorders or long periods of energy expenditure leads to multisystemic deregulation favoring the essential functions of the body. This phenomenon, described as the female athlete triad, occurs in a considerable percentage of high-performance athletes, with harmful consequences for their future. The present review was carried out based on a critical analysis of themost recent publications available and aims to provide a global perception of the topic relative energy deficit in sport (RED-S). The objective is to promote theacquisition ofmore consolidated knowledgeon an undervaluedtheme, enabling the acquisition of preventive strategies, early diagnosis and/or appropriate treatment.

Resumo Emumaatleta saudável, oaporte calórico é suficientepara anecessidade energética esportiva e para as funções fisiológicas corporais, permitindo um equilíbrio entre disponibilidade energética (DE), metabolismo ósseo e função menstrual. Por outro lado, um desequilíbrio devido à baixa disponibilidade energética (BDE) por dieta restritiva, perturbações alimentares ou grandes períodos de gasto energético conduz a uma desregulação multissistêmica priorizando as funções essenciais do corpo. Este fenômeno, descrito inicialmente como tríade da mulher atleta e, atualmente, comodéfice energético relativo no esporte (RED-S, nasigla eminglês) tem como pilares a BDE, disfunção menstrual e alterações na densidade mineral óssea (DMO), estando presente em uma percentagem considerável de atletas de alta competição, com consequências nefastas para o seu futuro a curto, médio e longo prazo. A presente revisão foi realizada a partir da análise crítica das publicações mais recentes disponíveis e pretende proporcionar uma percepção global do tema RED-S. O objetivo é promover a aquisição de um conhecimento mais consolidado sobre uma temática subvalorizada, possibilitando a aquisição de estratégias preventivas, diagnóstico precoce e/ou tratamento adequado.

Gerenciamento da renda familiar por jovens casais / The management of family income for young couples

Objetivo: avaliar o gerenciamento da renda de casais heterossexuais, de classe média, com renda individual, identificando aspectos positivos e negativos e se o gerenciamento é distinto entre casais cuja maior renda é da esposa ou do marido. Participantes: oito casais com idade entre 25 a 35 anos. Instrumentos: entrevista aberta, verificando a administração financeira individual e familiar, como são tomadas decisões financeiras, conhecimento de ambos sobre a renda e gastos do parceiro. Procedimentos: Entrevista individual com cada cônjuge. Resultados: Realizou-se análise de conteúdo qualitativa e quantitativa por meio de categorias de respostas. Em três casais o homem gerencia a renda, três deles compartilham entradas e despesas financeiras e dois dividem as despesas. As mulheres foram mais propensas a cometer infidelidade financeira. A satisfação financeira relacionou-se à consulta ao cônjuge em relação aos investimentos e aquisição de bens e a insatisfação aos gastos sem planejamento.(AU)

Objective: To evaluate the management of the income of heterosexual couples, middle-class, with individual income, identifying strengths and weaknesses and the management is distinct among couples whose income is greater with the wife or husband. Participants: Eight couples aged 25 to 35 years. Instruments: open interviews, checking the individual and family financial management, such as financial decisions, knowledge of both on income and partner spending are taken. Procedures: Individual interview with each spouse. Results: An analysis of qualitative and quantitative content through categories of answers. In three couples man manages income, three of them share financial income and expenses and two share the costs. Women were more likely to commit financial infidelity. The financial satisfaction was related to consulting the spouse for investments and acquisition of goods and dissatisfaction to spending without planning.(AU)

ASC-H cytological result: clinical relevance and accuracy of colposcopy in predicting high-grade histological lesions-a 7-year experience of a single institution in Portugal.

INTRODUCTION: Atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H) represents an interpretative challenge in clinical practice. We aimed to evaluate the histological outcome of ASC-H cytology and to evaluate the accuracy of colposcopy in predicting high-grade histological lesions. MATERIALS AND METHODS: Retrospective study of ASC-H cervical cytology results, from January 2010 to December 2016, at a tertiary hospital. Demographic characteristics, colposcopic findings, diagnostic procedures, and histological outcomes were analyzed using SPSS, version 22.0. RESULTS: ASC-H prevalence was 0.25%. Patient mean age was 42.02 ± 12.8 years. The overall incidence of cervical dysplasia of any grade was 83.6% (n = 56) and the incidence of high-grade lesions was 50.8% (n = 34) (including 1 case of in situ adenocarcinoma and 2 cases of squamous cell carcinoma). Among patients with type 1 or 2 transformation zone (TZ), 84.9% (n = 45) had abnormal colposcopic findings, with 62.2% (n = 28) corresponding to grade 2 and 37.8% (n = 17) to grade 1. Colpo-histologic concordance was 85.4% (82.1% for grade 2 lesions and 100% for grade 1 lesions). The sensitivity, specificity, positive predicted value (PPV) and negative predictive value (NPV) was 100%, 75%, 82.1%, and 100%, respectively. The histological study of patients with type 3 TZ revealed 45.8% (n = 11) of high-grade lesions. CONCLUSIONS: ASC-H is strongly associated with high-grade histological lesions. Immediate evaluation of patients with this cytology abnormality is therefore mandatory. Colposcopy, when performed by expert clinicians, has great accuracy in detecting high-grade lesions. Histological evaluation of patients with type 3 TZ is extremely important because almost 50% of patients have this type of lesion.

Contaminação dos alimentos por aflatoxinas e riscos à saúde / Contamination of food by aflatoxin and risks to health

Aflatoxinas são metabólitos secundários produzidos por fungos do gênero Aspergillus, principalmente A. flavus e A. parasiticus. Devido sua ampla distribuição na natureza, contaminando diversos grupos de alimentos, a presente revisão tem como objetivo mostrar os riscos e efeitos à saúde pela contaminação por estas substâncias, tendo como base dezenas de pesquisas obtidas através de bancos de dados internacionais. Considerando-se ampla ocorrência das aflatoxinas em alimentos no Brasil, a sua alta toxidade, carcinogenicidade, mutagenicidade e teratogenicidade, se faz necessário a atuação da vigilância de forma preventiva e educativa, a fim de minimizar a contaminação humana e animal com essas micotoxinas, bem como o desenvolvimento de novas pesquisas que apontem novos componentes nutricionais que minimizem os efeitos destas toxinas.

Aspectos da contaminação alimentar por Salmonella / Aspects of the alimentary contamination for Salmonella

A importância do controle da qualidade dos alimentos é de fundamental importância, a fim de que sejam eliminados os riscos de contaminação da população por via alimentar, principalmente de patógenos como as bactérias do gênero Salmonella. O objetivo deste trabalho foi abordar questões sobre segurança alimentar, correlacionadas à Salmonella, seus principais aspectos epidemiológicos e a possibilidade da sua transmissão para o homem por alimentos e animais. Foi realizado um levantamento bibliográfico através de bancos de dados internacionais SCIELO, HIGHWIRE e LILACS. Através deste levantamento, podemos concluir que ainda há muito a ser estudado sobre a bactéria Salmonella e suas formas de contaminação no meio, entretanto, com cuidados sobre a qualidade do alimento e uma fiscalização dos manipuladores de alimento, os índices de contaminação e mortalidade diminuirão.

Características epidemiológicas da Escherichia coli enterotoxigênica (ETEC) e de outras E. coli / Characteristic epidemiologists of the Enterotoxigênic a Escherichia coli (ETEC) and of others E. coli

Escherichia Coli Enterotoxigênica (ETEC) é uma das principais E. coli responsável pela maioria das diarréias em crianças e adultos viajantes de países em desenvolvimento. Por ser uma doença relacionada com o poder aquisitivo da população, saneamento básico e higiene alimentar, esta revisão tem como objetivo mostrar os riscos, sintomas, mecanismos de controles e prevenção das diarréias de ETEC. Foi realizada uma revisão bibliográfica através de artigos científicos coletados dos bancos de dados internacionais SCIELO, HIGHWIRE e LILACS. A diarréia de ETEC é um dos maiores problemas nos países que possuem um baixo nível sócio-econômico, dificultando boa alimentação, moradia digna e uma educação básica. Programas educacionais, orientação nutricional e saneamento básico, são um dos fatores que devem ser aplicados nesses locais, até que se consiga desenvolver uma vacina. Como se trata de um programa de saúde pública, a ação governamental é indispensável nessas medidas de controles.

Vinculación del médico y enfermera de la familia con la microbrigada social / Linking of the family physician and nurse with the social microbrigada

Resumen: Se realiza un estudio descriptivo, retrospectivo del quinquenio 1990-1995, en el Consultorio 34-3, del área de salud "XX Aniversario" de Santa Clara, Villa Clara, para conocer la vinculación del trabajo del médico y la enfermera de la familia a la microbrigada social de un barrio insalubre sometido a acciones físico-constructivas y de animación social y algunos cambios introducidos por los investigadores. El análisis de los resultados se realizó mediante la aplicación de métodos cuantitativos técnicas de investigación cualitativas, arribando a las siguientes conclusiones: la creación de la microbrigada social vinculada al equipo de salud constituye el acontecimiento más relevante de la barriada en los últimos años. Se constatan cambios positivos en el estilo de vida, y en el estado de salud de la población. Las modificaciones en los riesgos sociales son el resultado del trabajo de participación comunitaria y social bajo el liderazgo del grupo profiláctico multidisciplinario

Vinculación del médico y enfermera de la familia con la microbrigada social / Linking of the family physician and nurse with the social microbrigada

Resumen: Se realiza un estudio descriptivo, retrospectivo del quinquenio 1990-1995, en el Consultorio 34-3, del área de salud "XX Aniversario" de Santa Clara, Villa Clara, para conocer la vinculación del trabajo del médico y la enfermera de la familia a la microbrigada social de un barrio insalubre sometido a acciones físico-constructivas y de animación social y algunos cambios introducidos por los investigadores. El análisis de los resultados se realizó mediante la aplicación de métodos cuantitativos técnicas de investigación cualitativas, arribando a las siguientes conclusiones: la creación de la microbrigada social vinculada al equipo de salud constituye el acontecimiento más relevante de la barriada en los últimos años. Se constatan cambios positivos en el estilo de vida, y en el estado de salud de la población. Las modificaciones en los riesgos sociales son el resultado del trabajo de participación comunitaria y social bajo el liderazgo del grupo profiláctico multidisciplinario(AU)

Resultados preliminares del programa de vacunación del personal de sanidad, contra la hepatitis B / Preliminary results of the vaccination program of health personnel, agounst hepatitis B

El personal de sanidad se encuentra entre las poblaciones de alto riesgo para contraer hepatitis B. Por tal motivo se decidió preseleccionar, mediante marcadores virales en suero, y ofrecer la vacuna a las personas expuestas, con seguimiento de los vacunados a fin de determinar la aparición de anticuerpos (AU)

Resultados preliminares del programa de vacunación del personal de sanidad, contra la hepatitis B / Preliminary results of the vaccination program of health personnel, agounst hepatitis B

El personal de sanidad se encuentra entre las poblaciones de alto riesgo para contraer hepatitis B. Por tal motivo se decidió preseleccionar, mediante marcadores virales en suero, y ofrecer la vacuna a las personas expuestas, con seguimiento de los vacunados a fin de determinar la aparición de anticuerpos