Post Vaccine Rubella During a Measles Outbreak: Clinical Case.

Rubella is a vaccine preventable infection, and congenital rubella the most feared complication of this disease. Although young adult women are at greatest risk of post-vaccine rubella, this is also the group who potentially benefits the most from vaccine protection. Since post-vaccine disease has a mild and self-limited course, the benefit clearly exceeds the risk. During a measles outbreak in the north of Portugal, a 38-year-old woman presented with cervical posterior lymphadenopathies, fever and a maculo-papular rash one week after the administration of the measles, mumps and rubella vaccine. Measles was discarded and rubella viremia was demonstrated. Symptoms of rubella are non-specific and laboratory confirmation is essential. This is particularly relevant during a measles outbreak.

A rubéola é uma infeção prevenível por vacina, sendo a rubéola congénita a apresentação mais grave da doença. Apesar de serem o grupo que mais beneficia dela, as mulheres em idade fértil são também o grupo com maior risco de doença associada à vacina. Uma vez que as manifestações clínicas são ligeiras e transitórias, o benefício compensa largamente o risco. Durante o surto de sarampo que ocorreu no Porto em 2018, uma mulher de 38 anos recebeu a primeira dose da vacina contra o sarampo, rubéola e papeira. Uma semana depois, recorreu ao Serviço de Urgência por febre, exantema maculo-papular e adenopatias cervicais posteriores. Foi excluído sarampo e demonstrada viremia pelo vírus da rubéola. Os sintomas da rubéola são inespecíficos pelo que a confirmação laboratorial é essencial. Isto é ainda mais relevante em contexto de surto de sarampo.

Descriptive Acute Respiratory Distress Syndrome (ARDS) in adults with imported severe Plasmodium falciparum malaria: A 10 year-study in a Portuguese tertiary care hospital.

BACKGROUND: Acute respiratory distress syndrome (ARDS) is a severe complication of malaria that remains largely unstudied. We aim to describe the development of ARDS associated with severe P. falciparum malaria, its management and impact on clinical outcome. METHODS: Retrospective observational study of adult patients admitted with severe P. falciparum malaria in an Intensive Care Unit (ICU) of a tertiary care hospital from Portugal from 2008 to 2018. A multivariate logistic regression analysis was used to identify factors associated with the development of ARDS, defined according to Berlin Criteria. Prognosis was assessed by case-fatality ratio, nosocomial infection and length of stay. RESULTS: 98 patients were enrolled, of which 32 (33%) developed ARDS, a median of 2 days after starting antimalarial medication (IQR 0-4, range 0-6). Length of stay in ICU and in hospital were significantly longer in patients who developed ARDS: 13 days (IQR 10-18) vs 3 days (IQR 2-5) and 21 days (IQR 15-30.5) vs 7 days (IQR 6-10), respectively. Overall case-fatality ratio in ICU was 4.1% and did not differ between groups. The risk of ARDS development is difficult to establish. CONCLUSION: ARDS is a hard to predict late complication of severe malaria. A low threshold for ICU admission and monitoring should be used. Ideally patients should be managed in a centre with experience and access to advanced techniques.

Immunoglobulin-induced aseptic meningitis: a case report.

BACKGROUND: Immunoglobulin associated meningitis is a rare disease that mimics infectious meningitis. This is, to our knowledge, the first case of Immunoglobulin-associated meningitis described in a patient with Systemic Lupus Erythematosus and hypogammaglobulinemia secondary to Rituximab. CASE PRESENTATION: A 46-year-old female with a past medical history of Systemic Lupus Erythematosus, presented with meningismus 36 h after first infusion of intravenous immunoglobulin. The cerebrospinal fluid analysis showed neutrophilic pleocytosis and hyperproteinorrachia. All microbiological tests were negative. The patient recovered remarkably fast without sequela after just five days of antibiotic therapy. CONCLUSION: Systemic Lupus Erythematosus is a well-documented risk factor for aseptic meningitis associated with other drugs. Possibly, it is also a risk factor for Immunoglobulin associated meningitis. This diagnosis, although rare, should be considered in patients receiving Immunoglobulin since it is a self-limited condition and treatment is supportive.

Da estética do desporto à estética do futebol / From the aesthetics of sport to the aesthetics of football / De la estética del deporte hasta la estética del fútbol

O futebol é um facto social fruído por todas as pessoas, de todas as idades, profissões e credos, apresentando-se como um fenómeno de globalização que evidencia uma capacidade convocatória universal. O objetivo deste estudo consistiu em aprofundar o conhecimento acerca do futebol, com o contributo da abordagem estética, partindo para a exploração da sua importância na formação de jogadores. Para dar resposta aos objetivos, a metodologia percorrida baseou-se na síntese e confrontação de diversos estudos que desdobramos ao sabor das nossas próprias concepções, construindo um ensaio de natureza exploratória que, mais do que resumir conclusões includente e excludentemente delimitadas, pretendeu levantar questões que estimulem o estudo da temática.

Football is a social fact enjoyed by everyone, of every age, professions, beliefs, presenting itself as a globalization phenomenon that shows a particular capacity of universal gathering. The aim of this study was to deepen the knowledge of football, with the contribution of the aesthetics approach going on to the exploration of its importance on the players' education. In order to respond to these objectives, the methodology used was based on the summary and confrontation of several studies that we unfold using our own conceptions, writing an exploratory essay that, more than resuming including and excluding delimited conclusions, allows us to bring up questions that stimulate inquiry about of theme.

El fútbol es un hecho social disfrutado por todas las personas, de todas edades, profesiones y creencias presentándose como un fenómeno de globalización que refleja una particular capacidad de llamamiento universal. El objetivo de este estudio consistió en profundizar el conocimiento sobre el fútbol con la aportación del enfoque estético, partiendo hacia la exploración de su importancia en la formación de jugadores. Intentando dar una respuesta a los objetivos, la metodología recorrida se basó en la síntesis y confrontación de diversos estudios que vamos desplegando al correr de nuestras propias concepciones, construyendo un ensayo de naturaleza exploratoria que, más que resumir conclusiones incluyente y excluyentemente delimitadas, busca levantar cuestiones que estimulen el estudio de la temática en causa.