Nursing Delirium Screening Scale: Avaliação das propriedades psicométricas num serviço de ortopedia em Portugal / Nursing Delirium Screening Scale: Evaluation of psychometric properties in an orthopedic service in Portugal / Nursing Delirium Screening Scale: Evaluación de las propiedades psicométricas en un servicio de ortopedia de Portugal

Resumo Enquadramento: A identificação do delirium pelos enfermeiros é de extrema relevância. Assim, parece relevante a possibilidade de recurso à versão portuguesa da Nursing Delirium Screening Scale (Nu-DESC). Objetivo: Avaliar as propriedades psicométricas da versão portuguesa da Nu-DESC em contexto cirúrgico. Metodologia: Estudo metodológico, incluindo utentes com 65 ou mais anos de idade, com o diagnóstico de fratura proximal do fémur. Recorreu-se a três medidas de avaliação para analisar a concordância entre os resultados obtidos através das mesmas. Resultados: Numa amostra de 81 utentes, a sensibilidade da Nu-DESC foi de 92% relativamente ao Confusion Assessment Method (CAM) e de 91% face à aplicação dos critérios do DSM-5. Já a especificidade do instrumento foi de 98% relativamente ao CAM e de 94% face à aplicação dos critérios do DSM-5. O alfa de Cronbach da Nu-DESC variou entre 0,86 e 0,89. Conclusão: A avaliação das propriedades psicométricas da Nu-DESC num contexto cirúrgico confirmou que a escala apresenta uma elevada sensibilidade e especificidade para a avaliação de delirium nesse mesmo contexto.

Abstract Background: The identification of delirium by nurses extremely relevant. The Portuguese version of the Nursing Delirium Screening Scale (Nu-DESC) is a tool that can be used in this setting. Objective: To evaluate the psychometric properties of the Portuguese version of the Nu-DESC in a surgical context. Methodology: Methodological study with patients aged 65 years or older with a diagnosis of proximal femur fracture. Three assessment tools were used to analyze the agreement between the results. Results: In a sample of 81 patients, the sensitivity of the Nu-DESC was 92% compared to the Confusion Assessment Method (CAM) and 91% compared to the application of the DSM-5 criteria. The specificity of the instrument was 98% compared to CAM and 94% compared to the DSM-5. Cronbach's alpha ranged between 0.86 and 0.89 Conclusion: The evaluation of the psychometric properties of the Nu-DESC in a surgical context confirmed the validity and reliability of the instrument. The results show that the scale has a high sensitivity and specificity for assessing delirium.

Resumen Marco contextual: La identificación del delirio por parte del personal de enfermería es extremadamente importante. De ahí la posibilidad de utilizar la versión portuguesa del Nursing Delirium Screening Scale (Nu-DESC). Objetivo: Evaluar las propiedades psicométricas de la versión portuguesa del Nu-DESC en entornos quirúrgicos. Metodología: Estudio metodológico que incluyó a usuarios de 65 años o más, con diagnóstico de fractura proximal de fémur. Se utilizaron tres medidas de evaluación para analizar la concordancia entre los resultados obtenidos a través de ellas. Resultados: En una muestra de 81 usuarios, la sensibilidad del Nu-DESC fue del 92% en relación con el Confusion Assessment Method (CAM) y del 91% cuando se aplican los criterios del DSM-5. La especificidad del instrumento fue del 98% en relación con el CAM y del 94% frente a la aplicación del DSM-5. El alfa de Cronbach de la Nu-DESC varió entre 0,86 y 0,89. Conclusión: La evaluación de las propiedades psicométricas de la Nu-DESC en un contexto quirúrgico confirmó que la escala presenta una alta sensibilidad y especificidad para la evaluación del delirio en este mismo contexto.

Office endometrial sampling: effectiveness and predictive factors of success in Novak versus Endosampler devices.

BACKGROUND: The study aimed to evaluate the rate of endometrial sampling (ES) failure, predictive factors of success, and reliability as diagnostic methods of Endosampler versus Novak. METHODS: A retrospective single-center study was carried out with all patients who underwent ES via Endosampler or Novak in 2020 and 2021. Demographic data, personal background, and histopathologic results were evaluated. RESULTS: Eighty-six patients underwent ES by Novak and 90 by Endosampler. The failure rate of ES was 43.2% with lower values for Endosampler (33.3% vs. 53.5%, P<0.05). Age, biopsy device, menopausal status, indication for biopsy, and amount of sample collected were predictive factors of failure. Analyzing each device, Endosampler was only affected by menopausal status. Only 50% in Novak and 62.5% in the Endosampler group of endometrial neoplasia cases were detected by these methods. Analyzing the performance for endometrial neoplasia (EN), we obtained higher values of sensitivity and accuracy for Endosampler (62.5% vs. 50.0% and 83.3% vs. 72.7%), respectively. CONCLUSIONS: In our study, the failure rate obtained was in line with other previous studies. Menopausal status, age, type of biopsy device, indication for biopsy, and amount of sample collected affected ES performance. Analyzing diagnostic performance for EN, we found that these methods have better reliability for positive results than for negative ones, which may indicate the need for further evaluation in cases of high clinical suspicion. In short, we obtain a higher rate of success rate in Endosampler devices and better performance in diagnosing EN, which is the major objective of an ES.

Tailoring the Electron Trapping Effect of a Biocompatible Triboelectric Hydrogel by Graphene Oxide Incorporation towards Self-Powered Medical Electronics.

Triboelectric nanogenerators (TENGs) are associated with several drawbacks that limit their application in the biomedical field, including toxicity, thrombogenicity, and poor performance in the presence of fluids. By proposing the use of a hemo/biocompatible hydrogel, poly(2-hydroxyethyl methacrylate) (pHEMA), this study bypasses these barriers. In contact-separation mode, using polytetrafluoroethylene (PTFE) as a reference, pHEMA generates an output of 100.0 V, under an open circuit, 4.7 µA, and 0.68 W/m2 for an internal resistance of 10 MΩ. Our findings unveil that graphene oxide (GO) can be used to tune pHEMA's triboelectric properties in a concentration-dependent manner. At the lowest measured concentration (0.2% GO), the generated outputs increase to 194.5 V, 5.3 µA, and 1.28 W/m2 due to the observed increase in pHEMA's surface roughness, which expands the contact area. Triboelectric performance starts to decrease as GO concentration increases, plateauing at 11% volumetric, where the output is 51 V, 1.76 µA, and 0.17 W/m2 less than pHEMA's. Increases in internal resistance, from 14 ΩM to greater than 470 ΩM, ζ-potential, from -7.3 to -0.4 mV, and open-circuit characteristic charge decay periods, from 90 to 120 ms, are all observed in conjunction with this phenomenon, which points to GO function as an electron trapping site in pHEMA's matrix. All of the composites can charge a 10 µF capacitor in 200 s, producing a voltage between 0.25 and 3.5 V and allowing the operation of at least 20 LEDs. The triboelectric output was largely steady throughout the 3.33 h durability test. Voltage decreases by 38% due to contact-separation frequency, whereas current increases by 77%. In terms of pressure, it appears to have little effect on voltage but boosts current output by 42%. Finally, pHEMA and pHEMA/GO extracts were cytocompatible toward fibroblasts. According to these results, pHEMA has a significant potential to function as a biomaterial to create bio/hemocompatible TENGs and GO to precisely control its triboelectric outputs.

3D digital breast cancer models with multimodal fusion algorithms.

Breast cancer image fusion consists of registering and visualizing different sets of a patient synchronized torso and radiological images into a 3D model. Breast spatial interpretation and visualization by the treating physician can be augmented with a patient-specific digital breast model that integrates radiological images. But the absence of a ground truth for a good correlation between surface and radiological information has impaired the development of potential clinical applications. A new image acquisition protocol was designed to acquire breast Magnetic Resonance Imaging (MRI) and 3D surface scan data with surface markers on the patient's breasts and torso. A patient-specific digital breast model integrating the real breast torso and the tumor location was created and validated with a MRI/3D surface scan fusion algorithm in 16 breast cancer patients. This protocol was used to quantify breast shape differences between different modalities, and to measure the target registration error of several variants of the MRI/3D scan fusion algorithm. The fusion of single breasts without the biomechanical model of pose transformation had acceptable registration errors and accurate tumor locations. The performance of the fusion algorithm was not affected by breast volume. Further research and virtual clinical interfaces could lead to fast integration of this fusion technology into clinical practice.

Peripheral axonal ensheathment is regulated by RalA GTPase and the exocyst complex.

Axon ensheathment is fundamental for fast impulse conduction and the normal physiological functioning of the nervous system. Defects in axonal insulation lead to debilitating conditions, but, despite its importance, the molecular players responsible are poorly defined. Here, we identify RalA GTPase as a key player in axon ensheathment in Drosophila larval peripheral nerves. We demonstrate through genetic analysis that RalA action through the exocyst complex is required in wrapping glial cells to regulate their growth and development. We suggest that the RalA-exocyst pathway controls the targeting of secretory vesicles for membrane growth or for the secretion of a wrapping glia-derived factor that itself regulates growth. In summary, our findings provide a new molecular understanding of the process by which axons are ensheathed in vivo, a process that is crucial for normal neuronal function.

Comportamentos auto-lesivos na adolescência: intervenção do enfermeiro especialista em saúde mental e psiquiátrica / Self-injurious behaviors in adolescence: intervention of the specialist nurse in mental and psychiatric health

Os Comportamentos Auto-Lesivos (CAL) afirmam-se como uma problemática séria de saúde pública e mental que em 2018 afetou cerca de 20% dos adolescentes portugueses. Descrito como comportamento deliberado realizado por uma pessoa que tem intenção de provocar lesões a si mesmo, podendo existir ou não, intenção suicida, os CAL parecem ser uma estratégia adotada pelos adolescentes para regulação emocional, por existirem pensamentos e sentimentos negativos, associados à incapacidade e imaturidade de gerir as emoções e controlar os impulsos, comuns na adolescência. As abordagens terapêuticas descritas na literatura evidenciam a importância de desenvolver com os adolescentes, estratégias de identificação de emoções, sentimentos e reações comportamentais a processos intra e interpessoais, que por serem vivenciados de forma desajustada causam sofrimento mental. Para o desenvolvimento de competências do Enfermeiro Especialista em Saúde Mental e Psiquiátrica (EESMP) foi realizado um estágio com vertente hospitalar e comunitária. O estágio hospitalar teve como objetivo desenvolver técnicas psicoterapêuticas e socioterapêuticas, promotoras do desenvolvimento de competências de gestão emocional; sociais e de resolução de problemas em adolescentes que adotam CAL. As intervenções de enfermagem especializadas a esta população foram suportadas pela Teoria das Relações Interpessoais de Hildegard Peplau. A avaliação do risco clínico; a promoção do milieu therapy e o desenvolvimento de intervenções especializadas de enfermagem promoveram a diminuição do sofrimento associado, resultando na diminuição do risco de CAL. O estágio em contexto comunitário permitiu desenvolver competências de enfermagem no âmbito da promoção de saúde mental na primeira infância. Este relatório dá conta do percurso desenvolvido e agrega um conjunto de propostas de intervenção do EESMP no âmbito dos Comportamentos Auto-Lesivos na Adolescência.

Non-suicidal self-injury (NSSI) is a serious problem of public and mental health, that in 2018 affected almost 20% of the portuguese adolescent. Described as a deliberated behavior made by a person who as the intention to make injury to his self, with or without suicidal ideation, NSSI seems to be a strategy used by adolescents to emotional regulation, for existing bad thoughts and feelings, usually associated to the incapacity and immature to deal with their emotions and self-control, common at adolescence. Therapeutic approaches described at the literature evidence the importance of development with the adolescent strategies to identify emotions, feelings and reactions behavioral to intra and interpersonal processes, that experienced in an unsuitable mode, cause mental suffering. To the development of the skills of the mental health and psychiatry specialized nurse, was performer an internship at the community and at the hospital. The hospital internship aimed at the development of psychotherapeutic and social therapeutic techniques, promoting the development of emotional management skills; social skills and problem-solving skills at adolescents that commit NSSI. Specialized nursing interventions to this population were supported by the Theory of Interpersonal Relations by Hildegard Peplau. Risk assessment; the promotion of milieu therapy and the development of specialized nursing interventions promoted a reduction of the suffering associated, resulting in a decrease of the NSSI risk. The community internship allowed the development of the nursing skills within the scope of the promotion of mental health in the early childhood. This academic report gives an account of the course developed and adds a set of intervention proposals by the EESMP in the context of NSSI in Adolescence.

Dichorionic twins discordant for body-stalk anomaly: a management challenge.

Body-stalk anomaly is a sporadic and rare maldevelopment disorder characterised by large abdominal wall defect, spinal deformity and rudimentary umbilical cord. It is considered a lethal condition as there are only few reports of survival but there was at least one case of long-term survival after neonatal surgery.Differential diagnosis includes isolated omphalocele or gastroschisis, short umbilical cord, amniotic band, limb body-wall complex and other polymalformative syndromes.There are few reports about the expectant prenatal management of the body stalk anomaly as the majority of prenatal diagnosed cases undergo early elective termination. Twin pregnancies discordant for the anomaly represent a challenge to prenatal management as a healthy fetus should also be considered.We describe a case of dichorionic-diamniotic twins discordant for body stalk anomaly which underwent selective feticide of the affected fetus late in pregnancy, in accordance with parents' decision focused on the neonatal well-being of the unaffected twin.

Influence of body mass index in anti-Müllerian hormone levels in 951 non-polycystic ovarian syndrome women followed at a reproductive medicine unit.

PURPOSE: Anti-Müllerian hormone (AMH) is a useful marker of ovarian reserve. Obesity/overweight are increasing and may affect the reproductive health. Previous studies regarding the effect of body mass index (BMI) on AMH levels are discordant. Our main goal was to evaluate the influence of BMI on AMH levels in women without polycystic ovarian syndrome. METHODS: Revision of medical records of 951 women who performed AMH determinations as part of their fertility workup, between 2011 and 2016. RESULTS: Median AMH concentration was 1.75 [interquartile range (IQR) 2] ng/mL (12.9 pmol/mL) and median age at AMH determination was 35 (IQR 6) years. These women evidenced a median BMI of 23 (IQR 5) kg/m2. Caucasian women were more represented [889(89.3%)]. Smoking habits (present/past) were present in 359(36.1%), and 147(14.8%) harboured a history of ovarian surgery. On univariable analysis AMH was not correlated with BMI (r = 0.048/p = 0.135); the only factors influencing AMH were age (p < 0.001), ethnicity (p = 0.004), and previous ovarian surgery (p < 0.001). On multivariable analysis, age was the only variable significantly associated with AMH, evidencing a reduction of 6.2% for each additional year (p < 0.0001). Furthermore, we verified a trend suggesting an AMH reduction of 22% (p = 0.08) in black patients comparing with the caucasian ones, when controlling for the other variables. CONCLUSION: We report one of the largest series evaluating the influence of BMI on AMH levels and, consequently, on ovarian reserve. BMI does not seem to affect AMH levels. The reported concerns on infertility in overweight and obese women may be related to follicular development/oocyte maturation or endometrial disorders, rather than decreased ovarian reserve.

Qualidade de vida relacionada com a saúde da pessoa com esclerose múltipla e sintomas do trato urinário inferior / Health-related quality of life in people with multiple sclerosis and lower urinary tract symptoms

A EM consiste numa patologia crónica e degenerativa do SNC que ocorre tipicamente no adulto jovem assumindo um caracter de imprevisibilidade, capaz de gerar incapacidade de forma preocupante, potenciando, aos portadores da doença, uma vida de inquietações constantes. O objetivo deste estudo é descrever o impacto que os STUI apresentam na QV relacionada com a saúde, no que diz respeito às pessoas com EM. O presente estudo recorre à metodologia do tipo quantitativo, nível II, descritivo-correlacional. A amostra tem por base o tipo não probabilística acidental, sendo constituída por 72 indivíduos (50 feminino / 22 masculino), com média de idade 45,72 anos (? 10,16), que frequentaram a consulta de Enfermagem / Hospital de dia de Neurologia A, CHUC-HUC no período entre 3/12/2016 e 14/01/17. Procedeu-se à adaptação cultural e linguística do Qualiveen para Português (Europeu), instrumento que foi utilizado na colheita de dados. Os participantes fizeram-no de livre e espontânea vontade, dando o seu consentimento por escrito. Identificou-se, na sua esmagadora maioria, mais do que um STUI, sendo mais frequentes os STUI mistos. O STUI mais frequente é a urgência. O IPUQV é notório e apresentou maiores valores no sexo feminino, nos reformados, nos que necessitam de ajuda nas atividades de vida diária dentro e fora de casa e nas pessoas que usam dispositivos protetores. Apresenta correlação com a perceção da pessoa sobre a forma como urina, o número de STUI, a frequência urinária diária aumentada e os anos de evolução dos STUI. Verificaram-se ainda outras correlações fracas mas, não relevantes, e encontraram-se correlações e relações inexistentes. Em conclusão os STUI constituem um problema real das pessoas com EM, que causam impacto na sua qualidade de vida. Estes resultados urgem a necessidade cabal da intervenção ativa e imediata dos Enfermeiros de Reabilitação na identificação precoce dos STUI junto da pessoa com EM, desenhando e implementando o melhor plano de intervenção com vista à prevenção de complicações e à redução do impacto na sua vida. Sugerem-se novos estudos, averiguando quais os STUI que causam maior impacto e que técnicas de enfermagem de Reabilitação modificam o IPUQV recorrendo como método de avaliação o Qualiveen

Intraplacental Choriocarcinoma: Rare or Underdiagnosed? Report of 2 Cases Diagnosed after an Incomplete Miscarriage and a Preterm Spontaneous Vaginal Delivery.

Intraplacental choriocarcinoma is a rare malignant tumor diagnosed after an abortion, an ectopic pregnancy, or a term or preterm pregnancy or following the diagnosis of a hydatidiform mole. During pregnancy, it may be more common than reported, as most patients are asymptomatic and placental choriocarcinomas are usually inconspicuous macroscopically and are often mistaken for an infarct. Based upon a case study methodology, we describe 2 cases of intraplacental choriocarcinoma: the first case was identified in the product of a uterine curettage following an incomplete miscarriage and the second in one of the placentas of a bichorionic twin pregnancy. Maternal investigation did not reveal evidence of metastatic disease and neither did the infants' one in the second case. The two cases underwent maternal surveillance with serum hCG and remained disease-free until the present. In conclusion, intraplacental choriocarcinoma is easily underdiagnosed but with current treatment, even in the presence of metastasis, the prognosis is excellent. A routine microscopic examination of all the placentas and products of miscarriage can increase the real incidence of this entity and consequently improve its management.

Short and Long-Term Efficacy of Laparoscopic Ovarian Diathermy in Women with Polycystic Ovary Syndrome.

INTRODUCTION: Polycystic ovary syndrome is the most frequent cause of anovulatory infertility and management involves a multistep approach. Laparoscopic ovarian diathermy is accepted as a second-line treatment of patients who failed to respond to clomiphene citrate. The aims of this study were to determine the efficacy of this technique at short and long-term and to perform an analysis of predictive factors of spontaneous pregnancy. MATERIAL AND METHODS: This retrospective study involved 76 women who underwent laparoscopic ovarian diathermy between 2004 and 2013 in a university hospital. Main outcomes were cycle regularity and pregnancy. Short-term outcomes recorded during followup in our centre were reviewed and long-term outcomes were evaluated by a telephone interview to all women whose surgery was undertaken more than three years ago. Clinical and biochemical data were analysed as predictive factors of spontaneous conceptionin patients without other infertility factors. RESULTS: Menstrual cycle regularity was initially achieved in 53 (70%) women and in the long-term follow-up subgroup, 52% (12/23) had regular periods. In general, 53 (70%) women conceived and 77 pregnancies were achieved, 60% of which were spontaneous. The only prognostic factor found to be significantly associated with spontaneous conception was a shorter duration of infertility (< 3 years) (p < 0.05). DISCUSSION: Laparoscopic ovarian diathermy showed pregnancy rates comparable to other ovulation induction treatments with the advantage of having a long lasting beneficial effect in menstrual regularity and fertility. CONCLUSION: Laparoscopic ovarian diathermy is a safe and effective treatment option for anovulatory infertility in women with polycystic ovary syndrome.

Introdução: A síndrome dos ovários poliquísticos é a causa mais frequente de anovulação e o tratamento envolve uma abordagem faseada. A electrocoagulação laparoscópica dos ovários é aceite como segunda linha no tratamento das doentes que não respondem ao citrato de clomifeno. Os objectivos deste estudo foram determinar a eficácia desta técnica a curto e longo prazo e definir os factores preditivos de gravidez espontânea. Material e Métodos: Este estudo retrospectivo envolveu 76 mulheres submetidas a electrocoagulação dos ovários entre 2004 e 2013, num hospital universitário. Os desfechos principais foram a regularidade menstrual e gravidez. Os resultados a curto prazo registados durante a vigilância na unidade foram revistos e os desfechos a longo prazo foram avaliados através de entrevista telefónica realizada a todas as mulheres operadas há mais de três anos. Dados clínicos e bioquímicos foram analisados como factores preditivos de gravidez espontânea em doentes sem outros factores de infertilidade. Resultados: A regularidade do ciclo menstrual foi alcançada inicialmente em 53 (70%) mulheres e a longo prazo, 52% (12/53) tinham ciclos regulares. Em geral, 53 (70%) mulheres engravidaram e foram obtidas 77 gravidezes, 60% das quais foram espontâneas. O único factor de prognóstico associado a gravidez espontânea foi a duração da infertilidade inferior a três anos (p < 0,05). Discussão: A electrocoagulação dos ovários demonstrou taxas de gravidez comparáveis a outros tratamentos de indução da ovulação com a vantagem de ter efeitos benéficos duradouros na regularidade menstrual e fertilidade. Conclusão: A electrocoagulação dos ovários é uma opção de tratamento segura e eficaz na infertilidade anovulatória em mulheres com síndrome dos ovários poliquísticos.

Dificuldades sentidas pelos pais de crianças em idade pré-escolar com diabetes mellitus na gestão da terapia e alimentação / Dificuldades sentidas pelos pais de crianças em idade pré-escolar com diabetes mellitus na gestão da terapia e alimentação

A literatura nacional e internacional tem mostrado que a incidência de Diabetes Mellitus tipo 1 (DM1) em crianças tem aumentado significativamente, constituindo a doença crónica com maior incidência nas crianças e adolescentes em Portugal. Por forma a garantir um controlo metabólico adequado, a gestão da terapêutica e alimentação torna-se crucial, sendo este assegurado na íntegra pelos pais das crianças em idade pré-escolar, o que por vezes se torna um desafio. Através da consulta bibliográfica verifica-se que este não é um processo fácil, não se encontrando isento de obstáculos. Neste contexto específico importa conhecer as dificuldades sentidas pelos pais de crianças diabéticas, em idade pré-escolar, na gestão da terapêutica e alimentação. Para a compreensão deste fenómeno, foi desenvolvido um estudo exploratório descritivo, de natureza qualitativa, recorrendo-se a uma amostra não probabilística, constituída por dez pais de crianças em idade pré-escolar e portadoras de DM1, que frequentam a consulta de endocrinologia do Hospital Pediátrico de Coimbra e que quiseram participar voluntariamente no estudo. A recolha de dados realizou-se através de uma entrevista semiestruturada e decorreu de Julho a Agosto de 2014, após consentimento informado dos participantes e da autorização da Comissão de Ética da Instituição onde foi realizado o estudo. Os dados foram analisados com recurso à técnica de análise de conteúdo, segundo Bardin (2009). Da análise efectuada aos discursos dos pais emergiram cinco categorias principais, correspondentes às dificuldades sentidas na gestão da terapêutica e alimentação dos seus filhos: controlo da alimentação e cálculo das unidades de insulina no infantário, sentimentos negativos associados pela criança à doença, sentimentos negativos vivenciados pelos pais, complexidade dos cálculos e, por último, opiniões e sugestões dos pais. Os resultados do estudo permitiram concluir que a gestão da terapêutica e alimentação, assumida pelos pais de crianças diabéticas, em idade pré-escolar, é um processo intenso e por vezes complexo, permitindo-nos identificar um conjunto de dificuldades que estes pais vivenciam no seu dia-a-dia. Os pais apresentam uma grande reserva em delegar funções inerentes à gestão da terapêutica e alimentação aos profissionais do infantário alegando insegurança e falta de conhecimentos dos mesmos, constituindo um factor de constante preocupação e conduzindo a ausências frequentes ao emprego. Foi ainda notória a vivência de sentimentos negativos tanto pelas crianças (punição e discriminação) como pelos seus pais (medo de descompensação metabólica, preocupação e receio da ineficácia do tratamento realizado pelos profissionais escolares e discriminação pela sociedade) associadas à doença. Tornou-se também evidente a dificuldade que apresentavam na realização dos cálculos inerentes ao processo de gestação da terapêutica e alimentação dos seus filhos. Deste modo, obtivemos contributos por forma melhorar o conhecimento neste âmbito, sugerindo como medidas de suporte a estas famílias a criação de uma rede de apoio multidisciplinar disponível para apoiar e esclarecer as dúvidas dos pais, que possa deslocar-se às escolas regularmente para formação dos profissionais e um acompanhamento mais assíduo destas crianças.

Necessidades do lesionado vertebro medular sensíveis aos cuidados do enfermeiro de reabilitação / Needs of the spinal cord injured person sensitive to the care of the rehabilitation nurse

A incidência das lesões vertebro medulares tem aumentado nas últimas décadas, tal fato começa a refletir-se no contexto do nosso exercício profissional, ortopedia pediátrica, onde verificamos que estes doentes apresentam uma grande diversidade e complexidade de problemas, que exigem respostas atempadas e adequadas. Objetivo: Identificar e descrever as principais necessidades dos lesionados vertebro medulares sensíveis aos cuidados do enfermeiro de reabilitação, no sentido de desenvolver programas eficazes e consequentemente promover uma maior qualidade de vida ao doente e família. Método: Revisão sistemática da literatura, tendo-se efetuado uma pesquisa bibliográfica na base de dados EBSCO, limitada a artigos publicados entre janeiro de 2003 e janeiro de 2013, utilizando os seguintes descritores em língua inglesa: Spinal Cord Injury, Rehabilitation Nursing, Rehabilitation e Nursing. Resultados: A amostra final inclui oito artigos com diversidade metodológica que analisam várias necessidades dos lesionados vertebro medulares. Os resultados mostram duas áreas principais: necessidades de ordem relacional e de aprendizagem e necessidades de ordem física. Conclusão: As necessidades de ordem relacional são ainda pouco entendidas entre os enfermeiros de reabilitação, havendo uma atuação predominantemente ao nível físico, sobretudo, no âmbito dos autocuidados, da eliminação intestinal e vesical, respiração, deambulação e mobilidade/imobilidade. No entanto, para se obter maior clareza sobre as necessidades destes doentes é necessário a realização de outros estudos na população Portuguesa.

A powerful yeast model to investigate the synergistic interaction of α-synuclein and tau in neurodegeneration.

Several studies revealed consistent overlap between synucleinopathies and tauopathies, demonstrating that α-synuclein (ASYN) and tau co-localize in neurofibrillary tangles and in Lewy bodies from Alzheimer's and Parkinson's disease patients and corresponding animal models. Additionally, it has been shown that ASYN can act as an initiator of tau aggregation and phosphorylation and that these two proteins directly interact. Despite these evidences, the cellular pathway implicated in this synergistic interaction remains to be clarified. The aim of this study was to create a yeast model where the concomitant expression of ASYN and tau can be used to perform genome wide screenings for the identification of genes that modulate this interaction, in order to shed light into the pathological mechanism of cell dysfunction and to provide new targets for future therapeutic intervention. We started by validating the synergistic toxicity of tau and ASYN co-expression in yeast, by developing episomal and integrative strains expressing WT and mutant forms of both proteins, alone or in combination. The episomal strains showed no differences in growth delay upon expression of ASYN isoforms (WT or A53T) alone or in combination with tau 2N/4R isoforms (WT or P301L). However, in these strains, the presence of ASYN led to increased tau insolubility and correlated with increased tau phosphorylation in S396/404, which is mainly mediated by RIM11, the human homolog of GSK3ß in yeast. On the other hand, the integrative strains showed a strong synergistic toxic effect upon co-expression of ASYN WT and tau WT, which was related to high levels of intracellular ASYN inclusions and increased tau phosphorylation and aggregation. Taken together, the strains described in the present study are able to mimic relevant pathogenic features involved in neurodegeneration and are powerful tools to identify potential target genes able to modulate the synergistic pathway driven by ASYN and tau interaction.

A powerful yeast-based screening assay for the identification of inhibitors of indoleamine 2,3-dioxygenase.

Activation of the enzyme indoleamine 2,3-dioxygenase 1 (IDO1) underlies the course of several human pathological conditions and, to date, no efficacious therapeutic IDO inhibitors are available. We proposed to develop a robust screening system based on the use of yeast cells to identify new lead compounds for the pharmacological inhibition of IDO-the BLOCKADE platform. Yeast combines the advantages of a relevant surrogate model for eukaryotic cell processes with the amenity to miniaturization and automation. We brought added value to the system by increasing the stringency of our assay, as the BLOCKADE strain was not deleted for any efflux pump, thus creating additional challenges for test compounds to be identified as hits. Screening of a library of 50 080 small molecules led to the identification of 101 potential IDO inhibitors, a low hit rate of 0.2%, reflecting the stringent assay conditions imposed. Most important, secondary pharmacology assays in mammalian cells confirmed activity for 76% of the hits, whereas hepatotoxicity testing indicated that 87% of them displayed a safe profile. The high predictivity rates obtained using the BLOCKADE platform clearly validate our system as a powerful tool for drug discovery.

[Langerhans cell histiocytosis and breast]. / Doença de células de langerhans e mama.

Langerhans cell histiocytosis (LCH) is a rare systemic disorder, with a diversified presentation and natural history. It can compromise any organ. We report a case of a 32-year-old woman who came to our clinic with an asymptomatic palpable breast mass. She underwent excisional biopsy. Immunohistochemical and pathological evaluation revealed Langerhans cell histiocytosis. No multisystem involvement was found.

Psicologia da Religião no Brasil: a produção em periódicos e livros / Psychology of Religion in Brazil: the production in journals and books

Apresenta-se apreciação crítica da Psicologia da Religião no Brasil, no período de 1956 a 2005, realizada com base em artigos publicados principalmente em periódicos nacionais de Psicologia. Avaliaram-se 125 artigos, segundo o tema, a teoria e a metodologia. Observou-se tendência de aumento gradativo do número de publicações. Os temas preferidos foram saúde, experiência religiosa, vocação, identidade e relações entre psicologia e religião. A produção revela utilização de teorias, conceitos e métodos da linha-mestra da Psicologia. A apreciação crítica é contextualizada em termos da origem da Psicologia da Religião no Brasil, da sua institucionalização acadêmica e dos eventos que resultaram numa literatura científica específica.(AU)

A critical evaluation of Psychology of Religion in Brazil, from 1956 to 2005, based mainly on articles published in Brazilian journals of Psychology, is presented. One hundred and twenty five articles were evaluated according to their subject matter, and their theoretical and methodological dimensions. It was observed an increasing trend in the number of publications. The subject matters most studied were health, religious experience, vocation, identity and relationship between psychology and religion. The production demonstrates preference for theories, concepts and methods of Psychology mainstream. The critical evaluation is placed in the context of the history of Psychology of Religion in Brazil, its academic institutionalization and the events that resulted in a specific scientific literature.(AU)

Psicologia da Religião no Brasil: a produção em periódicos e livros / Psychology of Religion in Brazil: the production in journals and books

Apresenta-se apreciação crítica da Psicologia da Religião no Brasil, no período de 1956 a 2005, realizada com base em artigos publicados principalmente em periódicos nacionais de Psicologia. Avaliaram-se 125 artigos, segundo o tema, a teoria e a metodologia. Observou-se tendência de aumento gradativo do número de publicações. Os temas preferidos foram saúde, experiência religiosa, vocação, identidade e relações entre psicologia e religião. A produção revela utilização de teorias, conceitos e métodos da linha-mestra da Psicologia. A apreciação crítica é contextualizada em termos da origem da Psicologia da Religião no Brasil, da sua institucionalização acadêmica e dos eventos que resultaram numa literatura científica específica.

A critical evaluation of Psychology of Religion in Brazil, from 1956 to 2005, based mainly on articles published in Brazilian journals of Psychology, is presented. One hundred and twenty five articles were evaluated according to their subject matter, and their theoretical and methodological dimensions. It was observed an increasing trend in the number of publications. The subject matters most studied were health, religious experience, vocation, identity and relationship between psychology and religion. The production demonstrates preference for theories, concepts and methods of Psychology mainstream. The critical evaluation is placed in the context of the history of Psychology of Religion in Brazil, its academic institutionalization and the events that resulted in a specific scientific literature.

Pregnancy after a previous gestation complicated by an acute aortic dissection.

Acute aortic dissection is a rare life-threatening event. No further pregnancies in women who had a previous acute aortic dissection have been reported. We present the case of a chronic hypertensive woman, who in her previous gestation was submitted to an acute aortic dissection repair at 28 weeks of gestation with cesarean delivery at the same operative procedure. The index pregnancy was uneventful. An elective cesarean was performed at 33 weeks' gestation. Aneurysm expansion, rupture or redissections are potential complications of operated aortic dissection. Normal blood pressure values and close cardiologic and obstetrical follow-up are essential to obtain a favourable outcome.

Screening pentachlorophenol degradation ability by environmental fungal strains belonging to the phyla Ascomycota and Zygomycota.

Pentachlorophenol (PCP) bioremediation by the fungal strains amongst the cork-colonising community has not yet been analysed. In this paper, the co- and direct metabolism of PCP by each of the 17 fungal species selected from this community were studied. Using hierarchical data analysis, the isolates were ranked by their PCP bioremediation potential. Fifteen isolates were able to degrade PCP under co-metabolic conditions, and surprisingly Chrysonilia sitophila, Trichoderma longibrachiatum, Mucor plumbeus, Penicillium janczewskii and P. glandicola were able to directly metabolise PCP, leading to its complete depletion from media. PCP degradation intermediates are preliminarily discussed. Data emphasise the significance of these fungi to have an interesting potential to be used in PCP bioremediation processes.