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What parents teach about sexuality to their children
Get PDFIntrodução: O desenvolvimento sexual da criança é um processo fisiológico, influenciado pela idade, pelo que vivencia e lhe é ensinado. Assim, quem participa ativamente na sua educação deve estar consciencializado da pertinência do tema.
Objetivos: Caracterizar a educação sexual (ES) realizada a crianças de seis e sete anos.
Material e métodos: Estudo de base comunitária, observacional e transversal dirigido a pais de crianças com 6/7 anos de idade. Aplicou-se um questionário de autopreenchimento, com questões sociodemográficas e de caracterização da ES das crianças, a partir das quais foi efetuada uma escala com o objetivo de avaliar a envolvência dos pais na ES dos filhos, que foi tanto maior, quanto maior for a cotação obtida (máximo 33). A analise estatística dos dados utilizou o programa informático Statistical Package for the Social Sciences® (SPSS), versão 22.0.
Resultados: Obtiveram-se questionários de 127 pais, com idade média de 38 anos e predomínio de respostas maternas. Procuraram obter conhecimentos acerca da sexualidade dos seus filhos apenas 22% dos pais, e destes 1/3 fê-lo junto de um médico. Apesar de 91,2% dos pais referirem sentir-se confortáveis para falar de sexualidade com os seus filhos, 62,9% nunca o fez, principalmente por considerarem ser precoce. Quando abordada, a iniciativa partiu maioritariamente da criança. A reprodução humana e as diferenças entre sexos foram abordadas, exclusivamente em casa, em 55,8% e 35,5% dos casos, respetivamente. Foi iniciativa dos pais a abordagem de comportamentos de exploração do corpo adequados aos domínios público/privado (88,5%) e de comportamentos inadequados por terceiros à exploração do corpo da criança (97%). A cotação média da escala que traduz a ES das crianças e a envolvência parental foi 13,7±5,18, havendo diferença entre a cotação obtida pelas mães (14,5±5,3) e pais (12,6±4,9) (p<0,05).
Conclusões: Os resultados evidenciam que os pais não priorizam esta vertente do desenvolvimento infantil, aspeto reiterado pela abordagem pouco frequente de temas relativos à ES no seio familiar, por iniciativa dos pais.info:eu-repo/semantics/publishedVersio
Breastfeeding: changes after 12 years
Get PDFIntrodução: Nas últimas décadas têm-se desenvolvido iniciativas para a promoção e proteção do aleitamento materno (AM). Este estudo pretende avaliar a taxa de manutenção de AM na maternidade e a sua manutenção aos três e aos seis meses de vida, no ano de 2012 num hospital de apoio perinatal diferenciado e comparar os resultados com os obtidos em estudos anteriores, em 2000 e 2003, realizados na mesma instituição.
Material e Métodos: Estudo longitudinal prospetivo. Amostra de conveniência dos recém-nascidos internados na maternidade de 1 de fevereiro a 30 de abril de 2012. Recolheram-se dados sociodemográficos, perinatais e determinantes da interrupção do AM, na maternidade, aos três e seis meses de vida e comparam-se com os dados dos estudos realizados em 2000 e 2003 na mesma instituição.
Resultados: Incluíram-se 292 díadas mãe/filho. Em comparação com os estudos anteriores, as mães apresentavam uma idade média e nível de escolaridade superior. Relativamente ao estudo de 2000, verificou-se um aumento da percentagem de prematuros, uma redução dos partos por cesariana bem como uma diminuição na administração de leite para lactantes (LPL) e tempo da primeira mamada. Constatou-se um aumento da taxa do AM na maternidade (98%) em comparação ao ano de 2003 (91%). Obtivemos um menor número de respostas aos 3 e 6 meses de seguimento relativamente aos estudos anteriores, mantendo-se o AM, respetivamente em 78,7% e 53,1% dos casos avaliados nestes dois períodos. A hipogaláctia manteve-se a principal causa de aleitamento de substituição. Aos seis meses, a iniciativa da interrupção foi maioritariamente tomada pela mãe.
Discussão/Conclusão: Todas as mães que iniciaram o AM na maternidade mantiveram-no até à alta o que representa um incentivo às iniciativas de promoção do AM na maternidade desenvolvidas ao longo dos anos. A redução da administração de leite para lactante e do tempo até início do AM, representaram ganhos na sua promoção.
A hipogaláctia manteve-se a principal causa de abandono mas contrariamente aos estudos anteriores a iniciativa da interrupção do AM foi mais frequentemente tomada pela mãe. É premente a criação de políticas e estruturas na comunidade que visem o apoio à manutenção do AM após a alta hospitalar.info:eu-repo/semantics/publishedVersio
Spontaneous pneumomediastinum: report of two cases
Get PDFIntrodução: O Pneumomediastino espontâneo é uma entidade rara na infância, sendo na maioria dos casos desencadeado por uma crise asmática grave. A dor torácica e dispneia são os sintomas mais frequentes de apresentação, sendo o diagnóstico feito habitualmente pela radiografia de tórax. O tratamento conservador é preferencial, com prognóstico favorável.
Casos clínicos: O primeiro caso, um adolescente de 14 anos, com o diagnóstico de pneumomediastino e enfisema subcutâneo espontâneos, sem fator desencadeante evidente, apesar de ter antecedentes de asma. O segundo caso, uma criança de 19 meses que desenvolveu, como complicação de uma pneumonia, um pneumomediastino espontâneo toraco-cervical e um pneumotórax.
A evolução foi favorável, no primeiro caso apenas com medidas sintomáticas e no segundo, houve necessidade de colocação de dreno torácico com melhoria progressiva do quadro respiratório.
Discussão/conclusões: Estes casos constituem exemplos de pneumomediastino espontâneo que se destacam pela raridade desta patologia nesta faixa etária.info:eu-repo/semantics/publishedVersio
[Translation and Validation of the FOUR Scale for Children and its Use as Outcome Predictor: A Pilot Study]
Get PDFINTRODUCTION:
The Full Outline of UnResponsiveness - FOUR scale has been previously validated to assess impaired consciousness in the adult population. The aim of this study is the translation into Portuguese and validation of the FOUR scale in the pediatric population. The study also compares the FOUR scale and Glasgow coma scale score ratings and the clinical outcome of patients hospitalized in Pediatric Intensive Care Units.
MATERIAL AND METHODS:
This study prospectively rated patients admitted to the Pediatric Intensive Care Units with impaired consciousness during one year. Both scales were applied daily to patients by three types of examiners: intensivists, residents and nurses, from the moment of admission until clinical discharge. Neurological sequelae was evaluated using the King's Outcome Scale for Childhood Head Injury - KOSCHI.
RESULTS:
Twenty seven patients between one and 17 years of age were included. Both scales are reliable and inter-rater reliability was greater for the FOUR score. Glasgow coma scale showed a minimum score in eight evaluations, whereas the FOUR scale obtained the minimum score in only two of these evaluations. In both scales there was a strong association between the admission score and the patient's outcome (area under curve FOUR = 0.939, versus Glasgow coma scale = 0.925).
DISCUSSION:
The FOUR scale provides more neurological information than Glasgow coma scale in patients with impaired consciousness and has prognostic interest.
CONCLUSION:
The FOUR scale can be applied in patients admitted with impaired consciousness in Pediatric Intensive Care Units. We think that a multicenter study would be very beneficial for confirming and generalizing these results.info:eu-repo/semantics/publishedVersio
A Endocrinologia em Portugal - Censo 2016. Direção do Colégio de Endocrinologia e Nutrição da Ordem dos Médicos
Get PDFINTRODUCTION:
On September 2016, the Board of the College of Endocrinology and Nutrition of the Portuguese Medical Association carried out a national survey, about all Endocrinology, Diabetes and Metabolism Departments of the public hospitals included in the Portuguese National Health Service and a simplified version of this survey was sent to all endocrinologists working in Portugal and registered with the Portuguese Medical Association.
MATERIAL AND METHODS:
Data related to organizational and human resources were collected, reporting the situation by the end of year 2015. The census registered 107 individuals and 27 Departments.
RESULTS:
The ratio of endocrinologists-population was 1.4, much lower than in the other European countries (varies between 2 to 4), resulting in alarming shortages of services in some areas of Portugal and in worse quality indicators.
DISCUSSION:
These data suggest that actions should be taken to increase the number of endocrinologists and departments in the country.
CONCLUSION:
In recent years, the number of residents has significantly increased, which will make it possible to correct this situationIntrodução: A Direção do Colégio de Endocrinologia e Nutrição da Ordem dos Médicos realizou um inquérito nacional em setembro de 2016, a todos os serviços de Endocrinologia, Diabetes e Metabolismo dos hospitais do Serviço Nacional de Saúde e uma versão simplificada do mesmo foi enviada a todos os endocrinologistas a trabalhar em Portugal e inscritos no colégio.
Material e Métodos: O censo inclui dados organizacionais e de recursos humanos relativos ao fim do ano de 2015. Registou 107 respostas individuais e 27 serviços.
Resultados: O ratio de endocrinologistas por 100 000 habitantes era de 1,4, muito inferior a outros países europeus (varia de 2 a 4), que resulta numa carência grave de serviços em algumas zonas do País e em piores indicadores de qualidade.
Discussão: Estes dados indicam que devem ser implementadas medidas para aumentar o número de endocrinologistas e serviços em Portugal.
Conclusão: Nos últimos anos, o número de internos tem vindo a aumentar, o que vai permitir melhorar esta situação.info:eu-repo/semantics/publishedVersio
Sacral Fractures and Associated Injuries
Get PDFSTUDY DESIGN:
Literature review.
OBJECTIVE:
The aim of this review is to describe the injuries associated with sacral fractures and to analyze their impact on patient outcome.
METHODS:
A comprehensive narrative review of the literature was performed to identify the injuries associated with sacral fractures.
RESULTS:
Sacral fractures are uncommon injuries that result from high-energy trauma, and that, due to their rarity, are frequently underdiagnosed and mistreated. Only 5% of sacral fractures occur in isolation. Injuries most often associated with sacral fractures include neurologic injuries (present in up to 50% of sacral fractures), pelvic ring disruptions, hip and lumbar spine fractures, active pelvic/ abdominal bleeding and the presence of an open fracture or significant soft tissue injury. Diagnosis of pelvic ring fractures and fractures extending to the lumbar spine are key factors for the appropriate management of sacral fractures. Importantly, associated systemic (cranial, thoracic, and abdominopelvic) or musculoskeletal injuries should be promptly assessed and addressed. These associated injuries often dictate the management and eventual outcome of sacral fractures and, therefore, any treatment algorithm should take them into consideration.
CONCLUSIONS:
Sacral fractures are complex in nature and often associated with other often-missed injuries. This review summarizes the most relevant associated injuries in sacral fractures and discusses on their appropriate management.info:eu-repo/semantics/publishedVersio
Aneurysmal Degeneration of the Brachial Artery after Vascular Access Creation: Surgical Treatment Results
Get PDFTrue peripheral artery aneurysms proximal to a longstanding arteriovenous fistula is a well-recognized complication. Late aneurysmal degeneration is rare. This study analyzed the characteristics, therapeutic options, and outcomes of true donor brachial artery aneurysms (DBAA) after arteriovenous fistula (AVF) for hemodialysis. We retrospectively collected the data of patients with DBAA after AVF creation, surgically repaired between January 2001 and September 2015. We excluded patients with pseudoaneurysms, anastomotic aneurysms, and infected aneurysms. We recorded patient's demographics, type of access, aneurysm characteristics, symptoms, treatment, and follow-up. Ten patients were treated for aneurysmal degeneration of the brachial artery. Average aneurysm diameter was 37.5 mm. All cases had, at least, one previous distal AVF, ligated or thrombosed, at the time of diagnosis. The first access was created in mean 137 months before the diagnosis of DBAA. Nine patients had previous medical history of renal transplant and were under immunosuppressive therapy. All patients were symptomatic at the time of diagnosis. In all cases, the treatment was aneurysmectomy followed by interposition bypass. One patient developed a postoperative hematoma with the need of surgical drainage. At 50 months of follow-up, one patient was submitted to percutaneous angioplasty due to an anastomotic stenosis. No other complications occurred during the entire follow-up period (mean: 69 months). The pathogenesis underlying DBAA remains unclear. Increased blood flow after AVF creation, immunosuppressive therapy, and ligation/thrombosis of the AVF may contribute to aneurysm formation. Surgical treatment by aneurysmectomy and bypass, with autogenous conducts, is a safe and effective option.info:eu-repo/semantics/publishedVersio
Familial amyloid polyneuropathy in Portugal: New genes modulating age-at-onset
Get PDFOBJECTIVES:
Familial amyloid polyneuropathy (FAP ATTRV30M) shows a wide variation in age-at-onset (AO) between clusters, families, and among generations. We will now explore some candidate genes involved in altered disease pathways in order to assess their role as genetic modifiers of AO, using a family-centered approach.
METHODS:
We analyzed 62 tagging SNPs from nine genes-NGAL,MMP-9,BGN,MEK1,MEK2,ERK1,ERK2,HSP27, and YWHAZ - in a sample of 318 V30M Portuguese patients (106 families), currently under follow-up. A generalized estimating equation analysis was used to take into account nonindependency of AO between relatives. Also, an in silico analysis was performed in order to assess the functional impact of significant variants associated with AO.
RESULTS:
We found for the first time variants from six genes (NGAL,BGN (in the female group), MEK1,MEK2,HSP27, and YWHAZ) that were significantly associated with early- and/or late-onset. Then, we confirmed a strong synergistic interaction between NGAL and MMP-9 genes. Additionally, by an in silico analysis, we found some variants for MEK1 gene that may alter binding of the transcription factors and that influence the regulation of gene expression regarding microRNA binding sites and splicing regulatory factors.
INTERPRETATION:
These findings showed that different genetic factors can modulate differently the onset of disease's symptoms and revealed new mechanisms with clinical implications in the genetic counseling and follow-up of mutation carriers and could contribute for development of potential therapeutical targets.info:eu-repo/semantics/publishedVersio
Genetic polymorphisms in key hypoxia-regulated downstream molecules and phenotypic correlation in prostate cancer
Get PDFBackground
In this study we sought if, in their quest to handle hypoxia, prostate tumors express target hypoxia-associated molecules and their correlation with putative functional genetic polymorphisms.
Methods
Representative areas of prostate carcinoma (n = 51) and of nodular prostate hyperplasia (n = 20) were analysed for hypoxia-inducible factor 1 alpha (HIF-1α), carbonic anhydrase IX (CAIX), lysyl oxidase (LOX) and vascular endothelial growth factor (VEGFR2) immunohistochemistry expression using a tissue microarray. DNA was isolated from peripheral blood and used to genotype functional polymorphisms at the corresponding genes (HIF1A +1772 C > T, rs11549465; CA9 + 201 A > G; rs2071676; LOX +473 G > A, rs1800449; KDR – 604 T > C, rs2071559).
Results
Immunohistochemistry analyses disclosed predominance of positive CAIX and VEGFR2 expression in epithelial cells of prostate carcinomas compared to nodular prostate hyperplasia (P = 0.043 and P = 0.035, respectively). In addition, the VEGFR2 expression score in prostate epithelial cells was higher in organ-confined and extra prostatic carcinoma compared to nodular prostate hyperplasia (P = 0.031 and P = 0.004, respectively). Notably, for LOX protein the immunoreactivity score was significantly higher in organ-confined carcinomas compared to nodular prostate hyperplasia (P = 0.015). The genotype-phenotype analyses showed higher LOX staining intensity for carriers of the homozygous LOX +473 G-allele (P = 0.011). Still, carriers of the KDR−604 T-allele were more prone to have higher VEGFR2 expression in prostate epithelial cells (P < 0.006).
Conclusions
Protein expression of hypoxia markers (VEGFR2, CAIX and LOX) on prostate epithelial cells was different between malignant and benign prostate disease. Two genetic polymorphisms (LOX +473 G > A and KDR−604 T > C) were correlated with protein level, accounting for a potential gene-environment effect in the activation of hypoxia-driven pathways in prostate carcinoma. Further research in larger series is warranted to validate present findings.info:eu-repo/semantics/publishedVersio
CD56-Negative Aggressive NK Cell Leukemia Relapsing as Multiple Cranial Nerve Palsies: Case Report and Literature Review
Get PDFAggressive natural killer cell leukemia (ANKL) is extremely rare and habitually manifests as a systemic disease with multiorgan failure that rapidly evolves to death. The neoplastic natural killer (NK) cells usually harbor the Epstein-Barr virus (EBV) with a latent viral infection pattern type II; they often have a cytoplasmic CD3ε+ and surface CD3-, CD2+, and CD56+ immunophenotype, and they show complex genetic abnormalities affecting multiple tumor suppressor genes and oncogenes. We present a rare case of CD56-negative ANKL and review the clinical and laboratorial criteria for the diagnosis, as well as the available therapies.info:eu-repo/semantics/publishedVersio