Shorter Reperfusion Time in Stroke is Associated with Better Cognition.

BACKGROUND: Cognitive changes that result from cerebrovascular disease contribute to a poor functional outcome with reduced quality of life. Among patients undergoing endovascular therapy (EVT), we aim to assess cognitive function and evaluate the impact of reperfusion time in cognitive performance. METHODS: Patients with acute right anterior circulation strokes that underwent EVT between January 2018 and August 2020 at Centro Hospitalar de Vila Nova de Gaia/Espinho, participated in the study. Modified treatment in cerebral infarction (mTICI) assessed the level of recanalization. Cognitive evaluation was assessed with Addenbrooke's Cognitive Examination revised (ACE-R). Multiple linear regression analyses were used to determine the association between time for recanalization and ACE-R. The level of significance adopted was 0.05. RESULTS: The mean age of participants was 71.5 (interquartile range [IQR] 62.0-78.2) years, and 50% (22) were women. The median time after stroke was 28.6 months (IQR 18.94-31.55). All patients in our sample had a successful level of recanalization with EVT (mTICI ≥ 2b). Time for recanalization showed an inverse association with the ACE-R (b = -0.0207, P = 0.0203). Also the mRS at 3 months had an inverse association with cognition (b = -5.2803, p = 0.0095). Level of education had a strong and direct relationship with ACE-R results (b = 3.0869, p < 0.0001). CONCLUSIONS: Longer time between stroke symptoms and recanalization with EVT in patients with right hemisphere ischemic stroke lead to lower ACE-R scores. Measures to improve door-to-recanalization time are also important for cognitive performance after ischemic stroke.

Lateralized versus nonlateralized glenospheres in reverse shoulder arthroplasty: a systematic review with meta-analysis.

HYPOTHESIS/BACKGROUND: Lateralization in reverse shoulder arthroplasty (L-RSA) was proposed to overcome some limitations of the original Grammont-style design (S-RSA). This systematic review aims to compare the clinical and functional outcomes and complications of S-RSA with L-RSA, and to assess the individual results of metallic and bony lateralization implants. METHODS: A systematic search from January 1980 to December 2019 was performed. Studies were selected in 2 phases by 2 independent reviewers; disagreements were solved by discussion. Inclusion criteria were: (1) original studies; (2) written in English or French; (3) adult individuals submitted to RSA surgery; and (4) RSA with a lateralization device in at least one of the groups. Exclusion criteria were: (1) nonoriginal studies or case reports; (2) absence of clinical or radiographic outcomes; and (3) no comparison group using S-RSA. Data were extracted for outcomes of functional status (American Shoulder and Elbow Surgeons, Constant, visual analog scale, Simple Shoulder Test, Subjective Shoulder Value, Activities of Daily Life that require External Rotation, and Disabilities of the Arm, Shoulder, and Hand), range of motion (ROM), complications, revisions, and notching. Meta-analyses were performed when possible. Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed. RESULTS: Fifteen articles/16 studies were included (865 participants: 440 L-RSA and 425 S-RSA). Most studies found no differences between the L-RSA and S-RSA groups in qualitative and meta-analysis for American Shoulder and Elbow Surgeons, Constant, Simple Shoulder Test, Activities of Daily Life that require External Rotation, and Disabilities of the Arm, Shoulder, and Hand scores. Meta-analysis demonstrated significantly lower visual analog scale (1 point) and higher Subjective Shoulder Value (6 points) in L-RSA than in S-RSA. No significant differences were found in the qualitative analyses of most studies regarding ROM in forward elevation, abduction, and internal/external rotation, but meta-analysis reported a significantly higher external rotation in L-RSA groups and specifically in osseous lateralization. Complication rate was significantly lower in L-RSA (odds ratio = 0.38), but no significant differences were found for revision rates. Notching rate was significantly lower in the L-RSA group (odds ratio = 0.14), both for osseous and metallic lateralization. DISCUSSION/CONCLUSION: This systematic review focused on studies comparing L-RSA and S-RSA and found significantly lower notching and complication rates in L-RSA groups. This review highlighted similar outcomes in clinical scores and a slight advantage for L-RSA in ROM, especially in external rotation. L-RSA was not associated with increased revision rates, while presenting lower complication and notching rates. Inclusion of studies with metallic and osseous lateralization has helped to provide further evidence on this subject, but heterogeneity and low evidence levels of the included studies may limit our conclusions.

The Anatomic Pathology laboratory adjustments in the era of COVID-19 pandemic: The experience of a laboratory in a Portuguese central hospital.

The coronavirus disease 2019 (COVID-19) pandemic has dramatically changed the world over the past weeks, with already 8,25 million infections and 445,000 deaths worldwide, leading to an unprecedented international global effort to contain the virus and prevent its spread. The emergence of novel respiratory viruses such as the SARS-CoV-2 creates dramatic challenges to the healthcare services, including surgical pathology laboratories, despite their extensive daily experience in dealing with biological and chemical hazards. Here, we cover important aspects on the knowledge on COVID-19 gathered during the first six months of the pandemic and address relevant issues on human biological sample handling in the Anatomic Pathology laboratory in the context of COVID-19 global threat. In addition, we detail our strategy to minimize the risk of contamination upon exposure to the different biological products received in the laboratory, which can be of general interest to other laboratories worldwide. Our approach has enabled a safe work environment for laboratory staff, while ensuring the maintenance of high quality standards of the work performed. In times of uncertainty and given the lack of specific guidelines directed at Anatomic Pathology services to better deal with the global COVID-19 public-health emergency, it is essential to share with the community rigorous methodologies that will enable us to better cope with probable novel waves of COVID-19 infection and other viruses that will possibly arise in the near future.

Diagnosis and Treatment of Headache in a Pediatric Emergency Department.

OBJECTIVES: The aims of the study were (1) to analyze the etiology and clinical management of headaches in children in the emergency department and (2) to analyze the treatment used in children diagnosed with headaches and with migraines. METHODS: Retrospective study of all the patients who were admitted to the pediatric emergency department of Hospital Professor Doutor Fernando Fonseca, Lisbon, in 2014, with a chief complaint of headaches or the primary discharge diagnosis was headache/migraine. RESULTS: Headache related cases represented 3.8% of all the visits, a total of 2354 subjects. The median age was 10 years and 52.6% were female. The most frequent diagnoses were as follow: headaches (21.3%), upper respiratory infections (18.4%), and migraines (6.1%). There were 4 cases of meningitis, 6,5% of all patients underwent computed tomography which was mostly requested in school-age children and adolescents. The average time from the first medical observation until discharge was 85 minutes. Fifty-five percent did not take any pain relief medication, 17.2% took acetaminophen, and 11.1% took ibuprofen. Patients who received ondansetron had less revisits (P = 0.000). Subjects with mild-moderate pain treated with acetaminophen or no medication had more revisits (P = 0.000). CONCLUSIONS: Secondary benign headaches were the most common and very rarely headache as a symptom was associated with life-threatening situations. Antiemetics seem to be efficient ally in the treatment of primary headaches, but it is important to consider alternative pharmacological regimes in patients who present with higher pain scores.

Clinical validation of the nursing outcome falls prevention behavior in people with stroke.

PURPOSE: To review the nursing outcome, Fall Prevention Behavior, and clinically validate its indicators in people with stroke. METHODS: A methodological study performed with 106 patients in two outpatient clinics, from July to September of 2013. Two pairs of trained nurses applied the NOC scale, one with and one without the use of operational definitions. The internal consistency, stability and difference between the medians obtained by nurses were compared within and between pairs. RESULTS: Most participants were men, elderly, with low education and income. Statistically significant differences were noted in twelve indicators. Five indicators had different means that were greater than the least significant difference. CONCLUSIONS: The indicators were statistically significant; the internal consistency was similar between the pairs and the intraclass correlation coefficient was more satisfactory in the pair that used the definitions. Thus, the construction of empirical referents and the clinical validation process makes the nursing indicators and outcomes more adequate for specific populations and provides an effective means to better evaluate the nursing actions.

[Need for resuscitation in preterm neonates less than 32 weeks treated with antenatal magnesium sulphate for neuroprotection]. / Necesidad de reanimación en prematuros menores de 32 semanas expuestos a sulfato de magnesio para neuroprotección fetal.

INTRODUCTION: Magnesium sulphate administration is recommended for foetal neuroprotection in pregnant women at imminent risk of early preterm birth. OBJECTIVE: To evaluate the relationship between intrapartum magnesium sulphate for foetal neuroprotection and delivery room resuscitation of preterm infants less 32 weeks. PATIENTS AND METHOD: A prospective observational study was conducted on preterm infants less 32 weeks exposed to magnesium sulphate for neuroprotection, and a comparison made with another historic group immediately before starting this treatment. Cases in both groups that had not reached lung maturity with corticosteroids were rejected. The rates of resuscitation, morbidity and mortality for each of the groups were analysed and compared. RESULTS: There was a total of 107 preterm, with 56 exposed to magnesium sulphate. Rate of advanced resuscitation were similar between the two groups. There were no other differences in mortality, invasive mechanical ventilation, time to first stool, and other comorbidities. CONCLUSIONS: Intrapartum magnesium sulphate for foetal neuroprotection was not associated with an increased need for intensive delivery room resuscitation and other morbidities in these cohorts of less than 32 weeks preterm infants.

Migrant Pathology Screening in the Pediatric Population: A Five-Year Retrospective Study From a Level II Hospital.

INTRODUCTION: The migrant population residing in Portugal has been growing. In 2015, the pediatrics department at Professor Doutor Fernando Fonseca Hospital, a level II hospital, implemented a screening for endemic pathologies in asymptomatic migrant children to enable their timely diagnosis and treatment. This study aimed to identify and characterize the main findings in the migrant pathology screening. METHODS: This was a retrospective and descriptive study of asymptomatic children and adolescents who underwent opportunistic screening for migrant pathology in a hospital setting between January 2016 and April 2021. Data analysis was performed using Microsoft Excel®. RESULTS: A total of 256 individuals were included in the study; 53.5% (137/256) were female, with a median age of eight years and two months (minimum five months; maximum 17 years and 10 months). The majority of the participants were from Guinea-Bissau (29.7%, 76/256), Angola (19.1%, 49/256) and Cape Verde (12.1%, 31/256) and had been residents in Portugal for a median time of five months (minimum two days; maximum three years and five months). A total of 42.6% (109/256) participants did not have the Portuguese vaccination schedule updated. Screening was carried out in an outpatient setting in 71.9% (184/256) of individuals. A total of 38.7% (99/256) presented screening alterations, including 65 anemia cases (18 caused by iron deficiency and one by sickle cell anemia), 5 cases of tuberculosis infection and 1 case of pulmonary tuberculosis, 1 of human immunodeficiency virus infection, 3 hepatitis B virus infection cases, 20 of parasitic infections and 2 cases of female genital mutilations. CONCLUSION: The revised migrant pathology screening protocol enabled the detection of diseases with a significant impact on the health of individual children and adolescents. This protocol serves as a practical tool for accurately monitoring the health status of this population.

Idiopathic Systemic Capillary Leak Syndrome: Report of a Pediatric Case.

The idiopathic systemic capillary leak syndrome is characterized by recurrent episodes of hypovolemia, with an unknown cause, presenting as a distributive and hypovolemic shock, due to fluid loss to the extravascular space. We describe a case of a previously healthy seven-year-old boy, who started with prodromal symptoms (abdominal pain, fatigue, nausea), followed by a fluid extravasation phase, with hemoconcentration, hypoproteinemia, and muscular edema in the abdominal wall and lower limbs, accompanied by pain - compartment syndrome. After a couple of days, spontaneous and fast recovery was noted, with clinical and analytic improvement. The inflammatory markers were always normal, and the blood cultures were negative. In this case, it is possible to distinguish the three idiopathic systemic capillary leak syndromes phases, as described in the literature. Although rare, this syndrome can be fatal, and the differential diagnosis with other causes of shock represents a challenge.

Kikuchi-Fujimoto - an enigmatic and rare disease: a report of 3 cases and brief review of the literature.

Kikuchi-Fujimoto disease (KFD) is a rare and benign condition mainly characterized by fever and lymphadenopathies. Although many studies have been carried out over time, its aetiology remains unclear, with infectious and autoimmune processes being hypothesized as the main causes. We report three cases of Kikuchi-Fujimoto disease. All patients were female and presented with fever and cervical lymphadenopathies. Extensive work up was performed, in order to rule out infectious, autoimmune and lymphoproliferative diseases. The diagnosis was established through lymph node excisional biopsy and histopathological examination. All patients were followed-up in a medical appointment, with one developing systemic lupus erythematosus (SLE).

Antimicrobial susceptibility profile of bacteria of the genus Aeromonas and Escherichia coli isolated from samples of yellow hake (Cynoscion acoupa).

The aim of this study was to evaluate the antimicrobial susceptibility profile of Aeromonas sp., and Escherichia coli isolated from samples of yellow hake (Cynoscion acoupa). We analyzed 53 Aeromonas spp. and four E. coli isolates. We observed increased resistance of E. coli to levofloxacin and sulfa-trimethoprim as well as resistance of Aeromonas spp. to ampicillin, amoxicillin-clavulanate, cefuroxime, and cefotaxime. The multiple antimicrobial resistance(MAR) index indicated multidrug resistance in 90.54% (n=48) of Aeromonas spp. isolates and in 50% (n=2) of E. coli isolates. One strain of Aeromonas spp. was resistant to all 11tested antimicrobials (MAR index = 1.00). In vitro,piperacillin + tazobactam was the most effective antimicrobial for E. coli,and cefepime and levofloxacin were the most effective antimicrobials for Aeromonas spp. Therefore, in case of illnesses caused by these microorganisms, these antimicrobials should be used. The multidrug resistance of Aeromonas spp. and E. coli in this study is elevated. This is worrisome considering the increase in bacteria resistant to multiple drugs, reducing the options for successful clinical antimicrobial use.

Sotos Syndrome and Nephrocalcinosis, a Rare But Possible Association due to Impact on Contiguous Genes.

One-month old breastfeeding infant, full-term birth, with normal anthropometric measurements at birth is referred to Pediatric Nephrology due to a nephrocalcinosis. The patient presents dysmorphic features and heart disease. A metabolic study is conducted on blood and urine yielding results within normal parameters, except for renal concentration test and acidification test. At 6 months of age, patient presents overgrowth, which along with other clinical signs arouse suspicion of Sotos Syndrome. Molecular genetic testing detects heterozygous deletion in 5q35 between bands q35.2 and q35.3, affecting genes NSD1, SLC34A1 and FGFR4, which is compatible with this syndrome and with nephrocalcinosis as a rare association.

Infraocclusion level and root resorption of the primary molar in second premolar agenesis: A retrospective cross-sectional study in the Portuguese population.

BACKGROUND: Mandibular second premolar (M2P) agenesis results in the second primary molar (2pm) retention, infraocclusion, a reduced alveolar height and width, the supraeruption of antagonists, or the movement of the adjacent teeth. Infraocclusion affects the survival of the retained 2pm to a greater extent than root resorption. OBJECTIVES: The aim of the study was to evaluate the lifespan of the primary molar as a substitute, with root quality and occlusal adaptation, in cases of M2P agenesis in a low-income population to determine if the attitude of just vigilance could be the best clinical option whenever other clinical problems are absent. MATERIAL AND METHODS: A total of 12,949 orthopantomograms were analyzed. Sixty-one patients (25 males and 36 females aged 7­36 years) were divided into group 1 (the first permanent molar in occlusion) and group 2 (the second permanent molar also in occlusion). Vertical positioning to the occlusal plane, root condition and the movement of the adjacent teeth were evaluated. RESULTS: Despite the study having a cross-sectional design, root resorption, infraocclusion, the distance between the first permanent molar and the first primary molar or the first permanent premolar, and the width of the 2pm were correlated with age. The 2pm root resorption increased with age, which was more pronounced when the second permanent molar was also in occlusion. The mesial movement of the adjacent teeth was absent in all groups. The 2pm was often occluded, but infraocclusion increased with age. Age periods of 11­15 years and 21­25 years were critical for the primary tooth loss. CONCLUSIONS: The second primary molar remains functional in the mandibular arch for up to 25 years. A well-documented no-intervention attitude based on clinical and radiographic data must be weighed in cases without orthodontic issues or with financial constraints.

A Rare Cause of Low Back Pain: A Challenging Diagnosis.

One of the rarest causes of low back pain is septic arthritis of a lumbar facet joint. We report the case of a 92-year-old diabetic woman with a history of four days of back pain, dysuria, and fever. Due to a sudden worsening of lumbar pain, she went to the emergency department. Physical exam revealed pain with pressure over the D12 vertebral apophyses and the lower-left paraspinal musculature. Laboratory data showed a normochromic normocytic anemia with a hemoglobin of 9.3 g/dL, white cell count of 14.61x10e3/µL (83.1% neutrophils), serum creatinine 1.46 mg/dL and C-reactive protein of 32.11 mg/dL. In urinalysis, nitrites and leukocyturia were identified. CT scan showed an acute D12 fracture and fat stranding at L5, with no irregularities in the discs or in other lumbar spaces. Escherichia coli was isolated in blood culture. Lumbar MRI confirmed the diagnosis of septic arthritis of an L5-S1 facet joint and L5 vertebrae osteomyelitis. The patient was successfully treated with intravenous ceftriaxone for eight weeks. As far as we know, this is the second report of septic arthritis of the facet joint caused by Escherichia coli.

Validation of an educational game to promote cardiovascular health in children.

OBJECTIVE: The aim of this study was to validate the content and appearance of an educational game for children aged 7 to 10 years, focusing mainly on cardiovascular health promotion. METHOD: The study used methodological research, with a quantitative approach. The validation process included the participation of 17 specialists in children and/or cardiovascular health. A concordance index of at least 0.80 was considered for content validation and 0.75 for the appearance of the proposed educational material. RESULTS: The proposal of the educational game was considered valid, through some suggestions, in view of the purpose of sensitizing children in relation to the promotion of cardiovascular health while still in childhood. FINAL CONSIDERATIONS: As a relevant factor in the use of games as strategies to improve health education, we emphasize that the participant is the active agent and the protagonist of the health-disease process.

Superior pole patellar sleeve fracture after medial patellofemoral ligament reconstruction.

A 13-year-old boy sustained a superior pole patellar sleeve fracture after a blunt trauma of the knee. A medial patellofemoral ligament reconstruction had been performed 4 weeks earlier. The patient underwent surgery to reinsert the quadriceps tendon in the superior pole of the patella using two bone suture anchors. One-year postoperative assessment revealed excellent functional outcomes. Sleeve fractures are easily misdiagnosed, and in our case, clinical examination was essential in order to perform the diagnosis.

Predicting Outcome in a Cohort of Isolated and Combined Dystonia within Probabilistic Brain Mapping.

BACKGROUND: Probabilistic brain mapping is a promising tool to estimate the expected benefit of pallidal deep brain stimulation (GPi-DBS) in patients with isolated dystonia (IsoD). OBJECTIVES: To investigate the role of probabilistic mapping in combined dystonia (ComD). METHODS: We rendered the pallidal atlas and the volume of tissue activated (VTA) for a cohort of patients with IsoD (n = 20) and ComD (n = 10) that underwent GPi-DBS. The VTA was correlated with clinical improvement. Afterwards, each VTA was applied on the previously published probabilistic model (Reich et al., 2019). The correlation between predicted and observed clinical benefit was studied in a linear regression model. RESULTS: A good correlation between observed and predicted outcome was found for both patients with IsoD (n = 14) and ComD (n = 7) (r2 = 0.32; P < 0.05). In ComD, 42% of the variance in DBS response is explained by VTA-based outcome map. CONCLUSION: A probabilistic model would be helpful in clinical practice to circumvent unpredictable and less impressive motor results often found in ComD.

Systemic inflammation status at admission affects the outcome of intracerebral hemorrhage by increasing perihematomal edema but not the hematoma growth.

Acute stress and inflammation responses are associated with worse outcomes in intracerebral hemorrhage (ICH) but the precise mechanisms involved are unclear. We evaluated the effect of neutrophil-to-lymphocyte ratio (NLR) in ICH outcome, with focus on hematoma expansion and early cerebral edema. In a retrospective study, we included all patients with primary ICH admitted to our center within 24-h from symptom onset from January 2014 to February 2015. We retrieved demographic and medical history data, Glasgow Coma Scale scores, blood cell counts, glucose, and C-reactive protein, and calculated NLR. We obtained hematoma volumes by computerized planimetry. Outcomes included independence at 90 days (modified Rankin scale 0-2), mortality at 30 days, significant hematoma expansion (> 33% or > 6 mL) and early cerebral edema causing significant midline shift (> 2.5 mm) at 24 h. We included 135 patients. NLR independently associated with independence at 90 days (adjusted odds ratio (aOR) 0.79, 95% CI 0.67-0.93, p = 0.006) significant cerebral edema (aOR 1.08, 95%CI 1.01-1.15, p = 0.016) but not hematoma expansion (aOR 0.99, 95%CI 0.94-1.04, p = 0.736). The severity of midline shift was positively correlated with NLR (adjusted beta = 0.08, 95% CI 0.05-0.11, p < 0.001). In ICH, an immediate and intense systemic inflammatory response reduces the likelihood of a better functional outcome at 90 days, which is more likely to be explained by perihematomal edema growth than due to a significant hematoma expansion. These findings could have implications in new treatment strategies and trial designs, which endpoints tend to target exclusively hematoma enlargement.

"Bone-shot fracture" - An unusual iliac wing fracture caused by a projectile of autologous bone fragment. A case report.

CASE: A young adult male sustained a high-energy crash suffering multiple injuries including a comminuted right femoral shaft fracture and an ipsilateral iliac wing fracture. The iliac fracture was caused by a femoral fragment which was projected and pierced the iliac wing. The patient underwent surgery with retrieval of the femoral fragment and fixation of the iliac and femoral fractures. The lesions healed uneventfully. CONCLUSION: This is the first reported case of an iliac fracture caused by a projectile of autologous bone. High-energy trauma may present unusual or never seen injury patterns to the trauma surgeon.

A Technique for a More Accurate Acromioclavicular Joint Reduction in Arthroscopic Coracoclavicular Stabilization of Acromioclavicular Joint Dislocation.

Loss of reduction is the most common complication following acromioclavicular dislocations treatment, with literature showing greater postoperative coracoclavicular distances associated with worse clinical results. We present a surgical gesture that aims to help surgeons achieve and secure an anatomic acromioclavicular reduction during coracoclavicular fixation. This technique has the possibility to improve radiological and functional results of acromioclavicular dislocation treatment.

Use of educational technologies in the promotion of children's cardiovascular health: a systematic review.

OBJECTIVE: The aim of this study was to investigate the effectiveness of educational technologies for cardiovascular health promotion in children. METHODS: A systematic review was carried out through a search in Biblioteca Virtual de Saúde, Comissão de Aperfeiçoamento de Pessoal do Nível Superior, EBSCOHot Information Services, and US National Library of Medicine National Institutes of Health databases, using the descriptors: play and plaything, cardiovascular diseases, child, and health promotion, between 2012 and 2019. RESULTS: Eight articles were selected for this review. The identified technologies were based on low-tech interventions, such as play workshops, using tools such as CARDIOKIDS, the SI! program, MOVI-2, and activities with wide-ranging digital tools such as Fooya!, Fit2PlayTM, and the exergame cycling program. CONCLUSIONS: It is noteworthy that all of the analyzed interventions were effective and those that involved playing were better accepted by the children.