Long-term monitoring of the fish community in the Minho Estuary (NW Iberian Peninsula).

Background: The paper presents an extensive fish sampling dataset spanning a long-term period from 2010 to 2019. The data were collected in Lenta Marina, an upstream area in the Minho Estuary of the NW Iberian Peninsula, which belongs to a LTSER (Long-Term Socio-Ecological Research) platform. To capture fish, fyke nets were utilised as the sampling method and deployed at Lenta Marina. This dataset offers valuable insights into the abundance of each collected taxa recorded over time. New information: The dataset reports a comprehensive compilation of data on the abundance of fish species observed in the area during the sampling period (includes zeroes when a given taxonomic entity was absent in a given sampling event). It provides a detailed record of the abundances of the fish community through time in a frequent sampling regime (on average, sampling was done every 6 days). The dataset shows that the amount of fish from invasive taxa exceeds the count of fish from native taxa in the Minho Estuary.

Integrated Approach for Synthetic Cathinone Drug Prioritization and Risk Assessment: In Silico Approach and Sub-Chronic Studies in Daphnia magna and Tetrahymena thermophila.

Synthetic cathinones (SC) are drugs of abuse that have been reported in wastewaters and rivers raising concern about potential hazards to non-target organisms. In this work, 44 SC were selected for in silico studies, and a group of five emerging SC was prioritized for further in vivo ecotoxicity studies: buphedrone (BPD), 3,4-dimethylmethcathinone (3,4-DMMC), butylone (BTL), 3-methylmethcathinone (3-MMC), and 3,4-methylenedioxypyrovalerone (MDPV). In vivo short-term exposures were performed with the protozoan Tetrahymena thermophila (28 h growth inhibition assay) and the microcrustacean Daphnia magna by checking different indicators of toxicity across life stage (8 days sublethal assay at 10.00 µg L-1). The in silico approaches predicted a higher toxic potential of MDPV and lower toxicity of BTL to the model organisms (green algae, protozoan, daphnia, and fish), regarding the selected SC for the in vivo experiments. The in vivo assays showed protozoan growth inhibition with MDPV > BPD > 3,4-DMMC, whereas no effects were observed for BTL and stimulation of growth was observed for 3-MMC. For daphnia, the responses were dependent on the substance and life stage. Briefly, all five SC interfered with the morphophysiological parameters of juveniles and/or adults. Changes in swimming behavior were observed for BPD and 3,4-DMMC, and reproductive parameters were affected by MDPV. Oxidative stress and changes in enzymatic activities were noted except for 3-MMC. Overall, the in silico data agreed with the in vivo protozoan experiments except for 3-MMC, whereas daphnia in vivo experiments showed that at sublethal concentrations, all selected SC interfered with different endpoints. This study shows the importance to assess SC ecotoxicity as it can distress aquatic species and interfere with food web ecology and ecosystem balance.

Toxicity of the 3,4-Methylenedioxymethamphetamine and Its Enantiomers to Daphnia magna after Isolation by Semipreparative Chromatography.

MDMA (3,4-methylenedioxymethamphetamine) is a chiral psychoactive recreational drug sold in illicit markets as racemate. Studies on the impact of MDMA on aquatic organisms are scarce. While enantioselectivity in toxicity in animals and humans has been reported, none is reported on aquatic organisms. This study aimed to investigate the ecotoxicological effects of MDMA and its enantiomers in Daphnia magna. For that, enantiomers (enantiomeric purity > 97%) were separated by liquid chromatography using a homemade semipreparative chiral column. Daphnids were exposed to three concentrations of (R,S)-MDMA (0.1, 1.0 and 10.0 µg L-1) and two concentrations of (R)- and (S)-enantiomers (0.1 and 1.0 µg L-1) over the course of 8 days. Morphophysiological responses were dependent on the substance form and daphnia development stage, and they were overall not affected by the (R)-enantiomer. Changes in swimming behaviour were observed for both the racemate and its enantiomers, but enantioselective effects were not observed. Reproductive or biochemical changes were not observed for enantiomers whereas a significant decrease in acetylcholinesterase and catalase activity was noted at the highest concentration of (R,S)-MDMA (10 µg L-1). Overall, this study showed that sub-chronic exposure to MDMA racemate and its enantiomers can interfere with morphophysiological and swimming behaviour of D. magna. In general, the (R)-enantiomer demonstrated less toxicity than the (S)-enantiomer.

Sustainable and Active Program-Development and Application of SAVING Methodology.

The SAVING project aimed to create a sustainable and active aging program to promote the transition to sustainable aging in residential structures for the elderly (RSEs), developing research activities to apply the best strategies and good practices regarding the promotion of an active, healthy, and sustainable aging regarding social, economic, environmental, and pedagogic aspects. All this innovative methodology was built on a living-lab approach applied in one RSE, that was used as a case study. The results showed that the creation of the SAVING Brigade allowed not only increased reflection and mutual learning, but also created better conditions to face uncertainties and obstacles. Moreover, the use of indicators supported the basic themes and enabled comparison with other studies, between institutions or programs. Finally, the Action Plan acted as a tool for the development of previously defined strategies. It is possible to conclude that the breadth of the concept of quality of life encompasses the physical health of the individual, their psychological state, their social relationships, their perceptions, and the relationship with the characteristics of the context in which they are inserted. Therefore, active, sustainable, and healthy aging should be the goal.

Assessment of effluents quality through ecotoxicological assays: evaluation of three wastewater treatment plants with different technologies.

The water quality of the effluents is mainly focused on physicochemical and microbiological parameters. However, the ecotoxicological assessments are crucial to ensure an effective water quality of the effluents. This work aims to assess the ecotoxicity of effluents originated from WWTPs with different wastewater treatment technologies. For that, effluent samples from three WWTPs with different treatment processes were seasonally collected. Physicochemical parameters were determined, the toxicity towards daphnia, protozoan, and microalgae organisms was evaluated, and data correlated. Toxicity assays showed different susceptibility of the organisms to the effluents and that toxicity is dependent on the season and wastewater treatment technology. No toxicity was observed to daphnia in winter and spring, but ~100% of mortality was observed in effluent from WWTP A in summer. Growth inhibition was observed for both protozoan and microalgae for all effluents and in all seasons with highest values in spring in WWTP C (~80%) for the protozoan while the highest microalgae growth inhibition percentage was observed for WWTP B in both spring (~80%) and summer (~80%). These results show that effluents might have negative impacts into their receiving water systems and highlight that a global assessment of effluent quality should include ecotoxicological assays to complement physicochemical and microbiological data for an operative environmental management of wastewater treatment plants.

Clinical and laboratory parameters associated with li-rads as diagnostic of liver nodule in patients with cirrhosis.

BACKGROUND: Hepatocellular carcinoma (HCC) is the most common primary liver cancer in the world. Clinical and laboratory evaluation of a cirrhotic patient with a liver nodule may show alterations suggesting malignancy. There is a lack of questions related to diagnosis of HCC and evaluation of liver imaging reporting and data system (LI-RADS) could be a tool for early diagnosis of HCC. This aims to confirm an association between clinical and laboratory characteristics in cirrhotic patients with hepatic nodule after LI-RADS categorization. METHODS: A cross-sectional retrospective study was performed with 62 patients grouped according to LI-RADS algorithm. Differences between groups were confirmed using association tests and the Kappa test was employed to provide further confirmation. RESULTS: Associations were observed after univariate analysis with higher values of aspartate aminotransferase (AST) (P=0.008), alanine aminotransferase (ALT) (P=0.019), alkaline phosphatase (ALP) (P=0.0052), gamma glutamyl transferase (GGT) (P=0.0023), alpha-fetoprotein (AFP) (P=0.0001), nodule size (P=0.0001) and age (P=0.007) in LR 5 group compared to LR 3. Univariate analysis also revealed higher levels for the LR5 group of ALP (P=0.0228), AFP (P=0.022) and age (P=0.046) in relation to LR 1+2 group. AFP also had higher serum levels in the LR 4 group compared to LR 1+2 (P=0.004). After multivariate analysis, higher levels in LR5 group of nodule size (P=0.047) and ALP (P=0.027) were observed in relation to LR3, and were therefore considered predictors of HCC diagnosis. CONCLUSIONS: The study suggests that the combination of clinical-laboratory and radiological factors, such as heightened serum levels of ALP and hepatic nodule size, may support the screening of HCC in cirrhotic patients with hepatic nodules using the LI-RADS algorithm.

Clinical and Radiological Aspects of Cough-induced Rib Fractures: A Case Report.

Cough-induced rib fracture is a very rare condition, with a few cases described in the medical literature. This case report describes the case of a 77-year-old male patient with a history of chronic obstructive pulmonary disease (COPD) who presented with left eighth and ninth rib fractures after severe cough secondary to upper respiratory tract infection. The patient had a good clinical outcome, followed by conservative management. Conservative treatment is the first-choice approach in cases of daily activities limiting symptoms or complications. Cough-induced rib fracture should be remembered as a possible diagnosis, as diagnostic delays increase the risk of complications.

Critical assessment of the surgical treatment of low rectal adenocarcinoma in a reference hospital in Recife / Análise crítica do tratamento cirúrgico do adenocarcinoma de reto inferior em hospital de referência no Recife

ABSTRACT Objectives: To evaluate the rates of abdominoperineal resection in patients with low rectal adenocarcinoma at the Hospital Barão de Lucena - SES/PE. Methodology: This is a study based on the analysis of medical records of patients with low rectal adenocarcinoma submitted to surgical treatment at the Hospital Barão de Lucena Coloproctology Service between 2013 and 2016. Results: It was observed that 77.5% of patients underwent abdominoperineal resection and 22.5% underwent anal sparing surgery. Most of the patients were male (62.5%), were under 70 years old (72.5%), presented a BMI less than 30 kg/m2 (87.5%), presented American Society of Anesthesiologists (ASA) score I and III (82.5%), Rullier classification from I to III (95%) and TNM different from T1-T3 (95%). In 92.5% of medical records, there was no record of fecal continence before surgery. The most frequent period between the end of the radiotherapy and the surgery was over 11 weeks (57.5%); the most common distance from the tumor to the anal margin was between 3.1 and 4.0 cm (35% of patients). Conclusion: There was a high rate of non-sparing anal sphincter surgeries. The only predictive factor for abdominoperineal resection was the presence of tumors classified as Rullier type III and IV.

RESUMO Objetivos: Avaliar a taxa de ressecção abdominoperineal em portadores de adenocarcinoma de reto inferior no Hospital Barão de Lucena - SES/PE. Metodologia: Trata-se de um estudo baseado na análise de prontuários de pacientes com adenocarcinoma de reto inferior submetidos a tratamento cirúrgico no serviço de Coloproctologia do Hospital Barão de Lucena entre 2013 e 2016. Resultados: Observou-se que 77,5% dos pacientes foram submetidos à ressecção abdominoperineal e 22,5% à cirurgia com preservação esfincteriana. A maioria dos pacientes era do sexo masculino (62,5%), tinha menos que 70 anos (72,5%), apresentava IMC menor que 30 kg/m2 (87,5%), apresentava ASA I e II (82,5%), classificação de Rullier de I a III (95%) e TNM diferente de T1-T3 (95%). Em 92,5% dos prontuários, não havia registro sobre a continência fecal antes da cirurgia. O período mais frequente entre o término da radioterapia e a realização da cirurgia foi superior a 11 semanas (57,5%); a distância, mais comum, do tumor à margem anal estava entre 3,1-4,0 cm (35% dos pacientes). Conclusão: Houve uma alta taxa de cirurgias não poupadoras de esfíncter anal. O único fator preditivo para a realização da ressecção abdominoperineal foi a presença de tumores classificados como Rulier tipo III e IV.

Global hippocampal atrophy in major depressive disorder: a meta-analysis of magnetic resonance imaging studies / Atrofia global do hipocampo no transtorno depressivo maior: uma metanálise de estudos com ressonância magnética

Abstract Introduction: Major depressive disorder (MDD), an incapacitating mental disorder, is characterized by episodes of at least 2 weeks of apparent changes in mood, cognition, and neurovegetative functions. Many neuroimaging studies using magnetic resonance imaging (MRI) have examined morphometric changes in patients with MDD, but the results are not conclusive. This study aims to review the literature and perform a meta-analysis on hippocampal volume (HcV) in patients with MDD. Methods: Studies on HcV in patients with MDD diagnosis were identified from major databases (MEDLINE, EMBASE, The Cochrane Library, Scopus, PsycINFO, and SciELO) using the search terms depression, major depressive disorder, MDD, unipolar, magnetic resonance imaging, MRI, and hippocampus. Results: A meta-analysis of 29 studies fulfilling specific criteria was performed. The sample included 1327 patients and 1004 healthy participants. The studies were highly heterogeneous with respect to age, sex, age of onset, and average illness duration. However, the pooled effect size of depression was significant in both hippocampi. MDD was associated with right (-0.43; 95% confidence interval [95%CI] −0.66 to −0.21) and left (-0.40; 95%CI −0.66 to −0.15) hippocampal atrophy. Conclusions: MDD seems to be associated with global HcV atrophy. Larger longitudinal follow-up studies designed to analyze the influence of sociodemographic variables on this relationship are required to yield better evidence about this topic.

Resumo Introdução: O transtorno depressivo maior (TDM) é uma doença mental incapacitante caracterizada por episódios de pelo menos 2 semanas de mudanças claras no afeto, cognição e funções neurovegetativas. Vários estudos de neuroimagem, realizados através de imagem de ressonância magnética (IRM), examinaram mudanças morfométricas em pacientes com TDM, com resultados não conclusivos. Este estudo tem como objetivo revisar a literatura e realizar uma metanálise sobre o volume do hipocampo (VHc) em pacientes com TDM. Métodos: Estudos de VHc em pacientes com TDM foram identificados a partir dos principais bancos de dados (MEDLINE, EMBASE, The Cochrane Library, Scopus, PsycINFO e SciELO) usando os seguintes termos: depression, major depressive disorder, MDD, unipolar, magnetic resonance imaging, MRI e hippocampus. Resultados: Foi realizada uma metanálise de 29 estudos que preencheram os critérios específicos. A amostra foi composta por 1327 pacientes e 1004 indivíduos saudáveis. Os estudos foram altamente heterogêneos em relação a idade, gênero, idade do primeiro episódio e duração média da doença, mas o efeito combinado da depressão foi significativo em ambos os hipocampos. O TDM foi associado à atrofia do hipocampo à direita [-0,43; intervalo de confiança de 95% (IC95%) −0,66 a −0,21] e à esquerda (-0,40; IC95% −0,66 a −0,15). Conclusões: O TDM parece estar associado à atrofia global do VHc. Estudos longitudinais com maior tempo de seguimento, projetados para analisar a influência dos fatores sociodemográficos nessa relação, são necessários para obter evidências mais robustas.

Global hippocampal atrophy in major depressive disorder: a meta-analysis of magnetic resonance imaging studies.

INTRODUCTION: Major depressive disorder (MDD), an incapacitating mental disorder, is characterized by episodes of at least 2 weeks of apparent changes in mood, cognition, and neurovegetative functions. Many neuroimaging studies using magnetic resonance imaging (MRI) have examined morphometric changes in patients with MDD, but the results are not conclusive. This study aims to review the literature and perform a meta-analysis on hippocampal volume (HcV) in patients with MDD. METHODS: Studies on HcV in patients with MDD diagnosis were identified from major databases (MEDLINE, EMBASE, The Cochrane Library, Scopus, PsycINFO, and SciELO) using the search terms depression, major depressive disorder, MDD, unipolar, magnetic resonance imaging, MRI, and hippocampus. RESULTS: A meta-analysis of 29 studies fulfilling specific criteria was performed. The sample included 1327 patients and 1004 healthy participants. The studies were highly heterogeneous with respect to age, sex, age of onset, and average illness duration. However, the pooled effect size of depression was significant in both hippocampi. MDD was associated with right (-0.43; 95% confidence interval [95%CI] -0.66 to -0.21) and left (-0.40; 95%CI -0.66 to -0.15) hippocampal atrophy. CONCLUSIONS: MDD seems to be associated with global HcV atrophy. Larger longitudinal follow-up studies designed to analyze the influence of sociodemographic variables on this relationship are required to yield better evidence about this topic.

Urtica spp.: Phenolic composition, safety, antioxidant and anti-inflammatory activities.

Urtica dioica and other less studied Urtica species (Urticaceae) are often used as a food ingredient. Fifteen hydroxycinnamic acid derivatives and sixteen flavonoids, flavone and flavonol-type glycosides were identified in hydroalcoholic extracts from aerial parts of Urtica dioica L., Urtica urens L. and Urtica membranacea using HPLC-PDA-ESI/MSn. Among them, the 4-caffeoyl-5-p-coumaroylquinic acid and three statin-like 3-hydroxy-3-methylglutaroyl flavone derivatives were identified for the first time in Urtica urens and U. membranacea respectively. Urtica membranacea showed the higher content of flavonoids, mainly luteolin and apigenin C-glycosides, which are almost absent in the other species studied. In vitro, Urtica dioica exhibited greater antioxidant activity but Urtica urens exhibited stronger anti-inflammatory potential. Interestingly, statin-like compounds detected in Urtica membranacea have been associated with hypocholesterolemic activity making this plant interesting for future investigations. None of the extracts were cytotoxic to macrophages and hepatocytes in bioactive concentrations (200 and 350µg/mL), suggesting their safety use in food applications.

The European Portuguese adaptation of the Fear of Pain Questionnaire.

In Portugal, it is estimated that chronic pain affects 36.7% of the population, constituting a multifactorial phenomenon with great impact at individual, family, community, and social levels. In the fear-avoidance model of pain, one of the most consistent consensual in the literature, the fear arises as one of the variables that can contribute to the development and maintenance of this condition. Thus, instruments for evaluating the fear of pain, as Fear of Pain Questionnaire (FPQ-III), may be useful in the conceptualization of the subjective experience of pain. Accordingly, this paper aims to describe the adaptation of FPQ-III for the European Portuguese. A total of 1094 participants (795 women; mean age=25.16, SD=7.72) completed the web based questionnaire. The results pointed to a different factor solution found in the first study of the original scale (five factors: minor pain, severe pain, medical pain, injection pain, and afflicted pain), good internal consistency (.75-.85) and good correlations (between .30 and .59) between subscales and (between .68 and .85) for the total score and subscales. Given the need to meet the various dimensions of subjective experience of pain, the Fear of Pain Questionnaire is assumed as a useful tool, in combination with other, may contribute to the evaluation and intervention procedures progressively more comprehensive and adjusted to the challenges raised with the issue of chronic pain.

The European Portuguese adaptation of the Fear of Pain Questionnaire / Fear of Pain Questionnaire: adaptação para o português europeu

ABSTRACT In Portugal, it is estimated that chronic pain affects 36.7% of the population, constituting a multifactorial phenomenon with great impact at individual, family, community, and social levels. In the fear-avoidance model of pain, one of the most consistent consensual in the literature, the fear arises as one of the variables that can contribute to the development and maintenance of this condition. Thus, instruments for evaluating the fear of pain, as Fear of Pain Questionnaire (FPQ-III), may be useful in the conceptualization of the subjective experience of pain. Accordingly, this paper aims to describe the adaptation of FPQ-III for the European Portuguese. A total of 1094 participants (795 women; mean age = 25.16, SD = 7.72) completed the web based questionnaire. The results pointed to a different factor solution found in the first study of the original scale (five factors: minor pain, severe pain, medical pain, injection pain, and afflicted pain), good internal consistency (.75–.85) and good correlations (between .30 and .59) between subscales and (between .68 and .85) for the total score and subscales. Given the need to meet the various dimensions of subjective experience of pain, the Fear of Pain Questionnaire is assumed as a useful tool, in combination with other, may contribute to the evaluation and intervention procedures progressively more comprehensive and adjusted to the challenges raised with the issue of chronic pain.

RESUMO Em Portugal, estima-se que a dor crônica afete 36.7% da população, constituindo um fenômeno multifatorial com grande impacto em nível individual, familiar, comunitário e social. No modelo de medo-evitamento da dor, um dos mais consensuais na literatura, o medo surge como uma das variáveis que podem contribuir para o desenvolvimento e a manutenção dessa condição. Assim, instrumentos dedicados à avaliação do medo da dor, como o Fear of Pain Questionnaire (FPQ-III), podem ser úteis na conceitualização da experiência subjetiva de dor. Em concordância, este trabalho tem como objetivo descrever a adaptação do FPQ-III para o português europeu. Preencheram o questionário pela internet 1.094 participantes (795 mulheres; idade média = 25,16, DP = 7,72). Os resultados obtidos apontam para uma solução fatorial diferente da encontrada no primeiro estudo da escala original (cinco fatores: dor leve, intensa, médica, de injeção e aflita), uma boa consistência interna (entre .75 e .85), boas correlações entre subescalas (entre .30 e .59) e entre essas e a pontuação total (entre .68 e .85). Perante a necessidade de atender a várias dimensões da experiência subjetiva de dor, o questionário de medo da dor assume-se como uma ferramenta útil que, em combinação com outras, pode contribuir para processos de avaliação e de intervenção progressivamente mais compreensivos e ajustados aos desafios levantados pela problemática de dor crônica.

The European Portuguese adaptation of the Fear of Pain Questionnaire. / Fear of Pain Questionnaire: adaptação para o português europeu.

In Portugal, it is estimated that chronic pain affects 36.7% of the population, constituting a multifactorial phenomenon with great impact on individual, family, community, and social levels. In the fear-avoidance model of pain, one of the most consistent consensus in the literature, the fear arises as one of the variables that can contribute to the development and maintenance of this condition. Thus, instruments for evaluating the fear of pain, as Fear of Pain Questionnaire (FPQ-III), may be useful in the conceptualization of the subjective experience of pain. Accordingly, this paper aims to describe the adaptation of FPQ-III to the European Portuguese idiom. A total of 1,094 participants (795 female; mean age=25.16, SD=7.72 years old) completed the web based questionnaire. The results point to a different factor model found in the first study of the original scale (five factors: minor pain, severe pain, medical pain, injection pain, and afflicted pain), good internal consistency (0.75 to 0.85) and good correlations (between 0.30 and 0.59) between subscales and (between 0.68 e 0.85) for the total score and subscales. Given the need to meet the various dimensions of the subjective experience of pain, the Fear of Pain Questionnaire is assumed as a useful tool that, in combination with other tools, may contribute to the evaluation and intervention procedures progressively more comprehensive and adjusted to the challenges raised with the issue of chronic pain.

[Magnetic resonance imaging of the liver in postpartum stable women with HELLP syndrome]. / Ressonância magnética hepática em puérperas estáveis com síndrome HELLP.

OBJECTIVES: To describe magnetic resonance (MR) findings in the liver of stable patients with HELLP syndrome in the puerpuerium. METHODS: A descriptive study was carried out from August 2005 to July 2006, involving a series of 40 postpartum patients admitted to an obstetric intensive therapy unit in IMIP (Instituto Materno Infantil Prof. Fernando Figueira) with diagnosis of HELLP syndrome (complete and partial). Complete HELLP syndrome was defined when all laboratory parameters were present and incomplete when one or more but not all laboratory findings were present. All patients had stable clinical conditions and were evaluated with magnetic resonance of the liver and the main findings were recorded. RESULTS: Average maternal age was 26.8 +/- 6.4 years and gestational age at delivery was 34 +/- 26.8 weeks. The MR imaging was performed between eight and 96 hours after diagnosis of HELLP syndrome (56 +/- 31 h). The most frequent findings were ascitis in 20% (n = 8), pleural effusion in 17.5% and hepatic steatosis in 7.5%. The periportal intensity signal was normal in all cases. Cases of liver infarction and sub-capsular or parenchymatous hematoma were not observed. CONCLUSION: Findings of magnetic resonance imaging of the liver in stable HELLP syndrome postpartum patients were few and unspecific. Severe liver injuries such as parenchymatous or sub-capsular hematoma, entailing life risk were not found. Results do not corroborate the use of magnetic resonance as routine examination for stable patients with HELLP syndrome.

Ressonância magnética hepática em puérperas estáveis com síndrome HELLP / Magnetic resonance imaging of the liver in postpartum stable women with HELLP syndrome

OBJETIVOS: Descrever os achados hepáticos na ressonância magnética em puérperas estáveis com síndrome HELLP. MÉTODOS: Realizou-se um estudo descritivo, do tipo série de casos, envolvendo 40 puérperas internadas na UTI obstétrica do Instituto Materno Infantil Prof. Fernando Figueira (IMIP), com diagnóstico de síndrome HELLP completa (presentes todas as alterações laboratoriais) e incompleta (uma ou mais alterações laboratoriais, porém sem todos os critérios diagnósticos) no período de agosto de 2005 a julho de 2006. RESULTADOS: A idade média foi de 26,8 ± 6,4 anos, com idade gestacional média no parto de 34 semanas. A ressonância magnética foi realizada entre oito e 96 horas depois do diagnóstico de síndrome HELLP (média de 56 + 31horas). O achado mais freqüente foi ascite em 20 por cento (n = 8), seguindo-se derrame pleural (17,5 por cento) e esteatose hepática (7,5 por cento). A intensidade de sinal periportal foi normal em todos os casos e não se observaram casos de isquemia/infarto hepático ou de hematoma parenquimatoso ou subcapsular. CONCLUSÃO: Os achados da ressonância magnética pós-parto em puérperas estáveis com síndrome HELLP foram inespecíficos e, na presente série, não foram encontradas lesões importantes como hematoma parenquimatoso ou subcapsular, representando risco de vida para a paciente. Os resultados encontrados não corroboram a utilização desse exame de rotina para o seguimento de pacientes com síndrome HELLP.

OBJECTIVES: To describe magnetic resonance (MR) findings in the liver of stable patients with HELLP syndrome in the puerpuerium. METHODS: A descriptive study was carried out from August 2005 to July 2006, involving a series of 40 postpartum patients admitted to an obstetric intensive therapy unit in IMIP (Instituto Materno Infantil Prof. Fernando Figueira) with diagnosis of HELLP syndrome (complete and partial). Complete HELLP syndrome was defined when all laboratory parameters were present and incomplete when one or more but not all laboratory findings were present. All patients had stable clinical conditions and were evaluated with magnetic resonance of the liver and the main findings were recorded. RESULTS: Average maternal age was 26.8 ± 6.4 years and gestational age at delivery was 34 ± 26.8 weeks. The MR imaging was performed between eight and 96 hours after diagnosis of HELLP syndrome (56 ± 31 h). The most frequent findings were ascitis in 20 percent (n = 8), pleural effusion in 17.5 percent and hepatic steatosis in 7.5 percent. The periportal intensity signal was normal in all cases. Cases of liver infarction and sub-capsular or parenchymatous hematoma were not observed. CONCLUSION: Findings of magnetic resonance imaging of the liver in stable HELLP syndrome postpartum patients were few and unspecific. Severe liver injuries such as parenchymatous or sub-capsular hematoma, entailing life risk were not found. Results do not corroborate the use of magnetic resonance as routine examination for stable patients with HELLP syndrome.

Perfil das admissões em uma unidade de terapia intensiva obstétrica de uma maternidade brasileira / Admission profile in an obstetrics intensive care unit in a maternity hospital of Brazil

OBJETIVOS: descrever a experiência de três anos com terapia intensiva em obstetrícia em Unidade de Terapia Intensiva em setor que permite que obstetras continuem conduzindo as pacientes obstétricas criticamente enfermas. MÉTODOS: estudo avaliando 933 pacientes atendidas na UTI obstétrica do Instituto Materno Infantil Prof. Fernando Figueira (IMIP) de setembro de 2002 a fevereiro de 2005. As variáveis foram idade, paridade, diagnóstico de admissão, época da admissão, diagnósticos e complicações durante o internamento, procedimentos invasivos empregados e resultado final. RESULTADOS: as três principais causas de internamento foram hipertensão (87 por cento), hemorragia obstétrica (4,9 por cento) e infecção (2,1 por cento). A idade média foi 25 anos e 65 por cento dos partos, cesarianas. Anemia foi achado freqüente (58,4 por cento). Outros diagnósticos: insuficiência renal, doença tromboembólica, cardiopatia, edema agudo de pulmão, sepse, choque hemorrágico. Das 814 pacientes admitidas com hipertensão associada à gestação, 65 por cento tinham pré-eclâmpsia grave, 16 por cento pré-eclâmpsia leve e 11 por cento eclâmpsia. Síndrome HELLP ocorreu em 46 por cento. Ventilação mecânica foi necessária em 3,6 por cento e hemotransfusão em 17 por cento. A duração média do internamento foi cinco dias (1-41). A taxa de óbito foi 2,4 por cento. CONCLUSÕES: a taxa de morte foi relativamente baixa, sugerindo que uma UTI conduzida por obstetras pode ser uma estratégia factível para reduzir a mortalidade materna.

OBJECTIVES: to describe a three-year experience with obstetric Intensive Care Units (ICU), a unit allowing obstetricians to continue to care for critically ill obstetrics patients. METHODS: the study evaluated all admissions (933) to the Obstetric ICU, in the Instituto Materno Infantil Prof. Fernando Figueira (IMIP), from September 2002 to February 2005. Age, parity, diagnosis, admission time, diagnosis during ICU stay, associated complications, invasive procedures utilized, and final outcome were analyzed. RESULTS: hypertension (87 percent), obstetric hemorrhage (4.9 percent) and obstetric infection (2.1 percent) were the major cause of the admissions analyzed. Mean age was 25 years, 65 percent of the patients delivered by cesarean-section. Anemia was a very common finding (58.4 percent). Other diagnoses were renal insufficiency, thromboembolic disease, cardiac disease, acute pulmonary edema, sepsis, and hemorrhagic shock. Of the 814 patients with pregnancy-associated hypertension 65 percent had severe pre-ecclampsia, 16 percent mild pre-ecclampsia, and 11 percent ecclampsia. HELLP syndrome was found in 46 percent. Mechanical ventilation was necessary in 3.6 percent and hemotransfusion in 17 percent of the patients. Mean stay was five day (1 a 41) days. Death occurred in 2.4 percent of the patients. CONCLUSIONS: the rate of deaths was low. An obstetric ICU managed by obstetricians could be a feasible way of dealing with maternal mortality.