The Importance of Patient Empowerment: A Clinical Case of Hereditary Angioedem.

Hereditary angioedema (HAE) is a rare condition characterized by recurrent episodes of angioedema without urticaria or pruritus. Untreated angioedema can cause significant work absenteeism and, in rare cases, be lethal due to laryngeal involvement and suffocation. The authors report a case of a patient with laryngeal involvement who was unaware of the severity of their condition. Effective medical training in patient empowerment is essential, and it is an irreplaceable element in healthcare, as it contributes to therapeutic success.

Revisiting Paraphrenia: A Case Report.

Paraphrenia is a chronic psychotic disorder characterized by a strong delusional component with preservation of thought and personality. It was first introduced as a disorder associated with paranoid dementia and paranoia, but with less personality deterioration than schizophrenia and without fulfilling the clinical features of a delusional disorder. This classic diagnostic entity is not currently listed in main diagnostic systems, rendering delusional disorders difficult to classify in cases that resemble the concept of paraphrenia. We revisit the concept of paraphrenia through a critical review based on a clinical vignette of a patient followed at the psychiatry department of the University Hospital Center of São João.

Beyond Borders: Monkeypox Case on Madeira Island.

Human infection with monkeypox virus (MPXV) is characterized by a pox-like rash in various areas, including the anogenital region, and is accompanied by fever, headaches, fatigue, myalgias, and lymphadenopathy. These symptoms may occur a few days before the rash or simultaneously. Nonspecific and vague symptoms, particularly in the recent outbreak of the MPXV, have led to unrecognized or very mild prodromes, which can delay diagnosis. Diagnosis involves laboratory confirmation through polymerase chain reaction (PCR). The symptomatology of MPX is self-limiting, resolving in about two to four weeks. Therefore, the therapeutic approach includes supportive care, monitoring, intervention for possible complications (e.g., bacterial superinfection, cellulitis, and bronchopneumonia), and the implementation of preventive contact measures.  This clinical case emphasizes the importance of conducting a thorough medical history and maintaining a high level of clinical suspicion, even in the absence of a history of contact with suspected or confirmed cases and in regions without active or suspected infectious cases.

Prokaryotic and eukaryotic diversity in hydrothermal continental systems.

The term extremophile was suggested more than 30 years ago and represents microorganisms that are capable of developing and living under extreme conditions, these conditions being particularly hostile to other types of microorganisms and to humankind. In terrestrial hydrothermal sites, like hot springs, "mud pools", solfataras, and geysers, the dominant extreme conditions are high temperature, low or high pH, and high levels of salinity. The diversity of microorganisms inhabiting these sites is determined by the conditions of the environment. Organisms belonging to the domains Archaea and Bacteria are more represented than the one belonging to Eukarya. Eukarya members tend to be less present because of their lower tolerance to higher temperatures, however, they perform important ecosystem processes when present. Both prokaryotes and eukaryotes have morphological and physical adaptations that allow them to colonize extreme environments. Microbial mats are complex associations of microorganisms that help the colonization of more extreme systems. In this review, a characterization of prokaryotic and eukaryotic organisms that populate terrestrial hydrothermal systems are made.

Experiences of Homeless Families in Parenthood: A Systematic Review and Synthesis of Qualitative Evidence.

The objective of this systematic review was to identify the available qualitative data and to develop a framework to address the life experiences of homeless families in parenthood. The research was performed in the PubMed and CINAHL Complete databases, for works published in Portuguese, English, French and Spanish. Studies that included qualitative data, or both qualitative and quantitative data, were considered for this research. A total of 358 articles were obtained, of which 37 were assessed for eligibility, and 26 were rejected. In the end, 11 studies were selected. The Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research was used. These studies were conducted mostly in the United States, in temporary/transitional shelters for nuclear or single-parent families (led by women) in a homeless situation. In this context, the area which arose as the more relevant one was mental health, followed by the social studies. Two types of dimensions emerged from the results: mediating dimensions (which include the categories "Insecurity", "Lack of Privacy", "Isolation", "Stigma" and "Disempowerment") that are responsible for difficulties related to education, and behavioural changes in both the parents and the children; and supporting dimensions (which include the categories "Context as a Facilitator", "Relationship with Others" and "Parents' and children's Self") that lead to motivation, as well as the acquisition of strategies by the parents, to resolve parenting issues. This research helps expand nursing knowledge and presents a synthesis of the life experiences of homeless families in parenthood. Nursing can respond to the vulnerable population, due to its predominant role in promoting their health.

Staphylococcus epidermidis biofilms with higher proportions of dormant bacteria induce a lower activation of murine macrophages.

Staphylococcus epidermidis is an opportunistic pathogen and, due to its ability to establish biofilms, is a leading causative agent of indwelling medical device-associated infection. The presence of high amounts of dormant bacteria is a hallmark of biofilms, making them more tolerant to antimicrobials and to the host immune response. We observed that S. epidermidis biofilms grown in excess glucose accumulated high amounts of viable but non-culturable (VBNC) bacteria, as assessed by their low ratio of culturable bacteria over the number of viable bacteria. This effect, which was a consequence of the accumulation of acidic compounds due to glucose metabolism, was counteracted by high extracellular levels of calcium and magnesium added to the culture medium allowing modulation of the proportions of VBNC bacteria within S. epidermidis biofilms. Using bacterial inocula obtained from biofilms with high and low proportions of VBNC bacteria, their stimulatory effect on murine macrophages was evaluated in vitro and in vivo. The inoculum enriched in VBNC bacteria induced in vitro a lower production of tumour necrosis factor alpha, interleukin-1 and interleukin-6 by bone-marrow-derived murine macrophages and, in vivo, a lower stimulatory effect on peritoneal macrophages, assessed by increased surface expression of Gr1 and major histocompatibility complex class II molecules. Overall, these results show that environmental conditions, such as pH and extracellular levels of calcium and magnesium, can induce dormancy in S. epidermidis biofilms. Moreover, they show that bacterial suspensions enriched in dormant cells are less inflammatory, suggesting that dormancy can contribute to the immune evasion of biofilms.