The Use of Mobile Sensors by Children: A Review of Two Decades of Environmental Education Projects.

Over the past twenty years, the use of electronic mobile sensors by children and youngsters has played a significant role in environmental education projects in Portugal. This paper describes a research synthesis of a set of case studies (environmental education projects) on the use of sensors as epistemic mediators, evidencing the technological, environmental, social, and didactical dimensions of environmental education projects over the last two decades in Portugal. The triggers of the identified changes include: (i) the evolution of sensors, information and communication platforms, and mobile devices; (ii) the increasing relevance of environmental citizenship and participation; (iii) the recognition of the role of multisensory situated information and quantitative information in environmental citizenship; (iv) the cause-effect relation between didactical strategies and environmental education goals; (v) the potential of sensory and epistemic learners' practices in the environment to produce learning outcomes and new knowledge. To support the use of senses and sensors in environmental education projects, the SEAM model was created based on the developed research synthesis.

Life-Threatening Wunderlich Syndrome Associated with Apixaban and the Complexity of Anticoagulation Management in Bleeding Patients: A Case Report.

Wunderlich syndrome is a rare and possibly life-threatening haemorrhagic syndrome presenting as spontaneous nontraumatic renal rupture with subcapsular and perinephric haemorrhage. Apixaban, a direct oral anticoagulant recommended in patients with atrial fibrillation, has previously been associated with atraumatic solid organ rupture but, to date, no case of apixaban-related Wunderlich syndrome has been reported. We report a rare case of Wunderlich syndrome associated with apixaban while addressing the difficulties face by clinicians when managing anticoagulation in bleeding patients.

A síndrome de Wunderlich é uma síndrome hemorrágica rara caracterizada por rutura renal espontânea, não-traumática, com hemorragia subcapsular e peri-renal. O apixabano, um anticoagulante oral direto recomendado em doentes com fibrilação auricular, foi associado no passado a rutura atraumática de órgãos sólidos mas, à data, nenhum caso de síndrome de Wunderlich associada ao apixabano foi reportado. Reportamos um caso raro de síndrome de Wunderlich associada ao apixabano abordando concomitantemente as dificuldades na gestão da anticoagulação em doentes com hemorragia.

Mitral Valve Infective Endocarditis Complicated With Coronary Artery Embolization.

Infective endocarditis is a multisystem and potentially fatal disease. Systemic embolization is a relatively common complication, the spleen and central nervous system being the most frequent sites for septic emboli formation. Coronary artery septic embolization is extremely uncommon and its management remains controversial. We present the case of a 50-year-old male diagnosed with mitral valve infective endocarditis complicated with spleen and central nervous system embolization, who developed acute myocardial infarction two weeks after disease onset. The patient was successfully treated with combined mitral valve replacement and coronary artery bypass grafting.

An Unusual Cause of Knee Mass: Osseous Hydatidosis.

Hydatid disease (hydatidosis) is a zoonotic infection caused by the larval stage of the parasitic tapeworm Echinococcus granulosus endemic in some sheep-raising areas. The liver and lungs are most commonly affected. Bone involvement (osseous hydatidosis) is distinctly uncommon, and its diagnosis and treatment can be challenging. We report a case of a 54-year-old male with right knee pain and edema and an extensive lesion on the femur; he was diagnosed with knee hydatidosis and was successfully treated with surgery and albendazole. This case reinforces the importance of the rare osseous hydatidosis as part of the differential diagnosis of bone lesions.

Pain in an Internal Medicine Ward: An Undervalued Reality?

Introduction Pain is prevalent in most pathologic situations that require healthcare and is very common in hospitalised patients. However, there is limited evidence about the prevalence and the actual management of pain in medical wards. The aim of this work was to evaluate and characterise pain management in an internal medicine ward. Methods Retrospective analysis of clinical data of patients consecutively discharged from the internal medicine ward of a central tertiary hospital over a period of five months in 2018. Results 199 patients evaluated, the median age was 78 years and 63% were female. Of these, 14% had a previous diagnosis of chronic pain, 24% were on chronic pain medication, and in 29% medication was interrupted. Pain was noted in medical records of 118 patients, with moderate to severe intensity in 67%. Among those, 71% had pain occurrence registered in the medical notes but not characterised in duration in 61%. The most common attributed etiologies of pain were musculoskeletal (16%), visceral (9%), and headache (8%); no identifiable cause was specified in 57%. In the group of patients reporting pain, 63% received analgesics. Opioids were used in 35% and 47% of patients with moderate and severe pain, respectively. At discharge, 12 patients were still referred pain, 16 had pain listed as a diagnosis, 45 were medicated for pain, and eight were referred for pain consultation. Conclusions Despite being highly prevalent in the internal medicine ward, pain is still under-recognised, undervalued, and under-treated. Education of healthcare staff and adoption of treatment protocols is essential to improve care for these patients.

Total Pain Management and a Malignant Wound: The Importance of Early Palliative Care Referral.

Breast cancer may metastasize to the lung, liver, bone, brain, and skin, with especially high rates of metastasis to skin sites.These skin metastases are called malignant wounds. Patients with malignant wounds often report multiple symptoms, and pain is one of the most common and distressing among them. Despite the availability of multiple guidelines about treatment to relieve pain, almost half of all cancer patients still receive inappropriate care for pain. A multidisciplinary approach can improve outcomes in terms of symptom control and quality of life and enable the detection of previously unmet needs of both patients and caregivers. Palliative care is a multidisciplinary therapy that aims to alleviate physical, psychological, and emotional suffering in patients at any stage of the disease. We present the case of a 53-year-old male with a three-year history of stage IV breast cancer. He was admitted to the internal medicine ward in July 2021 with uncontrolled pain related to a malignant wound in the left hemithorax. This was a case with physical, emotional, social, and existential factors contributing to severe pain, necessitating a multidisciplinary approach for adequate relief. Opioid titration and insomnia and anxiety treatment were initiated. Dressing care was applied with metronidazole impregnation and aminocaproic acid for hemorrhagic spots, followed by fat gauze. He was proposed to undergo antalgic radiotherapy, which was unfortunately associated with new onset of symptoms. Psychological support was provided for the patient and his family. We managed to control the pain and stabilize the wound; however, cachexia become evident with the disease progression. In the last week of his life, the patient still believed he would be able to undergo chemotherapy. He died in the emergency room, where he had gone to seek relief for uncontrolled symptoms. Even though the patient had an incurable disease associated with immense suffering since early 2019, he was only referred to the palliative care team during the last three months of his life. Existential suffering was an important dimension of this patient's pain and was present until his death despite receiving psychological support. Late referral to palliative care is unfortunately frequent and often associated with poor quality of life and inability to plan or make end-of-life care decisions. Radiotherapy was proposed for pain control but was associated with serious side effects. In a palliative care setting, decision-making always needs careful consideration related to benefit versus harm and must involve the patient and his family. Living with stage IV cancer is an everyday challenge for patients, and clinicians may also find managing such patients very arduous and stressful. Symptoms must be actively studied and evaluated from a multidimensional perspective. Managing expectations throughout this process while maintaining hope is a delicate balancing act and should be undertaken by specialized palliative care teams.

Coronavirus Disease 2019: Clinical Review.

INTRODUCTION: In December 2019, an outbreak of pneumonia caused by a novel coronavirus occurred in Wuhan, the capital of Central China's Hubei Province and has been declared a public health emergency of international concern by the World Health Organization since January 2020. MATERIAL AND METHODS: A comprehensive search using the PubMed database was carried out to summarize the latest published information about the epidemiology, definition, pathogenesis, clinical characteristics, treatment options, prognosis and prevention of coronavirus disease 2019. DISCUSSION: This new strain of coronavirus, named severe acute respiratory syndrome coronavirus 2, enters human cells that express angiotensin-converting enzyme II receptors, which exist in the respiratory, gastrointestinal and genitourinary tracts and heart, causing coronavirus disease. Transmission occurs essentially through the respiratory tract and the main symptoms are fever, cough and dyspnea. Diagnosis is based on epidemiological, clinical and imaging features and confirmed by nucleic acid testing. CONCLUSION: Despite intensive research, the exact origin of the virus and pathophysiology of coronavirus disease is not yet completely known, and clinically approved vaccines and drugs that target severe acute respiratory syndrome coronavirus 2 are lacking.

Introdução: Em dezembro de 2019, ocorreu um surto de pneumonia causada por uma nova estirpe de coronavírus em Wuhan, a capital da província de Hubei, na China central e foi declarado emergência de saúde pública de âmbito internacional pela Organização Mundial de Saúde, em janeiro de 2020. Material e Métodos: Foi realizada uma pesquisa na base de dados PubMed, de forma a sintetizar a informação mais recentemente publicada sobre a epidemiologia, definição, fisiopatologia, manifestações clínicas, tratamento, prognóstico e prevenção da doença de coronavírus 2019. Discussão: Esta nova estirpe de coronavírus, denominada coronavírus da síndrome respiratória aguda grave 2 infeta células que expressem o recetor da enzima conversora da angiotensina tipo II, existentes nos tratos respiratório, gastrointestinal e geniturinário e no coração, provocando a doença de coronavírus 2019. A transmissão ocorre essencialmente através do trato respiratório e os principais sintomas são febre, tosse e dispneia. O diagnóstico é baseado em critérios epidemiológicos, clínicos e imagiológicos, sendo a confirmação da doença realizada através da análise de ácidos nucleicos. Conclusão: Apesar da extensa investigação, ainda não é totalmente conhecida a origem do vírus, a fisiopatologia da doença e não existem vacinas nem tratamento direcionados a esta nova estirpe de coronavírus.

Promoting the use of environmental data collected by concerned citizens through information and communication technologies.

Public participation within environmental monitoring may contribute to increasing the knowledge on the state of the environment at the same time it promotes citizens' involvement in environmental protection. However, the use of voluntary collected data is limited due to a lack of confidence in data collection procedures. Additionally, data quality is often unknown and the data are usually dispersed and non-structured. Information and communication technologies (ICT) may promote the use of voluntary collected data through the development of a collaborative system that incorporates tools and methodologies to facilitate data collection, access and validation. Furthermore, the use of ICT may promote public involvement within environmental monitoring, since it facilitates communication among all the stakeholders. This paper analyses the role of ICT in developing a system for environmental collaborative monitoring intending to promote the use of volunteer collected data. It starts by analysing the role of volunteers within environmental monitoring and continues analysing the potential of ICT to take advantage of the benefits of using data collected by citizens. A collaborative system that allows the public to express its knowledge on the state of the environment is described. Special emphasis is given to tools that explore non-traditional types of environmental data such as images, sounds and videos in association with spatial information. To illustrate the above mentioned concepts, a case study for beach quality monitoring developed within the Senses@Watch project, is described.