Renal screening sonography-A comparative study in a Portuguese basic emergency service.

INTRODUCTION: Renal Point-of-Care Ultrasound (POCUS) is a screening modality that aids in clinical decision-making for patients with suspected renal colic. This study intends to compare the accuracy and pertinence of sonographic findings obtained by a sonographer in a Basic Emergency Service (BES) with the imaging findings at the Referral Hospital (RH). METHODS: Thirty-one patients suspected of having renal pathology underwent initial sonography screening with POCUS at the BES and were subsequently referred to the RH for additional imaging examinations. The results of both examinations were compared to verify whether the findings from the BES were confirmed by the radiologist in the RH and to ensure that the patient referrals from BES to RH were appropriate. RESULTS: In our sample, the majority of patients (80%) exhibited varying degrees of pyelocaliceal distension, with nearly half (48%) patients presenting obstructions. A strong association between the sonographic findings in the BES and the RH was found in the variables 'Dilatation of pyelocaliceal system' (V = 0.895; P = 0.00), 'Simple cystic formation' (V = 0.878; P = 0.000), respectively. There was a statistically significant correlation between BES and RH findings, indicating a strong association between these two variables, respectively (k = 0.890; P = 0.000) and (k = 0.870; P = 0.000). There was also a strong statistically significant correlation in the ultrasonographic findings between BES and RH performers (k = 0.890; P = 0.000 and k = 0.870; P = 0.000). In this research, an achieved sensitivity of 96% and a specificity of 85% were demonstrated in the identification of pyelocaliceal dilatation. CONCLUSION: Renal POCUS screening successfully detected abnormalities in the urinary system of patients suspected of having renal colic. The sonographic findings at the BES had a good correlation with the complementary imaging results obtained at the RH in Portugal. These results suggest that Radiographers/Sonographers can have an important role in the preliminary assessment of urgent renal pathology in remote areas, contributing to a correct referral and early treatment.

Detraining and Retraining Effects from a Multicomponent Training Program on the Functional Capacity and Health Profile of Physically Active Prehypertensive Older Women.

BACKGROUND: Resuming a physical exercise program after a period of cessation is common in older women. Monitoring the responses during this detraining (DT) and retraining (RT) may allow us to analyze how the body reacts to an increase and a reduction in physical inactivity. Therefore, we conducted a follow-up training, DT, and RT in prehypertensive older women to analyze the response to these periods. METHODS: Twenty-three prehypertensive older women (EG; 68.3 ± 2.8 years; 1.61 ± 0.44 m) performed 36 weeks of the multicomponent training program (MTP) followed by twelve weeks of DT plus eight weeks of RT. Fifteen prehypertensive older women (CG; 66.3 ± 3.2 years; 1.59 ± 0.37 m) maintained their normal routine. Functional capacity (FC), lipid, and hemodynamic profile were assessed before, during 24 and 36 weeks of the MTP, after 4 and 12 weeks of DT, and after 8 weeks of RT. RESULTS: After 24 weeks of the MTP, only SBP did not improve. Four weeks of DT did not affect lower body strength (30-CS), TC, or GL. Eight weeks of RT improved BP (SBP: -2.52%; ES: 0.36; p < 0.00; DBP: -1.45%; ES: 0.44; p < 0.02), handgrip strength (3.77%; ES: 0.51; p < 0.00), and 30-CS (3.17%; ES: 0.38; p < 0.04) compared with 36 weeks of the MTP. CONCLUSIONS: Eight weeks of RT allowed patients to recover the benefits lost with detraining, which after only four weeks affected them negatively, and the systematic practice of exercise contributed to greater regulation of BP since 24 weeks of the MTP proved not to be enough to promote positive effects of SBP.

Follow-Up of Eight-Weeks Detraining Period after Exercise Program on Health Profiles of Older Women.

BACKGROUND: The multicomponent training program (MTP) is a physical exercise strategy used to combat the sedentary lifestyle in older women (OW). However, periods of interruption in training are common in this population. The aim of our study was to analyze the 8-week MTP effects followed by two, four, and eight weeks of interruption on the lipid profile (LP) and functional capacity (FC) of OW. METHODS: Twenty-one OW (experimental group [EG], 67.6 ± 3.1 years; 1.55 ± 0.35 m) were subjected to an 8-week MTP followed by a detraining period, and 14 OW (control group [CG], 69.4 ± 4.7 years; 1.61 ± 0.26 m) maintained their daily routine. FC (i.e., 30-s chair stand [30-CS], 8-foot up and go [8-FUG], 6-min walk [6-MWT], handgrip strength [HGS], and heart-rate peak during 6-WMT [HRPeak]), total cholesterol (TC) and triglycerides (TG) were assessed before and after MTP and two, four, and eight weeks after MTP. RESULTS: 8-week MTP resulted in higher FC and decreased LP values in EG (p < 0.05); two and four weeks of detraining did not promote changes. After eight weeks of detraining TC (ES: 2.74; p = 0.00), TG (ES: 1.93; p = 0.00), HGS (ES: 0.49, p = 0.00), HRPeak (ES: 1.01, p = 0.00), 6-MWT (ES: 0.54, p = 0.04), and 8-FUG (ES: 1.20, p = 0.01) declined significantly. CONCLUSIONS: Periods of more than four weeks of detraining should be avoided to promote a good quality of life and health in OW. If older people interrupt training for a period longer than four weeks, physical-education professionals must outline specific training strategies to maintain the adaptations acquired with MTP. Future studies should establish these criteria based on ideal training volume, intensity, and frequency.

Discrepancies between Screening Sonography and Ultrasound in Emergency Department - A Case Report.

INTRODUCTION: This case report presents a discrepancy in sonographic findings between a screening sonography performed by a Sonographer in the Basic Emergency Service (BES) and a subsequent ultrasound performed by a Radiologist physician in a Referral Hospital (RH). The aim of this report is to discuss the possible reasons for the discrepancy and its implications for patient care. CASE PRESENTATION: A patient with a history of epigastric pain and vomiting underwent screening sonography in a BES, which suggested Intrahepatic Biliary Dilatation Duct (IHBD) and main pancreatic duct dilatation. The patient was subsequently referred to the RH for further evaluation. However, the Radiologist in the RH did not confirm any of the initial suspicions from BES through a normal ultrasound procedure. The discrepancy raises questions regarding the quality of the screening ultrasound, misinterpretation of the BES images, or the potential for ambiguity in the point of care ultrasound (POCUS) exam. CONCLUSION: The differences in sonographic findings between BES and RH, in this case, suggest that the improvement of the patient's clinical condition and therapeutic interventions may have contributed to the discrepancy. Further investigation and standardization of POCUS training and interpretation may improve diagnostic accuracy and patient outcomes.

Effectiveness of ultrasound screening in right upper quadrant pain: A comparative study in a basic emergency service.

Background and Aims: The use of ultrasound screening is primarily facilitated by point-of-care ultrasound (POCUS) and its integration into healthcare systems is a result of the versatility of this imaging technique. This study intends to compare the accuracy and pertinence of sonographic findings obtained by a sonographer in a Basic Emergency Service (BES) with that of radiologists at referral hospital (RH) in Portugal. Methods: Twenty patients with right upper quadrant (RUQ) pain and suspected cholecystitis or biliary pathology underwent sonography screening using POCUS in the BES. They were then forwarded to the RH where a radiologist performed a conventional ultrasound exam on the same patients. The results of both exams were compared to determine if the findings obtained in the BES were confirmed by the radiologist in the RH. Results: In our sample, 60% of cases were related to biliary pathology, 20% were liver-related, 10% had hepatopancreatic biliary etiology, and 10% had unknown etiology. A strong association between the sonographic findings in the BES and the RH was found in the variables "Sonographic Murphy sign" (V = 0.859; p = 0.001), "Cholelithiasis/Gallbladder sludge" (V = 0.840; p = 0.001), and "Intrahepatic biliary tract dilatation" (V = 0.717; p = 0.006). Adequate measures of agreement between the findings of the radiographer and radiologist were obtained for the "Sonographic Murphy sign" (k = 0.664; p = 0.001) and the presence of "Cholelithiasis/Gallbladder sludge" (k = 0.712; p = 0.000). Conclusion: Major biliary abnormalities were detected in patients with RUQ pain in BES using sonography. The correlation between the sonographic findings obtained by the sonographers at BES and those obtained by radiologists at the RH in Portugal was strong, showing that POCUS screening could be extended to other similar settings; however, more studies are needed.

Three-Month vs. One-Year Detraining Effects after Multicomponent Exercise Program in Hypertensive Older Women.

Background: Chronic diseases are the leading causes of death and disability in older women. Physical exercise training programs promote beneficial effects for health and quality of life. However, exercise interruption periods may be detrimental for the hemodynamic and lipidic profiles of hypertensive older women with dyslipidemia. Methods: Nineteen hypertensive older women with dyslipidemia (exercise group: 67.5 ± 5.4 years, 1.53 ± 3.42 m, 71.84 ± 7.45 kg) performed a supervised multicomponent exercise training program (METP) during nine months, followed by a one-year detraining period (DT), while fourteen hypertensive older women (control group: 66.4 ± 5.2 years, 1.56 ± 3.10 m, 69.38 ± 5.24 kg) with dyslipidemia kept their continued daily routine without exercise. For both groups, hemodynamic and lipidic profiles and functional capacities (FCs) were assessed four times: before and after the METP and after 3 and 12 months of DT (no exercise was carried out). Results: The METP improved hemodynamic and lipidic profiles (p < 0.05), while three months of DT decreased all (p < 0.05) parameters, with the exception of diastolic blood pressure (DBP). One year of DT significantly (p < 0.01) decreased systolic blood pressure (7.85%), DBP (2.29%), resting heart rate (7.95%), blood glucose (19.14%), total cholesterol (10.27%), triglycerides (6.92%) and FC­agility (4.24%), lower- (−12.75%) and upper-body strength (−12.17%), cardiorespiratory capacity (−4.81%) and lower- (−16.16%) and upper-body flexibility (−11.11%). Conclusion: Nine months of the exercise program significantly improved the hemodynamic and lipid profiles as well as the functional capacities of hypertensive older women with dyslipidemia. Although a detraining period is detrimental to these benefits, it seems that the first three months are more prominent in these alterations.

Multicomponent Exercise Program for Improvement of Functional Capacity and Lipidic Profile of Older Women with High Cholesterol and High Triglycerides.

BACKGROUND: Physical inactivity is a primary cause of most chronic diseases. In addition, the negative effects of aging, physical inactivity and dyslipidemia are risk factors for cardiovascular diseases of older women. Exercise is considered fundamental for the treatment and prevention due to the benefits in the health of this population, but detraining periods after exercise can reverse them. Multicomponent exercise (ME) is a combined method of aerobic and resistance training that can improve the lipidic profile of older women with high cholesterol and triglycerides. METHODS: Seventeen older women (EG: 65.3 ± 4.7 years, 1.52 ± 4.12 m) followed a supervised ME program of nine months and three months of detraining (DT), and fifteen older women (CG: 66.4 ± 5.2 years, 1.54 ± 5.58 cm) continued their daily routine, without exercise. Total cholesterol (TC), triglycerides (TG), blood glucose (GL) and functional capacity (FC) were evaluated at the beginning and at the end of the program and after three months of DT. RESULTS: ME program improved (p < 0.05) lipidic profile: GL (-15.6%), TC (-15.3%), TG (-19.3%) and FC: agility (-13.3%), lower body strength (27.78%), upper body strength (26.3%), cardiorespiratory capacity (11.2%), lower body flexibility (66.67%) and upper body flexibility (85.72%). DT declined the lipidic profile and FC (p < 0.05). CONCLUSION: Lipidic profile and functional capacity can be improved with nine months of ME. Besides the negative effects of DT, three months were not enough to reverse the benefits of exercise in older women with high values of TG and TC.

Análise observacional das ações dos guarda-redes de futebol jovem / Análisis observacional de las acciones del joven portero del fútbol / Observational analysis of the young soccer goalkeeper actions

O guarda-redes (GR) tem uma ação preponderante no processo ofensivo e defensivo de uma equipa de futebol. O objetivo do estudo centrou-se na análise das ações ofensivas e defensivas do GR sub-17 de futebol, recorrendo à metodologia observacional. Foram analisados GR Sub-17 (n=4) em 30 jogos do campeonato distrital da AF Lisboa. A amostra observacional foi de 286 ações defensivas e 790 ações ofensivas. Utilizámos os sistemas de observação das ações técnico-táticas ofensivas e defensivas dos GR. As ações observadas foram codificadas recorrendo ao software informático LINCE versão 1.3. O tratamento de dados foi realizado através da análise descritiva, do teste U-Mann Whitneypara comparar as ações na condição de casa e fora e estatística gráfica. Verificámos nas ações defensivas maior número de ocorrências na forma de intervenção saída da baliza (n=140; 4.66±2.57), ação como último defesa (n=102; 3.4±2.34), forma de execução técnica com as duas mãos (n= 205; 6.83±3.32) e zona final da ação técnica 1 (n=155; 5.16±3.19). Nas ações ofensivas registámos mais ocorrências para forma de chegada da bola ao GR através de atraso (n=263; 8.76±3.89), início da ação na zona 1 (n=205; 13.30±4.72), ação técnica pontapé de baliza curto (n=191; 6.36±3.99), decisão tática ataque posicional (n=498; 16.60±5.87), final da ação manutenção da posse de bola (n=593; 19.76±5.81) e zona final da ação 5 (n=131; 4.36±3.47). No processo defensivo, a ação dos GR tem enorme preponderância como último defesa e defesa da baliza. No processo ofensivo as ações técnicas com os pés são relevantes na participação na construção do ataque posicional. A ação dos GR é influenciada pela condição de visitado ou visitante. (AU)

The goalkeeper (GK) has a major role in the offensive and defensive process of a soccer team. The aim of the study focused on the analysis of the offensive and defensive actions of the U-17 soccer GK, using observational methodology. U-17 GK (n=4) was analyzed in thirty Lisbon FA U-17 championship games. The observational sample consisted of 286 defensive actions and 790 offensive actions. We used the observational systems of the offensive and defensive technical-tactical GK’ actions. The actions observed were codified using the LINCE version 1.3computer program. Data processing was performed through descriptive analysis, of the U-Mann Whitneytest to compare actions in home and away condition and graphical statistics. We verified in the defensive actions a higher number of occurrences in the intervention form come off from goal (n=140; 4.66±2.57), action as last defender (n=102; 3.4±2,34), technical execution form with two hands (n= 205; 6.83±3.32) and final zone of technical action 1 (n=155; 5.16±3,19). In the offensive actions we recorded more occurrences for ball arrives the GK through back pass (n=263; 8.76±3.89), start of the action in zone 1 (n=205; 13.30±4.72), technical action short goal kick (n=191; 6.36±3.99), tactical decision positional attack (n=498; 16.60±5.87), final action maintenance of ball possession (n=593; 19.76±5.81) and final zone of action 5 (n=131; 4.36±3.47). In the defensive process, the action of the GKs has enormous preponderance in the action as the last defense and goal defense. In the offensive process, technical actions with the feet are relevant in the positional attack construction participation. The GK’ action is influenced by the condition of home game or visitor. (AU)

El portero (POR) tiene un papel importante en el proceso ofensivo y defensivo de un equipo de fútbol. El objetivo del estudio fue analizar las acciones ofensivas y defensivas de los POR U-17 del fútbol, utilizando la metodología observacional. POR Sub-17 (n=4) fueron analizados en treinta partidos del campeonato del distrito de AF Lisboa. La muestra observacional consistió en 286 acciones defensivas y 790 acciones ofensivas. Utilizamos los sistemas de observación de las acciones técnico-tácticas ofensivas y defensivas de los porteros. Las acciones observadas fueron codificadas utilizando el programa informático LINCE versión 1.3. El procesamiento de datos se realizó a través de análisis descriptivos, de la prueba U-Mann Whitneypara comparar las acciones en la condición de local y visitante y estadísticas gráficas. Verificamos en las acciones defensivas un mayor número de ocurrencias en forma de intervención fuera de gol (n=140; 4.66±2.57), acción como la última defensa (n=102; 3.4±2.34), forma de ejecución técnica con ambas manos (n= 205; 6.83±3.32) y zona final de la acción técnica 1 (n=155; 5.16±3.19). En las acciones ofensivas registramos más ocurrencias para la forma en que la pelota llegó al POR a través del pase atrás (n=263; 8.76±3.89), inicio de la acción en la zona 1(n=205; 13,30±4,72), patada de objetivo corto de acción técnica (n=191; 6.36±3.99), ataque posicional de decisióntáctica (n=498; 16.60±5.87), fin de la acción de mantenimiento de la posesión (n=593; 19.76±5.81) y zona final de la acción 5 (n=131; 4.36±3.47). En el proceso defensivo, la acción del POR tiene una enorme preponderancia como la última defensa y defensa de la portería. En el proceso ofensivo, las acciones técnicas con los pies son relevantes en la participación en la construcción del ataque posicional. La acción de los POR es influenciada por la condición de visitado o visitante. (AU)

Training Load in Different Age Category Soccer Players and Relationship to Different Pitch Size Small-Sided Games.

This study sought to evaluate the training load in different age category soccer players associated with distinct pitch size small-sided games (SSGs). Twenty-four soccer players (eight in each age category: U-12, U-15, and U-23) performed three consecutive 4 vs. 4 ball possession SSGs (SSG1: 16 × 24 m; SSG2: 20 × 30 m; and SSG3: 24 × 36 m) all with 3 min duration and 3 min rest. Subjects carried ultra-wideband-based position-tracking system devices (WIMU PRO, RealTrack System). Total distance covered increased from SSG1 to SSG3 in all age categories and predominantly in running speeds below 12 km·h-1. Moreover, distance covered in 12-18 km·h-1 running speed was different in all performed SSGs and age categories. Residual or null values were observed at 18-21 km·h-1 or above running speed, namely in U-12, the only age category where metabolic power and high metabolic load distance differences occurred throughout the performed SSGs. Edwards' TRIMP differences between age categories was only observed in SSG2 (U-12 < U-15). The design of SSGs must consider that the training load of the players differs according to their age category and metabolic assessment should be considered in parallel to external load evaluation in SSGs. Wearable technology represents a fundamental support in soccer.

Unveiling the Mechanism of Action of 7α-acetoxy-6ß-hydroxyroyleanone on an MRSA/VISA Strain: Membrane and Cell Wall Interactions.

The number of cases of failure in the treatment of infections associated with resistant bacteria is on the rise, due to the decreasing efficacy of current antibiotics. Notably, 7α-Acetoxy-6ß-hydroxyroyleanone (AHR), a diterpene isolated from different Plectranthus species, showed antibacterial activity, namely against Methicillin-resistant Staphylococcus aureus (MRSA) strains. The high antibacterial activity and low cytotoxicity render this natural compound an interesting alternative against resistant bacteria. The aim of this study is to understand the mechanism of action of AHR on MRSA, using the MRSA/Vancomycin-intermediate S. aureus (VISA) strain CIP 106760, and to study the AHR effect on lipid bilayers and on the cell wall. Although AHR interacted with lipid bilayers, it did not have a significant effect on membrane passive permeability. Alternatively, bacteria treated with this royleanone displayed cell wall disruption, without revealing cell lysis. In conclusion, the results gathered so far point to a yet undescribed mode of action that needs further investigation.

Relationship betweenof coaches' expectations with instruction and behavior of athletes in football / Relación entre las expectativas de los entrenadores con la instrucción y el comportamiento de los atletasen el fútbol / Relação entre as expectativas dos treinadores com a instrução e o comportamento dos atletas no futebol

This study aims to identify the expectations of the coacheson the instruction and behavior of athletes. The second objective is to correlate the expectations of the coaches with the instruction behavior of coaches and with the behavior of athletes in competition. Aiming to achieve these purpose four coaches of youth soccer teams that competed in the national championships in Portugal werestudied. We applied observation systems SAIC and SOCAC to encode behaviors of coach's instruction and the behavior of athletes in competition, respectively. To data collectionon expectations, the coaches responded to the Questionnaire about Expectations of Instruction and Behavior of Athletes in Competition. The results show that there is short relation between the coach'sexpectations and what actually happens in competition regarding the instruction behavior and the behavior of athletes

Este estudio tiene como objetivo identificar las expectativas de los entrenadores acerca de la instrucción y el comportamiento de los atletas. El segundo objetivo es correlacionar las expectativas de los entrenadores con el comportamiento de instrucción de los entrenadores y el comportamiento de los atletas en la competición. Para lograr los objetivos propuestos se estudiaron cuatro entrenadores de los equipos fútbol juvenil que compitieron en los campeonatos nacionales en Portugal. Se aplicaron los sistemas de observación de SAIC y SOCAC para codificar el comportamiento de instrucciones del entrenador y el comportamiento de los atletas en competición, respectivamente. Para la recogida de datos sobre las expectativas, entrenadores respondieron al Cuestionario sobre las Expectativas de la Instrucción y el Comportamiento de los Atletas en Competición. Los resultados muestran que hay poca relación entre las expectativas del entrenador y lo que realmente sucede en la competición con respecto a la conducta de instrucciones y el comportamiento de los atletas en competición

Este estudo tem como objetivo identificar as expectativas dos treinadores sobre a instrução e o comportamento dos atletas. O segundo objetivo é correlacionar as expectativas dos treinadores com o comportamento de instrução de treinadores e com o comportamento dos atletas em competição. Para atingir os objetivos propostos foram estudados quatro treinadores de equipas de futebol juvenil que competiram nos campeonatos nacionais em Portugal. Aplicámos ossistemas de observação SAIC e SOCAC para codificar comportamentos de instrução do treinador e do comportamento dos atletas em competição, respetivamente. Para a recolha de dados sobre as expectativas, os treinadores responderam ao Questionário sobre as Expectativas da Instrução e Comportamento dos Atletas em Competição. Os resultados mostram que existe pouca relação entre as expectativas do treinador e que realmente acontece na competição relativamente ao comportamento de instrução e ao comportamento dos atletas

Role of MurT C-Terminal Domain in the Amidation of Staphylococcus aureus Peptidoglycan.

Glutamate amidation, a secondary modification of the peptidoglycan, was first identified in Staphylococcus aureus It is catalyzed by the protein products of the murT and gatD genes, which are conserved and colocalized in the genomes of most sequenced Gram-positive bacterial species. The MurT-GatD complex is required for cell viability, full resistance to ß-lactam antibiotics, and resistance to human lysozyme and is recognized as an attractive target for new antimicrobials. Great effort has been invested in the study of this step, culminating recently in three independent reports addressing the structural elucidation of the MurT-GatD complex. In this work, we demonstrate through the use of nonstructural approaches the critical and multiple roles of the C-terminal domain of MurT, annotated as DUF1727, in the MurT-GatD enzymatic complex. This domain provides the physical link between the two enzymatic activities and is essential for the amidation reaction. Copurification of recombinant MurT and GatD proteins and bacterial two-hybrid assays support the observation that the MurT-GatD interaction occurs through this domain. Most importantly, we provide in vivo evidence of the effect of substitutions at specific residues in DUF1727 on cell wall peptidoglycan amidation and on the phenotypes of oxacillin resistance and bacterial growth.

First insights of peptidoglycan amidation in Gram-positive bacteria - the high-resolution crystal structure of Staphylococcus aureus glutamine amidotransferase GatD.

Gram-positive bacteria homeostasis and antibiotic resistance mechanisms are dependent on the intricate architecture of the cell wall, where amidated peptidoglycan plays an important role. The amidation reaction is carried out by the bi-enzymatic complex MurT-GatD, for which biochemical and structural information is very scarce. In this work, we report the first crystal structure of the glutamine amidotransferase member of this complex, GatD from Staphylococcus aureus, at 1.85 Å resolution. A glutamine molecule is found close to the active site funnel, hydrogen-bonded to the conserved R128. In vitro functional studies using 1H-NMR spectroscopy showed that S. aureus MurT-GatD complex has glutaminase activity even in the absence of lipid II, the MurT substrate. In addition, we produced R128A, C94A and H189A mutants, which were totally inactive for glutamine deamidation, revealing their essential role in substrate sequestration and catalytic reaction. GatD from S. aureus and other pathogenic bacteria share high identity to enzymes involved in cobalamin biosynthesis, which can be grouped in a new sub-family of glutamine amidotransferases. Given the ubiquitous presence of GatD, these results provide significant insights into the molecular basis of the so far undisclosed amidation mechanism, contributing to the development of alternative therapeutics to fight infections.

Short-Term Outcome of Spontaneous Intracerebral Hemorrhage in Algarve, Portugal: Retrospective Hospital-Based Study.

BACKGROUND: The short-term outcome from spontaneous intracerebral hemorrhage (SICH) is influenced by local quality of care and population specificities. There are no studies about the SICH mortality in southern Portugal. The objective of this study was to describe the predictors of 30-day in-hospital SICH mortality in Algarve, the southernmost region of Portugal. METHODS: Logistic regression was used to identify predictors of in-hospital death. Kaplan-Meier analysis was used to estimate survival over time based on SICH severity. RESULTS: Of the 549 cases, 349 (63.6%) were men; the mean age was 71.4 years. Two hundred seventeen patients (39.5%) did not receive stroke unit (SU) care. The 30-day mortality was 34.4%. Independent predictors of death were older age (odds ratio [OR] = 1.096, 95% confidence interval [CI] = 1.031-2.062, P = .022) per additional year, vitamin K antagonists use (OR = 5.464, 95% CI = 2.088-25.714, P = .043), admission Glasgow Coma Scale (GCS) score of 8 or lower (OR = 20.511, 95% CI = 7.862-62.168, P < .0001) or GCS score of 9-12 (OR = 12.709, 95% CI = 3.078-44.113, P < .0001), hematoma volume (OR = 1.037, 95% CI = 1.004-1.071, P = .028) per additional milliliter, intraventricular dissection (OR = 1.916, 95% CI = 1.105-4.566, P = .046), and pneumonia (OR 12.918, 95% CI = 4.603-24.683, P < .0001). SU care was independently associated with reduction of death (OR .395, 95% CI = .126-.635, P = .004). Severity correlated with short time to death (P < .0001). Sixty-five of the patients (39.2%) died after the seventh day of SICH ("non-neurological deaths"). CONCLUSIONS: The in-hospital 30-day mortality is high in the region. Admitting more patients to the SU and implementation of preventive strategies of complications can reduce mortality.

Incidence and case-fatality from spontaneous intracerebral hemorrhage in a southern region of Portugal.

BACKGROUND: There is scarce information on incidence and case fatality of spontaneous intracerebral hemorrhage (SICH) in certain regions of the world, including in Europe. There is no community-based data on SICH in Southern Portugal. AIM: To determine the incidence and early case-fatality from SICH in Algarve, the southernmost region of Portugal. METHODS: The recommended criteria for stroke incidence studies was used to identify cases of incident first-ever SICH from January 1st to December 31st 2015 in a subregion with 280,081 inhabitants. Crude incidence rates per age group and gender; standardized rates to the European population; and age adjusted case fatality rates were calculated. RESULTS: Eighty-two first-ever cases of SICH (64.6% men) occurred. The mean age was 72.3 years (SD±12.1); women were 3 years older than men on average and had more frequently lobar SICH. The crude annual incidence rate was 29.2/100,000 (95% CI 23.4- 38.6; p<0.001); higher in men (39.7/100,000) than women (19.8/100,000). The standardized to the European population incidence was 15.1/100,000 (95% CI 3.6-18.9; p<0.05); 26.9 and 10.9/100,000 for men and women respectively. The 30-day case-fatality was 40 % (95% CI 29-51) and increased steeply with age CONCLUSION: The incidence of SICH in Southern Portugal was high, but within the figures found in some parts of Europe. However, a marked predominance of males was found and the case-fatality rate was amongst the highest reported in western countries.

Training strategy of explosive strength in young female volleyball players.

OBJECTIVE: The aim of this study was to examine the effect of an 8-week combined jump and ball throwing training program in the performance of upper and lower extremities among young female volleyball players of the high school. MATERIALS AND METHODS: A total of 20 young female volleyball players playing at Scholar Sport in High School at the district level were divided in two groups: the experimental group (n=10; 14.0±0.0 years; 1.6±0.1 m; 52.0±7.0 kg and 20.7±2.4% body mass) and the control group (n=10; 13.8±0.4 years, 1.6±0.1 m; 53.5±4.7 kg and 20.3±1.7% body mass). The experimental group received additional plyometric and ball throwing exercises besides their normal volleyball practice. The control group underwent only their regular session of training. RESULTS: Strength performance in the experimental group significantly improved (medicine ball and volleyball ball throwing: P=0.00; and counter movement jump: P=0.05), with the improvement ranging from 5.3% to 20.1%. No significant changes in strength performance were observed in the control group (P>0.05). CONCLUSIONS: The 8-week combined jump and ball throwing training can significantly improve muscular performance in young female volleyball players. These findings may be useful for all physical education teachers and volleyball coaches.

Unusual presentations of eosinophilic gastroenteritis: two case reports.

Eosinophilic gastroenteritis is a rare disease that is characterized by eosinophil infiltration in one or multiple segments of the gastrointestinal tract. The etiology of this condition remains unknown. Eosinophilic gastroenteritis has heterogeneous clinical manifestations that depend upon the location and depth of infiltration in the gastrointestinal tract, and eosinophilia may or may not be present. This article reports two cases of eosinophilic gastroenteritis. The first is that of a 49-year-old woman with abdominal pain, ascites, eosinophilia, and a history of asthma. The second case is that of a 69-year-old male with a history of loss of appetite, belching, postprandial fullness, heartburn, and a 5-kilogram weight loss over a period of 9 months; ultimately, the patient was diagnosed with a gastric outlet obstruction due to pyloric stenosis. The rare character of eosinophilic gastroenteritis and its varied clinical presentations often lead to delayed diagnoses and complications. Case reports may help to disseminate knowledge about the disease, thereby increasing the likelihood of early diagnosis and intervention to prevent complications.

Contribution of peptidoglycan amidation to beta-lactam and lysozyme resistance in different genetic lineages of Staphylococcus aureus.

The enzymes responsible for peptidoglycan amidation in Staphylococcus aureus, MurT and GatD, were recently identified and shown to be required for optimal expression of resistance to beta-lactams, bacterial growth, and resistance to lysozyme. In this study, we analyzed the impact of peptidoglycan amidation in representative strains of the most widespread clones of methicillin resistant S. aureus (MRSA). The inhibition of the expression of murT-gatD operon resulted in different phenotypes of resistance to beta-lactams and lysozyme according to the different genetic backgrounds. Further, clonal lineages CC1 and CC398 (community-acquired MRSA [CA-MRSA]) showed a stronger dependency on MurT-GatD for resistance to beta-lactams, when compared to the impact of the impairment of the cell wall step catalyzed by MurF. In the remaining backgrounds similar phenotypes of beta-lactam resistance were observed upon the impairment of both cell-wall-related genes. Therefore, for CA-related backgrounds, the predominant beta-lactam resistance mechanism seems to involve genes associated with secondary modifications of peptidoglycan. On the other hand, the lack of glutamic acid amidation had a more substantial impact on lysozyme resistance for cells of CA-MRSA backgrounds, than for hospital-acquired MRSA (HA-MRSA). However, no significant differences were found in the resistance level of the respective peptidoglycan structure, suggesting that the lysozyme resistance mechanism involves other factors. Taken together, these results suggested that the different genetic lineages of MRSA were able to develop different molecular strategies to overcome the selective pressures experienced during evolution.

Purification, crystallization and preliminary X-ray diffraction analysis of GatD, a glutamine amidotransferase-like protein from Staphylococcus aureus peptidoglycan.

Amidation of peptidoglycan is an essential feature in Staphylococcus aureus that is necessary for resistance to ß-lactams and lysozyme. GatD, a 27 kDa type I glutamine amidotransferase-like protein, together with MurT ligase, catalyses the amidation reaction of the glutamic acid residues of the peptidoglycan of S. aureus. The native and the selenomethionine-derivative proteins were crystallized using the sitting-drop vapour-diffusion method with polyethylene glycol, sodium acetate and calcium acetate. The crystals obtained diffracted beyond 1.85 and 2.25 Å, respectively, and belonged to space group P212121. X-ray diffraction data sets were collected at Diamond Light Source (on beamlines I02 and I04) and were used to obtain initial phases.