Post Ligation Cardiac Syndrome: an Educational Presentation.

Although technically simple, surgical correction of patent ductus arteriosus can have serious complications. In this context, acute ventricular failure must be remembered, as its prompt diagnosis and proper management can change clinical outcomes.

Post Ligation Cardiac Syndrome: an Educational Presentation

ABSTRACT Although technically simple, surgical correction of patent ductus arteriosus can have serious complications. In this context, acute ventricular failure must be remembered, as its prompt diagnosis and proper management can change clinical outcomes.

The SARS-CoV-2 infection among students in the University of Porto: a cross-sectional study

IntroductionIncidence based on notified cases of SARS-CoV-2 infection underestimates the real extension of the infection. We aimed to quantify SARS-CoV-2 specific antibodies seroprevalence among University students in Porto. MethodsA rapid point of care testing for SARS-CoV-2 specific immunoglobulin (Ig) M and IgG antibodies was performed, and a questionnaire was applied to the 6512 voluntary students from September to December 2020. We computed the apparent IgM, IgG and IgM or IgG prevalence, and the true prevalence and 95% credible intervals (95% CI) using Bayesian inference. ResultsWe found an apparent prevalence (IgM or IgG) of 9.7%, the true prevalence being 7.9% (95% CI 4.9-11.1). Prevalence was significantly higher among males (10.9% vs 9.2%), international students (18.1% vs 10.4% local vs 8.8% nationally displaced) and increased with age. Those with a known risk contact, that experienced quarantine, had symptoms, or a previous negative molecular test had a higher seroprevalence. Of the 91 (1.4%) students who reported a molecular diagnosis, 86.7% were reactive for IgM or IgG. ConclusionBased on immunological evidence infection was 5.6 times more frequent than if based on a molecular diagnosis. The higher seroprevalence among male, older, and international students emphasizes the importance of identifying particular groups.

Incidence of SARS-CoV-2 infection in a cohort of workers from the University of Porto

BackgroundRepeated serosurveys in the same population provide more accurate estimates of the frequency of SARS-CoV-2 infection and more comparable data than notified cases. We aimed to estimate the incidence of SARS-CoV-2 infection, identify associated risk factors, and assess time trends in the ratio of serological/molecular diagnosis in a cohort of university workers. MethodsParticipants had a serological rapid test for SARS-CoV-2 Immunoglobulins M and G, and completed a questionnaire, in May-July 2020 (n=3628) and November 2020-January 2021 (n=2661); 1960 participated in both evaluations and provided data to compute the incidence proportion and the incident rate. Crude and adjusted incidence rate ratios (aIRR) and 95% confidence intervals (CI) were computed using generalised linear models with Poisson regression. ResultsThe incidence rate was 1.8/100 person-month (95%CI 1.6-2.1), and the 6 months cumulative incidence was 10.7%. The serological/molecular diagnosis ratio was 10:1 in the first evaluation and 3:1 in the second. Considering newly identified seropositive cases at the first (n=69) and second evaluation (n=202), 29.0% and 9.4% never reported symptoms, respectively, 14.5% and 33.3% reported contact with a confirmed case and 82.6%, and 46.0% never had a molecular test. Males (aIRR: 0.59; 95%CI: 0.42-0.83) and "high-skilled white-collar" workers (aIRR: 0.73, 95%CI: 0.52-1.02) had lower incidence of infection. ConclusionUniversity workers presented a high SARS-CoV-2 incidence while restrictive measures were in place. The time decrease in the proportion of undiagnosed cases reflected the increased access to testing, but opportunities continued to be missed, even in the presence of COVID-19 like symptoms. What is already known on this subjectO_LIThe median ratio of seroprevalence to the corresponding cumulative incidence is 18, however, there is great variability between studies. C_LIO_LISeroprevalence studies are essential to estimate the true burden of the infection. C_LIO_LIFew cohort studies focused on essential non-healthcare workers, such as university workers. C_LI What this study addsO_LIThis longitudinal seroprevalence study among university workers found a SARS-CoV-2-specific IgM or IgG incidence rate of 1.8/100 person-month, and a 6 months cumulative incidence of 10.7%. C_LIO_LIThe undiagnosed fraction was 3:1 in the second evaluation, representing a decrease from a 10:1 in the first evaluation in the same population showing that a gap to test-trace-isolate remained in this highly educated working population. C_LIO_LISeropositive participants were mostly pauci- or symptomatic with no known contact with a COVID-19 confirmed case; "high-skilled white-collar" workers were at lower risk of being an incident seropositive case. C_LI

Prevalence of SARS-CoV-2 antibodies among workers of the public higher education institutions of Porto, Portugal

ObjectivesTo assess the prevalence of SARS-CoV-2 specific immunoglobulin (Ig) M and IgG antibodies among workers of the three public higher education institutions of Porto, Portugal, up to July 2020. MethodsA rapid point of care test for specific IgM and IgG antibodies of SARS-CoV-2 was offered to all workers. Testing was performed to and a questionnaire was completed by 4592 workers on a voluntary basis. We computed the apparent IgM, IgG, and combined IgM or IgG prevalence, along with the true prevalence and 95% credible intervals (95% CI) using Bayesian inference. ResultsWe found an apparent prevalence of 3.1% for IgM, 1.0% for IgG, and 3.9% for either antibody class. The estimated true prevalence was 2.0% (95% CI 0.1-4.3) for IgM, 0.6% (95% CI 0.0-1.3) for IgG and 2.5% (95% CI 0.1-5.3) for IgM or IgG. A SARS-CoV-2 molecular diagnosis was reported by 21 (0.5%) workers, and of these, 90.5% had a reactive IgG result. Seroprevalence was higher among those reporting known contacts with confirmed cases, having been quarantined, having a previous molecular negative test, or having had symptoms. ConclusionsThe seroprevalence among workers from the three public higher education institutions of Porto after the first wave of the SARS-CoV-2 infection was relatively low. However, the estimated true seroprevalence was approximately five times higher than the reported SARS-CoV-2 infection based on a molecular test result.

Evaluation of the hypothalamic-pituitary-adrenal axis in a case series of familial partial lipodystrophy.

BACKGROUND: Familial partial lipodystrophy (FPL) is a rare genetic disease characterized by body fat abnormalities that lead to insulin resistance (IR). Clinical conditions linked to milder IR, such as type 2 diabetes (T2D) and metabolic syndrome, are associated with abnormalities of the hypothalamic-pituitary-adrenal (HPA) axis, but little is known about its activity in FPL. METHODS: Patients meeting the clinical criteria for FPL were subjected to anthropometric, biochemical and hormone analyses. A genetic study to identify mutations in the genes encoding peroxisome proliferator-activated receptor gamma (PPARγ) was performed. Polycystic ovary syndrome and hepatic steatosis were investigated, and the patient body compositions were analyzed via dual X-ray energy absorptiometry (DXA). The HPA axis was assessed via basal [cortisol, adrenocorticotrophic hormone (ACTH), cortisol binding globulin, nocturnal salivary cortisol and urinary free cortisol (UFC)] as well as dynamic suppression tests (cortisol post 0.5 mg and post 1 mg dexamethasone). RESULTS: Six patients (five female and one male) aged 17 to 42 years were included. In DXA analyses, the fat mass ratio between the trunk and lower limbs (FMR) was > 1.2 in all phenotypes. One patient had a confirmed mutation in the PPARγ gene: a novel heterozygous substitution of p. Arg 212 Trp (c.634C>T) at exon 5. HPA sensitivity to glucocorticoid feedback was preserved in all six patients, and a trend towards lower basal serum cortisol, serum ACTH and UFC values was observed. CONCLUSIONS: Our findings suggest that FPL is not associated with overt abnormalities in the HPA axis, despite a trend towards low-normal basal cortisol and ACTH values and lower UFC levels. These findings suggest that the extreme insulin resistance occurring in FPL may lead to a decrease in HPA axis activity without changing its sensitivity to glucocorticoid feedback, in contrast to the abnormalities in HPA axis function in T2D and common metabolic syndrome.

Realizando o acolhimento e o cuidado à população LGBT

Realizando o acolhimento e o cuidado à população LGBT é a unidade 3 do módulo Política Nacional de Saúde Integral Lésbicas, Gays, Bissexuais, Travestis e Transexuais. Nela são apresentadas as realidades da população LGBT, com foco na identificação das especificidades no contexto da saúde e do cuidado. Nesta unidade também são abordadas as questões da desconstrução dos preconceitos e do estímulo ao acolhimento, ao atendimento e ao encaminhamento das demandas da população LGBT, sem discriminação e com respeito. A unidade é dividida em 7 temas: refletindo sobre acolhimento e cuidado à população LGBT; acesso e acolhimento nos serviços de saúde; violência contra a população LGBT; saindo da teoria e transformando a prática; orientações para o atendimento profissional e institucional de travestis e transexuais; modificações corporais; HIV/Aids, Hepatites virais e outras DST.

Puberdade Precoce

O vídeo faz uma descrição das características de uma puberdade normal para possibilitar ao médico a identificação de distúrbios endócrinos que acarretam em uma puberdade precoce.

Análise do tratamento da síndrome coronariana aguda em centro cardiológico do norte fluminense / Analysis of treatment of acute coronary syndrome at a cardiology center in northem Rio de Janeiro State, Brazil

Fundamentos: As doenças cardiovasculares são importante causa de óbito no norte fluminense. Objetivo: Descrever as características de pacientes com suspeita clínica de síndrome coronariana aguda (SCA), identificando o tratamento médico e a mortalidade hospitalar nos pacientes do centro cardiológico do Norte Fluminense. Métodos: Foram avaliados 170 pacientes com SCA, de janeiro a dezembro de 2007, em relação às características basais, modalidade de apresentação da SCA, medicamentos durante a internação, indicação de tratamento clínico ou de revascularização miocárdica (RM) e mortalidade hospitalar. Resultados: 109 (64,12 por cento) pacientes eram do sexo masculino. O dignóstico final foi infarto agudo do miocárdio com supra ST em 61 (35,9 por cento) pacientes, sem supra ST em 72 (42,3 por cento) e angina instável em 37 (21,7 por cento) pacientes. Em relação às medicações usadas durante a internação: betabloqueadores (95,3 por cento), estatinas (99,4 por cento),...

Abordagem em grupo de pacientes com hipertensão arterial e diabetes mellitus na unidade básica de saúde da família de São Sebastião em Campos dos Goytacazes - RJ

A hipertensão arterial sistêmica e o diabetes mellitus são doenças altamente prevalentes na população adscrita pela Estratégia de Saúde da Familia (ESF) de São Sebastião na cidade de Campos dos Goytacazes. A partir desta constatação foi proposta a criação de um grupo Hiperdia (grupo de hipertensos e diabéticos) com reunião quinzenal às quintas-feiras pela manhã. Este grupo foi proposto com o objetivo de aumentar o conhecimento sobre as doenças, melhorar a aderência destes pacientes, ressaltando a importância do tratamento não farmacológico, além de compartilhar experiências e estabelecer um diálogo entre a equipe de saúde e a população hipertensa e diabética local. Conclui-se necessário a abordagem de prevenção e promoção em saúde para o esclarecimento sobre as doenças (HAS e DM) e melhora na adesão terapêutica.

Abordagem em grupo de pacientes com hipertensão arterial e diabetes mellitus na unidade básica de saúde da família de São Sebastião em Campos dos Goytacazes - RJ

A hipertensão arterial sistêmica e o diabetes mellitus são doenças altamente prevalentes na população adscrita pela Estratégia de Saúde da Familia (ESF) de São Sebastião na cidade de Campos dos Goytacazes. A partir desta constatação foi proposta a criação de um grupo Hiperdia (grupo de hipertensos e diabéticos) com reunião quinzenal às quintas-feiras pela manhã. Este grupo foi proposto com o objetivo de aumentar o conhecimento sobre as doenças, melhorar a aderência destes pacientes, ressaltando a importância do tratamento não farmacológico, além de compartilhar experiências e estabelecer um diálogo entre a equipe de saúde e a população hipertensa e diabética local. Conclui-se necessário a abordagem de prevenção e promoção em saúde para o esclarecimento sobre as doenças (HAS e DM) e melhora na adesão terapêutica.