Neuroimaging characterization of multiple sclerosis lesions in pediatric patients: an exploratory radiomics approach.

Introduction: Multiple sclerosis (MS), a chronic inflammatory immune-mediated disease of the central nervous system (CNS), is a common condition in young adults, but it can also affect children. The aim of this study was to construct radiomic models of lesions based on magnetic resonance imaging (MRI, T2-weighted-Fluid-Attenuated Inversion Recovery), to understand the correlation between extracted radiomic features, brain and lesion volumetry, demographic, clinical and laboratorial data. Methods: The neuroimaging data extracted from eleven scans of pediatric MS patients were analyzed. A total of 60 radiomic features based on MR T2-FLAIR images were extracted and used to calculate gray level co-occurrence matrix (GLCM). The principal component analysis and ROC analysis were performed to select the radiomic features, respectively. The realized classification task by the logistic regression models was performed according to these radiomic features. Results: Ten most relevant features were selected from data extracted. The logistic regression applied to T2-FLAIR radiomic features revealed significant predictor for multiple sclerosis (MS) lesion detection. Only the variable "contrast" was statistically significant, indicating that only this variable played a significant role in the model. This approach enhances the classification of lesions from normal tissue. Discussion and conclusion: Our exploratory results suggest that the radiomic models based on MR imaging (T2-FLAIR) may have a potential contribution to characterization of brain tissues and classification of lesions in pediatric MS.

Blood and CSF anti-neuronal antibodies testing in psychotic syndromes: a retrospective analysis from a tertiary psychiatric hospital.

A Consensus of Psychoimmunology Experts (Pollak et al., 2019) established a set of red flags and proposed diagnostic criteria for psychosis of autoimmune origin (AIP). Previous studies on AIP are limited by the scarcity of CSF analysis, preventing the valorization of blood anti-neuronal antibodies (Ab). The aims of this study are to determine the relative frequency and characterize AIP in a cohort of psychotic patients that underwent CSF workup. This work is a retrospective study in a tertiary psychiatric hospital. Clinical and paraclinical data were collected from medical records, and patients were classified according to Pollak et al. (2019) criteria. From 68 patients, ten (14.7%) had positive anti-neuronal antibodies (Ab): n = 5 in CSF and blood (n = 4 anti-NMDAr, n = 1 -GAD65), and n = 5 in blood only (n = 1 anti-GABAb, n = 1 -GAD65, n = 1 -SOX1, n = 1 -NMDAr, n = 1 -zic4). After 5- (2-10)-year follow-up, n = 6/68 (8.8%) had AIP diagnosis in context of autoimmune encephalitis (AE), and the remaining (n = 4/10, blood-only Ab) alternative diagnoses (n = 2 dementia, n = 1 schizophrenia, n = 1 intellectual disability). Ten of the 13 patients that fulfilled criteria for possible AIP were mimics, and only three AE had criteria for probable AIP. All AIP developed neurological manifestations (mostly cognitive dysfunction); EEG was usually abnormal (66.7%), and all had normal MRI. We found statistically significant associations between AIP/AE and systemic autoimmune disease, presentation with seizures and EEG abnormalities. All AE developed neurological symptoms alongside psychosis. Ab positivity occurred predominantly in AE but also in other neuropsychiatric disorders. Clinical suspicion based on the knowledge of the described presentations of established Ab is crucial in the psychotic patient approach.

Sufentanil Sublingual Tablet System vs. Intravenous Patient-Controlled Analgesia with Morphine: Postoperative Pain Control and Its Impact in Quality of Recovery.

CONTEXT: Patient-controlled analgesia (PCA) is commonly used for postoperative pain control. Although widely used, intravenous (IV) morphine PCA may not be suitable for all patients. Sufentanil sublingual tablet system (SSTS) PCA is a recent technique that has had success as a safe and effective alternative for acute pain management. AIMS: This study aims to compare both the efficacy and safety of SSTS PCA versus IV morphine PCA in postoperative pain control and the quality of recovery in adult patients following scheduled gynecological or orthopedic surgery. SETTINGS AND DESIGN: Open-label, parallel-group, randomized controlled trial with 54 patients. The primary outcome was postoperative pain control, while the secondary outcomes included adverse effects associated with two analgesic modalities, total opioid dose required, patient satisfaction, and impact on the quality of postoperative recovery. METHODS AND MATERIAL: Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp., Armonk, New York, United States). The chi-squared test was used in categorical variables. When distribution was normal, T-student (mean ± standard deviation) was used in continuous variables. In contrast, when distribution was not normal, the Mann-Whitney test (median (minimal-maximal)) was used. RESULTS: The results showed that there was a statistically significant difference in the total dose of opioid used by patients at 24 hours postoperatively, with patients receiving SSTS PCA requiring a higher total dose when compared to those receiving IV morphine PCA. However, there were no statistically significant differences in pain scores, adverse events, or patient satisfaction. CONCLUSIONS: The study suggests that both IV morphine and sublingual sufentanil are safe and effective for postoperative pain management.

Excess Mortality in Kidney and Kidney-Pancreas Transplant Recipients in the COVID-19 Pandemic in Portugal-A Cohort Study.

The COVID-19 pandemic increased morbidity and mortality worldwide, particularly in the Kidney and Kidney-Pancreas Transplant Recipient (KTR/KPTR) population. Aiming at assessing the absolute and relative excess mortality (EM) in a Portuguese KTR/KPTR cohort, we conducted a retrospective observational study of two KTR/KPTRs cohorts: cohort 1 (P1; n = 2,179) between September/2012 and March/2020; cohort 2 (P2; n = 2067) between March/2020, and August/2022. A correlation between relative and absolute EM and age, sex, time from transplantation and cause of death was explored. A total of 145 and 84 deaths by all causes were observed in P1 and P2, respectively. The absolute EM in P2 versus P1 was 19.2 deaths (observed/expected mortality ratio 1.30, p = 0.006), and the relative EM was 1.47/1,000 person-months (95% CI 1.11-1.93, p = 0.006). Compared to the same period in the general population, the standardized mortality rate by age in P2 was 3.86 (95% CI 2.40-5.31), with a peak at 9.00 (95% CI 4.84-13.16) in P2C. The higher EM identified in this population was associated, mainly, with COVID-19 infection, with much higher values during the second seasonal COVID-19 peak when compared to the general population, despite generalized vaccination. These highlight the need for further preventive measures and improved therapies in these patients.

An Unexpected Catastrophe-Renal Artery Thrombosis in a Living Donor: A Case Report.

BACKGROUND: Renal artery thrombosis is a devastating complication if not detected early. Cardioembolic disease or surgical and technical complications are frequent causes of renal artery thrombosis. There are some reports of renal artery thrombosis in a renal allograft, but to our knowledge, this is the first case of renal artery thrombosis reported in a kidney donor.

Pregnancy After Kidney Donation: The Experience in a Cohort of Portuguese Living Donors.

BACKGROUND: Living kidney donation (LKD) is a preferred treatment option for end-stage chronic kidney disease, but it can also pose potential risks for the donor, including hypertension and end-stage renal disease. Many donors are women of reproductive age who may have concerns about the effects of donation on future pregnancies. The aim of this study was to determine fetal and maternal outcomes in a cohort of pregnancies after LKD and to compare them with pregnancies before LKD. METHODS: We conducted a retrospective analysis of living kidney donors of childbearing age (<46 years old) at the time of donation who got pregnant after LKD in our center between 1987 and 2020 (N = 13). Clinical data were collected, including demographic characteristics and maternal and fetal outcomes. RESULTS: We observed 16 pregnancies after LKD and 12 pregnancies before LKD in the same group of patients. The rate of gestational hypertension was 12.5% in pregnancies after LKD and 8.3% before LKD (P = .999). There were 13 successful pregnancies after LKD with a mean gestational age of 38.6 ± 1.7 weeks. There were no episodes of acute kidney injury or other complications. CONCLUSION: The present study suggests that LKD does not have a negative effect on maternal and fetal outcomes. However, caution should be taken due to the small sample size. We agree with the guidelines recommending close monitoring of post-donation pregnancies.

Evaluation of parent bonding style and traumatic experiences in patients with schizophrenia and bipolar disorder: A case-control study.

BACKGROUND: There is no consensus about the etiology of schizophrenia (SQZ) and bipolar disorder (BD). Both hereditary and environmental factors are recognized, but the importance of variables like the role of parental attachment and trauma is still under research. AIMS: Evaluate and compare the patient-parent bonding and the frequency and severity of various types of trauma in patients with SQZ, BD, and a control group from Primary Health Care. METHOD: This study included 50 patients with SQZ and 50 with BD followed at a psychiatric hospital, through a convenience sample. Each participant of the clinical sample was paired with a control with no psychiatric background of the same gender and similar age, from a primary health center. Two scales were applied - Parental Bonding Instrument (PBI) and Childhood Trauma Questionnaire - Short Form (CTQ-SF). RESULTS: Regarding PBI, there was a higher frequency of the most dysfunctional attachment style (affectionless control), in patients with SQZ and BD, with p < .001 (always), both for the father and the mother. In addition, ideal parenting style (optimal parenting) was significantly more common in control samples, with p = .002 or <.001, both for the father and for the mother. Trauma was more frequent and severe in SQZ and BD than controls, in all evaluated dimensions. Again, differences between groups are obvious, with p = .012 or <.001. Parental bonding style and scores in the care and overprotection dimensions were also correlated. The only parental bonding style in which correlations were found was in affectionless control. Correlations were more common in cases of neglect compared to abuse. CONCLUSIONS: In this research we found important differences in terms of parental attachment and childhood trauma between patients with SQZ and BD, compared with controls of the same gender and age.

Amazônia Quilombola: cenário, produção e práticas de saúde

O artigo apresenta reflexões acerca do cenário de saúde da população quilombola do Rio Andirá, região do Baixo Rio Amazonas, cuja abordagem metodológica teve como intercessor a cartografia dos sentidos, bem como a narrativa e a observação participante como principais ferramentas para a produção de dados. Compreendendo o referido grupo social como um perfeito representativo da singularidade dos territórios amazônicos, verificamos que a garantia da atenção integral à saúde, bem como de outras ações para o bem-estar de populações quilombolas, revela uma busca constante permeada de presenças e ausências, o que nos convoca à realização de pesquisas que contribuam para o desocultamento de sua existência, bem como de suas demandas, almejando contribuir com o Sistema Único de Saúde para o acesso a todo cidadão, de forma equânime e resolutiva.

Pediatric Thyroidectomy: Experience From a Portuguese Hospital.

Background and objective Pediatric thyroid disease requiring surgery is rare. Thyroid nodules are a frequent indication for surgery and are mostly benign. However, up to 25% of cases can be malignant. In this study, we aimed to describe our center's experience with regard to pediatric thyroid surgery. Methods This was a retrospective transverse study involving pediatric patients who underwent thyroid surgery at a tertiary hospital between January 2010 and December 2021. Results A total of 14 patients underwent 15 surgeries. The main reason for referral to pediatric endocrinology was thyroid nodules (n=10). Thirteen fine needle aspirations (FNAs) were performed, with follicular tumor (n=6) being the most common finding. The median age of patients at surgery was 15.9 years [interquartile range (IQR): 14.0-16.8]. The most common surgical indications were the presence of a follicular tumor on FNA (n=5) and thyroid nodule size causing symptoms (n=5). There was one case of prophylactic thyroidectomy due to the identification of a multiple endocrine neoplasia type 2A (MEN2A) mutation. The most frequently described histopathology results were follicular adenoma (n=6) and colloid nodular goiter (n=6). Three postoperative complications were observed in three different patients: bilateral lesion of the recurrent laryngeal nerve, cervical hematoma, and transient hypoparathyroidism with hypocalcemia. Conclusion In our study, the most frequent surgical indication was a follicular tumor. A good correlation was found between FNA cytology and final histopathology results, which is in accordance with previous studies. This reinforces the importance of FNA in diagnosis and surgical planning. The rate of complications in our study is comparable to that in larger single-center series in the literature.

Type 1 diabetes mellitus - Population characterization and metabolic control outcomes in a Portuguese patient sample.

AIMS: To characterize a cohort of T1D patients and to compare diabetes control between patients using different regimen of insulin therapy and glucose monitoring. METHODS: Were included all T1D patients followed at the Pediatric Endocrinology Unit, between April 1st and June 30th, 2021. Several clinical and demographic variables were analyzed. RESULTS: Our sample included 208 patients, 56.7 % males, mean age of 12.7 ± 4.6 years. The median HbA1c was 7.3 %. Most patients, 78.8% were treated with continuous subcutaneous insulin infusion (CSII) and 81.3 % used continuous glucose monitoring (CGM). CSII had a lower HbAc compared with multiple daily injections (MDI) users (7.1vs 8.1 %, p < 0.01). In the CSII group, those who used CGM had a lower HbAc (7.1 vs 7.5 %,p = 0.02). Analyzing the data of the ambulatory glucose report, the CSII users had a lower glucose management indicator, (7.2 % vs 7.6 %, p < 0.01), more time in range (58.0 % vs 52.4 %;p < 0.01) and less time above range > 250 mg/dL (12.4 % vs 20.5 %;p < 0.01) than MDI users. CONCLUSIONS: The median HbA1c was 7.3% very close to the recommended target. In Portugal, pediatric patients can access a CSII provided by the national health service and a CGM system due to an elevated reimbursement of their cost. This healthy policy allows us to achieve better goals without the risk of hypoglycemia.

A importância da atenção básica nas questões relacionadas a crianças diagnosticada com desnutrição: impacto da assistência de enfermagem na problemática / The importance of primary care in issues related to children diagnosed with malnutrition: impact of nursing care on the problem / La importancia de la atención primaria en los problemas relacionados con los niños diagnosticados de desnutrición: repercusión de los cuidados de enfermería en el problema

INTRODUÇÃO: Os primeiros anos de vida da criança são importantes, pois é durante esta fase que ocorre a maioria dos processos nas esferas do desenvolvimento físico e motor. Entretanto, percebe-se que a desnutrição é uma realidade, sendo considerada um problema de saúde pública pois esta situação afeta a interação de múltiplos fatores e suas consequências extrapolam o crescimento e o desenvolvimento adequado, em casos extremos, resultando na morte precoce da criança. OBJETIVO: Com base nisso, este estudo tem como objetivo descrever o impacto da atenção primária, tendo o enfermeiro como principal profissional na intervenção da problemática relacionada a crianças com diagnostico de desnutrição. METODOLOGIA: Para tal finalidade foi realizado uma revisão de literatura na qual foram utilizadas as seguintes bases de dados: Scientific Electronic Library Online (SciELO), Literatura Latino- -Americana e do Caribe em Ciências da Saúde (LILACS) e Medical Literature Analysis and Retrieval Sistem Online (MEDLINE) e Base de Dados em Enfermagem (BDENF), utilizando as seguintes palavras chaves: desnutrição, enfermeiro e complicações, ligadas pelo operar booleano "AND".RESULTADOS: Os estudos identificados após os cruzamentos dos descritores de saúde foram de 191, na qual foram atribuídos aos filtros de elegibilidade, como descritos na metodologia, totalizando um total de 14 artigos que por seguinte serviram como base para a discussão. CONCLUSÃO: Após análises, conclui-se, portanto que a desnutrição é um problema de saúde pública e o enfermeiro é o principal profissional atuante na atenção primária que interfere diretamente na problemática em razão de toda a assistência que deve ser prestada as famílias.

INTRODUCTION: The first years of a child's life are important, as it is during this phase that most of the processes in the spheres of physical and motor development occur. However, it is perceived that malnutrition is a reality, being considered a public health problem because this situation affects the interaction of multiple factors and its consequences go beyond adequate growth and development, in extreme cases, resulting in the early death of the child. OBJECTIVE: Based on this, this study aims to describe the impact of primary care, with the nurse as the main professional in the intervention of problems related to children diagnosed with malnutrition. METHODOLOGY: For this purpose, a literature review was carried out in which the following databases were used: Scientific Electronic Library Online (SciELO), Latin American and Caribbean Literature in Health Sciences (LILACS) and Medical Literature Analysis and Retrieval Online System (MEDLINE) and Database in Nursing (BDENF), using the following keywords: malnutrition, nurse and complications, linked by the Boolean operator "AND". RESULTS: The studies identified after crossing the health descriptors were 191, in which the eligibility filters were assigned, as described in the methodology, totaling a total of 14 articles that subsequently served as the basis for the discussion. CONCLUSION: After analysis, it is concluded, therefore, that malnutrition is a public health problem and the nurse is the main professional working in primary care that directly interferes with the problem due to all the assistance that must be provided to families.

INTRODUCCIÓN: Los primeros años de vida de un niño son importantes, ya que es durante esta fase cuando se producen la mayoría de los procesos en las esferas del desarrollo físico y motor. Sin embargo, se percibe que la desnutrición es una realidad, siendo considerada un problema de salud pública, ya que esta situación afecta la interacción de múltiples factores y sus consecuencias van más allá de un adecuado crecimiento y desarrollo, en casos extremos, resultando en la muerte precoz del niño. OBJETIVO: En base a ello, este estudio pretende describir el impacto de la atención primaria, con la enfermera como profesional principal en la intervención de los problemas relacionados con los niños diagnosticados de desnutrición. METODOLOGÍA: Para ello, se realizó una revisión bibliográfica en la que se utilizaron las siguientes bases de datos: Scientific Electronic Library Online (SciELO), Latin American and Caribbean Literature in Health Sciences (LILACS) y Medical Literature Analysis and Retrieval Online System (MEDLINE) y Database in Nursing (BDENF), utilizando las siguientes palabras clave: desnutrición, enfermera y complicaciones, vinculadas por el operador booleano "AND". RESULTADOS: Los estudios identificados tras cruzar los descriptores de salud fueron 191, en los que se asignaron los filtros de elegibilidad, tal y como se describe en la metodología, sumando un total de 14 artículos que posteriormente sirvieron de base para la discusión. CONCLUSIÓN: Después del análisis, se concluye, por lo tanto, que la desnutrición es un problema de salud pública y la enfermera es el principal profesional que trabaja en la atención primaria que interfiere directamente en el problema debido a toda la asistencia que se debe prestar a las familias.

Which stretching instruction should be given to assess joint maximal range of motion?

This study aimed to determine the intra-day reliability, individuals performance expectancy, and biomechanical response of nine stretching instructions in assessing the maximal range of motion (mROM) during the passive ankle dorsiflexion test. Twenty healthy young participants were tested in two sessions within the same day. Nine stretching instructions composed by intensity-domain (i.e. minimum, point, and maximum) and sensation-domain (i.e. tolerance, discomfort, and pain) words were used to impose plantar flexors stretching. In the first session, individuals were requested to order the nine stretching instructions in ascending order. The ankle joint torque-angle and medial gastrocnemius, soleus and tibialis anterior electric activity were assessed in both sessions. A moderate to high reliability was observed across instructions (ICC = 0.65-0.87). Most stretching instructions showed high intra-day reliability outcomes, where discomfort and tolerance showed moderate reliability. 70% of individuals performed the stretching maneuvers consistently to stretching instructions performance expectancy. A greater torque-angle response was observed for the instructions involving the word pain (ROM = 40.5 ± 1.6°), compared to discomfort (29.5 ± 1.8°), and tolerance (30.5 ± 2.0°) that produced similar stretching intensities. Instructions involving the terms minimum (29.6 ± 2.0°), point (33.3 ± 7.6°), and maximum (37.6 ± 7.2°) were more discriminative of stretching intensities than sensation-domain terms. In conclusion, stretching instructions targeting the joint maximal range of motion produce different joint torque-angle responses and they may not be understandable by all individuals, although (in general) they can be used reliably.

Active Pregnancy: A Physical Exercise Program Promoting Fitness and Health during Pregnancy-Development and Validation of a Complex Intervention.

Physical activity during pregnancy is a public health issue. In the view of reproducibility and the successful implementation of exercise interventions, reporting the quality of such study design must be ensured. The objective of this study was to develop and validate a physical exercise program promoting fitness and health during pregnancy. A qualitative methodological study was carried out. For the description of the exercise program, the Consensus on Exercise Reporting Template (CERT) was used. For the validation of the program, the revised guideline of the Criteria for Reporting the Development and Evaluation of Complex Interventions in Health Care (CReDECI2) was followed and went through three stages of development, piloting, and evaluation. The customizable exercise program was designed and validated by exercise and health specialists based on evidence-based, international recommendations and supported by different educational tools to be implemented by qualified exercise professionals in health and fitness settings. A 12-week testing intervention addressing a group of 29 pregnant women was carried out. The program's feasibility was subsequently evaluated by all the pregnant women. The CReDECI2 process guides practitioners and researchers in developing and evaluating complex educational interventions. The presented intervention may assist exercise specialists, health professionals, and researchers in planning, promoting, and implementing a prenatal exercise program.

Pediatric adrenal insufficiency: thirty years experience at a Portuguese hospital.

BACKGROUND: Adrenal insufficiency (AI) is a life-threatening condition caused by an impaired secretion of the adrenal glucocorticoid and mineralocorticoid hormones. It comprises a heterogeneous group of primary, secondary and acquired disorders. Presentation differs according to the child's age, but it usually presents with nonspecific and insidious symptoms and signs. The main purpose of this study was to describe and compare patients with primary or secondary AI. METHODS: Retrospective analysis of all patients with adrenal insufficiency followed at the Pediatric Endocrinology Unit in a tertiary care Portuguese hospital over the last 30 years. Data on family history, age at the first manifestation and at etiological diagnosis, and clinical presentation (symptoms, signs and laboratory evaluation) was gathered for all patients. RESULTS: Twenty-eight patients with AI were included; 67.9% were male, with a median (25th-75th percentile, P25-P75) age of 1 (0.5-36) month at the first presentation. The principal diagnostic categories were panhypopituitarism (42.9%) and congenital adrenal hyperplasia (25%). The most frequent manifestations (75%) were vomiting and weight loss. They were followed for a median (P25-P75) period of 3.5 (0.6-15.5) years. In respect to neurodevelopmental delay and learning difficulties, they were more common in the secondary AI group. CONCLUSIONS: Despite medical advances, the diagnosis and management of AI remains a challenge, particularly in the pediatric population, and clinicians must have a high index of suspicion. An early identification of AI can prevent a potential lethal outcome, which may result from severe cardiovascular and hemodynamic instability.