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This article reviews Malformations of Cortical Development (MCD) diagnosed by Magnetic Resonance Imaging (MRI) in a series of patients with epilepsy. This study spans a five year period. The frequency of these malformations was 7.1%. Most of these were focal or multifocal and the most common ones were polymicrogyria (35.3% of the patients), heterotopia (29.4%), and focal cortical dysplasia (29.4%). The frontal lobes were the most frequently affected regions. The various MCD encountered reflect the wide spectrum of MCD leading to epilepsy.

The present study refers to the magnetic resonance characteristics observed in a group of three patients with clinical and laboratory evidence of Kallmann's Syndrome. This disease, also named olfactogenital dysplasia, affects the normal gonadal and olfactory development and is clinically characterized by the association of hypogonadotrophic hypogonadism and anosmia/hyposmia. The study protocol, which included the attainment of sagittal and coronal T1-weighted MPRAGE (Multiplanar Rapid Acquisition Gradient Echo) volumetric sequences, showed defective rhinocephalon development in all patients, expressed by the aplasia/hypoplasia of the olfactory bulbs/tracts and/or of the olfactory sulci. The changes observed corroborate the predictable imaging of this genetic disorder and have been mainly visible in the coronal slices obtained. The results shown are more clear evidence that magnetic resonance is an effective method to show the abnormalities in the olfactory region that are invariably found in this syndrome.

We present a review of 57 cases of nontraumatic subarachnoid hemorrhagesubmitted to CT angiography of the cerebral vessels. The purpose of our study was to estimate the value of CT angiography in the detection of intracranial aneurysms. These findings were compared with those from selective angiography. The results showed that CT angiography is a rapid, low-risk technique with a low level of invasiveness and high specificity and sensitivity in the detection of cerebral aneurysms, allowing the planning of endovascular intervention and surgical approach.

Among the 17 intracranial dural fistulae treated in the Department of Neuroradiology of the University Hospital of Coimbra (17 patients, 28 embolizations) between 19/10/98 and 20/11/2000, 4 cases (23%) were located on the tentorium cerebelli. Three patients were men aged 45, 53 and 56 years old. The remaining patient was an 85-year-old woman. All 4 patients were treated by embolization. One underwent post embolization surgical interruption of the draining vein. The authors analyse clinical presentation, complementary tests, therapy and outcome.

In 1994, Microbiology Laboratories of ten Portuguese hospitals analysed isolated microorganisms found in blood and urine samples and studied antimicrobial susceptibilities of the most frequent bacterial pathogens. From 63780 blood samples, the most frequent were Staphylococcus spp. and from 69189 urine samples significant numbers of Escherichia coli, Enterococcus spp., Pseudomonas aeruginosa and Candida spp. were isolated. Escherichia coli strains (c.7000) revealed a low percentage of resistance to antibiotics with the exceptions of ampicillin (48%) and co-trimoxazol (25%). Klebsiella pneumoniae isolates (c.2000) revealed important resistance to ampicillin (98%), cephalotin (31%), co-trimoxazol (38%) and gentamicin (28%), while values for 3rd generation cephalosporins varied among hospitals, with several strains showing phenotype of extended-spectrum beta-lactamase. A great variation in resistance values of P. aeruginosa (c.4000) was found in relation to the antibiotics as well as to the hospitals. Resistance to methicillin in S. aureus (c.6000) was high, reaching an average of 47%, and it was even higher with S. epidermidis (c.3000) and S. haemolyticus (c.650). Only vancomycin was always active against these strains. In E. faecalis (c.2500) resistance was of 2% to ampicillin, 35% to gentamicin, 45% to streptomycin and 1% to vancomycin. E. faecium isolates (c.300) showed the most worrying results with 70% resistance to ampicillin, 42% to gentamicin, 59% to streptomycin and 9% (30 strains isolated in 5 hospitals) to vancomycin. Vancomycin resistant strains were also resistant to all other antibiotics.

Numa breve introdução referem-se alguns conselhos práticos acerca da auscultação das valvulopatias. Revêem-se os problemas do diagnostico diferencial estetoacústico e das formas silenciosas de doença valvular: os rodados diastólicos sem estenose mitral orgânica, as chamadas estenoses mitrais silenciosas, as irradiações atípicas dos sopros de regurgitação mitral, os falsos diagnósticos de insuficiência em casos de aperto mitral, os casos de irradiação atípica do sopro sistólico de estenose aórtica, as estenoses aórticas silenciosas, as insuficiências mitrais silenciosas e as formas de irradiação atípica do sopro de insuficiência aórtica.

Introduction: The hospital setting faces a rate of bed occupation by patients whose discharge is limited by other factors apart from clinical needs. This urges the need for an early identification of the patients at risk of delayed discharge due to social factors in order to reduce expenses and to add value that converts itself into the patient health. The aim of this study was to identify the demographic and clinical factors that may be associated with delayed discharge., Material and Methods: Demographic and clinical comorbidity data on 582 patients of an internal medicine ward from a tertiary hospital center during the years 2018 and 2019 was analyzed. A binomial logistic regression model was used, adjusted for sex, age, and length of clinical stay, in order to identify potential risk factors associated with delayed discharge., Results: A total of 473 patients admitted in the internal medicine ward throughout the two years of study were included. Ninety-four (19%) of these patients had their discharge delayed beyond their clinical needs; sixty-four (68%) of these were females. The most representative age was between 75 - 89 years old (45.7%). The characteristics that significantly differed between both non-delayed and delayed discharge were female sex (OR 2.84, 95% CI 1.65 - 4.90, p-value < 0.05), prolonged clinical stay (OR 2.64, 95% CI 1.60 - 4.937, p-value < 0.05) and diabetes mellitus (OR 1.87, 95% CI 1.08 - 3.23, p-value < 0.05). Besides these, the presence of heart failure (OR 0.52, 95% CI 0.27 - 0.99, p-value < 0.05) and chronic kidney disease (OR 0.34, 95% CI 0.14 - 0.86, p-value < 0.05) were associated with a lower risk of delayed discharge., Conclusion: Female sex, a prolonged clinical stay and diabetes mellitus were associated with a higher risk of delayed discharge, while heart failure and chronic kidney disease were associated with a reduced risk. These findings create a basis for a possible future multicentre study aimed at creating a clinical prediction rule to stratify the risk of delayed hospital discharge in the Portuguese population.

Lower limb lymphorrhea is a condition with a considerable impact on the quality of life. It is usually associated with inguinal lymph node dissection and vascular procedures with femoral exposure. In this case report, we describe a patient who underwent a below-knee amputation and two years later developed lymphorrhea from the stump, preventing adaptation to the prosthesis. Lymphoscintigraphy showed a delayed lymphatic progression. After failure of conservative treatment, she underwent lymphaticovenular anastomosis with a successful outcome. Drainage cessation suggests that lymphaticovenular anastomosis may be an effective treatment for patients with lymphorrhea from and amputation stump, although further studies are required to determine long-term efficacy.

Introduction: Clostridioides difficile is the main cause of healthcare-associated diarrhea in Europe and North America. The aim of this study was to characterize the epidemiology and clinical burden of Clostridioides difficile infection among hospitalized patients in Portugal., Material and Methods: Retrospective study conducted in six public hospital centers in Portugal. All primary Clostridioides difficile infection episodes and related recurrences occurring in 2017, as well as episodes developing two to eight weeks after the last episode diagnosed in that year, were documented. The National Reference Laboratory (National Institute of Health Dr. Ricardo Jorge) provided national surveillance data on Clostridioides difficile infection., Results: A total of 385 inpatients with at least one primary episode diagnosed in 2017 were included. Most patients were aged over 70 years-old (73.2%). The included patients developed 451 episodes during the observation period. Approximately 44% of primary episodes were community-associated. Most episodes (94.9%) occurred in patients with one or more risk factors, with recent antibiotic exposure being particularly common (86.0%). All-cause in-hospital mortality was 19.5%, being significantly higher in patients aged over 65 years-old versus those aged 18 to 64 years-old (22.4% vs 7.8%, respectively). Over 50 different ribotypes were observed among 206 Clostridioides difficile strains received by the National Reference Laboratory., Conclusion: In Portugal, hospitalized patients with Clostridioides difficile infection are mostly older patients presenting risk factors for the development of this infection, particularly recent antibiotic exposure. Mortality is disproportionately high among the older population. Community-associated Clostridioides difficile infection is common among inpatients with this infection.

Introduction: Statins are among the most effective drugs in lowering cholesterol levels and, consequently, in reducing cardiovascular mortality and morbidity. Although generally well tolerated, they have adverse effects that may reduce patient adherence to therapy. The objective of this evidence-based review is to summarize the evidence on the effectiveness of alternative management strategies in patients with intolerance to statins., Material and Methods: A literature search including clinical practice guidelines, systematic reviews and meta-analyses was conducted, in January 2017, in major international databases, and considered articles published in the last 10 years. The search was complemented with research papers published over the past three years and found in the PubMed database. The level of evidence and strength of recommendation were determined using the scale Strength of Recommendation Taxonomy - SORT., Results: We included eight guidelines, six systematic reviews and one research paper., Discussion: The strategies proposed by the different studies vary according to the severity of symptoms of intolerance including maintenance of the statin therapy (dose reduction, addition of a statin of equal or lower intensity or alternate days' uptake) and lipid-lowering therapy with other drugs (ezetimibe monotherapy or association with statin tolerated dose). Supplementation with coenzyme Q10 or vitamin D, in order to improve adherence to treatment with statins, is not recommended., Conclusion: This review highlights some alternatives to address patients' intolerance to statins; however, these are mostly based on recommendations with low to moderate evidence. Therefore, further research with randomized studies involving greater number of patients is required, in order to obtain a more robust recommendation.

Lithium has a narrow therapeutic window. Frequent monitoring of both serum levels and clinical signs of toxicity is warranted because toxicity may be present even when concentrations are within the therapeutic range. We report the case of a man with lithium poisoning, with persistent neurologic signs and symptoms even after removal of lithium from circulation - a diagnosis of syndrome of irreversible lithium-effectuated neurotoxicity (SILENT) was made.

Introduction: Peyronie's disease, a fibrotic disorder of the tunica albuginea of the penis, has been associated with penile shortening and some degree of erectile dysfunction. It affects patient's quality of life, leading to severe psychological, mental, and physical stress. Penile deformation hampers sexual life leading to depression, lack of sexual confidence, loss of sexual function and performance anxiety. Peyronie's disease etiology is yet to be known., Material and Methods: Literature search was conducted in Medline, Embase, and Cochrane databases in January 2015 in order to identify papers related to Peyronie's disease, concerning evolving surgical management, technique, outcomes as well as ancillary treatments. Publications not concerning humans were not considered. We identified original articles, review articles, and editorials addressing the subject. All articles published in the English language were selected for screening. The eligibility criteria for inclusion were based on relevance concerning the subject., Results: The variety of penile deformities associated with Peyronie's disease still doesn't have an effective and reliable non-surgical therapy. We summarize the updated surgical techniques and management algorithm described for Peyronie's disease., Discussion: Surgical management shares similar goals: correcting the curvature, preserving erectile function and penile length, and minimizing morbidity., Conclusion: To date there is no high level of evidence-based data to determine the best surgical treatment of Peyronie's disease. After proper diagnosis, surgical reconstruction should be based on giving a functional penis, that is, rectifying the penis with rigidity enough to enable sexual intercourse.

Objective: Our evaluation pretends to evaluate the influence of prematurity / very low birthweight in motor coordination, in a group of premature children without clinical evidence of neurological injury., Methods: We assessed 58 ex-premature children born between 1997 and 2000 in Central's Portugal Region, of which 31 participated in the study. The whole-body coordination test was performed to assess motor performance., Results: Our sample was composed of 31 children, 14 males and 17 females, divided into two age groups: from 7 to 8 years and 9 to 10 years. The mean gestational age was 30 and 30.1 weeks respectively for the age groups from 7 to 8 years and 9 to 10 years. The birthweight was, on average, 1059 and 1169 g respectively for the group of 7 to 8 years and 9 to 10 years. Based on the results of motor quotient we found 71% (22) of children with reduced motor ability, 23% (7) with impaired motor skills, and only 6% (2), with normal motor coordination., Conclusions: From our study there was no evidence that premature and low birthweight children, have worse motor coordination, that female children have better coordination than the male, and there was not evidence also that children practicing physical activity have better coordination.

Urinary retention in women is not a common complaint. The main causes are structural or functional, which means that urological and neurological reviews are mandatory. Fowler's Syndrome has been described in 1988 and has stablished an association between urinary retention, electromyographic abnormality of the striated urethral sphincter and polycystic ovaries pathologies. Even though its phisiopathology is not completely understood, this disorder seems to be due to a primary failure of relaxation of the striated urethral sphincter. Not only a typical clinical history, but also the evaluation of the sphincter volume, sphincter pressure profilometry and electromyography are determinant to the diagnosis. Sacral neuromodulation seems to be the only therapeutic intervention that can restore voiding. Nevertheless an important group of women still need intermittent self-catheterization. We report the case of an otherwise healthy young women with isolated urinary retention, which exemplifies the diagnostic and therapeutic challenge of Fowler's Syndrome.

The urinary tract is one of the more common sites of bacterial infections, especially in women. Urinary infection can be defined as an infection of urinary tract structures which occurs, generally, as a consequence of the presence or colonization by urine bacteria. The aim of this study was to determine the etiology of urinary tract infections and their susceptibility to antimicrobial agents in the region of Vale do Sousa and Tâmega. From February 2008 to January 2009, 18653 urine cultures were analyzed. From these cultures 1037 were positive. From this total of positive cultures, 18,3% were from males and 81.7% were from females. In bacteriological positive tests, 23 different strains of microorganisms were found. It was verified that the most frequent microorganism was Escherichia coli, followed by Proteus mirabilis, Klebsiella pneumoniae, Enterococcus faecalis and Pseudomonas aeruginosa. For antimicrobial susceptibility it was verified that Escherichia coli showed low susceptibility to amoxicillin and cotrimoxazole. Proteus mirabilis showed good susceptibility to cefotaxime and low to cotrimoxazole, amoxicillin and ciprofloxacin. For Klebsiella pneumoniae was found only a reasonable susceptibility to gentamicin and Enterococcus faecalis showed amoxicillin susceptibility. Pseudomonas aeruginosa showed low susceptibility to all antibiotics analyzed with the exception of the combination piperacillin/tazobactam. In conclusion, this study shows that Escherichia coli, Proteus mirabilis and Klebsiella pneumoniae are the three main microorganisms that causes urinary infections in the region of Vale do Sousa and Tâmega. Therefore, the antimicrobial empirically used must have a spectrum against enterobacteria, because they are the most likely to be present in urinary tract infections acquired in the community. A periodic analysis of the susceptibility profile should be performed over time for each region in order to help in the beginning of the empirical antimicrobial treatment.

Spinal cord injury affects man in his physical and psychic features, making him go through changes and conditioning his sexual performance. This article presents a brief review of the concept and the epidemiology of spinal cord injury, as well as erectile physiopathology. Since sexual rehabilitation considers the evaluation and the restoration of erectile dysfunction, this article reviews the therapeutic means that allow sexual life recovery, allowing a sexual life with quality, maximizing existing potentialities and promoting adaptation to limitations.

Upper limb lymphedema is the most frequent complication of mastectomy. The efficacy of therapeutic modalities is crucial concerning the high prevalence and severity of some of its consequences. The authors make a revision of literature about epidemiology, clinic, diagnosis and treatment of this pathology.

Introduction: The neuromotor techniques do not have good results in severe spasticity prevention and treatment (Ashworth Scale > or = 3). High doses of oral Baclofen are required, thus intrathecal baclofen is a current alternative., Objectives: To assess the effectiveness of treatment, the eight Spinal Cord Injury (SCI) patients with a intrathecal baclofen pump are controlled in a specific consultation in the Rehabilitation Service of C.H.C. The authors analyse the results and made a bibliographic review., Methods: Medline research and retrospective study through the analysis of the individual clinical file., Results: Intrathecal baclofen is effective in severe spasticity when oral baclofen is ineffective or when intolerable side effects occur. In our study group of nine patients, one had infection to the material in the Baclofen pump, and in the other eight patients was observed improvement of spasticity: six were re-classified grade 2 and two were re-classified grade 3 (Modified Ashworth Scale)., Conclusion: Intrathecal baclofen infusion is an effective therapeutic alternative in severe spasticity due to spinal cord lesions. With this method, adequate liquor concentrations for hyperactivity/hipertonicity reduction are possible without the normal side effects that occur with the high oral dosage (about 100 times higher).

Monitoring antibiotic consumption is a valuable tool which has been increasingly used in the last years due to the current concern with the emergence of resistant microbial strains. The present study aimed at monitoring antibiotic consumption, evaluating the economic impact of hospital antibiotic prescription and assessing the relationship between the prescribed antibiotics and the indications for either prophylactic or therapeutic use. This was a longitudinal pilot-study for which data were collected in six privately managed public hospital units during the month of May 2004, with a resulting sample of 1,122 admitted patients. We observed a prescription incidence rate of 76.9%, corresponding to a total of 1,154 dispensed antimicrobials, with a mean 71.2% of these antimicrobials being dispensed for the prophylaxis of surgical site infection (SSI). The mean cost of antibiotic courses was higher in cases of "suspected infection" (9.09 euro) or "confirmed infection" (8.74 euro) and lower in cases of "prophylaxis" (5.67 euro), a finding which is explained by the shorter mean duration of the later. There was a considerable variation among the different hospital units regarding the type of antibiotic compound that was used for SSI prophylaxis, with a mean duration of antibiotic use of 2.61 days for this indication and about half of the prophylactic regimens lasting longer than 24 hours, a fact that suggests an insufficient observation of the current recommendations for antibiotic use in SSI prophylaxis. This finding indicates the need for an investigation on the actual existence of local recommendations for SSI prophylaxis in individual hospital units and also for the evaluation of the compliance of practicing surgeons with eventually existing recommendations.

Among the 17 intracranial dural fistulae treated in the Department of Neuroradiology of the University Hospital of Coimbra (17 patients, 28 embolizations) between 19/10/98 and 20/11/2000, 4 cases (23%) were located on the tentorium cerebelli. Three patients were men aged 45, 53 and 56 years old. The remaining patient was an 85-year-old woman. All 4 patients were treated by embolization. One underwent post embolization surgical interruption of the draining vein. The authors analyse clinical presentation, complementary tests, therapy and outcome.

This article reviews Malformations of Cortical Development (MCD) diagnosed by Magnetic Resonance Imaging (MRI) in a series of patients with epilepsy. This study spans a five year period. The frequency of these malformations was 7.1%. Most of these were focal or multifocal and the most common ones were polymicrogyria (35.3% of the patients), heterotopia (29.4%), and focal cortical dysplasia (29.4%). The frontal lobes were the most frequently affected regions. The various MCD encountered reflect the wide spectrum of MCD leading to epilepsy.

The present study refers to the magnetic resonance characteristics observed in a group of three patients with clinical and laboratory evidence of Kallmann's Syndrome. This disease, also named olfactogenital dysplasia, affects the normal gonadal and olfactory development and is clinically characterized by the association of hypogonadotrophic hypogonadism and anosmia/hyposmia. The study protocol, which included the attainment of sagittal and coronal T1-weighted MPRAGE (Multiplanar Rapid Acquisition Gradient Echo) volumetric sequences, showed defective rhinocephalon development in all patients, expressed by the aplasia/hypoplasia of the olfactory bulbs/tracts and/or of the olfactory sulci. The changes observed corroborate the predictable imaging of this genetic disorder and have been mainly visible in the coronal slices obtained. The results shown are more clear evidence that magnetic resonance is an effective method to show the abnormalities in the olfactory region that are invariably found in this syndrome.

We present a review of 57 cases of nontraumatic subarachnoid hemorrhagesubmitted to CT angiography of the cerebral vessels. The purpose of our study was to estimate the value of CT angiography in the detection of intracranial aneurysms. These findings were compared with those from selective angiography. The results showed that CT angiography is a rapid, low-risk technique with a low level of invasiveness and high specificity and sensitivity in the detection of cerebral aneurysms, allowing the planning of endovascular intervention and surgical approach.

In 1994, Microbiology Laboratories of ten Portuguese hospitals analysed isolated microorganisms found in blood and urine samples and studied antimicrobial susceptibilities of the most frequent bacterial pathogens. From 63780 blood samples, the most frequent were Staphylococcus spp. and from 69189 urine samples significant numbers of Escherichia coli, Enterococcus spp., Pseudomonas aeruginosa and Candida spp. were isolated. Escherichia coli strains (c.7000) revealed a low percentage of resistance to antibiotics with the exceptions of ampicillin (48%) and co-trimoxazol (25%). Klebsiella pneumoniae isolates (c.2000) revealed important resistance to ampicillin (98%), cephalotin (31%), co-trimoxazol (38%) and gentamicin (28%), while values for 3rd generation cephalosporins varied among hospitals, with several strains showing phenotype of extended-spectrum beta-lactamase. A great variation in resistance values of P. aeruginosa (c.4000) was found in relation to the antibiotics as well as to the hospitals. Resistance to methicillin in S. aureus (c.6000) was high, reaching an average of 47%, and it was even higher with S. epidermidis (c.3000) and S. haemolyticus (c.650). Only vancomycin was always active against these strains. In E. faecalis (c.2500) resistance was of 2% to ampicillin, 35% to gentamicin, 45% to streptomycin and 1% to vancomycin. E. faecium isolates (c.300) showed the most worrying results with 70% resistance to ampicillin, 42% to gentamicin, 59% to streptomycin and 9% (30 strains isolated in 5 hospitals) to vancomycin. Vancomycin resistant strains were also resistant to all other antibiotics.