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The uterine inversion is a rare but serious pathology of the delivery. We describe two cases of uterine inversion of secondary and quaternary degree; the first had a delay diagnosis and the second having a return after the manual replacement, finishing both on surgical resolution. The authors describe the causal factors, the diagnosis and the therapeutic of uterine inversion.

The aim of this paper is to briefly review recent data concerning urinary tract trauma. Upper urinary tract injuries occur in 1 to 1.5% of all trauma. Bladder trauma and urethral injuries are associated in 8 to 16% of pelvic fractures and perineal lesions. Functional and vital prognosis are reviewed and modern diagnostic management and treatment modalities are also mentioned. The association of urinary tract trauma with other injuries implies an interdisciplinary approach for these patients.

Significative enhancement of free radical formation (FRO) in vivo is an important feature of hypertensive disorders of pregnancy (HDP), namely preeclampsia (PIH). The latest investigations about the pathology of HDP, showed the contribution of placental circulation to the development and evolution of such disease. The placental bed can be a potential source of FRO or activation of cells that can produce FRO. Glutathione, is an important molecule for cellular protection against damage, is a cofactor of many enzymes, in particular, for the glutathione peroxidase of the placental tissue; this enzyme in the placenta bed prevent the production of thromboxan and lipoperoxides; the latter are potentially damaging to the endothelium cells and can cause vasoconstriction, the most important feature of PIH. The activity of that enzyme is deficient in PIH. We studied, by fluorometric assay, the concentrations of the two states of glutathione in placental homogenates (PLH) from pregnant women without pathology (PWN) and from pregnant women with PIH (PWPIH). The data showed significant low concentrations in the PLH of the two states of glutathione in the PWN against high concentrations of this molecule in the PLH from PWPIH. This feature can result from a deficient user of the glutathione by the cellular mechanism for prevention against oxidative factors. In addition, our study shows a biochemical marker that is suggestive that the placental bed is a potential source of FRO production in PIH.

Campylobacter jejuni is one of the most common causes of enteritis. In rare cases, extraintestinal infection can occur, with a handful of cases of cardiac involvement, of which the pathophysiological mechanism is unclear. We report a case of pericarditis in a patient with X-linked agammaglobulinemia presenting with chronic diarrhea and chest pain who evolved to cardiac tamponade, requiring a pericardial window and a long course of broad-spectrum antibiotics. To the best of our knowledge, this is the third case of pericarditis caused by Campylobacter jejuni reported in the literature, the second in a patient with X-linked agammaglobulinemia. Despite its rarity, this case serves as a reminder of Campylobacter as a potential cause of cardiac inflammation for clinicians treating pericarditis/myocarditis, especially in patients with a history of diarrhea or immunosuppression.

Introduction: Heart failure frequently coexists with several comorbidities. Our aim is to evaluate the prognostic role of various comorbidities in the risk of acute heart failure development., Material and Methods: Comorbidities of patients with acute heart failure were, retrospectively, compared to a control group of patients with chronic heart failure admitted to an Internal Medicine unit in a 2-year period. Logistic regression models were constructed to determine their association with acute heart failure and to develop a comorbidome., Results: We identified 229 patients with acute heart failure and 201 patients with chronic heart failure. Age and female gender were higher in acute heart failure group (p < 0.001) as was the number of comorbidities (4.0 ± 3.0 vs 4.0 ± 2.0, p = 0.044). Hyperuricemia (odds ratio 2.46, confidence interval 95% 1.41 - 4.31, p = 0.002), obesity (odds ratio 2.22, confidence interval 95% 1.31 - 3.76, p = 0.003), atrial fibrillation (odds ratio 1.93, confidence interval 95% 1.31 - 2.87, p = 0.001), peripheral artery disease (odds ratio 2.12, confidence interval 95% 1.01 - 4.42, p = 0.046) and chronic kidney disease (odds ratio 2.47, confidence interval 95% 1.65 - 3.71, p < 0.001) were associated with acute heart failure. Obesity, atrial fibrillation, peripheral artery disease and chronic kidney disease were identified as independent risk factors. Patients with multiple comorbidities had a superior risk of hospitalization due to heart failure: zero comorbidities - odds ratio 0.43, 95% confidence interval 0.28 - 0.67, p < 0.001; one comorbidity - odds ratio 0.69, 95% confidence interval 0.47 - 1.01, p = 0.057; two comorbidities - odds ratio 1.85, 95% confidence interval 1.11 - 3.08, p = 0.019; ≥ three comorbidities - odds ratio 5.81, 95% confidence interval 2.77 - 12.16, p < 0.001., Discussion: This study shows an association between several comorbidities and hospital admission due to acute heart failure. The association seems to strengthen in the presence of multiple comorbidities., Conclusion: A comorbidome is a useful tool to identify comorbidities associated with higher risk of acute heart failure. The identification of vulnerable patients may allow multidimensional interventions to minimize future hospital admissions.

Introduction: High-risk human papillomavirus cervical infection is currently a well-established cause of cervical cancer. However, only a few women with persistent infections will develop cervical precancerous and malignant lesions. Approximately 20% of all cervical cancers are attributable to non-16/18 serotypes. This study aims to evaluate the results of our clinical approach to women with this infection., Material and Methods: We conducted an observational and prospective study from September 2012 to September 2017, which included women with isolated non-16/18 high-risk human papillomavirus infection (with normal cytology). After re-evaluation, two groups were compared: women with spontaneous regression of the infection and women with persistent infection. Clinical and demographic data were analysed as well as the rate of progression to precancerous and malignant lesions., Results: We included 165 women, of which 121 were re-evaluated with co-test at least one year later. After re-evaluation, 13.2% of women revealed precancerous lesions but only two (1.7%) of them presented high-grade squamous intraepithelial lesions. Sixty-seven women (55.4%) showed spontaneous regression of the infection and 54 women (44.6%) maintained it. Women with persistent infection developed more precancerous lesions (27.8%; p < 0.001) and high-grade squamous intraepithelial lesions (3.7%; p < 0.001). There was also an association between persistent infection and postmenopausal status., Discussion: Human papillomavirus 16/18 cervical infection is associated with higher risk of cervical cancer when compared with other serotypes., Conclusion: Re-evaluation with co-test one year after the diagnosis of isolated non-16/18 human papillomavirus infection seems to be a reasonable approach.

Introduction: Though typically found in adolescents, acne frequently affects the adult population. In Portugal, no representative studies about acne prevalence in greater populational areas are known. This study had the following objectives: calculate acne prevalence in primary healthcare patients; its characteristics, including risk factors for onset and worsening; collect information concerning selfmedication and/or prescribed treatment., Material and Methods: Application of a questionnaire and physical examination into a convenience sample, composed by adults from20 - 60 years old that visited, in random days, five primary healthcare centers of the Greater Porto area., Results: From the 1,055 evaluated adults, acne prevalence was estimated at 61.5%. Only 36.8% of acne suffering adults was awareof their condition. More than half of tobacco users (62.3%) had acne. Just 25% of acne sufferers sought treatment. The most affected areas were the malars, differing from the younger disease form., Discussion: Acne prevalence was relatively higher than other studies. The results of this study have confirmed that acne seems to be related with increased calorie intake, tobacco smoking, whole milk and fat-reduced milk consumption, hirsutism, alopecia and seborrhea., Conclusion: In the primary healthcare set, more than half of adults were acne sufferers. These numbers show how important primary healthcare services can be in preventing and intervening when managing acne-related risk factors and psychosocial consequences.

In 2000, the Institute of Medicine's report, To Err Is Human: Building a Safer Health System, caught the public attention documenting the magnitude of the medical error problem and the inherent patient safety: medical errors cause between 44,000 and 98,000 deaths annually in the United States. Currently, there is a growing interest in risk management on the medical field, particularly in the management of adverse events. It has been mainly due to the commitment of the World Health Organization, that this field of research has gained increasing the attention it deserves. Medical imaging is one of the high risk fields for the occurrence of errors, especially due to the multiplicity of techniques, the several stakeholders and the complexity of the whole circuit that involves the conduct of studies. Many of the methods used to analyze patient safety were adapted from risk-management techniques in high-risk industries (e.g. chemical, nuclear power and aviation industry). It is recognized that we can learn more from our mistakes than from our successes and the reporting systems in these industries have provided a valuable contribution to error prevention and risk management techniques. At a minimum, adverse events reporting systems can help to identify hazards and risks, providing important information on the system aspects that should be improved. However, the accumulation of potentially relevant data contributes little to healthcare services improvement. It is crucial to apply models to identify the underlying system failures, the root causes, and enhance the sharing of knowledge and experience. In this paper, it is suggested a solution to reduce adverse events, by identifying and eliminating the root causes that are in their source. How the Eindhoven Classification Model was adapted and extended specifically for the Medical Imaging field is also presented. The proposed approach includes the root causes analysis and introduces incomplete information concepts through the use of logical-mathematical operators formally sustained. This model is the basis of the adverse event and near misses reporting and learning system that was developed for Medical Imaging and is implemented in two Portuguese healthcare institutions. The objectives, characteristics and function of this system are presented throughout this article.

The uterine inversion is a rare but serious pathology of the delivery. We describe two cases of uterine inversion of secondary and quaternary degree; the first had a delay diagnosis and the second having a return after the manual replacement, finishing both on surgical resolution. The authors describe the causal factors, the diagnosis and the therapeutic of uterine inversion.

Erectile dysfunction (ED), defined by the Impotence-NIH Consensus Conference as the "persistent inability to achieve and/or maintain erection sufficient for satisfactory sexual activity" affect more than 100 million men worldwide, at particular severity levels. The global prevalence of ED is estimated to affect about 10%, but has been found to increase significantly with age (39% in men 40 years of age and 67% at 70 years of age). In men aged 40 to 70 years, the severe ED prevalence increased of three folds, 5 to 15%. In order to evaluate the efficacy and tolerance of sildenafil, it was conducted a national open, multicentre study on a portuguese population affected by ED. Subjects under ambulatory treatment were recruited in Psychiatry/Sexology Clinical units and Urology/Andrology. The results of the study carried out on a group of 62 men with ED, demonstrate that sildenafil was effective in the recovering of erectile function, increasing the number of attempts to sexual activity and improving their success rates (mainly in severe dysfunction). Fifty one patients treated with sildenafil, at the end of the study referred a global improvement in their erections (92.2%). Doses of 50 mg and 100 mg sildenafil were used and were well tolerated and also effective in the treatment of this pathology (70% and 69% respectively). Being this study a flexible dose one and taking into consideration that the final dose used was found the more suitable to the patients, can be concluded that 43.1% of the patients elected dose of 50 mg whereas 56.9% elected the maximum prescribed dose of 100 mg. Over and above global efficacy experimented by patients, a significant improvement in the sexual activity with partners was occurred. These results make possible a final conclusion--in the studied patients group affected by Erectile Dysfunction, aside from associated somatic pathology, sildenafil use provided a remarkable clinical profit, in what concerns global efficacy, by erectile function mechanisms improvement, concerning patients sensitivity of improvement, occurring in the major part of them, being these of high importance to the lifting up of their self-esteem.

Labour is very important in breech presentation and it is associated to significant morbidity and mortality enhancement in recent years. The authors made a retrospective study of breech presentation and labour with this kind of fetal presentation, in Santa Maria Hospital in 1993 and analysed the following data: maternal age, parity, gestational age, the mode of delivery, the fetal weight, the maternal and fetal morbidity and mortality. The authors also reviewed the Literature on the incidence, the most frequent complications and the management in labour to compare with the results of the study. The authors found that the incidence of breech presentation in this hospital is slightly higher (4.7%) than the universal data. The remaining results had no significant difference.

The aim of this paper is to briefly review recent data concerning urinary tract trauma. Upper urinary tract injuries occur in 1 to 1.5% of all trauma. Bladder trauma and urethral injuries are associated in 8 to 16% of pelvic fractures and perineal lesions. Functional and vital prognosis are reviewed and modern diagnostic management and treatment modalities are also mentioned. The association of urinary tract trauma with other injuries implies an interdisciplinary approach for these patients.

Significative enhancement of free radical formation (FRO) in vivo is an important feature of hypertensive disorders of pregnancy (HDP), namely preeclampsia (PIH). The latest investigations about the pathology of HDP, showed the contribution of placental circulation to the development and evolution of such disease. The placental bed can be a potential source of FRO or activation of cells that can produce FRO. Glutathione, is an important molecule for cellular protection against damage, is a cofactor of many enzymes, in particular, for the glutathione peroxidase of the placental tissue; this enzyme in the placenta bed prevent the production of thromboxan and lipoperoxides; the latter are potentially damaging to the endothelium cells and can cause vasoconstriction, the most important feature of PIH. The activity of that enzyme is deficient in PIH. We studied, by fluorometric assay, the concentrations of the two states of glutathione in placental homogenates (PLH) from pregnant women without pathology (PWN) and from pregnant women with PIH (PWPIH). The data showed significant low concentrations in the PLH of the two states of glutathione in the PWN against high concentrations of this molecule in the PLH from PWPIH. This feature can result from a deficient user of the glutathione by the cellular mechanism for prevention against oxidative factors. In addition, our study shows a biochemical marker that is suggestive that the placental bed is a potential source of FRO production in PIH.