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Syphilis is a sexually transmitted disease caused by Treponema pallidum, progressing through active and latent stages if left untreated. Hepatic involvement can occur in secondary syphilis, but this is an uncommon complication, with few published case reports. A 34-year-old man without significant medical history was admitted to the gastroenterology department with a 2-week history of unexplained jaundice and acute cholestatic hepatitis. He also presented with erythematous papules and plaques in the genital area, suggestive of secondary syphilis. T. pallidum hemaglutination assay and venereal disease research laboratory test were both positive, the latter with a 1:16 titer. The diagnosis of secondary syphilis with hepatic involvement was considered. The improvement of cutaneous and laboratory findings after intramuscular benzathine penicillin injection supported this hypothesis. Symptomatic cholestatic hepatitis is a rare feature of the systemic spectrum of secondary syphilis. The clinical and laboratorial response after penicillin treatment is a strong clue for this diagnosis. info:eu-repo/semantics/publishedVersion

Introduction: In order to maintain assistential activity while ensuring social distancing and mobility restrictions imposed during the COVID-19 pandemic, the Dermatovenereology Department of Hospital de Santo António dos Capuchos implemented an asynchronous teledermatology platform based on e-mail and smartphones. This study aims to evaluate its application to urgent outpatient and inpatient consultations while considering its benefits and limitations. Methods: All written communications received via e-mail or smartphone between April 1, 2020 and April 31, 2021 were reviewed. Data was evaluated and statistical analysis was made using SPSS Statistics 25® software. Results: We reviewed 471 referrals (329 for outpatient and 142 for inpatient urgent consultations). E-mail was the most used platform (68.8%) and most referrals were composed of clinical information and clinical images (70.3%). Only 29% of these contained adequate clinical information and clinical images simultaneously. The majority of referrals received a response by a dermatologist in less than 24 hours (89%) and conversion to in-person evaluation was made in 58% of cases. The average time for in-person evaluation after triage was 0.25 days for inpatients and 4 days for outpatients. Conclusion: The COVID-19 pandemic hastened teledermatology implementation in order to maintain good healthcare. This study demonstrates that these platforms where wildly accepted by healthcare professionals and patients and remote consultations were possible in a significant percentage of cases. Teledermatology struggles with its own limitations and can never fully replace in-person evaluation, but can present itself as a useful tool in daily practice. Introdução: Com o objectivo de manter a actividade assistencial numa altura em que o distanciamento social e as restrições de mobilidade entre hospitais consequentes à pandemia COVID-19 se apresentavam como fundamentais, o departamento de Dermatovenereologia do Hospital de Santo António dos Capuchos implementou uma plataforma assíncrona de teledermatologia baseada em e-mail e smartphones. Este estudo pretende avaliar a sua aplicação a consultas de urgência de ambulatório e internamento, dando destaque aos seus benefícios e limitações. Métodos: Todas as comunicações escritas recebidas por e-mail ou smartphone entre 1 de Abril de 2020 e 31 de Abril de 2021 foram analisadas. Os dados foram avaliados e foi realizada análise estatística com recurso ao software SPSS Statistics 25®. Resultados: Foram analisadas 471 referenciações (329 consultas urgentes de ambulatório e 142 consultas urgentes em internamento). O e-mail foi a plataforma mais usada (68.8%) e a maioria das referenciações eram compostas por informação clínica escrita e imagens clínicas (70.3%). Apenas 29% destas continham, em simultâneo, informação clínica e imagens clínicas adequadas. A maior parte dos pedidos recebeu uma resposta por um dermatologista em menos de 24 horas (89%) e, em 58% dos casos, foi efectuada uma conversão a consulta presencial. O tempo médio para uma consulta presencial após triagem foi de 0.25 dias para consultas em internamento e 4 dias para consultas de ambulatório. Conclusão: A pandemia COVID-19 acelerou a implementação da teledermatologia de modo a assegurar a manutenção de bons cuidados de saúde. Este estudo demonstrou que estas plataformas foram amplamente adoptadas por profissionais de saúde e doentes e a realização de consultas remotas foi possível numa percentagem significativa de casos. A teledermatologia apresenta várias limitações e nunca poderá substituir integralmente uma avaliação presencial, podendo ser, no entanto, uma ferramenta útil no dia-a-dia. info:eu-repo/semantics/publishedVersion

This article focuses on the geriatric market segment which is becoming increasingly important as a result of demographic trends and aging populations. Using network science approach, this study maps the structure of knowledge, its changes over time and research opportunities in Tai-chi. Data collected from Web-of-Science and Scopus between 1996-2019 was used to build a network of 2,202 articles and 6,820 authors. The results show Tai-chi represents a small-world network as the majority of the articles were produced among universities and medical schools, displaying a connection between theoretical knowledge and pragmatic applications. The scientific achievements mainly emerge from the USA, China, and UK. The collaborative efforts focused on a giant component and converge on a small area of research. Future opportunities at the intersection of Tai-chi and geriatrics include mindfulness-meditation, osteoarthritis, sleep quality, cardio-respiratory function and pain management. This article provides contributes to the literature on Tai-chi and offers insights into the capabilities of CiteSpace, Vosviewer, Gephi, and Python. info:eu-repo/semantics/publishedVersion

A atividade coral formalmente instituída no âmbito do associativismo musical tem em Portugal uma expressão significativa revelada pelas várias centenas de grupos que mobilizam regularmente largos milhares de indivíduos na realização de distintos repertórios. Este artigo dá a conhecer as dinâmicas e complexidades desta atividade em Portugal a partir da análise dos dados de um inquérito extensivo aos grupos corais (n = 503) realizado em 2013, no âmbito dos projetos de investigação «“A música no meio”: O canto em coro no contexto do orfeonismo (1880-2012)» e «“A nossa música, o nosso mundo”: Associações musicais, bandas filarmónicas e comunidades locais (1880-2018)», na Universidade de Aveiro pelo INET-md. O inquérito permitiu conhecer a dimensão deste movimento em Portugal, evidenciando o perfil das instituições e dos indivíduos nelas envolvidos, bem como a diversidade de atividades (públicas e privadas) desenvolvidas, os repertórios musicais executados, contextos de atuação e os espaços performativos utilizados. Conclui-se que se trata de uma realidade multifacetada, dinâmica, em franco crescimento e com uma forte participação na vida social local, embora fortemente dependente dos apoios de instituições locais (sobretudo autarquias). info:eu-repo/semantics/publishedVersion

Idiopathic membranous nephropathy with high-risk criteria for renal disease progression is considered an indication for immunosuppressive treatment. HIV infection has been associated with membranous nephropathy in a minority of patients. A 44-year-old female diagnosed with HIV infection 11 years ago was referred for a nephrology consultation due to nephrotic syndrome. She presented with peripheral edema for 2 months and normal blood pressure. Serum creatinine was 0.74 mg/dL, total cholesterol 490 mg/dL, albumin 2.0 g/dL; urinary examination revealed leukoerythrocyturia and 24h proteinuria was 4.5g. Renal ultrasound showed normal-sized kidneys with preserved corticomedullary differentiation. Kidney biopsy showed thickening of the glomerular basal membrane and staining with Masson trichrome showed sub-epithelial humps. Immunofluorescence was negative except for IgA (+), C3c (+) and IgG (+). A diagnosis of membranous nephropathy was made. Secondary causes, such as neoplasic, infectious and autoimmune, were ruled out. Despite 6 months of conservative measures, proteinuria increased to 11 g/day. Since HIV viral load had been undetectable for several years, along with a CD4+ T cell count persistently above 400/mm3, a modified Ponticelli regimen was started: 3 pulses of methylprednisolone (1g/day), followed by 60 mg of prednisolone/day at months 1, 3 and 5, and cyclophosphamide 200mg/day at months 2, 4 and 6. At the end of the treatment, there was a partial response with proteinuria 3.94 g/day, albumin 3.2 g/dL, and creatinine 0.8 mg/dL. At 48 months of follow-up, the patient is asymptomatic, with creatinine 0.84 mg/dL and proteinuria 0.97 g/day. Conclusion: Membranous nephropathy should be considered in the differential diagnosis in patients with HIV infection complicated by nephrotic syndrome even in the absence of other coinfections and comorbidities typically associated with membranous nephropathy. In patients with sustained negative viral loads and at high risk of progression to end-stage renal disease, in whom secondary causes have been excluded, immunosuppressive therapy might be considered.

Background: Infective endocarditis (IE) is rarely described among renal transplant recipients. Methods: We conducted a retrospective study to identify all cases of IE in our renal transplant unit between 1992 and 2012 to elucidate IE’s clinical features and outcomes. Modified Duke criteria were applied to confirm diagnosis and patient evolution was evaluated. Results: Between 1992 and 2012, our renal transplant unit performed 1065 renal transplants. Seven episodes of IE were identified in six patients. Median age at presentation was 59 years and most cases occurred in males (71.4%). Blood cultures were negative in 42.9% of patients. Gram positive coccus were the most frequent etiologic agents. There were no fungal endocarditis. Aortic valve was involved in all patients. Three patients underwent cardiac surgery. Mortality at 30 days and 2 years were 16.7%. Conclusion: Infective endocarditis in renal transplant patients remains a rare disease. The diagnosis is challenging considering nonspecific presentation and the high proportion of negative blood cultures.

A correcção da clorose férrica em fruteiras instaladas em solos calcários faz-se frequentemente recorrendo a aplicações massivas de quelatos férricos sintéticos ao solo. No entanto, a aquisição destes quelatos é muito dispendiosa e o ferro aplicado num ano não previne o aparecimento da clorose no ano seguinte, e estas aplicações repetemse anualmente para o mesmo pomar. Com o presente trabalho pretende-se fazer uma revisão sobre o actual estado de conhecimentos relativo às práticas alternativas de correcção da clorose férrica e apresentar os resultado obtidos em ensaios realizados em campo onde se testou a aplicação foliar de diversos compostos em citrinos estabelecidos num solo calcário. A capacidade de recuperação das árvores foi estimada pelo aparelho SPAD-502 através da variação da concentração foliar de clorofila total entre o início e o final dos ensaios. No final dos ensaios foi ainda analisado o efeito dos tratamentos na composição mineral das flores. Simultaneamente, avaliou-se a duração dos efeitos de algumas das pulverizações efectuadas. Os resultados obtidos sugerem que as aplicações foliares de ferro em pomares de citrinos permitem controlar os decréscimos de produção e de qualidade do fruto motivados pela clorose férrica induzida pelo calcário. Além disso, estes tratamentos podem ser efectuados com produtos economicamente mais viáveis, como sejam as soluções com sulfato de ferro., Revista de Ciências Agrárias, vol. 32 n.º 1 (2009)

Incident and prevalent patients on dialysis are progressively older, with high comorbidity burden and functional dependency. Many could have benefited from a conservative approach, since considerations of symptoms, autonomy, quality of life and hospital-free days are sometimes more important for patients and families than survival. As result, nephrologists around the world are facing challenges to determine which treatment best fits their patients. Comprehensive conservative care in chronic kidney disease care has been recently defined as a holistic, multidisciplinary and patient-centered approach for care of patients with stage 5 CKD. It does not include dialysis, and a shared-decision-making process and advanced care planning are central pillars, providing a way to meet patient and families goals. This review will focus on comprehensive conservative care in CKD in order to provide a communication framework for decision-making process as a guide for nephrologists and other health care professionals.

The body of relevant literature in the digital information age is growing rapidly. Detecting the signs of potential valuable ideas has theoretical and practical benefits which can help one understand when, how and why a research issue has potential value in the scientific domain. The perceived value of this paper is to show the contribution of a scientometric analysis for an up-to date understanding of the scientific field’s intellectual structure and identify exactly how a current issue connects with previously disparate patches of knowledge, creating a network of ideas cognitively demanding. Applying a multiple temporal, structural and semantic metrics, scientometric analysis allows the visualization of patterns from both citing and cited items. The temporal interval is sliced into equal mutually exclusive time periods, and an individual citation network is derived from each slice. Networks of keywords, authors, categories, sources of publication are included for a better understanding of the subject of the scientific domain. This analysis allows the identification of trends and areas of research conducted so far, and an appreciation of the most relevant authors, papers, sources of publication, showing where most of the studies have been performed. This is pertinent if the trust of future research is to incorporate more innovative approaches. By building on prior research this creates a strong theoretical background, which is an issue in various areas of research, namely, tourism and marketing. Executives who continue to attempt to navigate with out-of-date strategies will be ill-prepared to avail themselves of the immense opportunities. Scientometrics provides a reflexive marking of research into any knowledge domain. info:eu-repo/semantics/acceptedVersion

A limit number of studies have applied bibliometric visualisation to explore the network structure of Alzheimer’s Disease (AD). This paper uses CiteSpace, Carrot and VOSviewer to analyse and visualise the intellectual structure of AD, characterizing, quantitatively and qualitatively, the global scientific outputs, and identifying their trends. The 9,753 articles obtained from the science citation index expanded database (SCI-E), from Web-of-Science, were analysed. The publication data is analysed computationally to identify publication patterns, a rate of growth of publications, types of authorship collaboration, the most productive authors, countries, institutions, journals, keywords, the citation and keyword patterns, the hotspots and the areas of research on the AD. The paper presents a detailed analytical mapping of AD research and charts the progress of discipline with various useful parameters. The authors expect to contribute to the theory, supplying researchers with new tools and enabling practitioners to improve their knowledge about the AD evolution and trends. info:eu-repo/semantics/acceptedVersion