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Background. The hypothesis that breasteeding has a protectve effect in childhood obesity is not new; however, controversial results have been published. Since the Azores reported the lowest rate of breasteeding in Portugal and a high prevalence of childhood obesity, it becomes important to understand whether these facts are related or not. Objectves. To investgate the relatonship between breasteeding and childhood obesity in a populaton of Azorean children. Material and methods. A cross-sectonal study was carried out on 183 Azorean children between 5–10 years of age between September and December 2016. The weight and height of the children were measured at the consultaton and other variables were investgated through a questonnaire. The associaton between breasteeding and childhood obesity was tested using logistc regression models. Results. 18.6% of the children were obese and 74.3% were breasted. The exclusive breasteeding rate at 6 months was 3.3%. Complementary breasteeding was present in 39.3% at 6 months and 7.1% at 2 years. Obese children were breasted less tme than non-obesechildren, suggestng a dose-effect relatonship (p = 0.025). We found a signifcant and independent relatonship between infant obesity and total tme of breasteeding (RR = 0.906; 95% CI [0.842, 0.974]; p = 0.008), physical actvity (RR = 0.883; 95% CI [0.801, 0.972]; p = 0.012) and maternal nutritonal status (RR = 3.452; 95% CI [1.361, 8.755]; p = 0.009). Conclusions. Breasteeding and physical actvity behaved as protectve factors for childhood obesity, while the nutritonal status of the mother acted as a risk factor. Childhood obesity is a current problem in the Azores, and breasteeding can be an effectve, simple and affordable tool to reduce this.

Introduction: Trapezium fracture is a rare entity whose treatment is controversial. The reported cases range from conservative treatment to surgical treatment with good reported results. Case Report: This paper reports a clinical case of trapezium-metacarpal fracture-dislocation associated with trapezius fracture and Bennett fracture, surgically treated with excellent functional and radiological results. The patient underwent open reduction and internal fixation with two screws, excision of fragments, and reinsertion of the anterior oblique ligament. At the year of follow-up, the patient presented no mobility limitations and recovered grip strength. Conclusion: This case study allows us to conclude that open reduction and internal fixation with screws of the dorsal trapezium ridge fractures with ligament repair of the anterior oblique ligament is a valid treatment with the reproduction of good clinical results. Keywords: Hand surgery, internal fixation, trapezium fracture.

Background: The benefits of the use of extracorporeal membrane oxygenation (ECMO) in patients with severe acute respiratory distress syndrome (ARDS) due to COVID-19 remain controversial. Methods: In this multicenter cohort study, we analyzed all the adult patients with ARDS due to COVID-19 who received extracorporeal respiratory support at 25 ECMO centers (23 in Spain and two in Portugal) during the first and second waves of the pandemic. Follow-up ended on December 1. Our primary aim was to describe this cohort taking into account its evolution during the pandemic. We also investigated hazard ratios for hospital mortality. Findings: A total of 334 patients were included. Patients supported during the second wave [176 (52.7%)] were older (54.6±9.7 vs 50.9±10.6,p=0.001), had more comorbidities, were more frequently coinfected at the start of ECMO [62 (35.2%) vs 37 (23.3%),p=0.028] and were less likely to be treated at a high-volume center [42 (23.9%) vs 54 (34.2%),p=0.008] than those supported during the first wave [158 (47.3%)]. At December 1, 134 (40.1%) patients had died and 49 (14.6%) were still on ECMO. Among patients supported during the first wave, 93 (58.8%) were discharged and all were alive at six months. Older age [HR 3.49 (1.94-6.28),p

FUNDING This research was supported by the Portuguese Foundation for Science and Technology (FCT, I.P.) via a postdoctoral grant to PR-S (SFRH/BPD/95784/2013), a Ph.D. grant to AV (SFRH/BD/137862/2018), and researcher contracts to ST (DL57/2016/CP1479/CT0022), VF (DL57/2016/CP1479/CT0024), FM, and AP, in the scope of the framework contract foreseen in the numbers 4, 5, and 6 of the article 23, of the Decree-Law 57/2016, of August 29, changed by Law 57/2017, of July 19. FCT, I.P. also provided support through the research project “Mytag– Integrating natural and artificial tags to reconstruct fish migrations and ontogenetic niche shifts” (PTDC/MAR-EST/2098/2014), under the Project 9471– Reforçar a Investigação, o Desenvolvimento Tecnológico e a Inovação (Projeto 9471-RIDTI) and subsidized by the European Regional Development Fund (FEDER, POCI-01-0145-FEDER-016787), the Centre for Functional Ecology Strategic Project (UID/BIA/04004/2019) within the PT2020 Partnership Agreement and COMPETE 2020, and the Marine and Environmental Sciences Centre Strategic Project (UID/MAR/04292/2019). Financial support was also provided by FEDER through the project ReNATURE– Valorization of the Natural Endogenous Resources of the Centro Region (Centro 2020, Centro-01-765-0145-FEDER-000007). Variations in otolith elemental composition are widely used to reconstruct fish movements. However, reconstructing habitat use and environmental histories of fishes within estuaries is still a major challenge due to the dynamic nature of these coastal environments. In this study, we performed a laboratory experiment to investigate the effects of variations in salinity (three levels; 5, 18, 30) and temperature (two levels; 16, 21 C) on the otolith elemental composition (Mg:Ca, Mn:Ca, Sr:Ca, Ba:Ca) of juvenile Senegalese sole Solea senegalensis. Temperature and salinity treatments mirrored the natural conditions of the estuarine habitats occupied by juvenile Senegalese sole, thereby providing information on the applicability of otolith microchemistry to reconstruct habitat use patterns within estuarine nurseries, where individual fish move across complex salinity and temperature gradients. While Sr:Ca and Ba:Ca in otoliths were both positively related to salinity, no temperature effect was observed. Partition coefficients, proxies for element incorporation rates increased with increasing salinity for Sr (DSr) and Ba (DBa). In contrast, salinity and temperature had little influence on otolith Mn:Ca and Mg:Ca, supporting physiological control on the incorporation of these elements. Our results are a stepping stone for the interpretation of otolith chemical profiles for fish collected in their natural habitats and contribute to better understanding the processes involved in otolith element incorporation. info:eu-repo/semantics/publishedVersion

Introdução: A esquizofrenia é uma síndroma psiquiátrica caracterizada por alterações cognitivas, comportamentais e emocionais associadas a uma marcada disfunção social. Os doentes com esta patologia não apresentam crítica face à própria doença, o que muitas vezes conduz à falta de adesão à terapêutica, condicionando descompensação e agravamento do quadro clínico. O internamento em regime compulsivo é uma ferramenta de último recurso para estas situações. Devido à dificuldade de avaliação destes doentes, muitas vezes só através de um acompanhamento de proximidade conseguido pelo médico de família é possível determinar as reais consequências da doença e desta forma permitir o início do tratamento psiquiátrico mais rápido. Descrição do caso: Mulher de 48 anos, divorciada, desempregada, constituindo uma família unitária, com diagnóstico de esquizofrenia desde os 30 anos de idade, que recorre à consulta da sua médica de família por queixas de descompensação do quadro psiquiátrico, com ideação delirante persecutória e interpretações delirantes. Ao longo de quatro meses recorre várias vezes à consulta da sua médica de família pelos mesmos motivos, verificando-se uma deterioração progressiva do seu funcionamento global, tendo a situação evoluído até um estado de agressividade com perigo iminente para si e para os outros. Como mantinha a recusa para se submeter ao necessário tratamento médico, foi contactada a autoridade de saúde para se proceder ao internamento em regime compulsivo. Comentário: A esquizofrenia é uma doença altamente incapacitante. Quando não controlada leva inevitavelmente a agudizações do estado clínico que são difíceis de gerir. A lei portuguesa contempla estes casos e prevê o recurso ao internamento em regime compulsivo. O médico de família tem vários recursos de saúde ao seu dispor e um conhecimento privilegiado do doente e do meio familiar que podem ser usados na gestão eficaz da deterioração psiquiátrica. Introduction: Schizophrenia is a syndrome characterized by changes in thinking, mood and behaviour. Patients with this disorder lack insight into the disease, which often leads to non-adherence to treatment and worsening of symptoms. Compulsory admission is a last resort in these situations. Because of the difficulty in assessing these patients, close monitoring by the family doctor is required. Thus it is possible to assess the effects of the disease and permit timely initiation of psychiatric treatment. Case description: A 48 year-old woman, divorced, unemployed, and living alone, who was diagnosed with schizophrenia at age 30, consulted her family doctor with persecutory delusions and delusional interpretations. Over a period of four months, she consulted with her family doctor for the same reasons, with a progressive deterioration in her condition. The situation evolved to a state of aggression with immediate danger to herself and others. Because she refused the necessary treatment, the health authority was contacted to arrange for compulsory admission. Comment: Schizophrenia is a highly debilitating disease. When not under control, exacerbations in clinical status are difficult to manage. Portuguese law permits compulsory admission. The family doctor has health resources available and a privileged knowledge of the patient and the family, which can be used effectively to manage psychiatric deterioration.

A doença arterial periférica (DAP) associa-se a risco de ulceração e amputação. A determinação do índice de pressão tornozelo-braço (IPTB) é recomendada para a sua deteção em doentes com diabetes selecionados, associada à avaliação clínica. Objetivos: Determinar a prevalência das manifestações de DAP em doentes com diabetes nos cuidados de saúde primários (CSP). Local: Centro de Saúde de São Martinho do Bispo. População: Doentes com diabetes em cuidados de saúde primários. Tipo de estudo: Estudo observacional, analítico e transversal, que resulta do projeto de intervenção Venha Pelo Seu Pé. Métodos: Amostra de conveniência de 418 doentes com diabetes (48,4% da população), idade ≥50 anos, observados em consulta de pé diabético. Metodologia e colheita de dados realizadas por profissionais de saúde com experiência. Variáveis: idade, sexo, IMC, perímetro abdominal, pressão arterial, antecedentes tabágicos, dislipidemia, hipertensão, lesões macrovasculares, local de acompanhamento, duração da diabetes, HbA1c registada, terapêutica da diabetes, claudicação arterial e dor em repouso, palpação de pulsos tibiais/pediosos e valores dos IPTB. Usaram-se os testes qui-quadrado ou de Fisher na análise de associação de variáveis. Resultados: Quatrocentos e dezoito doentes com idade média de 68,85±8,64 anos, 52,9% do sexo feminino. Com 2,9% de fumadores, 84,0% com dislipidemia e 87,1% hipertensos (ou terapêutica para esses problemas) e 19,1% com lesões macrovasculares. Duração média da diabetes de 10,72±8,48 anos e média de HbA1c de 6,86±1,16%. Proporção de doentes com úlcera, e amputados, de 0,5%. A prevalência de claudicação arterial foi de 9,8% (IC95%: 7,1-13,1), de pulso não palpável de 14,6% (IC95%: 11,3-18,3) e IPTB ≤0,9 de 11,5% (IC95%: 6,6-14,9), com prevalência global de alterações sugestivas de DAP de 28,5% (IC95%: 24,2-33,1). Foi identificada associação significativa entre IPTB ≤0,9 e pulso não palpável (p=0,009) ou claudicação arterial (p

Light-chain deposition disease (LCDD) is a rare monoclonal gammopathy that involves the deposition of light chains (LC) in multiple organs, leading to progressive dysfunction. The kidney is usually the most affected organ and responsible for the initial clinical manifestations. We present the case of a patient with LCDD with prominent liver involvement (marked cholestasis, hepatomegaly and portal hypertension) but with no evidence of coexisting lymphoproliferative disorder. LEARNING POINTS Light-chain deposition disease (LCDD) is rare, and diagnosis can be challenging, especially in the absence of a coexistent lymphoproliferative disorder. The presence of light chains in blood or urine can be intermittent, and immunohistochemistry results of biopsy can be difficult to interpret. Hence, there is a need for a high level of suspicion in this diagnosis. Although renal involvement is the most classic presentation, LCDD should be suspected when there is multiple organ involvement, as in this case, even when renal manifestations do not dominate the clinical picture. Prognosis depends on the affected organs, and treatment should be started as rapidly as possible to suppress production of the clonal light-chain and halt organ damage.

Primary hyperparathyroidism is caused by a single parathyroid adenoma in up to 90% of clinical cases. Selective surgical excision of the hyperfunctioning parathyroid gland is the treatment of choice for this condition, and parathyroid scintigraphy is one of the primary and standard methods used for preoperative localization. SPECT/CT is advantageous over planar imaging because SPECT/CT provides useful anatomic information, improving overall diagnostic confidence. This paper evaluates the initial findings of a hybrid parathyroid imaging technique that was put into effect after the installation of a SPECT/CT system in the nuclear medicine department at Torbay Hospital, Torquay, United Kingdom. The key findings from 3 of the initial sets of patient studies are discussed, along with the key learning points after the introduction of this new clinical service. Methods: From January 2009 until December 2009, 9 patients underwent a parathyroid study at Torbay Hospital (8 women [87.5%] and 1 man [12.5%]; mean age [±SD], 61 ± 10.12 y). All patients were referred from the endocrinology department because they had clinical signs of parathyroid adenoma (67%) or required preoperative localization of parathyroid adenoma (33%). For parathyroid scintigraphy, 640–990 MBq of 99mTc-sestamibi were administrated intravenously. A SPECT/CT system was used to acquire images from the level of the submandibular glands through the basal third of the heart. Three sets of images were acquired, and the processed images were reviewed for quality, attenuation correction, and registration. Results: Two (22%) of the 9 studies were negative for possible adenoma, and 7 (78%) were positive. Of the positive studies, 6 (86%) showed an adenoma on the left inferior gland and only 1 (14%) showed an adenoma in an eccentric position. Conclusion: The introduction of parathyroid SPECT/CT has resulted in the development of new imaging and processing protocols within our nuclear medicine department. Introducing any new technique requires knowledge, understanding, and practical skills. The additional information gained from the parathyroid SPECT/CT technique has provided new skills for practitioners and increased reporting confidence for physicians.

Catia Pereira1* and Ana Vaz2 1Department of Pediatrics, Hospital Santa Maria (CHLN), Lisbon Academic Medical Center, Portugal 2Department of Women and Child, Hospital de Cascais Dr. Jose de Almeida, Portugal *Corresponding author: Catia Pereira, Department of Pediatrics, Hospital Santa Maria (CHLN), Lisbon Academic Medical Center, 1649-035 Lisboa, Portugal, Tel: 351 217805000; Fax: 351 217805610; E-mail: catiamrpereira@gmail.com

Objectives: The aim of this study was to determine if the actions of progesterone on preterm labor are accomplished through modulation of the percentage of regulatory T-cells (Treg). Methods: The study was a cohort pilot study made in a single center tertiary obstetrical unit with women in preterm labor arrested with tocolytic treatment. Variation of the number and percentage of Treg cells obtained from peripheral blood samples of women with preterm labor were calculated by flow cytometry, before and after progesterone administration. Results: In the paired samples for each patient, there was a significant difference in the Treg cell pool after progesterone treatment, with an increase in both their percentage (48.9 vs. 53; P = 0.07) and absolute number (14.8 vs. 56.5 cells/μL; P = 0.046). Conclusions: This research demonstrated a considerable increase in the Treg cell pool after progesterone treatment. This indicates a possible mechanism for progesterone treatment benefits in preterm labor, potentially increasing its more rational use.

In African countries, higher rates of late-stage cancers at the time of first diagnosis are a reality. In this context, hazardous drugs (HDs), such as chemotherapy, play an important role and have immense benefits for patients' treatment. HDs should be handled under specific conditions. At least a class 5 environment primary engineering control (PEC), physically located in an appropriate buffer area, is mandatory for sterile HDs compounding, as well as administrative control, personal protective equipment, work practices and other engineering and environmental controls, in order to protect the environment, patient, and worker. The aim of this study is to describe the Angolan experience regarding the development of oncology pharmacy units and discuss international evidence-based guidelines on handling HDs and related waste. Measures to incorporate modern and economical solutions to upgrade or build adequate and safe facilities and staff training, in order to comply with international guidelines in this area, are crucial tasks for African countries of low and middle income.

Introduction:the number of cancer cases and related deaths worldwide is expected to double over the next 20-30 years. African countries will be the most affected by the burden of cancer. The improving economic situation of Angola creates conditions for an increase in life expectancy which by itself is associated with an increased risk of oncological diseases. Because cancer therapy requires a multidisciplinary approach, trained health professionals, satisfactory infrastructure and appropriate facilities, the availability of effective cancer therapy is a difficult task that requires support. The aim of this article is to share our experience achieved in the establishment of cancer units in Angola and to validate our checklist for this action. Methods:the survey method was a questionnaire addressed to Angolan cancer units, in order to evaluate the usefulness and feasibility of a checklist developed by the authors -The Cancer Units Assessment Checklist for low or middle income African countries- which was used previously in the establishment of those units. Afterwards, the crucial steps taken for the establishing of the main sites of each cancer unit considering, facilities, resources and professionals, were also recorded. Results:all cancer units reported that the checklist was a useful tool in the development of the cancer program for the improvement of the unit or the establishing of cancer unit sites. This instrument helped identifying resources, defining the best practice and identifying barriers. Local experts, who know the best practices in oncology and who are recognized by the local heads, are also important and they proved to be the major facilitators. Conclusion:the fight against cancer has just started in Angola. The training, education, advocacy and legislation are ongoing. According to our results, the assessment checklist for the establishment of cancer units is a useful instrument.

A protein map of Caenorhabditis elegans was constructed by using two-dimensional gel electrophoresis followed by peptide mass fingerprinting. A whole worm extract of a mixed population was separated on immobilized pH gradient strips 4-7 L, 3-10 NL, 6-11 L and 12% sodium dodecyl sulfate-polyacrylamide gel eletrophoresis (SDS-PAGE) gels. Gels were stained with colloidal Coomassie blue and 286 spots representing 152 proteins were subsequently identified by matrix-assisted laser desorption/ionization-mass spectrometry after in-gel digestion with trypsin. Most of the identified proteins with known cellular function were enzymes related to carbohydrate and lipid metabolism, or structural proteins with subcellular locations in the cytoplasm, mitochondria or cytoskeleton.

Mesodermal development is a multistep process in which cells become increasingly specialized to form specific tissue types. InDrosophila and mammals, proper segregation and patterning of the mesoderm involves the bHLH factor Twist. We investigated the activity of a Twist-related factor, CeTwist, during Caenorhabditis elegans mesoderm development. Embryonic mesoderm in C. elegans derives from a number of distinct founder cells that are specified during the early lineages; in contrast, a single blast cell (M) is responsible for all nongonadal mesoderm formation during postembryonic development. Using immunofluorescence and reporter fusions, we determined the activity pattern of the gene encoding CeTwist. No activity was observed during specification of mesodermal lineages in the early embryo; instead, the gene was active within the M lineage and in a number of mesodermal cells with nonstriated muscle fates. A role for CeTwist in postembryonic mesodermal cell fate specification was indicated by ectopic expression and genetic interference assays. These experiments showed that CeTwist was responsible for activating two target genes normally expressed in specific subsets of nonstriated muscles derived from the M lineage. In vitro and in vivo assays suggested that CeTwist cooperates with theC. elegans E/Daughterless homolog in directly activating these targets. The two target genes that we have studied,ceh-24 and egl-15, encode an NK-2 class homeodomain and an FGF receptor (FGFR) homolog, respectively. Twist activates FGFR and NK-homeodomain target genes during mesodermal patterning ofDrosophila and similar target interactions have been proposed to modulate mesenchymal growth during closure of the vertebrate skull. These results suggest the possibility that a conserved pathway may be used for diverse functions in mesodermal specification.

Xenopus laevis skin secretion contains a mixture of magainins, which are small positively charged oligopeptides with antimicrobial activity. In this study, we show that two of these peptides, i.e. magainin-2 and PGLa, are much more active in biological functions when added together than when added alone. This synergy applies for the antimicrobial activity of these peptides, and for the toxic effects on tumor cells. We show that this peptide combination is also synergistic when permeabilizing protein-free liposomes for glucose, when dissipating the membrane potential in cytochrome oxidase liposomes and Escherichia coli, and, reversibly, when stimulating respiration in the liposomes. The occurrence of synergy in these diverse systems (complex and simple) suggests that the biological synergy results from synergy in the primary activity of the magainin peptides, namely the permeabilization of free-energy transducing membranes, possibly by forming a multimeric transmembrane pore of mixed peptide composition. The antimicrobial activity of X. laevis skin secretions may be greatly enhanced by the application of this binary weapon.

History A 57-year-old man presented with a 3-month history of abdominal pain. Physical examination revealed a large firm palpable mass in the epigastric region. There was no history of alcoholism, trauma, or previous pancreatitis. Laboratory findings were unremarkable. The patient under< went abdominal upright radiography, upper gastrointestinal barium examination, abdominal ultrasonography (US), and abdominal computed tomography (CT).

ResumoIntrodução e objetivosA metformina é um agente amplamente usado no tratamento oral da diabetes mellitus tipo 2, considerada como terapêutica de primeira linha e usada em monoterapia ou em associação com outros fármacos antidiabéticos e com a insulina. Pela sua excreção exclusivamente renal, existem dúvidas quanto à segurança de seu uso em diabéticos com comprometimento da função renal. Esta revisão baseada na evidência pretende esclarecer a existência de valores de TFG, a partir dos quais o uso de metformina deve ser reduzido e/ou suspenso.MétodosPesquisa de normas de orientação clínica, revisões sistemáticas e estudos originais publicados em português ou inglês entre 1 de janeiro de 2000 e 31 de março de 2014 com os termos MeSH “metformin”, “glomerular filtration rate” e “chronic kidney disease”. Foi usada a Strenght of Recomendation Taxonomy (Sort) da American Family Physician para atribuição dos níveis de evidência e forças de recomendação.Resultados e conclusõesOito artigos cumpriam os critérios de inclusão (cinco normas de orientação clínica, duas revisões sistemáticas e um artigo original). Constatou‐se maior consenso quanto aos valores a partir dos quais se deve suspender a metformina em relação aos indicativos para a redução da sua dose. As guidelines internacionais e as revisões sistemáticas indicam a suspensão da metformina quando a TFG é inferior a 30ml/min (Sort A). Quanto à necessidade de ajuste da dose, em revisão sistemática, essa deve ser reduzida quando ocorre diminuição da TFG para valores inferiores a 60ml/min e a função renal monitorada a cada três meses e não se deve iniciar terapêutica de novo com metformina nesse estágio (Sort A).AbstractIntroduction and objectivesMetformin is widely used for the oral treatment of type 2 diabetes, considered first‐line therapy and used as monotherapy or in combination with other antidiabetic drugs or insulin. Because of its exclusive renal excretion, there are doubts about the safety of its use in diabetic patients with impaired renal function. This evidence‐based review aims to clarify the existence of values of GFR, from which the use of metformin should be reduced and/or suspended.MethodsSearch for clinical guidelines, systematic reviews and original studies published in English or Portuguese, between January 1, 2000 and March 31, 2014 using the MeSH terms “metformin”, “glomerular filtration rate” and “chronic kidney disease”. The Strength of Recommendation Taxonomy (Sort) by the American Academy of Family Physicians was used to assign levels of evidence and strength of recommendation.Results and conclusionsEight articles met the inclusion criteria (five clinical guidelines, two systematic reviews and one original article). There was a higher consensus about the values from which to suspend metformin compared to those from which to reduce the dosage. International guidelines and systematic reviews indicate the suspension of metformin when GFR is less than 30ml/min/m2 (Sort A). The need to adjust the dosage, in a systematic review, is indicated when GFR is decreased to less than 60ml/min/m2. The renal function should be monitored every 3 months, and therapy with metformin should not be started at this stage (Sort A).