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Introduction: Coronavirus disease 2019 was declared as a pandemic on March 2020. Research on its psychological effects is still lacking. Perinatal depression is a medical complication of pregnancy, especially in situations of stress. In this study, we aimed to investigate the presence of symptoms of depression in pregnant women during the lockdown period in Portugal. Methods: This study consisted in a cross-sectional study among Portuguese pregnant women, who completed an online self-report questionnaire between 25th April and 30th April 2020. An anonymous online questionnaire was developed to assess depression and concerns related to COVID-19. This study was approved by the IRB of Hospital Dona Estefânia and performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki. Eligibility criteria included pregnant women, ≥ 18 years and living in Portugal. The primary outcome was to evaluate the presence of depressive symptoms and its association to socio-demographic characteristics and to concerns related to COVID-19. Results: A total of 1698 pregnant women were enrolled. The mean age was 31.9 years. 82.4% felt a negative impact of the pandemic in the surveillance of pregnancy and 43% felt insufficient support. 26.3% showed "possible depression" according to the EPDS. A regression analysis revealed the possibility of depression increased as the concerns about COVID increased and was lower for women with support. The possibility of depression was higher for women with psychiatric medical history. Conclusion: This study demonstrated a significant increase in clinically significant depressive symptoms in pregnant women during the lockdown. It also revealed some of the socio-demographic characteristics of women at risk for depression. If left untreated, depression tends to persist, affecting the woman and also the child. Our findings suggest that COVID-19 represents a serious challenge for this population and reinforce the urgent need for early detection and intervention on mental health issues during pregnancy, especially during the pandemic. info:eu-repo/semantics/publishedVersion

Proliferative diabetic retinopathy (PDR), proliferative vitreoretinopathy (PVR), and neovascular age-related macular degeneration (nAMD) are among the leading causes of blindness. Due to the multifactorial nature of these vitreoretinal diseases, omics approaches are essential for a deeper understanding of the pathophysiologic processes underlying the evolution to a proliferative or neovascular etiology, in which patients suffer from an abrupt loss of vision. For many years, it was thought that the function of the vitreous was merely structural, supporting and protecting the surrounding ocular tissues. Proteomics studies proved that vitreous is more complex and biologically active than initially thought, and its changes reflect the physiological and pathological state of the eye. The vitreous is the scenario of a complex interplay between inflammation, fibrosis, oxidative stress, neurodegeneration, and extracellular matrix remodeling. Vitreous proteome not only reflects the pathological events that occur in the retina, but the changes in the vitreous itself play a central role in the onset and progression of vitreoretinal diseases. Therefore, this review offers an overview of the studies on the vitreous proteome that could help to elucidate some of the pathological mechanisms underlying proliferative and/or neovascular vitreoretinal diseases and to find new potential pharmaceutical targets.

Falls among the elderly are an important community health problem due to its high incidence, functional and social repercussion. Dissimilar results arose in recent studies con cerning fall risk and physical activity levels. This study measures the association between physical activity (PA) levels, and fall risk (FR), investigates which levels of PA are influential in FR and pre sents a fall risk prediction models for the elderly. One hundred and seventy elderly adults (72.34 ± 6.70 years old, 124 female), completed Performance-Orientated-Mobility-As sessment; PA was assessed by accelerometry. Pearson’s correlation verified the association between FR, Age, and PA. Multiple linear regression (MLR) was used to investigate the influence of variables on FR. PA, age are predictors of FR, with PA (moderate, negative) age (moderate, positive). MLR analysis showed FR variability explained by PA (42.0%) and by age (37.0%), and by gender, female FR explained by light PA (47.0%), while in male, FR explained by sedentary behaviour (44.1%) and age (22.7%) independently. Individuals with higher physical activity have lower fall risk. Older are prone to fall. Older women with light physical activity are less likely to fall. Older men with more sedentary behaviour are prone to fall.

Introduction: The Centro de Estudos do Bebé e da Criança in Hospital Dona Estefânia has organized a multidisciplinary model for children under three with suspected autism spectrum disorder, thus implementing the recent guidelines established by the Directorate General for Health. The aim of this study is to describe this model and case series. Material and methods: A retrospective descriptive study of observed children with suspected ASD. They were observed according to the model of the Centro de Estudos do Bebé e da Criança and DC:0-5TM classification, between January 2018 and September 2019. Results: The study included 178 children. The average age at the initial assessment was 27 months. From the total sample, 116 children concluded the diagnostic sessions (axis I): Autism Spectrum Disorder/Early Atypical (36%), Developmental Language Disorder (18%), Other (19%). Factors of axes II, III, IV and V of DC:0-5TM were determinant for clinical diagnosis in 26%. Discussion: Of 116 children, 36% were diagnosed with Autism Spectrum Disorder. This highlights the diagnostic challenge posed by neurodevelopmental disorders in early infancy. The sample shows that the characteristics of the relationship with the caregiver (axis II), presence of physical conditions (axis III), psycho-social stressors (axis IV) and developmental trajectory (axis V) have a significant clinical impact. In the future, the initial assessment should take place well before the age of 27 months because of the impact on prognosis. Conclusion: This model is a pioneering approach in Portugal. It promotes a common approach of Child and Adolescent Psychiatry and Neuropediatrics/Developmental Pediatrics in early infancy. Moreover, it increases the diagnostic acuity of Autism Spectrum Disorders and early therapeutic intervention. info:eu-repo/semantics/publishedVersion

Desde sempre que os eventos adversos no 1º ano de vida constituem um desafio para profissionais de saúde e são motivo de ansiedade para os cuidadores de um lactente. Na década de 1960, estes eventos designavam-se Sudden Infant Death Syndrome e possuíam uma conotação de fatalidade sem prenúncio. Posteriormente, na década de 1980 transitaram para Apparent Life-Threatening Event, sugerindo uma ameaça à vida e desprovido de objetividade, necessária à elaboração de um diagnóstico. Desta necessidade emergiu o Brief Resolved Unexplained Event (BRUE) em 2016, cuja natureza mais específica permitiu a categorização do risco de recorrência de eventos num algoritmo, o qual constitui um importante instrumento de trabalho para os profissionais de saúde que prestam cuidados a estes lactentes. Devido ao seu carácter recente, a enfermagem destaca a importância de se globalizar a transição de ALTE para BRUE, de ser usado este conceito em detrimento do seu antecessor e de fomentar a atualização das equipas de profissionais de saúde, assim como os ensinos aos cuidadores do lactente, potenciando a intervenção especializada de enfermagem sobre o lactente e respetiva estrutura familiar. O objetivo deste relatório é descrever, de modo reflexivo, analítico e crítico, as atividades desenvolvidas em contexto clínico de serviço de urgência de pediatria e cuidados intensivos neonatais, que deram resposta aos objetivos gerais no processo de aquisição e desenvolvimento de competências comuns de Enfermeiro Especialista e especializadas de Enfermeiro Especialista na área de Pessoa em Situação Crítica, nomeadamente à criança com BRUE no 1º ano de vida. No Modelo de Dreyfus adaptado à enfermagem ancorou-se o desenvolvimento das áreas de perícia de saberes e competências científicas, técnicas e humanas na prestação de cuidados de enfermagem especializados de elevada qualidade ao cliente crítico, estando atento às suas necessidades de forma holística, não esquecendo a família como vetor de informação e potencial cuidador. Este processo formativo foi sustentado pela Teoria de Sistemas de Betty Neuman, assim como pelo Modelo de Parceria de Cuidados de Anne Casey, ambos ancorados nos pilares da enfermagem pediátrica.

Introdução: A Síndrome de Ganser (SG) é uma doença rara descrita pela primeira vez em 1897, pelo neurologista Sigbert Ganser. Foi caracterizada originalmente como uma síndrome do foro histeriforme, no entanto manteve-se revestida de controvérsia desde o seu início até aos dias de hoje. Objetivos: Descrever um caso clínico cujas características são compatíveis com a SG e elaborar uma breve revisão sobre esta entidade nosológica. Métodos: Recolha e sistematização da informação clínica de um caso compatível com o diagnóstico de SG. Procedemos à revisão não sistemática do conceito e das características clínicas que lhe estão associadas. Resultados e Conclusões: A SG é de difícil identificação em grande parte devido à grande indefinição que persiste quanto à sua caracterização e uniformização dos sintomas que a compõe. É necessária uma melhor definição da doença dentro do conceito das perturbações dissociativas, de forma a facilitar a sua identificação e o diagnóstico diferencial., Psilogos, vol. 15 n.º 2 (2017)

Introduction. Falls among the elderly are an important community health problem due to its high incidence, functional and social repercussion. Dissimilar results arose in recent studies concerning fall risk and physical activity levels. This study measures the association between physical activity (PA) levels, and fall risk (FR), investigates which levels of PA are influential in FR and presents a fall risk prediction models for the elderly. Material and Methods. One hundred and seventy elderly adults (72.34 ± 6.70 years old, 124 female), completed Performance-Orientated-Mobility-Assessment; PA was assessed by accelerometry. Pearson’s correlation verified the association between FR, Age, and PA. Multiple linear regression (MLR) was used to investigate the influence of variables on FR. Results. PA, age are predictors of FR, with PA (moderate, negative) age (moderate, positive). MLR analysis showed FR variability explained by PA (42.0%) and by age (37.0%), and by gender, female FR explained by light PA (47.0%), while in male, FR explained by sedentary behaviour (44.1%) and age (22.7%) independently. Conclusion. Individuals with higher physical activity have lower fall risk. Older are prone to fall. Older women with light physical activity are less likely to fall. Older men with more sedentary behaviour are prone to fall.

This study aims to explore the role of infertility-psychosocial variables on treatment discontinuation after controlling for demographic and biomedical variables in couples seeking reimbursed fertility treatment.A prospective study was conducted in 139 couples seeking fertility treatment. Between February 2010 and March 2011, participants completed measures of anxiety (STAI-State), depression (BDI-II), infertility-stress (FPI), and infertility coping strategies (COMPI-CSS). Medical data related to diagnosis, treatment, and discontinuation were collected in December 2013. A multiple logistic regression was performed to identify the predictors of discontinuation.The discontinuation rate was 29.5%. Female education level, engagement in ART procedures, and female causation decreased the likelihood of treatment discontinuation, whereas female age and depression increased the likelihood of discontinuation. Female depression was the strongest predictor in this model. The model correctly identified 75.5% of cases.Female age and female depression are associated with a higher likelihood of treatment discontinuation in couples seeking treatment. Reproductive health professionals should therefore inform couples about the link between the fertility treatment discontinuation and both female age and female depression. Couples in which female partners present clinically relevant depression should be referred to a mental health professional to prevent premature abandonment of fertility treatments and thus increase success rates.

Pregnancy in women submitted to bariatric surgery is increasing. Recommendations for surveillance of these pregnancies have been suggested, but an adequate time interval from surgery to conception, to avoid perinatal negative outcomes, is still controversial. Medical records of pregnancies in women with previous bariatric surgery were retrieved and outcomes were assessed according to three different time thresholds (12, 18 and 24 months). The association between time from surgery to conception and the presence of adverse outcomes was analysed. Eighty-six pregnancies were assessed. Weight gain was higher (p = 0.014) and more adequate (p = 0.041) when pregnancy occurred more than 12 months after surgery. Foetal growth percentile was lower when pregnancy was achieved before 24 months following surgery (p = 0.021). No differences among groups were found in other assessed outcomes (BMI, gestational age at delivery, type of delivery, gestational diabetes, pregnancy hypertensive disease, anaemia, preterm delivery, foetal weight, foetal growth restriction, Apgar score, admission to neonatal intensive unit) in all considered thresholds. No association between time from surgery to conception and the presence of adverse outcomes was found. Despite differences found in maternal weight gain and foetal growth percentile, our study does not support the recommendation to delay pregnancy based on a fixed deadline. Other factors, including a more individualised approach, need to be considered.

VEGF-A and VEGF-B are proangiogenic and key regulating factors for blood vessel growth. This study aims to compare VEGF-A and VEGF-B levels in the serum and vitreous of patients with neovascular pathology versus non-neovascular pathology. Our findings showed vitreous VEGF-A and VEGF-B levels increased in patients with neovascular disease, with higher levels of VEGF-A compared to VEGF-B (p ≤ .05). In the diabetic retinopathy (DR) group, higher vitreous VEGF-A or VEGF-B were found in proliferative diabetic retinopathy (PDR) than in non-PDR. The strong correlation between VEGF-A and VEGF-B demonstrates a simultaneous pathological increase of cytokines (p, POCI-01-0145-FEDER-007491

Vision loss due to disease or degeneration of the eye (retina, choroid, retinal veins, or macula) is a leading cause of blindness worldwide. In most cases, vision-threatening ocular diseases are accompanied by abnormal changes in the vasculature of the eye, especially the retina, and these conditions are collectively referred to as retinal vasculopathies. Impaired blood supply or hypoxia stimulates angiogenesis in the vascular and non-vascular sections of the eye, which results in neovascularization, leading to conditions such as diabetic retinopathy or age-related macular degeneration. Studies show that vascular endothelial growth factors: VEGF-A, VEGF-B, and placental growth factor (PlGF) are elevated in these diseases, and hence, these factors could be used as markers for disease prognosis and therapy. In this review, we discuss the function of these growth factors in normal development and disease, with focus on ocular disorders and emphasize the importance of accurately determining their levels in the vitreous and serum of patients for correct diagnosis and therapy.

The aim of this study was to evaluate the chemical reactivity of 58S mesoporous bioactive glass (MBG) particles in as-synthesized condition and after embedding propolis and cranberry antibiofilm compounds at different concentrations. MBG 58S was synthesized by alkali sol-gel method with the addition of the triblock pluronic copolymer P123 as surfactant. Samples were characterized by physicochemical properties measurement, N

Vascular endothelial growth factor B (VEGF-B) is one of the enigmatic members of the VEGF family. The knowledge gap about VEGF-B expression and how its levels are altered in diabetic eyes were the focus of this investigation that was addressed by comparing and correlating vitreous VEGF-B between diabetic and non-diabetic patients. VEGF-B levels were measured by enzyme-linked immunosorbent assay in vitreous samples (n = 33) from diabetic (n = 25) and non-diabetic (n = 8) patients. Results were compared between groups. Optical coherence tomography from diabetic patients was evaluated for central retinal thickness (CRT) and macular volume (MV). Mean vitreous VEGF-B concentration was higher in diabetic (18.82 ± 1.44 pg/mL ) vs. non-diabetic patients (17.90 ± 0.32 pg/mL) (p = 0.006), and in proliferative diabetic retinopathy (PDR) (19.03 ± 1.52 pg/mL) vs. non-PDR (NPDR) patients (18.18 ±0.96 pg/mL) (p = 0.025). In diabetic retinopathy (DR) patients, correlation between VEGF-B and CRT (μm) was positive and moderate: rs = 0.441 (p ≤ 0.05) and the correlation between VEGF-B and MV (mm³) was positive and robust: rs = 0.716 (p ≤ 0.01). VEGF-B levels are overexpressed in vitreous of diabetic patients, and the levels are higher in developed stages of DR. Correlation results show that CRT and MV increase with increased levels of VEGF-B. Targeting VEGF-B inhibition may have therapeutic beneficial implications., CENTRO-07-ST24-FEDER-002014)

study question: Is perceived social support from partner, family, and friends associated with increased infertility-related stress? summaryanswer: While men’s perceived support did not seem to influence their partners’ stress, women’s perceptions of spousal and familial support can affect the way men deal with the challenge of infertility. what is known already: Previous studies showed that low levels of social support are associated with poor psychosocial adjustment and treatment termination in women and men. Studies examining the impact of social support using the couple as unit of analysis are lacking. study design, size, duration: A cross-sectional sample of 613 Portuguese patients participated in the research, online over a 3-month period, and in a public fertility clinic over 11 months. participants/materials, setting, methods: The final sample comprised 213 married or cohabiting couples (191 from the fertility clinic) who were actively attempting to have a child, were seeking infertility treatment and had not undergone previous preimplantation genetic diagnosis. Perceived social support was assessed through the Multidimensional Scale of Perceived Social Support and infertility-related stress was assessed with the fertility problem inventory. Hypotheses were tested by applying the actor–partner interdependence model using structural equation modeling. mainresultsandtheroleofchance: Couples had been living together for an average (+SD) of 6+ 3.5 years, and attempting a pregnancy for 3.8+ 2.6 years. Nearly half of the couples had undergone infertility treatment (41.3%). Infertility stress was found to be associated with low family support for women (b ¼ 20.27, P ¼ .003), and low partner support for both men (b ¼ 20.29, P ¼ .001) and women (b ¼ 20.45, P ¼ .006). Both women and men’s perceived friend support were not significantly related to male or female infertility stress. Men infertility stress was also associated with their partners low levels of partner (b ¼ 20.24, P ¼ .049) and family support (b ¼ 20.23, P , .001). No significant partner effects were observed for women. Despite being related to actor effects alone (female partner and family support), the explained variance of the model in women’s fertility stress was greater (R 2 ¼ 21%) than that (R 2 ¼ 15.6%) for the combined actor and partner effects in men’s fertility stress (male partner support, female partner and family support). limitations,reasonsforcaution: The study data are cross-sectional and the generalizability of results is limited by self-selection. The characteristics of non-participants in both the clinical and online samples were not available, the perception of infertility-specific supportive behaviors was not assessed and differential analyses according to infertility diagnosis were not included in this study. widerimplicationsofthefindings: Our data underline the importance of partner support in alleviating the burden of infertility. Men may experience infertility indirectly through the impact that it has on their partners. Our findings reinforce the need to involve the male partner throughout the whole treatment process and for couple-based interventions when providing infertility counseling. Further prospective research should be aimed at investigating the male experience of infertility.

Objectives:The aim of this work is to make a demographic and clinical characterization of a random sample of patients that resorted to the psychiatric emergency service of Hospital de Braga, as well as verify the percentage of real emergencies.Background:The Emergency Service aims to provide urgent care to serious clinical situations, which in the specialty of psychiatry means handling psychotic outbreaks, manic episodes, suicidal ideation/attempt, severe behavioral changes, among other situations that put the patient or those who surround him in danger, or that induce significant acute suffering. However, according to our clinical experience, since access to the psychiatric emergency service is easy, it is found that patients often resort without a valid reason. We also verify the referral of patients for urgent psychiatric observation of clinical situations that are actually the responsibility of other medical specialties.Materials and Methods:Consultation of the electronic clinical information of a random sample of patients that resorted to the emergency department of Psychiatry during the year 2018.Results and Conclusions:The data are being analysed.The unjustified resort to the emergency service entails monetary and human resources costs that end up limiting the access to the Emergency Department to the patients who really need it. At times, it is even doctors of other specialties who end up referring the patients unduly, which ends up denouncing the lack of literacy in Psychiatry by doctors of other specialties. It is important to clarify both the population and the doctors about the actual psychiatric referral criteria in order to optimize the existing resources.

Objectives:The aim of this work is to explore the relationship between Autism Spectrum Disorders (ASD) and Gender Dysphoria (GD), investigate the developed theories that justify the surprisingly high co-occurrence between them, and to analyse the clinical implications in relieving the suffering provoked by GD in these cases.Background:In clinical settings there has been a higher than expected diagnosis of ASD among individuals with GD: while in the general population it is estimated that the diagnosis of ASD occurs in about 1%, studies have pointed to prevalences of 7.8% of ASD among individuals with GD. The aim of this work is to make a review of recent literature on this co-occurrence and explore the inherent clinical implications and difficulties.Materials and Methods:Pubmed search using the terms u201cAutism Spectrum Disordersu201d and u201cGender Dysphoriau201d. Non-systematic review of the literature of interest on the topic.Results and Conclusions:The co-occurrence between ASD and GD is likely to be complex and may depend on several underlying mechanisms. Several theories for this co-occurrence have been suggested, but almost all are speculative and lack evidence. The authors also critically raise the hypothesis that it is a mere spurious relation.The evaluation of GD in individuals with ASD can be quite complex given their characteristics. The authors suggest some general guidelines in the management of these situations.

Sepsis is an important cause of maternal morbidity and mortality worldwide. Early recognition and timely treatment are the key to ensuring a favourable outcome. This article reviews recent literature about definitions, pathophysiology, incidence, diagnosis, management, treatment, prevention and outcome of sepsis during pregnancy and the postpartum period.

To describe clinical presentation, preoperative study, intervention, histology, surgical complications and follow-up characteristics, and survival in patients with thyroid carcinoma (TC) with less than 18 years at presentation.retrospective analysis of clinical data of all children and adolescents followed in S. João Hospital from January 1, 2000 to March 31, 2010 with histologic diagnosis of TC.Twenty-three patients were identified, 19 girls, and 4 boys. Median age at presentation was 17.0 years. Annual incidence was 2.3 cases/year. The main presenting symptom was a solitary thyroid nodule (60.8%). Three (13%) patients had risk factors for TC, 2 of the 3 had previous cervical irradiation. The other was a smoker. Total thyroidectomy was performed in 16 (69.6%), and 10 patients underwent a second surgical procedure. Four (17.4%) patients had postoperative complications. Histologic examination revealed differentiated TC in all, papillary thyroid carcinoma (PTC) in 86.9%, follicular carcinoma in the remaining. All patients received thyroxine suppressive therapy and 20 underwent therapeutic radioactive iodine (131I). During follow-up (7.1 years), 7 out of the 23 patients presented new metastases and needed new treatment. All patients are currently alive.TC is a reality in pediatric population, thyroid routine examination should take part in all clinical examination in children and adolescents.

The endocrine system may be the target of different types of trauma with varied consequences. The present article discusses trauma of the hypothalamic-pituitary axes, adrenal glands, gonads, and pancreas. In addition to changes in circulating hormone levels due to direct injury to these structures, there may be an endocrine response in the context of the stress caused by the trauma.

A female second twin infant was born to a 39-year-old primigravida via elective caesarean section at 28 weeks of gestation due to intrauterine growth restriction of the second fetus. A full course of antenatal corticosteroid therapy was administered. The birth weight was 645 g, and the Apgar score

Neonatal hyponatraemia is common, and related to significant morbidity and mortality. We report a case of a preterm newborn (gestational age of 36 weeks) with hyponatraemia, and with a prenatal diagnosis of cleft lip and palate, with a normal fetal karyotype. On the seventh day of life, a biochemical evaluation for jaundice and mild signs of dehydration showed hyponatraemia of 124 mmol/L. Investigation showed normal adrenal and thyroid functions, plasma hyposmolality (258 mOsm/kg); high urinary sodium (73 mmol/L) and high urinary osmolality (165 mOsm/kg). Despite oral sodium supplementation and fludrocortisone treatment, sodium levels remained between 124 and 130 mmol/L. Cranial ultrasound, brain MRI and renal ultrasound were normal. The diagnosis of hyponatraemia was unpredicted and the investigation was suggestive of reset osmostat, a subtype of the syndrome of inappropriate secretion of antidiuretic hormone, characterised by a subnormal threshold for antidiuretic hormone secretion.