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Neste autoensaio, descrevo minha experiência, até agora, com ferramentas de inteligência artificial (IA) na produção acadêmica. Algumas aplicações de IA tem sido úteis para traduções e revisões de textos acadêmicos, além da geração de animações para video abstracts de divulgação científica. Já o ChatGPT, que uso para explorações iniciais sobre temas e para notas de rodapé, ainda apresenta limitações e inconsistências, necessitando revisões e ajustes até a redação final. A IA, embora se configure como recurso valioso para pesquisadores, não substitui a capacidade humana de estabelecer conexões entre o mundo real e a literatura. Portanto, encorajo uma abordagem equilibrada em seu uso na produção acadêmica.

INTRODUCTION: Treatment decision in patients with asymptomatic carotid artery stenosis (ACS) is a matter of current debate with a recent shift towards isolated best medical treatment (BMT) as treatment of choice in most patients. However, poor medical compliance is one of the main constraints to the success of BMT. We hypothesized that more invasive treatment approaches can influence how patients perceive the severity of their illness and hence, treatment compliance. METHODS: A cross-sectional study was performed including patients with asymptomatic >50% carotid artery stenosis (NASCET method) followed-up as outpatients in a Vascular Surgery department from January 2017 to December 2021. Optimal BMT was defined according to the European Society of Vascular Surgery Carotid Atherosclerotic Disease 2023 guidelines. Demographic and risk factor patient data was attained and subsequently a Portuguese translation of the Morisky medication-taking adherence scale (MMAS-4) questionnaire was given to all patients. Several additional questions developed by our group were also applied. RESULTS: A total of 320 patients were identified (186 under BMT alone and 134 submitted to BMT and carotid endarterectomy - CEA). Most patients were male in both groups (75%) and the mean age was similar. Furthermore, patients undergoing CEA presented higher rates of current smoking (51.4% vs 15.9%; p

Hypomagnesemia type I is a rare autosomal recessive disorder characterized by severe hypomagnesemia, often accompanied by hypocalcemia. This disease is caused by mutations in the TRPM6 gene (which encodes the respective channel), leading to reduced intestinal absorption of magnesium and increased renal excretion due to a defect in reabsorption in the distal convoluted tubule. It usually manifests itself in the first months of life, with symptoms of neuromuscular hyperexcitability and seizures, refractory to antiepileptic therapy. Treatment consists of administering high doses of magnesium throughout life. Here, we report a case of hypomagnesemia type I with a novel pathogenic variant of TRPM6 in a 5-month-old girl who developed refractory seizures due to hypomagnesemia.

BACKGROUND: Endovascular mechanical thrombectomy (MT) changed acute ischaemic stroke management and is considered the standard of care for patients with proximal anterior circulation occlusion. MT improves functional independence, without an increase in mortality. Despite its advantages, up to 20% of patients treated with MT do not have successful recanalization, leading to poor clinical outcome. We present a case of an acute ischaemic stroke of the anterior circulation due to occlusion of the common carotid artery successfully submitted to surgical thrombectomy after failed MT. CASE REPORT: A 43-year-old male, with prior history of diabetes, hypertension, dyslipidaemia and heart failure was admitted at the emergency unit with acute bilateral lower limb ischaemia, due to cardioembolic phenomena. He was submitted to bilateral femoral thrombectomy and started endovenous unfractionated heparin. On the fifth postoperative day he developed sudden depression of cognitive status and left side hemiplegia of brachial predominance. Computed tomography angiography revealed an occlusion of brachiocephalic trunk, right subclavian artery and common carotid artery, preserving its branches. MT, performed by interventional neuroradiology, was unsuccessful (no recanalization or clinical improvement). After multidisciplinary discussion, the patient underwent urgent surgical thrombectomy through carotid and transaxillary approaches. Postoperatively, the patient’s mental status and left sided motor function recovered progressively over time. Three months after, patient maintains anticoagulation with warfarin, without neurological sequalae. CONCLUSION: The low rate of recanalization and poor clinical outcome after MT failure underlines the need for alternative rescue approaches. Surgical thrombectomy could represent a lifeline. More studies are needed to corroborate its efficacy in patients with anterior circulation acute ischaemic stroke.

INTRODUCTION: Vascular Surgery is a demanding specialty with vast technological and research advances in the last decades. This has led to an increasing complexity of providing adequate training programs for the modern Vascular Surgeon. Our aim was to understand the current satisfaction rates and perceived limitations of the Vascular Surgery residency program in Portugal by performing an online survey to residents. METHODS: A survey study was conducted between April and June 2021 targeting Angiology and Vascular Surgery Residents in Portugal. Residents were contacted by e-mail from the National Portuguese Society of Angiology and Vascular Surgery to answer the survey. The survey was anonymized, and all residents from the 1st to 6th year were invited to participate. The survey was carried out using the Google® Forms platform and using Portuguese language. Questions were developed with two main objectives, the first being to analyze the satisfaction rates with the current residency program and the second to understand current limitations and possible areas of improvement. RESULTS: Overall, 33 (65%) out of 51 invited residents participated in the survey, with equally distributions regarding the year of residency. Nineteen residents were male (57.6%). Most residents considered that the current one-year General Surgery rotation should be reduced and replaced by other specialties such as Radiology. Main surgical limitations were found with open aortic surgery. However, when compared to other European countries, residents considered that the main current limitation was scientific/academic training. Most residents were satisfied with their residency and felt professional fulfillment, however, most also reported having an unhealthy work-life balance and lack of time for academic and scientific research. When comparing the survey answers between younger and older residents, older residents reported more often having considered quitting and having experienced bullying or harassment. CONCLUSION: The findings from this study provide insight into the perceptions of the trainees regarding current training limitations and satisfaction rates with the residency program and may provide a base for improvement and development strategies in the residency programs in Portugal

INTRODUÇÃO: A doença quística adventicial é uma patologia que afeta principalmente o leito arterial, porém, em raros casos pode envolver o sistema venoso. O objetivo desta revisão foi padronizar a marcha diagnóstica, tratamento e vigilância de doentes com suspeita de doença quística adventicial venosa. MÉTODO: Para cumprir os objetivos supracitados, uma revisão narrativa sumarizando os principais achados da literatura usando as bases de dados PUBMED e EMBASE foi feita. RESULTADOS: Um total de 33 artigos foram selecionados traduzindo-se num total de 41 casos de vACD. Após analise dos dados, foi possível concluir que o vaso mais frequentemente atingido é a veia femoral comum, e a maior parte dos doentes refere edema unilateral de membro com tempo de evolução variável. Quando perante um doente com edema unilateral de membro, em que a TVP foi excluída, é necessário proceder a outros meios complementares de diagnóstico de forma a confirmar, ou excluir, a vACD.

ABSTRACT Plasmodium falciparum proliferates through schizogony in the clinically relevant blood stage of infection. During schizogony, consecutive rounds of DNA replication and nuclear division give rise to multinucleated stages before cellularization occurs. Although these nuclei reside in a shared cytoplasm, DNA replication and nuclear division occur asynchronously. Here, by mapping the proteomic context of the S-phase-promoting kinase PfCRK4, we show that it has a dual role for nuclear-cycle progression: PfCRK4 orchestrates not only DNA replication, but in parallel also the rearrangement of intranuclear microtubules from hemispindles into early mitotic spindles. Live-cell imaging of a reporter parasite showed that these microtubule rearrangements coincide with the onset of DNA replication. Together, our data render PfCRK4 a key factor for nuclear-cycle progression, linking entry into S-phase with the initiation of mitotic events. In part, such links may compensate for the absence of canonical cell cycle checkpoints in P. falciparum. IMPORTANCE The human malaria parasite Plasmodium falciparum proliferates in erythrocytes through schizogony, forming multinucleated stages before cellularization occurs. In marked contrast to the pattern of proliferation seen in most model organisms, P. falciparum nuclei multiply asynchronously despite residing in a shared cytoplasm. This divergent mode of replication is, thus, a good target for therapeutic interventions. To exploit this potential, we investigated a key regulator of the parasite’s unusual cell cycle, the kinase PfCRK4 and found that this kinase regulated not only DNA replication but also in parallel the rearrangement of nuclear microtubules into early mitotic spindles. Since canonical cell cycle checkpoints have not been described in P. falciparum parasites, linking entry into S-phase and the initiation of mitotic events via a kinase, may be an alternative means to exert control, which is typically achieved by checkpoints.

Malaria-causing parasites achieve rapid proliferation in human blood through multiple rounds of asynchronous nuclear division followed by daughter cell formation. Nuclear divisions critically depend on the centriolar plaque, which organizes intranuclear spindle microtubules. The centriolar plaque consists of an extranuclear compartment, which is connected via a nuclear pore-like structure to a chromatin-free intranuclear compartment. Composition and function of this non-canonical centrosome remain largely elusive. Centrins, which reside in the extranuclear part, are among the very few centrosomal proteins conserved in Plasmodium falciparum. Here we identify a novel centrin-interacting centriolar plaque protein. Conditional knock down of this Sfi1-like protein (PfSlp) caused a growth delay in blood stages, which correlated with a reduced number of daughter cells. Surprisingly, intranuclear tubulin abundance was significantly increased, which raises the hypothesis that the centriolar plaque might be implicated in regulating tubulin levels. Disruption of tubulin homeostasis caused excess microtubules and aberrant mitotic spindles. Time-lapse microscopy revealed that this prevented or delayed mitotic spindle extension but did not significantly interfere with DNA replication. Our study thereby identifies a novel extranuclear centriolar plaque factor and establishes a functional link to the intranuclear compartment of this divergent eukaryotic centrosome.

Abstract Background The brain vasculature plays a pivotal role in the inflammatory process by modulating the interaction between blood cells and the neurovascular unit. Argonaute-2 (Ago2) has been suggested as essential for endothelial survival but its role in the brain vasculature or in the endothelial–glial crosstalk has not been addressed. Thus, our aim was to clarify the significance of Ago2 in the inflammatory responses elicited by these cell types. Methods Mouse primary cultures of brain endothelial cells, astrocytes and microglia were used to evaluate cellular responses to the modulation of Ago2. Exposure of microglia to endothelial cell-conditioned media was used to assess the potential for in vivo studies. Adult mice were injected intraperitoneally with lipopolysaccharide (LPS) (2 mg/kg) followed by three daily intraperitoneal injections of Ago2 (0.4 nM) to assess markers of endothelial disruption, glial reactivity and neuronal function. Results Herein, we demonstrated that LPS activation disturbed the integrity of adherens junctions and downregulated Ago2 in primary brain endothelial cells. Exogenous treatment recovered intracellular Ago2 above control levels and recuperated vascular endothelial-cadherin expression, while downregulating LPS-induced nitric oxide release. Primary astrocytes did not show a significant change in Ago2 levels or response to the modulation of the Ago2 system, although endogenous Ago2 was shown to be critical in the maintenance of tumor necrosis factor-α basal levels. LPS-activated primary microglia overexpressed Ago2, and Ago2 silencing contained the inflammatory response to some extent, preventing interleukin-6 and nitric oxide release. Moreover, the secretome of Ago2-modulated brain endothelial cells had a protective effect over microglia. The intraperitoneal injection of LPS impaired blood–brain barrier and neuronal function, while triggering inflammation, and the subsequent systemic administration of Ago2 reduced or normalized endothelial, glial and neuronal markers of LPS damage. This outcome likely resulted from the direct action of Ago2 over the brain endothelium, which reestablished glial and neuronal function. Conclusions Ago2 could be regarded as a putative therapeutic agent, or target, in the recuperation of the neurovascular unit in inflammatory conditions.

OBJECTIVE: Venous stenting of iliocaval obstructions has become a more frequent procedure over the last two decades. In-stent stenosis and thrombosis are potential complications, causing one of the main causes of symptoms recurrence and impacting quality of life. The aim of this review is to report on the impact of venous stent patency loss, as well on risk factors and management. METHODS: A systematic review was conducted according to the recommendations of the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) statement. RESULTS: After a literature search, 12 studies (two prospective and 10 retrospective studies) were included in the analysis. A total of 1981 patients (34.1% male) and 2388 limbs (63.6% left side) were assessed. Mean age was 43.5 years (range 16-99). Indication for stenting included deep venous thrombosis (DVT) (4%), post-thrombotic syndrome (PTS) (18.8%) and non-thrombotic iliac vein lesions (NIVLs) (77.2%). Regarding treatment, most patients were submitted to angioplasty and stenting only (87%). Associated catheter directed thrombolysis or mechanical thrombectomy was performed when indicated (8.4%), and in the remaining an AVF/endophlebetomy was performed (4.6%). Primary, primary assisted and secondary patency rates at one year ranged from 68-100%, 79-90% and 85.8-100%, respectively. Reported anticoagulation duration after stenting ranged from 1-12 months. In one study involving only patients treated for NIVLs, no anticoagulation was prescribed, and antithrombotic therapy was continued for three months. Follow-up strategies included clinical and imagiological control with a mean follow-up of 19.7 months. Post-procedural stent re-stenosis was reported in 121 limbs (5.1%) and stent occlusion in 81 limbs (3.4%); the latter was distributed as follows: 11.1% after DVT, 77.8% PTS and 11.1% NIVLs. A total of 186 re-interventions were performed in symptomatic patients. The prognostic factor most consistently associated with stent failure was thrombotic inflow veins. Other reported factors were incomplete thrombolysis and age younger than 40 years. Stent placement below the inguinal ligament, type of stent and anticoagulation regimen do not seem to affect stent patency. CONCLUSION: Regarding venous lesions of the lower limbs, a selective approach and planning should focus on identification of risk factors for stent failure. It is noteworthy that most stent occlusions occur in post-thrombotic limbs. Stent failure continued after 6 months, emphasizing the importance of an extended surveillance especially on these patients.

INTRODUCTION: Aortoiliac occlusive disease (AIOD) can be treated using either open surgical revascularization (OSR) or endovascular revascularization (ER). METHODS: A Medline search was performed in order to identify articles focused on the treatment of aortoiliac occlusive disease. Additional articles of scientific interest for the purpose of this non-systematic review were included by cross-referencing. RESULTS: There are a few articles reporting direct results between both techniques based on retrospective or prospective single center or multicenter studies. In the majority of studies, primary patency is generally better for surgery in comparison to ER, but at a cost of more postoperative complications, with higher rates of respiratory failure and wound infection in the open group. On the other hand, endovascular recanalization is related to higher rates of limb ischemia/thrombosis, renal dysfunction and reinterventions. In the presence of femoral artery calcified disease, the hybrid approach should be considered. CONCLUSIONS: Endovascular treatment is a suitable alternative for extensive AIOD and can be accomplished in a less invasive manner, with most midterm outcomes comparable with open reconstruction. Surgery should be reserved for multilevel calcified disease and after endovascular failure.

INTRODUCTION: Inferior vena cava agenesis is one of the most uncommon anomalies of this vessel, with an estimated prevalence of 0.0005–1% in the general population. However, around 5% of the patients younger than 30 years with a diagnosis of deep vein thrombosis have this anomaly. METHODS AND MATERIAL: Report of two clinical cases of inferior vena cava agenesis with different clinical presentations. CLINICAL CASE 1: A 40-year-old man was admitted with a 3 days history of unilateral lower limb swelling and pain, gradually progressing to the inability to walk. On physical examination he had swelling, bruising and tenderness involving leg and thigh and prominent engorged superficial abdominal collateral veins. Venous Doppler Ultrasound showed left deep venous thrombosis extending from popliteal vein to common iliac vein. A computed tomography angiogram showed agenesis of the infrarenal vena cava and patent renal veins draining in to the azygous system and hemiazygous systems. The patient as discharged with rivaroxaban and compression stockings. At 2 months follow up he was asymptomatic and still anticoagulated. CLINICAL CASE 2: A 35 year- old woman, with a previous history of recurrent lower limb varicose veins surgery and left internal malleolar ulcer at 30 years presented at medical department 3 years later with complains of ulcer recurrence. A computed tomography angiogram revealed an absent infrahepatic vena cava, prominently dilated azygos and hemiazygos veins with enlarged retroperitoneal collaterals. The patient initiated dressing care with oxide zinc and oral rivaroxaban. DISCUSSION/CONCLUSION: The majority of cases remain asymptomatic. However, when symptomatic, the majority present as proximal DVT involving the iliac and femoral veins. CT or MRI should be the imagiological methods used to diagnose this anomaly. No clear consensus has been reached on therapeutic strategy, other than long-term antico- agulation and elastic stockings.

Introduction: Involvement of the ascending/aortic arch in the thoracic aorta pathology can preclude thoracic endovas- cular aortic repair (TEVAR) due to the absence of an adequate proximal landing zone. Hybrid interventions combining ascending/aortic arch replacement with TEVAR of the descending thoracic aorta (DTA) are associated with good outcomes. Despite the existence of dedicated devices (E-vita®, Thoraflex®), they may not be available in good time in emergent cases that might require inventive solutions, like the one we present. Case Report: A 53-year-old hypertensive, active smoker male was admitted due to a non-A-non-B acute aortic dissection, complicated with a contained rupture at the aortic isthmus and a left haemothorax. Considering the absence of a secure proximal landing zone we decided on an aortic arch replacement and frozen stented elephant trunk using off-the-shelf devices. Debranching of the innominate and left common carotid arteries was performed with a 16×8mm bifurcated graft. The aortic arch replacement was performed with a 28 mm Dacron, under hypothermic circulatory arrest. A 30×30×157mm stent graft was anterogradely advanced to the DTA, under direct vision, with its proximal part parked at the level of the Dacron anastomosis. The proximal arch anastomosis was completed at the level of the sinotubular junction. Completion angiography revealed appropriately reconstructed aortic arch, successful exclusion of the entry tear and rupture site, as well as adequate renal and visceral perfusion. The patient had an uneventful postoperative course, being discharged on postoperative day 23. Control CTA demonstrated successful arch reconstruction, true lumen expansion and no signs of complications. Conclusion: This hybrid approach with off-the-shelf devices was successful and avoided the cumulative morbidity of an additional left thoracotomy as the technical difficulty of a full open surgery in this setting. In the absence of readily available dedicated devices, hybrid techniques will undoubtedly play a role in the treatment of acute aortic syndromes. The existence of an “Aortic Team” available to evaluate, decide and combine the expertise of cardiothoracic and vascular surgery was essential in this case.

Introduction: Traumatic popliteal artery injury is a rare clinical entity, but it is the most common cause of amputation in injured extremities. The aim of this study was to report the incidence of popliteal artery injury after knee trauma and report therapeutic management and results. Methods and material: ICD-10/ ICD-9 codes (S85.0/904.41; S83.1/836.5; S83.4; S83.5; S72,4/821.2; S82,1/823.0) were used to identify patients admitted with popliteal artery injury and/or knee trauma at our tertiary center from 1/1/2010 to 31/5/2021. A statistical analysis was realized using the SPSS program version27. Results: At our center from 1/1/2010 to 31/5/2021 535 patients were admitted due to knee trauma (28 with knee dislocation and 507 with fracture close to the knee) and 9 patients with popliteal artery injury (seven males, median age 39.0 years) The mechanism of PAI was motorcycle (4) or bicycle (1) or work (1) accidents (4); one fall, one running over and one iatrogenic injury. The incidence of PAI after knee trauma was 1.5%, after knee dislocation 17.9% and 0.8% after fracture close to the knee. Regarding associated injuries, four patients had severe soft tissue damage, two had venous injuries and two had nerve disruptions. The median ischemic time was 6.0 hours and mean vascular surgical time was 2.4 hours. Regarding vascular treatment, eight patients were submitted to bypass surgery and one was treated conservatively. Therapeutic fasciotomies were performed in three patients. No primary amputations were performed. A secondary major amputation was performed in one patient. The mean hospital length of stay was 24.9 days and mortality was 0%. Three patients returned to their normal activity level and six were limited in their daily activity. Discussion/Conclusion: The risk of PAI after knee dislocation is higher than after knee fracture (17,9% vs 0.8% in our study, and 3,4-8,2% vs 0,2 % in Swedish registration), so orthopedic surgeons must be aware of that increased risk, to avoid missing this diagnosis. The amputation rate in our serie was lesser than the Swedish registration and the United States National Trauma Data Bank (11% vs 28% and 14,5%, respectively). However, it ́s still a high rate considering that it mostly affects a young and active population and only 33.3% patients return to a normal life. A multidisciplinary approach is essential to decrease ischemia time and to promote a holistic treatment.

Introduction: Chronic venous disease is a prevalent condition that worsens with age and is associated with poor quality of life. The treatment of varicose veins (VV) has multiple alternatives, and different practices across Europe. The aim of this article is to analyze the treatment of very elderly patients with severe forms of chronic venous disease using the VenaSeal technique. Method, Material and Results: Report of 5 very old patients with severe venous insufficiency treated with Vena- Seal in 2021. Clinical case 1: A 86-year-old woman, with untreated bilateral varicose veins and recurrent ulcers, was observed in consultation, complaining of severe pain in left leg with an doppler ultrasound (DUS) showing bilateral great saphenous vein (GSV) insufficiency. An outpatient basis treatment of the left great saphenous vein with VenaSeal associated with phlebectomies was performed in the left side. After 6 months of follow-up, she is asymptomatic with small areas of repermeabilization of the proximal trunk of GSV. Clinical case 2: A 85-year-old man was observed in consultation describing two episodes of varicorrhagia in his right leg and and DUS with bilateral great saphenous vein insufficiency. An outpatient basis treatment of the right great saphenous vein with VenaSeal associated with varicose veins foam esclerotherapy DUS guided was performed. After a 3-month follow-up, the patient is asymptomatic with the imaging control showing occlusion of the trunk of the great saphenous vein. Clinical case 3: A 97-year-old woman was observed in consultation complaining of severe pain in left leg associated with an ulcer with severe interference with her quality of life and a DUS with bilateral great saphenous vein insufficiency. An outpatient basis treatment of the left great saphenous vein with VenaSeal associated with varicose veins foam esclerotherapy DUS guided was performed. After a 2-month follow-up, the patient is asymptomatic with a healed ulcer, with the DUS control showing occlusion of the great saphenous trunk. Clinical case 4: A 95-year-old woman was observed in consultation describing bilateral severe pain and ulcers in both legs and DUS with bilateral great saphenous vein insufficiency. An outpatient basis treatment of bilateral great saphenous vein with VenaSeal associated with varicose veins foam esclerotherapy DUS guided was performed. After 1-month follow-up, she is asymptomatic with healed ulcers and has occlusion of the right GSV ́s trunk and areas of repermeabilization of left GSV ́s trunk. Clinical case 5: An 84-year-old woman was observed in consultation with severe pain and severe pruritus of the left leg and a DUS with left GSV insufficiency. An outpatient basis treatment of the left GSV with VenaSeal associated with phlebectomies was performed. After 1 month of follow-up, the patient is asymptomatic with occlusion of the proximal left GSV ́s trunk. Discussion/Conclusion: Treatment with Venaseal is not considered in the 2015 Guidelines of the ESVS, however the VeClose Study compared VenaSeal with radiofrequency ablation and reported equivalent improvement in symptoms scores and GSV occlusion. VenaSeal treatment doesn ́t require use of elastic compression after surgery and allows return to routine activity immediately, so it may be a good therapeutic option in this age group of patients with high clinical risk. In our experience, VenaSeal resulted in complete resolution of the symptoms and ulcers in the short term. However, a complete occlusion of GSV was not observed in all cases, so new studies and protocols doses can be necessary.

Introduction : May Thurner Syndrome (MTS) is a clinical condition as a result of an anatomical compression of the left common iliac vein by the fifth lumbar vertebra posteriorly, and by the right common iliac artery anteriorly associated with symptomatology. Affirming the diagnosis can be difficult and intravascular ultrasonography (IVUS) can help in the definitive decision. Clinical Case: A 43 years old man with a past history of a deep venous thrombosis of the left lower limb presented at our clinical appointment with a 5 months history of left limb edema and inability to stand up for long periods of time, disabling him from working. A venous-CT scan was obtained to diagnose the condition but was inconclusive. It was proposed to the patient to carry out a phlebography and an IVUS to eliminate the doubt and increase the diagnosis acuity, which was accepted. A phlebography and IVUS confirmed a significant compression of the left common iliac vein (image 1). The patient was treated by endovenous placement of an Abre 16/80 medtronic stent followed by dilatation with a 16/40 balloon Boston scientific. The phlebography and IVUS control showed complete resolution of the compression. (Image 2) Discussion/Conclusion: The diagnosis of MTS can be difficult and implies a high degree of clinical suspicion. The TC scan alone may not be diagnostic. The phlebography, and especially the more recent IVUS technology increases the accuracy of the diagnosis. Emergence of endovascular surgery revolutionized the treatment of obstructive venous disease, and became the gold standard of treatment. However, the implantation of stents in a young population implies additional cautions due to the lack of knowledge about their behavior over the long term. In this clinical case, the IVUS allowed us to reach the diagnosis and to increase the therapeutic accuracy of the ilio- cava stenting. We recommend the routine use of IVUS in the management of MTS.

Plasmodium, the unicellular parasite that causes malaria, evolved a highly unusual mode of reproduction. During its complex life cycle, invasive or transmissive stages alternate with proliferating stages, where a single parasite can produce tens of thousands of progeny. In the clinically relevant blood stage of infection, the parasite replicates its genome up to thirty times and forms a multinucleated cell before daughter cells are assembled. Thus, within a single cell cycle, Plasmodium develops from a haploid to a polypoid cell, harboring multiple copies of its genome. Polyploidy creates several biological challenges, such as imbalances in genome output, and cells can respond to this by changing their size and/or alter the production of RNA species and protein to achieve expression homeostasis. However, the effects and possible adaptations of Plasmodium to the massively increasing DNA content are unknown. Here, we revisit and embed current Plasmodium literature in the context of polyploidy and propose potential mechanisms of the parasite to cope with the increasing gene dosage.

Introdução: Os falsos aneurismas da artéria renal são maioritariamente causados por lesões iatrogénicas ou por trauma renal. A incidência destes está a aumentar devido ao incremento do uso de procedimentos minimamente invasivos n o tratamento da patologia renal e, consequente aumento das lesões iatrogénicas. Devido à natureza da parede, estes apresentam um alto risco de rutura e, portanto, devem ser diagnosticados e tratados precocemente. Objetivo: Avaliar a experiência do Departamento de Angiologia e Cirurgia Vascular do CHUP na abordagem dos falsos aneurismas da artéria renal. Métodos e materiais: Foi realizada uma revisão retrospetiva com recurso aos registos clínicos e imagiológicos de 20 pacientes com diagnóstico de falsos aneurismas da artéria renal entre 2010 a 2018. Resultados: Em 95% dos casos a etiologia foi iatrogénica. Todos os pacientes apresentaram-se sintomáticos, 85% com hematúria macroscópica. O tempo médio entre a lesão e a manifestação clínica foi de 4,5 dias. O tratamento realizado em todos os casos consistiu na embolização da artéria alimentadora. O tempo entre a lesão e o tratamento foi de 18,1 dias. A taxa de salvamento do rim foi de 95%. Discussão/Conclusão: Neste estudo, a principal etiologia e a técnica cirúrgica utilizada estão de acordo com a literatura publicada. Esta taxa de salvamento do rim, reforça que o tratamento endovascular é um método eficaz. Embora não haja referências publicadas na literatura que permitam a comparação, neste estudo observou-se que o tempo entre a lesão e o tratamento foi elevado, o que se traduz num diagnóstico tardio. Neste sentido, a consciencialização dos urologistas em relação a esta complicação é extremamente importante.

Introdução: A surdez congénita ou precocemente adquirida afeta 1 a 3 por cada 1000 recém-nascidos sem fatores de risco e 20 a 40/1000 com fatores de risco. O rastreio auditivo neonatal universal permite a sua identificação precoce. As crianças com surdez congénita/precocemente adquirida têm uma maior prevalência de outras patologias, especialmente oftalmológicas e do neurodesenvolvimento, tendo pelo menos 30% a 40% uma comorbilidade associada. Material e Métodos: Realizámos um estudo transversal, multicêntrico onde participaram 83% (n = 30) dos hospitais/maternidades do Serviço Nacional de Saúde. Resultados: Todos os hospitais/maternidades inquiridos realizam, por rotina, o rastreio auditivo neonatal universal a todos os recém-nascidos antes da alta; 63% encaminham para Otorrinolaringologia crianças com fatores de risco de surdez. Todas as crianças com surdez congénita/precocemente adquirida são encaminhadas para Pediatria em 23% hospitais/maternidades. Em 23 hospitais/maternidades todas as crianças com surdez congénita/precocemente adquirida são encaminhadas para: Terapia da Fala em 44% hospitais/maternidades; Oftalmologia em 17% hospitais/maternidades; Sistema Nacional de Intervenção Precoce na Infância (SNIPI) em 30% hospitais/maternidades; referenciação para Genética de todas as crianças com surdez congénita/ precocemente adquirida, sem causa identificada, em 22% hospitais/maternidades. O número de diagnósticos de surdez nos anos de 2014 e 2015 foi de 2,5 e 1,5 por cada 1000 recém-nascidos, respetivamente, em 15 dos hospitais/maternidades. Discussão: O rastreio auditivo neonatal universal parece estar amplamente difundido no Serviço Nacional de Saúde. O número de crianças com SC/SPA tal como a percentagem dos diferentes tipos de surdez diagnosticados, foram idênticos aos encontrados noutros estudos e mostra a indiscutível importância do rastreio. A avaliação/acompanhamento destas crianças por outras especialidades, além da Otorrinolaringologia, mostrou-se heterogéneo nas diferentes entidades de saúde e revelou que nem todas as crianças com fatores de risco de surdez realizam o seguimento aconselhado pelas normas existentes. Conclusão: Os resultados mostram que Portugal realizou um percurso importante no âmbito do rastreio e seguimento das crianças com SC/SPA. Importa, com o fim último da melhoria continua da prestação de cuidados a estas crianças, refletir sobre o envolvimento de outras especialidades, além da Otorrinolaringologia, tal como do Sistema Nacional de Intervenção Precoce na Infância no seguimento destas crianças.

Resumo Em pediatria oncológica, a taxa de sobrevivência tem sofrido um aumento acentuado, sendo considerável a probabilidade de cura. Não obstante, o processo de confronto com a doença pode sofrer alguns contratempos, nomeadamente uma recidiva. Esta última é responsável por elevado sofrimento, o qual poderá ser ainda maior que o confronto com o diagnóstico. Procurando conhecer as perceções dos profissionais de oncologia, relativamente às principais dificuldades experienciadas pelas crianças e adolescentes cuja doença recidivou, as autoras desenvolveram um estudo investigando o olhar desses profissionais. Entrevistaram-se 17 profissionais, de dois hospitais portugueses, exercendo funções hospitalares na área da saúde, serviço social, psicologia e educação. Suas reflexões apontaram como principais dificuldades a aceitação de ter que passar novamente por um processo fisica e psicologicamente penoso sendo que, entre os adolescentes - mais conscientes da gravidade da doença e suas implicações - acrescem as dificuldades em ter esperança na cura. Para os mais pequenos, os profissionais apontaram como mais comum a dificuldade em compreender os motivos de nova submissão a tratamentos dolorosos e do afastamento dos seus contextos de vida. Dando a conhecer uma etapa particularmente desafiante da doença oncológica, o presente estudo traz um olhar multifocal de um grupo de profissionais que acompanham de perto essas crianças/adolescentes (e respectivas famílas). A sua longa e diversa experiência - em termos de tipologias de câncer, evolução do quadro clínico, idade ou temperamento dos pacientes (e dos próprios pais) - fazem desses profissionais informantes-chave no mapeamento das dificuldades associadas ao processo de recidiva oncológica em pediatria, bem como no desenho e implementação de respostas mais ajustadas à fenomenologia destes processos.

Introduction: The incidence of multiple gestations is increasing worldwide and many studies have shown higher perinatal morbidity and mortality rates in monochorionic twins compared to dichorionic. The aim of this study was to assess the twin population born at a tertiary center and to evaluate the impact of chorionicity on perinatal outcomes of twin pregnancies. Material and Methods: Retrospective study of all twins born in a tertiary center from January 2004 to December 2013. Results: In this period, 1051 twins were born, related to 540 gestations (26.7% monochorionic; 73.3% dichorionic). There was no statistical significant difference between the groups concerning obstetric complications. The monochorionic group had a higher incidence of intrauterine growth restriction (20.5 vs 11.3%, p < 0.001), lower mean maternal age (29.9 vs 31.9 years, p < 0.001), lower mean gestational age (33.4 vs 34.3 weeks, p < 0.05) and lower mean birth weight (1943 vs 2147 g, p < 0.001). Monochorionic twins had a higher incidence of hyaline membrane disease (7 vs 4%, p < 0.05), sepsis (10.3 vs 5.8%, p < 0.05) and anemia (9.5 vs 5.4%, p < 0.05). There were no statistical significant differences concerning necrotizing enterocolitis, intraperiventricular hemorrhage or retinopathy of prematurity. Perinatal mortality was higher in the monochorionic group (5.2 vs 2.9%, p < 0.05). Discussion: Monochorionic twins represent considerable challenges to both obstetricians and neonatologists and should be monitored and delivered at tertiary centers. Conclusion: Currently gemelarity has a major impact on total births. It would be interesting to develop protocols to standardize clinical approach to twins.

Objetivo: Análise da experiencia no tratamento de aneurismas arteriais complexos bilaterais da artéria renal Introdução: Os aneurismas da artéria renal são uma entidade clinica rara, não estando definido na literatura de forma clara a sua epidemiologia, fisiopatologia e o melhor tratamento. Material e Métodos: Análise retrospetiva da base de dados prospetiva de doentes com o diagnóstico de aneurismas da artéria renal. Um total de 3 doentes com aneurismas bilaterais foram tratados cirurgicamente, procedendo-se a uma análise descritiva aplicada caso a caso. Resultados Caso clínico 1: Doente do sexo feminino, com 46 anos de idade, hipertensa arterial com diagnóstico incidenta de 2 dois aneurismas saculares da artéria renal direita e dois aneurismas saculares da artéria renal esquerda. Efetuou-se uma nefrectomia esquerda por via laparoscópica, em banca o rim foi perfundido e arrefecido com solução de Euro-Collins, tendo-se efetuado uma aneurismectomia e angioplastia com veia safena interna e implante do rim na fossa ilíaca esquerda. Quatro meses após foi realizado o tratamento do rim direito com realização de nefrectomia, por via laparoscópica, efetuou-se aneurismorrafia associada a aneurismectomia e pontagem renal com veia safena interna, prolongamento da veia renal com prótese espiralada de veia safena interna colhida na coxa e implantação do rim na fossa ilíaca direita Os pós operatórios decorreram sem intercorrências com patência renal bilateral. Caso clínico 2: Doente do sexo feminino, 38 anos de idade, hipertensa arterial com o diagnóstico incidental de dois aneurismas saculares da artéria renal direita e esquerdo. Efetuou-se uma nefrectomia esquerda por via laparoscópica tendo os aneurismas sido excluídos com clips de titânio de Yasergil associado a aneurismorrafia, e implante fossa ilíaca esquerda. Quatro meses após, foi realizado efetuando-se nefrectomia por via laparoscópica, e tratamento dos aneurismas por aneurismorrafia e prolongamento da veia renal com prótese espiralada de veia safena interna colhida na coxa, com implantação na fossa ilíaca direita Os pós operatórios decorreram sem intercorrências com patência renal bilateral Caso clinico 3: Doente do sexo masculino, com 33 anos, com o diagnóstico incidental em de 2 dois aneurismas fusiformes da artéria renal direita e dois aneurismas saculares da artéria renal esquerda. Foi efetuado nefrectomia direita, por via laparoscópica, os aneurismas foram isolados efetuando-se a laqueação da artéria polar renal por impossibilidade de reconstrução, e implantado o rim na fossa ilíaca direita. Dezassete meses após foi efetuada nefrectomia por via laparoscópica e tratamento por aneurismectomia associada a duas pontagens renais com veia safena interna e implantação do rim na fossa ilíaca esquerda. Os pós operatórios decorreram sem intercorrências com patência renal bilateral Discussão e conclusão O tratamento de aneurismas bilaterais é raro, tendo sido em 2014 publicado o primeiro caso de tratamento bilateral por autotransplante. Não há contudo estudos randomizados comparando a cirurgia in situ, ex-vivo e a cirurgia endovascular. No nosso centro, o tratamento de aneurismas da artéria renal complexos, que definimos como aqueles que necessitam para o seu tratamento de tempos de clampagem da artéria renal superior a 45 minutos, localizados em áreas da artéria não acessíveis à reconstrução in situ ou a tratamento endovascular normalmente localizados na bifurcação do tronco principal da artéria renal ou nos seus ramos iniciais, é efetuado através de cirurgia ex-vivo e autotransplante na fossa ilíaca e representa uma excelente terapêutica com morbilidade e mortalidade nula. A experiência em transplantação renal e cirurgia vascular é um requisito fundamental para o sucesso do tratamento.

Thrombospondin type I repeat (TSR) domains are commonly O-fucosylated by protein O-fucosyltransferase 2 (PoFUT2), and this modification is required for optimal folding and secretion of TSR-containing proteins. The human malaria parasite Plasmodium falciparum expresses proteins containing TSR domains, such as the thrombospondin-related anonymous protein (TRAP) and circumsporozoite surface protein (CSP), which are O-fucosylated. TRAP and CSP are present on the surface of sporozoites and play essential roles in mosquito and human host invasion processes during the transmission stages. Here, we have generated PoFUT2 null-mutant P. falciparum and Plasmodium berghei (rodent) malaria parasites and, by phenotyping them throughout their complete life cycle, we show that PoFUT2 disruption does not affect the growth through the mosquito stages for both species. However, contrary to what has been described previously by others, P. berghei PoFUT2 null mutant sporozoites showed no deleterious motility phenotypes and successfully established blood stage infection in mice. This unexpected result indicates that the importance of O-fucosylation of TSR domains may differ between human and RODENT malaria parasites; complicating our understanding of glycosylation modifications in malaria biology.

Recent WHO guidelines on control of human immunodeficiency virus (HIV) call for the widespread use of antiretroviral (AR) therapy (ART) for people living with HIV. Given the considerable overlap between infections by HIV and Plasmodium, the causative agent of malaria, it is important to understand the impact of AR compounds and ART regimens on infections by malaria parasites. We undertook a systematic approach to identify AR drugs and ART drug combinations with inhibitory activity against the obligatory hepatic stage of Plasmodium infection. Our in vitro screen of a wide array of AR drugs identified the non-nucleoside reverse transcriptase inhibitors efavirenz and etravirine (ETV), and the protease inhibitor nelfinavir, as compounds that significantly impair the development of the rodent malaria parasite P. berghei in an hepatoma cell line. Furthermore, we show that WHO-recommended ART drug combinations currently employed in the field strongly inhibit Plasmodium liver infection in mice, an effect that may be significantly enhanced by the inclusion of ETV in the treatment. Our observations are the first report of ETV as an anti-Plasmodial drug, paving the way for further evaluation and potential use of ETV-containing ARTs in regions of geographical overlap between HIV and Plasmodium infections.

Inflammatory mechanisms triggered by microglial cells are involved in the pathophysiology of several brain disorders, hindering repair. Herein, we propose the use of retinoic acid-loaded polymeric nanoparticles (RA-NP) as a means to modulate microglia response towards an anti-inflammatory and neuroprotective phenotype (M2). RA-NP were first confirmed to be internalized by N9 microglial cells; nanoparticles did not affect cell survival at concentrations below 100 μg/mL. Then, immunocytochemical studies were performed to assess the expression of pro- and anti-inflammatory mediators. Our results show that RA-NP inhibited LPS-induced release of nitric oxide and the expression of inducible nitric oxide synthase and promoted arginase-1 and interleukin-4 production. Additionally, RA-NP induced a ramified microglia morphology (indicative of M2 state), promoting tissue viability, particularly neuronal survival, and restored the expression of postsynaptic protein-95 in organotypic hippocampal slice cultures exposed to an inflammatory challenge. RA-NP also proved to be more efficient than the free equivalent RA concentration. Altogether, our data indicate that RA-NP may be envisioned as a promising therapeutic agent for brain inflammatory diseases.

The isolation of bioactive compounds from medicinal plants, based on traditional use or ethnomedical data, is a highly promising potential approach for identifying new and effective antimalarial drug candidates. The purpose of this review was to create a compilation of the phytochemical studies on medicinal plants used to treat malaria in traditional medicine from the Community of Portuguese-Speaking Countries (CPSC): Angola, Brazil, Cape Verde, Guinea-Bissau, Mozambique and São Tomé and Príncipe. In addition, this review aimed to show that there are several medicinal plants popularly used in these countries for which few scientific studies are available. The primary approach compared the antimalarial activity of native species used in each country with its extracts, fractions and isolated substances. In this context, data shown here could be a tool to help researchers from these regions establish a scientific and technical network on the subject for the CPSC where malaria is a public health problem.

La hiperplasia estromal pseudoangiomatosa (PASH) es una lesión mamaria benigna infrecuente, que afecta comúnmente a mujeres premenopáusicas y que se presenta como un nódulo único, móvil, de consistencia firme y por lo general unilateral. Hay un sobrecrecimiento benigno de tejido conectivo fibroso de la mama que produce numerosos espacios que semejan estructuras vasculares. En la actualidad, la alternativa diagnóstica la provee la punción biopsia percutánea eco-dirigida o por estereotaxia, la que permite determinar la naturaleza de la lesión y descartar patología maligna, como el angiosarcoma, a fin de evitar la realización de biopsias quirúrgicas innecesarias. Presentamos dos casos que fueron categorizados en el control inicial por mamografía como BI-RADS 4c, lo que determinó la realización de una punción biopsia.Pseudoangiomatous stromal hyperplasia (PASH) is a rare benign breast lesion, which commonly affects premenopausal women. It occurs as a single node, which is mobile, firm and usually unilateral. PASH is characterized by a benign overgrowth of fibrous connective tissue of the breast, which produces numerous spaces resembling vascular structures. The diagnostic alternative is currently provided by the ultrasound guided percutaneous biopsy or stereotactic biopsy, which determines the nature of the lesion and rules out malignancy, such as angiosarcoma, in order to avoid unnecessary surgical biopsies. We present two lesions that were classified as BI-RADS 4c in the initial control by mammography, which led to a needle biopsy.

Dados epidemiológicos sobre oncologia infantil revelam que o avanço científico nesta área aumentou consideravelmente as hipóteses de cura. Com o aumento gradual das taxas de sobrevivência, deixou de haver um foco exclusivo na eminente morte da criança, passando o cancro pediátrico a ser considerado uma doença crónica prolongada. A forma como o confronto e adaptação à doença se processa no paciente e sua família constitui um importante objeto de estudo. O presente trabalho, de natureza exploratória, analisa a dimensão fenomenológica e as repercussões psicossociais da doença oncológica pediátrica em crianças/ adolescentes e seus pais, mais especificamente: as dificuldades, necessidades e preocupações vivenciadas desde o seu diagnóstico até uma fase terminal. Concomitantemente, procuram-se analisar as medidas de intervenção existentes nos serviços de oncologia pediátrica em estudo e o seu contributo para a promoção do bem-estar. Realizaram-se 30 entrevistas semi-estruturadas com profissionais das áreas da saúde, educação, serviço social e psicologia que acompanham diretamente estas famílias nos serviços de ambulatório e internamento do Hospital de S. João e do Instituto Português de Oncologia do Porto. Adicionalmente, realizaram-se três grupos focais com palhaços profissionais da Operação Nariz Vermelho. Também aqui foram exploradas as suas perceções relativamente às preocupações, necessidades e dificuldades destas famílias. A opção por uma abordagem indireta à fenomenologia destes processos decorreu de questões éticas: a necessidade de respeitar a integridade e sofrimento dos seus protagonistas. Ultrapassada a etapa de transcrição das entrevistas, encontra-se em curso o seu tratamento e análise por recurso ao programa de análise qualitativa de dados WebQDA. São apresentados resultados preliminares deste estudo.

Antimalarial drug resistance remains a major obstacle in malaria control. Evidence from Southeast Asia shows that resistance to artemisinin combination therapy (ACT) is inevitable. Ethnopharmacological studies have confirmed the efficacy of curcumin against Plasmodium spp. Drug interaction assays between curcumin/piperine/chloroquine and curcumin/piperine/artemisinin combinations and the potential of drug treatment to interfere with the ubiquitin proteasome system (UPS) were analyzed. In vivo efficacy of curcumin was studied in BALB/c mice infected with Plasmodium chabaudi clones resistant to chloroquine and artemisinin, and drug interactions were analyzed by isobolograms. Subtherapeutic doses of curcumin, chloroquine, and artemisinin were administered to mice, and mRNA was collected following treatment for RT-PCR analysis of genes encoding deubiquitylating enzymes (DUBs). Curcumin was found be nontoxic in BALB/c mice. The combination of curcumin/chloroquine/piperine reduced parasitemia to 37% seven days after treatment versus the control group’s 65%, and an additive interaction was revealed. Curcumin/piperine/artemisinin combination did not show a favorable drug interaction in this murine model of malaria. Treatment of mice with subtherapeutic doses of the drugs resulted in a transient increase in genes encoding DUBs indicating UPS interference. If curcumin is to join the arsenal of available antimalarial drugs, future studies exploring suitable drug partners would be of interest.

Partindo do princípio que o processo educativo em saúde é um dos processos de trabalho da enfermagem, e que o aprofundamento e busca de definições quanto ao mesmo é uma das grandes necessidades da profissão, as autoras apresentam conceitos básicos para uma fundamentação da assistência de enfermagem que recupere a articulação educação-cidadania, na perspectiva de uma visão dialética do processo de trabalho da enfermagem. O marco proposto inclui os conceitos de homem, sociedade, processo saúde-doença, sistemas de saúde, enfermagem, educação, participação, praxis e cidadania.

O texto apresenta uma síntese do filme "Mulher: Sonho, Razão e Poder", no qual as autoras discutem as relações de poder presentes no cotidiano de uma enfermeira. 0 eixo principal se estabelece em torno da condição da mulher e da enfermagem profissional na sociedade brasileira. A reflexão, enriquecida com recortes de vários .átudiosos contemporâneos do tema "poder", percorre três momentos: - o confronto consigo mesma, - o despertar para a realidade, e - a tomada de consciência do poder. O objetivo do trabalho foi estabelecer a trajetória do processo de amadurecimento pessoal e profissional que culmina numa nova visão de si e da profissão e recupera a consciência da diversidade e do potencial de oposição às forças que condicionam a realidade impondo-lhe novo rumo.

Resumo

Partindo do princípio que o processo educativo em saúde é um dos processos de trabalho da enfermagem, e que o aprofundamento e busca de definições quanto ao mesmo é uma das grandes necessidades da profissão, as autoras apresentam conceitos básicos para uma fundamentação da assistência de enfermagem que recupere a articulação educação-cidadania, na perspectiva de uma visão dialética do processo de trabalho da enfermagem. O marco proposto inclui os conceitos de homem, sociedade, processo saúde-doença, sistemas de saúde, enfermagem, educação, participação, praxis e cidadania.