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Introduction: Neonatal isolated suppurative submandibular sialadenitis (NISSS) is uncommon. The first case was described by Shulman in 1950, and since then there have been 39 more cases reported. NISSS is more frequent in preterm neonates in contrast with acute suppurative parotitis, which is mainly present in term neonates. We report a case of NISSS, which highlights the features of diagnosis, treatment, and prognosis. Case presentation: A premature female was born at 27 weeks and 3 days of gestation from a 22-year-old Caucasian female with good prenatal care. On the 28th day of life, the infant developed suspected sepsis, and on the next day, the infant presented with a red indurated swelling of the left submandibular area. When the oral cavity was examined, spontaneous discharge of pus from the orifice of the left Wharton’s duct could be visible. The ultrasound examination confirms the diagnosis of acute submandibular sialadenitis. Bacteriological analysis of the purulent discharge from Wharton’s duct isolated heavy growth of methicillin-resistant Staphylococcus aureus (MRSA), and the blood cultures were negative. The infant completed 14 days of vancomycin and 10 days of gentamicin. Conclusion: Although rare, NISSS should not be forgotten as a differential diagnosis in premature infants presenting with submandibular mass with inflammatory signs. Empiric antimicrobial therapy should include S. aureus coverage with vancomycin treatment in areas where MRSA is common until sensitivities are known.

Epidemiologic data suggest an increasing incidence of congenital syphilis (CS) in developed countries in recent years. Fetal infection by Treponema pallidum can cause a wide spectrum of clinical manifestations, including stillbirth and prematurity. The physician should always consider infections caused by toxoplasmosis, rubella, cytomegalovirus, herpes simplex virus, and other agents (TORCH) when facing a severely ill preterm neonate. The authors describe 2 very similar cases of severe CS in preterm newborns, both of whom were admitted to the Neonatal Intensive Care Unit. At birth, in addition to severe respiratory distress needing invasive ventilation, the neonates presented with ascites, hepatosplenomegaly, and hydrocele. The preliminary evaluation revealed anemia and thrombocytopenia, which required aggressive transfusion support. Increased inflammatory parameters and cholestasis were also noted. Based on the clinical signs and analytic alterations, TORCH infections were suspected. An investigation was conducted and both neonates had treponemal and non-treponemal positive tests. Both mothers had reactive serologies at the time of delivery, which was previously unknown. Other viral and bacterial infections were excluded. Ultrasonograms of the brains were unremarkable. Ophthalmologic, audiologic, and bone screenings were negative. The neonates received a course of treatment with aqueous crystalline penicillin G for 14 days, and had good outcomes. The diagnosis of CS can be difficult because most infants are asymptomatic at birth and rarely present with severe disease, as shown by our cases. To make a correct diagnosis, it is important to compare treponemal and non-treponemal tests from the mother and newborn because serologies are difficult to interpret. The cases described herein are a reminder of the importance of screening and treatment for these infections during pregnancy and at the time of delivery. It is essential to prioritize health investments in screening programs and to allocate specialized healthcare staff so that syphilis can be treated earlier in the population of reproductive age.

A encefalite neonatal a parechovirus é uma situação potencialmente grave e que pode originar sequelas neurológicas irreversíveis. Descreve-se o caso de um recém-nascido com encefalite a parechovirus, cuja sintomatologia inicial foi irritabilidade e recusa alimentar. Posteriormente apresentou convulsões, de difícil cedência à terapêutica farmacológica. O eletroencefalograma e a ressonância magnética crânio-encefálica mostraram-se alterados, as análises séricas não revelaram parâmetros de infeção, assim como os exames citológico e bacteriológico do líquido cefalorraquidiano. O diagnóstico foi efetuado por método Polymerase Chain Reaction (PCR) do líquido cefalorraquidiano. O recém-nascido apresentou boa evolução clínica. A propósito deste caso alerta-se para a variabilidade clínica desta infeção, dependendo do serotipo viral, e para a sintomatologia inespecífica, gravidade clínica e evolução célere da doença no período neonatal. Realçamos a necessidade da caracterização epidemiológica nacional, quanto à prevalência dos vários subtipos de parechovirus, e da realização de mais estudos sobre esquemas de imunização e terapêutica antiviral eficazes, face ao risco elevado de doença neurológica grave.

A qualidade dos serviços de saúde prestados tem uma importância fulcral na satisfação dos utentes em geral, uma vez que as suas opiniões são baseadas nas experiências. Com este estudo pretendemos identificar o grau de satisfação dos utentes, utilizando os indicadores EUROPEP e os das áreas específicas; determinar em que medida as variáveis do estado de saúde influenciam a satisfação dos utentes; descrever o nível de satisfação dos utentes em relação às dimensões de enfermagem, médicas, administrativas e funcionamento geral da Unidade de Saúde; determinar em que medida as variáveis sociodemográficas influenciam a satisfação; compreender de que modo os fatores sociodemográficos interferem na satisfação dos utentes face do estado de saúde sobre a satisfação e promover a melhoria dos cuidados de saúde aos utentes da Unidade de Saúde de Tondela. Este é um estudo quantitativo, descritivo-correlacional e transversal, envolvendo uma amostra de 1343 utentes (idade média=53,32 anos; desvio padrão=19,498 anos). Fez-se a colheita de dados com base no EUROPEP. Concluiu-se que não existem diferenças significativas entre o sexo e a satisfação dos utentes. Relativamente à idade e à satisfação, verificou-se que existem diferenças significativas entre os indicadores, Continuidade e Cooperação, Atitudes após Experiência e Dimensão Interpessoal e Instrumental; a Pertinência revela diferenças altamente significativas. Quanto ao nível de literacia, existem diferenças bastante significativas no indicador Relação de Ajuda e diferenças altamente significativas nos indicadores Profissionais e Pertinência. Em relação ao estado geral de saúde e satisfação, constatou-se que não existem diferenças significativas.

Actinomycosis is a rare disorder caused by an anaerobic gram-positive bacillus (Actinomyces), predominantly by the Actinomyces israelii species. Only 20% of cases show an abdominal manifestation, the appendix and ileocecal valve being the most frequent locations. Definitive diagnosis is based on microbiological cultures, microscopy or macroscopy examination. Nevertheless, histological examination of the percutaneous biopsy and blood microbiological cultures are rarely positives. Preoperative diagnosis is hampered by the lack of specific clinical and imaging manifestations, which often mimic malignancy. The rate of preoperative diagnosis is less than 10%, however, the outcome is excellent, with a low mortality rate. The authors describe the case of a patient who was diagnosed with primary hepatic actinomycosis only by a histological examination of the surgical specimen of left hepatectomy extended to segments V and VIII, for suspected malignant lesion. This case demonstrates the difficulties in diagnosing hepatic actinomycosis.

Objective. This prospective open trial aimed to evaluate the efficacy and safety of isotretinoin (13-cis-retinoic acid) in patients with Cushing’s disease (CD). Methods. Sixteen patients with CD and persistent or recurrent hypercortisolism after transsphenoidal surgery were given isotretinoin orally for 6–12 months. The drug was started on 20 mg daily and the dosage was increased up to 80 mg daily if needed and tolerated. Clinical, biochemical, and hormonal parameters were evaluated at baseline and monthly for 6–12 months. Results. Of the 16 subjects, 4% (25%) persisted with normal urinary free cortisol (UFC) levels at the end of the study. UFC reductions of up to 52.1% were found in the rest. Only patients with UFC levels below 2.5-fold of the upper limit of normal achieved sustained UFC normalization. Improvements of clinical and biochemical parameters were also noted mostly in responsive patients. Typical isotretinoin side-effects were experienced by 7 patients (43.7%), though they were mild and mostly transient. We also observed that the combination of isotretinoin with cabergoline, in relatively low doses, may occasionally be more effective than either drug alone. Conclusions. Isotretinoin may be an effective and safe therapy for some CD patients, particularly those with mild hypercortisolism.

Resumo: A doença de Kawasaki (DK) é uma vasculite sistémica, de etiologia desconhecida, constituindo a principal causa de cardiopatia adquirida em idade pediátrica em países desenvolvidos. As principais complicações resultam do aparecimento de aneurismas coronários que podem evoluir para doença coronária isquémica.Apresenta-se o caso clínico de um adolescente com diagnóstico de DK aos 7 anos. Efetuou terapêutica com imunoglobulina e ácido acetilsalicílico e a avaliação ecocardiográfica na fase aguda foi aparentemente normal. Aos 11 anos de idade desenvolveu quadro de angor e dispneia de esforço. A cintigrafia de perfusão miocárdica com prova de esforço revelou hipoperfusão dos territórios correspondentes às artérias descendente anterior esquerda (DA) e coronária direita (CD). O cateterismo cardíaco demonstrou oclusão dos segmentos proximais de ambas as artérias. Foi submetido a cirurgia de revascularização coronária (artéria mamária interna para a DA e veia safena interna para a CD) com boa evolução clínica e desaparecimento das alterações isquémicas na cintigrafia.Este caso clínico vem alertar para a importância do diagnóstico e terapêutica atempados e seguimento posterior na DK, salientando-se a potencial gravidade das complicações cardiovasculares a longo prazo desta doença pediátrica. Abstract: Kawasaki disease (KD) is a systemic vasculitis of unknown etiology, which is the main cause of acquired heart disease in children in developed countries. The main complications result from the development of coronary aneurysms which can lead to ischemic heart disease.We present the case of a teenage boy with a diagnosis of KD at the age of seven. He was treated with gammaglobulin and aspirin and echocardiographic evaluation in the acute phase was apparently normal. At the age of eleven, he developed chest pain and exertional dyspnea. Nuclear perfusion scans with exercise revealed hypoperfusion of the left anterior descending (LAD) and right coronary (RC) artery territories. Cardiac catheterization showed occlusion of the proximal segments of both arteries. He underwent coronary artery bypass graft surgery (internal mammary artery bypass graft to the LAD artery and saphenous vein graft to the RC artery), with a good clinical result.This case report highlights the importance of early diagnosis and treatment of KD and regular cardiological follow-up, bearing in mind the potential late complications of this pediatric disease. Palavras-chave: Doença de Kawasaki, Aneurismas coronários, Cirurgia de revascularização coronária, Keywords: Kawasaki disease, Coronary aneurysm, Coronary artery bypass

Recensão crítica ao espectáculo Título: Ocidente (Occident, 2005). Autor: Rémi De Vos. Tradutora: Regina Guimarães. Encenador: Victor Hugo Pontes. Cenografia: F. Ribeiro. Desenho de luz: Wilma Moutinho. Desenho de som: Luís Aly. Piano (banda sonora): Pedro Frias. Interpretação: Maria do Céu Ribeiro e Pedro Frias. Co-produção: Ao Cabo Teatro / As Boas Raparigas… / Centro Cultural Vila Flor. Local e data de apresentação: TeCA, Porto, 9 de Maio de 2014.

It is probable that the town of Miranda do Corvo has developed around the mound of the old castle, an important fortification in the defense of Coimbra during the 'Reconquista'. However, nothing is known about its history. It is almost certain that the toponym Miranda has Latin origin, related to the function of the hill as a lookout. However, the first documentary reference to this village appears in the tenth century, and its castle appears only mentioned after the twelfth century. Today, however, virtually nothing remains of medieval fortification, except a tower – current bell tower of the church – that would be part of the wall, as well as the cistern, located at the top of the hill.The archaeological work here presented, performed at the request of the Municipality, takes place under the project Rede Urbana dos Castelos e Muralhas Medievais do Mondego, in order to carry out a rehabilitation program.

In recent years, the time for motherhood has been postponed, which is related to social aspects and can lead to health problems for the pregnant women and the child. An appropriate follow-up of the pregnancy is essential for identification and early treatment of possible complications. The purpose of this study was to evaluate some social and demographic characteristics and the pregnancy follow-up among puerperas, in two different times separated by 17 years (1991 e 2008). In this study, we found that the birth of a first child occurs now later, is more planned and happens more frequently outside of marriage. The postponement of motherhood can be associated with an increased rate of miscarriages. There has been a decrease in the rate of induced abortions, which is probably the result of the implementation of strategies for family planning. We noticed a decline in the number of pregnancies that had not a proper follow-up, demonstrating the improvement of health care. The immigrant population is responsible for about one quarter of the births in the Algarve, with a higher percentage of unplanned pregnancies, which eventually might be related to socio-economic vulnerabilities, but no difference was found in the surveillance of pregnancy, demonstrating a good accessibility of this population to health care. It is essential the existence of information about the risks of a late pregnancy and of social infrastructures to support motherhood at younger ages. Pregnancy surveillance programs have been successful, but there are still gaps in obstetric monitoring. Despite good results in terms of surveillance of pregnancy, the immigrant population may present some vulnerabilities, which means that their access to maternal and child health care should be monitored.

Turner syndrome is one of the most frequent chromosome disorders in clinical practice. It is characterized by a multisystemic involvement, responsible for a high morbidity and an increased mortality at all ages. Therefore it is essential that there is a continuous and integrated approach in reference centers to improve the quality of life and prevent early mortality. There has been a growing interest in the scientific community to achieve these goals, with the publication of clinical guidelines. This article intends to review these guidelines, with particular emphasis on a multidisciplinary care of these patients from the age of diagnosis and throughout their adult life.

Introdução: Esta publicação pretende divulgar uma metodologia de articulação inter-institucional. Desde 2000, equipas do Centro de Saúde de Tábua e do Departamento de Pedopsiquiatria do Hospital Pediátrico (Centro Hospitalar de Coimbra) reúnem periodicamente com vista à triagem, discussão e supervisão de casos clínicos com problemáticas na área da Psiquiatria da Infância e Adolescência. Após sete anos de trabalho conjunto, é feita reavaliação desta parceria complementada com a análise estatística de 2007. Objectivos: Melhorar a acessibilidade, triar e supervisionar casos clínicos, promover a circulação bidireccional de informação clínica, rentabilizar recursos e promover a formação de médicos de família e psicólogos. Metodologia: Reuniões interdisciplinares presenciais mensais; contacto escrito e telefónico. Resultados: Realizaram-se oito reuniões/ano; foram discutidos em média 3,75 primeiros casos/reunião; dos 30 novos casos discutidos em 2007, 40% necessitaram de consulta no Departamento de Pedopsiquiatria; 60% necessitaram apenas de intervenção do Centro de Saúde; lista de espera de cinco semanas (média); motivos mais frequentes de discussão: problemas de comportamento e aprendizagem, disfuncionalidade familiar inerente a psicopatologia familiar e troca de informações bilateral. Discussão:Aumento de primeiros casos, devido provavelmente à integração de um novo médico de família na consultadoria; decréscimo de primeiros casos orientados para o Departamento devido à boa qualidade do trabalho desenvolvido nos Cuidados Primários; motivos de referenciação/discussão entre o médico de família e o psiquiatra em concordância com a bibliografia consultada. Conclusões: com esta parceria, existe maior participação e mobilização dos recursos locais, menor necessidade de deslocação das famílias para consultas no Departamento de Pedopsiquiatria, diminuição das listas de espera e altas mais precoces.Apenas não alcançámos o objectivo dos estágios de formação, por falta de técnicos locais (nomeadamente psicólogos). Existem poucas equipas a trabalhar em consultadoria. Sugere-se maior implementação deste modelo organizacional que fortaleça a ligação entre Cuidados de Saúde Primários e Secundários.

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