Resumo Objetivos O presente estudo tem como objetivo caracterizar o equilíbrio sagital (SB, na sigla em inglês) espinhal em adultos jovens com nódulos de Schmorl (NS). Métodos Este é um estudo transversal de uma amostra composta por 47 adultos jovens. Ressonância magnética (RM) lombar foi usada para separar os pacientes em um grupo com NS e um grupo controle. Radiografias da coluna vertebral em pé foram usadas para comparar os parâmetros espinopélvicos do SB entre os grupos: eixo vertical sagital, cifose torácica, lordose lombar (LL), incidência pélvica (PI, na sigla em inglês), inclinação pélvica (PT, na sigla em inglês) e inclinação sacral (SS, na sigla em inglês). Resultados Os valores de LL e SS foram significativamente menores nos pacientes com NS em comparação com o grupo controle (54,5° versus 64,3°; 36,2° versus 41,4°, respectivamente). Não foram observadas diferenças significativas nos demais parâmetros. Os dois grupos apresentaram correlações significativas entre LL e SS, PI e PT e PI e SS. Conclusões Adultos jovens com NS apresentam modificações associadas ao SB, principalmente valores menores de LL e SS, em comparação com o grupo controle. Este perfil mais plano assemelha-se ao observado em pacientes com lombalgia e patologia discal em estágio inicial. Acreditamos que o NS seja um achado clínico relevante que deve levar ao estudo do SB de um paciente por poder revelar variações associadas aos primeiros estágios de degeneração discal. Nível de Evidência III

Abstract Objectives The present study aims to characterize the spinal balance (SB) in young adults with Schmorl nodes (SN). Methods A cross-sectional study was conducted on a sample of 47 young adults. Lumbar magnetic resonance imaging (MRI) was used to divide the patients into an SN group and a control group. Standing full spine radiographs were used to compare the spinopelvic SB parameters between groups: sagittal vertical axis, thoracic kyphosis, lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS). Results The LL and SS values were significantly lower in patients with SN when compared with the control group (54.5° versus 64.3°; 36.2° versus 41.4°, respectively). No significant differences were observed for the other parameters. Significant correlations were found in both groups between LL and SS; PI and PT; and PI and SS. Conclusions Young adults with SN have associated SB modifications, particularly lower LL and SS values, when compared with a control group. This flatter profile resembles that observed in patients with lower back pain and early disc pathology. We believe that SNs are relevant clinical findings that should prompt the study of the SB of a patient, as it may uncover variations associated with early disc degeneration. Level of Evidence III

ABSTRACT Introduction: Social disparities in chronic kidney disease are a reality. Low socioeconomic status is associated with increased incidence of chronic kidney disease and overall worse outcomes. In Portugal, similarly to many European countries, a National Health System was established to provide equity in healthcare access, but its impact in specialized chronic kidney disease care is unclear. This study aims to compare the effects of economic insufficiency in referral and overall specialized kidney care in a Portuguese center. Subjects and Methods: Retrospective cohort study evaluating maintenance hemodialysis patients of a Public Portuguese Nephrology Center from 2017 through 2021. Medical records were compared for presence of low-income status, with primary outcome as baseline estimated glomerular filtration rate at Nephrology referral and secondary outcomes as presence of kidney replacement therapy options appointment, timely vascular access assessment and time to dialysis from referral. Results: A total of 212 participants were evaluated, 96 with low-income status. This group presented higher serum creatinine and lower estimated glomerular filtration rate at referral (2.35 vs. 3.29 mg/dl, p<0.001; 27.63 vs. 18.47 ml/min/1.73 m2, p<0.001; respectively). Low-income status associated with absence of kidney replacement therapy options appointment (OR 2.7, 95% CI: 1.44-5.08; p=0.003) and late vascular access evaluation (OR 2.77, 95% CI: 1.55-4.98, p=0.001). Dialysis-free survival analysis revealed shorter time to dialysis in the low-income status group (15.77 vs. 20.71 months, p<0.001) with a higher cumulative incidence in dialysis at 24 months (HR: 2.11, 95% CI: 1.39-3.21, p < 0.001), a difference that was not verified after adjusting for estimated glomerular filtration rate at referral (HR: 1.16, 95 % CI: 0.74 - 1.80, p = 0.53). Conclusion: Low-Income chronic kidney disease Portuguese patients are at risk for late Nephrology referral, an established factor for adverse outcomes. Shorter time to dialysis appears significative in reducing adequate kidney care access, which can be attenuated through education of primary care providers and general population for chronic kidney disease.

ABSTRACT Introduction: Erythropoietin-stimulating agents hyporesponsiveness is common among hemodialysis patients. The aim was to analyze factors predictive of Erythropoietin-stimulating agent resistance and its association with mortality. Subjects and methods: Retrospective analysis of prevalent hemodialysis patients. Dose-response effect of Erythropoietin-stimulating agent therapy was evaluated using Erythropoietin-stimulating agent resistance index (ERI). Patients were classified in groups (ERI≤10 and ERI>10). All-cause mortality was assessed using standard survival methods. Results: Among 59 patients, 24 had ERI>10. Patients with ERI >10 had more central venous catheters, higher C-reactive protein levels, lower body mass index, serum iron, transferrin saturation, albumin and intact parathormone levels. Hyporesponsive patients had an increased risk of one-year mortality. Discussion and conclusion: Our study confirmed that malnutrition, inflammation, and iron deficiency are the main causes of Erythropoietin-stimulating agent hyporesponsiveness, and intact parathormone levels and central venous catheter use may also play a role. Erythropoietin-stimulating agent resistance appear to be associated with an increased mortality risk among prevalent hemodialysis patients.

Objetivo: A epifisiólise femoral proximal (EFP) é o distúrbio mais frequente na anca do adolescente. A fixação in situ da epífise femoral é um dos tratamentos cirúrgicos com resultados consistentes, mas as consequências a longo prazo da sua fixação em posição não anatómica têm sido alvo de debate. Este trabalho teve por objetivo a avaliação retrospetiva dos resultados clínicos e funcionais de doentes submetidos a fixação in situ de EFP entre 1989-1999. Materiais e Métodos: Os pacientes submetidos a fixação in situ da epífise femoral por EFP entre 1989 e 1999, na nossa instituição, foram convocados a avaliação clínica presencial e avaliação funcional e de qualidade de vida com questionário HOOS e SF-36v2. Foram criados dois grupos de pacientes, segundo a classificação de Wilson. Os grupos foram comparados utilizando ferramentas estatísticas (t-test, teste exato de Fisher e ANOVA). Resultados: A amostra estudada foi de 27 pacientes (um total de 32 ancas). Na avaliação clínica não se identificaram diferenças entre os grupos. Na avaliação de resultados funcionais, o grupo II apresentou resultados do score funcional HOOS mais baixos que os casos grau I, e resultados do score SF-36 mais baixos do que o grupo I e do que os valores padronizados da população portuguesa. Conclusões: Embora alguns estudos apontem para uma semelhança de resultados a longo prazo para fixação in situ em desvios ligeiros e moderados, neste estudo observa-se uma diferença significativa entre estes grupos, constatando-se que o grau de deslizamento metafisário determina um pior resultado funcional a longo prazo.

Objective: Slipped capital femoral epiphysis (SCFE) is the most frequent disorder of the adolescent's hip. In situ fixation of the femoral epiphysis is one of the surgical treatments with consistent results, but the long-term consequences of the fixation of the femoral epiphysis in a non-anatomical position have been debated. This study aimed to retrospectively evaluate the clinical and functional results of patients subjected to in situ fixation of SCFE, between 1989-1999. Materials and Methods: Patients subjected to in situ fixation of femoral epiphysis for SCFE between 1989-1999, in our institution, were invited to clinical examination plus functional and quality-of-life assessment with HOOS and SF-36v2 questionnaires. Two groups of patients were created according to Wilson’s classification. The groups were compared using statistical tools (t-test, Fisher exact test and ANOVA). Results: A sample of 27 patients (a total of 32 hips) was studied. In the clinical evaluation, no differences were identified between groups. In the evaluation of functional results, group II presented lower HOOS scores than grade I cases, and SF-36 scores lower than group I and of the standardized values for the portuguese population. Conclusions: Although some studies point to a similarity of long-term results for in situ fixation in mild and moderate SCFE, a significant difference between these groups is observed in this study, showing that the degree of metaphyseal slip determines a worse long-term functional outcome.

As sequelas das lesões traumáticas da espinal medula representam um elevado prejuízo pessoal, familiar e social. Desde 1984, foi investigado e proposto o tratamento com succinato sódico metilprednisolona em altas doses, como forma de reverter ou prevenir o agravamento dessas lesões. Apresentamos uma revisão da literatura sobre essa temática. Sabe-se que essa terapêutica tem uma elevada taxa de complicações, mas, acerca das suas vantagens e real eficácia, não existe concordância entre autores de trabalhos. Enquanto uns a defendem, outros chegam a considerar provada a sua total contraindicação nessa patologia. Já existem, em nível mundial, alguns centros que não fazem a sua administração. Em Portugal é prática generalizada a sua utilização. Não o fazer poderia mesmo ser difícil de defender em situação de litígio. Mas será que estamos mesmo a ajudar os nossos doentes?

Sequelae of the traumatic injuries to the spinal cord represent a high personal, family and social damage. Since 1984, it has been investigated and considered that the treatment with sodium succinate methylprednisolone in high doses was a solution to revert or to prevent the aggravation of such injuries. We present a revision of literature on this subject. It is well established that this therapeutic has a high rate of complications, but concerning its advantages and real effectiveness, there is no agreement between paper authors. While some defend it, others state that this is a total contraindication in this pathology. There are already some medical centers worldwide that do not use it. In Portugal, the practice of its administration is generalized. Not to do it could be difficult to defend in a litigation situation. But are we really helping our patients with it?

Las secuelas de las lesiones traumáticas de la médula espinal representan una gran pérdida personal, familiar y social. Desde el 1984, se investigó y se ofreció tratamiento con succinato sódico de metilprednisolona en altas dosis, como una forma de revertir o prevenir el empeoramiento de estas lesiones. Los autores presentan una revisión de la literatura sobre este tema. Se sabe que esta terapia tiene un alto índice de complicaciones. Sin embargo, sobre sus ventajas y eficacia real, no hay acuerdo entre las publicaciones. Mientras que algunas la defienden y otros llegan a tomar como prueba de su contraindicación total en esta patología.Ahora, existen en todo el mundo, algunos centros que no hacen su administración. En Portugal, se encuentra en uso generalizado. No hacerlo sería difícil de defender en situaciones de conflicto. ¿Pero, es esto una real ayuda a nuestros pacientes?