Abstract Introduction: In 2018, an observational study developed at a Portuguese Primary Care Health Unit estimated a mild cognitive impairment (MCI) prevalence of 29.1%, with an association between better performance in Montreal Cognitive Assessement (MoCA) test and reading of newspapers and books or hobbies. The objective of the present project was to improve the cognitive capacity of the elderly with MCI through cognitive training activities. Methods: We conducted an intervention project in a Primary Care Health Unit, with a sample of 20 elderly with MCI. Cognitive training sessions took place with delivery of homework exercise books. The Portuguese version of MoCA was applied at zero, three and six months to evaluate cognitive performance. Results: At the beginning of the study, the median MoCA score was 18.5. After six months, a median score of 23 was observed. There was an improvement in the global score at all cognitive domains except language and orientation. Conclusion: The cognitive performance improved after the six months period achieving our purpose. Cognitive training has a potential beneficial effect on the health of the elderly population and requires simple, low-cost materials that can be applied in nursing homes and day care centers through caregivers.

Resumo Introdução: Em 2018, um estudo de investigação realizado numa Unidade de Saúde Familiar (USF) estimou uma prevalência de défice cognitivo ligeiro (DCL) de 29,1%, verificando-se uma associação entre o melhor desempenho no teste Montreal Cognitive Assessement (MoCA) com a leitura de jornais e livros e a realização de passatempos. O objetivo do projeto foi melhorar a capacidade cognitiva nos idosos com DCL através de atividades de treino cognitivo. Métodos: Projeto de intervenção realizado numa USF com uma amostra de 20 idosos com DCL. Decorreram sessões presenciais de treino cognitivo e foram entregues cadernos de trabalhos de casa. Foi aplicado o MoCA versão portuguesa aos zero, três e seis meses para avaliação do desempenho cognitivo. Resultados: No início do estudo, a pontuação mediana no MoCA foi 18,5. Após seis meses, registou-se uma pontuação mediana de 23. Verificou-se uma melhoria da pontuação global em todos os domínios cognitivos, com exceção da linguagem e da orientação. Conclusão: O objetivo foi atingido pela melhoria do desempenho cognitivo após seis meses de estudo. O treino cognitivo tem um potencial efeito benéfico na saúde da população idosa e requer materiais de simples elaboração e baixo custo que podem ser aplicados em lares de idosos e centros de dia através dos cuidadores.

ABSTRACT Renal hypouricemia (RHUC) is an autosomal recessive disease caused by the dysfunction of uric acid (UA) transporters in the proximal tubule causing increased fractional excretion of uric acid (FEUA). It is associated with mutations of SLC22A12 that codifies for URAT1, involved in RHUC type 1, or SLC2A9 which codifies for GLUT9 and is involved in RHUC type 2. We present the case of a man diagnosed with RHUC type 2 following hospitalization for acute kidney injury (AKI). A 43-year-old was hospitalized due to AKI after a 20 km walk at an outdoor temperature of 30°C. On the objective examination, he was dehydrated. Blood tests presented severe azotemia (creatininemia 16.43 mg/dL, uremia 254 mg/dL), UA 3.6 mg/dL, fosfatemia 6 mg/dL, Na 138 mEq/L, K 4.2 mEq/L, Cl 102 mEq/l, arterial gasometry with pH 7.35, pCO2 36 mmHg, HCO3 20 mmol/L, lactates 1.4 mmol/L. Urine test with proteinuria and unremarkable sediment. His kidneys had foci of microlithiasis. He started vigorous fluid therapy and sustained improvement in renal function was seen, with no need for renal function replacement therapy. The subsequent evaluation showed hypouricemia <1.5 mg/dL and FEUA of 32.5% (normal range 5.5%-8.5%). The molecular study identified the variant c.1221del p.(His407Glnfs*8) in the SLC2A9 gene in homozygosis, which established the diagnosis of RHUC type 2. This case highlights the importance of recognizing hereditary RHUC to prevent its manifestations, including exercise-induced AKI, nephrolithiasis, nephrocalcinosis, and more rarely, progression to stage 5 CKD. Its diagnosis should be considered in individuals with serum UA <2 mg/dL and elevated FEUA. Additionally, it should be confirmed by the identification of mutations in homozygous or compound heterozygous in SLC22A12 or SCL2A9. Treatment includes xanthine oxidoreductase inhibitors and adequacy of physical activity. The use of uricosuric antihypertensive drugs whose mechanism of action involves blocking the URAT1 transporter should be avoided.

Vanadis®8 is a high-value tool steel, that undergoes gas atomization and hot isostatic pressing during production , resulting in costly waste. Repurposing this waste material through powder metallurgy (PM) offers a cost-effective solution. This study explores the PM process applied to Vanadis®8 steel scraps, involving high energy ball milling, uniaxial pressing, and sintering. The final product and the as-received steel underwent heat treatments, including quenching and tempering. Microstructural evaluation employed X-ray diffraction and scanning electron microscopy, while physical evaluation entailed Archimedes density measurements. Mechanical analysis was carried out through microhardness and compression strength tests. Results revealed that optimal milling conditions were achieved at 30 hours with 400 rpm (s-1). Vanadis®8 steel produced through PM attained 85% densification compared to the as-received material (6.31 g/cm3). MC-type carbides were present in all evaluated conditions. Heat treatments improved mechanical values for all conditions, suggesting that PM-produced Vanadis®8 steel, subjected to quenching and tempering, presents a viable reuse option.

Abstract The purpose of circular economy is to maximize resources efficiency. With the increase in consumption of raw materials, energy and waste generation, recycling is necessary for environmental and industrial reasons. Thus, the powder metallurgy, together with mechanical milling, stands as a new method for scraps recycling. This study aimed to produce UNS S31803 duplex stainless steel powders, with vanadium carbide (VC) addition as reinforcement, through mechanical milling. Different uniaxial compaction pressures (700, 800 and 900 MPa) were used, as well as sintering temperatures (1200, 1240 and 1280 °C) and times (1, 1.5 and 2 hours), in order to determine the best conditions. Particle size analysis, scanning electron microscopy and x-ray diffraction were used to characterize the powders. It was observed that the use of VC increased the comminution during the milling process, being obtained an average particle size of 42 μm. The highest density obtained was of 82% and hardness of 72%, in comparison with the steel from the manufacturing process. According to the analysis, it was verified that this method is viable, becoming an alternative route to reuse UNS S31803 duplex stainless steel scraps.

Abstract In this paper, Fe-15at.%Nb alloys were produced from high purity Fe (min. 99.8%) and Nb (min. 99.8%) powders via a mechanical alloying process. The effects of different Process Control Agents (i.e., methanol, hexane, and stearic acid) were investigated with powder morphologies, particle size distribution, and phase formation, and were sampled after up to 80 milling hours at 350 rpm. The powder morphologies and particle sizes were evaluated using scanning electron microscopy and laser diffraction analysis, respectively, and phases were identified via X-ray powder diffractometry. The results demonstrate for all conditions that, in the early stages, there was significant particle agglomeration due to the ductile-ductile feature of Fe and Nb powders, and latter an amorphization trend up to 80 milling hours. Methanol was the most efficient Process Control Agent in terms of avoiding cold welding, reducing of agglomeration, particle size distribution, reducing contamination and crystallinity reduction rate.

Abstract Introduction and objectives: The use of neuromuscular blockers during surgery represented a landmark for anesthesiology. However, their use can prompt residual Neuromuscular Blockade (RNMB) and objective monitoring of neuromuscular function is crucial to warrant the recovery of muscle strength. The present study aimed to estimate the incidence of RNMB and late Neuromuscular Blockade (LNMB) at the Post-Anesthetic Recovery Unit (PACU). Method: The study included 85 patients, 43 of which received cisatracurium and 42 of which, rocuronium. The depth of the Neuromuscular Blockade (NMB) was assessed by Train Of Four (TOF). NMB reversal was performed with the administration of neostigmine and atropine.RNMB was defined when a patient presented TOF below 90% at the PACU. Results: RNMB at the PACU was diagnosed in 39.5% and 40.5% of the patients receiving cisatracurium and rocuronium, respectively (p= 1.0). LNMB at the PACU was found in 32.6% and 16.7% of the patients receiving cisatracurium and rocuronium, respectively (p= 0.131). Conclusions: The incidence ofRNMB remains significant despite the use of intermediate-acting neuromuscular blockers and reversal agents. There was no statistically significant difference in the incidence of RNMB or LNMB in patients receiving cisatracurium or rocuronium. The use of objective NMB monitoring is effective for the diagnosis of RNMB, as well as for treatment management.

RESUMO Objetivo Avaliar a acurácia de uma estratégia de rastreamento de hipertensão pulmonar baseada na combinação de dados de ecocardiograma com as medidas derivadas da tomografia computadorizada (diâmetro da artéria pulmonar e razão entre diâmetro da artéria pulmonar e diâmetro da aorta ascendente) em pacientes pneumopatas crônicos encaminhados para transplante pulmonar. Métodos Estudo observacional retrospectivo realizado com pacientes com enfisema e fibrose pulmonar avaliados para transplante entre 2012 e 2016. Definiu-se hipertensão pulmonar como pressão arterial pulmonar média ≥25mmHg, ou entre 21 a 24mmHg, com resistência vascular pulmonar >3 unidades Wood no cateterismo direito. As medidas tomográficas foram realizadas por dois radiologistas independentes. Resultados Foram incluídos 13 pacientes com enfisema e 19 com fibrose pulmonar, sendo 18 com hipertensão pulmonar. Houve alta concordância entre os radiologistas em relação às medidas tomográficas (coeficientes de correlação intraclasse para diâmetro da artéria pulmonar de 0,936 e diâmetro da artéria pulmonar/diâmetro da aorta ascendente de 0,940). As áreas abaixo da curva ROC de diâmetro da artéria pulmonar, diâmetro da artéria pulmonar/diâmetro da aorta ascendente, e pressão sistólica da artéria pulmonar como preditores de hipertensão pulmonar foram 0,540, 0,629 e 0,783, respectivamente. A sensibilidade, especificidade e valor preditivo negativo da pressão de sistólica de artéria pulmonar ≥40mmHg foram 67%, 79% e 65%, respectivamente. O critério combinado de diâmetro da artéria pulmonar/diâmetro da aorta ascendente >1 e/ou pressão sistólica da artéria pulmonar ≥40mmHg mostrou sensibilidade de 72%, especificidade de 79%, e valor preditivo negativo de 69%. Conclusão Os diâmetros da artéria pulmonar e da aorta ascendente foram altamente reprodutíveis. A associação entre diâmetro da artéria pulmonar e diâmetro da aorta ascendente >1 e/ou pressão sistólica da artéria pulmonar ≥40mmHg melhorou a sensibilidade e o valor preditivo negativo para rastreamento de hipertensão pulmonar. Essa estratégia requer validação prospectiva para se avaliarem segurança e custo-efetividade.

ABSTRACT Objective To examine the accuracy of a pulmonary hypertension screening strategy based on a combination of echocardiographic data and tomographic measurements (pulmonary artery diameter and pulmonary artery diameter to ascending aorta diameter ratio) in patients with chronic lung disease referred for lung transplantation. Methods A retrospective observational study with patients with pulmonary emphysema or fibrosis referred for transplantation between 2012 and 2016. Pulmonary hypertension was defined as mean pulmonary artery pressure ≥25mmHg, or between 21 and 24mmHg, with pulmonary vascular resistance >3 Wood units on right heart catheterization. Tomographic measurements were made by two independent radiologists. Results This sample comprised 13 patients with emphysema and 19 patients with pulmonary fibrosis. Of these, 18 had pulmonary hypertension. The level of agreement in tomographic measurements made by radiologists was high (intraclass correlation coefficients 0.936 and 0.940, for pulmonary artery diameter and pulmonary artery diameter to ascending aorta diameter ratio, respectively). Areas under the ROC curves constructed for pulmonary artery diameter, pulmonary artery diameter to ascending aorta diameter ratio, and pulmonary artery systolic pressure as predictors of pulmonary hypertension were 0.540, 0.629 and 0.783, respectively. The sensitivity, specificity and negative predictive value of pulmonary artery systolic pressure ≥40mmHg were 67%, 79% and 65%, respectively. The combined criterion (pulmonary artery diameter to ascending aorta diameter ratio >1 and/or pulmonary artery systolic pressure ≥40mmHg) achieved sensitivity of 72%, specificity of 79%, and a negative predictive value of 69%. Conclusion Measurements of pulmonary artery and ascending aorta diameter were highly reproducible. The association of pulmonary artery and aortic diameter >1 and/or pulmonary artery systolic pressure ≥40mmHg improved the sensitivity and the negative predictive value for pulmonary hypertension screening. This strategy demands prospective validation to assess safety and cost-effectiveness.

Abstract The Vanadis® 8 is a tool steel used in the manufacture of dies, punches and tools. It has a high carbon content combined with chromium, molybdenum and vanadium, and presents good performance in its mechanical properties. Usually, its chips obtained by machining are sold to companies that use remelting. However, this technique is considered expensive and harmful to the environment. Therefore, this work aimed to analyze the efficiency of the addition of vanadium carbide (VC) and molybdenum carbide (Mo2C) in the high energy ball milling of the Vanadis® 8 steel. Microstructural analysis were performed in the pure steel and with 3% of VC and Mo2C additions. The milling parameters used were: speed of 350 rpm, ball-to-powder weight ratio of 15:1 and times of 4, 8 and 12 hours. The results indicated that the Vanadis® 8 steel milled with VC presented the best microstructural results in all of the conducted tests.

Marco contextual: La disfunción sexual en la persona con enfermedad renal crónica es progresiva, y se verifica un agravamiento con el deterioro de la función renal. El trasplante renal puede restaurar la función sexual en la mayoría de estas personas, sin embargo, pueden persistir muchos problemas sexuales. Objetivos: Caracterizar la función sexual de la persona con trasplante renal y analizar su relación con las variables demográficas y clínicas. Metodología: Se trata de un estudio descriptivo-correlacional, realizado a partir de una muestra de conveniencia de 139 personas con trasplante renal. Los datos se recogieron mediante un cuestionario de caracterización sociodemográfica y clínica, así como mediante el Índice de Evaluación del Funcionamiento Sexual y el Inventario de Depresión de Beck. Resultados: La tasa de prevalencia de la disfunción sexual en la persona con trasplante renal es elevada (> 90%), y el deseo sexual es la dimensión más afectada. La función sexual se ve influenciada por la edad, los estados depresivos y la presencia del ciclo menstrual. Conclusión: Considerando la prevalencia de la disfunción sexual, es importante que en la práctica clínica los enfermeros integren los resultados de la investigación y promuevan la salud sexual.

Enquadramento: A disfunção sexual na pessoa com doença renal crónica é progressiva, verificando-se um agravamento com a deterioração da função renal. O transplante renal pode restaurar a função sexual na maioria destas pessoas, no entanto, muitos problemas sexuais podem persistir. Objetivos: Caracterizar a função sexual da pessoa transplantada renal e analisar a sua relação com as variáveis demográficas e clínicas. Metodologia: Trata-se de um estudo descritivo-correlacional, realizado a partir de uma amostra de conveniência de 139 pessoas transplantadas renais. Os dados foram colhidos com recurso a um questionário de caracterização sociodemográfica e clínica, e ao Índice de Avaliação do Funcionamento Sexual e ao Inventário Depressivo de Beck. Resultados: A taxa de prevalência de disfunção sexual na pessoa transplantada renal é elevada (> 90%) sendo o desejo sexual a dimensão mais afetada. A função sexual é influenciada pela idade, estados depressivos e presença de ciclo menstrual. Conclusão: Tendo em conta a prevalência da disfunção sexual é importante que na prática clínica os enfermeiros integrem os resultados da investigação e promovam a saúde sexual.

Background: Sexual dysfunction in people with chronic kidney disease is progressive and worsens with the deterioration of kidney functions. Although most people recover their sexual function after kidney transplantation, many sexual problems may persist after transplantation. Objectives: To characterize the sexual function of kidney transplant recipients and analyze their association with demographic and clinical variables. Methodology: A descriptive-correlational study was conducted with a sample of 139 kidney transplant recipients. Data were collected using a questionnaire for sociodemographic and clinical characterization, the International Index of Erectile Function, the Female Sexual Function Index, and the Beck Depression Inventory. Results: The prevalence rate of sexual dysfunction in kidney transplant recipients was high (> 90%), and sexual desire was the most affected domain. Sexual function was influenced by age, depressive states, and the presence of a menstrual cycle. Conclusion: Considering the prevalence of sexual dysfunction, nurses should integrate the research findings and promote sexual health in their daily clinical practice.

Introdução: Em contraste com a colonoscopia, há poucos estudos relativos à qualidade dos relatórios da endoscopia digestiva alta (EDA) e métodos para a sua melhoria. Auditorias de qualidade são recomendadas, mas a sua influência na qualidade da EDA não está suficientemente estudada. O objetivo foi avaliar a qualidade dos relatórios de EDA, bem como do efeito de uma intervenção com auditoria. Métodos: Estudo prospetivo realizado num centro terciário de referência. O estudo incluiu a análise de 1,000 relatórios de EDA consecutivas realizadas antes de uma intervenção e de 250 após. Os relatórios foram analisados de acordo com parâmetros de qualidade definidos por três gastrenterologistas com experiência. Resultados: Antes da intervenção, 51.8% das endoscopias incompletas não continham qualquer justificação para o facto e 88.1% das lesões foram corretamente descritas. No total, 64.1% dos relatórios foram considerados de alta qualidade. Após a intervenção, a recomendação de follow-up (53.4% vs. 80.8%, p = 0.001), descrição correta das lesões (88.1% vs. 95.8%, p = 0.001) e descrição correta de todos os segmentos (92.2% vs. 96.4%, p = 0.020) aumentaram significativamente. A percentagem de endoscopias incompletas não justificadas diminuiu significativamente (51.8% vs. 28.9%, p = 0.010). A percentagem de EDA de alta qualidade aumentou 13.9% após a intervenção (p < 0.001). Tanto especialistas como internos melhoraram com a intervenção, verificando-se um aumento similar na percentagem de EDA de alta qualidade (13.9% vs. 13.4%). Conclusões: Uma intervenção baseada numa auditoria é uma boa forma de melhorar a qualidade da documentação de EDA independentemente do grau ou experiência. O cumprimento de parâmetros de qualidade pode depender do software utilizado e como tal o seu melhoramento deve ser uma prioridade.

Background and Aim: In contrast to colonoscopy, there are few studies regarding upper gastrointestinal (UGI) endoscopy reporting its quality and ways of improving it. Quality audits are recommended, but their influence on the abovementioned quality is not well studied. Our aim was to evaluate the quality of UGI endoscopy reports and assess the effect of a simple audit intervention on UGI endoscopy reporting quality. Methods: This was a prospective study in a tertiary referral center, including the evaluation of 1,000 consecutive reports of UGI endoscopies before an audit intervention and 250 after. The reports were analyzed according to performance measures defined by three experienced gastroenterologists. Results: Before the intervention, 51.8% of the incomplete endoscopies did not present any justification for its incompleteness and 88.1% of lesions were correctly described. Overall, 64.1% of the reports were considered as being of high quality. After the audit intervention, follow-up recommendation (53.4 vs. 80.8%, p = 0.001), correct lesion description (88.1 vs. 95.8%, p = 0.001), and correct segment description (92.2 vs. 96.4%, p = 0.020) improved significantly. The rate of unjustified incomplete endoscopies decreased significantly (51.8 vs. 28.9%, p = 0.010). The highquality endoscopy rate improved 13.9% after the intervention (p < 0.001). Both specialists and residents improved with the audit intervention with a similar percentage of improvement in the high-quality endoscopy rate (13.9 vs. 13.4%). Conclusions: A simple audit intervention is a good way to improve the quality of reporting of UGI endoscopy, independently of degree and experience. Some of the performance measure accomplishments may depend on the software used by the endoscopy centers and it should be a priority to optimize it.

Resumo Justificativa e objetivos: Bloqueios seletivos dos membros superiores guiados por ultrassom podem trazer grandes benefícios em pacientes portadores de doenças graves. Pacientes portadores da doença de Steinert apresentam fraqueza muscular e riscos de desencadear miotonia ou hipertermia maligna devido ao uso de agentes anestésicos e ao estresse cirúrgico. O objetivo deste relato foi mostrar uma opção viável para a cirurgia de fratura de clavícula com bloqueio do tronco superior e nervo supraclavicular, diminui-se assim a dispersão do anestésico local para o nervo frênico em paciente com distrofia muscular. Relato de caso: Paciente do sexo masculino, 53 anos, portador de doença de Steinert, associada a dispneia, rouquidão e disfagia. Encaminhado ao bloco cirúrgico para osteossíntese de fratura de clavícula. Feito bloqueio de tronco superior (1 mL ropivacaína a 0,75%) e de nervo supraclavicular (1 mL de ropivacaína 0,75 em cada ramificação) associado à anestesia venosa com propofol sob máscara laríngea (alvo de 4 mcg.mL-1 em bomba de infusão). Ao despertar, o paciente apresentava-se sem dor ou queixas respiratórias. Admitido em CTI para acompanhamento do pós-operatório imediato com alta dessa unidade após 24 horas sem intercorrências. Conclusões: O bloqueio do tronco superior e do plexo cervical associado à anestesia venosa sob máscara laríngea, sem uso de opioides, mostrou-se adequado no caso de fratura da clavícula em paciente com doença de Steinert. Com o uso da ultrassonografia em anestesia regional é possível fazer bloqueios cada vez mais seletivos e possibilitar assim maior segurança para o procedimento anestésico-cirúrgico e menor morbidade para o paciente.

Abstract Background and objectives: Ultrasound-guided upper limb blocks may provide great benefits to patients with serious diseases. Patients with Steinert's disease have muscle weakness and risk of triggering myotony or malignant hyperthermia due to the use of anesthetic agents and surgical stress. The objective of this report was to demonstrate a viable alternative for clavicle fracture surgery with upper trunk and supraclavicular nerve block, thus reducing the spread of local anesthetic to the phrenic nerve in a patient with muscular dystrophy. Case report: A 53-year-old male patient with Steinert's disease, associated with dyspnea, hoarseness and dysphagia, referred to the surgical theater for osteosynthesis of clavicle fracture. Upper limb (1 mL 0.75% ropivacaine) and supraclavicular nerve block (1 mL 0.75% ropivacaine in each branch) were combined with venous anesthesia with propofol under laryngeal mask (infusion pump target of 4 mcg.mL-1). Upon awakening, the patient had no pain or respiratory complaints. He was transferred to the ICU for immediate postoperative follow-up with discharge from this unit after 24 h without complications. Conclusions: The superior trunk and cervical plexus block associated with venous anesthesia under laryngeal mask, without the use of opioids, proved to be adequate in the case of a patient with clavicle fracture and Steinert's disease. With the use of ultrasonography in regional anesthesia it is possible to perform increasingly selective blocks, thus allowing greater security for the anesthetic-surgical procedure and lower morbidity for the patient.

Resumo Analisa-se a influência do capital humano do empreendedor, o seu capital social e a adoção de práticas gerenciais na sobrevivência de empresas em seus primeiros anos de atividade. De forma inédita, verifica-se como o efeito desses fatores varia de acordo com o gênero, masculino ou feminino, do empreendedor. Usando uma base de 2.000 empresas cadastradas na Junta Comercial do Estado de São Paulo (Jucesp), entre 2003 e 2007, foram ajustados dois modelos econométricos para mensurar o efeito dessas variáveis na sobrevivência de empresas nascentes. Os resultados sugerem que a adoção de práticas gerenciais e alguns aspectos ligados ao capital humano do empreendedor podem favorecer a sobrevivência da empresa. O efeito de competências superiores e capital social sobre a sobrevivência foram maiores para mulheres do que para homens. Os resultados sugerem que empreendedoras enfrentam mais barreiras à constituição de novos negócios, exigindo, portanto, configurações distintas de recursos para atenuar essas barreiras e aumentar a probabilidade de sobrevivência das empresas nascentes.

Abstract In this article, we assess the impact of an entrepreneur’s human capital, social capital, and adoption of management practices on the survival of firms in their first years of life. We innovate by assessing how the effect of those factors varies according to gender: whether the entrepreneur is male or female. Using a database of 2,000 firms registered in the Junta Comercial do Estado de São Paulo (Jucesp), between 2003 and 2007, we employed two distinct econometric models to measure the effect of those variables on the survival of new firms. Our results suggest that the adoption of management practices and some traits related to human capital positively affect firm survival. The effect of competencies and social capital on firm survival was higher for female than for male entrepreneurs. These results suggest that female entrepreneurs face higher barriers to launch new firms, thus require distinct resource configurations to overcome these barriers and increase the probability of survival.

Objetivo: Efetuar uma revisão atualizada da literatura sobre o diagnóstico e o tratamento da instabilidade multidirecional do ombro. Fontes dos dados: A informação foi pesquisada através da base de dados PubMed, usando as seguintes palavras-chave: “instability”, “multidirectional”, “shoulder”, “diagnosis”, “treatment” e “surgery”. A pesquisa restingiu-se a artigos em inglês, publicados depois de 2000. Outros trabalhos foram pesquisados a partir de referências dos anteriores. Foram ainda incluídos artigos com data anterior à definida, pela particular relevância ao tema, perfazendo um total de 64 referências. Síntese dos dados: A instabilidade multidirecional do ombro é uma patologia caracteristicamente atraumática, bilateral, resultante da falência dos estabilizadores estáticos e dinâmicos da glenoumeral, originando o aparecimento de subluxações ou mesmo luxações. O diagnóstico é essencialmente clínico, podendo ser complementado pela imagiologia através da ressonância magnética com ou sem injeção de contraste. A abordagem terapêutica deve ser maioritariamente conservadora, pois apresenta taxas de sucesso de cerca de 90%. Em caso de falência, o tratamento cirúrgico aberto ou artroscópico, através de capsulorrafias e plicaturas, pode estar indicado, resultando em taxas de sucesso superiores a 80%. Conclusões: Embora classicamente o tratamento preconizado para a instabilidade multidirecional do ombro seja conservador, através de um programa de reabilitação muscular e propriocetiva, a consulta da bibliografia sugere que, em casos de persistência da sintomatologia, o recurso a técnicas cirúrgicas, abertas ou artroscópicas, está indicado, apresentando taxas de sucesso elevadas (à exceção da capsulorrafia térmica) quando complementadas por adequada reabilitação pós-cirúrgica, embora os períodos de follow-up sejam inferiores a 5 anos.

Goal: Review of the current literature on the diagnosis and treatment of multidirectional shoulder instability. Sources of data: The information was researched on the PubMed data basis, using the following keywords: “instability”, “multidirectional”, “shoulder”, “diagnosis”, “treatment” and “surgery”. The survey was restricted to articles in English, published after 2000. Other papers were researched from the previous references. There were included articles with an earlier publication date due to their particular relevance, resulting in 64 references. Summary of data: Multidirectional shoulder instability is a characteristically atraumatic and bilateral pathology, caused by the failure of the glenohumeral joint static and dynamic stabilizers, resulting in subluxations or even dislocations. The diagnosis is mainly clinical and it can be complemented with imagiology through magnetic resonance imaging with or without contrast. The therapeutic approach should mainly be conservative as it presents with 90% success rate. In case it fails, open or arthroscopic surgical treatment through capsular shifts and plicatures may be indicated, resulting in success rates higher than 80%. Conclusions: Although the gold standard treatment for multidirectional shoulder instability is conservative, through a muscular and proprioceptive rehabilitation program, the present review suggests that, in case of persistence of the symptoms, surgical treatment, open or arthroscopic, is indicated, as it presents with high success rates (except for thermal capsulorraphy) when complemented by a proper post-operative rehabilitation, even though the follow-up periods are less than 5 years.