Resumo Fundamento Os distúrbios de condução (DC) são a complicação mais frequente após a substituição da válvula aórtica transcateter (TAVR) e ainda não há consenso sobre seu tratamento. Objetivo Avaliar novos DC e implante de marca-passo definitivo (MPD) após a TAVR e avaliar a porcentagem de estimulação ventricular (EV) até 1 ano de acompanhamento. Métodos Pacientes submetidos a TAVR de outubro de 2014 a novembro de 2019 foram cadastrados; pacientes com MPD anterior foram excluídos. Dados clínicos, do procedimento, do ECG e do MPD foram coletados até 1 ano após o implante. O nível de significância adotado para a análise estatística foi 0,05%. Resultados Um total de 340 indivíduos foram submetidos a TAVR. O DC mais comum foi bloqueio de ramo esquerdo novo (BRE; 32,2%), sendo que 56% destes foram resolvidos após 6 meses. O bloqueio do ramo direito (BRD) foi o maior fator de risco para bloqueio atrioventricular avançado (BAV) [RC=8,46; p<0,001] e implante de MPD [RC=5,18; p<0,001], seguido de BAV de baixo grau prévio [RC=2,25; p=0,016 para implante de MPD]. Em relação às características do procedimento, válvulas de gerações mais recentes e procedimentos de válvula-em-válvula foram associados a menos DC. No total, 18,5% dos pacientes tiveram MPD implantado após a TAVR. Na primeira avaliação do MPD, pacientes com BAV avançado tinham uma porcentagem mediana de EV de 80%, e, após um ano, de 83%. Em relação aos pacientes com BRE e BAV de baixo grau, a EV mediana foi mais baixa (6% na primeira avaliação, p=0,036; 2% após um ano, p = 0,065). Conclusão O BRE foi o DC mais frequente após a TAVR, com mais da metade dos casos se resolvendo nos primeiros 6 meses. O BRD foi o principal fator de risco para BAV avançado e implante de MPD. O BAV avançado foi associado a uma porcentagem mais alta de EV no acompanhamento de 1 ano.

Abstract Background Conduction disturbances (CD) are the most frequent complication after transcatheter aortic valve replacement (TAVR), and there continues to be a lack of consensus on their management. Objective To assess new CD and permanent pacemaker (PPM) implantation after TAVR and to evaluate the ventricular pacing percentage (VP) up to 1 year of follow-up. Methods Patients who underwent TAVR from October 2014 to November 2019 were enrolled; patients with previous PPM were excluded. Clinical, procedure, ECG, and PPM data were collected up to 1 year after implantation. The significance level adopted in the statistical analysis was 0.05. Results A total of 340 patients underwent TAVR. The most frequent CD was the new left bundle branch block (LBBB; 32.2%), which 56% resolved after 6 months. Right bundle branch block (RBBB) was the biggest risk factor for advanced atrioventricular block (AVB) [OR=8.46; p<0.001] and PPM implantation [OR=5.18, p<0.001], followed by previous low-grade AVB [OR=2.25; p=0.016 for PPM implantation]. Regarding procedure characteristics, newer generation valves and valve-in-valve procedures were associated with fewer CDs. Overall, 18.5% of patients had a PPM implanted post-TAVR. At first PPM evaluation, patients with advanced AVB had a median percentage of VP of 80% and 83% at one year. Regarding patients with LBBB plus low-grade AVB, median VP was lower (6% at first assessment, p=0.036; 2% at one year, p = 0.065). Conclusion LBBB was the most frequent CD after TAVR, with more than half being resolved in the first six months. RBBB was the major risk factor for advanced AVB and PPM implantation. Advanced AVB was associated with a higher percentage of VP at 1 year of follow-up.

Resumo A pandemia COVID-19 implicou alterações no funcionamento do sistema de saúde, com interrupção da atividade clínica programada, que, associada ao receio pelos doentes do risco de contaminação, condicionou o atendimento médico. No presente artigo analisámos os dados da atividade nos centros de Cardiologia dos hospitais CUF Infante Santo e CUF Porto durante o estado de emergência nacional. Estes hospitais, com características semelhantes na multifuncionalidade cardiovascular e integrados nos centros para tratamento da COVID-19, tiveram uma redução superior a 70% nas consultas presenciais, ultrapassando os 60% para a quase totalidade dos exames complementares de diagnóstico, em comparação com o período homólogo de 2019. Estes valores foram mais acentuados na evolução do primeiro quadrimestre de 2020, sobretudo à custa de atividade residual em abril. Os procedimentos invasivos eletivos também diminuíram, apresentando uma queda mais marcada em abril. No entanto, as intervenções urgentes por síndroma coronária aguda mantiveram-se sem variação face a igual período de 2019. Reforça-se a necessidade de divulgar a importância de recorrer às urgências hospitalares e da manutenção das normas de segurança na retoma gradual da atividade, e aborda-se o papel crescente da telemedicina e assistência domiciliária, bem como da reorganização do funcionamento das equipas hospitalares para melhorar a dinâmica multidisciplinar nas várias componentes da Cardiologia.

Abstract The COVID-19 Pandemic involved changes in the organization of the health care system, with interruption of the clinical programmed activity during the lockdown period, which, associated with the fear of contamination, had important repercussions in medical care. In this article, we analyzed data from the cardiology centers of CUF Infante Santo and CUF Porto hospitals during the state of national emergency. These hospitals, with similar characteristics in cardiovascular multifunctionality and integrated in the centers for treatment of COVID-19, had a reduction of more than 70% of face-to-face consultations, surpassing 60% for almost all diagnostic tests, compared to the same period of 2019. This was even more pronounced when looking for the evolution during the first four months of 2020. Elective invasive procedures were also reduced, with a marked fall in April. However, urgent interventions due to acute coronary syndromes remained unchanged compared to the same period in 2019. The need to inform the population regarding the importance of using hospital emergencies and the maintenance of safety recommendations is reinforced, and the growing role of telemedicine and home-based care is addressed, as well as the reorganization of the hospital teams to improve the multidisciplinary dynamicity in Cardiology.

Apresenta-se o caso de um rapaz de 17 anos com dor persistente na vertente anterior do joelho sem traumatismo agudo. Realizou radiografia e tomografia computorizada que revelou um quadro de doença de Osgood-Schlatter. A doença de Osgood-Shlatter é uma causa frequente de dor em adolescentes e ocorre por traumatismo repetido na inserção tibial do tendão rotuliano, com dor e tumefação localizadas. O tratamento conservador é geralmente suficiente para aliviar a dor e permitir o regresso à atividade.

We present a case of a 17-year-old male adolescent with persistent anterior knee pain without acute trauma. X-ray and computed tomography revealed Osgood-Shlatter disease. Osgood-Schlatter disease is a common cause of knee pain in adolescents caused by repeated stress on the tibial insertion of the patelar tendon and is associated with localized pain and swelling at the tibial tubercule. In most cases conservative treatment will relieve the pain and allow return to daily activities.

CONTEXTO E OBJETIVO: Este projeto de pesquisa surgiu de proposta feita aos professores pelos estudantes de um curso de medicina de uma universidade federal do Brasil, a partir de suas vivências pessoais acerca das habilidades e competências que devem ser desenvolvidas durante o estágio de Ginecologia e Obstetrícia (GO) ao longo do internato. O objetivo é desenvolver uma matriz de habilidades necessárias para a formação de um bom médico generalista no Curso de Medicina.TIPO DE ESTUDO E LOCAL: Pesquisa qualitativa do tipo exploratória realizada em uma universidade federal do Brasil.MÉTODOS: A base para o desenvolvimento dessas competências do internato em GO foi "A Matriz de Competências para o Internato Médico", desenvolvida por Bollela e Machado. Este instrumento foi, em duas sessões, apresentado a, analisado e modificado por um grupo de especialistas em GO.RESULTADOS: As competências específicas esperadas do estudante no decorrer do internato foram enquadradas a partir de temas globais previamente determinados e listados: atenção à saúde, tomada de decisões, comunicação e relação interpessoal, gerenciamento e ordenação do SUS (Sistema Único de Saúde) e profissionalismo.CONCLUSÕES: Uma matriz de competências que padronize os requisitos mínimos que os internos sejam capazes de pôr em prática, após a conclusão do estágio em GO, é uma ferramenta valiosa para garantir o desempenho e avaliação justa e rigorosa dos estudantes, buscando a formação de um bom médico generalista, que atenda às necessidades da comunidade.

CONTEXT AND OBJECTIVE: This research project arose from a proposal made to the teachers by the students of a medical course at a federal university in Brazil, from their personal experiences regarding the skills and competencies that should be developed during the obstetrics and gynecology (OBG) stage of the internship. The objective here was to develop the matrix of skills necessary for training good general physicians in the medical course.DESIGN AND SETTING: Exploratory qualitative study conducted in a federal university in Brazil.METHODS: The basis for developing these competencies among OBG interns was "The Competency Matrix for Medical Internship" developed by Bollela and Machado. The instrument was presented to, analyzed by and modified by a set of OBG specialists, at two sessions.RESULTS: The specific competencies expected from students over the internship in OBG were framed within overall topics that had previously been determined and listed: healthcare, decision-making, communication and interpersonal relationships, management and organization of the Brazilian National Health System (Sistema Único de Saúde, SUS) and professionalism.CONCLUSIONS: A competency matrix that standardizes the minimum requirements that interns should be capable of putting into practice after concluding the OBG stage is a valuable tool for ensuring student performance and a fair and rigorous assessment for them, thereby seeking to train good general physicians who meet the community's needs.

We present a case of a 15‑year‑old boy with sudden onset of left hip pain while playing football. The x‑ray revealed an avulsion injury of the anterior inferior iliac spine. The anterior inferior iliac spine is one of the places in the pelvis where avulsion injuries can occur and is due to forceful contractions of the rectus femoris muscle.

Foram utilizados trinta e quatro cordeiros machos não castrados, sendo 16 Santa Inês (SI) e 18 ½ Dorper + ½ Santa Inês (½ D+ ½ SI). Os animais foram abatidos com 2,0; 3,0 e 4,0mm de espessuras de gordura subcutânea, para verificar o efeito do grupo genético e espessura de gordura ao abate na composição química da carne de cordeiros. Os cordeiros foram confinados, recebendo ração completa peletizada, calculada para ganho médio diário de 0,30kg. Foram realizadas avaliações por ultrassonografia na região do lombo entre a 12ª e 13ª costelas. Para os teores de lipídeos totais da carne foram observadas diferenças entre o grupo genético (SI: 4,78g/100g; ½ D+ ½ SI: 6,45g/100g) e as espessuras de gordura ao abate (2,0mm: 4,77g/100g; 3,0mm: 5,20g/100g e 4,0mm: 6,86g/100g). Foram observadas diferenças para o teor de ácidos graxos saturados nas diferentes espessuras ao abate (2,0mm: 26,52g/100g; 3,0mm: 27,07g/100g e 4,0mm: 24,63g/100g). Constatou-se a presença de um isômero de ácido linoleico conjugado, C18:1n 9cis ,11trans. Analisando-se a concentração total dos ácidos graxos insaturados, observou-se que diferentes espessuras de gordura influenciaram significativamente as concentrações dos ácidos graxos poliinsaturados (2,0mm: 8,36g/100g; 3,0mm: 8,54g/100g e 4,0mm:11,18g/100g). A carne de cordeiros demonstrou ser altamente benéfica no teor lipídico e de um isômero de Ácido Linoleico Conjugado. Nas condições de realização do experimento a carne de cordeiros com 4,0mm de espessura de gordura subcutânea demonstraram melhor incremento de ácidos graxos poli-insaturados em relação aos demais, melhorando assim a qualidade nutricional da carne tornando-a mais adequada para a alimentação humana.

Thirty-four not castrated lambs, 16 Santa Ines (SI) and 18 ½ Dorper + ½ Santa Ines (½ D + ½ SI), were slaughtered with different subcutaneous fat thicknesses to verify the effect of genotype and fat thickness on chemical composition of the meat. The lambs remained confined, from weaning to slaughter, and they were fed with complete pelleted ration calculated for daily weight gain of 0.3 kg. Ultrasound evaluations were performed between the 12th and 13th ribs in the loin area. The slaughter was carried out when the lambs reached the thickness of fat pre-determined: 2.0, 3.0 and 4.0 mm. There were differences in the total lipids of the meat between the genetic groups (SI: 4.78g / 100g; ½ D ½ + SI: 6.45g / 100g) and fat thickness at slaughter (2.0mm: 4.77g / 100g; 3.0mm: 5.20g / 100g and 4.0mm: 6.86g / 100g). The contents of fatty acids differed in the different fat thicknesses at slaughter (2.0mm: 26.52g/100g; 3.0mm: 27.07g/100g e 4.0mm: 24.63g/100g). It was observed the presence of an isomer of Conjugated Linoleic Acid, C18: 1n 9cis, 11trans. Analyzing the total concentration of unsaturated fatty acids, it was observed that the different thicknesses of fat signifycantly affected the concentration of polyunsaturated fatty acids (2.0mm: 8.36g/100g; 3.0mm: 8.54g/100g e 4.0mm: 11.18g/100g). Meat from lambs proved highly beneficial in lipid content and an isomer of CLA. Under the conditions of the experiment the lamb meat slaughtered with 4.0mm thickness of subcutaneous fat showed better increase of polyunsaturated fatty acids in relation to the other, thus improving the nutritional quality of the meat making it more suitable for human consumption.

We present a case of a 14-year-old girl with fever and cough in whom the chest x-ray revealed a bizarre density over the upper two thirds of the left lung. It was due to the superimposed long hair hanging on her back. Artefacts images must systematically be suspected specially when being of strange shapes.

We present a case of a six-year old child with wrist pain after sustaining trauma the previous day. The x-ray revealed a torus fracture of the distal radio metaphysis. The torus fracture is one of the fractures occurring in the immature skeleton. Some specific types of children fractures are described as well as the value of the imaging techniques for the diagnosis.

The incidence of estrus in nulliparous Santa Inês (n = 16), Texel (n = 16) and Ile de France (n = 15) ewes fed two levels of crude protein (CP, 12 or 16%) was monitored from July 2005 to December 2006, and seasonality in the Santa Inês breed in the south of Brazil was characterized. The solar radiation data were recorded daily, and samples of blood were collected biweekly for determination of the plasma concentration of progesterone in Santa Inês lambs at, on average, 11±1 months of age. The female Santa Inês lambs, in the experimental period, stayed among teaser rams with a powdered-dye-ink mixture placed on their chest to mark the females that accepted to be mounted. Santa Inês ewes did not manifest estrus in the first fortnight of November and in December 2005, nor in the last fortnight of December 2006. Estrus activity was not observed on any of the three breeds in October 2006. Breeds differed at the level of 12% CP. Santa Inês and Ile de France females did not differ as for the probability estrus manifestation and both presented higher probabilities then Texel. When the effect of 12 or 16% CP on each breed was evaluated separately, it was verified that levels of 12 or 16% of crude protein did not change the probability of estrus manifestation in any of the studied breeds. The concentration of plasma progesterone in Santa Inês ewes during the spring of 2005 and 2006 indicated that there is difference between 12% CP (0.68±1.32 ng/mL) and 16% CP (1.28±1.99 ng/mL) and between the years 2005 (0.39±0.78 ng/mL) and 2006 (1.47±2.08 ng/mL), demonstrating the anestrous seasonality of Santa Inês in South Brazil.

We present a case of a 6-year-old child in whom a chest x-ray is performed for a respiratory infection. An inverted comma opacity was seen in the right upper lobe, typical of an azygos fissure. This is one of the numerous anatomic variants of the azygos vein.

We present the clinical case of an 11-year-old boy with cerebral palsy. He was observed in the Gastroenterology Department for the presence of recurrent episodes of vomiting (bilious and/or fecaloides) with one year of development, preceded by pallor, sweating, sense of abdominal pain and abdominal swelling. Recently the episodes occur every week. The abdominal Computed Tomography (CT) showed megacolon compatible with the diagnosis of ileocolic intestinal pseudo-obstruction. Laparoscopic cecostomy was performed for decompression of exuberant aerocolia, result of permanent aerophagia typical of adolescents with cerebral palsy, allowing the administration of antegrade enemas in order to improve the constipation.

We present the case of a 5 year old asmathic girl admitted to the hospital for acute non traumatic edema and crepitus of the face, neck and upper thorax. Thoracic x-ray (not shown) and thoracic and neck CT were performed, showing extensive subcutaneous and mediastinal enfisema. These are rare complications of asthma. The imaging features are described.