Resumo A mordedura de cobra é uma causa rara mas potencialmente fatal de envenenamento em crianças em todo o mundo. É um problema de saúde pública negligenciado na Europa, que afeta sobretudo agricultores e crianças, com efeitos mais graves na população pediátrica devido à sua menor massa corporal. Perante suspeita de envenenamento, o doente deve ser internado para vigilância clínica e instituição precoce de terapêutica. A mordedura de cobra pode ser uma emergência médica. No entanto, contrariamente a várias outras condições graves de saúde, dispõe de um tratamento altamente eficaz - o soro anti-ofídio. É fundamental investir em soros mais eficazes, seguros e de fácil acesso em casos de mordedura de cobra. É descrito o caso de um adolescente afetado por mordedura de víbora, seu tratamento e evolução clínica.

Abstract Snakebite is a rare but potentially fatal cause of poisoning in children worldwide. It is a neglected public health issue in Europe, mainly affecting farmers and children, the latter suffering more severe consequences due to their small body mass. If poisoning is suspected, hospitalization of these patients is mandatory for clinical monitoring and early initiation of therapy. Snakebite can be a medical emergency. However, unlike many other serious health conditions, there is a highly effective treatment - anti-ophidian serum. It is crucial to invest in more effective and safer serums and to make them easily accessible in the event of a snakebite. The case of an adolescent affected by viper bite, its treatment and clinical course is reported.

Abstract Introduction: Paraneoplastic hyperhidrosis presents as a challenge due to lack of consensus on its approach in palliative care. This article aims to review the scientific evidence on the approach to paraneoplastic hyperhidrosis in patients in palliative care. Methods: An integrative review was conducted by searching articles in MEDLINE/Pubmed®, Cochrane, DARE®, BMJ EBM®, NICE®, CMAJ® and Bandolier, using the MeSH terms “Sweating”, “Hyperhidrosis”, “Palliative Care”, and “Palliative Medicine”. Included studies were classified using the Oxford scale. Results: This review includes 13 articles on the therapeutic approach to paraneoplastic hyperhidrosis using the following interventions: thioridazine, thalidomide, olanzapine, gabapentin, cannabinoids, acupuncture and Chinese herbal medicine. We obtained heterogeneous results and no robust evidence exists that unequivocally demonstrates one approach is more beneficial than another. Conclusions: The available evidence on the therapeutic approach to paraneoplastic hyperhidrosis in palliative care has low quality (Level of Evidence 4; Strength of Recommendation C).

Resumo Introdução: A hiperidrose paraneoplásica constitui um desafio pela falta de consenso quanto à sua abordagem em cuidados paliativos. Este artigo pretende rever a evidência científica acerca da abordagem da hiperidrose paraneoplásica em doentes paliativos. Métodos: Realizou-se uma revisão integrativa com artigos da MEDLINE/Pubmed®, Cochrane, DARE®, BMJ EBM®, NICE®, CMAJ® e Bandolier, através dos termos MeSH “Sweating”, “Hyperhidrosis”, “Palliative Care” e “Palliative Medicine”. A evidência encontrada foi classificada de acordo com a Escala de Oxford. Resultados: Incluíram-se 13 artigos sobre a abordagem da hiperidrose paraneoplásica. As intervenções avaliadas nestes estudos incluíram o uso de tioridazina, talidomida, olanzapina, gabapentina, canabinóides, acupunctura e fitoterapia chinesa. Os resultados foram heterogéneos e não se encontrou evidência robusta que comprove o benefício inequívoco de uma abordagem em relação a outra. Conclusão: A evidência sobre a abordagem da hiperidrose paraneoplásica em cuidados paliativos é de qualidade fraca (Nível de evidência 4; Força de recomendação C).

Resumo Introdução: A neoplasia do esófago associa-se a disfagia e perda ponderal, sendo a desnutrição agravada pelo tratamento multimodal. Objetivo: Avaliar o impacto da colocação de gastrostomia percutânea endoscópica (PEG) no estado nutricional de doentes com neoplasia do esófago propostos para quimiorradioterapia (QRT). Métodos: Estudo comparativo com braço prospetivo e contro-lo retrospetivo. Incluídos doentes com neoplasia do esófago propostos para QRT definitiva ou neoadjuvante, com disfagia grau >2 e/ou perda de peso >10%. Colocada PEG (método pull) antes do início de QRT. Avaliada se-menteira tumoral por zaragatoa e histologia. Como controlo, utilizada coorte histórica de doentes sem PEG. Registo ACTRN12616000697482. Resultados: 29 doentes (grupo intervenção, GI) foram comparados com 30 controlos (GC). Sem diferença significativa nos principais outcomes: perda de peso durante a QRT 8.1 ± 5.5 kg versus 9.1 ± 4.2 kg (p = 0.503); mortalidade aos 6 meses após QRT ou cirurgia 17.2% versus 26.7% (p = 0.383); taxa de complicações perioperatórias 54.5% versus 55.6% (p = 1.000); admissões hospitalares não planeadas 34.5% versus 40.0% (p = 0.661). No GC, durante a QRT, 14 (46.7%) apresentaram disfagia graus 3-4, dos quais 12 necessitaram de nutrição por sonda nasogástrica (n = 10), gastrostomia cirúrgica (n = 1) ou dilatação esofágica (n = 1). No GI, 89.7% utilizaram a PEG durante QRT, em algum momento de forma exclusiva em 51.7%. Os eventos adversos foram sobretudo minor (n = 12; 41.4%), sobretudo infeções tardias periestoma; 1 complicação major (laparotomia exploradora por suspeita de interposição de cólon, não confirmada). Sem evidência citológica ou histológica de sementeira tumoral no estoma. Conclusão: Embora não se tenham observado diferenças na perda de peso, complicações cirúrgicas e mortalidade entre grupos, metade dos utentes necessitou de nutrição entérica exclusiva, tornando a colocação de PEG uma alternativa a considerar.

Abstract Introduction: Oesophageal cancer causes dysphagia and weight loss. Malnutrition further worsens with multimodal treatment. Aim: The aim of the study was to evaluate the impact of percutaneous endoscopic gastrostomy (PEG) placement in the nutritional status of patients with oesophageal cancer requiring chemoradiotherapy (CRT). Methods: A comparative study with a prospective arm and a historical cohort was conducted. Oesophageal cancer patients undergoing CRT with dysphagia grade >2 and/or weight loss <10% were submitted to PEG-tube placement (pull method) before CRT. Stoma seeding was evaluated through a swab obtained after placement and, in surgical patients, the resected stoma. A matched historical cohort without PEG placement was used as control (trial ACTRN12616000697482). Results: Twenty-nine patients (intervention group, IG) were compared to 30 patients (control group, CG). Main outcomes did not differ in the IG and CG: weight loss during CRT 8.1 ± 5.5 kg versus 9.1 ± 4.2 kg (p = 0.503); 6-month mortality after CRT or surgery 17.2% versus 26.7% (p = 0.383); perioperative complication rate 54.5% versus 55.6% (p = 1.000); unplanned hospital admissions 34.5% versus 40.0% (p = 0.661). In the CG, during CRT, 14 (46.7%) patients presented with dysphagia grade 3-4, of whom 12 required nasogastric tube feeding (n = 10), surgical gastrostomy (n = 1), and oesophageal dilation (n = 1). In the IG, 89.7% used the PEG tube during CRT, sometimes exclusively in 51.7%. Adverse events were mainly minor (n = 12, 41.4%), mostly late peristomal infections, 1 major complication (exploratory laparotomy due to suspected colonic interposition, not confirmed). There was no cytological or histological evidence of stomal tumour seeding. Conclusion: Weight loss, hospital admissions, surgical complications, and mortality were identical in oesophageal cancer patients referred for CRT, regardless of prophylactic PEG. However, half of the patients required exclusive enteral nutritional support, making PEG-tube placement an alternative to consider.

Abstract Objectives: The aim of this study is to develop and validate a novel clinical report form in the format of a structured interview to enable the characterization of the Portuguese population of the Baixo Vouga region with different subtypes of nodular thyroid pathologies (NTyPs). Materials and methods: A structured interview was developed and to the best of our knowledge, this is the first structured interview built and validated for that purpose in Portugal. Results: This structured interview enables the identification of possible correlations between each subtype of nodular lesions and sociodemographic data, consumption habits and lifestyle, endocrine history, and family predisposition. Conclusion: The novel structured interview will simultaneously, enable a detailed characterization of the group of patients with nodular thyroid lesions and will support future metabolomic studies. Objectives NTyPs. NTyPs . (NTyPs) methods knowledge Portugal Results data lifestyle history predisposition Conclusion simultaneously studies (NTyPs

ABSTRACT Objective: To evaluate the influence of maternal pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) on blood glucose levels at diagnosis of gestational diabetes mellitus (GDM) and obstetric/neonatal outcomes. Subjects and methods: Retrospective cohort study including 462 women with GDM and singleton pregnancy delivered in our institution between January 2015 and June 2018 and grouped according to BMI/GWG. Results: The diagnosis of GDM was more likely to be established in the 1st trimester (T) in women with obesity than in normal-weight (55.8% vs 53.7%, p = 0.008). BMI positively and significantly correlated with fasting plasma glucose (FPG) levels in the 1stT (rs = 0.213, p = 0.001) and 2ndT (rs = 0.210, p = 0.001). Excessive GWG occurred in 44.9% women with overweight and in 40.2% with obesity (p < 0.001). From women with obesity, 65.1% required pharmacological treatment (p < 0.001). Gestational hypertension (GH) was more frequent in women with obesity (p = 0.016). During follow-up, 132 cesareans were performed, the majority in mothers with obesity (p = 0.008). Of the 17 large-for-gestational-age (LGA) birthweight delivered, respectively 6 and 9 were offsprings of women with overweight and obesity (p = 0.019). Maternal BMI had a predictive value only for macrosomia [aOR 1.177 (1.006-1.376), p = 0.041]. BMI and GWG positively correlated with birthweight (rs = 0.132, p = 0.005; rs = 0.188, p = 0.005). Conclusion: Maternal obesity is related with a major probability of diagnosis of GDM in 1stT, fasting hyperglycemia in 2ndT and a more frequent need for pharmacological therapy. Pre-gestational obesity is associated with GH, cesarean delivery and fetal macrosomia.

Abstract Introduction: Proton pump inhibitors represent one of the most prescribed drug classes, often maintained without reevaluation of the need for treatment. The goals for this study were to identify the therapeutic and prophylactic indications of use, analyze the demographic characteristics of patients and the relative frequency of inappropriate use. Material and Methods: Retrospective, observational, cross-sectional study, which consulted the clinical files of patients admitted in Internal Medicine Services of a District Hospital from June to October 2020, and whose usual medication included a proton pump inhibitor. Results: 76.4% of patients (n = 233) were under proton pump inhibitors with no indication. Conclusion: The fact that they are not subjected to a prescription, contributed to their excessive and growing consumption without medical opinion. However, it is essential to evaluate the indications for treatment and inappropriate use as several studies have exposed potential adverse reactions associated with prolonged exposure.

Resumo Introdução: Os inibidores da bomba de protões representam uma das classes medicamentosas mais prescritas, e são muitas vezes mantidos sem reavaliação da necessidade de tratamento. Os objetivos deste estudo foram identificar as indicações terapêuticas e profiláticas de uso, analisar as caraterísticas demográficas dos doentes e a frequência relativa do uso inadequado. Material e Métodos: Estudo retrospetivo, observacional do tipo transversal, onde foram consultados os processos clínicos dos doentes internados no Serviço de Medicina Interna de um Hospital distrital universitário no período de Junho a Outubro de 2020, e cuja medicação habitual incluía um inibidor da bomba de protões. Resultados: 76,4% dos doentes (n = 233) encontravam-se sob inibidores da bomba de protões sem indicação. Conclusão: O facto de não estarem sujeitos a receita médica, contribuiu para o consumo excessivo e crescente, sem parecer médico. No entanto, é fundamental avaliar as indicações de tratamento e uso inapropriado, uma vez que vários estudos expuseram potenciais reações adversas associadas à exposição prolongada.

Resumo Introdução: O objetivo deste estudo foi identificar barreiras ao início de insulina e fatores sociodemográficos e laborais associados. Material e Métodos: Estudo transversal desenvolvido a partir de um questionário aplicado a 146 médicos do ACeS Almada-Seixal, entre outubro e dezembro de 2019, avaliando a concordância com 30 barreiras, utilizando uma escala de Likert de 5 pontos. Utilizou-se uma regressão logística para medir a associação entre a concordância com cada item e os fatores associados ao médico. Resultados: A taxa de resposta foi de 74%. Numa amostra de 146 médicos, a idade média foi de 44 anos, 75% eram mulheres e 64% trabalhavam numa USF modelo B. As barreiras que geraram maior concordância estão relacionadas com características dos utentes e com a perceção do impacto positivo da insulina no prognóstico da diabetes. As de maior discordância foram a possibilidade de prejudicar a relação médico-doente, dúvidas sobre a quem compete e quando deve ser iniciada a insulina. Os médicos mais velhos discordam com barreiras relacionadas com características dos utentes e com a falta de formação. Com o aumento da categoria profissional, os médicos tendem a discordar com fatores relacionados com a falta de formação e experiência e com a relação médico-doente. Os médicos das UCSP concordam que não têm uma equipa multidisciplinar adequada ao acompanhamento de diabéticos. Discussão: Identificaram-se barreiras já descritas na literatura, sobretudo para médicos mais novos, em formação e das UCSP. Conclusão: Os resultados podem ser usados localmente, melhorando a formação de médicos mais novos e incentivando a criação de equipas multidisciplinares dedicadas à diabetes nas UCSP.

Abstract Introduction: Our study aimed at identifying barriers to the initiation of insulin therapy and its associated sociodemographic and labor factors. Material and Methods: This cross-sectional study was carried out through a survey applied to 146 general practitioners working in Almada and Seixal primary health care centers, between October and December 2019, assessing their agreement on 30 barriers using a 5-point Likert scale. We used logistic regression to measure the association between each item’s agreement and physician’s factors. Results: The response rate was 74%. Physicians’ average age was 44 years, 75% were women and 64% worked in model B family health units. Most physicians agreed with the barriers related to patients’ characteristics and physicians perceived positive impact of insulin on the prognosis of patients. They disagreed with the ones associated with the possibility of harming the doctor-patient relationship and having doubts about who is responsible and when to start insulin. Older doctors disagreed with barriers related to patients’ characteristics and lack of training. As the professional category increases, physicians tend to disagree with factors related to the lack of training, experience, and the doctor-patient relationship. Physicians from non-reformed health units agree that they do not have a multidisciplinary team appropriate for diabetes care. Discussion: We identified barriers already described in the literature, especially for younger doctors, in residency and from non-reformed health units. Conclusion: These results may be used locally to improve the training of younger doctors and to create multidisciplinary teams dedicated to diabetes in non-reformed health units.

ABSTRACT Objective: To evaluate the influence of maternal pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) on blood glucose levels at diagnosis of gestational diabetes mellitus (GDM) and obstetric/neonatal outcomes. Subjects and methods: Retrospective cohort study including 462 women with GDM and singleton pregnancy delivered in our institution between January 2015 and June 2018 and grouped according to BMI/GWG. Results: The diagnosis of GDM was more likely to be established in the 1st trimester (T) in women with obesity than in normal-weight (55.8% vs 53.7%, p = 0.008). BMI positively and significantly correlated with fasting plasma glucose (FPG) levels in the 1stT (rs = 0.213, p = 0.001) and 2ndT (rs = 0.210, p = 0.001). Excessive GWG occurred in 44.9% women with overweight and in 40.2% with obesity (p < 0.001). From women with obesity, 65.1% required pharmacological treatment (p < 0.001). Gestational hypertension (GH) was more frequent in women with obesity (p = 0.016). During follow-up, 132 cesareans were performed, the majority in mothers with obesity (p = 0.008). Of the 17 large-for-gestational-age (LGA) birthweight delivered, respectively 6 and 9 were offsprings of women with overweight and obesity (p = 0.019). Maternal BMI had a predictive value only for macrosomia [aOR 1.177 (1.006-1.376), p = 0.041]. BMI and GWG positively correlated with birthweight (rs = 0.132, p = 0.005; rs = 0.188, p = 0.005). Conclusion: Maternal obesity is related with a major probability of diagnosis of GDM in 1stT, fasting hyperglycemia in 2ndT and a more frequent need for pharmacological therapy. Pre-gestational obesity is associated with GH, cesarean delivery and fetal macrosomia.

ABSTRACT Introduction: During the pandemic, all pregnant women underwent a nasopharyngeal swab for SARS-CoV-2. Objective: To describe the clinical characteristics and evolution of pregnant women with a positive PCR study for SARS-CoV-2 and their newborns in a hospital population. Materials and methods: This was an ambispective observational, cohort follow-up study, in the maternity ward of the Social Security Institute Hospital between March 01, 2020 to May 31, 2021. Third trimester pregnant women admitted for delivery, with a positive result for SARS-CoV-2, were included. Variables: age, symptoms, pregnancy complications, COVID-19 classification, admission to intensive care, neonatal anthropometry, follow-up of the mother-neonate pair up to 7 days postpartum. The data was analyzed in SPSS using descriptive statistics. The protocol was approved by the research ethics committee. Results: 136 pregnant women and 139 newborns (3 twins) were admitted. 78.6% were symptomatic, 8.1% had severe forms. 10.3% presented pre-eclampsia, 10.3% entered intensive care and 2.2% died. 86.4% were born by cesarean section, there were 2 stillbirths. 29.2% were preterm, 18.2% had low birth weight, 24.8% were hospitalized. 3/137 died before 7 days of age. The neonatal swab was positive in 3. 78% were breastfed. Conclusions: 15.5% of positive pregnant women were admitted with moderate to severe forms of COVID 19, 10.3% were admitted to the ICU and 3 died. The percentage of caesarean section, prematurity and neonatal hospitalization was very high. There were 2 stillbirths and 2.9% of live births died. The neonatal swab was positive in 2.2%.

RESUMEN Introducción: Durante la pandemia, todas las mujeres embarazadas fueron sometidas a hisopado nasofaríngeo para SARS-CoV-2. Objetivo: Describir las características clínicas y evolución de las embarazadas con estudio de PCR positivo para SARS-CoV-2 y sus recién nacidos en una población hospitalaria. Materiales y Métodos: Estudio observacional ambispectivo de seguimiento de una cohorte, en la maternidad del Instituto de Previsión Social entre marzo 01 de 2020 a mayo 31 de 2021. Participaron embarazadas del tercer trimestre ingresadas para parto, con resultado positivo para SARS-CoV-2. Variables: edad, síntomas, complicaciones del embarazo, clasificación de COVID-19, ingreso a terapia intensiva, antropometría neonatal, seguimiento de la dupla madre-neonato hasta los 7 días post parto. Datos analizados en SPSS utilizando estadísticas descriptivas. Protocolo aprobado por el comité de ética de la investigación. Resultados: Ingresaron 136 embarazadas y 139 neonatos (3 gemelares). El 78,6% sintomáticas, 8,1% presentó formas graves. El 10,3% presentó preeclampsia, el 10,3% ingresó a terapia intensiva y el 2,2% falleció. El 86,4% nació por cesárea, hubo 2 mortinatos. El 29,2% fue pretérmino, el 18,2% de bajo peso de nacimiento, 24,8% fue hospitalizado Fallecieron 3/137 antes de los 7 días. El hisopado neonatal fue positivo en 3. El 78 % se alimentó con pecho materno. Conclusión: El 15,5% de embarazadas positivas ingresaron con formas moderada a grave, de COVID 19, el 10,3% ingresó a UTI y 3 fallecieron. El porcentaje de cesárea, prematuridad y hospitalización neonatal fue muy elevado. Hubo 2 mortinatos y el 2,9% de los nacidos vivos fallecieron. El hisopado neonatal fue positivo en el 2,2%.

Abstract Gitelman syndrome is a rare autosomal recessive inherited disease that affects the thiazidesensitive sodium-chloride cotransport channels and the magnesium channels in the distal convoluted tubule, leading to hypokalemic metabolic alkalosis, hypomagnesemia and hypocalciuria. There is no cure for this condition and supportive treatment relies on ionic supplementation and symptom management. Literature regarding the anesthetic approach is scarce. This case report presents the anesthetic management of a child with Gitelman syndrome and its difficult electrolyte optimization.

RESUMO Objetivos realizar uma revisão integrativa da literatura sobre o uso da fotobiomodulação nos músculos de cabeça e pescoço. Estratégia de pesquisa As buscar foram realizadas nas bases de dados: PubMed, Scopus, Web of Science, LILACS e SciELO. A pesquisa ocorreu entre junho de 2019 e março de 2021. Os descritores utilizados foram Terapia com Luz de Baixa Intensidade, Fototerapia, Músculo Masseter, Músculos Mastigatórios, Língua, Palato, Boca, Pescoço, Músculos do Pescoço, Músculos Faciais e seus respectivos termos em inglês. Não houve limitação de ano de publicação e idioma. Critérios de seleção estudos que respondessem a pergunta norteadora: qual o uso da fotobiomodulação na musculatura de cabeça e pescoço?. Resultados Foram encontrados 2857 artigos, sendo selecionados 102 para leitura completa, dos quais 52 foram excluídos, totalizando 50 artigos incluídos. As publicações incluídas datam de 2003 a 2020. O Brasil foi o país que mais publicou sobre o tema. Quanto aos objetivos, 82% dos estudos pesquisaram o efeito analgésico da fotobiomodulação, e desses, 50% eram relacionados à disfunção temporomandibular (DTM) articular ou muscular. A heterogeneidade dos estudos impossibilita a definição de protocolos dosimétricos. Conclusão A fotobiomodulação tem sido utilizada na musculatura de cabeça e pescoço principalmente para o tratamento da dor proveniente de DTM. Não existe um protocolo de aplicação que defina os parâmetros dosimétricos a serem utilizados, devido a heterogeneidade das metodologias e dos resultados encontrados.

ABSTRACT Purpose To carry out an integrative review of the literature on the use of photobiomodulation (PBM) for the head and neck muscles. Research strategy The research took place between June/2019 and March/2021, in the following databases: PubMed, Scopus, Web of Science, LILACS, and SciELO. The MeSH used were Low-Level Light Therapy, Phototherapy, Masseter Muscle, Masticatory Muscles, Tongue, Palate, Mouth, Neck Muscles, and Facial Muscles in English and Portuguese. No limitation was imposed on the year and language of publication. Selection criteria studies that answered the guiding question: what is the use of photobiomodulation to the head and neck muscles?. Results 2857 articles were found, of which 102 were selected for full reading, 52 of those were excluded, giving a total of 50 articles included. The included publications date from 2003 to 2020. Brazil was the country that most published on the topic. With regard to the objectives, 82% of the studies aimed to investigate the analgesic effect of PBM, of these, 50% were related to articular or muscular temporomandibular disorders (TMD). The heterogeneity of the studies makes it impossible to define the dose protocols. Conclusion PBM has been applied to the head and neck muscles mainly for the treatment of pain caused by TMD. There is no treatment protocol to define the doses to be used, due the heterogeneity of the methodologies applied and results found.

RESUMO Objetivos: compreender o significado do envelhecimento para cuidadores de idosos senis. Métodos: estudo qualitativo realizado com 12 cuidadores de idosos cadastrados no Serviço de Atenção Domiciliar, adotando-se o Modelo Explicativo de Doença de Kleinman como referencial teórico. Os dados foram coletados no período de abril a junho de 2019, mediante entrevistas semiestruturadas, audiogravadas, realizadas no domicílio e submetidas à análise de conteúdo. Resultados: cuidar de idoso senil desencadeia reflexões sobre o envelhecimento que por vezes levam à ressignificação desse processo, além de estimular o reconhecimento dos fatores que o influenciam, com destaque para a história de vida, ocupação e comportamentos deletérios adotados ao longo da vida. Considerações Finais: a experiência de cuidar influencia o significado atribuído ao envelhecimento, favorecendo: a identificação de aspectos e comportamentos modificáveis e não modificáveis que o tornam saudável; a reflexão sobre o próprio envelhecimento, com ressignificação de hábitos e comportamentos a serem adotados.

ABSTRACT Objectives: to understand the meaning of aging for caregivers of senile elderly people. Methods: qualitative study carried out with 12 caregivers of elderly people registered in the Home Care Service, adopting the Explanatory Model of Kleinman’s Disease as a theoretical framework. Data were collected from April to June 2019, through semi-structured, audio-recorded interviews, carried out at home and submitted to content analysis. Results: taking care of senile elderly people triggers reflections on aging that sometimes lead to a new meaning of this process, besides stimulating the recognition of the factors that influence it, with emphasis on the life history, occupation and deleterious behaviors adopted throughout life. Final Considerations: the care experience influences the meaning attributed to aging, favoring: the identification of modifiable and non-modifiable aspects and behaviors that make it healthy; reflection on aging itself, with a new meaning of habits and behaviors to be adopted.

RESUMEN Objetivos: comprender el significado del envejecimiento para cuidadores de ancianos seniles. Métodos: estudio cualitativo realizado con 12 cuidadores de ancianos registrados en Servicio de Atención Domiciliario, adoptándose el Modelo Explicativo de Enfermedad de Kleinman como referencial teórico. Datos recogidos en el período de abril a junio de 2019, mediante entrevistas semiestructuradas, audiograbadas, realizadas en el domicilio y sometidas al análisis de contenido. Resultados: cuidar de anciano senil desencadena reflexiones sobre el envejecimiento que por veces llevan a la resignificación de ese proceso, además de estimular el reconocimiento de factores que lo influencian, con destaque a la historia de vida, ocupación y comportamientos deletéreos adoptados al largo de la vida. Consideraciones Finales: experiencia de cuidar influencia el significado atribuido al envejecimiento, favoreciendo: la identificación de aspectos y comportamientos cambiables y no cambiables que lo vuelven saludable; la reflexión sobre el propio envejecimiento, con resignificación de hábitos y comportamientos a ser adoptados.

Objetivos: Rever a evidência disponível sobre a eficácia da dieta com restrição de FODMAP (sigla inglesa para oligossacarídeos, dissacarídeos, monossacarídeos e poliois fermentáveis) no alívio dos sintomas gastrointestinais dos doentes com síndroma do intestino irritável (SII). Métodos: Pesquisa de meta-análises, revisões sistemáticas e normas de orientação clínica na MEDLINE/PubMed, DARE, Trip DataBase, Evidence-based Medicine, Clinical Evidence, Web of Science, Canadian Medical Association Practice Guidelines, National Guidelines Clearing House e The Cochrane Library, publicados entre 2009 e 2017 na língua inglesa, utilizando os termos MeSH irritable bowel syndrome, signs and symptoms, diet therapy e o termo não MeSH ‘FODMAPs’. Foi utilizada a escala Strenght of Recommendation Taxonomy (SORT) para atribuição de níveis de evidência e forças de recomendação. Resultados: Depois de analisados 203 artigos resultantes da pesquisa foram incluídos 11 artigos: três meta-análises, três revisões sistemáticas e cinco normas de orientação clínica. Existe evidência de que a dieta com restrição em FODMAP (DRFODMAP) reduz a globalidade dos sintomas gastrointestinais dos doentes com SII, com maior expressão na melhoria do bloating* e dor abdominais e nos subtipos de predomínio de diarreia e misto. Alguns estudos sugerem que a eficácia da dieta é mais evidente a partir da sexta semana. Esta dieta parece ser pelo menos tão eficaz no alívio sintomático quanto outras dietas convencionalmente recomendadas para o SII. Nas normas de orientação clínica analisadas, a DRFODMAP é considerada como uma opção terapêutica no SII, sobretudo quando o aconselhamento dietético tradicional não é eficaz. Conclusão: Existe evidência para recomendar uma DRFODMAP como prova terapêutica em doentes com SII com predomínio de quadro diarreico ou misto, sobretudo se bloating e dor abdominais presentes (força de recomendação B). São necessários mais estudos que suportem a eficácia e a segurança a longo prazo da dieta.

Objective: We aimed to review the evidence for the efficacy of a low FODMAP (fermentable oligo-, diand monosaccharides and polyols) diet in the management of gastrointestinal symptoms in irritable bowel syndrome (IBS). Methods: We searched MEDLINE/PubMed, DARE, Trip DataBase, Evidence-based Medicine, Clinical Evidence, Web of Science, Canadian Medical Association Practice Guidelines, National Guidelines Clearing House and The Cochrane Library databases for guidelines, meta-analysis and systematic reviews published in English between 2009 and 2017, using the MeSH terms ‘irritable bowel syndrome’, ‘signs and symptoms’, ‘diet therapy’ and the non-MeSH term ‘FODMAPs’. The Strength of Recommendation Taxonomy (SORT) scale was used to determine levels of evidence and strength of recommendations. Results: Of 203 articles found, 11 studies were included: three meta-analyses, three systematic reviews, and five guidelines. There is evidence supporting the efficacy of a low FODMAP diet in improving gastrointestinal symptoms in IBS patients, mainly bloating and abdominal pain, especially in the diarrhea-predominant and mixed subtypes. Some studies show a greater improvement after six weeks. A low FODMAP diet seems to be at least as effective as traditional dietary advice for IBS. Some guidelines recommend this diet in the management of IBS patients, especially when traditional dietary advice is not effective. Conclusions: There is enough evidence to recommend a low FODMAP diet in the management of diarrhea-predominant and mixed subtypes IBS patients with bloating and abdominal pain (grade of recommendation B). There is no sufficient evidence on the long-term efficacy and safety of this diet.

Introdução: O narrow-band imaging (NBI) permite a classificação “in-vivo” dos pólipos colo-rectais. Objectivos: Avaliámos o diagnóstico óptico na prática clínica diária em endoscopistas da comunidade, sem experiência prévia em NBI, o impacto do treino e se estes conseguiam atingir o limiar da estratégia de “não ressecar”. Métodos: Estudo observacional, realizado em dois períodos (P1 e P2). Os endoscopistas não apresentavam experiência prévia em NBI em P1 e aplicaram a técnica diariamente durante um ano antes da participação em P2. As lesões foram classificadas aplicando as classificações NBI International Colorectal Endoscopic (NICE) e Workgroup serrated polypS and Polyposis (WASP), simultaneamente. Resultados: Foram analisados 290 pólipos. A acuidade global do diagnóstico óptico foi de 0.75 (IC 95%, 0.68-0.81) em P1, aumentando para 0.82 (IC 95%, 0.73-0.89) em P2 (p = 0.260). A acuidade das classificações de NICE/WASP na diferenciação de histologia adenomatosa de não-adenomatosa foi de 0.78 (IC 95%, 0.72-0.84) em P1, e 0.86 (IC 95%, 0.77-0.92) em P2 (p = 0.164); as predições realizadas com alto grau de confiança alcançaram significado estatístico (melhoria de 13%, IC 95%, 3-22%; p = 0.022). O valor preditivo negativo para histologia adenomatosa dos pólipos diminutos recto-sigmóides foi de 81% (IC 95%, 64-93%) e 80% (IC 95%, 59-93%), em P1 e P2, respetivamente. Conclusões: Endoscopistas sem experiência em NBI alcançaram acuidade moderada no diagnóstico óptico em tempo real de lesões colo-rectais, utilizando as classificações de NICE/WASP. O desempenho global melhorou após a utilização contínua do diagnóstico óptico, mas não alcançou o limiar definido para a implementação da estratégia de “não ressecar”.

Background: Narrow-band imaging (NBI) allows “in vivo” classification of colorectal polyps. Objectives: We evaluated the optical diagnosis by nonexpert community-based endoscopists in routine clinical practice, the impact of training, and whether the endoscopists could achieve the threshold for the “do not resect” policy. Methods: This was an observational study performed in two periods (P1 and P2). Endoscopists had no prior experience in NBI in P1 and applied the technique on a daily basis for 1 year before participation in P2. Lesions were classified by applying the NBI International Colorectal Endoscopic (NICE) and Workgroup serrAted polyps and Polyposis (WASP) classifications, simultaneously. Results: A total of 290 polyps were analyzed. The overall accuracyof optical diagnosis was 0.75 (95% CI 0.68-0.81) in P1, with an increase to 0.82 (95% CI 0.73-0.89) in P2 (p = 0.260). The accuracy of the NICE/WASP classifications to differentiate adenomatous from nonadenomatous histology was 0.78 (95% CI 0.72-0.84) in P1 and 0.86 (95% CI 0.77-0.92) in P2 (p = 0.164); assignments made with a high confidence level achieved statistical significance (13% improvement, 95% CI 3-22%; p = 0.022). The negative predictive value for adenomatous histology of diminutive rectosigmoid polyps was 81% (95% CI 64-93%) and 80% (95% CI 59-93%) in P1 and P2, respectively. Conclusions: Nonexpert endoscopists achieved moderate accuracy for real-time optical diagnosis of colorectal lesions with the NICE/WASP classifications. The overall performance of the endoscopists improved after sustained use of optical diagnosis, but did not achieve the standards for the implementation of the “do not resect” strategy.

As vivências afetivas experienciadas no seio familiar têm um papel privilegiado no desenvolvimento dos jovens. A presente investigação teve como objetivo analisar o efeito dos estilos parentais no desenvolvimento das competências sociais e testar o papel mediador da personalidade. A amostra incluiu 1976 jovens com idades entre os 14 e os 25 anos. Os resultados apontam que a empatia, a assertividade e o autocontrolo são preditos positivamente pelo estilo democrático e que a assertividade e o autocontrolo são preditos negativamente pelo estilo permissivo. Os dados sugerem o efeito mediador positivo da personalidade emocionalmente ajustada na associação do estilo democrático e as competências sociais, e um efeito mediador negativo entre o estilo permissivo e determinadas competências socias.

Affective experiences lived in the family have a privileged role in the development of young people. This research aimed to analyze the effect of parenting styles in the development of social skills of young people. It was also tested the mediating role of personality. The sample included 1976 young, 14 to 25 years aged. The results show that empathy, assertiveness and self-control were positively predicted by democratic style, and assertiveness and self-control were negatively predicted by permissive style. The data also suggested the positive mediating effect of personality on the association between democratic style and social skills, and a negative mediating effect on the association between permissive style and social skills.