ABSTRACT Introduction: Total laryngectomy is a maiming surgical procedure, that causes irrecoverable functional changes, and the person has to adapt to a new health condition, as well as the requirement for postoperative care. Objective: To identify sensitive outcomes to the performance of Rehabilitation Nurse in the prevention of respiratory complications in total laryngectomized person. Methodology: Descriptive study of the case study type, elaborated according to the guidelines of case report. Presented the case of a person submitted to total laryngectomy, admitted to an inpatient unit of a hospital center, with respect for ethical principles in their approach. Data collection was carried out through anamnesis, consultation of the person's clinical file, physical examination (inspection and auscultation) and evaluation of vital signs. Results: With the implementation of five respiratory functional re-education sessions, there were gains in ventilation, airway cleaning and the ability to promote airway cleaning, preventing postoperative respiratory complications and promoting adaptation to their new health condition. Conclusion: After implementing a respiratory functional re-education program for the person under study, who underwent total laryngectomy, there were gains in ventilation, airway cleaning and the ability to promote airway cleaning. it will be advantageous to carry out further studies in this area, to understand the effect of respiratory functional re-education programs on a representative sample.

RESUMO Introdução: A laringectomia total é um procedimento cirúrgico mutilante, que provoca alterações funcionais irrecuperáveis, tendo a pessoa que se adaptar a uma nova condição de saúde, bem como à exigência dos cuidados pós-operatórios. Objetivo: Identificar os ganhos sensíveis à atuação do Enfermeiro Especialista em Enfermagem de Reabilitação, na prevenção de complicações respiratórias na pessoa laringectomizada total. Metodologia: Estudo descritivo do tipo estudo de caso elaborado de acordo com as guidelines da Case REport. Apresentado o caso de uma pessoa submetida a laringectomia total, admitida numa Unidade de Internamento de um Centro Hospitalar, tendo sido respeitados os princípios éticos na sua abordagem. A recolha de dados foi efetuada através da anamnese, consulta do processo clínico da pessoa, exame físico (inspeção e auscultação) e avaliação dos sinais vitais. Resultados: Com a implementação de cinco sessões de reeducação funcional respiratória verificou-se ganhos na ventilação, limpeza das vias aéreas e capacidade para promover a limpeza das vias aéreas, prevenindo, deste modo, complicações respiratórias no pós-operatório e promovendo a adaptação à sua nova condição de saúde. Conclusão: Após a implementação de um programa de reeducação funcional respiratória à pessoa em estudo, submetida a laringectomia total, verificaram-se ganhos na ventilação, limpeza das vias aéreas e capacidade para promover a limpeza da vias aéreas. Será vantajoso realizar outros estudos nesta área, para perceber o efeito dos programas de reeducação funcional respiratória numa amostra representativa.

RESUMEN Introducción: La laringectomía total es un procedimiento quirúrgico mutilar, que provoca cambios funcionales irrecuperables y que requiere que la persona se adapte a una nueva condición de salud, así como a la exigencia de los cuidados postoperatorios. Objetivo: Identificar las ventajas relacionadas con el papel de la Enfermera Especialista en Enfermería de Rehabilitación en la prevención de complicaciones respiratorias en personas con laringectomía total. Metodología: Estudio descriptivo del tipo estudio de caso elaborado de acuerdo con las directrices del Case REport. Se presenta el caso de un paciente sometido a una laringectomía total, ingresado en una Unidad de Internamiento de un Centro Hospitalario, respetando los principios éticos en su abordaje. La recolección de datos se realizó a través de anamnesis, consulta del expediente clínico de la persona, examen físico (inspección y auscultación) y evaluación de signos vitales. Resultados: Con la implementación de cinco sesiones de reeducación funcional respiratoria, se constataron beneficios en cuanto a ventilación, limpieza de las vías respiratorias y la capacidad de promover la limpieza de las vías aéreas, evitando así complicaciones respiratorias en el postoperatorio y promoviendo la adaptación a su nuevo estado de salud. Conclusión: Después de implementar un programa reeducación funcional respiratoria para el persona en estudio, que se sometió a laringectomía total, hubo ganancias en la ventilación, la limpieza de las vías aéreas y la capacidad para promover la limpieza de las vías aéreas. Será ventajoso realizar más estudios en esta área, para comprender el efecto de los programas de reeducación funcional respiratoria en una muestra representativa.

Resumo Introdução: O médico de família desenvolve uma abordagem centrada na pessoa, orientada para o indivíduo, a família e a comunidade em que se insere, sendo a empatia a chave-mestra desta relação. Objetivos: Compreender a relação médico-doente no contexto dos cuidados de saúde primários (CSP) do Nordeste Transmontano. Métodos: Foi realizado um estudo descritivo com uma amostra de utentes de CSP. Os dados demográficos (sexo biológico - classificação binária, idade, concelho de residência e escolaridade), perguntas acerca da perceção dos CSP e a aplicação da Escala de Empatia de Jefferson (JSPPPE-VP) foram recolhidos através de uma plataforma online, recorrendo à divulgação pelas redes sociais, e em formato físico nos CSP da Unidade Local de Saúde do Nordeste. A análise estatística descritiva foi realizada com recurso ao software IBM SPSS® Statistics. Resultados: A amostra incluiu 584 indivíduos (idade mediana: 45 anos), maioritariamente mulheres (67,47%), com um nível de escolaridade não graduado (57,71%). A maioria dos inquiridos (75,51%) revela que o seu médico de família é a primeira pessoa a quem recorrem quando têm um problema de saúde, considerando que este tem as capacidades necessárias para a melhor orientação dos seus problemas de saúde (69,52%). Relativamente à acessibilidade, 61,30% e 60,96% considera, respetivamente, que o acesso à marcação de consulta e esclarecimento de dúvidas pontuais é fácil. Dos inquiridos, 22,95% discorda do tempo médio de consulta praticado (20 minutos), defendendo uma duração de 30 minutos. Quando aplicada a JSPPPE-VP, cerca de 50,00% dos indivíduos responderam que estão bastante ou totalmente de acordo com as afirmações que se encontram ao longo de toda a escala. Conclusões: A amostra obtida revela uma satisfação global relativamente à prestação, acessibilidade e qualidade dos serviços, bem como à duração da consulta. Além disso, pode-se concluir que existe uma elevada satisfação com a empatia do médico de família.

Abstract Introduction: The family doctor develops a person-centered approach, oriented toward the individual, the family, and the community in which he is inserted, with empathy being the major key to this relationship. Objectives: Understand the doctor-patient relationship in the context of primary health care (PHC) in the Northeast of Portugal. Methods: A descriptive study was carried out with a sample of PHC. Demographic data (biological sex-binary classification, age, county of residence, and education), questions about the perception of PHC, and the application of the Jefferson Empathy Scale (JSPPPE-VP) were collected through an online platform with the dissemination of information through social media and physical format in PHC of the Unidade Local de Saúde do Nordeste. Descriptive statistical analysis was performed using the IBM SPSS® Statistics software. Results: The sample consisted of 584 individuals (median age: 45 years old), mostly women (67.47%), with an undergraduate level of education (57.71%). Most people (75.51%) say that their family doctor is the first person that they turn to when they have a health problem because they believe he has the necessary skills to better manage their health problems (69.52%). In terms of accessibility, 61.30% and 60.96% respectively consider that it is easy to get an appointment and to clarify specific doubts. Of the respondents, 22.95% did not agree with the average duration of consultations (20 minutes), preferring 30 minutes. When the JSPPE-VP was applied, approximately 50.00% of the respondents indicated that they strongly or completely agreed with all the items evaluated. Conclusions: The sample obtained showed overall satisfaction with the provision, accessibility, and quality of services, as well as the duration of the consultation. It can also be concluded that there is a high level of satisfaction with the empathy of the family doctor.

Abstract Introduction: Blunt thoracic aortic injuries (BTAI) are defined as a tear in the thoracic aorta caused by a high energy blunt trauma with sudden deceleration and increased intravascular pressure. The most common reported mechanism of injury is motor vehicle accidents, and it can be potentially lethal. The purpose of this study was to analyze and report our center’s experience in the treatment of blunt traumatic injuries of thoracic aorta and supra-aortic trunks. Methods: A retrospective review of a single center's database was done to identify all patients treated for BTAI, in a four-year period, from January 2018 to December 2021. Follow-up period ranged from three to 24 months. Patients’ demographics, injury mechanism, location and grade of aortic injury, treatment details, timing of intervention, length of hospital stay, follow-up time, and postoperative morbidity and mortality were extracted from patients’ medical records. A descriptive analysis of all the data was performed. Results and discussion: We identified six patients to include in the study. Mean age was 29 years and 83.3% of patients were male. The mechanism of injury was motor vehicle accident for all cases. The most common injury grade was type III (pseudoaneurysm) in five patients (83.3%), and one patient presented with a type IV aortic injury with rupture. All injuries were in the aortic isthmus and all patients were suitable for TEVAR. Mean time to intervention was 17 days. Mean oversizing was 11%. Two patients had coverage of their LSA. No deaths occurred in the hospital or during the follow-up period, and there were no registered vascular procedure-related morbidities. Conclusion: This study reports a level one trauma center experience in management of BTAI. All patients underwent CTA for diagnosis and grading of aortic injury. TEVAR proved to be effective in the treatment of BTAI, with few complications and good outcomes at short and mid-term follow-up, and it should be the first-line treatment for these patients. OSR should be an option when a patient’s injury is not suitable for endovascular approach.

Abstract Background: Laryngeal cancer is a worldwide public health problem, with surgery being the most common treatment for this type of cancer. People submitted to total laryngectomy will experience complex changes in their lives, with a growing concern os nurses with the adaptation and quality of life of people in the postoperative period being verified, when they return home. Objective: Identify which domains impact the adaptation of the person undergoing total laryngectomy, and which may reflect the main difficulties experienced when returning home. Methodological Procedures of Integrative Review: Integrative review of the literature, according to the PICo variant, with the research question: “What are the domains that impact the adaptation of the patient submitted to a total laryngectomy when returning home?” The research was conducted in January 2020, in the CINAHL® and MEDLINE® Complete databases. Results: 42 articles were identified, which after applying the inclusion criteria, 4 were selected for analysis and data extraction. Conclusion: The integrative review allowed to answer the research question and to identifying different domains that impact the adaptation of the person submitted to total laryngectomy and that translate into the difficulties felt by people when returning home. It was possible to aggregate these domains into 5 groups: Physical Function, Role Function, Social Function, Emotional / Psychological Function and Global Health Status.

Resumo Introdução: O cancro da laringe é um problema mundial de saúde pública, sendo a cirurgia o tratamento mais comum para este tipo de neoplasia. As pessoas submetidas a laringectomias totais vivenciarão complexas alterações na sua vida, verificando-se uma preocupação crescente dos enfermeiros com a adaptação e qualidade de vida das pessoas no pós-operatório, aquando do regresso a casa. Objetivo: Identificar quais os domínios que impactam a adaptação da pessoa submetida a laringectomia total, e que possam traduzir as principais dificuldades sentidas pelas mesmas aquando do regresso a casa. Procedimentos Metodológicos de Revisão Integrativa: Revisão integrativa da literatura, de acordo com a estratégia PICo, com a seguinte questão de investigação: “Quais os domínios que impactam a adaptação da pessoa submetida a laringectomia total, aquando do regresso a casa?”. Pesquisa realizada em janeiro de 2020, nas bases de dados CINAHL® e MEDLINE® Complete. Resultados: Foram identificados 42 artigos, que após aplicação dos critérios de inclusão, resultaram em 4 para análise. Conclusão: A revisão integrativa permitiu responder à questão de investigação, identificando-se diferentes domínios que impactam a adaptação da pessoa submetida a laringectomia total e que se traduzem nas dificuldades sentidas pelas pessoas aquando do regresso a casa. Foi possível agregar estes domínios em 5 grupos: Função Física, Função de Papel, Função Social, Função Emocional / Psicológica e Estado Global de Saúde.

Abstract Introduction: Informal consultations are medical acts characterized by the individual’s self-referral to a doctor, without clinical record or adequate follow-up. Despite controversy, this practice is an integral part of medical culture. This case report highlights the importance of understanding the consequences of informal consultations and the desirability of a preventive attitude towards one’s own health. Case description: A 28-year-old female health professional requests an informal consultation due to low-back pain after two months of evolution where a tentative diagnosis and treatment plan were brainstormed. Symptom aggravation led her to a formal ortho-traumatology consultation, whereupon she was definitively diagnosed with a herniated lumbar disc, and a treatment plan was discussed and implemented, with good outcomes. Commentary: This case reveals the complexity of clinical communication and psychosocial context involving informal consultations. Healthcare professionals are particularly susceptible to belittling signs and symptoms, using informal consultations to tackle the clinical situation quickly and be able to work, but without really addressing the underlying problem.

Resumo Introdução: As consultas informais são atos médicos caracterizados pela autorreferenciação a um médico, sem registo clínico ou seguimento adequado. Apesar de controversa, esta prática assume-se como parte integrante da cultura médica. Este caso clínico mostra a importância de compreender as consequências das consultas informais e as vantagens de uma atitude preventiva em relação à saúde do próprio. Descrição do caso: Profissional de saúde do sexo feminino, de 28 anos, com lombalgia com dois meses de evolução recorre a uma consulta informal, na qual foram discutidos um diagnóstico presuntivo e um plano de tratamento a ser implementado. Devido ao agravamento sintomatológico recorreu a uma consulta formal de ortotraumatologia, na qual se estabeleceu um diagnóstico definitivo de hérnia lombar e foi discutido e implementado um plano de tratamento de forma partilhada, que teve bons resultados. Comentário: Este caso revela a complexidade da relação clínica e contexto psicossocial das consultas informais. Os profissionais de saúde estão particularmente suscetíveis à trivialização dos sinais e sintomas, recorrendo a consultas informais para uma rápida resolução da condição clínica, de forma a conseguirem manter-se a trabalhar, mas sem aprofundar a etiologia e causa do problema.

Resumo Introdução: A colonoscopia é eficaz a detetar e remover lesões do colon e reto. Contudo, após uma colonoscopia normal, podem ser detetadas neoplasias durante o intervalo de vigilância recomendado entre colonoscopias. O objetivo do estudo foi identificar características e fatores de risco para o desenvolvimento de cancro colorretal pós-colonoscopia - subtipo de intervalo. Material e Métodos: Estudo retrospetivo e unicêntrico realizado entre janeiro de 2018 e dezembro de 2019 que incluiu todos os doentes diagnosticados de novo com cancro colorretal. Variáveis clínicas, demográficas e endoscópicas foram obtidas após consulta do processo clínico. Doentes com diagnóstico de cancro colorretal entre duas colonoscopias consecutivas, realizadas no intervalo de vigilância recomendado, foram considerados como tendo cancro colorretal pós-colonoscopia - subtipo de intervalo. Foi, então, realizada a comparação entre o grupo de doentes com cancro color-retal não pós colonoscopia - subtipo de intervalo e o grupo de doentes com cancro colorretal pós colonoscopia - subtipo de intervalo. Resultados: Durante o período de estudo, 491 doentes foram diagnosticados de novo com cancro colorretal. Destes, 61 (12.4%) foram considerados como tendo cancro colorretal pós-colonoscopia - subtipo de intervalo. O cancro colorretal pós-colonoscopia - subtipo de intervalo foi três vezes mais prevalente no colon proximal (p = 0.014) e associou-se a presença de dois ou mais fatores de risco cardiovasculares (aOR = 0.45; p = 0.016), colecistectomia no passado (aOR = 10.09; p = 0.0.19) e história familiar de cancro colorretal num familiar de primeiro grau (aOR = 4.25; p = 0.006). Aquando da análise dos fatores de risco cardiovasculares isolados, observou-se um fator protetor aquando da ausência de to-dos os fatores de risco cardiovasculares (aOR = 20; p = 0.034). A curva ROC associada ao modelo multivariado revelou um poder preditivo de 77.8% (p < 0.001). Conclusão: O cancro colorretal pós-colonoscopia - subtipo de intervalo é mais comum no colon proximal e em doentes com história familiar (em familiares de primeiro grau) de cancro colorretal, dois ou mais fatores de risco cardiovasculares e história de colecistectomia. Todos estes fatores de risco são facilmente detetáveis na prática clínica e podem ser de extrema importância no controlo, a curto e longo prazo, do cancro colorretal pós-colonoscopia.

Abstract Background and Aims: Colonoscopy is effective to detect and remove colorectal lesions. However, after a negative colonoscopy, cancers could be detected during the interval follow-up. This study was designed to identify characteristics and risk factors for postcolonoscopy colorectal cancer - interval type. Methods: Medical records of individuals who were newly diagnosed with colorectal cancer between January 2018 and December 2019 were reviewed. Clinical, demographic, and endoscopic variables were analyzed. Those with the diagnosis of colorectal cancer between two consecutive colonoscopies performed within the appropriated surveillance range were considered to have postcolonoscopy colorectal cancer - interval type. A comparison between the group of patients with non-postcolonoscopy colorectal cancer - interval type and the group of patients with post-colonoscopy colorectal cancer - interval type was then performed. Results: During the study period, 491 patients were newly diagnosed with colorectal cancer. Among them, 61 (12.4%) had postcolonoscopy colorectal cancer - interval subtype. Postcolonoscopy colorectal cancer - interval type was three times more prevalent on the proximal colon (p = 0.014) and was associated with the presence of two or more cardiovascular risk factors (aOR = 4.25; p = 0.016), cholecystectomy in the past (aOR = 10.09; p = 0.019), and family history of colorectal cancer on a first-degree relative (aOR = 4.25; p = 0.006). Moreover, isolated cardiovascular risk factors revealed a protective effect for the absence of all cardiovascular risk factors (aOR = 20; p = 0.034). The ROC curve associated with the multivariate model revealed a predictive power of 77.8% (p < 0.001). Conclusions: Postcolonoscopy colorectal cancer - interval type is more common in the proximal colon and in patients with a family history (first-degree relative) of colorectal cancer, two or more cardiovascular risk factors, and a history of cholecystectomy. All of these are easily detectable in clinical practice and may be of extreme importance in the control of postcolonoscopy colorectal cancer in the near future.

Abstract Introduction: Blunt thoracic aortic injuries (BTAI) are defined as a tear in the thoracic aorta caused by a high energy blunt trauma. The most common reported mechanism of injury is motor vehicle accidents, and it can be potentially lethal. The Society for Vascular Surgery (SVS) and the European Society for Vascular Surgery (ESVS) guidelines recommend thoracic endovascular aortic repair (TEVAR) as the first line treatment for BTAI. Other controversies regarding BTAI management were reported in the literature, such as the best treatment for minimal aortic injuries with intimal tear, ideal stent graft oversizing, best timing for treatment and necessity to cover the left subclavian artery (LSA). The purpose of this review is to identify and analyze appropriate studies published so far about the management of BTAI. Methods: We performed a thorough electronic search of the literature using PubMed and Embase databases. We used the following combination of key words in our search strategy ((aortic injury) AND (blunt thoracic trauma)) AND (vascular surgery* OR treatment* OR TEVAR*). Articles not in English were excluded. The primary subject was results of endovascular treatment. Secondary subjects were indications and results of OSR, best timing for intervention, ideal graft oversizing, need for left subclavian artery (LSA) coverage, and management of BTAI grade I (intimal tear). Results: Data related to our primary and secondary subjects were extracted from the selected articles. TEVAR is considered the primary treatment for BTAI, if the patient has suitable anatomy, with good short and mid-term outcomes, with lower mortality and paraplegia rates at short and mid-term follow-up, compared to OSR. Despite good term results at short-term follow-up after TEVAR, long-term outcomes are still a concern. OSR is still a valid option in selected cases, and it should be considered for patients whose injury location is unsuitable for the endovascular approach. In most patients with BTAI, it is recommended around 10% of graft oversizing. However, a more aggressive approach with oversizing between 10-20% should be considered for patients with considerable hypotension and even >20% for patients presenting with severe hypotensive hemorrhagic shock. A necessity of LSA coverage has been reported in 30% of TEVAR for urgent treatment of BTAI, and it seems to be well tolerated. We should considered expectant approach with serial follow-up CT scans in patients with BTAI grade I injuries with asymptomatic intimal aortic tear. Conclusions: This literature review reports and synthetizes published data about the management strategies for BTAI. TEVAR seems to be effective in the treatment of BTAI, with few complications and good outcomes at short and mid-term follow-up, and it should be the first-line treatment for these patients. OSR should be an option when a patient’s injury is not suitable for endovascular approach.

Abstract Neonatal alloimmune thrombocytopenia (NAIT) occurs when the mother develops antiplatelet antibodies against fetal platelets and is confirmed by the presence of maternal antihuman platelet antibodies. A full-term newborn from a first pregnancy without complications was routinely examined on the first day of life. The newborn appeared well and had multiple petechiae on the axillary, inguinal, and popliteal folds and on the lower abdomen, with no other findings. Blood work revealed thrombocytopenia of 28,000/ul with a normal remaining hemogram and negative C-reactive protein. Because of the suspicion of NAIT, an intravenous dose of immunoglobulin was administered with a subsequent increase in platelet count. The diagnosis was confirmed on day 5 with the detection of maternal antiplatelet anti-HPA-1a alloantibodies. A thorough physical examination of the newborn is essential, as some serious conditions may present with subtle changes. NAIT should be considered in the differential diagnosis of isolated petechiae of the newborn.

Resumo A trombocitopenia neonatal aloimune (TNA) ocorre quando a mãe produz anticorpos anti-plaquetários contra plaquetas fetais e é confirmada pela presença de anticorpos anti-plaquetários maternos. Um recém-nascido de termo fruto de uma primeira gravidez sem complicações foi observado num exame de rotina no 1º dia de vida. A criança apresentava bom estado geral e múltiplas petéquias nas pregas inguinais, axilares e poplíteas e na região abdominal inferior, sem outras alterações. O hemograma revelou trombocitopenia de 28,000/uL sem outras alterações e proteína C-reativa negativa. Devido à suspeita de TNA, foi administrada imunoglobulina endovenosa, com aumento subsequente da contagem plaquetária. O diagnóstico foi confirmado ao quinto dia com a presença de aloanticorpos anti-plaquetários anti-HPA-1a maternos. Dado que certas doenças graves podem apresentar-se com alterações subtis, é fundamental a realização de um exame objetivo exaustivo do recém-nascido. A TNA deve ser considerada no diagnóstico diferencial de petéquias isoladas no recém-nascido.

Abstract Introduction: Blunt thoracic aortic injuries (BTAI) are defined as a tear in the thoracic aorta caused by a high energy blunt trauma. The most common reported mechanism of injury is motor vehicle accidents, and it can be potentially lethal. The Society for Vascular Surgery (SVS) and the European Society for Vascular Surgery (ESVS) guidelines recommend thoracic endovascular aortic repair (TEVAR) as the first line treatment for BTAI. Other controversies regarding BTAI management were reported in the literature, such as the best treatment for minimal aortic injuries with intimal tear, ideal stent graft oversizing, best timing for treatment and necessity to cover the left subclavian artery (LSA). The purpose of this review is to identify and analyze appropriate studies published so far about the management of BTAI. Methods: We performed a thorough electronic search of the literature using PubMed and Embase databases. We used the following combination of key words in our search strategy ((aortic injury) AND (blunt thoracic trauma)) AND (vascular surgery* OR treatment* OR TEVAR*). Articles not in English were excluded. The primary subject was results of endovascular treatment. Secondary subjects were indications and results of OSR, best timing for intervention, ideal graft oversizing, need for left subclavian artery (LSA) coverage, and management of BTAI grade I (intimal tear). Results: Data related to our primary and secondary subjects were extracted from the selected articles. TEVAR is considered the primary treatment for BTAI, if the patient has suitable anatomy, with good short and mid-term outcomes, with lower mortality and paraplegia rates at short and mid-term follow-up, compared to OSR. Despite good term results at short-term follow-up after TEVAR, long-term outcomes are still a concern. OSR is still a valid option in selected cases, and it should be considered for patients whose injury location is unsuitable for the endovascular approach. In most patients with BTAI, it is recommended around 10% of graft oversizing. However, a more aggressive approach with oversizing between 10-20% should be considered for patients with considerable hypotension and even >20% for patients presenting with severe hypotensive hemorrhagic shock. A necessity of LSA coverage has been reported in 30% of TEVAR for urgent treatment of BTAI, and it seems to be well tolerated. We should considered expectant approach with serial follow-up CT scans in patients with BTAI grade I injuries with asymptomatic intimal aortic tear. Conclusions: This literature review reports and synthetizes published data about the management strategies for BTAI. TEVAR seems to be effective in the treatment of BTAI, with few complications and good outcomes at short and mid-term follow-up, and it should be the first-line treatment for these patients. OSR should be an option when a patient’s injury is not suitable for endovascular approach.

Abstract Introduction: Onychomadesis refers to the proximal separation of the nail plate from the matrix following a temporary arrest in nail formation, leading to nail shedding. While it can be a consequence of multiple aetiologies, it is uncommon in childhood. To our knowledge, this is the first case reporting the association between onychomadesis and hand-foot-and-mouth disease in the context of primary health care in Portugal. Case description: A previously healthy 21-month-old male child, otherwise asymptomatic except for fingernail alterations, was diagnosed with hand-foot-and-mouth disease four weeks before nail changes. Comment: Beau’s lines and onychomadesis are late complications of hand-foot-and-mouth disease. Clinicians must invest in a proper and detailed patients’ medical history and assess recent viral infections. On the other hand, the knowledge of probable indicators and of the association between onychomadesis and hand-foot-and-mouth disease itself may avoid inadequate investigations, referrals, and treatments. Furthermore, advising, and reassuring patients/parents/caregivers about possible nail alterations weeks following hand-foot-and-mouth disease may also prevent unnecessary concerns.

Resumo Introdução: A onicomadese é a separação da unha da matriz ungueal após paragem temporária da sua formação, originando destacamento da mesma. Este fenómeno pode ter múltiplas etiologias, sendo pouco frequente na infância. Os autores desconhecem outro caso que reporte a associação entre onicomadese e a doença mão-pé-boca, no âmbito dos cuidados de saúde primários em Portugal. Descrição do caso: Criança de 21 meses de idade, do sexo masculino, previamente saudável, recorre à consulta na sua unidade de saúde por apresentar alterações ungueais, sem outros sinais ou sintomas associados, que surgiram quatro semanas após o diagnóstico de doença mão-pé-boca. Comentário: As linhas de Beau e a onicomadese são complicações tardias da síndroma mão-pé-boca. Deste modo, é importante que os clínicos invistam numa anamnese adequada, incluindo infeções recentes. Por outro lado, conhecer os indicadores prováveis e a associação entre onicomadese e a doença mão-pé-boca pode evitar investigações, referenciações e tratamentos inadequados. Adicionalmente, informar e aconselhar os pais, cuidadores e pacientes sobre possíveis alterações ungueais semanas após a infeção poderá ajudar a prevenir preocupações desnecessárias.

Abstract Background and Aim: Aeromonas are Gram-negative rods known to cause a spectrum of diseases. Inflammatory bowel disease (IBD) is an idiopathic complex condition resulting from interaction of multiple factors. Aeromonas infection in association with IBD is still largely unknown. We aim to look for the significance of Aeromonas infection and for significant differences between IBD and non-IBD patients. Methods: A retrospective observational analysis was performed of all patients positive for Aeromonas in stool cultures, during a 10-year period, from a tertiary and university hospital. Results: Fifty patients were included, 56% male with a mean age of 42.1 years. Thirty-eight (76%) were non-IBD and 12 (24%) IBD patients. IBD patients were more frequently under immunosuppressors. Two patients were asymptomatic and 44% developed mild, 44% moderate, and 16.7% severe infection. The main strains isolated were Aeromonas hydrophila/caviae. Bacterial co-isolation was found in 4 non-IBD and histological findings of cytomegalovirus in 2 IBD patients. Non-IBD patients presented more frequently with fever and IBD patients with bloody diarrhea and abdominal pain. There was higher tendency for severe infection rate in IBD patients with higher antimicrobial therapy use. Steroids were exclusively used in the IBD group. From IBD, 4 patients had the diagnosis of ulcerative colitis and 9 of Crohn’s disease with colonic involvement. Of these patients, 5 received IBD diagnosis after the acute episode of Aeromonas infection. Conclusions: Clinical presentation of Aeromonas infection differs between IBD and non-IBD patients. Non-IBD patients had milder severity of infection with less use of antibiotics. Aeromonas infection seems to greatly contribute to IBD manifestation.

Resumo Introdução: A etiologia da Doença Inflamatória Intestinal (DII) é complexa e resultante da interação de diversos fatores, nomeadamente microbiológicos. A infeção por Aeromonas caracteriza-se por um espectro alargado de manifestações clínicas. O papel da infeção por Aeromonas na DII não está caracterizado. Objetivos: Avaliar o significado da infeção por Aeromonas na DII e as diferenças com a infeção em doentes não-DII. Métodos: avaliação retrospetiva e observacional de todos os doentes com isolamento microbiológico de Aeromonas em amostras fecais num período de 10 anos, num hospital terciário. Resultados: foram avaliados 50 doentes, 56% do sexo masculino, com idade média de 42.1 anos. Doze (24%) com diagnóstico de DII e trinta e oito (76%) não-DII. Os doentes com DII encontravam-se mais frequentemente sob imunossupressão. Dois doentes foram assintomáticos, 44% desenvolveram doença ligeira, 44% moderada e 16.7%severa, havendo maior tendência para infeção severa nos DII. Os doentes não-DII apresentaram mais frequentemente febre e os DII diarreia sanguinolenta e dor abdominal. O uso de antimicrobianos foi superior no grupo DII e a utilização de corticoesteroides foi exclusiva nestes doentes. Isolamento concomitante de outros agentes microbiológicos ocorreu em 4 doentes não-DII e 2 com DII tinham histologia compatível com infeção por Citomega-lovírus. Da população DII, 4 eram Colite Ulcerosa e 9 Doença de Crohn com envolvimento cólico. Destes, 5 receberam o diagnóstico após a infeção por Aeromonas. Conclusão: A apresentação clínica da infeção por Aeromonas foi distinta entre as populações DII e não-DII, sendo que os doentes DII apresentaram doença mais severa e maior utilização de antimicrobianos. A infeção na DII ocorreu essencialmente em doentes com envolvimento cólico.

RESUMEN Objetivos: adaptar transculturalmente la escala “Resultados en la valoración y evolución de la cicatrización de heridas”, RESVECH 2.0 al portugués de Brasil; estimar su consistencia interna, validez de constructo y de criterio para su utilización en úlceras varicosas. Métodos: es un estudio metodológico, basado en directivas internacionales sobre investigaciones de esta naturaleza. Se evaluaron las heridas por medio de la RESVECH 2.0 y de la Escala de Cicatrización de Úlceras por Presión 3.0 (PUSH). Se llevó a cabo con análisis descriptivo, análisis factorial confirmatorio, alfa de Cronbach y correlación de Spearman (p<0,05). Resultados: participaron 12 enfermeros y 77 personas que tenían 153 úlceras venosas. La traducción fue exitosa, el modelo factorial propuesto fue validado, el alfa de Cronbach = 0,832 (95%CI=0,780-0,880) y el coeficiente de correlación (RESVECH 2.0 y PUSH 3.0) = 0,74. Conclusiones: la adaptación de la RESVECH 2.0 al portugués brasileño es sólida. La fiabilidad y la validez demuestran la compatibilidad para su utilización en el país en la evaluación de las úlceras varicosas. Objetivos Resultados heridas, , heridas” 20 2 0 2. Brasil interna varicosas Métodos metodológico naturaleza 30 3 3. PUSH. . (PUSH) descriptivo confirmatorio p<0,05. p005 p p<0,05 05 (p<0,05) 1 7 15 venosas exitosa validado 0832 832 0,83 95%CI=0,7800,880 95CI07800880 CI 95%CI=0,780 0,880 95 780 880 (95%CI=0,780-0,880 074 74 0,74 Conclusiones sólida (PUSH p00 p<0,0 (p<0,05 083 83 0,8 7800 95%CI=0,7800,88 95CI0780088 95CI0780 95%CI=0,78 0880 0,88 9 78 88 (95%CI=0,780-0,88 07 0,7 p0 p<0, (p<0,0 08 8 0, 95%CI=0,7800,8 95CI078008 95CI078 95%CI=0,7 088 (95%CI=0,780-0,8 p<0 (p<0, 95%CI=0,7800, 95CI07800 95CI07 95%CI=0, (95%CI=0,780-0, p< (p<0 95%CI=0,7800 95CI0 95%CI=0 (95%CI=0,780-0 (p< 95CI 95%CI= (95%CI=0,780- (p 95%CI (95%CI=0,780 (95%CI=0,78 (95%CI=0,7 (95%CI=0, (95%CI=0 (95%CI= (95%CI

ABSTRACT Objectives: to cross-culturally adapt the scale Resultados en la valoración y evolución de la cicatrización de las heridas - RESVECH 2.0 for Brazilian Portuguese; to estimate the internal consistency and construct and criterion validity of the scale in the evaluation of venous ulcers. Methods: methodological study, based on international guidelines for studies of this type. Wounds were evaluated using the RESVECH 2.0 and Pressure Ulcer Scale of Healing 3.0 (PUSH). Descriptive analysis, confirmatory factor analysis, Cronbach’s alpha and Spearman’s correlation (p<0.05) were used. Results: 12 nurses and 77 people with 153 venous ulcers participated in the study. The translation was successful, the proposed factor model was validated, and Cronbach ‘s alpha = 0.832 (95%CI, 0.780-0.880) and correlation coefficient (RESVECH 2.0 and PUSH 3.0) = 0.74 were obtained. Conclusions: the adaptation of RESVECH 2.0 to Brazilian Portuguese is robust. Reliability and validity show compatibility for use in the country in the evaluation of venous ulcers. Objectives crossculturally cross culturally 20 2 0 2. Methods study type 30 3 3. PUSH. . (PUSH) analysis Cronbachs s Spearmans Spearman p<0.05 p005 p 05 (p<0.05 used Results 1 7 15 successful validated 0832 832 0.83 95%CI, 95CI CI 95 (95%CI 0.7800.880 07800880 0.780 0.880 780 880 0.780-0.880 074 74 0.7 obtained Conclusions robust (PUSH p<0.0 p00 (p<0.0 083 83 0.8 95%CI 9 7800 0.7800.88 0780088 0780 0.78 0880 0.88 78 88 0.780-0.88 07 0. p<0. p0 (p<0. 08 8 0.7800.8 078008 078 088 0.780-0.8 p<0 (p<0 0.7800. 07800 0.780-0. p< (p< 0.7800 0.780-0 (p 0.780-

RESUMO Objetivos: adaptar transculturalmente a escala Resultados en la valoración y evolución de la cicatrización de las heridas - RESVECH 2.0 para o português do Brasil; estimar sua consistência interna, validade de construto e de critério para utilização em úlceras venosas. Métodos: estudo metodológico, baseado em diretrizes internacionais para estudos dessa natureza. Realizou-se avaliação das feridas por meio da RESVECH 2.0 e da Pressure Ulcer Scale of Healing 3.0 (PUSH). Empregou-se análise descritiva, análise fatorial confirmatória, alfa de Cronbach e correlação de Spearman (p<0,05). Resultados: participaram 12 enfermeiros e 77 pessoas com 153 úlceras venosas. A tradução foi bem-sucedida, o modelo fatorial proposto foi validado, obteve-se alfa de Cronbach = 0,832 (IC95%=0,780-0,880) e coeficiente de correlação (RESVECH 2.0 e PUSH 3.0) = 0,74. Conclusões: a adaptação da RESVECH 2.0 para o português do Brasil é robusta. A confiabilidade e validade evidenciam compatibilidade para utilização no país e avaliação de úlceras venosas. Objetivos 20 2 0 2. interna venosas Métodos metodológico natureza Realizouse Realizou se 30 3 3. PUSH. . (PUSH) Empregouse Empregou descritiva confirmatória p<0,05. p005 p p<0,05 05 (p<0,05) 1 7 15 bemsucedida, bemsucedida bem sucedida, sucedida bem-sucedida validado obtevese obteve 0832 832 0,83 IC95%=0,7800,880 IC9507800880 IC IC95%=0,780 0,880 IC95 780 880 (IC95%=0,780-0,880 074 74 0,74 Conclusões robusta (PUSH p00 p<0,0 (p<0,05 083 83 0,8 7800 IC95%=0,7800,88 IC950780088 IC950780 IC95%=0,78 0880 0,88 IC9 78 88 (IC95%=0,780-0,88 07 0,7 p0 p<0, (p<0,0 08 8 0, IC95%=0,7800,8 IC95078008 IC95078 IC95%=0,7 088 (IC95%=0,780-0,8 p<0 (p<0, IC95%=0,7800, IC9507800 IC9507 IC95%=0, (IC95%=0,780-0, p< (p<0 IC95%=0,7800 IC950 IC95%=0 (IC95%=0,780-0 (p< IC95%= (IC95%=0,780- (p IC95% (IC95%=0,780 (IC95%=0,78 (IC95%=0,7 (IC95%=0, (IC95%=0 (IC95%= (IC95% (IC95 (IC9 (IC

Abstract Background The incidence and mortality of melanoma have increased in the last years in the Caucasian population. This 40-year study of melanoma incidence in Blumenau-SC shows the impact of primary prevention on the decrease of mortality. Objectives To classify cutaneous melanomas and evaluate their incidence in Blumenau from 1980 to 2019. Methodology This retrospective, descriptive and cross-sectional study collected 2,336 histopathological examinations of individuals living in the city, considering sex, age, primary location, histopathological type, invasion level (Clark), and tumor thickness (Breslow). The crude coefficients of annual incidence rates were calculated using the number of melanomas and the population estimated by the Brazilian Institute of Geography and Statistics between 1980 and 2019. Results Melanoma incidence rates reached 44.26 cases/100,000 inhabitants/year and the rates by sex reached 52.87 in men and 46.73 cases in women per 100,000 inhabitants. The most affected age group was 70 years old and over, with 421 cases in men and 301 cases/100,000 inhabitants in women. Superficial spreading melanoma occurred in 64.5% of the cases, followed by nodular melanoma in 22.8%. Early diagnoses reached 1900% with Breslow < 0.5 mm. Study limitations This study only covers histopathological reports with definitive diagnoses of cutaneous melanoma; therefore, the data are underestimated, consequently resulting in lower rates than in reality. Conclusions The incidence of cutaneous melanoma has increased fivefold between 1980 and 2009 and early diagnosis increased as a result of health education and primary prevention. 40year year 40 BlumenauSC SC 198 2019 retrospective crosssectional cross sectional 2336 2 336 2,33 city location type Clark, Clark , (Clark) Breslow. . (Breslow) 4426 44 26 44.2 cases100000 100 000 cases/100,00 inhabitantsyear 5287 52 87 52.8 4673 46 73 46.7 100000 100,00 7 over 42 30 645 64 5 64.5 228 22 8 22.8% 1900 05 0 0. mm therefore underestimated reality 200 4 19 201 233 33 2,3 (Clark (Breslow 442 44. cases10000 10 00 cases/100,0 528 52. 467 46. 10000 100,0 3 6 64. 22.8 190 20 1 23 2, cases1000 cases/100, 1000 100, 22. cases100 cases/100 cases10 cases/10 cases1 cases/1 cases/

RESUMO Objetivo: identificar o impacto do uso de máscara de proteção facial na performance comunicativa dos repórteres durante a pandemia da COVID-19, bem como verificar se existe associação entre esses aspectos. Métodos: trata-se de um estudo transversal, de caráter descritivo, com abordagem quantitativa. Participaram 32 repórteres que atuaram durante a pandemia, sendo 16 do sexo feminino e 16 do sexo masculino. A maioria dos participantes tinha ensino superior (n = 28; 87,5%). A amostra apresentou média de idade de 35,09 anos (DP = 9,41) e tempo de atuação na área de 10,09 anos (DP = 7,62). Os repórteres responderam a um formulário online composto por 26 questões, elaborado pelos próprios pesquisadores, sobre a autopercepção vocal e performance comunicativa do repórter com o uso de máscara durante a pandemia. Foi realizada análise descritiva dos dados e aplicado o teste Qui-quadrado por meio do software Statistical Package for Social Sciences 20 (SPSS). Resultados: a maioria dos repórteres (n = 20; 62,5%) classificou sua voz e articulação de fala como boas (n = 19; 59,4%). A maioria dos participantes relatou sentir dificuldade de ouvir e/ou ser ouvido pelo entrevistado em locais com ruído e perceber a sua voz mais baixa, com pouco volume ou abafada (n= 28; 87,5%), bem como 22 (68,8%) relataram ter que falar mais alto do que o normal para ser ouvido. Por fim, verificou-se a presença de associações entre as questões sobre a performance comunicativa dos repórteres e o uso de máscaras durante as reportagens. Conclusão: os repórteres apresentaram impactos negativos com uso das máscaras de proteção facial durante as reportagens, bem como verificou-se associação entre o uso destas com a performance comunicativa. Objetivo COVID19, COVID19 COVID 19, 19 COVID-19 aspectos Métodos tratase trata transversal descritivo quantitativa 3 1 masculino n 28 87,5%. 875 87,5% . 87 5 87,5%) 3509 35 09 35,0 DP 9,41 941 9 41 1009 10 10,0 7,62. 762 7,62 7 62 7,62) 2 pesquisadores Quiquadrado Qui quadrado SPSS. SPSS (SPSS) Resultados 62,5% 625 59,4%. 594 59,4% 59 4 59,4%) eou baixa n= 87,5%, , 68,8% 688 68 8 (68,8% fim verificouse verificou reportagens Conclusão COVID1 COVID-1 87,5 350 0 35, 9,4 94 100 10, 76 7,6 6 (SPSS 62,5 59,4 68,8 (68,8 COVID- 87, 9, 7, 62, 59, 68, (68, (68 (6 (

ABSTRACT Purpose: to identify the impact of wearing protective face masks on reporters’ communicative performance during the COVID-19 pandemic and verify whether there was an association between these aspects. Methods: a quantitative, descriptive, cross-sectional study with a sample of 32 reporters (16 females and 16 males) who worked, during the pandemic. Most participants had a bachelor’s degree (n = 28; 87.5%). The sample’s mean age was 35.09 years (SD = 9.41), and they had been working in the area for a mean of 10.09 years (SD = 7.62). Reporters answered an online form with 26 questions, developed by the researchers, on their self-perception of voice and communicative performance when wearing a mask, during the pandemic. Data were descriptively analyzed, and the chi-square test was applied with the Statistical Package for the Social Sciences 20 (SPSS). Results: most reporters (n = 20; 62.5%) classified their voices and speech articulation as good (n = 19; 59.4%) and reported difficulties hearing and/or being heard by interviewees in noisy places and perceived their voices were lower, muffled, or with a low volume (n = 28; 87.5%). Also, 22 (68.8%) reported having to speak louder than usually to be heard. Lastly, the questions on reporters’ communicative performance were associated with wearing masks while reporting. Conclusion: wearing protective face masks, during reportage, negatively impacted reporters and was associated with their communicative performance. Purpose COVID19 COVID 19 COVID-1 aspects Methods quantitative descriptive crosssectional cross sectional 3 (1 1 males worked bachelors bachelor s n 28 87.5%. 875 87.5% . 87 5 87.5%) samples 3509 35 09 35.0 SD 9.41, 941 9.41 , 9 41 9.41) 1009 10 10.0 7.62. 762 7.62 7 62 7.62) 2 researchers selfperception self perception mask analyzed chisquare chi square SPSS. SPSS (SPSS) Results 62.5% 625 59.4% 594 59 4 andor lower muffled Also 68.8% 688 68 8 (68.8% Lastly reporting Conclusion reportage COVID1 COVID- ( 87.5 350 0 35. 94 9.4 100 10. 76 7.6 6 (SPSS 62.5 59.4 68.8 (68.8 87. 9. 7. 62. 59. 68. (68. (68 (6