Abstract Objective To evaluate a fixed UV-C light emitting device for its antimicrobial effectiveness in the disinfection of distinct surfaces and its antifungal effectiveness on air quality in the hospital environment. Methods This quasi-experimental study was conducted in a hospital inpatient unit, in which a six-stage air Biosampler (Andersen®) was used for air analysis. In the evaluation of surfaces, three suspensions of microorganisms (Acinetobacter sp. multidrug-resistant, Escherichia coli, and KPC-producing Klebsiella pneumoniae) were used to contaminate the environment. In both evaluations, pre- (control) and post-activation of UV-C light (test) collections were made. Results In the air evaluation, an important reduction was observed in the colony count after irradiation with UV-C light, and pathogenic or toxigenic fungi were not found in either of the two moments. Regarding the disinfection of surfaces, no bacterial growth was observed after the application of UV-C light, showing 100% bacterial inactivation under the tested conditions. Conclusion The use of fixed UV-C light emission technology was effective and can be considered a promising intervention for hospital surface disinfection protocols.

Resumen Objetivo Evaluar la eficacia antimicrobiana de un dispositivo fijo emisor de luz UV-C para la desinfección de diferentes superficies del ambiente hospitalario y su eficacia antifúngica en la calidad del aire. Métodos Estudio cuasi experimental realizado en una unidad de internación hospitalaria, en que se utilizó el biomuestreador de aire Andersen® de seis etapas para el análisis del aire. En el análisis de las superficies, se utilizaron tres suspensiones de microorganismos (Acinetobacter sp. MDR, Escherichia coli y Klebsiella pneumoniae productora de KPC) para contaminar el ambiente. En ambos se tomó una muestra antes (control) y después de accionar la luz UV-C (prueba). Resultados En el análisis del aire hubo una reducción importante del recuento de colonias después de la luz UV-C y no se encontraron hongos patógenos ni toxigénicos en ninguno de los dos momentos. Con relación a la desinfección de las superficies, no se observó ningún crecimiento bacteriano después de la intervención de la luz, lo que demuestra un 100 % de inactivación bacteriana en las condiciones analizadas. Conclusión El uso de la tecnología con emisión de luz UV-C fija fue eficaz y puede ser considerada una intervención prometedora para protocolos de desinfección de superficies hospitalarias.

Resumo Objetivo Avaliar a eficácia antimicrobiana de um dispositivo fixo emissor de luz UV-C na desinfecção de diferentes superfícies do ambiente hospitalar e sua eficácia antifúngica na qualidade do ar. Métodos Estudo quase-experimental realizado em uma unidade de internação hospitalar, que utilizou o Bioamostrador de ar Andersen® de seis estágios para análise do ar; e na avaliação das superfícies, utilizaram-se três suspensões de microrganismos (Acinetobacter sp. MDR, Escherichia coli e Klebsiella pneumoniae produtora de KPC) para contaminar o ambiente. Para ambos foram feitas coletas pré (controle) e pós-acionamento da luz UV-C (teste). Resultados Na avaliação do ar houve uma redução importante da contagem de colônias após a luz UV-C e não foram encontrados fungos patogênicos ou toxigênicos em nenhum dos dois momentos. Em relação à desinfecção das superfícies, nenhum crescimento bacteriano foi observado após a intervenção da luz, demonstrando 100% de inativação bacteriana nas condições testadas. Conclusão A utilização da tecnologia com emissão de luz UV-C fixa foi eficaz e pode ser considerada uma intervenção promissora para protocolos de desinfecção de superfícies hospitalares.

ABSTRACT Wild birds have great prominence in the transmission of diseases to humans, mainly due to their ease of access to human populations, raising concerns about the potential impact of that proximity on public health. The present study reports ARV and PBV occurrence in wild birds from an environmental protection area in the Amazon biome, in Pará state, Brazil. We obtained 155 fecal specimens from 47 species of wild birds for RNA extraction, ARV and PBV detection utilizing molecular methods, nucleotide sequencing, and phylogenetic analysis. ARV prevalence was 0.6% (1/155), being positive in an individual of Myrmotherula longipennis, and PBV prevalence was 1.29% (2/155), affecting two individuals of Guira guira. The PBV strains were assigned to genogroup I based on phylogenetic analysis, and they shared a strong phylogenetic link with strains isolated from different geographic locations. The ARV strain was more closely related to strains that had previously circulated in the same region. The presence of ARV and PBV in this habitat suggests that infection cycles of these agents occur naturally in the wild ecosystem, potentially triggering transmission events between bird species and humans. This is the first study on ARV detection in wild birds in Brazil and the first report on the occurrence of PBV in wild Guira guira. Additional studies are required to determine the epidemiology, origin, evolution, and emergence of new potentially pathogenic viruses in the Amazon.

RESUMO As aves silvestres têm grande destaque na transmissão de doenças ao homem, principalmente pela facilidade de acesso à população humana, levantando preocupações sobre o potencial impacto dessa proximidade no contexto da saúde pública. O presente estudo relata a ocorrência de ARV e PBV em aves silvestres de uma área de proteção ambiental no bioma Amazônico. Obtivemos 155 espécimes fecais de 47 espécies de aves silvestres, que foram submetidos a extração de RNA, detecção de ARV e PBV por técnicas moleculares, sequenciamento nucleotídico e análise filogenética. A prevalência de infecção por ARV foi 0,6% (1/155), sendo positivo em um indivíduo de Myrmotherula longipennis, e a prevalência de PBV foi 1,29% (2/155), afetando dois insdivíduos de Guira guira. A análise filogenética agrupou as cepas de PBV no genogrupo I, mostrando intensa relação filogenética com cepas isoladas de outras regiões geográficas. A cepa de ARV esteve mais relacionada filogeneticamente a cepas previamente circulantes na mesma região. Este é o primeiro estudo sobre detecção de ARV em aves silvestres no Brasil e o primeiro relato sobre a ocorrência de PBV em Guira guira. A circulação de ARV e PBV nesse ambiente demonstra que os ciclos desses agentes estão ocorrendo de forma natural no ecossistema silvestre, o que pode desencadear possíveis eventos de transmissão entre as espécies aviárias e humanos. Estudos adicionais são necessários para determinar a epidemiologia, origem, evolução e surgimento de novos vírus potencialmente patogênicos na Amazônia.

Abstract We quilombola women, a documentary that considers the quilombola identity and the right to COVID-19 vaccination, evokes notions of priority, rights, privileges and identity during the process of matching the number of vaccine doses available to citizens’ arms. Omission by a Brazilian federal government grounded in necro-politics and denial, plus a lack of information, led quilombo communities to take it on themselves to draw up lists of those eligible for vaccination. The production team’s aim was to use images as political language in the health field, so as to document and give visibility to these issues as one illustration of combating social and health inequalities and inequities rooted in structural racism. By combining science and art and interlacing references from the sociology of images, visual anthropology, plus the work and aesthetic devices of Eduardo Coutinho, the audiovisual production method brought out three key categories: I, We, and They, quilombola women. This article explores these categories underpinning construction of the documentary narrative, which drew on the potential of images, which in turn served as anti-racist, political and educational devices, both in the course of the production process and during the public screenings.

Resumo Eu, nós... ELAS quilombolas, documentário que aborda a identidade quilombola e o direito à vacinação contra a COVID-19, faz emergir noções como prioridade, direito, privilégio e identidade durante o processo que precisa vincular os números de doses a braços de cidadãos. No Brasil, diante da omissão do governo federal, fundamentada na necropolítica e no negacionismo, a falta de informações levou as comunidades quilombolas a se responsabilizarem pela construção das listas de aptos a receberem a vacina. O objetivo da produção foi utilizar as imagens como linguagem política na área da saúde, documentando e dando visibilidade para essas questões, como ilustração de processos de enfrentamento das desigualdades e iniquidades sociais e de saúde pautadas no racismo estrutural. Ao associar ciência e arte, o método de produção audiovisual, entrelaçado com os referenciais da sociologia das imagens, da antropologia visual e dos dispositivos de produção e estética de Coutinho, emergiram três categorias: o eu, o nós e o elas. Este artigo apresenta as categorias que embasaram a construção narrativa do documentário a partir das potencialidades das imagens, que se apresentaram como dispositivo político-pedagógico antirracista, tanto durante o processo de produção quanto ao longo das exibições públicas.

ABSTRACT Purpose: To evaluate the quality of life and stress level related to visual function following pediatric cataract surgery in a Brazilian public hospital. Methods: This prospective study analyzed children aged 6-14 years old who underwent cataract surgery. The Childhood Stress Scale and Children’s Visual Function Questionnaire (CVFQ) were used to assess stress levels and quality of life, respectively. Both instruments were applied by two psychologists before and after the surgery. Eye examination was performed by two ophthalmologists. Preoperative and postoperative data were compared. Results: In total, 23 children (32 eyes) were enrolled in the study, of which 9 had bilateral cataracts. The average age group at the time of surgery was 9.65 ± 2.26 (6-14) years old. One month after the surgery, the spherical equivalent was -0.90 ± 1.66D, and the corrected distance visual acuity was 0.13 ± 0.10 (0-0.3) LogMAR in bilateral cases and 0.50 ± 0.39 (0-1.3) LogMAR in unilateral cases (p<0.01). According to the Childhood Stress Scale, 77.7% of the bilateral cases and 57.1% of the unilateral cases had stable stress levels, and 34.7% of the children improved their stress level. The analysis of the CVFQ was based on scores for general health, general vision health, competence, personality, and treatment. After cataract surgery, 78.2% of the patients had improved or maintained CVFQ scores in the general health domain; 82.6%, general vision health; 95.6%, competence; 56.5%, personality; and 78.2%, treatment. Conclusion: Pediatric cataract surgery improves the visual function and the quality of life even in patients undergoing surgical procedures, without increasing the stress levels.

RESUMO Objetivo: Avaliar a qualidade de vida e o nível de estresse relacionada à função visual após a cirurgia de catarata pediátrica em um hospital público brasileiro. Métodos: Estudo prospectivo em crianças de seis a 14 anos submetidas à cirurgia de catarata. A Escala de Stresse Infantil e o Questionário de Função Visual em Crianças foram usados para avaliar o nível de estresse e a qualidade de vida, respectivamente. Ambos os instrumentos foram aplicados por duas psicólogas antes e após a cirurgia. O exame oftalmológico foi realizado por dois oftalmologistas. Os dados coletados no pré e pós-operatório foram comparados. Resultados: Vinte e três crianças (32 olhos) foram incluídas no estudo, nove delas apresentavam catarata bilateral. A média de idade na cirurgia foi de 9,65±2,26 (6 a 14) anos. Um mês após a cirurgia, o equivalente esférico foi de -0,90 ± 1,66D e a acuidade visual corrigida a distância foi de 0,13 ± 0,10 (0-0,3) LogMAR em casos bilaterais e 0,50 ± 0,39 (0-1,3) LogMAR em casos unilaterais (p<0.01). De acordo com a Escala de Stresse Infantil, 77,7% dos casos de catarata bilaterais, e 57,1% dos casos unilaterais mantiveram o nível de estresse e 34,7% das crianças melhoraram o nível de estresse. A análise do Questionário de Função Visual em Crianças foi baseada em pontuações para saúde geral, saúde geral da visão, competência, personalidade e tratamento. Após a cirurgia de catarata, 78,2% dos pacientes melhoraram ou mantiveram o escore do Questionário de Função Visual em Crianças na saúde geral, 82,6% na saúde geral da visão, 95,6% na competência, 56,5% na personalidade e 78,2% no tratamento. Conclusão: A cirurgia de catarata pediátrica melhora a função visual e a qualidade de vida em pacientes submetidos a procedimento cirúrgico, sem aumentar o nível de estresse.

ABSTRACT The use of residues resulting from the processing of agricultural products is an widely studied topic, which is justified by the need to reduce costs and by the search for productive sustainability, which has as one of its principles the full use production, reducing waste and therefore increasing the amount of products extracted per unit of area. Residual seeds, resulting from the production of fruit pulps, are rich in nutrients and with the potential to be further improved by the application of germination, increasing the protein content and the content of bioactive compounds. However, in the germination process, the product acquires a high water content, requiring immediate drying and control of the water adsorption kinetics after dehydration. Therefore, the objective of this study was to determine the water adsorption isotherms of germinated seeds flours from pumpkins of three varieties at temperatures of 15, 25 and 35 °C, to obtain the most appropriate mathematical model to describe the hygroscopic behavior and to determine the thermodynamic properties of water adsorption, through the values of the integral isosteric heat, differential entropy, differential enthalpy and Gibbs free energy for the studied conditions. The GAB and Peleg models fit the experimental data well. With increasing water activity, there was a reduction in isosteric heat and entropy. The enthalpy-entropy compensation theory was confirmed. Gibbs free energy was negative for all temperatures, increasing with increasing equilibrium water content, demonstrating that it is a spontaneous process.

ABSTRACT Introduction: Delayed graft function (DGF), an outcome for which inflammation is critical, has been associated with worse outcomes after kidney transplantation (KT). The neutrophil to lymphocyte and platelet (NLP) ratio is a biomarker of systemic inflammation. We assessed postoperative NLP ratio applicability as an early predictor of DGF in KT patients. Methods: Retrospective cohort of adult patients submitted to KT at our unit, between 1 January 2010 and 31 December 2020. NLP was calculated at 24 hours post-KT. Primary outcome was development of DGF. Logistic regression was calculated to determine significant factos which may have contributed to DGF. Results: We included 527 patients with a mean age of 49.9 ± 12.8 years. In 47.8% of patients expanded criteria donors were used, and in 3.6% non-heart-beating donors. DGF occurred in 17.8% of patients. Mean post-KT NLP was higher in patients submitted to induction therapy with lymphocyte depleting antibodies (50.2±40.3 vs 11.9±7.4 with basiliximab, p<0.001), but it was found to be higher even before KT (5.2±1.8 vs 1.9±1.2, p=0.001). Grafts from non-heart-beating donors (OR 13.989, 95% CI 4.741, 41.274, p=0.000), longer warm ischemia time (OR 1.035, 95% CI 1.007, 1.064, p=0.014) and higher NLP ratio 24 hours after transplantation (OR 1.009, 95% CI 1.002, 1.016, p=0.015) were independently associated with DGF. Conclusion: Higher NLP ratio at 24 hours after KT was independently associated with DGF. This reflects the impact of inflammation on KT outcomes and highlights the role of the NLP ratio as a sensitive marker of systemic inflammatory response after KT.

Abstract Introduction and objectives: Myofascial Pain Syndrome (MPS) of the Quadratus Lumborum muscle (QL) is a frequent cause of chronic low back pain. With this study, we aimed to assess the efficacy of ultrasound-guided infiltration with 0.25% levobupivacaine and 40 mg triamcinolone for MPS of the QL. Methods: Observational and retrospective study of participants submitted to ultrasound-guided infiltration of the QL muscle from January 1, 2015 to June 31, 2019. Pain intensity was assessed using the five-point pain Numeric Rating Scale (NRS): pre-intervention, at 72 hours, 1 month, 3 months and 6 months post-intervention. Additional data collected were demographic characteristics, opioid consumption, and adverse effects. Results: We assessed 90 participants with mean age of 55.2 years. Sixty-eight percent of participants were female. Compared to the pre-intervention assessment, there was an improvement in pain at 72 hours (Mean Difference [MD = 3.085]; 95% CI: 2.200-3.970, p < 0.05), at the 1st month (MD = 2.644; 95% CI: 1.667-3.621, p < 0.05), at the 3rdmonth (MD = 2.017; 95% CI: 0.202-2.729, p < 0.05) and at the 6th month (MD = 1.339; 95% CI 0.378-2.300, p < 0.05), post-intervention. No statistically significant differences in opioid consumption were observed. No adverse effects associated with the technique were reported. Conclusions: Ultrasound-guided infiltration of the QL muscle is a safe and effective procedure for the treatment of pain in the QL MPS within 6 months post-intervention.

Resumo Introdução: O cancro do cólon e reto é a neoplasia mais frequente considerando os dois géneros. . A deteção de lesões pré-malignas por colonoscopia está associada a uma redução da incidência e da mortalidade. Estudos sobre a utilização da luz de banda estreita (NBI) na deteção de lesões serreadas tiveram resultados promissores, mas heterogéneos. Métodos: Realizámos um ensaio clínico randomizado para comparar o número médio de lesões serreadas e lesões hiperplásicas ≥10 mm com NBI ou luz branca de alta-definição (HD-WL). Como resultados secundários comparámos a prevalência e as taxas de deteção de lesões serreadas sésseis, adenomas e todas as lesões. Resultados: Foram randomizados 782 doentes (392 no grupo HD-WL e 390 no grupo NBI). O número médio de lesões serreadas e hiperplásicas ≥10 mm não apresentou diferença estatisticamente significativa entre dois grupos (0.118 vs. 0.156, p = 0.44). A taxa de deteção de adenomas (55.2% vs. 53.2%, p = 0.58) e a taxa de deteção de lesões serreadas sésseis (6.8% vs. 7.5%, p = 0.502) também não foram diferentes. O tempo de retirada foi maior no grupo NBI (10.88 vs. 9.47 min, p = 0.004) e o tempo total de procedimento teve um ligeiro aumento não atingindo significância estatística (20.97 vs. 19.30 min, p = 0.052). Conclusão: A utilização da luz NBI por rotina não aumenta a deteção de lesões serreadas nem de qualquer lesão pré-maligna e aumenta o tempo de retirada na colo-noscopia.

Abstract Background: Colorectal cancer (CRC) is a leading cause of cancer. The detection of premalignant lesions by colonoscopy is associated with reduced CRC incidence and mortality. Narrow band imaging has shown promising but conflicting results for the detection of serrated lesions. Methods: We performed a randomized clinical trial to compare the mean detection of serrated lesions and hyperplastic polyps ≥10 mm with NBI or high-definition white light (HD-WL) withdrawal. We also compared all sessile serrated lesions (SSLs), adenoma, and polyp prevalence and rates. Results: Overall, 782 patients were randomized (WL group 392 patients; NBI group 390 patients). The average number of serrated lesions and hyperplastic polyps ≥10 mm detected per colonoscopy (primary endpoint) was similar between the HD-WL and NBI group (0.118 vs. 0.156, p = 0.44). Likewise, the adenoma detection rate (55.2% vs. 53.2%, p = 0.58) and SSL detection rate (6.8% vs. 7.5%, p = 0.502) were not different between the two study groups. Withdrawal time was higher in the NBI group (10.88 vs. 9.47 min, p = 0.004), with a statistically nonsignificant higher total procedure time (20.97 vs. 19.30 min, p = 0.052). Conclusions: The routine utilization of narrow band imaging does not improve the detection of serrated class lesions or any pre-malignant lesion and increases the with-drawal time.

ABSTRACT The concern over the quality of life, well-being and mental health of the elderly has been evident in the literature, where the regular practice of physical exercise plays a crucial role, particularly considering the demographic ageing of the population. The purpose of this study was to characterise the subjective well-being levels (life satisfaction and positive and negative affect), quality of life, and depressive and anxious symptomology in a sample of Portuguese elders. A comparative analysis of the variables according to the weekly frequency of physical exercise practice was also performed. The associations between the variables were also analysed. A total of 92 Portuguese elders (76,55± 9.73 years) were enrolled in the present study. The Portuguese versions of “SWLS”, “PANAS”, “HADS”, and “EUROHIS-QOL-8” were used. The main results showed the existence of significant differences in the variable positive affect (p= 0,01) (elders without physical exercise practice had lower values) and for the variable depressive symptomology (p= 0,01) (elders with a higher frequency of physical exercise practice had lower depressive symptomology). Furthermore, it is noteworthy the correlation between the studied variables (well-being, quality of life, and depressive and anxious symptomology). Subsequently, this study represents an important contribution to the comprehension of the role of regular physical exercise practice, not just for the physical health of the elderly but also for their well-being and depressive and anxious symptomology.

RESUMO A preocupação com a qualidade de vida, bem-estar e saúde mental dos idosos tem sido evidente na literatura, assumindo a prática regular de exercício físico um papel fundamental na sua promoção, especialmente tendo em conta o envelhecimento demográfico a que temos assistido. O objetivo deste estudo foi caracterizar os níveis de bem-estar subjetivo (satisfação com a vida e afeto positivo e negativo), qualidade de vida e sintomatologia depressiva e ansiosa numa amostra de idosos portugueses, incluindo uma análise comparativa destas variáveis em função da frequência semanal de prática de Exercício Físico. Foram ainda analisadas as associações entre as variáveis. Para tal, recorreu-se a uma amostra de 92 idosos portugueses (76,55± 9.73 anos), 26 (28,3%) do sexo masculino e 66 (71,7%) do sexo feminino. Foram utilizadas as versões portuguesas da “SWLS”, do “PANAS”, bem da “HADS” e da “EUROHIS-QOL-8”. Os principais resultados revelaram a existência de diferenças significativas na variável afeto positivo (p= 0,01) (idosos que não praticavam exercício físico com valores mais reduzidos) e na variável sintomatologia depressiva (p= 0,01) (idosos com maior frequência de prática de exercício físico com menor sintomatologia depressiva). Destacam-se ainda as associações entre as variáveis em estudo (bem-estar, qualidade de vida e sintomatologia depressiva e ansiosa). Este estudo parece assim dar um importante contributo na compreensão do papel da prática regular de exercício físico, não apenas para a saúde física do idoso, mas também para o seu bem-estar e sintomatologia depressiva e ansiosa.

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 Hematuria is a common condition that can range from an incidental finding to a significant symptom requiring immediate treatment. It can be associated with a variety of conditions, but once urinary tract and renal disease have been excluded, vascular causes, including nutcracker syndrome (NCS), should be considered. NCS is a diagnosis of exclusion, and Doppler ultrasound is recommended as first-line investigation. Hematuria associated with NCS is an underestimated entity, which the authors aim to raise awareness of with this case.

Resumo A hematúria é uma condição comum que pode ser assintomática ou bastante sintomática e com necessidade de tratamento imediato. Pode estar associada a várias doenças, mas quando a patologia renal e urinária são excluídas, deve ser considerada a patologia vascular, nomeadamente a síndrome de quebra-nozes. Esta síndrome representa um diagnóstico de exclusão, sendo a ecografia com Doppler o exame complementar de diagnóstico de primeira linha. A hematúria associada à síndrome de quebra-nozes é uma entidade subestimada, para o qual os autores pretendem alertar com o presente caso clínico.

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 Pituitary apoplexy refers to a rare clinical syndrome consisting of signs and symptoms that occur due to rapid expansion of the contents of the sella turcica. It can occur spontaneously or associated with pituitary tumors. It can have a broad clinical spectrum, but usually presents with severe headache, visual impairment and hypopituitarism. Sudden onset of symptoms associated to imagiologic confirmation makes the diagnosis. Surgical treatment is advised when there is important compression of the optic tract. We present a case report and a review of the literature on pituitary apoplexy in pregnancy. The cases were reviewed to obtain information on maternal characteristics, clinical presentation, diagnostic studies, therapeutic modalities and maternal and fetal outcomes. Our review found 36 cases of pituitary apoplexy in pregnancy. Most of the cases occurred in the second trimester of pregnancy and headache was the most frequent symptom at presentation. Surgical therapy was required in more than half of the patients. In what respect maternal and fetal outcomes, there were 3 cases of preterm delivery and one case of maternal death. Our clinical case and literature review reinforces the importance of an early diagnosis to avoid potential adverse consequences.

Abstract Objective: To identify factors associated with C-peptide levels at the diagnosis of type 1 diabetes mellitus (T1DM). Material and Methods: Retrospective review of the clinical records of patients with newly diagnosed T1DM admitted to a Portuguese reference center between August 2010 and July 2019. Results: The study included 109 subjects, with a mean age at T1DM diagnosis of 8.6 years and 29.4% already showing puberty development. The mean body mass index (BMI) z-score was 0.09. Subjects presented a median fasting C-peptide level of 0.46 ng/mL and a median hemoglobin A1C (HbA1C) of 10.85%. Diabetic ketoacidosis was identified in 22% of patients. A positive correlation was found between fasting C-peptide levels and age at diagnosis (p<0.001) and between fasting C-peptide levels and BMI z-score (p=0.041). Higher C-peptide levels were found in overweight/obese (p=0.008) and pubertal (p<0.001) individuals. C-peptide levels were found to be correlated with serum bicarbonate (p=0.005) but not with venous pH, HbA1C, or previous symptom duration. No statistically significant differences were observed in fasting C-peptide levels according to gender, diabetes autoantibodies, T1DM family history, or seasonality. Conclusion: Older, pubertal, and overweight/obese children presented higher C-peptide levels. In the acute setting, serum bicarbonate was the biochemical parameter that best correlated with residual β-cell function.

Resumo Objetivos: Identificar fatores relacionados com os níveis de peptídeo C ao diagnóstico de diabetes mellitus tipo 1 (DM1). Material e Métodos: Revisão retrospetiva dos processos clínicos de doentes diagnosticados com DM1 entre agosto de 2010 e julho de 2019 num centro de referência português. Resultados: O estudo incluiu 109 participantes, com idade média de 8.6 anos e 29.4% púberes. O z-score médio do índice de massa corporal (IMC) foi 0.09. O nível de peptídeo C em jejum mediano foi 0.46 ng/mL e a hemoglobina A1C (HbA1C) mediana foi 10.85%. Vinte e dois por cento dos casos apresentaram-se com cetoacidose diabética. Foi observada uma correlação positiva significativa entre o nível de peptídeo C e a idade (p<0.001) e o nível de peptídeo C e o z-score do IMC (p=0.041). Foram detetados níveis mais elevados de peptídeo C em crianças com excesso de peso/obesidade (p=0.008) e púberes (p<0.001). Os níveis de peptídeo C correlacionaram-se positivamente com os níveis séricos de bicarbonato (p=0.005), mas não com o pH venoso, HbA1C ou duração dos sintomas anteriores. Não foram registadas diferenças estatisticamente significativas nos níveis de peptídeo C em jejum em função do sexo, autoanticorpos para a DM1, história familiar de DM1 e sazonalidade. Conclusão: Os doentes mais velhos, púberes e com excesso de peso/obesidade apresentaram níveis mais elevados de peptídeo C ao diagnóstico. Em contexto agudo, o bicarbonato sérico foi o parâmetro bioquímico que melhor se correlacionou com a função residual das células β.