Abstract This is a rare case of prenatal diagnosis of Loeys-Dietz syndrome, which is usually diagnosed after birth. The fetus has a dilatation of the great vessels of the heart. Very little is known about prenatal dilation of ascending aorta and main pulmonary artery. Fetuses should be referred for a detailed anomaly scan, a fetal cardiologist and genetic counseling.

Resumo Caso clínico raro de diagnóstico pré-natal de Síndrome de Loeys-Dietz, usualmente, apenas, realizado após o nascimento. O achado diagnóstico fetal foi a dilatação dos grandes vasos do coração. A evidência é escassa no que concerne à dilatação pré-natal da aorta ascendente e do tronco pulmonar. Sempre que este achado diagnóstico ocorra a realização de ecocardiografia fetal detalhada, a referenciação para cardiologista fetal e o aconselhamento genético devem ser mandatórios.

Abstract The contraceptive counselling to people with severe intellectual disability is a challenge. The healthcare professional ought to be a facilitator of healthcare access and it should attend patient’s needs, always respecting the wishes and autonomy, but also the concerns of caretakers. This article intends to revise the contraceptive choices available, but also address its non-contraceptive benefits and legal issues as the rights of people with disabilities, crimes against sexual self-determination and other issues such as cervical and breast cancer early detection.

Resumo O aconselhamento contracetivo a doentes portadores de deficiência intelectual (DI) grave é um desafio. O profissional de saúde deve ser um agente facilitador de acesso a cuidados de saúde e deve considerar as preocupações dos cuidadores informais, respeitando os desejos e autonomia da doente. Pretende-se com este artigo rever as escolhas contracetivas disponíveis, bem como os seus benefícios não contracetivos, abordando ainda temas como a participação em rastreios de cancro do colo do útero e da mama, questões legislativas, tais como os direitos da pessoa com deficiência e crimes contra a autodeterminação sexual.

Resumo Emumaatleta saudável, oaporte calórico é suficientepara anecessidade energética esportiva e para as funções fisiológicas corporais, permitindo um equilíbrio entre disponibilidade energética (DE), metabolismo ósseo e função menstrual. Por outro lado, um desequilíbrio devido à baixa disponibilidade energética (BDE) por dieta restritiva, perturbações alimentares ou grandes períodos de gasto energético conduz a uma desregulação multissistêmica priorizando as funções essenciais do corpo. Este fenômeno, descrito inicialmente como tríade da mulher atleta e, atualmente, comodéfice energético relativo no esporte (RED-S, nasigla eminglês) tem como pilares a BDE, disfunção menstrual e alterações na densidade mineral óssea (DMO), estando presente em uma percentagem considerável de atletas de alta competição, com consequências nefastas para o seu futuro a curto, médio e longo prazo. A presente revisão foi realizada a partir da análise crítica das publicações mais recentes disponíveis e pretende proporcionar uma percepção global do tema RED-S. O objetivo é promover a aquisição de um conhecimento mais consolidado sobre uma temática subvalorizada, possibilitando a aquisição de estratégias preventivas, diagnóstico precoce e/ou tratamento adequado.

Abstract In a healthy athlete, the caloric intake is sufficient for sports energy needs and body physiological functions, allowing a balance between energy availability, bone metabolism, andmenstrual cycle.Onthe other hand, an imbalance causedby low energy availability dueto a restrictive diet, eating disorders or long periods of energy expenditure leads to multisystemic deregulation favoring the essential functions of the body. This phenomenon, described as the female athlete triad, occurs in a considerable percentage of high-performance athletes, with harmful consequences for their future. The present review was carried out based on a critical analysis of themost recent publications available and aims to provide a global perception of the topic relative energy deficit in sport (RED-S). The objective is to promote theacquisition ofmore consolidated knowledgeon an undervaluedtheme, enabling the acquisition of preventive strategies, early diagnosis and/or appropriate treatment.

Introdução: O cancro da mama é a neoplasia mais comum em mulheres Portuguesas e é responsável por elevadas taxas de hospitalização. Como tal, este estudo pretende caracterizar as admissões hospitalares por cancro da mama feminino no período de 2002–2016, com foco adicional nos padrões espácio-temporais das hospitalizações por cancro da mama (código principal). Métodos: Após uma análise descritiva de todas as hospitalizações com código de cancro da mama, os internamentos com código principal para esta patologia foram estudados com recurso a técnicas de mapeamento, análise de clusters espácio-temporais e variações espaciais em tendências temporais. Resultados: A taxa de internamento hospitalar por cancro da mama foi 118.72/105 mulheres, mostrando um crescimento de 3.109%/ano neste período. A mediana do tempo de hospitalização nestas doentes foi 5 dias, e a maioria dos internamentos corresponderam a admissões cirúrgicas programadas. Vários clusters espácio-temporais e variações espaciais em tendências temporais foram detetados. A zona costeira do país apresentou 4 clusters com elevada taxa de internamento hospitalar na análise espácio-temporal. Adicionalmente, a zona norte costeira e 2 concelhos isolados exibiram tendências temporais significativamente diferentes das descritas no resto do país. Estes clusters sugerem assimetrias regionais, apresentando divergências nas características demográficas (idade de admissão e ruralidade do concelho de residência), tipo de admissão, tempo de internamento e outcome da hospitalização. Conclusão: Este estudo identificou áreas chave de elevada taxa de internamento hospitalar por cancro da mama e uma tendência crescente nestes internamentos, fornecendo dados sobre a heterogeneidade espacial neste indicador de saúde.

Introduction: Breast cancer (BC) is the most common cancer among Portuguese women and it is associated with high hospitalization rates. Therefore, this study aims to characterize the BC hospital admission rate (HAR) in women in the period of 2002–2016, with an additional focus on spatiotemporal patterns of hospitalizations by BC (main code). - Methods: After a descriptive analysis of all BC hospitalizations, the main BC code HAR was studied using mapping techniques, analysis of spatiotemporal clusters, and analysis of spatial variations in temporal trends. - Results: The BC-HAR was 118.72/10(5) women, showing a growth of 3.109% per year in this period. The median length of stay (LOS) in these patients was 5 days, and most cases were programmed surgical admissions. Several spatiotemporal clusters and spatial variations in temporal trends were detected. The seaside area of the country showed 4 high HAR clusters in the spatiotemporal analysis. Additionally, the seaside north of the country and 2 isolated counties presented significantly different temporal trends in BC-HAR versus the rest of the country. These clusters suggest regional asymmetries, as they showed differences in terms of: demographic characteristics (age at admission and rurality of county of residence), the type of admission, LOS, and outcomes of hospitalization. - Conclusion: This study identified key areas of high BC-HAR and increasing trends for female HAR, providing evidence of spatial heterogeneities in this health indicator.

Resumo Um elevado número de escolas secundárias portuguesas possui coleções científicas, elementos centrais para a memória e identidade das instituições que as preservam, concorrendo para a compreensão das características que foram definindo a instrução pública de nível secundário em Portugal ao longo do tempo. Porém, esse património é ainda largamente desconhecido. O artigo chama a atenção para o debate historiográfico que envolve o uso de fontes materiais na história do ensino das ciências, dando a conhecer a relevância das coleções de história natural dos liceus de Portugal, bem como sua vulnerabilidade, dada a ausência de uma política geral ou diretrizes orientando sua conservação.

Abstract A large number of Portuguese secondary schools have scientific collections, which are central elements for the memory and identity of the institutions that maintain them, and contribute to understanding the characteristics that over time have defined public secondary education in Portugal. However, this heritage is still largely unknown. This article draws attention to the historiographic debate surrounding the use of material sources in the history of science education, describing the relevance of natural history collections in Portuguese secondary schools as well as their vulnerability, considering the lack of a general policy or guidelines related to conservation.

Overview and Aims: Urinary tract infections (UTI) are frequent in pregnancy and are associated with increased preterm delivery and low birth weight. Asymptomatic bacteriuria (ABU) is the most common clinical entity and in the absence of treatment it can progress to pyelonephritis in 25% to 30% of the cases. The culture of a urine specimen is the gold standard for the diagnosis of UTI, being Escherichia coli the most common agent. The aim of this study is 1) to identify which are the main microbial agents of the urine cultures in a pregnant population, 2) to observe the agents' antibiotic resistance and sensitivity, 3) to investigate which are the best antimicrobials for the treatment of an UTI in pregnant women, and 4) to compare with a similar study conducted at the same hospital between 2005 and 2006 in order to analyze the evolution of the antimicrobial resistances pattern. Study design: Retrospective observational study. Population: 305 cases with positive urine cultures obtained in the obstetrics outpatient clinic of a tertiary care hospital, between January 2014 and December 2015. Results: E. coli was isolated in 48,9% of cases. Streptococcus agalactiae was identified in 18,4%, Klebsiella pneumoniae in 10,1% and Proteus mirabilis in 8,5%. The global antimicrobial resistance profile was: ampicillin 50%, nitrofurantoin 24%, cotrimoxazole 17%, cefalotin 11%, amoxicilin+clavulanate and gentamycin both 6%, cefuroxime 3%, ceftazidime ceftriaxone and piperacilin-tazobactam 0%. Conclusions: In our population, the most frequent agent was E. coli. Cefuroxime is a good choice as a first-line agent for empiric treatment. Ampicillin and cotrimoxazole presented both high global and E. coli specific resistance rates. Comparatively to 2005 and 2006, the resistances have increased for nitrofurantoin and decreased for amoxicilin+clavulanate

Overview and Aims: In Portugal, induced abortion for non-medical reasons by woman's choice until 10 weeks of gestation is permitted since 2007, when conducted in official recognized establishments. The main goal was to compare the demography of women admitted for abortion by request, following depenalization and the beginning of the world financial crisis, with the period post-troika, represented by the years 2008 and 2015, respectively. Study design and Population: Retrospective, observational and comparative study of women's clinical files that attended at our service for abortion in 2008 and 2015. Methods: We compared the referral source, women's age, number of previous induced abortions, nationality, place of residence, marital status, progeny, couple cohabitation, literacy, women and partner labor, contraception use and gestational age. Results: Were included 1212 women (2008: 665 and 2015: 547). The mean age was 28,1 vs 27,99 (2008 vs 2015). The results were higher at 2008 than 2015 in couple cohabitation: 52% vs 42% (p=0.001) and contraception use: 74% vs 65% (p=0,002). The results were lower at 2008 than 2015 in number of previous induced abortions: 19% vs 29% (p<0,001), in women inhabiting in the same area of our institution: 87% vs 94% (p <0.001), in unmarried women: 63% vs 77% (p< 0,001), in women with more than third grade of primary school: 76% vs 89% (p <0.001), on unemployment in woman: 17% vs 28% (p=0.002) and partner: 8% vs 19% (p <0.001) and in abortions at 10 weeks: 2% vs 14% (p<0.001). We haven't observed statistically significant alterations on the other cases. Conclusions: Between 2008 and 2015 there was an increase in previous induced abortions, women inhabiting in the same area of our institution, unmarried women, literacy, unemployed woman and partner and gestational age attended for abortion. There was a decrease in couple cohabitation and in contraception use choice until 10 weeks of gestation is permitted since 2007, when conducted in official recognized establishments. The main goal was to compare the demography of women admitted for abortion by request, following depenalization and the beginning of the world financial crisis, with the period post-troika, represented by the years 2008 and 2015, respectively

A violência contra pessoas idosas em contexto familiar constitui um problema de saúde pública numa sociedade envelhecida. A dimensão do problema exige a realização de estudos que permitam um maior conhecimento deste fenómeno na sociedade portuguesa, justificando as intervenções de saúde como jurídico-penais. Este artigo apresenta uma abordagem terminológica dos conceitos, bem como uma operacionalização das condutas descritas face à legislação portuguesa. Considerando a complexidade deste fenómeno, entendeu-se pertinente a realização de uma análise de direito comparado, à luz do caso português. No âmbito dos ordenamentos jurídicos estudados, foram considerados aqueles que procuram acautelar os direitos sociais da pessoa idosa.

The violence against elderly people in the family context is a recognized problem of public health in an ageing society. The dimension of the problem requires the development of prevalence studies in order to deepen our knowledge about it in Portuguese society; in order to justify health intervention and legal framework. The aim of this article is to propose a terminological approach of the concepts and the operationalization of abusive conducts according to the Portuguese Law. Given the complexity of the phenomenon, a comparative law analysis was considered relevant in the light of Portuguese case. In addition, in the case of the international jurisdictions analyzed, we adopted those that better reflect the protection of the social rights of the elderly.

Diferenças na disponibilidade de radiação podem causar modificações na estrutura e função das folhas do cafeeiro, que podem responder de maneira diferencial à radiação por alterações morfológicas, anatômicas, de crescimento e na taxa fotossintética. O objetivo deste trabalho foi avaliar características morfofisiológicas de cafeeiros (Coffea arabica L. cv. "Oeiras") sombreados por acácia (Acacia mangium Willd.) na época seca e chuvosa no sul de Minas Gerais. As maiores taxas fotossintéticas e maiores espessuras da epiderme adaxial foram observadas na estação chuvosa nas linhas de cafeeiros a pleno sol. O sombreamento influenciou em menor espessura das folhas e em espaços intercelulares maiores no tecido esponjoso. Foi também verificada mudança na forma dos cloroplastos, os quais apresentaram-se mais alongados em folhas de cafeeiros a pleno sol quando relacionados aos arborizados.

Light availability is one of the most important environmental factors affecting leaf structure and functions in coffee plants that can respond differently to radiation by changes in leaf anatomy, morphology, growth and photosynthetic rate. The objective of this research was evaluate some morphophysiological aspects in leaves of coffee (Coffea arabica L. cv. 'Oeiras') cropped under shelter trees in the south of Minas Gerais during the rainy and dry season. The shade caused lower leaves thickness and higher intercellular spaces in spongious tissue. There was also verified a change in chloroplast shape, which showed more elongated in coffee tree kept at full sunlight in relation to that ones maintained on shading.