Resumo A hérnia diafragmática congénita (HDC) resulta do encerramento incompleto do canal pleuroperitoneal durante o desenvolvimento fetal, permitindo a herniação do conteúdo abdominal para a cavidade torácica. Apresenta-se tipicamente durante o período neonatal sob a forma de dificuldade respiratória, podendo no entanto manifestar-se mais tarde na vida. O diagnóstico de HDC tardia deve ser considerado no diagnóstico diferencial de crianças com sintomas agudos ou recorrentes inespecíficos, principalmente respiratórios ou gastrointestinais, ou ambos. A clínica e a radiografia simples continuam a ser os elementos-chave para o diagnóstico. A correção cirúrgica precoce do defeito diafragmático é crucial para prevenir uma possível passagem ou estrangulamento das vísceras abdominais e problemas respiratórios graves. Neste artigo, os autores apresentam o caso de uma HDC de apresentação tardia, caracterizada pelo início agudo de sintomas gastrointestinais, como dor abdominal e vómitos. Foi realizada correção toracoscópica com redução do conteúdo abdominal (intestino delgado e cólon) e sutura do defeito diafragmático posterior.

Abstract Congenital diaphragmatic hernia (CDH) results from incomplete closure of the pleuroperitoneal canal during fetal development, allowing herniation of abdominal contents into the thoracic cavity. It usually presents in the neonatal period with respiratory distress, but can also manifest later in life. The diagnosis of late-onset CDH should be kept in mind in the differential diagnosis of children with acute or recurrent nonspecific symptoms, especially respiratory or gastrointestinal symptoms or both. Clinical suspicion and plain radiography remain the key to diagnosis. Early surgical correction of the diaphragmatic defect is crucial to prevent possible passage or strangulation of abdominal viscera and severe respiratory problems. In the present report, the authors present a typical case of late-onset CDH with acute presentation of gastrointestinal symptoms (e.g., abdominal pain and vomiting). Thoracoscopic repair was performed, with reduction of the abdominal contents (small bowel and colon) and suturing of the posterior diaphragmatic defect.

ABSTRACT Ecological restoration mitigates the negative effects of fragmentation and habitat loss. This practice allows the conservation of key species, such as Ocotea porosa, a tree native to the Araucaria Forest and extremely endangered. A key point in restoration projects is the source of seeds, as well as guidelines for collection. When carried out under technical criteria, the collection allows the maintenance of genetic diversity and adaptive potential in restoration plantations. Given the importance of seed source, genetic diversity, and adaptive potential, this study aimed to define areas and criteria for collecting seeds by characterizing the demography, genetics, and reproductive phenology of an O. porosa population. A plot of 16 hectares was installed in the municipality of Passos Maia, Santa Catarina, Brazil, and a demographic survey of trees with diameter at breast height (DBH) > 15 cm was carried out. Indices of diversity and internal genetic structure (IGS) were estimated using allozyme markers. The reproductive phenology of 67 individuals was evaluated during 8 months. The studied population showed a high density of individuals (10.7 ind. ha-1) with normal diametric distribution. The phenological pattern of the species is regular, seasonal, and annual. The evaluated population showed high genetic diversity, high fixation index, and significant IGS up to 80 meters away. Based on these results, the evaluated fragment can be used as a seed collection area. It has high genetic diversity, density, and area size sufficient to contain several demes. In addition, it is highly recommended that the matrices be at least 80 meters apart to avoid the effects of significant IGS. loss endangered plantations demography genetics O 1 Maia Catarina Brazil DBH (DBH (IGS markers 6 months 10.7 107 10 7 (10. ind ha1 ha ha-1 distribution regular seasonal annual index away results demes addition 10. (10 ha- (1 (

RESUMO A restauração ecológica é uma forma de mitigar os efeitos negativos da fragmentação e perda de habitat. Essa prática permite a conservação de espécies-chave, como Ocotea porosa, uma árvore nativa da Floresta com Araucária e extremamente ameaçada de extinção. Um ponto fundamental em projetos de restauração é a fonte de sementes bem como as diretrizes para a coleta. Quando realizada sob critérios técnicos, a coleta permite a manutenção da diversidade genética e potencial adaptativo nos plantios de restauração. Diante do exposto, o objetivo do presente estudo foi caracterizar aspectos da demografia, genética e fenologia reprodutiva de uma população de O. porosa, visando gerar informações para definição de áreas e critérios para a coleta de sementes. Foi instalada uma parcela de 16 hectares no munícipio de Passos Maia, Santa Catarina e realizado levantamento demográfico de árvores com Diâmetro à Altura do Peito (DAP) > 15 cm. Foram estimados índices de diversidade e de estrutura genética interna (EGI), utilizando-se marcadores isoenzimáticos. A fenologia reprodutiva de 67 indivíduos foi avaliada durante 8 meses. O fragmento estudado apresentou uma alta densidade de indivíduos (10,7 ind. ha-1), com uma distribuição diamétrica similar a normal. O padrão fenológico da espécie é sazonal regular e anual. A população avaliada apresentou uma alta diversidade genética, elevado índice de fixação, além de uma EGI significativa até 80 metros de distância. Conclui-se que o fragmento avaliado pode ser utilizado como área de coleta de sementes. O mesmo possui alta diversidade genética, densidade e tamanho de área suficiente para conter várias demes. Além disso, é altamente recomendado que as matrizes tenham no mínimo 80 metros de distância entre si, evitando os efeitos da EGI significativa. habitat espécieschave, espécieschave espécies chave, chave espécies-chave porosa extinção técnicos exposto demografia 1 Maia DAP (DAP cm EGI, , (EGI) utilizandose utilizando se isoenzimáticos 6 meses 10,7 107 10 7 (10, ind ha1, ha1 ha ha-1) normal anual fixação Concluise Conclui demes disso si (EGI 10, (10 ha-1 (1 ha- (

Resumo Introdução: Em março de 2020, a Organização Mundial da Saúde declarou o estado de pandemia COVID-19. Foram aplicadas várias medidas, como a reestruturação dos cuidados de saúde primários, que conduziu à acumulação de novas funções pelos profissionais, proporcionando maior stress laboral e maior desgaste com consequente predisposição a síndroma de Burnout. Objetivos: Caracterizar as dificuldades dos profissionais; avaliar a prevalência da síndroma de Burnout; correlacionar a síndroma com variáveis sociodemográficas e profissionais. Métodos: Estudo transversal, observacional e descritivo com componente analítica, aos profissionais dos cuidados de saúde primários de Portugal, que decorreu entre abril e junho de 2021. Foram avaliadas variáveis demográficas e profissionais, assim como a síndroma de Burnout através do Maslach Burnout Inventory - Human Services Survey. Resultados: Foram aceites 1.434 respostas. A maioria dos inquiridos trabalhou durante fins-de-semana ou feriados e horas extraordinárias, assim como foram destacados para outros pólos associados à gestão da pandemia. Um terço não foi renumerado por horas extraordinárias ou incómodas e metade dos profissionais foram vítimas de agressão verbal ou física. A maioria discordou que tivesse suficientes recursos humanos e metade discordou que tivesse suficientes materiais. A prevalência da síndroma de Burnout foi de 20,4%. A síndroma e as suas dimensões associaram-se a idade de serviço, sexo, região, número de inscritos nas unidades funcionais, agressão física ou verbal, trabalho durante os fins-de-semana ou feriados, horas extraordinárias e respetivo não pagamento, assim como destacamento para outros pólos. Conclusões: No presente estudo encontrou-se uma maior prevalência da síndroma de Burnout comparativamente a estudos prévios, possivelmente devido à pandemia COVID-19, corroborada pelas associações encontradas.

Abstract Introduction: In March 2020, the World Health Organization declared the COVID-19 pandemic status. Several measures were applied, such as the restructuring of primary health care, which led to the accumulation of new functions by professionals, originating in more work-related stress and fatigue, with a consequent predisposition to Burnout syndrome. Objectives: Characterize the difficulties of professionals; evaluate the prevalence of Burnout syndrome; correlate the syndrome with sociodemographic and professional variables. Methods: A cross-sectional, observational, and descriptive study with an analytical component of primary health care professionals in Portugal, which took place between April and June 2021. Demographic and professional variables were evaluated, as well as the Burnout syndrome through the Maslach Burnout Inventory - Human Services Survey. Results: 1,434 responses were accepted. Most worked during weekends or holidays and overtime and were allocated to other poles associated with managing the pandemic. A third was not paid for overtime or inconvenient hours and half of the professionals were victims of verbal or physical aggression. Most disagreed that they had enough human resources and half disagreed that they had enough materials. The prevalence of Burnout syndrome was 20.4%. The syndrome and its dimensions were associated with the age of service, sex, region, the number of people enrolled in functional units, physical or verbal aggression, work during weekends or holidays, overtime, and respective non-payment, as well as being allocated to other poles. Conclusions: In the present study, there was a higher prevalence of the syndrome compared to previous studies, possibly due to the COVID-19 pandemic, corroborated by the associations found.

Resumo Enquadramento: A família é o principal recurso da pessoa que adoece, assumindo-se, os seus constituintes, como cuidadores familiares. Objetivo: Identificar as variáveis que influenciam o impacto da perturbação neurocognitiva nos familiares e caracterizar os cuidadores de pessoas com PNC. Metodologia: Estudo quantitativo, descritivo e correlacional, com 262 familiares de pessoas com perturbação neurocognitiva. Resultados: Os cuidadores evidenciam uma associação entre as dimensões impacto emocional (r = 0,526; n = 102; p < 0,01), económica (r = 0,292; n = 102; p < 0,01), procura de suporte (r = 0,279; n = 102; p < 0,01), prestação de cuidados (r = 0,375; n = 102; p < 0,01) com maior sobrecarga percecionada. Entre os membros da família, quanto maior o impacto das relações familiares percebidas, maior o suporte social percebido (r = 0,219; n = 104; p < 0,05); quanto maior o impacto emocional, maior a necessidade de procura de suporte (r = 0,303; n = 104; p < 0,01); e quanto maior o impacto percebido na dimensão económica, maior a necessidade de procura de suporte (r = 0,319; n = 104; p < 0,01). Conclusão: O grau de funcionalidade da família, a dependência da pessoa cuidada, a escolaridade, o género e o grau de parentesco parecem ter influência na adaptação das famílias.

Abstract Background: The family is the main resource of patients, and family members take on the role of family caregivers. Objective: To identify the variables influencing the impact of a neurocognitive disorder (NCD) on family members and characterize the caregivers of people living with a NCD. Methodology: Quantitative, descriptive, and correlational study with a sample of 262 family members of people living with a NCD. Results: Caregivers revealed an association between the emotional dimension (r = 0.526; n = 102; p < 0.01), economic dimension (r = 0.292; n = 102; p < 0.01), support-seeking (r = 0.279; n = 102; p < 0.01), the healthcare-seeking dimension (r = 0.375; n = 102; p < 0.01) and a higher perceived burden. Among family members, the greater the impact of perceived family relations, the greater the perceived social support (r = 0.219; n = 104; p < 0.05); the greater the emotional impact, the greater the need to seek support (r = 0.303; n = 104; p < 0.01); and the greater the perceived impact on the economic dimension, the greater the need to seek support (r = 0.319; n = 104; p < 0.01). Conclusion: The family’s functioning, the patient’s level of dependence, the education level, the gender, and the degree of kinship seem to influence family adaptation.

Resumen Marco contextual: La familia es el principal recurso de la persona que cae enferma y sus miembros se consideran cuidadores familiares. Objetivo: Identificar las variables que influyen en el impacto del trastorno neurocognitivo en los familiares y caracterizar a los cuidadores de personas con PNC. Metodología: Estudio cuantitativo, descriptivo y correlacional, con 262 familiares de personas con trastorno neurocognitivo. Resultados: Los cuidadores observan una asociación entre las dimensiones impacto emocional (r = 0,526, n = 102, p < 0,01), económica (r = 0,292, n = 102, p < 0,01), búsqueda de apoyo (r = 0,279, n = 102, p < 0,01), prestación de cuidados (r = 0,375, n = 102, p < 0,01) con una mayor carga percibida. Entre los miembros de la familia, cuanto mayor es el impacto de las relaciones familiares percibidas, mayor es el apoyo social percibido (r = 0,219, n = 104, p < 0,05); cuanto mayor es el impacto emocional, mayor es la necesidad de buscar apoyo (r = 0,303, n = 104, p < 0,01), y cuanto mayor es el impacto percibido en la dimensión económica, mayor es la necesidad de buscar apoyo (r = 0,319, n = 104, p < 0,01). Conclusión: El grado de funcionalidad de la familia, la dependencia de la persona cuidada, la educación, el género y el grado de parentesco parecen influir en la adaptación de las familias.

ABSTRACT X-linked hypophosphatemic rickets is a monogenic disease, characterized by hyperphosphaturia and hypophosphatemia. Due to its rarity and wide phenotypic variability, a diagnostic delay is common in X-linked hypophosphatemic rickets. Short stature, limb deformities, dental anomalies, craniosynostosis and chronic pain are common in this disease. Recently, burosumab, a monoclonal antibody anti-fibroblast growth factor 23, was approved for the treatment of X-linked hypophosphatemic rickets. Awareness among clinicians must be increased to improve the care of these patients. We present a clinical case of a 4-year-old girl presented with deformities of the lower limbs and an abnormal gait, associated with hyperphosphaturia and hypophosphatemia. Asymptomatic Arnold Chiari malformation was identified. No dental problems were detected. The diagnosis of X-linked hypophosphatemic rickets was confirmed by the identification of a PHEX mutation. The patient developed diarrhea, nephrocalcinosis, and hyperparathyroidism secondary to conventional therapy with phosphate supplements. Burosumab was initiated with a fast increase on serum phosphate levels and a decrease on alkaline phosphatase. With the description of this case, we highlight the clinical manifestations and complications of X-linked hypophosphatemic rickets and its treatment and we discuss new treatment strategies to improve the quality of life of these patients.

Abstract A 38 weeks pregnant woman presents with lump in right breast associated with tenderness, heat and erythema for 1 month. After 2 antibiotic therapy regimens and abscess drainage without improvement, Trucut breast biopsy was performed, whose histological result was Granulomatous Mastitis. Medicated with high-dose, long-lasting corticosteroid therapy, there was improvement of the clinical condition. Idiopathic Granulomatous Mastitis is a rare entity that mimics breast cancer, whose etiology, incidence and treatment are yet to be defined. The knowledge of this disease leads to a timely diagnosis, avoiding unnecessary costs and improving the patient’s approach.

Resumo Grávida de 38 semanas apresenta tumefação na mama esquerda associada a dor com 1 mês de evolução. Após 2 esquemas de antibioterapia com drenagem de abcesso sem melhoria procede-se a biopsia mamária Trucut cujo resultado histológico foi de Mastite Granulomatosa. Medicada com corticoterapia em alta dosagem e de longa duração, o quadro clínico teve resolução completa. A Mastite Granulomatosa Idiopática é uma entidade rara, que mimetiza o carcinoma da mama, cuja etiologia, incidência e tratamento ainda estão por definir. O seu conhecimento conduz ao diagnóstico atempado evitando custos desnecessários e melhorando a abordagem da doente.

RESUMO Objetivo: Validar um questionário de avaliação do impacto da demência num dos membros do agregado familiar. Métodos: Estudo metodológico. O instrumento foi construído, com base na revisão da literatura, na opinião de peritos e na experiência dos investigadores. Foi aplicado a uma amostra não probabilística de conveniência constituída por 262 familiares de pessoas que coabitam diariamente com a pessoa com demência. A validade de constructo foi estudada pela análise fatorial exploratória, método dos componentes principais, com rotação varimax dos itens. Resultados: Obteve-se um instrumento com 30 itens distribuídos por quatro dimensões “Dimensão emocional”, “Dimensão económica”, “Dimensão relações familiares” e “Dimensão procura de suporte”. A análise fatorial revelou uma variância explicada total de 54,96% e um alfa de Cronbach total de ,899. Conclusões: O instrumento apresenta uma consistência interna elevada agrupando-se em quatro dimensões, todas elas intimamente ligadas à adaptação da família ao aparecimento da demência num dos seus membros.

ABSTRACT Objective: To validate a questionnaire to assess the impact of dementia on one of the household members. Methods: Methodological study. The instrument was designed based on literature review, expert opinion, and researchers’ experience and then applied to a non-probability convenience sample consisting of 262 family members who live daily with a person with dementia. The construct validity was studied by exploratory factor analysis, principal components method, with varimax rotation of the items. Results: An instrument with 30 items was obtained, distributed in four dimensions: “Emotional dimension,” “Economic dimension,” “Family relations dimension,” and “Support-seeking dimension.” Factor analysis revealed a total explained variance of 54.96% and a total Cronbach’s alpha of .899. Conclusions: The instrument presents high internal consistency, grouped into four dimensions, all closely related to the family’s adaptation to the onset of dementia in one of its members.

RESUMEN Objetivo: Validar encuesta de evaluación del impacto de la demencia en uno de los miembros del agregado familiar. Métodos: Estudio metodológico. El instrumento fue construido basado en la revisión de la literatura, opinión de peritos y experiencia de los investigadores y, en seguida, aplicado a una muestra no probabilística de conveniencia constituida por 262 familiares que cohabitan diariamente con una persona con demencia. La validez de constructo fue estudiada por análisis factorial exploratorio, método de los componentes principales, con rotación varimax de los ítems. Resultados: Obtuvo un instrumento con 30 ítems, distribuidos en cuatro dimensiones: “Emocional”, “Económica”, “Relaciones familiares” y “Búsqueda de soporte”. El análisis factorial reveló variancia explicada total de 54.96% y alfa de Cronbach total de .899. Conclusiones: El instrumento presenta consistencia interna elevada agrupándose en cuatro dimensiones, todas íntimamente relacionadas a la adaptación de la familia delante el aparecimiento de la demencia en uno de sus miembros.

Resumo Este trabalho pretende analisar os cidadãos que viviam em Portugal durante a pandemia COVID-19 2020/2021, a saúde subjetiva, o risco percebido e a perceção relacionada com o surto, a motivação para a proteção e adoção de comportamentos preventivos, e suas expetativas de futuro. Foram incluídos 225 indivíduos, 81,3% do sexo feminino (18-83 anos; M = 36 anos; DP = 13,42), 49,8% solteiros, e 53,3% empregados. Os dados foram analisados através do software SPSS v. 26 e teste Qui-quadrado. Os resultados mostram que as mulheres se destacam numa maior perceção de probabilidade de infeção, apresentando maior motivação para a proteção e comportamentos como desinfetar o telemóvel. São também, a par dos jovens, quem menos se sente protegido por parte das ações tidas pelas autoridades locais. Com menor perceção de probabilidade de infeção, os jovens foram quem menos aumentou os seus comportamentos de proteção como evitar tocar a face. Semelhantemente aos adultos +55 anos, são quem apresenta expectativas mais positivas do tempo que a situação do país levará a melhorar. As mulheres e grupo 35-44 anos, são quem perceciona maior severidade dos impactos na saúde. Com base nos resultados, espera-se contribuir para o desenvolvimento e adaptação de políticas de saúde pública e de prevenção e promoção da saúde relacionadas com a pandemia, repensando-se a adaptação e desenvolvimento de estratégias de promoção da saúde e bem-estar para grupos-alvo específicos, como os jovens e mulheres.

Abstract This work aims to analyse citizens living in Portugal during the pandemic COVID-19 2020/2021, subjective health, perceived risk and perception related to the outbreak, motivation for protection and adoption of preventive behaviours, and their expectations for the future. Were included 225 individuals, 81.3% female (18-83 years; M = 36 years; SD = 13.42), 49.8% single, and 53.3% employed. Data were analyzed with SPSS v. 26 software and Chi-square test. The results highlight that women stand out in the perception of a higher probability of infection, presenting a higher motivation for protection and behaviours such as disinfecting their mobile phones. They are also, along with young people, those who feel less protected by the actions taken by local authorities. With a lower perception of the probability of infection, young people were the ones who least increased their protective behaviours such as avoiding touching their face. Similarly to adults +55 years, they are the ones who have more positive expectations of how long it will take for the situation in the country to improve. Women and the 35-44 age group are those who perceive the most severe health impacts. Based on the results, it is expected to contribute to the development and adaptation of public health and prevention and health promotion policies related to the pandemic, rethinking the adaptation and development of health promotion and well-being strategies for specific target groups, such as youth and women.

Resumen Marco contextual: La crisis provocada por la pandemia de la COVID-19 produjo cambios en la vida académica de los estudiantes de educación superior, que pueden afectar su bienestar psicológico. Objetivo: Analizar la relación entre las estrategias de afrontamiento utilizadas y el bienestar psicológico en estudiantes de enfermería durante la cuarentena por la COVID-19. Metodología: Estudio transversal, descriptivo-correlacional, con una muestra de 136 estudiantes. La recopilación de datos se realizó en línea mediante la Escala de Medición de la Manifestación del Bienestar Psicológico y el Brief COPE. Resultados: Los estudiantes de los últimos cursos utilizan con más frecuencia la estrategia de afrontamiento apoyo instrumental (p = 0,015) y emocional (p = 0,009), y también tienen mayores niveles de bienestar psicológico (p = 0,012). Los cambios en los ingresos familiares se asocian con el bienestar psicológico (p = 0,024), así como con las estrategias de afrontamiento religión (r = 0,36; p ≤ 0,01), reinterpretación positiva (r = 0,47; p ≤ 0,01) y estado de ánimo (r = 0,37; p ≤ 0,01). Conclusión: Las estrategias de afrontamiento adoptadas por los estudiantes parecen estar relacionadas con el bienestar psicológico durante la cuarentena.

Resumo Enquadramento: A crise pandémica da COVID-19 acarretou mudanças na vida académica dos estudantes do ensino superior, o que poderá afetar o seu bem-estar psicológico. Objetivo: Analisar a relação entre estratégias de coping utilizadas e o bem-estar psicológico em estudantes de enfermagem durante a quarentena pela COVID-19. Metodologia: Estudo transversal, descritivo-correlacional, utilizando uma amostra de 136 estudantes. Colheita de dados online, com recurso à Escala de Medida de Manifestação de Bem-estar Psicológico e à Brief COPE. Resultados: Os estudantes dos últimos anos de curso utilizam mais frequentemente a estratégia de coping suporte instrumental (p = 0,015) e emocional (p = 0,009), apresentam ainda, maiores níveis de bem-estar psicológico (p = 0,012). As alterações no rendimento familiar estão associadas ao bem-estar psicológico (p = 0,024), assim como as estratégias de coping religião (r = 0,36; p ≤ 0,01), reinterpretação positiva (r = 0,47; p ≤ 0,01) e humor (r = 0,37; p ≤ 0,01). Conclusão: As estratégias de coping adotadas pelos estudantes parecem estar relacionadas com o bem-estar psicológico durante a quarentena.

Abstract Background: The COVID-19 pandemic crisis has brought about changes in the lives of higher education students that may influence their psychological well-being. Objective: To analyze the association between nursing students’ coping strategies and their psychological well-being during the COVID-19 quarantine. Methodology: Cross-sectional, descriptive-correlational study using a convenience sample of 136 students. Data were collected online using the Portuguese version of the Échelle de Mesure des Manifestations du Bien-être Psychologique and the Brief COPE. Results: Students in the last years of their undergraduate studies used the instrumental support (p = 0.015) and emotional support (p = 0.009) coping strategies more often and had higher levels of psychological well-being (p = 0.012). Psychological well-being is associated with household income changes (p = 0.024), as well as with religion (r = 0.36; p ≤ 0.01), positive reframing (r = 0.47; p ≤ 0.01), and humor (r = 0.37; p ≤ 0.01) coping strategies. Conclusion: Students’ coping strategies seem to be associated with their psychological well-being during the COVID-19 quarantine.

ABSTRACT Cardiovascular disease continues to be the most frequent cause of death in peritoneal dialysis patients and an important obstacle for the improvement of technique survival. Heart failure diagnosis and management is particularly challenging among dialysis patients, and this condition remains underdiagnosed and undertreated in this population. The most common phenotype of heart failure among peritoneal dialysis patients is heart failure with preserved ejection fraction, diastolic disfunction and left ventricular hypertrophy. Unfortunately, unlike what happens with heart failure with reduced ejection fraction, there is lack of evidence to support a specific drug regimen to treat heart failure with preserved ejection fraction. Several conditions associated with end stage kidney disease, such as anemia, hyperphosphatemia, secondary hyperparathyroidism, inflammation, and insulin resistance seem to be involved in the pathogenesis of heart failure with preserved ejection fraction and for this reason, the term uremic cardiomyopathy has been proposed. There is a lack of evidence regarding the optimal heart failure treatment for peritoneal dialysis patients and more studies are needed to assess the efficacy and safety of the new drugs available for heart failure treatment. This review explores the spectrum of heart failure on peritoneal dialysis, its pathogenesis, risk factors and possible therapeutic and preventive measures.

ABSTRACT Chronic kidney disease is an increasingly common diagnosis in the very elderly and identifying the patients who benefit from a nephrologist’s intervention and the ones who would not might avoid wasteful or harmful interventions. The aim of this study is to identify the risk factos for progressive versus non‑progressive chronic kidney disease in a population aged over 80 years old. We performed a cohort single‑center retrospective study including 101 patients over 80 years old with chronic kidney disease diagnosed for at least five years and followed regularly by a nephrologist. Progressive disease was defined as glomerular filtration rate declines greater than 5 mL/min/1.73 m2/year. Of the 101 patients, 33.7% had progressive chronic kidney disease. The median glomerular filtration progression rate was 3.0 [2.1‑6.0] mL/min/1.73m2/year. Hypertension and diabetes mellitus prevalence was similar between groups. Nephrology follow‑up time was longer in the progressive group (5.0 vs 2.0 years, p=0.01). Regarding chronic kidney disease complications, 37.6% had anemia and half of these needed erythropoiesis‑stimulating agents. None of the patients had hyperphosphatemia. About 18.8% presented metabolic acidosis. In multivariable analysis, after adjusting for covariables such as age, hypertension, and diabetes mellitus only the presence of metabolic acidosis (OR 0.4, CI: 0.1‑0.8) was associated with the development of progressive chronic kidney disease. Progressive chronic kidney disease group presented higher mortality (log rank 4.5, p=0.03). Ischemic cardiomyopathy (OR: 0.5, CI: 0.2‑0.9) and progressive chronic kidney disease (OR: 0.6, CI:0.3‑0.8) were associated with all‑cause mortality. Our results showed that most elderly patients have non‑progressive chronic kidney disease. Patients with metabolic acidosis seem to be at an increased risk for developing progressive disease. Most elderly patients die before reaching end‑stage kidney disease, so it is importante to look at progressive kidney disease in those patients as an important marker of comorbidity and privilege cardioprotective measures.

ABSTRACT Coronavirus disease 2019 (COVID-19) has affected millions worldwide, and in particular the care of patients on maintenance hemodialysis. These patients are thought to be at high risk of severe SARS-CoV-2 infection due to their older age and multiple comorbidities. The aim of this study was to compare hemodialysis and non-dialysis COVID-19 patients and find possible risk factors for mortality in hemodialysis patients. We developed a single-center retrospective cohort study, from March 1st to December 31st, 2020, that included maintenance hemodialysis patients hospitalized with laboratory confirmed SARS-CoV-2 infection, and age and sex propensity matched non-dialysis patients also hospitalized with a laboratory confirmed SARS-CoV-2 infection (1:1). A total of 34 hemodialysis patients were included, 70.6% male, mean age 76.5 years and on maintenance hemodialysis for 3.0 [0.5-23] years. At admission, 50.0% needed oxygen supply. Median hospital stay duration was 11.0 [5.8-17.0] days, and 38.2% developed bacterial superinfection. Maintenance hemodialysis patient mortality rate was 32.4%. When matched to the non-dialysis group, the hemodialysis group developed more often respiratory insufficiency (50.0% vs 8.8%, p<0.001) and had higher ferritin (1658.0 vs 623.5, p=0.004) and troponin T (130.0 vs 31.0, p<0.001) levels, whereas the non-dialysis group had higher transaminases levels. There was no statistical difference regarding hospitalization time, bacterial superinfection, or mortality between groups. When the logistic regression was performed, only bacterial superinfection was a predictor for mortality in hemodialysis COVID-19 patients (0.01 [0.00-0.26]). There was no difference in hospital stay nor in death rate between hemodialysis and non-dialysis COVID-19 patients. Despite these results, we must emphasize that mortality in the dialysis group was particularly high, with up to 32% of in-hospital mortality, and that bacterial superinfection has been shown to be an independent predictor of mortality. These results highlight the importance of interventions, such as full vaccination coverage, to mitigate the burden of COVID-19 in hemodialysis patients.

Abstract Epidural analgesia is frequently used for labour analgesia, and major complications are rare. This article illustrates a case of a healthy woman submitted to a caesarean section under epidural anaesthesia, which developed postpartum fever, worsening abdominal and lumbar pain and neurologic deficits. Lumbar magnetic resonance confirmed the epidural abscess with spinal compression, demanding urgent laminectomy and surgical drainage , along with prolonged antibiotic therapy. Epidural abscess, although a rare complication, can have an important impact on neurologic integrity. The clinical manifestations are unspecific, and timely diagnosis and treatment are crucial to prevent permanent neurologic damage and death.