As situações de quarentena têm efeitos deletérios na saúde mental da população geral, mas é de esperar que as pessoas LGBTQ (lésbicas, gays, bissexuais, transgénero e queer) sejam ainda mais afetadas. Objetivámos investigar em que medida os efeitos psicossociais da pandemia do COVID-19 estão associados a mudanças na saúde mental de adolescentes e jovens adultos LGBTQ (N = 403). Os resultados indicaram que: (i) não ter ou não frequentar um curso universitário, (ii) o impacto negativo da pandemia no quotidiano e (iii) um clima familiar negativo estavam associados a níveis mais elevados de depressão e ansiedade. Além disso, o clima familiar mediou parcialmente a associação entre o impacto individual da pandemia e a depressão e a ansiedade. As organizações que promovem os direitos de pessoas LGBTQ, os serviços de saúde e educação, bem como as demais redes de apoio, devem permanecer disponíveis para atender às necessidades desta população.

Quarantine situations have deleterious effects on the mental health of the general population, but it is expected that LGBTQ (lesbian, gay, bisexual, transgender, and queer) individuals are even more affected. We aimed to investigate the extent to which the psychosocial effects of the COVID-19 pandemic are associated with changes in the mental health of LGBTQ adolescents and young adults (N = 403). The findings indicated that (i) not having or entered into a university degree, (ii) the daily negative impact of the pandemic, and (iii) a negative family climate were associated with higher levels of depression and anxiety. Furthermore, family climate partially mediated the association between the pandemic's individual impact and both depression and anxiety. Organizations promoting the rights of LGBTQ individuals, health and educational services, and other support networks, should remain available to meet the needs of this population.

Purpose: To critically evaluate salvage radical prostatectomy (SRP) in the treatment of patients with recurrent prostate cancer (PCa). Materials and Methods: From January 2005 to June 2007, we assessed patients with recurrent localized PCa. Recurrence was suspected when there were three or more successive increases in prostate specific antigen (PSA) after nadir. After the routine imagery examinations, and once localized PCa was confirmed, patients were offered SRP. Following surgery, we evaluated bleeding, rectal injury, urinary incontinence or obstruction and impotence. PSA values were measured at 1, 3, 6, months and thereafter twice a year. Results: Forty-two patients underwent SRP. The average age was 61 years. Following radiotherapy , the mean PSA nadir was 1.5 ng/mL (0.57-5.5). The mean prostate specific antigen doubling time (PSA-DT) was 14 months (6-20). Prior to SRP, the mean PSA was 5.7 ng/mL (2.9-18). The pathologic staging was pT2a: 13%; pT2b: 34%; pT2c: 27%; pT3a: 13%; and pT3b: 13%. Bleeding > 600 mL occurred in 14% of the cases; urethral stenosis in 50%; and urinary incontinence (two or more pads/day) in 72%. The mean follow-up post-SRP ranged from 6 to 30 months. The PSA level rose in 9, of which 6 had PSA-DT < 10 months. Conclusions: SRP is a feasible method in the management of localized radioresistant PCa. PSA-DT has shown to be important for the selection and SRP should not be performed if PSA-DT > 10 months. Due to its increased morbidity, SRP should be only offered to the patients who are more concerned about survival rather than quality of life.

OBJETIVO: As fístulas vesicovaginais e ureterovaginais são complicações incomuns, secundárias a doenças ou a cirurgias pélvicas. O sucesso terapêutico dessas fístulas depende de adequada avaliação pré-operatória para o diagnóstico e visualização do seu trajeto. Este trabalho tem o objetivo de demonstrar o potencial da urorressonância no diagnóstico das fístulas urogenitais e na visualização dos seus trajetos. MATERIAIS E MÉTODOS: Foram analisados, retrospectivamente, os prontuários médicos e as imagens radiológicas e de urorressonância magnética de sete pacientes do sexo feminino com diagnóstico de fístula urogenital. Para a urorressonância foram realizadas seqüências 3D-HASTE com saturação de gordura. RESULTADOS: Seis pacientes apresentavam fístula vesicovaginal e uma paciente tinha diagnóstico de fístula ureterovaginal à direita. Com a utilização da urorressonância magnética, foi possível demonstrar o trajeto da fístula em seis das sete pacientes (85,7%), sem a necessidade de cateterização vesical ou da injeção de contraste. CONCLUSÃO: Este estudo demonstra o potencial e a aplicabilidade da urorressonância na avaliação dessas fístulas.

OBJECTIVE: Vesicovaginal and ureterovaginal fistulas are unusual complications secondary to pelvic surgery or pelvic diseases. The therapeutic success in these cases depends on an appropriate preoperative evaluation for diagnosis and visualization of the fistulous tract. The present study is aimed at demonstrating the potential of magnetic resonance urography for the diagnosis of vesicovaginal and ureterovaginal fistulas as well as for defining the fistulous tracts. MATERIALS AND METHODS: Seven female patients clinically diagnosed with vesicovaginal or ureterovaginal fistulas had their medical records, radiological and magnetic resonance images retrospectively reviewed. Magnetic resonance urography included 3D-HASTE sequences with fat saturation. RESULTS: Six patients presented vesicovaginal fistulas and, in one patient, a right-sided ureterovaginal fistula was diagnosed. Magnetic resonance urography allowed the demonstration of the fistulous tract in six (85.7%) of the seven patients evaluated in the present study, without the need of bladder catheterization or contrast injection. CONCLUSION: This study demonstrates both the potential and applicability of magnetic resonance urography in the evaluation of these types of fistulas.

OBJECTIVE: To analyze how scrotal neoplasias have been managed during the past decade and to question possible factors or professions associated to its presence. MATERIALS AND METHODS: We retrospectively evaluated every case reported from 1995 to 2005 at our hospital. We described the clinical scenario, complementary exams, treatments and outcomes. We also tried to verify if there was any risk, predisposing factors or professions that would explain the cancer origin. RESULTS: Six cases were reviewed. Out of these, three patients were truck drivers. Five of them showed restricted lesions without inguinal lymph nodes enlargement. Histologically, six patients presented squamous carcinoma, with two of them having the verrucous type. The median age of patients was 52 years old (31 to 89). The five patients who are still alive had their lesions completely removed with safety margin and primary closure. CONCLUSIONS: We have noticed that the scrotal carcinoma behavior is similar to that of the penis, where removal of the lesion and study of the regional lymph nodes help to increase the patient survival rate. The outstanding fact was that three out of six patients were truck drivers, raising the hypothesis that such profession, maybe due to the contact or attrition with the diesel exhaust expelled by the engine or to sexual promiscuity, would imply in a larger risk of developing this rare neoplasia.

O infarto renal (IR) é usualmente secundário a obstrução arterial por êmbolos originários do coração. O chagásico crônico pode apresentar alterações cardíacas que originam trombos intracavitários mesmo sem insuficiência cardíaca congestiva (ICC). Neste trabalho avaliou-se comparativamente, a freqüência de IR em chagásicos crônicos, nas diferentes formas anátomo-clínicas e em não chagásicos. Realizou-se a revisão dos laudos de necropsias de indíviduos com idade maior ou igual a 20 anos. Em 259 necropsias, 78 (30,1%) eram de chagásicos crônicos, destes 19 (24,4%) desenvolveram IR, enquanto 27 (15,0%) não chagásicos apresentaram IR. A idade dos chagásicos com IR foi semelhante a dos não chagásicos. Encontrou-se predomínio significante de IR e trombose nos chagásicos. Observou-se uma prevalência significantemente maior de IR nos chagásicos com ICC (52,6%) quando comparados às outras formas anátomo-clínicas da doença e aos não chagásicos. Concluiu-se que o IR foi mais freqüente nos chagásicos, especialmente naqueles que desenvolveram ICC, provavelmente colaborando nas eventuais manifestações renais e alterações hemodinâmicas sistêmicas nestes pacientes.

Renal infarction (RI) is usually secondary to arterial obstruction due to emboli originating from the heart. Chronic chagasic patients may present cardiac alterations originating from intracavitary thrombi, even without congestive heart failure (CHF). In this study R1 incidence was comparatively evaluated in chronic chagasic individuals, in different anatomoclinic forms and in non chagasic individuals. There has been a review on necropsy reports of individuals aged 20 or over. In 259 necropsies, 78 (30.1%) were chagasics, and 19 of them (24.4%) developed RI, while 27 (15.0%) of the non chagasic individuals presented RI. The ages of chagasics with RI were similar to those of non chagasic individuals. A significant prevalence of RI and thrombosis among chronic chagasic individuals has been found. A significantly higher prevalence of RI among chronic chagasics hairing CHF (52.6%) was observed when they were compared to other forms of chronic Chagas disease and when compared to non chagasic individuals. It was concluded that RI was more frequent in chronic chagasic individuals, specially those who developed CHF, which probably played a role in the renal manifestations and systemic hemodynamic changes in those patients.