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The results support that the ETUQ is a valid assessment for measuring the relevance of and perceived difficulty of ET use and is able to detect differences and similarities between older adults in these European countries in relation to ET use in the home and society.

ObjectivesIdentifying the factors affecting the outcome of patients with Fournier's Gangrene and assaying the accuracy of the Fournier Gangrene Severity Index (FGIS), the Uludag score (UdS), affected Body Surface Area (BSA) and the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) model as prognostic tools.Materials and methodsRetrospective study involving all patients with Fournier's gangrene treated in our Hospital between January 2008 and December 2015. The epidemiological, clinical, biochemical and management data of these patients was obtained and analyzed.ResultsThe series includes 19 patients, 14 male and 5 female, with a median age of 70 (62; 78,5) years. The mortality rate was 21%. From the data analyzed, only the affected BSA (BSA>3.25%) was associated with mortality (p = 0.016). None of the established scores (FGSI; UdS; LRINEC) proved to be a useful tool for predicting mortality. The combination of affected BSA and FSGI (FGSI≥9 or BSA>3.25%), (p = 0.004) and the combination of the affected BSA and the LRINEC model (LRICEC≥8 and BSA>3.25%), (p = 0.004) led to a major improvement in these scores.ConclusionsAffected BSA is a useful prognostic factor in Fournier's gangrene. The existing prognostic scores can be improved with the introduction of this factor.

IntroductionPrimary adrenal insufficiency (PAI) is a rare but severe and potentially life-threatening condition. No previous studies have characterized Portuguese patients with PAI.AimsTo characterize the clinical presentation, diagnostic workup, treatment and follow‐up of Portuguese patients with confirmed PAI.MethodsThis multicentre retrospective study examined PAI patients in 12 Portuguese hospitals.ResultsWe investigated 278 patients with PAI (55.8% were females), with a mean age of 33.6 ± 19.3 years at diagnosis. The most frequent presenting clinical features were asthenia (60.1%), mucocutaneous hyperpigmentation (55.0%) and weight loss (43.2%); 29.1% of the patients presented with adrenal crisis. Diagnosis was established by high plasma ACTH and low serum cortisol in most patients (43.9%). The most common aetiology of PAI was autoimmune adrenalitis (61.0%). There were 38 idiopathic cases. Autoimmune comorbidities were found in 70% of the patients, the most frequent being autoimmune thyroiditis (60.7%) and type 1 diabetes mellitus (17.3%). Seventy-nine percent were treated with hydrocortisone (mean dose 26.3 ± 8.3 mg/day) mostly in three (57.5%) or two (37.4%) daily doses. The remaining patients were treated with prednisolone (10.1%), dexamethasone (6.2%) and methylprednisolone (0.7%); 66.2% were also on fludrocortisone (median dose of 100 µg/day). Since diagnosis, 33.5% of patients were hospitalized for disease decompensation. In the last appointment, 17.2% of patients had complaints (7.6% asthenia and 6.5% depression) and 9.7% had electrolyte disturbances.ConclusionThis is the first multicentre Portuguese study regarding PAI. The results emphasize the need for standardization in diagnostic tests and etiological investigation and provide a framework for improving treatment.

This study assesses the epidemiology of invasive fungal infection (IFI) in Portuguese Neonatal Intensive Care Units (NICUs) and compares the effectiveness and safety of antifungal therapies. A survey concerning the period 2005-2010 was carried out in NICUs of Greater Lisbon. Among 10 473 admitted neonates, 44 cases were identified, 29 among extreme low birth weight neonates (65.9%). Cumulative incidence rate was 0.42% (95%CI 0.309-0.559). A central vascular catheter was present before IFI in all cases. Candida albicans and Candida parapsilosis were the most frequent isolates. The initial antifungic was fluconazole in 22 cases and liposomal amphotericin B (L-AmB) in 18. Therapy was switched in 10 patients on fluconazole and 3 on L-AmB. Case fatality rate was 11.4% (95%CI 4.39-23.91). No serious adverse drugs reactions (SADRs) or clinical side effects were observed. The knowledge of the local epidemiology helps to identify adequate prophylactic and treatment strategies.

Introduction: Guidance for pregnant women has been particularly problematic since the beginning of the COVID-19 pandemic. The aim of this study was to describe the characteristics and outcomes of pregnant women with SARS-CoV-2 infection and their newborns.Material and Methods: Case review of clinical records of pregnant women with SARS-CoV-2 infection admitted for delivery and their newborns from April to December 2020 at a hospital in the Lisbon metropolitan area.Results: From 1755 births, 81 (4.6%) were from SARS-CoV-2 positive mothers. Most (83.9%) were term newborns. Almost 16% were preterm, while there was an overall prematurity rate of 9.9%. Most women (88.6%) were asymptomatic. Rooming-in occurred in 80.8% cases and 19.2% newborns were admitted to the Neonatal Intensive Care Unit. From the total, 56.7% newborns were breastfed from birth and 43% had mixed feeding. None of the newborns had symptoms related to COVID-19 infection, and all had negative rt-PCR for SARS-CoV-2 at birth and at 48 hours of life. The majority (85.2%) was discharged home with their mothers.Discussion: Pregnant women with COVID-19 have shown immune characteristics resembling healthy pregnancies, and it is not yet clear if SARS-CoV-2 can be vertically transmitted. Recent updates on neonatal guidance now recommend rooming-in and support the relative safety of breastfeeding.Conclusion: This study supports other published articles regarding maternal and neonatal outcomes of SARS-CoV-2 infected pregnant women, including the absence of short-term adverse outcomes with rooming-in and breastfeeding.

A talha dourada é uma parte importante do patrimônio cultural português. Aproveitando uma intervenção no órgão da Igreja de Santa Cruz (Coimbra) procedeu-se à caracterização da talha dourada da sua decoração. Fontes históricas indicam que o órgão data dos séculos XV-XVI, tendo posteriormente sofrido várias intervenções. As amostras foram recolhidas em diferentes locais da parte central do órgão e foram caracterizadas por microscopia óptica e eletrônica de varredura, microanálise, difração de raios-X e espectroscopia de infravermelho com transformada de Fourier. A sequência estratigráfica e as análises química e mineralógica permitiram elucidar as técnicas de douramento usadas. A técnica que os artistas portugueses trouxeram da China, introduzindo caulim na composição do bolus, foi identificada em todas as amostras. O uso de gesso (gesso mate e gesso grosso) na camada de preparação está evidente em algumas amostras, indicando o uso da técnica desenvolvida na Itália e em Flandres no século XIV e largamente usada no século XVII.Gilded wood is an important part of Portuguese cultural heritage. We profit an intervention in the organ of the Church of Santa Cruz (Coimbra) to make a study on its gilded wood decoration. Historical sources indicate that the organ dates from the XV-XVI centuries, although it has suffered several restoration works over the centuries. Samples were collected from different places of the central part of the organ. Scanning electron microscopy combined with energy dispersive X-ray spectroscopy, optical microscopy, X-ray diffraction and Fourier transform infrared spectroscopy were the techniques used in this work to analyze the samples. Stratigraphical sequence and global chemical and mineralogical analysis data allowed the identification of the gilding techniques. All the samples exhibit the typical technique brought by Portuguese artists from China, with kaolin in the bolus composition. Some samples present a typical Italian and Flemish technique developed in the XIV century, and used in the XVII century, with gypsum (gesso mate and gesso grosso) in the preparation layer.

Gastrointestinal stromal tumors (GISTs) are a type of mesenchymal tumors. They are rare in rectum. This location is a surgical challenge due to the high morbidity after aggressive surgeries. We present the case of an 81-year-old female with a high-grade GIST treated with transvaginal excision and adjunctive therapy with imatinib. The postoperative period was uneventful without anal dysfunction. Within the types of surgical treatment available, transvaginal excision is an acceptable procedure in lesions located in the rectovaginal region.