In a rat model of artificial ureteral calculosis, the aim of the study was to characterize the behavioural manifestations of direct visceral pain and to evaluate the relationship between number, duration and complexity of the visceral episodes and the extent of referred lumbar muscular hyperalgesia. As evidenced by non-stop video-tape recordings over 4-14 days, almost 98% of stone-implanted rats showed episodes similar to the writhing behaviour characteristic of noxious visceral stimulation in animals. From one rat to another, these episodes varied from very few (1-3) to a very high number (+/- 60), lasted a few minutes to over 45 min and were of variable complexity, as evaluated via an arbitrary scale on the basis of the combination of movements. Their number and duration decreased significantly, in a linear fashion, as time passed after the operation, so that they were mostly concentrated during the first 3 days. Number, duration and complexity of episodes were reduced by chronic treatment with morphine in a dose-dependent fashion. Stone-implanted rats displaying visceral episodes also showed hyperalgesia of the ipsilateral oblique musculature, as evidenced by a decrease in the vocalization threshold to electrical muscle stimulation, which was maximum on the first 3-4 days after implantation but lasted up to 10 days. The visceral episodes and the muscle hyperalgesia showed a strict relationship of interdependence: a significant, direct linear correlation was found between number and duration of episodes and tendency to also develop a contralateral muscle hyperalgesia. By applying the results of the study to the interpretation of human pathology, referred lumbar muscle hyperalgesia from ureteral calculosis would appear to be a strict function of the colic pain experienced.

RESUMOO caso apresentado diz respeito a uma grávida saudável, de termo, que teve o parto por cesariana num hospital nível III. Pela presença de contexto epidemiológico de risco, foi realizado o teste de pesquisa de SARS-CoV-2 que foi positivo no dia do internamento para indução do trabalho de parto. Dada a presença de um índice de Bishop < 4 e os antecedentes obstétricos, com uma cesariana anterior, foi decidido proceder à realização de um parto por cesariana. Durante todo o procedimento e contacto com a grávida foram utilizados dispositivos de proteção individual adequados e respeitados circuitos previamente definidos, que são descritos de seguida de forma mais pormenorizada. Quer a mãe, quer o recém-nascido encontram-se bem à data da descrição deste caso. Trata-se do primeiro parto por cesariana de uma grávida com COVID-19 em Portugal. Com esta publicação, o objetivo dos autores é apresentar as preocupações, orientação clínica face à presença de doença, os desfechos maternos e neonatais, bem como os circuitos definidos e as adaptações adotadas para dar resposta à situação atual de pandemia que vivemos. ABSTRACTWe report the first cesarean delivery in a woman with COVID-19 in a level III hospital in Portugal. It refers to a healthy woman with a term pregnancy that tested positive for COVID-19 on the day of labor induction. Given a Bishop score < 4 and the prior history of a cesarean section, the team decided to perform a surgical delivery. Appropriate personal protective equipment and safety circuits were employed, as described in more detail in the case report. Both the mother and the newborn are well. With this report we aimed to share our concerns, clinical management, maternal and neonatal outcomes, and to present our current circuits and adjustments regarding the COVID-19 pandemic in our maternity hospital.

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Although birth rate in Portugal is the fourth lowest in Europe and the number of COVID-19 cases in our country is one of the lowest, we already managed a case of a pregnant woman at term infected with SARS-CoV-2 who went into labor at term [1]. On March 17th 2020, in a level III hospital in Porto, a Caucasian 31-year-old woman with 38 weeks' gestation was admitted at the obstetrical emergency department. She was a healthy gravida 2 para 1, with no complications during pregnancy. At admission, she was complaining of mild painful uterine contractions for a few hours. She was in home isolation as her husband was diagnosed with COVID-19 and hospitalized on March 12th 2020. At admission, she presented dry cough, with no fever, chills or shortness of breath. Because she was a close contact of a confirmed COVID-19 case, she was attended as a suspected case and settled in an isolation room. SARS-CoV-2 was detected by reverse-transcription polymerase chain reaction (RT-PCR) analysis on nasal and oropharyngeal swabs. After obstetric evaluation, latent phase of labor was diagnosed, the cervix was 3 cm dilated and 30 % effaced. Care in labor continued in the same isolation room. All health care workers in contact with the pregnant woman wore appropriate personal protective equipment for contact and airborne precautions with eye protection. Epidural analgesia was performed as

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ObjectiveThe aim of the study was to evaluate risk factors for positive margins on surgical specimens of patients submitted to transformation zone excision (TZE).Materials and MethodsWe conducted a retrospective study evaluating women submitted to TZE in our center, between 2012 and 2020. Our study population included only women with the diagnosis of high-grade intraepithelial lesion (HSIL) in the pathologic examination of the TZE surgical specimen. Positive margins were defined as the presence of HSIL in the endocervical and/or ectocervical margin of the specimen. Factors evaluated included demographic characteristics, pretreatment Pap smear and human papillomavirus test, colposcopic findings, TZE indication, and pathologic features of the surgical specimen. We performed univariate analysis and logistic regression modeling including variables associated with the outcome of positive margins in the univariate analysis.ResultsOur sample included 264 women, with a 15.2% positive margins rate (40 patients). In the univariate analysis, patients with immunocompromised status, HSIL Pap smear, and higher number of quadrants involved in colposcopic examination were more likely to have positive margins. After multivariate analysis, only immunocompromised status was found to be an independent risk factor (odds ratio = 4.94; 95% CI = 1.43–17.15; p < .05).ConclusionsImmunocompromised status was the sole significant predictor for positive margins in TZE surgical specimens. To our knowledge, this is the first report of immunodepression as a risk factor for positive margins in cervical excisional procedures.