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Urachal sinus (US) is a rare congenital abnormality resulting from the improper involution of embryological tissues connecting the bladder to the umbilicus. It typically presents in childhood but can remain asymptomatic into adulthood.A 70-year-old male with hypertension and dyslipidemia presented with periumbilical pain, swelling, and purulent discharge. Initial empirical treatment with antibiotics was ineffective. Further imaging revealed fluid collections consistent with an infected urachal sinus. Surgical drainage and subsequent elective umbilical amputation with herniorrhaphy and hernioplasty resulted in full recovery, with no recurrence of symptoms. This case report highlights the diagnostic challenges posed by its non-specific clinical presentation and emphasizes the need for awareness of urachal anomalies in adults presenting with recurrent omphalitis. Early diagnosis and appropriate surgical management are essential for successful outcomes. Resumen: El seno uracal es una anomalía congénita poco común que resulta de la involución inadecuada de los tejidos embriológicos que conectan la vejiga con el ombligo. Generalmente se presenta en la infancia, pero puede permanecer asintomático hasta la edad adulta.Varón de 70 años con hipertensión y dislipidemia que presentó dolor periumbilical, hinchazón y secreción purulenta. El tratamiento empírico inicial con antibióticos fue ineficaz. Imágenes adicionales revelaron colecciones de líquido compatibles con un seno uracal infectado. El drenaje quirúrgico y la posterior amputación umbilical electiva con herniorrafia y hernioplastia dieron como resultado una recuperación completa, sin recurrencia de los síntomas. Este caso enfatiza la necesidad de tomar conciencia de las anomalías del uraco en adultos que presentan onfalitis recurrente. El diagnóstico temprano y el manejo quirúrgico apropiado son esenciales para obtener resultados exitosos

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Adequate radiographic positioning on the X-ray table is paramount for canine hip dysplasia (HD) screening. The aims of this study were to evaluate femoral parallelism on normal ventrodorsal hip extended (VDHE) view and the effect of femoral angulation (FA) on Norberg Angle (NA) and Hip Congruency Index (HCI). The femoral parallelism was evaluated comparing the alignment of the long femoral axis with the long body axis in normal VDHE views and the effect of FA on NA and HCI on repeated VDHE views with different levels of FA. The femoral long axis in normal VDHE views showed a ranged of FA from −4.85° to 5.85°, mean ± standard deviation (SD) of −0.06 ± 2.41°, 95% CI [−4.88, 4.76°]. In the paired views, the mean ± SD femur adduction of 3.69 ± 1.96° led to a statistically significant decrease NA, and HCI, and femur abduction of 2.89 ± 2.12 led to a statistically significant increase in NA and HCI (p

Objectives Anxiety and depression are relevant comorbidities in asthma, but, in Portugal and Spain, data on this topic are scarce. We assessed, in patients with asthma, the frequency of anxiety and depression using the Hospital Anxiety and Depression Scale (HADS) and the European Quality of Life Five Dimension Questionnaire (EQ-5D); the level of agreement between these questionnaires, and the factors associated with these symptoms.Methods This is a secondary analysis of the INSPIRERS studies. A total of 614 adolescents and adults with persistent asthma (32.6±16.9 years, 64.7% female) were recruited from 30 primary care centres and 32 allergy, pulmonology and paediatric clinics. Demographic and clinical characteristics, HADS and EQ-5D were collected. A score ≥8 on Hospital Anxiety and Depression Scale-Anxiety/Hospital Anxiety and Depression Scale-Depression or a positive answer to EQ-5D item 5 indicated the presence of these symptoms. Agreement was determined by Cohen’s kappa. Two multivariable logistic regressions were built.Results According to HADS, 36% of the participants had symptoms of anxiety and 12% of depression. According to EQ-5D, 36% of the participants had anxiety/depression. The agreement between questionnaires in identifying anxiety/depression was moderate (k=0.55, 95% CI 0.48 to 0.62). Late asthma diagnosis, comorbidities and female gender were predictors of anxiety/depression, while better asthma control, health-related quality of life and perception of health were associated with lower odds for anxiety/depression.Conclusion At least 1/3 of the patients with persistent asthma experience symptoms of anxiety/depression, showing the relevance of screening these disorders in patients with asthma. EQ-5D and HADS questionnaires showed a moderate agreement in the identification of anxiety/depression symptoms. The identified associated factors need to be further investigated in long-term studies.

We have presented the case of a right radial artery aneurysm (RAA) in a 27-year-old man with cerebral and coronary artery aneurysms and features of Parkes-Weber syndrome (port-wine stains and right upper extremity arteriovenous malformation and overgrowth). The RAA was repaired with an interposition great saphenous vein bypass graft. Analysis of the intracranial artery aneurysm and affected skin demonstrated a somatic mutation in the platelet-derived growth factor receptor-β gene. Mosaicism was present in the RAA but not in the great saphenous vein. Somatic mosaicism should be considered as a possible etiology for peripheral aneurysms in patients for whom standard genetic test results are unrevealing.

X-ray bone semantic segmentation is one crucial task in medical imaging. Due to deep learning's emergence, it was possible to build high-precision models. However, these models require a large quantity of annotated data. Furthermore, semantic segmentation requires pixel-wise labeling, thus being a highly time-consuming task. In the case of hip joints, there is still a need for increased anatomic knowledge due to the intrinsic nature of the femur and acetabulum. Active learning aims to maximize the model's performance with the least possible amount of data. In this work, we propose and compare the use of different queries, including uncertainty and diversity-based queries. Our results show that the proposed methods permit state-of-the-art performance using only 81.02% of the data, with O(1) time complexity.

Abstract Background Roux-en-Y gastric bypass (RYGB) surgery is one of the most efficient procedures for the treatment of obesity, also improving metabolic and inflammatory status, in patients with mild obesity. The underlying mechanisms have not been fully understood, but gut microbiota is hypothesized to play a key role. Our aim was to evaluate the association between gut microbiota changes and anthropometric, metabolic and inflammatory profiles after metabolic surgery compared with medical therapy, in type 2 diabetic (T2DM) adults with mild obesity (BMI 30–35 kg/m2). Methods DM2 was an open-label, randomised controlled clinical trial (RCT: ISRCTN53984585) with 2 arms: (i) surgical, and (ii) medical. The main outcome was gut microbiota changes after: metabolic surgery (Roux-en-Y gastric bypass—RYGB) versus standard medical therapy. Secondary outcomes included anthropometric, metabolic and inflammatory profiles. Clinical visits, blood workup, and stool samples were collected at baseline and months (M)1, 3, 6, 12. Gut microbiota was profiled using 16S rRNA targeted sequencing. Results Twenty patients were included: 10 in surgical and 10 in medical arm. Anthropometric and metabolic comparative analysis favoured RYGB over medical arm. At M12, the percentage of weight loss was 25.5 vs. 4.9% (p

Due to the energy crisis that some countries are facing nowadays, the gasification process appears to be a good alternative to produce some energy from solid materials. Increasingly, gasification involves using wastes as a solid fuel, making the process green and reusing some materials that otherwise could end up in a landfill. However, the process of finding the best gasification parameters of a sample can be very expensive and time-consuming. In this sense, a refuse-derived fuel (RDF) char produced from an original RDF under 30 min at 400 °C was tested on a small-scale reactor using macro thermogravimetric analysis (TGA), as presented in this paper. The goal was to study and evaluate the devolatilization and residual carbon rate of the sample under several conditions and, at the same time, quantify and analyze the released gas. In the first round of tests, 5, 10, and 20 g of samples were tested at 750 °C with an excess of air coefficient (λ) = 0 and 0.2. It was possible to conclude that the lower the mass, the higher the devolatilization rate. The λ only had an influence on the devolatilization rate with a 20 g sample. Regarding the gas, CO, CO2, and H2 had no variation in the sample mass in contrast to CH4, which increased with the increase in the sample mass. The second round of tests was performed with samples of 10 g of mass at temperatures of 700, 800, and 900 °C and λ values of 0.15, 0.2, and 0.25. The tests indicated that the temperature influenced the devolatilization rate but not the residual carbon combustion rate. Regarding the gas composition, CH4, CO2, and CO followed the same trend, decreasing the concentration with the increase in temperature; in contrast, H2 increased in concentration with an increase in temperature. The heating value of the gas followed the same behavior as CH4.

Background Activating variants in platelet‐derived growth factor receptor beta (PDGFRB), including a variant we have previously described (p.Tyr562Cys [g.149505130T>C [GRCh37/hg19]; c.1685A>G]), are associated with development of multiorgan pathology, including aneurysm formation. To investigate the association between the allele fraction genotype and histopathologic phenotype, we performed an expanded evaluation of post‐mortem normal and aneurysmal tissue specimens from the previously published index patient. Methods and Results Following death due to diffuse subarachnoid hemorrhage in a patient with mosaic expression of the above PDGFRB variant, specimens from the intracranial, coronary, radial and aortic arteries were harvested. DNA was extracted and alternate allele fractions (AAF) of PDGFRB were determined using digital droplet PCR. Radiographic and histopathologic findings, together with genotype expression of PDGFRB were then correlated in aneurysmal tissue and compared to non‐aneurysmal tissue. The PDGFRB variant was identified in the vertebral artery, basilar artery, and P1 segment aneurysms (AAF: 28.7%, 16.4%, and 17.8%, respectively). It was also identified in the coronary and radial artery aneurysms (AAF: 22.3% and 20.6%, respectively). In phenotypically normal intracranial and coronary artery tissues, the PDGFRB variant was not present. The PDGFRB variant was absent from lymphocyte DNA and normal tissue, confirming it to be a non‐germline somatic variant. Primary cell cultures from a radial artery aneurysm localized the PDGFRB variant to CD31‐, non‐endothelial cells. Conclusions Constitutive expression of PDGFRB within the arterial wall is associated with the development of human fusiform aneurysms. The role of targeted therapy with tyrosine kinase inhibitors in fusiform aneurysms with PDGFRB mutations should be further studied.

BackgroundHealth and fitness apps have potential benefits to improve self-management and disease control among patients with asthma. However, inconsistent use rates have been reported across studies, regions, and health systems. A better understanding of the characteristics of users and nonusers is critical to design solutions that are effectively integrated in patients’ daily lives, and to ensure that these equitably reach out to different groups of patients, thus improving rather than entrenching health inequities. ObjectiveThis study aimed to evaluate the use of general health and fitness apps by patients with asthma and to identify determinants of usage. MethodsA secondary analysis of the INSPIRERS observational studies was conducted using data from face-to-face visits. Patients with a diagnosis of asthma were included between November 2017 and August 2020. Individual-level data were collected, including age, gender, marital status, educational level, health status, presence of anxiety and depression, postcode, socioeconomic level, digital literacy, use of health services, and use of health and fitness apps. Multivariate logistic regression was used to model the probability of being a health and fitness app user. Statistical analysis was performed in R. ResultsA total of 526 patients attended a face-to-face visit in the 49 recruiting centers and 514 had complete data. Most participants were ≤40 years old (66.4%), had at least 10 years of education (57.4%), and were in the 3 higher quintiles of the socioeconomic deprivation index (70.1%). The majority reported an overall good health status (visual analogue scale [VAS] score>70 in 93.1%) and the prevalence of anxiety and depression was 34.3% and 11.9%, respectively. The proportion of participants who reported using health and fitness mobile apps was 41.1% (n=211). Multivariate models revealed that single individuals and those with more than 10 years of education are more likely to use health and fitness mobile apps (adjusted odds ratio [aOR] 2.22, 95%CI 1.05-4.75 and aOR 1.95, 95%CI 1.12-3.45, respectively). Higher digital literacy scores were also associated with higher odds of being a user of health and fitness apps, with participants in the second, third, and fourth quartiles reporting aORs of 6.74 (95%CI 2.90-17.40), 10.30 (95%CI 4.28-27.56), and 11.52 (95%CI 4.78-30.87), respectively. Participants with depression symptoms had lower odds of using health and fitness apps (aOR 0.32, 95%CI 0.12-0.83). ConclusionsA better understanding of the barriers and enhancers of app use among patients with lower education, lower digital literacy, or depressive symptoms is key to design tailored interventions to ensure a sustained and equitable use of these technologies. Future studies should also assess users’ general health-seeking behavior and their interest and concerns specifically about digital tools. These factors may impact both initial engagement and sustained use.

ABSTRACT Objective: Dornase alfa (rhDNase) reduces the viscosity of purulent sputum in the lungs. The use in patients with cystic fibrosis (CF) is proven. However, the evidence of its applicability to other conditions is limited. This study aims to present the authors’ experience with the use of rhDNase in non-CF patients admitted to the Pediatric Intensive Care Unit (PICU). At the study center, rhDNase was used during flexible bronchoscopies in 24 cases, of which 20 (83%) had atelectasis and seven (29%) were admitted to PICU. Four patients (57%) were on invasive mechanical ventilation (MV). Case description: Two cases of daily rhDNase administration at PICU are presented: patient A was an 8-year-old boy admitted with septic shock and acute respiratory distress syndrome (ARDS). The patient required mechanical ventilation with aggressive settings and experienced several clinical complications. On D50, he started rhDNase treatment with an improvement in FiO2, PaCO2 and PaO2/FiO2 ratio according to radiologic findings. He was extubated on D23 of treatment. Patient B was a 17-month-old girl admitted with a convulsive status epilepticus who experienced respiratory complications (infectious and barotrauma) with ARDS, requiring aggressive ventilation. She initiated rhDNase treatment on D60. During the treatment an improvement in FiO2, PaO2/FiO2 ratio and a tendency of PaCO2 decrease were found. She had radiological improvement. No complications were described. Comments: RhDNase may be a helpful and safe tool to use in PICU prolonged intubated patients with ventilator-induced lung injury. Further studies are needed to assess and propose valid indications.

Background: Poor medication adherence is a major challenge in asthma and objective assessment of inhaler adherence is needed. InspirerMundi app aims to monitor inhaler adherence while turning it into a positive experience through gamification and social support.Objective: We assessed the medium-term feasibility of the InspirerMundi app to monitor inhaler adherence in real-world patients with persistent asthma (treated with daily inhaled medication). In addition, we attempted to identify the characteristics of the patients related to higher app use.Methods: Two real-world multicenter observational studies, with one initial face-to-face visit and a 4-month telephone interview, were conducted in 29 secondary care centers from Portugal. During an initial face-to-face visit, patients were invited to use the app daily to register their asthma medication intakes. A scheduled intake was considered taken when patients took a photo of the medication (inhaler, blister, or others) using the image-based medication detection tool. Medication adherence was calculated as the number of doses taken as a percentage of the number scheduled. Interacting with the app ≥30 days was used as the cut-off for higher app use.Results: A total of 114 patients {median 20 [percentile 25 to percentile 75 (P25–P75) 16–36] years, 62% adults} were invited, 107 (94%) installed the app and 83 (73%) completed the 4-month interview. Patients interacted with the app for a median of 18 [3–45] days, translated on a median use rate of 15 [3–38]%. Median inhaler adherence assessed through the app was 34 [4–73]% when considering all scheduled inhalations for the study period. Inhaler adherence assessed was not significantly correlated with self-reported estimates. Median adherence for oral and other medication was 41 [6–83]% and 43 [3–73]%, respectively. Patients with higher app use were slightly older (p = 0.012), more frequently taking medication for other health conditions (p = 0.040), and more frequently prescribed long-acting muscarinic antagonists (LAMA, p = 0.024). After 4 months, Control of Allergic Rhinitis and Asthma Test (CARAT) scores improved (p < 0.001), but no differences between patients interacting with the app for 30 days or less were seen.Conclusions: The InspirerMundi app was feasible to monitor inhaler adherence in patients with persistent asthma. The persistent use of this mHealth technology varies widely. A better understanding of characteristics related to higher app use is still needed before effectiveness studies are undertaken.

Accurate radiographic screening evaluation is essential in the genetic control of canine HD, however, the qualitative assessment of hip congruency introduces some subjectivity, leading to excessive variability in scoring. The main objective of this work was to validate a method-Hip Congruency Index (HCI)-capable of objectively measuring the relationship between the acetabulum and the femoral head and associating it with the level of congruency proposed by the Fédération Cynologique Internationale (FCI), with the aim of incorporating it into a computer vision model that classifies HD autonomously. A total of 200 dogs (400 hips) were randomly selected for the study. All radiographs were scored in five categories by an experienced examiner according to FCI criteria. Two examiners performed HCI measurements on 25 hip radiographs to study intra- and inter-examiner reliability and agreement. Additionally, each examiner measured HCI on their half of the study sample (100 dogs), and the results were compared between FCI categories. The paired t-test and the intraclass correlation coefficient (ICC) showed no evidence of a systematic bias, and there was excellent reliability between the measurements of the two examiners and examiners’ sessions. Hips that were assigned an FCI grade of A (n = 120), B (n = 157), C (n = 68), D (n = 38) and E (n = 17) had a mean HCI of 0.739 ± 0.044, 0.666 ± 0.052, 0.605 ± 0.055, 0.494 ± 0.070 and 0.374 ± 0.122, respectively (ANOVA, p < 0.01). Therefore, these results show that HCI is a parameter capable of estimating hip congruency and has the potential to enrich conventional HD scoring criteria if incorporated into an artificial intelligence algorithm competent in diagnosing HD.

Projections of the stage of the Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) pandemic and local, regional and national public health policies to limit coronavirus spread as well as "reopen" cities and states, are best informed by serum neutralizing antibody titers measured by reproducible, high throughput, and statically credible antibody (Ab) assays. To date, a myriad of Ab tests, both available and FDA authorized for emergency, has led to confusion rather than insight per se. The present study reports the results of a rapid, point-in-time 1,000-person cohort study using serial blood donors in the New York City metropolitan area (NYC) using multiple serological tests, including enzyme-linked immunosorbent assays (ELISAs) and high throughput serological assays (HTSAs). These were then tested and associated with assays for neutralizing Ab (NAb). Of the 1,000 NYC blood donor samples in late June and early July 2020, 12.1% and 10.9% were seropositive using the Ortho Total Ig and the Abbott IgG HTSA assays, respectively. These serological assays correlated with neutralization activity specific to SARS-CoV-2. The data reported herein suggest that seroconversion in this population occurred in approximately 1 in 8 blood donors from the beginning of the pandemic in NYC (considered March 1, 2020). These findings deviate with an earlier seroprevalence study in NYC showing 13.7% positivity. Collectively however, these data demonstrate that a low number of individuals have serologic evidence of infection during this "first wave" and suggest that the notion of "herd immunity" at rates of ~60% or higher are not near. Furthermore, the data presented herein show that the nature of the Ab-based immunity is not invariably associated with the development of NAb. While the blood donor population may not mimic precisely the NYC population as a whole, rapid assessment of seroprevalence in this cohort and serial reassessment could aid public health decision making.

ABSTRACT Objective: To highlight the pathogenicity of Streptococcus anginosus, which is rare in pediatric patients, but can cause severe infections that are known to have a better outcome when treated early with interventional procedures and prolonged antibiotic therapy. Case description: The patient is a 6-year-old boy with global developmental delay, examined in the emergency room due to fever and respiratory distress. The physical examination and diagnostic workout revealed complicated pneumonia with empyema of the left hemithorax; he started antibiotic therapy and underwent thoracic drainage. Pleural fluid cultures grew Streptococcus anginosus. On day 11, the child had a clinical deterioration with recurrence of fever, hypoxia, and respiratory distress. At this point, considering the causative agent, he was submitted to video-assisted thoracoscopic decortication, with good progress thereafter. Comments: Streptococcus anginosus is a commensal bacterium of the human oral cavity capable of causing severe systemic infections. Although reports of complicated thoracic infections with this agent are rare in the pediatric population, they have been increasing in adults. Streptococcus anginosus has a high capacity to form abscess and empyema, requiring different therapeutic approaches when compared to complicated pneumonia caused by other agents.

Neste artigo, depois de caracterizar as extraordinárias mudanças operadas a partir dos anos 1970-1990 em diversos domínios, com destaque para a dominação das tecnologias digitais da comunicação e da informação, que contribuíram fortemente para o novo 'regime de historicidade', procuro estabelecer conexões, diretas e indiretas, entre a ideologia do presente, a memória, a história e o património, tentando mostrar os efeitos dessas profundas transformações nos domínios da cultura escolar, entendida como categoria de análise e campo de investigação e renovação da história da educação. Na senda de muitos estudos publicados nas últimas décadas, marcados por uma abertura teórica e metodológica a outras áreas disciplinares, proponho um aprofundamento dessa discussão à luz das (contra) propostas apresentadas por João Maria André, numa evocação das seis propostas para o próximo milénio, formuladas por Italo Calvino.

Although there are many studies available in literature about biomass pyrolysis or devolatilization using thermogravimetric analysis (TGA), the effects of important operating parameters have infrequently been investigated for pine wood particle combustion. Consequently, the present study investigates the influence of particle size (63 µm to 1 mm), heating rate (5 to 243 °C/min), and air flow rate (10 to 150 mL/min) on the mass loss of pine wood using TGA. Additionally, the kinetic parameters considering the different conditions were determined to be incorporated in a numerical model. The effect of the heating rate on the thermal decomposition behavior has shown that the thermogravimetric and derivative thermogravimetric curves were shifted to higher temperatures with the increase in the heating rate. In this way, the heating rate affects the temperature at which the highest mass loss rate occurs as well as its value. Furthermore, comparing the higher and lower heating rate, the time to complete the combustion and the release are around 22 times higher when a higher heating rate is applied. On the other hand, the effects of four different air flow rates were compared and similar results were obtained. Regarding the kinetic analysis, it was verified at various heating and air flow rates with different particle sizes that the highest activation energy was mostly obtained during char combustion (~131–229 kJ/mol). Furthermore, in the second stage higher heating rates had the highest reactivity, and in the third stage there were not too many changes. In terms of the effect of air flow rates, a maximum variation of 15 kJ/mol was obtained in the third stage and, therefore, no significant effect on the reactivity for all particles was found.

Abstract Objectives Since most of the studies evaluates diabetics on multiple daily injections therapy and continuous subcutaneous insulin infusion may help gain better metabolic control and prevent complications, the objective of this study was to evaluate the prevalence of dental caries, the unstimulated salivary flow rate and the total bacteria load, Streptococcus spp. levels and Lactobacillus spp. levels in saliva and supragingival dental biofilm of type 1 diabetics on insulin pump. Material and Methods Sixty patients with type 1 diabetes on insulin pump and 60 nondiabetic individuals were included. The dental caries evaluation was performed using ICDAS and the oral hygiene was assessed according to Greene and Vermillion Simplified Oral Hygiene Index. Unstimulated saliva and supragingival dental biofilm were collected. Total bacteria, Streptococcus spp. and Lactobacillus spp. was quantified by qPCR. Results Patients with type 1 diabetes had a higher prevalence of dental caries and filled and missing teeth when compared with the control group. These patients were associated with more risk factors for the development of dental caries, namely a lower unstimulated salivary flow rate and a higher bacterial load in saliva and dental biofilm. Conclusion Some risk factors related to dental caries were associated with type 1 diabetics. An early diagnosis combined with the evaluation of the risk profile of the diabetic patient is imperative, allowing the dental caries to be analyzed through a perspective of prevention and the patient to be integrated into an individualized oral health program.

Quando decidi trabalhar com os Karajá da ilha do Bananal estava dividido entre a novidade de fazer uma pesquisa de campo etnográfica pela primeira vez, ou seja, passar por aquilo que alguns chamam de rito de iniciação da profissão, e as ponderações de etnólogos que pintavam uma situação de contato interétnico difícil entre o grupo, alertando que a etnografia seria contaminada pela aura desanimadora daqueles que fizeram uma experiência etnográfica com os Karajá. Diziam que os Karajá expulsavam os antropólogos, ou ainda, que os que começavam as etnografias não conseguiam terminá- las, devido ao caos provocado pela bebida alcoólica no grupo. O receio aumentou quando percebi que no levantamento etnológico do Centro-Oeste, de modo especial o que foi realizado pelo Harvard Central Brazil Research Project (Maybury Lewis, 1979), os Karajá não haviam sido contemplados. E assim, entre a animação do noviço em Antropologia e um certo receio em relação à situação do grupo, ficava uma desesperança no ar. Foi então que se fez presente a sensatez e a serenidade do professor Julio Cezar Melatti, que sabiamente me mostrou algumas etnografias de sucesso sobre o grupo e ainda sentenciou: “Em último caso, você ouve os índios do lado da cidade...” Ou seja, as dificuldades do campo não seriam maiores que a contribuição que a etnografia poderia dar ao estudar pela primeira vez, e de maneira global, o rito de iniciação dos meninos Karajá ou o rito da Casa Grande.

Introduction and Objective: Ebstein's anomaly is a rare complex congenital heart defect of the tricuspid valve. We aimed to describe the frequency, clinical profile, and early and short-term post-operative results in patients under the age of 18 years operated for this anomaly in a tertiary center in Angola. Methods: A retrospective cross-sectional study was conducted over a period of 37 months. We analyzed all patients diagnosed with congenital heart defects. Results: Of the 1362 patients studied, eight (0.6%) had Ebstein's anomaly; six patients (75%) were female. Mean age was 69±59 months. Five patients were in NYHA functional class III or IV. Mean cardiothoracic index was 0.72. Seven patients (87.5%) had severe tricuspid regurgitation and five (62.5%) had another associated congenital heart defect. All patients were operated: two had complications and one (12.5%) died in the early post-operative period. The mean follow-up time was 1.22±0.6 years, and mortality during follow-up was 12.5% (n=1). At the end of the study, of the five patients in whom cone reconstruction was performed, four (80%) were in functional class I. Mean cardiothoracic index decreased to 0.64. Three patients had mild and two had moderate tricuspid regurgitation. The patient who underwent cone reconstruction and a Glenn procedure was in functional class I. Conclusion: The frequency of Ebstein's anomaly was similar to that in other centers. Cone reconstruction was viable in the majority of patients, with good early and short-term results. Resumo: Introdução e Objectivos: A anomalia de Ebstein é uma cardiopatia congénita complexa e rara da válvula tricúspide. Descrever a frequência, o perfil clínico e os resultados pós operatórios imediatos desta anomalia em crianças e adolescentes. Métodos: Estudo transversal retrospetivo no único centro com tratamento integrado em cardiopatias congénitas em recém nascidos, crianças e adolescentes (

The growing proliferation of management systems standards (MSSs), and their individualized implementation, is a real problem faced by organizations. On the other hand, MSSs are aimed at improving efficiency and effectiveness of organizational responses in order to satisfy the requirements, needs and expectations of the stakeholders. Each organization has its own identity and this is an issue that cannot be neglected; hence, two possible approaches can be attended. First, continue with the implementation of individualized management systems (MSs); or, integrate the several MSSs versus related MSs into an integrated management system (IMS). Therefore, in this context, organizations are faced with a dilemma, as a result of the increasing proliferation and diversity of MSSs. This paper takes into account the knowledge gained through a case study conducted in the context of a Portuguese company and unveils some of the advantages and disadvantages of integration. A methodology is also proposed and presented to support organizations in developing and structuring the integration process of their individualized MSs, and consequently minimize problems that are generators of inefficiencies, value destruction and loss of competitiveness. The obtained results provide relevant information that can support Top Management decision in solving that dilemma and consequently promote a successful integration, including a better control of business risks associated to MSSs requirements and enhancing sustainable performance, considering the context in which organizations operate.

Gut microbiota dysbiosis has been recognized as having key importance in obesity- and metabolic-related diseases. Although there is increasing evidence of the potential benefits induced by probiotics in metabolic disturbances, there is a lack of large cross-sectional studies to assess population-based prevalence of probiotic intake and metabolic diseases. Our aim was to evaluate the association of probiotic ingestion with obesity, type 2 diabetes, hypertension, and dyslipidemia. A cross-sectional study was designed using data from the National Health and Nutrition Examination Survey (NHANES), 1999−2014. Probiotic ingestion was considered when a subject reported consumption of yogurt or a probiotic supplement during the 24-h dietary recall or during the Dietary Supplement Use 30-Day questionnaire. We included 38,802 adults and 13.1% reported probiotic ingestion. The prevalence of obesity and hypertension was lower in the probiotic group (obesity-adjusted Odds Ratio (OR): 0.84, 95% CI 0.76−0.92, p < 0.001; hypertension-adjusted OR: 0.79, 95% CI 0.71−0.88, p < 0.001). Accordingly, even after analytic adjustments, body mass index (BMI) was significantly lower in the probiotic group, as were systolic and diastolic blood pressure and triglycerides; high-density lipoprotein (HDL) was significantly higher in the probiotic group for the adjusted model. In this large-scale study, ingestion of probiotic supplements or yogurt was associated with a lower prevalence of obesity and hypertension.

Neste artigo analisamos as representações sociais articuladas pelos grafismos aplicados nas bonecas karajá a partir do entendimento de que a cultura material está inserida em contextos sócio-ecológico-territoriais e imbricada nas dinâmicas de poder que envolvem sua produção, significação e circulação. A análise é feita a partir dos dados levantados na pesquisa coletiva que subsidiou o registro do modo de fazer e formas de expressão das Ritxoko como Patrimônio Cultural Imaterial do Brasil. A pintura dos grafismos integra o processo de fabricação das figuras em cerâmica pelas mulheres, articula o mundo simbólico karajá e revela igualmente um processo criativo próprio, decorrente de fatores exógenos como aqueles imputados pelo contato interétnico. Nesse sentido, as ceramistas são classificadas internamente como "boas ceramistas" a partir de categorias que interligam arte, relações de gênero, saber tradicional, inovação e prestígio.This article analyses the social representations of graphisms on Karajá dolls based on the idea that material culture is embedded in socio-ecological-territories contexts and interconnected to the dynamics of power involved within its production, meaning and circulation. The study is based on the data collected by a research group which informed the registry of "how to do" and "the expression forms" of the Ritxoko as Patrimônio Cultural Imaterial do Brasil. The graphisms drawing is a phase of the fabrication of ceramic dolls by women which articulates Karajá symbolic world as well as unveils a singular creative process coming up from external factors as the inter-ethnical contact. From this standpoint, the ceramists are classified by the members of their group as "good ceramists" based on categories that merge art, gender relationships, traditional knowledge, creativity and prestige.

Entre 1835 e 1862, passaram por Aveiro muitos galegos, com destino a diversas vilas e cidades portuguesas, ou a caminho da América Latina. Deixando familiares no Porto, Espinho e Estarreja, alguns desses “peregrinos do trabalho” fixaram-se em Aveiro, deixando marca (discreta) na toponímia, na antroponímia e em diversas atividades económicas, nomeadamente no trato do sal, na pesca, no comércio ambulante ou de “porta aberta”. Testemunham de forma eloquente uma excelente integração económica, social e cultural, facilitada pelas origens históricas e linguísticas comuns, pela proximidade geográfica, pela identidade cultural. Na verdade, “todo o Portugal é mais ou menos galego”. Essa familiaridade chegou aos nossos dias, não obstante o “carácter assimétrico das relações entre Portugal e a Galiza”, até há poucas décadas.

BACKGROUND:Dedicated pediatricians in emergency departments (EDs) may be beneficial, though no previous studies have assessed the related costs and benefits/harms. We aimed to evaluate the net benefits and costs of dedicated emergency pediatricians in a pediatric ED. METHODS:Cost-consequences analysis of visits to a pediatric ED of a tertiary hospital. Two pediatric ED Medical Teams (MT) were compared: MT-A (May-September 2012), with general pediatrics physicians only; and MT-B (May-September 2013), with emergency dedicated pediatricians. The main outcomes analyzed were relevant clinical outcomes, patient throughput time and costs. RESULTS:We included 8,694 children in MT-A and 9,417 in MT-B. Medication use in the ED increased from 42.3% of the children in MT-A to 49.6% in MT-B; diagnostic tests decreased from 24.2% in MT-A to 14.3% in MT-B. Hospitalization increased from 1.3% in MT-A to 3.0% in MT-B; however, there was no significant difference in diagnosis-related group relative weight of hospitalized children in MT-A and MT-B (MT-A, 0.979; MT-B, 1.075). No differences were observed in ED readmissions or in patients leaving without being seen by a physician. The patient throughput time was significantly shorter in MT-B, with faster times to first medical observation. Within the cost domains analyzed, the total expenditures per children observed in the ED were 16% lower in MT-B: 37.87 euros in MT-A; 31.97 euros in MT-B. CONCLUSION:The presence of dedicated emergency pediatricians in a pediatric ED was associated with significantly lower waiting times in the ED, reduced costs, and similar clinical outcomes.

Two cases of inflammatory myofibroblastic tumor (IMT) of the bladder are reported here. Both patients were male and presented with macroscopic hematuria; in the first case terminal hematuria was associated with irritative voiding symptoms. The second case was a smoker with hematuria unresponsive to medical treatment and anemia. Clinical presentation, pathological features, treatment, and prognosis are discussed. Due to rarity of this pathological condition, there are no guidelines concerning treatment and follow-up. We present our follow-up scheme and highlight the use of laparoscopic partial cystectomy as a successful treatment approach.

Este artigo resulta de um trabalho de mestrado em Ciências da Educação e pretendemos apresentar, brevemente, os conceitos e opiniões de diferentes autores sobre a integração, internacionalização da educação e ideais de interculturalidade estabelecidos, entre Portugal e Brasil no ensino superior. Examinamos alguns Acordos e Leis celebrados entre os países com a finalidade de compreendermos o papel social dos mesmos. Buscamos esclarecer como os programas de internacionalização e cooperação para mobilidade estudantil facilitam e estimulam a integração na vida estudantil e o desenvolvimento pessoal e social dos alunos brasileiros, em Portugal, bem como as questões da interculturalidade no sistema educativo universitário português, com base na realidade da Universidade de Aveiro.

This study aims to characterize the specific domains (SPD) and non-specific domains (NSD) of practice on the procedures of learning training in football, quantifying and identifying the experiences in order to find possible links between the estimates of accumulation of spent hours, relating them to the general aspects of practice. In this study, it was used a model of semi-structured interview. The sample (N=40), was composed of male subjects, athletes from junior category (u-20) from different populations - Portugal (pt=20) and Brazil (br=20), enabling comparative analysis of the results. After collecting the data, we analyzed the possible relationship between the profile of practice and the general aspects of training that each athlete analyzed. Regarding the discussion of the data, we made up comparisons of the results between the two clubs where the interviews were applied. The results are summarized having in mind the following aspects: (a) Portuguese Athletes (about 3000 hrs) have more experience in specific areas than Brazilian athletes (about 2600 hrs) up to 18 years old, (b) Brazilian Athletes (approx. 1600 hrs) have more experience in areas than non-specific athletes Portuguese (about 1000 hrs) up to 18 years old.

Goalball (G) is a collective sport, featured by specific individual and collective relationships. Purpose: to identify some behavioural patterns during a G game (offensive actions). Methods: Sample: 5 male teams from Portugal National Championships and 12 teams from G European Championship. Results: (i) Starting Point :the athletes often employed the Right Hand (p≤0,011) and Both Hands together (p≤0,003); (ii) Offensive Position: The Standing Offensive Position (p≤0,001) and the Bended Knees Position (p≤0,013) seemed to be the most adopted; (iii) Offensive Zone: concerning this zone the right zone (p≤0,001) and the Left Zone (p≤ 0.001) prevailed; iv) Throwing Type : concerning the number of throws on the viewed games, the Throwing (p=0,033), the Tricky Throwing (p≤0,001), the Easy Ball Throwing (p≤0,015) and the Penalty (p= 0,048) are the most employed; and (v) Throwing Trajectory: the athletes used the right-right zone (p≤0,025), right-central zone (p≤0,001) and left – right zone (p≤0,003).

El Goalball (G) es un deporte colectivo, caracterizado por relaciones individuales y colectivas específicas. Objetivo: identificar algunos patrones comportamentales de practicantes del G (acciones ofensivas). Método: la muestra está formada por 5 equipos masculinos del paro Campeonato Nacional de Portugal y 12 del Campeonato de Europa. Resultados: (i) Punto de partida: los atletas utilizaron con mayor frecuencia la mano derecha (p¿0.011) y las dos manos juntas (p¿0.003). (ii) Posición ofensiva: la posición ofensiva de pie (p¿0.001) y de rodillas (p¿0.013) aparecen como las más utilizadas. (iii) Zona ofensiva: con relación a la zona, uno prevalecía de las zonas derecha (p¿0.001) e izquierda (p¿0.001). (iv) Tipo de lanzamiento: el remate (p¿0.033), el remate con finta (p¿0.001), el remate a la pelota fácil (p¿0.015) y el penalti (p=0.048) aparecen como los más utilizados. En cuanto a la (v) trayectoria de los lanzamientos, los atletas utilizaron las zonas derecha-­¿derecha (p¿0.025), derecha-­¿central (p¿0.001) e izquierda-­¿derecha (p¿0.003).

En este artículo se realiza una reflexión sobre el proceso de conformación del ámbito de los estudios sociales sobre el patrimonio cultural en Brasil, tomando como eje principal el papel ocupado por la antropología, y los antropólogos en particular, en dicho contexto. Por una parte, se describe el desarrollo de las discusiones académicas de este medio a través del análisis de los principales trabajos que lo han modelado y de los entornos sociales y políticos en que emergen. Por la otra, se analiza el papel que han jugado los antropólogos en la apertura de la discusión y de las formas de gestión del patrimonio, históricamente dominado por la arquitectura. Por último, y a lo largo del texto, se plantea una discusión sobre el papel y las encrucijadas que enfrenta la antropología, y sus practicantes, en los nuevos procesos ligados a la adopción del denominado patrimonio cultural inmaterial.

Introdução: Em Portugal, a vacinação anti-pneumocócica é gratuita e recomendada pela Direção-Geral da Saúde na população pediátrica de alto risco para doença invasiva pneumocócica. O objetivo deste estudo foi analisar o cumprimento vacinal numa população pediátrica seguida em consulta hospitalar. Material e Métodos: Estudo observacional transversal, em crianças com diagnóstico de alto risco de doença invasiva pneumocócica e consulta num hospital nível três, entre julho e dezembro de 2014. Os dados foram obtidos através do processo clínico, Boletim Individual de Saúde e Plataforma de Dados da Saúde®. Resultados: Dos 122 participantes, 95,9% realizaram, pelo menos, uma dose de vacina mas, destes, só 64,8% efetuaram o esquema completo. O cumprimento do esquema vacinal foi melhor nos de idade inferior a cinco anos (p < 0,01). A proporção de crianças com esquema completo foi de: 100% nas hemoglobinopatias, 100% nas infeções por vírus da imunodeficiência humana, 66,7% nos prematuros com idade gestacional ≤ 28 semanas, 62,5% nos esplenectomizados e 54,7% na síndrome de Down. As crianças têm mais esquemas completos quando são seguidas em consulta de Infeciologia (100%) e de Pneumologia pediátricas (88,2%). O grupo com idade superior a cinco anos está mais vacinado com a vacina polissacarida 23-valente do que o dos 2-5 anos (74,5% vs 40,5%; p < 0,01). Discussão: A maioria da nossa população de alto risco para doença invasiva pneumocócica efetuou vacinação anti-pneumocócica, mas apenas dois terços completaram o esquema recomendado, sendo a maior falha na administração da vacina polissacarida 23-valente. Conclusões: Embora estes resultados sejam melhores do que em países europeus com recomendações semelhantes, é necessário explorar as causas das falhas observadas para otimizar a vacinação.

A proposta do texto em questão é a de refletir acerca da simbólica do objeto e seus vínculos com a experiência cotidiana dos grupos sociais, imersos em suas paisagens de pertencimento. Portanto, busca situá-lo para além de uma visão reducionista do "objeto museal" desvinculado do vivido. A imaterialidade dos bens culturais emerge, assim, como uma instância das relações dos sujeitos com o mundo social e uma simbólica das coisas que circulam, dispersando sentidos no mundo. Uma antropologia do objeto documental acenaria, dessa maneira, para o objeto e sua dinâmica social, considerando a circularidade e a "alma nas coisas" junto às formas sociais que as engendram e dinamizam. Nesses termos, o papel da mediação se configura como o caminho mais profícuo para evitar o congelamento do objeto e o isolamento da cultura na ação.The article aims to reflect on the symbolism of the object and its links to day-to-day experience of social groups, immersed in the scenery to which they belong. Therefore, the article tries to take it beyond a reductionism viewpoint of a museum piece disconnected from the living. The immateriality of cultural goods appears, just as an instance in the relationship of subjects in the social world and a symbolism of things which circulate, spreading meaning in the world. In this way, an Anthropology of Documented Objects could demonstrate its social dynamic to the object, considering the circularity and "spirit of things" with the social forms which generated and dynamized them. In this way, the role of mediation can be construed as a more perfect way in order to avoid the congealing of the object and the isolation of the culture of action.

Respiratory morbidity in the first two years of life, including recurrent symptoms and frequent hospitalizations, is a common problem in very preterm and very low birth weight (VLBW) infants. We conducted a retrospective cohort study aiming to describe the respiratory morbidity at 2 years of corrected age for very preterm and VLBW infants and to identify potential risk factors for its development in a Portuguese based population born in a tertiary referral center between 2009 and 2011. Data were collected from patient’s clinical files and using a standardized questionnaire-based clinical interview for parents. A total 59 children were included. Thirteen (22.0%) had recurrent respiratory symptoms and 12 (20.3%) were using chronic respiratory medication. Health care utilization for respiratory causes was frequent (57.6%), particularly emergency department attendance (50.8%). Twenty seven (45.8%) had additional outpatient visits for respiratory causes and hospital admission was necessary for 8 (13.6%) patients. Factors associated with increased recurrent respiratory symptoms included maternal hypertensive disorders during pregnancy, umbilical artery flow disturbances, being small for gestational age, bronchopulmonary dysplasia, retinopathy of prematurity, intraventricular hemorrhage and a weight percentile below 3 at 6, 12 and 24 months of corrected age. Premature rupture of membranes was negatively associated with respiratory morbidity. Respiratory morbidity at 2 years of age is a common problem in very preterm and VLBW children from our population. Several perinatal and developmental risk factors were identified for respiratory morbidity. Further studies are needed to clarify the importance of these factors, as they can lead to changes in healthcare guidelines.

A rare case of perinephric abscess with unilateral secondary pulmonary involvement that was further complicated by spillover of purulent content into the contralateral lung is reported here. Its diagnosis, treatment, and evolution are described and discussed along with certain features of nephropulmonary fistulas. The diagnosis of these abscesses is difficult, largely because of the paucity of primary symptoms and the frequent presence of misleading secondary symptoms. Deceptive cases like this one highlight the importance of its contemplation in every physician’s differential diagnosis.

BACKGROUND: β2 adrenergic receptor (ADRβ2) polymorphisms including ADRβ2+46G>A have been reported to cause adverse outcomes in mild asthmatics. The extent to which ADRβ2 polymorphisms and in particular their haplotypes contribute to severe asthma is unknown. OBJECTIVE: To determine the association of ADRβ2 polymorphisms and haplotypes with asthma severity. METHODS: Caucasians (n = 2979) were genotyped for 11 ADRβ2 polymorphisms. The cohort (mean age 39.6, 60% female) included 2296 non-asthmatics, 386 mild asthmatics, 172 moderate asthmatics and 125 severe asthmatics. Haplotype frequency and haplotype pair for each subject was determined using the PHASE algorithm. RESULTS: The three asthmatic cohorts were comparable in age and gender but were distinguishable from each other in terms of symptoms, spirometry, medication use and health care utilisation (p

Analiso aqui o espaço social da cidade de Aragarças que foi construída pela Expedição Roncador-Xingu (1942-1943) e Fundação Brasil Central, (1943-1967), contextualizadas no movimento Marcha para o Oeste, iniciada pelo governo de Getúlio Vargas. A parte Alta da cidade é a materialização no espaço das representações sociais da comunidade de memória que se formou, de modo especial, representada pelos pioneiros servidores que viveram na cidade o apogeu da Fundação Brasil Central, nas décadas de 1940 e 1950, quando foram construídas suas principais obras como o hospital, o hotel Getúlio Vargas, a olaria, o aeroporto e as pontes sobre os rios Garças e Araguaia que uniram a cidade com Barra do Garças (MT). No período, constitui-se uma grande malha área regional, militarizando o espaço aéreo do Brasil Central e Amazônia. Em oposição, existe a parte Baixa da cidade, situada às margens do rio Araguaia, que a Expedição Roncador Xingu já encontrara ocupada pelos garimpeiros e sertanejos. Compreender a fusão cidade/pioneiro é primordial para se ter acesso à cadeia de signos que produzem uma comunicação da cultura do pioneiro do médio Araguaia e suas relações sociais.I analyze here the social space of the city of Aragarças. Built by the Roncador-Xingu Expedition (1942-1943) and Fundação Brasil Central [(1943-1967), both contextualized in the movement March to the West, begun by Getúlio Vargas's government. The high part of the city, begun in the space named by the pioneers of the 'Old Base' is the materialization in the space of the social representations from community memory that was formed, in a special way, represented by the pioneer workers that lived in the city the acme of the Brazil Central Foundation, in the decades of 1940 and 1950. Its main works were the building of the hospital, Getúlio Vargas Hotel, the pottery , the airport and the bridges on the rivers Garças and Araguaia that united the city with Barra Garças (MT). At the period, a great regional aerial mesh is constituted, militarizing the aerial space of Central Brazil and Amazônia. In opposition, exists the low part of the city placed at the margins of the river Araguaia, that the Roncador-Xingu Exedition had already found hold for the gravel washer and backwoodsman. To understand the coalition city/pioneers is primordial to have access to the chain of signs that has produced a communication of the pioneer's of medium Araguaia culture and its social relationships.

Apresento no presente artigo algumas reflexões etnográficas a respeito das redes sociais da cidade de ouro Preto tendo o patrimônio cultural como víeis metodológico. A análise dialoga com dados provenientes de pesquisa de campo por meio de entrevistas, levantamento em arquivos e acervos realizados entre os anos de 2007 a 2009. Neste trabalho fizemos um recorte analítico enquadrando um dos dramas sociais da cidade, a escravidão, que compõe um dos fios das teceduras patrimoniais de ouro Preto. As categorias conceituais utilizadas na análise são patrimônio, memória, museus, e história. Por meio destas categorias percebe-se a cristalização de outra categoria, a do sofrimento, presente no imaginário sobre a cidade, e reificado pelas práticas museológicas a favor da história síntese do estado-Nação brasileira, numa perspectiva hierárquica, excludente e redutora. Práticas que inviabilizam a complexidade da cosmovisão afroouro-pretano que podem levar a uma ideia ingênua da vitimização social ou obliterar novas possibilidades patrimoniais relacionadas à cidadania.

Neste artigo visito algumas idéias e práticas que marcaram o saber e o fazer inerentes ao tema do patrimônio cultural brasileiro. A intenção é procurar fugir não apenas das explicações repetitivas, históricas e já desgastadas que permeiam a política denominada "de pedra e cal", mas também da moda do patrimônio imaterial como se fosse uma política redentora do patrimônio brasileiro. A oscilação entre esses dois pólos conceituais é identificada aqui como um trauma que norteou, até o momento, as políticas patrimoniais do país. Aponto que é preciso sair dessa velha tensão, na realidade um falso problema, que pode desfocar a compreensão/interpretação e ressemantização social do patrimônio pelos grupos sociais, que deveria ser a razão, a priori, da existência de tais políticas. Nessa cartografia das políticas públicas brasileiras relacionadas ao patrimônio cultural, jogo luz para focar o lugar da Antropologia, sua contribuição e seus limites, como área de conhecimento interlocutora crescente na reconstrução de tais políticas.

Neonatal lupus erythematosus (NLE) is a rare immune disease. Clinical findings include congenital heart block (CHB), cutaneous manifestations, and hepatic and haematological abnormalities. The authors present a case of a baby with prenatal diagnosis of bradycardia. On the first day of life, she was bradycardic and a CHB (Mobitz type II) with left branch complete block was diagnosed. She had no structural cardiac abnormalities on the scan. Spontaneous resolution of the CHB occurred and she was discharged on the seventh day of life. On the third month of life cutaneous lesions and alimental difficulties were noted. She was diagnosed a complete heart block and a definitive pacemaker was instituted with clinical improvement. Anti-Ro antibodies were positive in the mother and in the child, with the skin biopsy consistent with NLE. Heart block is usually permanent but it can spontaneously revert temporarily to sinus rhythm. A long term follow-up is essential.

The article aims to reflect on the symbolism of the object and its links to day-to-day experience of social groups, immersed in the scenery to which they belong. Therefore, the article tries to take it beyond a reductionism viewpoint of a museum piece disconnected from the living. The immateriality of cultural goods appears, just as an instance in the relationship of subjects in the social world and a symbolism of things which circulate, spreading meaning in the world. In this way, an Anthropology of Documented Objects could demonstrate its social dynamic to the object, considering the circularity and "spirit of things" with the social forms which generated and dynamized them. In this way, the role of mediation can be construed as a more perfect way in order to avoid the congealing of the object and the isolation of the culture of action.

Introdução: A introdução em Portugal de métodos de rastreio pré-natal de anomalias cromossómicas veio causar dúvidas, junto dos profissionais de saúde, quanto à sua correcta aplicação. A aplicação dos protocolos de diagnóstico pré-natal (DPN) a grávidas consideradas de alto risco pelos padrões habituais (idade materna/história familiar) não detecta os cerca de 80% de recém-nascidos com trissomia 21 (T21) que nascem de mulheres com menos de 35 anos, e os 95% com defeitos do tubo neural (DTN) e que constituem o primeiro caso na família. Os testes de rastreio identificam grupos de risco aumentado, com indicação para realização de testes adicionais. Objectivos: Apresentar uma revisão actualizada e sistematizada sobre os métodos de rastreio pré-natal disponíveis, suas particularidades e implementação prática. Métodos: Foi efectuada uma revisão bibliográfica baseada em consulta de manuais, consulta de páginas de Internet de Sociedades e Associações de referência na área da obstetrícia e medicina geral e familiar, e pesquisa na base de dados Medline, entre os anos de 1995 e 2002, através da introdução dos descritores «prenatal diagnosis» e «screening test». Corpo da revisão: O rastreio pode ser efectuado no primeiro trimestre de gravidez, utilizando múltiplos marcadores bioquímicos, e a medição ecográfica da translucência da nuca. Permite calcular o risco específico de ocorrência de T21 ou de trissomia 18, sendo a taxa de detecção próxima dos 85% das gravidezes afectadas. O rastreio do segundo trimestre usa também múltiplos marcadores bioquímicos em conjunto com estudo ecográfico. Pode identificar cerca de 76% das gravidezes T21 e cerca de 80% das com DTN. Ambos apresentam cerca de 5% de falsos positivos. O rastreio integrado (primeiro e segundo trimestre) possibilita maior taxa de detecção. Um rastreio positivo é indicação para teste diagnóstico. Um resultado normal não exclui a doença. As grávidas de 35 ou mais anos constituem um grupo não consensual na aplicação dos testes. Conclusão: O médico deve informar o utente das opções existentes, seu significado e repercussões, para que este tome a sua decisão.