Acta Medica Port
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Acute appendicitis (AA) is the leading cause of emergency abdominal surgery in children. The diagnosis is essentially clinical, but some methodologies, such as Alvarado score (AS), have been developed in order to avoid non-therapeutic laparotomy (15-30%). AS ≥ 5 or 6 is compatible with AA and is an indication for the patient to remain on observations, if AS ≥ 7 a laparotomy procedure may be indicated. ⋯ We recommend using a cut-off value of 5 points, since only 18 children with AA were initially classified as appendicitis unlikely, this value would increase to 67 patients for the SA value of ≥ 7. The AS is a valuable tool in screening children with abdominal pain for the diagnosis of AA. Nonetheless the diagnosis and final decision must be based on clinical and systematic reassessment of patients.
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Empathy is a key feature of the doctor-patient relationship. Several studies have shown a link between empathic relationships and clinical outcomes. However, reports of a decline in empathy over the course of undergraduate medical education and medical practice have raised concern among medical educators. Our study focuses on the exploration of the temporal stability of attitudes towards empathy in first-year medical students. We also aimed to characterise this sample regarding attitudes towards empathy and its associations with socio-demographic determinants, motives for entering Medicine and professional expectations. Finally, we wanted to contribute to the preliminary validation in Portugal of the Jefferson Scale of Physician Empathy, students' version (JSPE-S), following Hojat's definition of empathy as a predominantly cognitive concept. ⋯ In general, our findings support the idea that empathy can be learnt in medical schools. This study also provides evidence for the validation of the JSPE-S and for the acceptability of an instrument assessing motivation for medical school, in Portugal. Albeit weak, the correlations between motivational factors and empathy components deserve further exploration in research.
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Demoralization refers to a persistent failure of coping with stress as defined by Jerome Frank thirty years ago. Feelings of despair, isolation, hopelessness, loss of meaning and existential distress are the core features of the definition of demoralization. It is frequently associated with a chronic medical illness, fear of loss of dignity and perception of being a burden on others and it evolves to a desire to die. The authors reviewed the literature related to this concept and present the evidence related to the diagnosis, classification, treatment and relation of demoralization with the palliative care setting.
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The nutcracker syndrome is associated with left renal vein compression in its passage between the abdominal aorta and superior mesenteric artery. This phenomenon can cause left renal vein hypertension manifested by abdominal pain, hematuria, and pelvic congestion syndrome. ⋯ We describe two clinical cases of children with hematuria whose investigation led to the diagnosis of Nutcracker Syndrome. In the presence of hematuria of unknown origin it's necessary to consider this entity, highlighting the essential role of a noninvasive test such as renal ultrasound with Doppler in its diagnosis.
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To determine the prevalence of dysmenorrhea, limitations in daily living and health care use due to menstrual pain. ⋯ Dysmenorrhea is highly prevalent among this sample of adolescents and young adults and is related to absenteeism. Thus, health care providers should regularly screen for dysmenorrhea and offer appropriate treatment.