Acta Medica Port
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Comparative Study
Haemodynamic parameters obtained by transthoracic echocardiography and Swan-Ganz catheter: a comparative study in liver transplant patients.
To compare the haemodynamic measurements of cardiac output (CO), central venous pressure (CVP), pulmonary capillary wedge pressure (Pw) and pulmonary artery systolic pressure (PASP), obtained by Swan-Ganz catheter and transthoracic echocardiography. ⋯ The non-invasive determination of CO in critical care post liver transplant patients correlates well with the invasive determinations. Transthoracic echocardiography was not appropriate for calculating filling parameters studied. Although the data was obtained in post liver transplant patients, they could be useful in defining the role of echocardiography in the ICU.
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The prevalence of celiac disease is unknown in Portugal. In European countries the prevalence is between 1:200 and 1:400. The incidence obtained through diagnosed cases in the paediatric gastroenterology units in Portugal was 1:3648. To determine the best current celiac disease screening method and its prevalence in a portuguese population, 536 sera of teenagers with 14 years +/- 6 months from Braga town schools were tested as follows: a) total IgA, b) anti-tissue transglutaminase antibodies c) anti-endomysium antibodies (AEA). One female adolescent, with negative AEA and anti-transglutaminase antibodies had a diagnosed celiac disease; this patient was under appropriate diet. Eleven adolescents had positive anti-transglutaminase antibodies and 4 of these had also positive AEA. A jejunal biopsy was carried out on the latter adolescents. Three presented intestinal villous atrophy, 2 a flat mucosa and 1 a moderate atrophy. One female adolescent had a normal mucosa. The prevalence was 1:134, [confidence interval at 95%, 1:53-1:500]. ⋯ Presently, total IgA with determination of anti-tissue transglutaminase antibodies is apparently the best screening method; it is less expensive test and, given the use of ELISA, less dependent on the observer. The celiac disease prevalence found in the present study falls within the range of prevalence recently found in other European populations, which implies that the celiac disease is under-diagnosed in Portugal.
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Meningococcal disease has a wide spectrum of clinical presentation. Occult bacteremia is not easily diagnosed and may have good prognostic. ⋯ Meningococcal disease may present with fever without toxic appearance--unsuspected meningococcal disease--causing difficulty in the diagnosis and delaying the treatment. Spontaneous resolution is rare and severe complications may occur.
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This review is focused on doctors' occupational stress. A synthesis of the broad negative impact of distress is presented, as well as its spreading importance and magnitude according to recent research. Contemporary definitions of stress and burnout models are underlined with a remembering of their historical evolution. ⋯ The core risk factors of occupational medical stress are detailed and discussed, with more emphasis in those related to doctors vulnerabilities. Great need actually unmeeted regards the public recognition of the professional medical risks, the acceptance by the doctors of their normal fragility as humans, and their insight about their own vulnerabilities as a group with specifics professional representation. The conclusion is that there is a major and urgent need for the doctors to develop and practice competences of stress management.
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Comparative Study Historical Article
[The myth of Apollo and Marsyas. Artistic representations and anatomical studies].
The authors analyze an interesting sculpture found in the gardens of a 17th Century palace in Lisbon, representing the myth of Apollo and Marsyas, which led them to compare the details of the sculpture of the flayed satyr with the previous anatomic studies by Leonardo da Vinci (cc.1510-1530) or Vesalius (cc.1543). The photographic material obtained from the 17th century Italian sculpture presents amazing similitude with these, earlier, 16th century anatomical studies. ⋯ Some of the artistic representations of surface anatomy depict other motives, as is the case of the self-portrait of Michelangelo, painted in the Sistine Chapel, in honour of St. Bartholomew.