Abstract Introduction: the structured and systematic assessment of malnutrition in cancer patients will make it possible to provide personalized nutritional support. Objective: to assess the nutritional risk of patients admitted to the Oncohematology service of an Oncology Portuguese Institute. Methodology: a descriptive quantitative study was conducted, with assessment at admission and on the 7th day of hospitalization, in a sample of 72 patients and 145 episodes of hospitalization, between April and June 2021, using the MUST scale. Results: the majority of the sample was male (54.2%). Regarding the predominance of oncohematological pathology: Lymphoma (65%), Leukemia (25.3%) and Multiple Myeloma (6.9%). On admission, regardless of the hematological diagnosis, the mean nutritional risk was 1,94 and on the 7th day of hospitalization was 2,09, both values representing high nutritional risk, with readmission increasing the prevalence of higher nutritional risk. Conclusion: malnutrition is a risk for oncohematological patients, when detected early, through systematic evaluation, adequate transdisciplinary care plans can be implemented.

Resumo Introdução: a avaliação estruturada e sistemática da malnutrição no doente oncológico permitirá disponibilizar um suporte nutricional personalizado. Objetivo: avaliar o risco nutricional dos doentes admitidos no serviço de Oncohematologia de um Instituto Português de Oncologia. Metodologia: foi conduzido um estudo transversal, com avaliação na admissão e 7º dia de internamento, numa amostra de 72 doentes e 145 episódios de internamento, entre abril e junho de 2021, utilizando a escala MUST, escala disponível no sistema de informação de Enfermagem da instituição. Resultados: a maioria da amostra era do género masculino (54,2%). Quanto à predominância da patologia oncohematológica: Linfoma (65%), Leucemia (25,3%) e Mieloma Múltiplo (6,9%). Na admissão, independentemente do diagnóstico hematológico, a média de risco nutricional foi 1,94 e ao 7º dia de internamento foi 2,09, traduzindo ambos os valores alto risco nutricional, sendo que o reinternamento aumentou a predominância de maior risco nutricional. Conclusão: sendo a malnutrição um risco do doente oncohematológico, ao detetar-se precocemente, através de avaliação sistemática, poder-se-ão implementar planos de cuidados transdisciplinares e adequados.

Abstract Leucism has been reported in at least 14 cetacean species, including Risso’s dolphin (Grampus griseus). Risso’s dolphins with abnormal pigmentation were sighted and photographed north of Faial Island, Azores Archipelago, in 6 separate events between 2020 and 2023. In 2020, a calf and a juvenile/subadult were observed within a group of over 100 individuals. A leucistic calf with pale skin and dark eyes was observed in 2021, 2022, and 2023 in the same area followed by the same adult within a pod of about 12 individuals, including 3 juveniles, all with normal coloration. This is the first report of wild leucistic Risso’s dolphins in the Atlantic, which could be of interest in future local population and hypopigmentation studies on a dolphin species known to become completely white with age.

Resumen Se ha reportado leucismo en al menos 14 especies de cetáceos, incluido el delfín de Risso (Grampus griseus). Se avistaron y fotografiaron delfines de Risso con pigmentación anormal en el norte de la isla de Faial, archipiélago de las Azores, en 6 eventos diferentes entre 2020 y 2023. En 2020, se avistaron una cría y un juvenil/subadulto dentro de un grupo de más de 100 individuos. Una cría con piel pálida y ojos oscuros fue observada en 2021, 2022 y 2023 en la misma zona seguida del mismo adulto dentro de un grupo de aproximadamente 12 individuos, incluso 3 juveniles, todos con coloración típica. Este es el primer registro de delfines de Risso leucíticos silvestres en el Atlántico, lo cual puede ser útil en futuros estudios poblacionales y de hipopigmentación en una especie de delfín que se conoce se vuelve completamente blanca con la edad.

RESUMO Objetivo: Avaliar a qualidade de vida relacionada com a saúde e a incapacidade no primeiro mês após a alta para domicílio de todos os sobreviventes de COVID-19 grave internados por mais de 24 horas no Serviço de Medicina Intensiva. Metódos: Estudo realizado no Serviço de Medicina Intensiva do Centro Hospitalar Universitário São João, entre 8 de outubro de 2020 e 16 de fevereiro de 2021. Aproximadamente 1 mês após a alta para domicílio, uma enfermeira com experiência em medicina intensiva realizou uma consulta telefônica a 99 sobreviventes, aplicando os questionários EuroQol Five-Dimensional Five-Level e World Health Disability Assessment Schedule 2.0 - 12 itens. Resultados: A média de idade da população estudada foi de 63 ± 12 anos, e 32,5% foram submetidos à ventilação mecânica invasiva. O Simplified Acute Physiology Score médio foi de 35 ± 14, e o Índice de Comorbilidades de Charlson foi de 3 ± 2. O tempo de internamento em medicina intensiva e no hospital foi de 13 ± 22 e 22 ± 25 dias, respectivamente. A média da Escala Visual Analógica da EuroQol foi de 65% (± 21), sendo que apenas 35,3% dos sobreviventes não apresentaram ou tiveram problemas ligeiros para realizar suas atividades habituais, a maioria com algum grau de dor/desconforto e ansiedade/depressão. O World Health Disability Assessment Schedule 2.0 - 12 itens, mostrou incapacidade marcada em retomar o trabalho habitual ou atividades comunitárias e na mobilidade. O uso de ambas as ferramentas sugeriu que o estado de saúde dos sobreviventes seria pior do que a sua percepção. Conclusão: A identificação precoce de sequelas pode ajudar a definir fluxos e prioridades para a reabilitação e reinserção após a COVID-19 grave.

ABSTRACT Objective: To assess early postdischarge health-related quality of life and disability of all survivors of critical COVID-19 admitted for more than 24 hours to na intensive care unit.. Methods: Study carried out at the Intensive Care Medicine Department of Centro Hospitalar Universitário São João from 8th October 2020 to 16th February 2021. Approximately 1 month after hospital discharge, an intensive care-trained nurse performed a telephone consultation with 99 survivors already at home applying the EuroQol Five-Dimensional Five-Level questionnaire and the 12-item World Health Organization Disability Assessment Schedule 2.0. Results: The mean age of the population studied was 63 ± 12 years, and 32.5% were submitted to invasive mechanical ventilation. Their mean Simplified Acute Physiologic Score was 35 ± 14, and the Charlson Comorbidity Index was 3 ± 2. Intensive care medicine and hospital lengths of stay were 13 ± 22 and 22 ± 25 days, respectively. The mean EuroQol Visual Analog Scale was 65% (± 21), and only 35.3% had no or slight problems performing their usual activities, most having some degree of pain/discomfort and anxiety/depression. The 12-item World Health Organization Disability Assessment Schedule 2.0 showed marked impairments in terms of reassuring usual work or community activities and mobility. The use of both tools suggested that their health status was worse than their perception of it. Conclusion: This early identification of sequelae may help define flows and priorities for rehabilitation and reinsertion after critical COVID-19.

RESUMO Objetivos: analisar o conceito de risco cardiovascular para fundamentar a prática de enfermagem. Métodos: trata-se de uma análise para definição do conceito de risco cardiovascular, por meio da utilização de oito etapas do referencial de Walker e Avant, utilizando uma revisão da literatura em periódicos científicos indexados. Resultados: define-se o risco cardiovascular de forma ampla e original como contexto de saúde e de cuidado de enfermagem que permite identificar fatores de risco para doenças cardiovasculares modificáveis (cardiometabólicos, comportamentais, psicossociais, culturais e laborais) e não modificáveis (biológicos), que atuam como marcadores precoces e inter-relacionados, de etiologia múltipla e heterogênea, predispondo à vulnerabilidade cardiovascular. Conclusões: com a análise e definição do conceito de risco cardiovascular, percebemos que será possível fundamentar a prática de enfermagem, com implicações na prática clínica para identificação e redução dos fatores de risco para doenças cardiovasculares, com protagonismo da enfermagem no cuidado desses sujeitos.

ABSTRACT Objectives: to analyze the concept of cardiovascular risk to support nursing practice. Methods: this is an analysis to define the concept of cardiovascular risk, through the use of eight steps of Walker’s and Avant’s framework, using a literature review in indexed scientific journals. Results: cardiovascular risk is defined in a broad and original way as a context of health and nursing care that makes it possible to identify modifiable (cardiometabolic, behavioral, psychosocial, cultural and occupational) and non-modifiable (biological) risk factors for cardiovascular diseases that act as early and interrelated markers, of multiple and heterogeneous etiology, predisposing to cardiovascular vulnerability. Conclusions: with the analysis and definition of the concept of cardiovascular risk, we realized that it will be possible to base nursing practice, with implications in clinical practice for identifying and reducing risk factors for cardiovascular diseases, with nursing relevance in the care of these subjects.

RESUMEN Objetivos: analizar el concepto de riesgo cardiovascular para apoyar la práctica de enfermería. Métodos: se trata de un análisis para definir el concepto de riesgo cardiovascular, mediante el uso de los ocho pasos del marco Walker y Avant, utilizando una revisión bibliográfica en revistas científicas indexadas. Resultados: el riesgo cardiovascular se define de manera amplia y original como un contexto de salud y cuidado de enfermería que permite identificar factores de riesgo modificables (cardiometabólicos, conductuales, psicosociales, culturales y laborales) y no modificables (biológicos) de enfermedades cardiovasculares, que actúan como marcadores tempranos e interrelacionados, de etiología múltiple y heterogénea, que predisponen a la vulnerabilidad cardiovascular. Conclusiones: con el análisis y definición del concepto de riesgo cardiovascular, percibimos que será posible fundamentar la práctica de enfermería, con implicaciones en la práctica clínica para la identificación y reducción de los factores de riesgo de enfermedades cardiovasculares, con protagonismo de enfermería en el cuidado de estas asignaturas.

Abstract Overview and Aims: The incidence of women in their antenatal and postpartum period who require hospitalization in the Intensive Care Unit (ICU), has been repeatedly used as a marker of quality for health services. In Portugal there are currently few studies that report on obstetric complications and the need for a more multidisciplinary approach after admission to an ICU. The main objective of this study is to determine the probability for intensive care admission need of this Centre’s obstetric population. The secondary objectives are to characterize the obstetric population, it’s risk factors and outcomes. Study design: Descriptive and retrospective study Population: All women hospitalized at an ICU in our Centre, during pregnancy or in the 42 days postpartum, in 2013 and 2020. Methods: We assessed the electronic and physical records of our eligible population and analyzed relevant variables such as maternal age, body mass index, gestational age at admission, and delivery route. Neonatal variables, such as weight at delivery, apgar scores and adverse neonatal outcomes were also evaluated. Results: During the study period, 41 women required hospitalization in ICU, out of a total of 14 688 births. The most frequent diagnosis at admission were hypertensive disorders and postpartum hemorrhage. Mean age was 30.4 years. Most admissions were in the postpartum period (97,6%). We observed two maternal deaths and one fetal death. Conclusions: The admission rate to the ICU was 2.8 per 1000 births. Most admissions occurred in the postpartum period (97.6%), with the most common reasons being hypertensive disorders (56.1%) and postpartum hemorrhage (31.7%). The maternal mortality rate was 0.14 per 1000 births. These results were similar to those found in other international and national studies.

ABSTRACT SARS-Cov2 infection is a highly transmissible disease associated with serious pulmonary disease. Renal involvement is frequent and associated with poor prognosis; however, mechanisms of kidney injury are not well established. We present a SARS-Cov2 patient with severe acute kidney injury. Kidney biopsy findings revealed a pattern of acute tubular necrosis with isometric vacuolization of the proximal tubule. The interstitium and glomeruli were normal. Electronic microscopy showed multiple viral-like particles in both the glomeruli and proximal tubule. This case study shows how SARS-Cov 2 infection can result in different kinds of kidney lesion.

ABSTRACT Introduction: Systemic lupus erythematosus (SLE) is an autoimmune disease that can affect multiple organs. When the kidney is involved it is generally termed lupus nephritis (LN), and is a major contributor to the morbidity and mortality associated with SLE. The classic pattern of lupus nephritis in a renal biopsy is an immune complex mediated glomerulonephritis. The presence of crescents, in diffuse proliferative lupus nephritis, and serologic positivity for antineutrophil cytoplasmatic antibodies (ANCA), more often antimyeloperoxidase than anti-proteinase 3, has been linked with specific clinicopathological features, poor treatment response and a worse kidney survival. Clinical case: We present the case of a 19-year-old male, without relevant past medical history, who presented severe headaches, hypertension and peripheral edema. The blood analysis revealed hemoglobin (Hb) 7.6 g/dL, creatinine (Cr) 2.64 mg/dL, blood urea nitrogen (BUN) 101 mg/dL, and urine analysis, hematuria and nephrotic proteinuria. The autoimmunity panel results were consistent with SLE paired with positivity for ANCA-proteinase 3 antibody. A renal biopsy revealed crescentic glomerulonephritis with fibrinoid necrosis and Bowman capsule rupture. The patient was diagnosed with class IV LN. The initiation treatment consisted of cyclophosphamide (CIPH) and prednisolone (PDN). At the 6-month follow-up, CIPH was stopped and mycophenolate mofetil (MMF) initiated as maintenance therapy, combined with PDN. Although microscopic hematuria and C3 consumption were still present (a new biopsy was pondered but the patient refused any further invasive diagnostic measures), C1q levels decreased from 26.6 to 19.3 U/ml (negative if < 20 U/ml) and anti-dsDNA was also negative with progressive declination of the degree of proteinuria. The creatinine levels returned to normal. Conclusion: The authors emphasize the importance of this class IV LN, influenced by the association with anti-proteinase 3, due to the implications in the histopathological pattern and in therapy selection. In this specific case kidney function, proteinuria and lupus activity had an important decrease without significant complications with the chosen treatment.

Objetivos: Analisar a perspetiva dos profissionais de saúde sobre o abuso de idosos e avaliar as dificuldades experienciadas na abordagem deste tipo de casos, concretizando-se, complementarmente, uma revisão de conceitos fundamentais relacionados com esta temática. Fontes de dados: Pesquisa nas bases de dados PubMed, MEDLINE, Embase, Repositórios Científicos de Acesso Aberto de Portugal e OpenAIRE. Foi ainda consultado o Código Deontológico da Ordem dos Médicos, o Código Deontológico dos Enfermeiros, o Código Penal e a informação disponibilizada nos sites da Organização Mundial da Saúde, Direção-Geral da Saúde e Associação Portuguesa de Apoio à Vítima. Métodos de revisão: Pesquisa nas bases de dados através da combinação dos seguintes termos: abuso; maus-tratos; idosos; profissionais de saúde; pessoal de saúde; Portugal. Resultados: Foram selecionados 32 artigos científicos originais, publicados entre 2010 e 2018, disponíveis na sua totalidade em português e/ou inglês, com conteúdos direcionados para os objetivos delineados. Conclusões: A falta de deteção e de adequada orientação, por parte dos profissionais da saúde, de situações abusivas contra as pessoas idosas pode estar associada a défices na formação sobre este tema, sendo crucial melhorar os conteúdos curriculares neste domínio. A formação deve focar as situações que podem ser consideradas abusivas, os sinais e sintomas associados, o contexto em que os abusos podem ocorrer, a legislação existente e as autoridades a que se pode recorrer. Associadamente deve promover-se a consciencialização do público em geral, realçando a importância da deteção precoce e as instituições disponíveis para fornecer apoio aos idosos vulneráveis.

Objectives: Analyze the professionals' perspective on elder abuse and to explore the difficulties they experience in addressing this type of situation. Furthermore, a review was made on some fundamental concepts related to this subject. Data sources: Research in the following databases PubMed, MEDLINE, Embase, Scientific Repositories of Open Access of Portugal and OpenAIRE. It was also consulted Code of Conduct of the Portuguese Medical Association, Code of Conduct of Nurses, Portuguese Penal Code and the information provided in the websites of the World Health Organization, General-Directorate of Health and the Portuguese Association for Victim Support. Review methods: Database research by combining the following terms: elder abuse; mistreatment; elderly; health professionals; health personnel; health care personnel; Portugal. Results: Thirty-two original scientific articles, published between 2010 and 2018, all of which were available in Portuguese and/or English, with content directed to the proposed objectives. Conclusions: Lacks in detection and management by health professionals of abusive situations against the elderly may be associated with deficits in education on this topic, thus it is crucial to improve curricular content. Training should focus on situations that may be considered abusive, associated signs and symptoms, the context in which abuse may occur, the existing legislation and entities that may provide assistance. In addition, public awareness should be promoted, emphasizing the importance of early detection and identifying institutions that provide support to the vulnerable elderly.

ABSTRACT Actinomycosis is an uncommon, endogenous, and chronic infection with varied and nonspecific clinical features such as abdominal, pelvic or cervical masses, ulcerative lesions, abscesses, draining fistula, fibrosis, and constitutional symptoms. The disease ensues when the bacteria disrupt the mucosal barrier, invade, and spread throughout interfascial planes. Currently, the diagnosis of actinomycosis is challenging because of its very low frequency and depending on the clinical presentation it may masquerade malignancies. Therapy consists initially in intravenous penicillin, followed by an oral regimen that may be extended until a year of treatment. A timely diagnosis is crucial to avoid extensive therapeutic attempt as surgery. However, a biopsy or drainage of abscesses and fistula’s tract may be required not only as a diagnostic procedure as part of the therapy. We report the case of a 72-year-old woman with an abdominal mass initially misdiagnosed as a liposarcoma. A second biopsy of a skin lesion of the abdominal wall made the diagnosis of actinomycosis, avoiding a major surgical procedure. The patient was treated with a long-term course of antibiotics with favorable outcome. Liposarcoma was ruled out after the patient’s full recovery with antibiotics and the misdiagnosis was credit to the overconfidence on the immunohistochemical positivity to MDM2.

ABSTRACT Objective: Developing a mobile application for the teaching of the International Classification for Nursing Practice. Methods: Methodological applied research for technological production, performed in three phases of the contextualized instructional design model: analysis, design and development. Results: The application has an initial screen, which provides information about the team and its purpose. Then, four moblets are listed, including presentation, user’s guide consisting of five modules, educational games and five clinical cases. The references on which the application was based are also presented. Final considerations: It was possible to develop an application with the potential to promote the knowledge of nursing students and professionals about this classification system.

RESUMEN Objetivo: Desarrollar una aplicación móvil para enseñar la Clasificación Internacional en la Práctica de Enfermería. Métodos: Estudio metodológico aplicado, de elaboración tecnológica, realizado en tres fases del modelo de diseño instructivo contextualizado: análisis, diseño y desarrollo. Resultados: La aplicación tiene una pantalla de bienvenida, en que brinda información sobre el personal y el tema de auxilio. A continuación, se enumeran cuatro moblets, que versan sobre la presentación, el guía del usuario constituido por cinco módulos, juegos educativos y cinco casos clínicos. También se encuentran las referencias utilizadas en la elaboración de la aplicación. Consideraciones finales: Fue posible desarrollar la aplicación con potencial para impulsar a estudiantes y a profesionales de enfermería que conozcan mejor dicho sistema de clasificación.

RESUMO Objetivo: Desenvolver um aplicativo móvel para o ensino da Classificação Internacional para a Prática de Enfermagem. Métodos: Estudo metodológico aplicado, de produção tecnológica, realizado em três fases do modelo de design instrucional contextualizado: análise, design e desenvolvimento. Resultados: O aplicativo possui uma tela inicial, na qual são fornecidas informações sobre a equipe e o tópico de ajuda. Em seguida, são listados quatro moblets, que versam sobre apresentação, guia do usuário constituído por cinco módulos, jogos educativos e cinco casos clínicos. Também são dispostas as referências utilizadas para a construção do aplicativo. Considerações finais: Foi possível desenvolver o aplicativo com potencial para impulsionar estudantes e profissionais de enfermagem a ter um melhor conhecimento sobre o referido sistema de classificação.

RESUMO Objetivo: Desenvolver um aplicativo móvel para o ensino da Classificação Internacional para a Prática de Enfermagem. Métodos: Estudo metodológico aplicado, de produção tecnológica, realizado em três fases do modelo de design instrucional contextualizado: análise, design e desenvolvimento. Resultados: O aplicativo possui uma tela inicial, na qual são fornecidas informações sobre a equipe e o tópico de ajuda. Em seguida, são listados quatro moblets, que versam sobre apresentação, guia do usuário constituído por cinco módulos, jogos educativos e cinco casos clínicos. Também são dispostas as referências utilizadas para a construção do aplicativo. Considerações finais: Foi possível desenvolver o aplicativo com potencial para impulsionar estudantes e profissionais de enfermagem a ter um melhor conhecimento sobre o referido sistema de classificação.

ABSTRACT Objective: Developing a mobile application for the teaching of the International Classification for Nursing Practice. Methods: Methodological applied research for technological production, performed in three phases of the contextualized instructional design model: analysis, design and development. Results: The application has an initial screen, which provides information about the team and its purpose. Then, four moblets are listed, including presentation, user’s guide consisting of five modules, educational games and five clinical cases. The references on which the application was based are also presented. Final considerations: It was possible to develop an application with the potential to promote the knowledge of nursing students and professionals about this classification system.

RESUMEN Objetivo: Desarrollar una aplicación móvil para enseñar la Clasificación Internacional en la Práctica de Enfermería. Métodos: Estudio metodológico aplicado, de elaboración tecnológica, realizado en tres fases del modelo de diseño instructivo contextualizado: análisis, diseño y desarrollo. Resultados: La aplicación tiene una pantalla de bienvenida, en que brinda información sobre el personal y el tema de auxilio. A continuación, se enumeran cuatro moblets, que versan sobre la presentación, el guía del usuario constituido por cinco módulos, juegos educativos y cinco casos clínicos. También se encuentran las referencias utilizadas en la elaboración de la aplicación. Consideraciones finales: Fue posible desarrollar la aplicación con potencial para impulsar a estudiantes y a profesionales de enfermería que conozcan mejor dicho sistema de clasificación.