Anterior shoulder anatomy and subcoracoid impingement: An anatomical study.

Objective: The aim of our study was to describe the anatomy of the anterior shoulder, specifically structures potentially involved in subscapularis tears pathophysiology and also to identify structures at risk during surgical approaches of this area.

Materials And Methods: We designed an observational, experimental study based on cadaveric models. Dissection was performed and several structures of the anterior shoulder were characterized including the subscapularis, coracoid morphology, the coracoacromial ligament, coraco-humeral distance, and the axillary and musculocutaneous nerves.

Pitfalls of HbA1c in the Diagnosis of Diabetes.

Many health care providers screen high-risk individuals exclusively with an HbA1c despite its insensitivity for detecting dysglycemia. The 2 cases presented describe the inherent caveats of interpreting HbA1c without performing an oral glucose tolerance test (OGTT). The first case reflects the risk of overdiagnosing type 2 diabetes (T2D) in an older African American male in whom HbA1c levels, although variable, were primarily in the mid-prediabetes range (5.

A Rare Cause of Acute Liver Failure: Diffuse Liver Metastization of Merkel Cell Carcinoma.

The authors describe a case of a 76-year-old male with a medical history of Merkel cell carcinoma (MCC) of the right lower eyelid. He was admitted to the emergency department due to abdominal pain in the right hypochondrium, nauseas, asthenia, and choluria with 3 days of evolution. Biochemical liver workup revealed a cytocholestase pattern as well as a prolonged prothrombin time.

Botulism disguised as parotitis.

Botulism is an acute toxin-mediated neuroparalytic syndrome caused by some species. It typically presents itself as an acute symmetric descending paralysis of cranial and peripheral nerves, which can potentially evolve to respiratory failure and death. We report a case of botulism diagnosed in a patient presenting with a parotitis probably due to xerostomia, even though he had already sought medical assistance for blurred vision and dysphagia.

Review of methods for detecting glycemic disorders.

Prediabetes (intermediate hyperglycemia) consists of two abnormalities, impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) detected by a standardized 75-gram oral glucose tolerance test (OGTT). Individuals with isolated IGT or combined IFG and IGT have increased risk for developing type 2 diabetes (T2D) and cardiovascular disease (CVD). Diagnosing prediabetes early and accurately is critical in order to refer high-risk individuals for intensive lifestyle modification.

Facial Reconstruction Based on Combined Three-Dimensional Printing and Microsurgical Free Transfer.

There are patients with craniofacial deformity that can lead to extensive bone loss and severe disfigurement. Autologous reconstruction may be challenging in these patients, and it is usually associated with flap donor area morbidity and unfavorable aesthetic and functional results. A 51-year-old patient with human immunodeficiency virus infection, developed in the context of immunosuppression a fulminant fungal rhino-sinusitis with the need for surgical debridement, and in consequence extensive destruction of the nasal cavity and upper jaw, resulting in severe disfigurement due to nasal deformity and maxillary collapse.

The role of vertical semicircular canal function in the vertical component of skull vibration-induced nystagmus.

Generally, vertical component of the skull vibratory nystagmus (VCN) is ignored in the clinical practise. Thus, the relative contribution of the vestibular organs in the presence of VCN remains unknown. To determine the association between vertical semicircular canal (vSCC) function and the presence of VCN.

Coracoid morphology and humeral version as risk factors for subscapularis tears.

Background: The pathophysiology of subscapularis (SS) lesions is still relatively unknown despite recent interest in predictive factors for SS tears. Our goal was to determine the influence of the coracoid morphology and humeral version on SS tears.

Methods: This was a retrospective, controlled, single-blinded study.

Prevalence, determinants, and effects of violence during pregnancy: A maternity-based cross-sectional study in Luanda, Angola.

Information on the extent of violence against women is scarce in Angola. This study aims to estimate the prevalence of violence against pregnant women in Angola and to identify its sociodemographic determinants and effects on pregnancy outcomes. A cross-sectional study was conducted between December 2012 and February 2013, involving 995 women who delivered at a Maternity in Luanda, Angola.

Vertical Endoscopic Gastroplasty in a Patient With Situs Inversus Totalis.

Bariatric surgery in patients with any deviation from normal anatomy is a challenge and requires considerable experience on the part of the surgeon. Situs inversus totalis (SIT) is a rare congenital abnormality (1:5,000-1:20,000 live births), and any surgical procedure on these patients can be somewhat challenging. A 44-year-old woman with morbid obesity, systemic arterial hypertension, and SIT underwent vertical endoscopic gastroplasty.

The First Study Evaluating Effectiveness and Safety of the Endoscopic Sleeve Gastroplasty in HIV Patients.

The authors evaluated, retrospectively, the endoscopic sleeve gastroplasty impact in seven HIV patients, regarding effectiveness and safety outcomes. The mean baseline body mass index (BMI) was 33.76 kg/m.

Efficacy and safety of calcium carbonate in normophosphataemic patients with chronic kidney disease Stages 3 and 4.

Background: Disordered bone and mineral metabolism are a common complication of chronic kidney disease (CKD). Phosphate binders are often prescribed in advanced CKD, when hyperphosphataemia develops. Little is known about the role of these drugs in earlier stages, when serum phosphorus levels are kept in the normal range by increased urinary excretion.

Reducing socio-economic inequalities in all-cause mortality: a counterfactual mediation approach.

Background: Socio-economic inequalities in mortality are well established, yet the contribution of intermediate risk factors that may underlie these relationships remains unclear. We evaluated the role of multiple modifiable intermediate risk factors underlying socio-economic-associated mortality and quantified the potential impact of reducing early all-cause mortality by hypothetically altering socio-economic risk factors.

Methods: Data were from seven cohort studies participating in the LIFEPATH Consortium (total n = 179 090).

Evaluation of Small-Bowel Patency in Crohn's Disease: Prospective Study with a Patency Capsule and Computed Tomography.

Background And Purpose: Patency capsule (PC) examination is usually performed - previously to capsule endoscopy - to evaluate small-bowel patency in patients with established Crohn's disease (CD). The reported PC retention rate is significantly higher than expected. Our aims were to assess small-bowel patency, to determine the precise location of the retained PC in patients with CD, and to determine the false positive rate of evaluation with a radiofrequency identification tag (RFIT) scanner.

Life-course socioeconomic status and lung function in adulthood: a study in the EPIPorto cohort.

Objective: This study aims to investigate the association of life-course socioeconomic status (SES) with lung function during adulthood, by exploring the influence of life-course social mobility and of cumulative exposure to low SES.

Methods: Participants were 1458 individuals from EPIPorto study, a population-based cohort of Portuguese adults. The life-course SES was computed using participants' paternal occupation and own occupation, resulting in four patterns: stable high, upward, downward, stable low.

Assessment of indoor air conditions in households of Portuguese families with newborn children. Implementation of the HEALS IAQ checklist.

Conducting epidemiological and risk assessment research that considers the exposome concept, as in the case of HEALS project, requires the acquisition of higher dimension data sets of an increased complexity. In this context, new methods that provide accurate and interpretable data summary on relevant environmental factors are of major importance. In this work, a questionnaire was developed to collect harmonized data on potential pollutant sources to air in the indoor environment where children spend an important part of their early life.

Endometrial cancer: Preoperative versus intraoperative staging.

Purpose: To determine the accuracy of transvaginal ultrasonography (TVS) and pelvic magnetic resonance imaging (MRI) in preoperative staging of endometrial cancer in comparison to frozen section (FS) for the assessment of myometrial invasion, considering permanent section as the gold standard.

Methods: A retrospective longitudinal study of all endometrial carcinomas diagnosed in our institution between March 2012 and October 2018 was conducted. Women with histologically confirmed endometrial malignancy, planned for surgery as primary treatment and submitted either to TVS, MRI and/or intraoperative FS followed by comprehensive surgical staging were eligible.

Resuturing of Stomach in Endoscopic Sleeve Gastroplasty 8 Months After Original Procedure.

Endoluminal treatments such as endoscopic gastroplasty have been gaining ground in obesity treatment. A 52-year-old woman gained weight 5 months after endoscopic gastroplasty. Thus, it was decided to resuture the greater curvature of the stomach 8 months after the initial procedure by reducing the gastric pouch even further.

Breast Metastasis From a Combined Hepatocellular-Cholangiocarcinoma.

Combined hepatocellular-cholangiocarcinoma (cHCC-CC) is a unique entity that contains mixed elements of both hepatocellular carcinoma and cholangiocarcinoma. We report a 62-year-old woman with alcoholic cirrhosis with elevated α-fetoprotein of 25.3 ng/mL.

Reconstruction of a Chronic Volkmann Contracture following Forearm Revascularization with Burkhalter's Procedure and Fractional Flexor Tendon Lengthening after a Failed Stiles-Bunnell Transfer.

Volkmann ischemic contracture is a cause of limb dysfunction that can lead to varying amounts of limb deformity, stiffness, and paralysis. Several procedures have been used to improve limb function in these patients. An 11-year-old male patient sustained a domestic accident with a glass door, resulting in a severe soft tissue trauma to his proximal third of the right forearm with damage to flexor muscles and tendons, complete section of median and ulnar nerves, and radial and ulnar arteries.

Hotspots of childhood obesity in a large metropolitan area: does neighbourhood social and built environment play a part?

Background: Effective place-based interventions for childhood obesity call for the recognition of the high-risk neighbourhoods and an understanding of the determinants present locally. However, such an approach is uncommon. In this study, we identified neighbourhoods with elevated prevalence of childhood obesity ('hotspots') in the Porto Metropolitan Area and investigated to what extent the socio-economic and built environment characteristics of the neighbourhoods explained such hotspots.

Necrotic Loxoscelism of the Scalp.

A 15 month old boy was referred to our department after he and his mother moved to our country. He had been bitten by a brown recluse spider (Loxosceles reclusa) at the age of 7 months, in Brazil. Initially, he presented to the emergency department of his local hospital with rash in the scalp, near the bite.

Unilateral acute cervical lymphadenitis in children: can we predict the need for surgery?

Introduction: Paediatric acute cervical lymphadenitis is a frequent diagnosis in the emergency department. Traditionally, suppurative cervical lymphadenitis (SCL) is associated with a higher need of surgical drainage. However, a great variability in the management of this suppurative infections can be observed.