The most frequent cause of splenic rupture is trauma. Rarely do spontaneous splenic ruptures occur. The authors report the case of an atraumatic splenic rupture (ASR) following a recent intranasal cocaine abuse that highlights the importance of a detailed social history, since early diagnosis and treatment can produce a positive outcome.

Abstract The most frequent cause of splenic rupture is trauma. Rarely do spontaneous splenic ruptures occur. The authors report the case of an atraumatic splenic rupture following a recent intranasal cocaine abuse that highlights the importance of a detailed social history, since early diagnosis and treatment can produce a positive outcome.

A perfuração da membrana timpânica (MT) é um problema otológico relativamente frequente nos dias atuais, causada, na maioria das vezes, por traumatismos. Esta patologia provoca comprometimento da impermeabilidade da membrana que separa o ouvido externo do médio, sendo que a colocação de um fragmento de celulose bacteriana tornou-se um método eficaz para a recuperação anatómica e fisiológica.

Syphilis is a systemic disease with an increasing incidence in adolescents and young adults. Clinical manifestations can be variable and diagnosis requires a high index of suspicion, as syphilis can mimic other systemic diseases. Condylomata lata is a highly infectious manifestation of secondary syphilis, reported in 9-44% of cases. Here is reported the case of an adolescent girl who presented with inguinal lymphadenopathies, urinary and constitutional symptoms, and a history of unprotected sex with her boyfriend, who had been previously diagnosed with a genital ulcer. A complete physical examination was performed, and the detection of an anal lesion raised the hypothesis of perianal condylomata lata as a manifestation of secondary syphilis. All signs and symptoms of infection resolved with treatment. Early detection, appropriate treatment, and prevention of transmission are essential to reduce the burden of the disease.

The use of technological tools has become over the years increasingly used in all social and cultural aspects, and in education it has been no different. Schools are leaving the standard teaching aside, adopting new teaching methodologies, using, besides books and pictures, technology in their favor. In this way, the student, through the interaction of books, teachers and technological tools, creates cognitive skills that will help him/her to build his/her own knowledge. In view of these factors, this work aimed to develop an educational computer game in the area of zoology with a focus on animals threatened with extinction in the state of Amazonas, in order to improve the teaching of this area at the Carolina Perolina Raimunda Almeida municipal school, located in the city of Manaus/AM. In order to achieve this goal, complementary activities were applied after each class so that the students could become more familiar with the contents covered. At the end of this part, the game was applied as a way of evaluating all the knowledge obtained in a playful, instigating and meaningful way. Finally, in order to know if the software was useful and if it was able to achieve its objective, that is, if it helped the students to understand the animals that exist in their region, a questionnaire was applied containing ten questions regarding the quality of the game and the contents approached in class. Thus, it was concluded from the application of the activities and the game, that it was of great effectiveness for the students, because in a playful, instigating and different way, the students remembered important points of the classes, in which from this, they became able to recognize the characteristics of the animals studied, to know their habits and way of life, and most importantly, to know the methods of preservation of these animals.

Introdução: As Metástases da Coróide (MC) por um tumor à distância constituem a neoplasia mais frequente do olho. Os carcinomas da mama e do pulmão são os principais intervenientes e a apresentação mais comum é a diminuição da acuidade visual. Objectivo: Apresentar um caso clínico paradigmático e uma revisão narrativa da literatura. Caso clínico: Doente do sexo feminino, 57 anos, com antecedente de carcinoma da mama em 2010, foi referenciada à consulta de oftalmologia pela oncologia, por diminuição da acuidade visual e peso ocular, associado a um diagnóstico recente de metástases hepáticas. À fundoscospia identificou-se uma lesão sólida procidente para a cavidade vítrea, com alteração do epitélio pigmentado da retina e descolamento da retina inferior sem rasgaduras observáveis, sugestiva de metástase. Pelos achados dos exames auxiliares de diagnóstico e em associação com os antecedentes da doente, foi feito o diagnóstico de MC. Referenciou-se para tratamento com radioterapia externa, que foi bem tolerada, com uma melhoria significativa da sintomatologia e resolução da lesão nos exames de controlo. Métodos: Foi realizada uma pesquisa bibliográfica na PubMed. Resultados: A MC apresenta uma prevalência de 2-9% e tem origem no carcinoma da mama em 39 a 47% e no carcinoma do pulmão em 20 a 29% dos casos. A maioria dos doentes apresenta uma história prévia de neoplasia e cerca de 70% possui metástases extra-oculares. O diagnóstico é feito, principalmente, através da história de neoplasia ou de doença sistémica, juntamente com os achados clínicos do exame oftalmológico. O tratamento depende do estado geral do doente, do tumor primário, do número de tumores da coróide e da localização. A radioterapia continua a ser referenciada como o tratamento mais utilizado. Novas terapêuticas têm sido desenvolvidas com resultados promissores. Conclusão: É essencial uma abordagem multidisciplinar e precoce aos doentes com suspeita de MC. A doença tem uma evolução muito rápida e está associada a um mau prognóstico, especialmente se não tratada em fases iniciais. O tempo é crucial para a manutenção da acuidade visual e sobrevida dos doentes.

This paper aims to investigate how the Pact for Education in Pernambuco, Brazil, contributes to fostering practices that characterize management innovations from the perspective of public policies’s effectiveness, adopting as theoretical and sensitizing lens the Theory of Possibilities by Guerreiro Ramos and its approach on Administration for Development. By means of a qualitative case study and thematic analysis of the content of the interviews carried out at the strategic and tactical levels of its operationalization, it was possible to identify categories concentrated around practices specifically related to the referred pact, such as the use of performance indicators and advertising of school descriptors. The effectiveness indicators identified for these categories relate to the creation of a differentiated look for the schools and priority students of the public system, credibility, transparency, perception of empowerment and improvement of awareness about the school context.Keywords: Public management innovation, Administration for Development, Pact for Eduucation in Pernambuco, Brazil.