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Purpose: to study the potential relationship between disfiguring facial modifications and psychosocial and Quality of Life (QoL) impact in a group of acromegaly patients. Methods: Thirty patients accepted to participate in this study (n=13) women and 56.6% (n=17) men; mean age was 61.1 ± 15.8 and 56.3 ± 12.4 years, respectively. Variables studied included: a) Anxiety level, measured through the State-Trait Anxiety Questionnaire (STAI); b) Quality of life evaluation by AcroQoL; c) Self-esteem status through the Rosemberg Self-Esteem Scale and d) Facial acromegaly phenotypic changes evaluated from face photographs and scored by 8 trained endocrinologists. Results: Gender differences were observed in Anxiety levels, with higher values in women than in men (trait: 6.1±2.2 and 5.0±2.0 (p=0.025); state: 8.2±1.1 and 3.1±2.1 (p=0.004), respectively. Also, there were differences in the global AcroQoL score, being 69.3 (SD±17.7) for males and 51.1 (SD±21.8) for females (p = 0.004) and it was reflected in all dimensions. Self-Steem was similar in both groups. There were lower values at the face appearance scoring in women at pre-diagnostic phase (3.4±1.3 vs. 4.75±1.5). A negative correlation was found between self-esteem and changes in facial scores at the pre-diagnostic and diagnostic periods (rs= -0.559, p=0.074), consistent with a high impact of facial changes in the psychologic status of the patients. Conclusion: acromegaly facial changes negatively impact the psychosocial condition of these patients with maximal deleterious effects observed at the time of diagnosis; these disturbances persist over time despite disease control or curation and are of higher intensity in women.

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Shiga-toxin producing Escherichia coli (STEC) infection is the most common cause of haemolytic uremic syndrome (HUS) in children. It should be noted that 5% of STEC-HUS patients have no prodromal diarrhoea, while it may be present in up to 30% of atypical HUS (aHUS) cases. In patients at risk for aHUS, STEC infection may act as a trigger rather than playing a causative role. Presently, eculizumab is the first-line therapy for children presenting with aHUS, whereas treatment of children with STEC-HUS is mainly supportive. We report the case of a child with STEC-HUS who had a severe presentation, requiring renal replacement therapy in the acute phase and surgical treatment for a colonic stricture that arose as a late extra-renal complication of the disease. We aim to review the diagnostic workup of children presenting with HUS, stressing the resources available in our setting. In Portugal, O157 E. coli isolation medium is widely available in clinical laboratories. Non-O157 STEC identification requires specific testing, which is increasingly relevant as non-O157 STEC is becoming a more common cause of STEC-HUS than serogroup O157. The National Health Institute Doutor Ricardo Jorge (INSA) has the capacity to identify verotoxin genes and to proceed to verotxin-producing E. coli (VTEC) pathogenicity assessment using multiplex polymerase chain reaction. Fresh stool samples must be obtained early in the disease course to be sent for culture in O157 E. coli isolation medium and for non-O157 E. coli identification assays.