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Percorrer IV. Entidades Cooperantes por Objetivos de Desenvolvimento Sustentável (ODS) "03:Saúde de Qualidade"
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- Assessing the role of CT imaging in identifying candidates for neoadjuvant chemotherapy in right colon cancer: a critical analysisPublication . Lopes, João Leão; Soares, Ana Sofia S.; Mendes, Beatriz; Tomada, Elisa Paoluzzi; Cunha, Miguel F.; Melina Fernandez, Laura; Amorim, Edgar; Azevedo, José; Parvaiz, AmjadBackground and purpose Standard treatment for localized right colon cancer is radical surgery, followed by adjuvant chemotherapy for stage III or intermediate MSS and high-risk stage II tumours. Recent studies suggest a benefit from neoadjuvant chemotherapy (NAC), particularly for T4b and/or N+tumours. Patient selection for NAC relies on CT-based clinical staging, but the accuracy of CT in detecting high-risk features is variable, raising concerns about potential overtreatment. The study aims to demonstrate the accuracy of CT staging of the right colon with the purpose of indicating neoadjuvant CT. Methods Patients undergoing curative right hemicolectomy between 2013 and 2023 at two Portuguese institutions were included. All had preoperative CT; those receiving NAC were excluded. Sensitivity, specificity, positive predictive value, and negative predictive value of CT in identifying T4b and N+tumours were calculated by comparing clinical (cTNM) and pathological (pTNM) staging. Results Among 165 patients (48% male, mean age 70.5 years), CT showed low sensitivity (26%) but high specificity (91%) for pT4b tumours, with a tendency toward understaging. For nodal disease, sensitivity was 87% and specificity 41%. Only 57% of cT4b and/or cN+cases confirmed at least one unfavorable pathological factor, implying potential overtreatment in 43% of patients if NAC were applied solely based on CT findings. Conclusion CT remains the standard for clinical staging but demonstrates limited accuracy in identifying high-risk right colon cancers. NAC decisions should integrate additional criteria beyond CT findings to avoid overtreatment.
- Cold agglutinin syndrome in a patient with metastatic breast cancer: a Case reportPublication . Bandarra, Daniel; Rochate, Dina; Gosalbez, Beatriz; Ferreira, José; Cunha, Nidia Maltez; Carvalhal, SaraBackground: Cold agglutinin syndrome (CAS) is a form of autoimmune hemolytic anemia (AIHA), most often associated with lymphoproliferative disorders or infections. Its occurrence in breast cancer is rare and may be triggered by systemic treatment. Case presentation: We report the case of a woman in their fifties diagnosed with breast cancer in 2019. She underwent surgery followed by adjuvant chemotherapy and radiotherapy and subsequently received 3 years of endocrine therapy before developing bone and hepatic metastases. First-line treatment with ribociclib plus letrozole achieved partial response, and fulvestrant was administered at progression. Following further progression, paclitaxel was introduced as third-line metastatic therapy. After four weekly administrations, the patient was admitted to our hospital with severe anemia and diagnosed with CAS. Prompt management and a multidisciplinary approach resulted in partial hematological recovery. Nevertheless, paclitaxel was permanently discontinued, and subsequent therapies provided only transient benefit. The disease continued to progress, her performance status declined, and she ultimately transitioned to exclusive palliative care until death. Conclusion: This case illustrates a rare and severe immune complication of paclitaxel in metastatic breast cancer. The emergence of CAS not only limited systemic options but also reshaped the therapeutic trajectory, highlighting the need for close monitoring during cancer treatments. Early recognition, multidisciplinary approach, and prompt management can provide some improvement, although overall prognosis remains determined by the underlying malignancy.
- Description of the Hamburg Alexander Leukodystrophy Cohort—Insights into Practical Classification and the Care SituationPublication . Kokaly, Nadia; Guerreiro, Helena; Bredow, Janna; Dreha-Kulaczewski, Steffi; Ohlenbusch, Andreas; Köhler, Wolfgang; Reinhardt, Tabea; Schön, Gerhard; Volk, Alexander E.; Sigel, Helen; Bley, AnnetteBackground: Alexander disease (AxD) is a rare severe leukodystrophy that has no cure to date. A pathogenic gain-of-function variant in the GFAP gene affects the astrocytes and subsequently the function of the white matter in the CNS. Methods: We retrospectively analyzed the most frequent symptoms of nine AxD cases, classified them according to published classifications, and described the need of care and support. Results: The description of the courses of disease of nine cases with AxD reflects the broad spectrum of different phenotypes of AxD, with often occurring apnoea. Data about care and support for AxD patients indicate a high and heterogeneous need of support. Treatment with steroids reduced symptoms in two patients. Some patients showed lasting improvement during their course of disease. Conclusions: The course of AxD is very heterogeneous. Thus, we extracted relevant key features to describe the severity of the disease, namely feeding problems, epilepsy, age-appropriate motor function, failure to thrive, age-appropriate language and apnoea. We recommend early evaluation for clinical care and support. For some AxD patients, treatment with steroids may alleviate symptoms. Further development of efficient treatments is necessary
- Frailty and outcomes in elderly ICU patients: insights from a portuguese cohortPublication . Lourenço, Eva; Rodrigues, Isabel; Sampaio, Mário; da Costa, EmiliaBackground: Frailty is a key determinant of outcomes in critically ill elderly patients, but data from Portugal remain limited. To our knowledge, this is the first study to examine the prevalence and prognostic impact of frailty among elderly ICU patients in a Portuguese hospital setting. Objective: To determine the prevalence of frailty among elderly patients admitted to an intensive care unit (ICU) in southern Portugal and to examine its crude associations with illness severity, organ support, and mortality outcomes. Methods: We conducted a retrospective cohort study including 125 patients aged ≥ 65 years admitted to the polyvalent ICU of Hospital de Faro over the last six months of 2024. Data included demographics, comorbidities, Charlson Comorbidity Index (CCI), severity scores (SOFA, SAPS II, APACHE II), and frailty status assessed by the Clinical Frailty Scale (CFS). Outcomes were the need for organ support, ICU and hospital mortality, and length of stay. Results: Frailty (CFS ≥ 5) was identified in 30.4% of patients. Frail patients were older, had higher comorbidity burden (CCI), and presented with significantly higher severity scores at admission. They also required more invasive support, including vasopressors and invasive mechanical ventilation, while acute kidney injury (AKI) requiring renal replacement therapy (RRT) was similar between groups. ICU mortality was significantly higher among frail patients (50.0% vs. 31.0%), as was hospital mortality (76.3% vs. 33.3%). Length of ICU stay did not differ, although frail patients tended to have longer hospitalizations overall. Conclusions: Frailty was highly prevalent and strongly associated with increased severity, greater need for organ support, and higher mortality. Routine frailty assessment at ICU admission may enhance prognostic accuracy and support patient-centered decision-making.
- Functional respiratory re-education interventions in people with respiratory disease: a systematic literature reviewPublication . Dias, Pedro Miguel Martins; Teixeira, Helena Margarida dos Santos; Palma, Magali Cavaco; Messias, Patrícia Alexandra Lopes; Vieira, João Vítor da Silva; Ferreira, Rogério Manuel FerrinhoObjectives: to identify nursing interventions in rehabilitation, within the scope of functional respiratory reeducation, which allow a respiratory function improvement in people with respiratory disease. Methods: systematic literature review using the MEDLINE database search, adopting the PICO mnemonic and the Joanna Briggs Institute’s assessment of the level of evidence and methodological quality. The search for randomized controlled trials was carried out in June 2021 considering the period from 2015 to 2020, in English or Portuguese. Results: a sample of nine randomized controlled trials with methodological quality was obtained which highlighted the use of positive expiratory pressure devices as an important component and intervention for respiratory functional reeducation. Conclusions: nursing interventions in rehabilitation with an emphasis on functional respiratory reeducation are essential, showing improvements in people’s general health.
- Home mechanical ventilation in adults: clinical practice recommendations from the Portuguese respiratory society home mechanical ventilation assemblyPublication . Ribeiro, Carla; Gomes, Rita; Carreiro, Alexandra; Vieira, Ana Luísa; Seabra, Bárbara; Conde, Bebiana; Nogueira, Carla; Jácome, Cristina; Lages, Joana; Aguiar, Margarida; Grafino, Mónica; Pamplona, Paula; Cysneiros, Ana; Durães, Célia; Rodrigues, Cidália; Pimenta, Cidália; Cristóvão, Cristina; Rodrigues, Daniela; Ferreira, Diva; Gonçalves, Filipe; helena Chaves Ramos; Cravo, João; Silva, João Paulo; da Silva Cunha Granatin, Karl Jonathan; Méndez, Lucía; Zeller, Mafalda Van; Araújo, Márcia; Barata, Margarida; Raposo, Margarida; Redondo, Margarida; Jacob, Maria; Araújo, Maria João; Gonçalves, Miguel R.; Guia, Miguel; Faria, Nuno; Viegas, Pedro; Conde, Sara; Drummond, Marta; Pinto, PaulaBackground: The use of home mechanical ventilation (HMV) has been increasing worldwide, driven by widening of clinical applications and improved patient survival rates. In Portugal, recent data indicate an even faster growth, although national HMV recommendations have remained unchanged for 25 years. Research question: We aimed to provide an update in clinical practice guidelines for HMV in adults, applicable to the Portuguese context, grounded on the latest available evidence and experts' opinion. Study design and methods: A multidisciplinary panel with experience in HMV in the adult population was assembled. A comprehensive literature search was conducted during March 2023 regarding specific topics: equipment, ventilatory modes and interfaces, HMV initiation, follow-up and monitoring, disease specificities (neuromuscular diseases, obesity-hypoventilation syndrome, restrictive chest wall diseases; chronic obstructive pulmonary disease, and other diseases), home mechanical invasive ventilation, and palliative and end of life care. A 2-round Delphi process was conducted to establish consensus among panel members. A minimum agreement threshold of 80% was required. Results: Out of 88 recommendations initially included in the Delphi process, 61 were selected by consensus. Conclusion: Final recommendations grounded in the current level of evidence are outlined, and the key limitations and proposals for future research are discussed.
- Impact of bariatric and metabolic surgery on sarcopenia-related parameters according to the EWGSOP2 consensus criteria in persons living with obesityPublication . Cardoso, Paulo Alexandre e Castro; Santos, Tânia V.; Ramon-Krauel, Marta; Pais, Sandra; De Sousa-Coelho, Ana LuísaAlthough bariatric and metabolic surgery (BS) has proved effective in the treatment of obesity based on the reduction in fat mass and the remission of comorbidities, there is also loss of lean mass after BS which could compromise muscle functionality. According to the European Working Group on Sarcopenia in Older People (EWGSOP), sarcopenia is a disease associated with loss of muscle mass, strength, and function. Through a comprehensive review of the literature, we identified a range of studies focusing on evaluating sarcopenia-related parameters according to the EWGSOP2 consensus criteria, before and after BS. Although most studies reported reductions in skeletal muscle mass and absolute muscle strength after surgery, improvements in muscle functionality were generally achieved, independent of the type of BS.
- The influence of subclinical active inflammation on IFX pharmacokinetic modeling and disease progression assessment: findings from a prospective real-world study in inflammatory bowel disease patientsPublication . Magro, Fernando; Fernandes, Samuel; Patita, Marta; Arroja, Bruno; Lago, Paula; Rosa, Isadora; Sousa, Helena Tavares; Ministro, Paula; Mocanu, Irina; Vieira, Ana; Castela, Joana; Moleiro, Joana; Roseira, Joana; Cancela, Eugénia; Sousa, Paula; Portela, Francisco; Correia, Luís; Moreira, Paula; Dias, Sandra; Afonso, Joana; Danese, Silvio; Peyrin-Biroulet, Laurent; Vucicevic, Katarina M; Santiago, MafaldaBackground and aims: Effective management of inflammatory bowel disease (IBD) relies on a comprehensive understanding of infliximab (IFX) pharmacokinetics (PK). This study’s primary goal was to develop a robust PK model, identifying key covariates influencing IFX clearance (CL), while concurrently evaluating the risk of disease progression during the maintenance phase of IBD treatment. Methods: The multicenter, prospective, real-world DIRECT study was conducted in several care centers, which included 369 IBD patients in the maintenance phase of IFX therapy. A two-compartment population PK model was used to determine IFX CL and covariates. Logistic and Cox regressions were applied to elucidate the associations between disease progression and covariates embedded in the PK model. Results: The PK model included the contributions of weight, albumin, antidrug antibody (ADA), and fecal calprotectin (FC). On average, higher ADA, FC concentration and weight, and lower albumin concentration resulted in higher IFX CL. In the multivariate regression analyses, FC levels influenced the odds of disease progression in the majority of its definitions, when adjusted for several confounding factors. Additionally, alongside FC, both IFX and CL demonstrated a significant impact on the temporal aspect of disease progression. Conclusion: In this 2-year real-world study, readily available clinical covariates, notably FC, significantly impacted IFX availability in IBD patients. We demonstrated that subclinical active inflammation, as mirrored by FC or CRP, substantially influenced IFX clearance. Importantly, FC emerged as a pivotal determinant, not only of IFX pharmacokinetics but also of disease progression. These findings underscore the need to integrate FC into forthcoming IFX pharmacokinetic models, amplifying its clinical significance.
- Metabolism and the impact of protein intake in chronic critically ill adult patients: protocol for a unicentric prospective cohort study (MetaChronic Study)Publication . Castro, Sílvia; Granja, Cristina; Dionne, Joanna C.; Pires, Teresa; Oliveira, Carolina; Binnie, AlexandraBackground: Survival of acutely critically ill patients has improved, resulting in a growing population of chronic critically ill (CCI) patients with prolonged organ dysfunction, mechanical ventilation, and high morbidity. While nutritional guidelines during the acute phase of critical illness are well defined, our understanding of metabolism and nutritional needs in CCI patients is limited. Persistent inflammation may influence the metabolic response and nutritional uptake, highlighting the need for prospective studies in this area. Methods: The MetaChronic Study is a single-center, prospective cohort study of metabolism in patients with CCI. Adult ICU patients with invasive mechanical ventilation ≥48 h and ICU stay >7 days are eligible. Patients are followed for up to 42 days after ICU admission, with final outcomes assessed at 90 days. Resting energy expenditure is measured weekly by serial indirect calorimetry. Weekly protein and calorie intake are recorded and inflammation is assessed using serum C-reactive protein and procalcitonin measurements. Patients are categorized according to high or low protein intake (>1.3 g/kg/ day vs. ≤1.3 g/kg/day after the first week). The primary objective is to characterize longitudinal metabolic trajectories. Secondary objectives include subgroup analyses (septic, trauma, neurocritical patients), assessment of the interaction between inflammation and metabolic rate, and exploratory analyses of the association between protein intake and clinical outcomes. Ethics and dissemination: The study has been approved by the institutional ethics committee. Findings will be disseminated through peer-reviewed journals and scientific conferences.
- Minimally invasive surgery for inflammatory Bowel Disease: a systematic review and meta-analysis of robotic versus laparoscopic surgical techniquesPublication . Cunha, Miguel F.; Roseira, JoanaWe read with great interest the article ‘Minimally invasive surgery for inflammatory bowel disease: a systematic review and meta-analysis of robotic versus laparoscopic surgical techniques’, recently published in the Journal of Crohn’s and Colitis. 1 Zaman and colleagues performed the first comprehensive systematic review and meta-analysis to examine the outcomes of robotic versus conventional laparoscopic colorectal resections in patients with inflammatory bowel disease [IBD], focusing on the comparative effectiveness, safety pro files, and surgical performance metrics of these two minimally invasive approaches.