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Percorrer IV. Entidades Cooperantes por Objetivos de Desenvolvimento Sustentável (ODS) "10:Reduzir as Desigualdades"
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- Assessment of European health professionals’ educational needs in basic principles of geriatric medicine: a focus group qualitative analysis from the PROGRAMMING COST Action 21122Publication . Frost, Rachael; Viegas, Ana; Tsamasiotis, Georgios-Konstantinos; Gugu, Mitilda; Mougakou, Efterpi; Savas, Sumru; Kupis, Robert; Piotrowicz, Karolina; Arranhado, Susana Ganhão; Farinha, Ana; Herghelegiu, Anna Marie; Bajenaru, Ovidiu Lucian; Nuta, Catalina Raluca; Fonseca, João; Rudzińska, Anna; Popov, Vesna; Milosavljevikj, Pavlinka; Sakellari, Vasiliki; Yilmaz, Nilufer Demiral; Przybył, Helena Lesz; Prada, Ana Gabriela; Tampaki, Maria; Pérez, Laura M.; Martín, Yolanda Barrado; Avgerinou, Christina; Hadziabdic, Maja Ortner; Christakou, Anna; Moumtzi, Eleni; Arsov, Stefan; Rodeles, Santiago Cotobal; Kravvariti, Evrydiki; Kotsani, Marina; Yellon, TamarPurposeIn many countries, geriatrics is still emerging as a speciality, with limited training options for healthcare professionals (HCPs). This international qualitative study aimed to explore the geriatric educational needs of HCPs, focussing on countries where geriatric medicine (GM) is emerging or underdeveloped.MethodsFourteen focus groups (n = 125 participants, 82% female, mean age 41.6 years) were carried out representing ten European countries and a range of HCPs and settings. Focus group discussions were recorded, transcribed verbatim, and inductively coded in the original language. Codes were aggregated into a shared English codebook applied to all transcripts. Descriptive and subsequently analytical themes were then developed.ResultsThree themes were identified. (1) Current experiences of geriatric care: participants described caring for older adults as medically and socially complex, requiring strong communication skills and interprofessional collaboration. (2) Structural and contextual challenges: limited staffing, fragmented care pathways, and GM's emerging status hindered effective care delivery. (3) Uncertainties and unmet training needs: key uncertainties included distinguishing ageing from disease, applying assessment tools, recognising red flags, and safe medication management. Participants emphasised the need for practical training during undergraduate studies, standardised interprofessional courses for non-specialists, and structural support (e.g. accessible programmes, protected time for training).ConclusionCurrently, geriatrics training is limited and there are multiple contextual challenges, especially in countries with emerging GM. There is significant unmet need for HCP basic training in GM. Our study contributes to an empirical basis for developing relevant and feasible GM training for HCPs. Structural support is needed for these initiatives.
- 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.
- Is fluoroscopy necessary for oesophageal SEMS placement? A retrospective cohort studyPublication . Relvas, Luís Miguel; Gago, Tânia; Barros, Sónia; Carvalho, Isabel; Portugal, Margarida; Velasco, Francisco; Caldeira, Paulo; Peixe, BrunoIntroduction: self-expanding metal stents (SEMS) are widely used for the palliation of malignant esophageal conditions, including strictures, fistulas, and extrinsic compression. Placement may be guided by fluoroscopy, direct endoscopy, or both. However, few studies have directly compared the outcomes of these techniques. Objective: to compare the safety and efficacy of SEMS placement under endoscopic versus fluoroscopic control in a real-world clinical setting. Methods: we conducted a retrospective observational study of adult patients who underwent esophageal SEMS placement between January 2011 and December 2023. Patients were assigned to either the endoscopic control (EC) or fluoroscopic control (FC) group based on fluoroscopy availability. Outcomes included technical success, complication rates (early and late), and overall survival. Results: a total of 103 patients were included (mean age 69.4 years; 79 % male), with 43 receiving SEMS under EC and 60 under FC. The primary indication was malignant esophageal stricture (91.3 %). Technical success was achieved in 97 % of EC cases and 100 % of FC cases. Early complications occurred in 53 % of EC and 49 % of FC patients (p = 0.70), including chest pain (40.7 %), vomiting (22.3 %), and stent migration (5.8 %). Late complications occurred in 28 % of EC and 31 % of FC cases (p = 0.74), most commonly tumor overgrowth (14.6 %) and stent migration (10.7 %). Thirty-day mortality was 2.3 % in the EC group and 0 % in the FC group (p = 0.31). Median survival was 102 days (EC) versus 113 days (FC) (p = 0.44). Conclusions: SEMS placement under both endoscopic and fluoroscopic control is safe and effective, with no significant differences in complication rates, technical success, or survival. Endoscopic guidance may be a viable alternative to fluoroscopy in experienced hands, particularly in resource-limited settings.
- Lipid-lowering therapy and LDL cholesterol control among high- and very high-risk patients in Portugal: An analysis of the SANTORINI studyPublication . Aguiar, Carlos; Aguiar, Patrício; Duarte, João Sequeira; Gil, Victor; Mimoso, Jorge; Monteiro, Pedro; Pinto, Fausto J.; Pinto, Fernando; Raposo, João; von Hafe, Pedro; Ruivo, Jorge A.; Teixeira, Carla; Catapano, Alberico L.; Ray, Kausik K.Introduction and objectives: The SANTORINI study is the first large-scale, European observational study conducted following the release of the 2019 European Society of Cardiology/European Atherosclerosis Society ESC/EAS guidelines on dyslipidemia management. This analysis aims to assess lipid-lowering therapy (LLT) use and low-density lipoprotein cholesterol (LDL-C) goal attainment in patients at high or very high cardiovascular (CV) risk enrolled in Portugal. Methods: In Portugal, 117 patients were enrolled across 10 sites between September 2020 and February 2021. Paired LDL-C values at baseline and one-year follow-up were available for 102 patients. LDL-C levels, LLT utilization patterns, and LDL-C goal attainment (as per the 2019 ESC/EAS guidelines) were assessed at both time points and compared with the broader European cohort, excluding Portuguese participants. Results: Over the one-year follow-up, the use of statin monotherapy decreased from 49.5% to 45.2%, while combination therapy with statin and ezetimibe increased from 35.9% to 40.9%. LLT intensity was escalated in 12.8% of patients, unchanged in 79.5%, and de-escalated in 6.0%. Mean LDL-C levels were similar between baseline and one-year follow-up: corresponding values were 90.2 mg/dL and 90.1 mg/dL in high-risk patients, and 74.1 mg/dL and 75.2 mg/dL in very high-risk patients. LDL-C goal attainment declined from 34.1% to 22.7% in high-risk patients and 27.6% to 22.4% in very high-risk patients. Conclusions: The Portuguese cohort of the SANTORINI study demonstrates both encouraging developments and ongoing challenges in the real-world management of dyslipidemia following the 2019 ESC/EAS guidelines. Reasons for lack of LLT intensification and factors underlying worsening rates for LDL-C goal attainment should be explored. (c) 2025 Sociedade Portuguesa de Cardiologia. Published by Elsevier Espana, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
- P0397 Soluble transferrin receptor as a reliable inflammation-independent marker of iron deficiency in crohn’s disease and ulcerative colitisPublication . Portela, F.; Santos, M. P. Ministro dos; Sousa, Helena Tavares; Roseira, Joana; Fernandes, S. R.; Crespo, R.; Domingues, B.; Santiago, M.; Miranda, R.; Dias, S.; Dias, C. C.; Magro, F.Background: Iron deficiency is a common complication in inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn’s disease (CD).1 However, standard iron markers are influenced by inflammation, complicating the diagnosis of true iron deficiency.1,2 Soluble transferrin receptor (sTfR) has been proposed as a more reliable, inflammation-independent marker of iron demand.3 This study aimed to assess the utility of sTfR in identifying iron deficiency without anaemia (IDWA). Methods: The ID_IBD study was a multicentre, cross-sectional study. Iron status was classified using two approaches: the ECCO consensus definition, focusing on ferritin thresholds adjusted for inflammatory markers (C-reactive protein [CRP] and faecal calprotectin [FCAL]), and a stricter definition that adds transferrin saturation to the ECCO criteria. sTfR levels were compared across groups, and ROC curve analysis was used to identify optimal diagnostic cut-offs. Results: This analysis included 411 IBD patients (130 UC, 281CD) and 178 controls. sTfR showed no correlation with CRP or FCAL. In UC, patients with IDWA had significantly higher sTfR levels (median 1.20mg/L, IQR 1.02-1.42) compared to non-IDWA patients (median 1.05mg/L, IQR 0.92-1.22; p=0.013). Anaemic UC patients also showed elevated sTfR levels (median 1.27mg/L, IQR 1.14-1.59) compared to non-IDWA individuals (patients but was significantly higher in anaemic patients (p=0.003). Conclusion: sTfR appears to be an inflammation-independent marker of iron status in IBD. It showed potential for identifying IDWA in UC, while in CD it mainly reflected increased iron demand in anaemia. Further longitudinal studies are warranted to validate its role and assess its clinical utility in IBD.
- Sarcopenia in women with anorectal dysfunctions—a female sarcopelvic studyPublication . Vieira, Ana Margarida Duarte da Silva; Pais, Sandra; Martins, Viviana; Castelo, Barbara; Saraiva, Miguel MascarenhasAnorectal dysfunctions (ARDs) include fecal incontinence (FI) and functional defecation disorders (FDDs). The pelvic floor muscles play a central role in the physiology of continence and defecation. We aimed to investigate the prevalence of sarcopenia in a female group with anorectal dysfunctions and compare them with a healthy female age-matched group. As secondary objectives, the relationship between anorectal dysfunction outcomes and sarcopenia was analyzed. Methods: We conducted a single-center cross-sectional, interventional, controlled, and double-blind study involving female adults admitted to an ARD outpatient clinic assessed for FI and/or FDD. A control group was also included of age-matched women without ARD. Sarcopenia was evaluated in the entire cohort, according to the latest criteria. Statistical analysis was performed using SPSS software v.29, considering a confidence interval of 95%. Results: A total of 130 participants were included, equally divided by the two groups. The median age was 64 years. Both groups were also similar regarding body mass index (BMI), physical activity index values, and dietary patterns. Among the 130 investigated women, there were no cases of confirmed sarcopenia or severe sarcopenia, but 15 women (11.5%) had probable sarcopenia or dynapenia. The case group had significantly more probable sarcopenia than women in the control group (14 (21.5%) vs. 1 (1.5%), p < 0.001). The presence of relevant comorbidities, such as irritable bowel syndrome (IBS), urinary incontinence (UI), and meat dietary pattern (MDP), was a risk factor for probable sarcopenia. The binomial logistic regression analysis showed that probable sarcopenia (OR 3.9; CI 1.1–14.1, p = 0.039) was associated with a worse treatment response. Conclusions: Probable sarcopenia or dynapenia was significantly more prevalent in women with ARD and was a predictive factor of a worse treatment response, regardless of the ARD severity. Concomitant UI, MDP, IBS, and psychiatric conditions were significantly associated with dynapenia. The inclusion of the evaluation of sarcopenia in these patients should be considered.