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- 313P Disease and treatment patterns for advanced cholangiocarcinoma: A multicentric study from PortugalPublication . Gonçalves, J. C. N.; Freitas, A. R. R.; Fortuna, A. R.; Menezes, M. B.; Gramaça, J.; Fernandes, I. C. Gomes; Ângelo, I. C.; Trabulo, C. F. P.; Sousa, C. Xavier de; Pina, I. M. MatosGemcitabine plus cisplatin (GC) was standard first-line treatment for advanced biliary tract cancers until recently, supported by the UK ABC-02 study. However, TOPAZ-1 showed survival improvement with Durvalumab plus GC. Nevertheless, a significant proportion of patients face challenges with GC tolerability, prompting into alternatives such as gemcitabine and carboplatin (GCb). Moreover, there remains a paucity of stratified data pertaining to cholangiocarcinomas (CCA). We analyzed 5-year trends to determine treatment rates and cisplatin use in the real world.
- Acute kidney injury after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in a Portuguese populationPublication . Carias, Eduarda; Ferreira, Hugo; Chuva, Teresa; Paiva, Ana; Maximino, JoseBackground: Acute kidney injury (AKI) after cytoreductive surgery followed by the infusion of hyperthermic intraperitoneal chemothera-py (CRS/HIPEC) is associated with a higher rate of major complica-tions, resulting in prolonged hospitalization and increased mortality. Our objective was to evaluate the incidence of AKI and further pro-gression to chronic kidney disease (CKD) in patients submitted to this procedure and recognize the associated risk factors. Methods: This retrospective study collected demographic, tumor -related, intraoperative, and postoperative data from 182 patients who underwent CRS/HIPEC from January 2016 to December 2019. Re-nal impairment was defined according to Kidney Disease Improv-ing Global Outcomes criteria for AKI. We conducted univariate and multiple logistic regression analyses to assess the association between variables of interest and AKI. Results: Twenty-three patients (12.6%) developed AKI. In the AKI group, the risk for developing CKD was six times higher (odds ra-tio (OR) 6.48, confidence interval (CI) 1.601 -26.255). Multivariate regression identified higher risk of developing AKI in patients who underwent HIPEC with cisplatin (OR 12.21, CI 1.26 -109.70, P = 0.025), in each additional day spent in the intensive care unit (ICU) (OR 2.42, CI 1.07 -5.45, P = 0.033), and an association for each unit increase in estimated glomerular filtration rate (eGFR) before HIPEC (OR 0.96, CI 0.94 -0.98, P = 0.037) and AKI development. Conclusion: Patients who are at higher risk of AKI after CRS/HIPEC include those who performed cisplatin HIPEC regimen, had poorer preoperative renal function and had longer ICU stays. Early institu-tion of preventive measures and frequent monitoring should be considered to minimize AKI risk and its associated morbidity, such as CKD progression.
- Adalimumab and number of previous biological disease-modifying antirheumatic drugs as predictive factors for the development of immune-mediated skin lesionsPublication . Martins, A.; Oliveira, D. Santos; Martins, F. R.; Nicolau, R.; Pinheiro, F. Oliveira; Rato, M.; Bernardo, A.; Pimenta, S.; Bernardes, M.; Costa, L.Treatment of inflammatory rheumatic diseases has dramatically changed with the introduction of biologic disease modifying anti-rheumatic drugs (bDMARDs). However, these drugs aren’t exempt from risks and skin lesions are the most frequent adverse reactions. Among the possible adverse skin reactions, immune-mediated skin lesions (IMSL) may occur. Risk factors associated with the occurrence of IMSL in rheumatic patients under bDMARDs are poorly known and studied.
- Age‐related structural remodelling of the coronary circulationPublication . Faria, Daniel; Lombardi, Marco; van der Hoeven, Nina; Travieso, Alejandro; Heemelaar, Julius C.; Nijjer, Sukhjinder S.; Mejía‐Rentería, Hernán; Waard, Guus A. de; Sen, Sayan; van de Hoef, Tim P.; Petraco, Ricardo; Echavarría‐Pinto, Mauro; Piek, Jan J.; Davies, Justin E.; van Royen, Niels; Escaned, JavierWhile it is broadly accepted that ageing is associated with impairment of coronary microvascular function, little is known about the underlying mechanisms.
- Anorectal melanoma: a rare entityPublication . Relvas, Luís Miguel; Gago, Tânia; Velasco, Francisco; Barros, Sónia; Carvalho, Isabel; Caldeira, PauloAnorectal melanoma is a rare malignant tumor with the potential of simulating a benign anorectal disease, making its diagnosis difficult. We describe a case of anorectal melanoma, in which the interpretation of symptoms as hemorrhoidal disease delayed diagnosis and appropriate intervention.
- Anthracyclines versus no anthracyclines in the neoadjuvant strategy for HER2+ breast cancer: real-world evidencePublication . Pinho, Inês Soares de; Luz, Paulo; Alves, Lucy; Brás, Raquel Lopes; Patel, Vanessa; Martins, Miguel Esperança; Gonçalves, Lisa; Freitas, Ritas; Simão, Diana; Roldán Galnares, Maria; Fernandes, Isabel; Criado, Silvia Artacho; Gamez Casado, Salvador; Baena Cañada, Jose; Vega, Isabel M. Saffie; Costa, João G.; Fernandes, Ana S.; Sousa, Rita Teixeira de; Costa, LuísDeescalation strategies omitting anthracyclines (AC) have been explored in early human epidermal growth factor receptor 2-positive breast cancer (HER2+ EBC), showing similar efcacy regarding pathological complete response (pCR) and long-term outcomes as AC-containing regimens. The standard treatment for this tumor subtype is based on chemotherapy and dual HER2 blockade with trastuzumab and pertuzumab, with AC-containing regimens remaining a frequent option for these patients, even in non-high-risk cases. The primary aim of this study was to assess and compare the efectiveness of neoadjuvant regimens with and without AC used in the treatment of HER2+ EBC in the clinical practice according to the pCR achieved with each.
- Anxiety and depression in patients with giant cell arteritisPublication . Martinho, Joana Martins; Ponte, André; Dourado, Eduardo; Khmelinskii, Nikita; Barreira, Sofia C.; Machado, Ana R. Cruz; Macieira, Carla; Teixeira, Vítor; Rodrigues, Ana M.; Correia, Diogo Telles; Fonseca, João E.; Ponte, CristinaObjectives To compare the prevalence of anxiety and depression in patients with GCA with that in the general population, using the Hospital Anxiety and Depression Scale (HADS), and to identify independent predictors of these psychiatric manifestations in patients with GCA.Methods We conducted a cross-sectional study including all patients diagnosed with GCA followed during 1 year in a vasculitis outpatient clinic. The HADS and 36-item Short Form (SF-36) questionnaires were prospectively collected. Patients' HADS results were compared with an age- and gender-matched control group. HADS anxiety (HADS-A) and HADS depression (HADS-D) scores between 8 and 10 defined possible anxiety and depression and >= 11 defined probable anxiety and depression, respectively.Results We included 72 patients and 288 controls. Compared with controls, patients with GCA had a statistically significant higher prevalence of HADS-A >= 8 (48.6% vs 26.4%), HADS-A >= 11 (30.6% vs 12.2%) and HADS-D >= 11 (33.3% vs 18.1%). GCA was an independent predictor of HADS-A >= 8 [odds ratio (OR) 3.3 (95% CI 1.9, 5.9)], HADS-A >= 11 [OR 3.8 (95% CI 2.0, 7.4)] and HADS-D >= 11 [OR 2.6 (95% CI 1.4, 4.7)]. Among patients with GCA, a negative correlation was observed between HADS-A/D and SF-36 mental health scores (r = -0.780 and r = -0.742, respectively). Glucocorticoid therapy was a predictor of HADS-A >= 8 [OR 10.4 (95% CI 1.2, 94.2)] and older age of HADS-D >= 8 [OR 1.2 (95% CI 1.1, 1.3)] and HADS-D >= 11 [OR 1.1 (95% CI 1.0, 1.2)].Conclusions Compared with the general population, patients with GCA have a higher prevalence of anxiety and depression and GCA is an independent predictor of these symptoms. Glucocorticoid treatment and older age are predictors of anxiety and depression, respectively, in patients with GCA. What does this mean for patients?Giant cell arteritis (GCA) is a condition that causes inflammation of the arteries, most frequently in the head and neck. It affects predominantly the elderly and can potentially lead to stroke and blindness. Both GCA-related symptoms and treatment with glucocorticoids can impact mental health. We compared the prevalence of anxiety and depression in individuals with GCA with that of the general population using the Hospital Anxiety and Depression Scale (HADS). We found that GCA was an important contributor to a higher prevalence of anxiety and depression in this group compared with the general population. We also explored which aspects contributed the most to anxiety and depression in people with GCA. We found that treatment with glucocorticoids was a predictor for anxiety and older age was a predictor for both anxiety and depression. Moreover, we described a negative correlation between anxiety/depression scores and quality of life among people with GCA, which suggests an impact of mental health on overall well-being. These findings highlight the burden of anxiety and depression in GCA, emphasizing the need for awareness and physician attention to mental health in this population in order to improve overall care and elevate the quality of life for individuals with GCA.
- Approaches for greening endoscopy and reducing wastePublication . Neves, João A Cunha; Rodríguez de Santiago, Enrique; Aabakken, LarsClimate change represents a global crisis and a major menace to the future of the environment and humanity. Notably, the healthcare sector is responsible for 4.4% of the global carbon footprint.1 Nonetheless, direct and indirect emissions from healthcare facilities contribute far less compared with healthcare supply chains (71%). Gastrointestinal (GI) endoscopy is ranked third among the highest medical waste producers within a hospital. This is related to the fact that endoscopy is a resource-intensive activity that requires various single-use, plastic predominant consumables. However, the environmental impact of GI endoscopy is yet to be adequately addressed, as we currently still face a lack of interest from most stakeholders. The fact that endoscopy has a significant impact on the global carbon footprint leads to the question: What can we do to turn GI endoscopy into a more sustainable practice?
- Ascites, pleural, and pericardial effusion in primary hypothyroidism: a rare case reportPublication . Santos, Pedro Gomes; Marques, Roberto Calças; Santos, Pedro Martins dos; Costa, Catarina Carreira da; Mogildea, MihailHypothyroidism is caused by a deficiency of thyroid hormones and is a common endocrine disorder worldwide. It can affect nearly every organ, resulting in multiple clinical manifestations. Ascites, pleural effusion, and pericardial effusion, although less frequent than peripheral edema, can also be present. These manifestations are thought to be caused by increased vascular permeability to albumin, extravasation of mucopolysaccharides, and inappropriate antidiuretic hormone secretion. Most effusions in hypothyroid patients resolve with thyroxine replacement therapy. However, due to the insidious and nonspecific nature of these symptoms, hypothyroidism is seldom considered a differential diagnosis. We report a case of a 48year-old male with pericardial effusion, pleural effusion, and ascites due to primary hypothyroidism. Although isolated effusions can be frequent in patients with hypothyroidism, the presentation of Hashimoto's thyroiditis as a combination of pericardial effusion, pleural effusion, and ascites is extremely rare. With this case report, we highlight the importance of considering hypothyroidism as a possible cause of unexplained polyserositis, even in the absence of other signs and symptoms.
- Asdas responses in patients with axial Spondyloarthritis starting bdmards: results from a multicentre prospective cohortPublication . Santos, M. E.; Ramiro, S.; van der Heijde, D.; Landewe, R.ASAS and EULAR recommend the use of an improvement ≥1.1 in ASDAS at 12 weeks to determine the continuation of a bDMARD. However, it is debated whether improvements can occur and whether patients’ characteristics influence (time to) response.