ULS_10.1-MED-Artigos
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- 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.
- 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.
- 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.
- 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.
- Assessing medication use patterns by clinical outcomes severity among inpatients with COVID-19: a retrospective drug utilization studyPublication . Ferreira-da-Silva, Renato; Maranhão, Priscila; Dias, Cláudia Camila; Alves, João Miguel; Pires, Ligia; Morato, Manuela; Polónia, Jorge Junqueira; Ribeiro-Vaz, InêsPurpose: This study assessed medication patterns for inpatients at a central hospital in Portugal and explored their relationships with clinical outcomes in COVID-19 cases. Methods: A retrospective study analyzed inpatient medication data, coded using the Anatomical Therapeutic Chemical classification system, from electronic patient records. It investigated the association between medications and clinical severity outcomes such as ICU admissions, respiratory/circulatory support needs, and hospital discharge status, including mortality (identified by ICD-10-CM/PCS codes). Multivariate analyses incorporating demographic data and comorbidities were used to adjust for potential confounders and understand the impact of medication patterns on disease progression and outcomes. Results: The analysis of 2688 hospitalized COVID-19 patients (55.3% male, average age 62.8 years) revealed a significant correlation between medication types and intensity and disease severity. Cases requiring ICU admission or ECMO support often involved blood and blood-forming organ drugs. Increased use of nervous system and genitourinary hormones was observed in nonsurvivors. Corticosteroids, like dexamethasone, were common in critically ill patients, while tocilizumab was used in ECMO cases. Medications for the alimentary tract, metabolism, and cardiovascular system, although widely prescribed, were linked to more severe cases. Invasive mechanical ventilation correlated with higher usage of systemic anti-infectives and musculoskeletal medications. Trends in co-prescribing blood-forming drugs with those for acid-related disorders, analgesics, and antibacterials were associated with intensive interventions and worse outcomes. Conclusions: The study highlights complex medication regimens in managing severe COVID-19, underscoring specific drug patterns associated with critical health outcomes. Further research is needed to explore these patterns.
- Assisted peritoneal dialysis: Position paper for the ISPDPublication . Oliver, Matthew J.; Abra, Graham; Béchade, Clémence; Brown, Edwina A.; Sanchez-Escuredo, Ana; Johnson, David W.; Guedes, Anabela Malho; Graham, Janet; Fernandes, Natalia; Jha, Vivekanand; Kabbali, Nadia; Kanjanabuch, Talerngsak; Li, Philip Kam-Tao; Lundström, Ulrika Hahn; Salenger, Page; Lobbedez, ThierryPeritoneal dialysis (PD) should be offered to every eligible individual with kidney failure who is considering maintenance dialysis. Many individuals prefer PD because it can be provided in their homes and offers them more independence than in-centre haemodialysis (HD). PD is prioritised in many regions because it has similar health outcomes and is often less costly than in-centre HD.1–3 However, a significant number of individuals with kidney failure are elderly, frail or have other physical or cognitive disabilities, which may limit their ability to perform self-care PD. Individuals may also lack family support for PD. Providing assistance may overcome these barriers, permitting more individuals to receive PD, so assisted PD is a crucial strategy that increases patient choice and provides more equitable access to home dialysis. The objectives of this review are to define the scope of assisted PD for this statement, describe major aspects of assisted PD and provide recommendations to expand its availability internationally.
- Association between COVID-19 and the incidence of type 1 diabetes in Portugal – a registry studyPublication . Andersen, Morten Bjerregaard; Silva, Jessica Da; Diogo,. Rui; Claro, Ana Raquel; Ferro, Inês; Romana, Andreia; Rocha, Patrícia; Sá, Beatriz; Lobarinhas, Goreti; Rolim, Sara; Juhl, Claus Bogh; Højlund, Kurt; Fernandes, Isabel; Antunes, Sónia; Calha, Maria Manuela Félix; Gama, Guida; Amálio, Sofia; Figueiras, Mariana; Silva, Teresa; Rosado, Margarida; Ferrão, Estela; Arez, Luísa; Baptista, Ana; Ferreira, Adriana Martins; Alba, Diana; Godinho, Carlos; Leite, Ana Luísa; Lopes, Maria de Lurdes Afonso; Sampaio, Maria Lurdes; Caetano, Joana Serra; Carvalho, EugéniaBackground: Viral respiratory infections may precipitate type 1 diabetes (T1D). A possible association between the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for COVID-19, and the incidence of T1D is being determined. This study was carried out using Portuguese registries, aiming at examining temporal trends between COVID-19 and T1D.MethodsHospital data, comparing the incidence before and during the COVID-19 pandemic, from children and young adults diagnosed with new-onset T1D, was acquired beginning in 2017 and until the end of 2022. Data was obtained from nine different Portuguese hospital units. The impact of the COVID-19 pandemic, beginning in March 2020, was assessed comparing the annual numbers of new-onset T1D cases. The annual median levels of glucose, glycated hemoglobin (HbA1c) and fasting C-peptide at T1D diagnosis were compared. The annual number of diabetic ketoacidosis (DKA) episodes among new T1D cases was also assessed at two centers.ResultsIn total, data from 574 newly diagnosed T1D patients was analyzed, including 530 (92.3%) children. The mean ages for child and adult patients were 9.1 (SD 4.4) and 32.8 (SD 13.6) years, respectively. 57.8% (331/573) were male, one patient had unknown sex. The overall median (25-75 percentiles) levels of glucose, HbA1c and fasting C-peptide at diagnosis were 454 mg/dL (356-568), 11.8% (10.1-13.4) and 0.50 mu g/L (0.30-0.79), respectively. DKA at T1D diagnosis was present in 48.4% (76/157). For eight centers with complete 2018 to 2021 data (all calendar months), no overall significant increase in T1D cases was observed during the COVID-19 pandemic, i.e. 90 cases in 2018, 90 cases in 2019, 112 in 2020 and 100 in 2021 (P for trend = 0.36). Two of the centers, Faro (CHUA) and Dona Estef & acirc;nia (CHULC) hospitals, did however see an increase in T1D from 2019 to 2020. No significant changes in glucose (P = 0.32), HbA1c (P = 0.68), fasting C-peptide (P = 0.20) or DKA frequency (P = 0.68) at the time of T1D diagnosis were observed over the entire study period.ConclusionThe T1D incidence did not increase significantly, when comparing the years before and during the COVID-19 pandemic, nor did key metabolic parameters or number of DKA episodes change.
- Bladder perforation in the elderly: unraveling the diagnostic challenges with magnetic resonance imagingPublication . Silva, Frederico; Lopes, Mari Angela; Valente, Dilia; Simões, Inês G.; Arez, LuísaBladder perforation, a significant urological emergency, presents a diagnostic challenge due to its diverse etiologies and varying clinical manifestations. This paper discusses a rare case of bladder perforation in an 87-year-old woman with a history of hypertension and previous stomach and uterine cancer. The patient was admitted with a urinary tract infection and subsequently experienced mild abdominal discomfort and reduced urinary output, prompting further investigation. Imaging studies revealed bladder wall thickening and ureterohydronephrosis, raising suspicion of a bladder tumor. Intriguingly, a catheter-related bladder perforation was identified through MRI. This case emphasizes the importance of considering bladder perforation as a potential complication, especially in elderly patients with indwelling catheters. Clinicians must maintain a high index of suspicion and employ appropriate diagnostic modalities to ensure timely recognition and suitable management of this rare condition.
- Bradiarritmias: abordagem em contexto pré e intra-hospitalarPublication . Costa, Hugo; Azevedo, Pedro; Carvalho, Daniela; Candeias, Rui; Jesus, IlidioAs bradiarritmias são eventos arrítmicos frequentes em contexto urgente e emergente. A sua frequência aumenta com a idade devido à evolução degenerativa do sistema de condução cardíaco, embora também possam ser encontradas em idades jovens e atletas treinados. A doença sinoauricular e os bloqueios auriculoventriculares são os mecanismos fisiopatológicos mais comuns no que diz respeito aos distúrbios da condução. Uma correta investigação é essencial na identificação etiológica (intrínseca ou extrínseca ao tecido cardíaco) bem como na forma de instalação e no caráter de reversibilidade. As causas reversíveis devem ser prontamente corrigidas e são essenciais na estabilização do doente. Na presença de bradicardia, a apresentação clínica deve guiar a abordagem inicial, assim como a existência de sinais de gravidade no electrocardiograma. A terapêutica farmacológica e o pacing transcutâneo são medidas/atitudes intermédias de suporte hemodinâmico como ponte para intervenções especializadas. Assim, uma correta avaliação e rápida abordagem em ambiente pré-hospitalar ou hospitalar possibilita a estabilização do doente e posterior encaminhamento para estudo dirigido.