ULS_10.1-MED-Artigos
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- 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.
- 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.
- 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/).
- Adjuvant ovarian function suppression and aromatase inhibitors in premenopausal patients with hormone receptor and HER2 positive breast cancer, by timing of chemotherapy and trastuzumab and response to neoadjuvant therapyPublication . Shai, Ayelet; Wildiers, Hans; Venieri, Claudio; Pogoda, Katarzyna; Linderholm, Barbro; Lambertini, Matteo; Matos, Leonor; D'Esposito, Eleonora De Maio; Hajjaji, Nawale; Matos, Erika; Cortijo, Lucía González; Fotia, Giuseppe; Fortuna, Ana; Sella, Tal; Gouveia, Helena; Rosset, Laurent; Constantinidou, Anastasia; Angeli, Eurydice; Cicin, Irfan; Tjan-Heijnen, Vivianne; Ruyssers, Natacha; Demasure, Sofie; Remilah, Areen Abu; Huygh, Greet; Shimon, Shani Paluch; Chiappe, Edoardo; Shirron, Natali; Neven, Patrick; Artac, Mehmet; Kilictas, Bilgesah; Baranseh, Jalal; Rubio, Elena Vicente; Atci, Mustafa; Amato, Ottavia; van Duijnhoven, FrederiekeBackground: The benefit of adjuvant ovarian function suppression (OFS) and aromatase inhibitors (AI) in premenopausal patients with hormone receptor positive, HER2 positive (HR+/HER2+) breast cancer (BC) is unclear. We aimed to investigate this question in a retrospective cohort, stratified by timing (adjuvant or neoadjuvant) of chemotherapy and trastuzumab and by response to neoadjuvant therapy. Methods: Patients aged <45Y at diagnosis, with stage I-III HR + HER2+ BC, treated with (neo)adjuvant chemotherapy and trastuzumab ( +/- pertuzumab) and endocrine therapy were included. LHRH-agonists and oophorectomy were considered OFS. We compared distant disease-free survival (DDFS) with tamoxifen, OFS + tamoxifen and OFS + AI in three cohorts: neoadjuvant-pathologic complete response (pCR), neoadjuvantresidual disease (RD) and adjuvant. Endocrine therapy (ET) was modeled as a time dependent covariate in cox logistic regression analyses. Results: The study included 1124 patients with median follow-up of 72.6 months (range:0-205 months). DDFS rates at 5 years were 83.9 %, 86.8 % and 92.1 % with tamoxifen, OFS + tamoxifen and OFS + AI respectively in the RD group, 94.3 %, 97.6 % and 96.5 % in the pCR group, and 94.3 %, 93.4 % and 98.6 % in the adjuvant group. OFS + AI was associated with better DDFS compared to tamoxifen in the RD group (n = 366) (multi-variable weighted HR 0.28. 95 % CI 0.11-.069, p = 0.006), but associations of ET with DDFS in the pCR (n = 307, p = 0.59) and adjuvant (n = 451, p = 0.18) cohorts were not detected. Stage III was associated with worse DDFS in all groups. Conclusion: OFS + AI were associated with better DDFS in patients with RD after neoadjuvant therapy. Our findings can assist shared decision-making on adjuvant endocrine therapy of these patients.
- 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.
- 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.
- Serum biomarkers of extracellular matrix remodeling in ulcerative colitis—one step closer to fibrosis biomarkers in inflammatory bowel diseasePublication . Sousa, Helena Tavares; de Oliveira, RaquelFibrosis is a serious complication of both Crohn's disease (CD) and ulcerative colitis(UC) and is currently the major unmet need in inflammatory bowel disease (IBD) management [1]. Although much less prevalent in UC, strong evidence supports severity and chronicity of inflammation are the main drivers of excessive extracellular matrix (ECM) deposition in the submucosa and muscularis mucosae [2], leading to increased wall stiffness, and ultimately to motility and anorectal dysfunction, rectal urgency and incontinence.
- Prevalence and diagnostic comparison of helicobacter pylori and non-helicobacter pylori helicobacter infections in patients undergoing upper gastrointestinal endoscopy with gastric biopsy in Algarve, PortugalPublication . Mateus, Teresa Letra; Aguieiras, Catarina; Louro, Ricardo; Peixe, Bruno; Calhindro, Mauro; Nunes, Francisco José Viegas Cortez; Queirós, Patrícia; Castelo-Branco, PedroH. pylori infects over half of the global population and is associated with various gastric and extra-gastric diseases. Other species, such as zoonotic non-Helicobacter pylori Helicobacters (NHPHs), have shown similar associations with gastritis and MALT lymphoma and H. pylori-negative cases with gastric disease have been identified, including gastric MALT lymphoma, chronic gastritis, and gastroduodenal ulcers. Accurate identification of these species is of great relevance but remains challenging using conventional diagnostic methods. This cross-sectional study aimed to determine the prevalence of H. pylori and NHPH infections, comparing standard histological protocols with molecular techniques. Between December 2024 and February 2025, 54 adult patients undergoing upper gastrointestinal endoscopy (UGE) with gastric biopsy in three hospitals in Algarve, Portugal were recruited. Endoscopic assessment was performed, and gastric biopsies were collected for histological and molecular analysis. DNA was extracted from antral biopsies and analyzed by conventional PCR to detect H. pylori and NHPH. H. pylori diagnostic techniques were compared, descriptive plus statistical analysis was performed, and p-values < 0.05 were considered to be statistically significant. Fifty-four patients were included in the study, with 51.9% of them presenting symptoms. Endoscopic gastritis was observed in 66.7% of patients, while histological gastritis was present in 88.9%, with statistically significant differences between the two diagnostic techniques (p = 0.004). Helicobacter spp. were identified in 44.4% (24/54) of the patients. H. pylori was detected in 42.6% of the patients by Modified Giemsa stain and in 33.3% by PCR. H. bizzozeronii was found in 35.9% of the patients, with 22.2% showing mixed infections. This study reveals a significant prevalence of Helicobacter spp. in patients from the Algarve region, with both H. pylori and zoonotic H. bizzozeronii detected. This is the first report of H. bizzozeronii DNA detection in gastric biopsies via PCR from patients undergoing UGE in Portugal, highlighting the need to consider NHPH in clinical diagnosis. It is important to include molecular methods in routine diagnostics and the need for broader studies to assess regional and national trends in Helicobacter infections besides H. pylori.
- 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.
- Pretreatment antithrombotic strategies in non-ST elevation acute coronary syndromes in contemporaneous clinical practicePublication . Costa, Hugo; Espírito-Santo, Miguel; Fernandes, Raquel; Bispo, João; Guedes, João; Azevedo, Pedro; Carvalho Silva, Daniela; Vinhas, Hugo; Gonçalves, Rui Baptista; Mimoso, JorgeBACKGROUND Pretreatment antithrombotic strategies in non-ST elevation acute coronary syndromes (NSTE-ACS) during hospitalization is still a matter of contention within the cardiology community. Our aim was to analyze in-hospital and one-year follow-up outcomes of patients with NSTE-ACS pretreated with dual antiplatelet therapy (DAPT) versus single antiplatelet therapy (SAPT). METHODS A retrospective study was carried out with NSTE-ACS patients who planned to undergo an invasive strategy and were included in the Portuguese Registry of ACS between 2018 and 2021. A composite primary outcome (in-hospital re-infarction, stroke, heart failure, hemorrhage, death) was compared regarding antiplatelet strategy (DAPT versus SAPT). Secondary outcomes were defined as one-year all-cause mortality and one-year cardiovascular rehospitalization. RESULTS A total of 1469 patients were included, with a mean age of 66 12 years, and 73.9 % were male. The DAPT regime was used in 38.2 % of patients and SAPT in 61.8 % of patients. NSTE myocardial infarction was the most frequent presentation (88.5 %). Revascularization was performed within 24 h in 55.2% of patients. Time until revascularization >24 h occurred in 44.8% of patients, with 16.5% of these between [24 h–48 h], 10.6% in [48 h–72 h] and 17.6% > 72 h. The primary outcome was more frequently observed in the SAPT group (10.4 %, p ¼ 0.033), mainly driven by more ischemic events. Time until revascularization >72 h and the SAPT regime were independent predictors of the primary outcome (OR 3.09, p ¼ 0.005, and OR 2.03, p ¼ 0.008, respectively).