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- Pantoprazole-induced liver injury in the setting of diabetic ketoacidosisPublication . de Oliveira, Raquel; Almeida, Manuel; Lavado, Pedro; Baptista, AlexandreCritically ill patients are at higher risk of acquired liver in-jury, given the multiple coexisting potential causes of injury.1They are also at risk of stress ulcers, and prophylaxis with proton pump inhibitors (PPIs) is common in Intensive Care Units (ICUs). A 54-year-old woman was admitted to the ICU due to diabetic ketoacidosis (DKA). On admission, she was hemo-dynamically stable, with a Glasgow Coma Scale score of 7 (E2V1M4). Her abdominal examination was normal, without palpable organomegalies, and her liver blood tests were within the normal range. She was intubated for airway pro-tection and started on intravenous fluids, insulin perfusion, and prophylaxis with intravenous pantoprazole 40 mg/day.
- Endoscopy‐related musculoskeletal injuries: a systematic review and meta‐analysis on prevalence, risk factors and preventionPublication . de Oliveira, Raquel; Roseira, Joana; Estevinho, Maria Manuela; Sousa, Helena Tavares; Rolanda, Carla; Meining, Alexander; Walter, BenjaminBackgroundEndoscopy-related musculoskeletal injuries (ERIs) are a major occupational hazard, impacting career longevity and personal well-being.ObjectiveThis systematic review and meta-analysis aimed to update and expand on previous findings by assessing prevalence, risk factors and management of ERIs among endoscopists.MethodsFollowing PRISMA guidelines, we systematically searched MEDLINE, Web of Science and Scopus for relevant studies published since the last comprehensive review. A manual search of the references of relevant manuscripts was also performed. Outcomes of interest included the prevalence of ERIs, common pain syndromes, risk factors, and preventive or treatment strategies. Studies' quality was assessed using the National Institutes of Health (NIH) Quality Assessment Tool.ResultsThirty studies were included, incorporating data from 7646 gastrointestinal endoscopists. The pooled career-long prevalence of overall ERI was 62.5% (CI 52.6-71.8, I2 = 98%), including pain (67.5%; CI 46.4%-85.6%; I2 = 98%) and numbness (12.4%; 95% CI 6.6%-19.7%; I2 = 98%) syndromes. Among pain syndromes, the most affected areas were the hand (28.2%; CI 19.2%-38.2%; I2 = 99%), lower back (27.3%; CI 20.1%-35.2%; I2 = 97%), thumb (27.1%; CI 18.9%-37.7%; I2 = 99%) and neck (25.7%; CI 19.3%-32.7%; I2 = 98%). Higher procedural volume, years in practice and female gender were consistently reported as risk factors for ERIs. Concerning therapy, 41.8% of endoscopists used medications (CI 31.2%-52.8%; I2 = 94%), while 28.2% engaged in physical therapy (CI 18.2%-39.5%; I2 = 96%). Sick leave was reported by 13.8% of endoscopists (CI 7.9%-20.9%; I2 = 94%). Practice modifications to manage ERIs included adjusting monitor (45.5%, CI 22.2%-69.9%; I2 = 96%) and table (32.4%, CI 14.5%-53.5%; I2 = 97%) height, but also reducing the number of cases per endoscopy session (14.6%; CI 10.4%-19.4%; I2 = 72%).ResultsThirty studies were included, incorporating data from 7646 gastrointestinal endoscopists. The pooled career-long prevalence of overall ERI was 62.5% (CI 52.6-71.8, I2 = 98%), including pain (67.5%; CI 46.4%-85.6%; I2 = 98%) and numbness (12.4%; 95% CI 6.6%-19.7%; I2 = 98%) syndromes. Among pain syndromes, the most affected areas were the hand (28.2%; CI 19.2%-38.2%; I2 = 99%), lower back (27.3%; CI 20.1%-35.2%; I2 = 97%), thumb (27.1%; CI 18.9%-37.7%; I2 = 99%) and neck (25.7%; CI 19.3%-32.7%; I2 = 98%). Higher procedural volume, years in practice and female gender were consistently reported as risk factors for ERIs. Concerning therapy, 41.8% of endoscopists used medications (CI 31.2%-52.8%; I2 = 94%), while 28.2% engaged in physical therapy (CI 18.2%-39.5%; I2 = 96%). Sick leave was reported by 13.8% of endoscopists (CI 7.9%-20.9%; I2 = 94%). Practice modifications to manage ERIs included adjusting monitor (45.5%, CI 22.2%-69.9%; I2 = 96%) and table (32.4%, CI 14.5%-53.5%; I2 = 97%) height, but also reducing the number of cases per endoscopy session (14.6%; CI 10.4%-19.4%; I2 = 72%).ConclusionERIs are highly prevalent among international gastrointestinal endoscopists, and are linked to procedural volume, years in practice, and gender. Ergonomic training and workplace adaptations are essential to mitigate risks and support career sustainability.Trial RegistrationPROSPERO Registration: CRD42024534349
- 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.
- Prescribed hospital diet influence on dietary intake of hospitalised patients: a cross-sectional studyPublication . Gameiro, Joana; de Oliveira, Raquel; Baltazar, Ana Lúcia; Rocha, Clara; Pereira, Marta; Martins, Diana; Lima, João P. M.; Mendes, FernandoThe dietary intake of hospitalised patients is often compromised during hospitalisation, which can be a causal factor for hospital malnutrition. This is considered a public health problem worldwide and is associated with an increased risk of other complications. Objectives: Our objective was to determine the dietary intake of hospitalised individuals and if the prescribed diet influences it. Methods: Food intake data were collected from 299 lunches of patients admitted to a hospital, using the visual estimation method with a five-point scale. Three existing diets were considered, and the energy and macronutrient values of the meal were calculated. The minimum energy and protein requirements were also calculated. Results: The components of the tray with the highest intake were soup and dessert; no significant differences were found between the percentage intake of each element and the prescribed diet. More than 50% of the individuals did not meet their minimum energy requirements, and only 36.5% had a protein intake that was within the recommendations. Conclusions: Dietary intake is much lower than prescribed, and nutritionists need to act to reduce the prevalence of hospital malnutrition.
- The effect of nutritional intervention in nutritional risk screening on hospitalised lung cancer patientsPublication . de Oliveira, Raquel; Cabrita, Bruno; Cunha, Ângela; Silva, Sónia; Lima, João P. M.; Martins, Diana; Mendes, FernandoBackground: Lung cancer (LC) patients are prone to suffer from malnutrition. Malnutrition negatively affects patients’ response to therapy, increases the incidence of treatment-related side effects, and decreases survival. Early identification of LC patients who are malnourished or at risk of malnutrition can promote recovery and improve prognosis. Objective: This study aimed to assess the risk and nutritional status of lung cancer patients who are hospitalised, as well as to evaluate the impact of nutritional intervention on the risk of malnutrition. Methods: From January 2022 to December 2023, 53 LC patients hospitalised in a pulmonology department had their nutritional risk (initial and final) and nutritional status (initial) assessed. All were selected for nutritional intervention. Nutrition counselling was the first intervention option, along with dietary changes with/without oral nutritional supplements. Results: At the time of hospitalisation, 90.6% of the patients were at nutritional risk, 45.3% were classified as moderately malnourished, and 35.8% were classified as severely underweight. After the hospitalisation, 73.6% were at nutritional risk at the time of discharge, suggesting a statistically significant decrease in the number of patients with nutritional risk. Conclusions: Most LC patients hospitalised presented an altered nutritional status. Our study suggests that a nutritional intervention must be implemented to reduce malnutrition risk, which may impact prognosis. The comprehensive nutritional problems experienced by LC patients require nutritional assessment and improved individually tailored nutritional support.