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Updated American Urological Association Guidelines for the Management of Benign Prostatic Hyperplasia: Prostatic Artery Embolization Made it into the Guidelines!
No full textinfo:eu-repo/semantics/publishedVersio
Age‐Related White Matter Hyperintensities and Overactive Bladder: a Systematic Review
No full textIntroduction: Age-related white matter hyperintensities (ARWMHs) on brain magnetic resonance imaging have been associated with lower urinary tract symptoms/dysfunction (LUTS/LUTD), namely overactive bladder (OAB) and detrusor overactivity. We aimed to systematically review existing data on the association between ARWMH and LUTS and which clinical tools have been used for this assessment.
Materials and methods: We searched PubMed/MEDLINE, Cochrane Library, and clinicaltrials.gov (from 1980 to November 2021) and considered original studies reporting data on ARWMH and LUTS/LUTD in patients of both sexes aged 50 or above. The primary outcome was OAB. We calculated the unadjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) for the outcomes of interest using random-effects models.
Results: Fourteen studies were included. LUTS assessment was heterogeneous and mainly based on the use of nonvalidated questionnaires. Urodynamics assessment was reported in five studies. ARWMHs were graded using visual scales in eight studies. Patients with moderate-to-severe ARWMHs were more likely to present with OAB and urgency urinary incontinence (UUI; OR = 1.61; 95% CI: 1.05-2.49, p = 0.03), I2 = 21.3%) when compared to patients with similar age and absent or mild ARWMH.
Discussion and conclusions: High-quality data on the association between ARWMH and OAB is scarce. Patients with moderate to severe ARWMH showed higher levels of OAB symptoms, including UUI, when compared to patients with absent or mild ARWMH. The use of standardized tools to assess both ARWMH and OAB in these patients should be encouraged in future research.info:eu-repo/semantics/publishedVersio
The Potential Role of Psychodrama Group Interventions for Child and Adolescents of Residential and Foster Care
No full textinfo:eu-repo/semantics/publishedVersio
Epigenetic and Drug Response Modulation of Epigalocaten-In-3-Gallate in Staphylococcus aureus with Divergent Resistance Phenotypes
No full textHealthcare-associated methicillin-resistant Staphylococcus aureus infections represent extremely high morbidity and mortality rates worldwide. We aimed to assess the antimicrobial potential and synergistic effect between Epigalocatenin-3-gallate (EGCG) and different antibiotics in S. aureus strains with divergent resistance phenotypes. EGCG exposure effects in epigenetic and drug resistance key modulators were also evaluated. S. aureus strains (n = 32) were isolated from infected patients in a Lisbon hospital. The identification of the S. aureus resistance phenotype was performed through automatized methods. The antibiotic synergistic assay was performed through disk diffusion according to EUCAST guidelines with co-exposure to EGCG (250, 100, 50 and 25 µg/mL). The bacteria's molecular profile was assessed through FTIR spectroscopy. The transcriptional expression of OrfX, SpdC and WalKR was performed by using qRT-PCR. FTIR-spectroscopy analysis enabled the clear discrimination of MRSA/MSSA strains and the EGCG exposure effect in the bacteria's molecular profiles. Divergent resistant phenotypes were associated with divergent transcriptional expression of the epigenetic modulator OrfX, particularly in MRSA strains, as well as the key drug response modulators SpdC and WalKR. These results clearly demonstrate that EGCG exposure alters the expression patterns of key epigenetic and drug response genes with associated divergent-resistant profiles, which supports its potential for antimicrobial treatment and/or therapeutic adjuvant against antibiotic-resistant microorganisms.info:eu-repo/semantics/publishedVersio
Homeless Outreach Psychiatric Engagement for Lisboa (HOPE 4 Lisboa): One Year of Marontology, and One John Doe Living with Diogenes Syndrome
No full textBackground: In Europe, psychiatric disorders seem to affect up to 50% of the homeless. In Portugal there were, at a certain time, circa 3,396 homeless people, half living in the capital city, Lisboa.
Aims: The Homeless Outreach Psychiatric Engagement for Lisboa (HOPE 4 Lisboa) was created, in January 1st 2022, as a collaboration including staff from the local state asylum, medical school and town hall in Lisboa, Portugal, in order to provide better treatment for the super difficult cases of psychiatric patients living homeless in Lisboa.
Method: During 2022, the HOPE 4 team made night rounds, every 15 days on Tuesday's night (20:30 to 23:30) trying to reach, at least, one dozen of homeless psychiatric patients, previously identified.
Results: The HOPE 4 Lisboa interviewed 101 patients (53.4%) out of the 189 programed visits. From this group, 72 (72%) had already a previous psychiatric diagnosis. From those 101 patients, reports for 47 (47%) were sent for an eventual compulsory psychiatric assessment. From those 47 only 21 patients (21%) were admitted in the psychiatry ward. Finally we discuss the most super difficult patient we found, as a small case report: a John Doe living in complete Diogenes syndrome.
Conclusions: there are still a few psychiatrists interested in treating homeless people completely or partially out of the classic mental health care systems. Some claim to be doing interstitial psychiatry, others street psychiatry, but we could also call it marontology.info:eu-repo/semantics/publishedVersio
Magnetic Resonance Diagnosis of Laryngeal Chondritis After Transoral Laser Microsurgery for Laryngeal Cancer
No full textObjective: Laryngeal chondritis (LC) is a rare complication of carbon dioxide transoral laser microsurgery (CO2 TOLMS) for laryngeal tumours and can pose a diagnostic challenge. Its magnetic resonance (MR) features have not been previously described. This study aims to characterise a cohort of patients who developed LC after CO2 TOLMS and describe its clinical and MR findings.
Methods: Clinical records and MR images of all patients presenting with LC after CO2 TOLMS between 2008 and 2022 were reviewed.
Results: Seven patients were analysed. Timing of LC diagnosis ranged from 1 to 8 months after CO2 TOLMS. Four patients were symptomatic. Abnormal endoscopic findings included suspected tumour recurrence in 4 patients. MR documented focal or extensive signal changes involving the thyroid lamina and para-laryngeal space with T2 hyperintensity, T1 hypointensity and intense contrast enhancement (n = 7), and minimally reduced mean apparent diffusion coefficient (ADC) values (1.0-1.5 x 10-3 mm2/s) (n = 6). A favourable clinical outcome was achieved in all patients.
Conclusions: LC after CO2 TOLMS has a distinctive MR pattern. When tumour recurrence cannot be confidently excluded based on imaging, antibiotic therapy, close clinical and radiological follow-up and/or biopsy are recommended.info:eu-repo/semantics/publishedVersio
Case Report: Dermatofibrosarcoma Protuberans of the Foot: What Steps Can We Take?
No full textIntroduction and importance: Dermatofibrosarcoma protuberans (DFSP) is a rare soft tissue sarcoma affects mainly the trunk and proximal limbs. Clinically, it typically presents as an asymptomatic plaque or nodular-like lesion that progresses slowly before entering a rapid growth phase. DFSP exhibits a low potential for metastasis, mainly in cases where fibrosarcomatous transformation occurs, but it has a high rate of local recurrence. Diagnosis of DFSP is often delayed, and it is challenging to establish without performing a biopsy and histologic analysis. The mainstay treatment for DFSP is surgical wide excision with free margins, although this can be challenging depending on the location of the tumor.
Case presentation: We report a rare presentantion of dermatofibrosarcoma protuberans according to the SCARE guidelines. The patients main concern was the slow evolving mass on the dorsum of the foot that at presentation was 1x1cm. The biopsy showed a dermatofibrosarcoma protuberans. A radical excision involving ray amputation of the 2nd and 3rd finger provided a 1 cm clear margin. CLíNICAL DISCUSSION AND CONCLUSION: This case shows how an inconspicuous nodule in an uncommon area can be the primary manifestation of a serious condition
Comparative Outcomes of Extracorporeal Membrane Oxygenation for COVID-19 Delivered in Experienced European Centres During Successive SARS-CoV-2 Variant Outbreaks (ECMO-SURGES): an International, Multicentre, Retrospective Cohort Study.
No full textBackground: To inform future research and practice, we aimed to investigate the outcomes of patients who received extracorporeal membrane oxygenation (ECMO) for acute respiratory distress syndrome (ARDS) due to different variants of SARS-CoV-2.
Methods: This retrospective study included consecutive adult patients with laboratory-confirmed SARS-CoV-2 infection who received ECMO for ARDS in 21 experienced ECMO centres in eight European countries (Austria, Belgium, England, France, Germany, Italy, Portugal, and Spain) between Jan 1, 2020, and Sept 30, 2021. We collected data on patient characteristics, clinical status, and management before and after the initiation of ECMO. Participants were grouped according to SARS-CoV-2 variant (wild type, alpha, delta, or other) and period of the pandemic (first [Jan 1-June 30] and second [July 1-Dec 31] semesters of 2020, and first [Jan 1-June 30] and second [July 1-Sept 30] semesters of 2021). Descriptive statistics and Kaplan-Meier survival curves were used to analyse evolving characteristics, management, and patient outcomes over the first 2 years of the pandemic, and independent risk factors of mortality were determined using multivariable Cox regression models. The primary outcome was mortality 90 days after the initiation of ECMO, with follow-up to Dec 30, 2021.
Findings: ECMO was initiated in 1345 patients. Patient characteristics and management were similar for the groups of patients infected with different variants, except that those with the delta variant had a younger median age and less hypertension and diabetes. 90-day mortality was 42% (569 of 1345 patients died) overall, and 43% (297/686) in patients infected with wild-type SARS-CoV-2, 39% (152/391) in those with the alpha variant, 40% (78/195) in those with the delta variant, and 58% (42/73) in patients infected with other variants (mainly beta and gamma). Mortality was 10% higher (50%) in the second semester of 2020, when the wild-type variant was still prevailing, than in other semesters (40%). Independent predictors of mortality were age, immunocompromised status, a longer time from intensive care unit admission to intubation, need for renal replacement therapy, and higher Sequential Organ Failure Assessment haemodynamic component score, partial pressure of arterial carbon dioxide, and lactate concentration before ECMO. After adjusting for these variables, mortality was significantly higher with the delta variant than with the other variants, the wild-type strain being the reference.
Interpretation: Although crude mortality did not differ between variants, adjusted risk of death was highest for patients treated with ECMO infected with the delta variant of SARS-CoV-2. The higher virulence and poorer outcomes associated with the delta strain might relate to higher viral load and increased inflammatory response syndrome in infected patients, reinforcing the need for a higher rate of vaccination in the population and updated selection criteria for ECMO, should a new and highly virulent strain of SARS-CoV-2 emerge in the future. Mortality was noticeably lower than in other large, multicentre series of patients who received ECMO for COVID-19, highlighting the need to concentrate resources at experienced centres.None
Seminal Vesicle Calculi as a Cause of Hematospermia and Ejaculatory Pain: a Case Report.
No full textSeminal vesicle calculi are a rare entity that may present with hematospermia, painful ejaculation, or urinary complaints. We present a case of a 40-year-oldmale with complaints of hematospermia, ejaculatory pain, and perineal discomfort in the last five years. A 7 mm left seminal vesicle calculi were diagnosed by magnetic resonance imaging (MRI), and a laparoscopic robot-assisted vesiculectomy was performed. All the complaints improved completely after treatment. Seminal vesicle lithiasis should be kept in mind when evaluating patients with hematospermia and ejaculatory pain. Transrectal ultrasound (TRUS) and magnetic resonance imaging are the best radiology techniques to diagnose this kind of lithiasis. Different surgical treatments can be used to treat these calculi, depending on the size and location of the calculi and the surgical experience of the surgeon
Ascending Aortobifemoral and Adjunct Carotid Bypass Grafts.
No full textWe describe a case of simultaneous ascending aortobifemoral and right common carotid artery bypass to treat a symptomatic brachiocephalic artery and juxtarenal chronic total occlusion in a 68-year-old female patient with unfavorable characteristics for endovascular and standard aortofemoral procedures. Mid-term follow-up revealed sustained remission of symptoms, quality of life quality of life improvement, and patent bypass grafts. In highly selected patients, this solution can be useful when treating other intrathoracic diseases, as well as allowing the simultaneous revascularization of two remote arterial beds