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Popeye Deformity: a Red Flag for Wild-Type Transthyretin Amyloidosis
No full textinfo:eu-repo/semantics/publishedVersio
Consumo de Álcool Pós-Transplante hepático: um Estudo Transversal
No full textBackground: Listing patients with alcohol-associated liver disease (ALD) for liver transplant (LT) remains challenging especially due to the risk of alcohol resumption post-LT. We aimed to evaluate post-LT alcohol consumption at a Portuguese transplant center.
Methods: We conducted a cross-sectional study including LT recipients from 2019 at Curry Cabral Hospital, Lisbon, Portugal. A pretested survey and a validated Portuguese translation of the Alcohol Use Disorder Identification Test (AUDIT) were applied via a telephone call. Alcohol consumption was defined by patients' self-reports or a positive AUDIT.
Results: In 2019, 122 patients underwent LT, and 99 patients answered the survey (June 2021). The mean (SD) age was 57 (10) years, 70 patients (70.7%) were males, and 49 (49.5%) underwent ALD-related LT. During a median (IQR) follow-up of 24 (20-26) months post-index LT, 22 (22.2%) recipients consumed any amount of alcohol: 14 had a drink monthly or less and 8 drank 2-4 times/month. On drinking days, 18 patients usually consumed 1-2 drinks and the remainder no more than 3-4 drinks. One patient reported having drunk ≥6 drinks on one occasion. All post-LT drinking recipients were considered low risk (score <8) as per the AUDIT score (median [IQR] of 1 [1-2]). No patient reported alcohol-related problems, whether self-inflicted or toward others. Drinking recipients were younger (53 vs. 59 years, p = 0.020), had more non-ALD-related LT (72.7 vs. 44.2%, p = 0.018) and active smoking (31.8 vs. 10.4%, p = 0.037) than abstinent ones.
Conclusion: In our cohort, about a quarter of LT recipients consumed alcohol early posttransplant, all with a low-risk pattern according to the AUDIT score.info:eu-repo/semantics/publishedVersio
Navegação no Sistema de Saúde: Qual o Melhor Caminho?
No full textNavegar no sistema de saúde como uma pessoa com doença ou como um cuidador informal pode ser uma experiência avassaladora, sobretudo para aqueles que enfrentam múltiplas barreiras no acesso aos cuidados de saúde. Estas barreiras podem ser de diversos tipos: individuais, de literacia, culturais e estruturais.
Na linha do tempo da história de vida da pessoa, esses desafios podem começar antes do diagnóstico, no processo de avaliação e diagnóstico e continuar durante todo o processo de tratamento, monitorização, follow-up e supervisão do equilíbrio instável saúde-doença.
Percursos de cuidados bem estabelecidos para a pessoa com doença podem ajudá-la a compreender melhor e a envolver-se com sistemas de cuidados de saúde complexos, saber melhor que perguntas fazer aos profissionais de saúde no sentido de garantir que está a receber os melhores cuidados.
Diferentes situações de doença requerem diferentes níveis e complexidades de cuidados e desta forma a pessoa necessitará de mais acompanhamento e apoio em diferentes estádios ao longo do continuum da doença.
Várias intervenções clínicas têm sido desenvolvidas para dar resposta às barreiras encontradas nos cuidados clínicos e de saúde. Patient navigation é uma delas - a navegação do doente tem sido identificada como uma estratégia para superar barreiras ao nível do doente e ao nível do sistema, para reduzir disparidades relacionadas com a doença e melhorar o acesso e a coordenação de cuidados atempados.info:eu-repo/semantics/publishedVersio
Massive Blood Loss from Urethrorrhage in a 16-year-old boy: Case Report and Review of Two Rare Causes
No full textUrethral varices and hemangiomas are rare, underreported conditions that can be asymptomatic or present with intermittent urethrorrhage that can start or worsen with erection, sexual intercourse and ejaculation. Diagnosis can be made with urethroscopy and there are a wide variety of possible treatments that can suit both conditions. We present a case of a pediatric patient with severe blood loss from urethral varices that was treated with electrofulguration after laser treatment with Holmium failed.info:eu-repo/semantics/publishedVersio
Multiple Keratotic Projections on the Palms and Soles
No full textpiny keratoderma (SKD) is a rare palmoplantar keratoderma that presents with few to numerous millimetric hyperkeratotic projections on the palms and soles. It has been described with both hereditary and acquired variants. The acquired form, which presents in older adults, has been associated with a variety of systemic diseases and malignant conditions. In patients suspected of having acquired spiny keratoderma, an evaluation for malignant conditions may be warranted. Treatment with topical keratolytics or topical and oral retinoids is usually insufficient. Herein, we present the case of a 58-year-old man diagnosed with idiopathic SKD.info:eu-repo/semantics/publishedVersio
The Role of Multidimensional Prognostic Index to Identify Hospitalized Older Adults with COVID-19 Who Can Benefit from Remdesivir Treatment: An Observational, Prospective, Multicenter Study
No full textBackground: Data regarding the importance of multidimensional frailty to guide clinical decision making for remdesivir use in older patients with coronavirus disease 2019 (COVID-19) are largely unexplored.
Objective: The aim of this research was to evaluate if the Multidimensional Prognostic Index (MPI), a multidimensional frailty tool based on the Comprehensive Geriatric Assessment (CGA), may help physicians in identifying older hospitalized patients affected by COVID-19 who might benefit from the use of remdesivir.
Methods: This was a multicenter, prospective study of older adults hospitalized for COVID-19 in 10 European hospitals, followed-up for 90 days after hospital discharge. A standardized CGA was performed at hospital admission and the MPI was calculated, with a final score ranging between 0 (lowest mortality risk) and 1 (highest mortality risk). We assessed survival with Cox regression, and the impact of remdesivir on mortality (overall and in hospital) with propensity score analysis, stratified by MPI = 0.50.
Results: Among 496 older adults hospitalized for COVID-19 (mean age 80 years, female 59.9%), 140 (28.2% of patients) were treated with remdesivir. During the 90 days of follow-up, 175 deaths were reported, 115 in hospital. Remdesivir treatment significantly reduced the risk of overall mortality (hazard ratio [HR] 0.54, 95% confidence interval CI 0.35-0.83 in the propensity score analysis) in the sample as whole. Stratifying the population, based on MPI score, the effect was observed only in less frail participants (HR 0.47, 95% CI 0.22-0.96 in propensity score analysis), but not in frailer subjects. In-hospital mortality was not influenced by remdesivir use.
Conclusions: MPI could help to identify less frail older adults hospitalized for COVID-19 who could benefit more from remdesivir treatment in terms of long-term survival.info:eu-repo/semantics/publishedVersio
Clinical, Economic, and Humanistic Impact of Short-Bowel Syndrome/Chronic Intestinal Failure in Portugal (PARENTERAL Study)
No full textIntroduction: This study aimed to assess the clinical, economic, and humanistic impact of short-bowel syndrome/chronic intestinal failure (SBS/CIF) in Portugal.
Methods: This is a retrospective multicenter cohort chart review study, with a cross-sectional component for quality-of-life (QoL) evaluation. Inclusion criteria comprised patients with SBS/CIF, aged ≥1 year, with stable parenteral nutrition (PN). Data collection included patient chart review over a 12-month period and patient/caregiver self-report and SF-36/PedsQL™ questionnaires. Main endpoints comprised clinical and PN characterization, healthcare resource use (HRU), direct costs, and patient QoL.
Results: Thirty-one patients were included (11 adults and 20 children). Patients' mean age (standard deviation [SD]) was 57.9 (14.3) years in adults and 7.5 (5.0) years in children, with a mean time since diagnosis of 10.2 (5.9) and 6.6 (4.2) years, respectively. PN was administered for a mean of 5.2 and 6.6 days/week in adults and children, respectively; home PN occurred in 81.8% of adults and 90.0% of children for a mean of 9.6 and 10.8 months/year, respectively. The mean annual number of hospitalizations was 1.9 and 2.0 which lasted for a mean of 34.0 and 29.4 days in adults and children, respectively. Twenty-one and forty hospitalization episodes were reported in adults and children, respectively, of which 71.4% and 85.0% were due to catheter-related complications. Mean annual direct costs per patient amounted to 47,857.53 EUR in adults and 74,734.50 EUR in children, with PN and hospitalizations as the main cost-drivers. QoL assessment showed a clinically significant impaired physical component in adults and a notable deterioration in the school functioning domain in children.
Conclusion: In Portugal, SBS/CIF patient management is characterized by a substantial therapeutic burden and HRU, translating into high direct costs and a substantial impairment of the adults' physical function and children's school functioning.info:eu-repo/semantics/publishedVersio
TAC Score Better Predicts Survival Than the BCLC Following Resection of Hepatocellular Carcinoma
No full textBackground: Heterogeneity in hepatocellular carcinoma (HCC) still exists within the Barcelona clinic liver cancer (BCLC) subcategories. We developed a simple model to better discriminate and predict prognosis following resection.
Methods: Patients who underwent curative-intent resection for HCC were identified from a multi-institutional database. Predictive factors of survival were identified to develop TAC (tumor burden score [TBS], alpha-fetoprotein [AFP], Child-Pugh CP]) score.
Results: Among 1435 patients, median TBS was 5.1 (interquartile range [IQR]: 3.2-8.1), median AFP was 18.3 ng/ml (IQR 4.0-362.5), and 1391 (96.9%) patients were classified as CP-A. Factors associated with overall survival (OS) included TBS (low: referent; medium: HR 2.26, 95% CI: 1.73-2.96; high: HR = 3.35, 95% CI: 2.22-5.07), AFP (400 ng/ml: HR = 1.56, 95% CI: 1.27-1.92), and CP (A: referent; B: HR = 1.81, 95% CI: 1.12-2.92) (all p < 0.05). A simplified risk score demonstrated superior concordance index, Akaike information criteria, homogeneity, and area under the curve versus BCLC (0.620 vs. 0.541; 5484.655 vs. 5536.454; 60.099 vs. 16.194; 0.62 vs. 0.55, respectively), and further stratified patients within BCLC groups relative to OS (BCLC 0, very low: 86.8%, low: 47.8%) (BCLC A, very low: 79.7%, low: 68.1%, medium: 52.5%, high: 35.6%) (BCLC B, low: 59.8%, medium: 43.7%, high: N/A).
Conclusion: TAC is a simple, holistic score that consistently outperformed BCLC relative to discrimination power and prognostication following resection of HCC.info:eu-repo/semantics/publishedVersio
Heterotopic Caval Valve-in-Valve Procedure for Prosthetic Migration: Two Case Reports
No full textBackground: Heterotopic bicaval stenting or caval valve implantation (CAVI) either with non-dedicated balloon-expandable Sapien™ valves (Edwards Lifesciences) or with dedicated TricValve™ (Products + Features) has emerged as a safe and effective percutaneous treatment for high-risk patients with severe tricuspid regurgitation (TR). One technical difficulty of CAVI is the lack of native calcified structures to anchor the device, which may lead to paravalvular leak or migration.
Cases summary: We describe two patients with severe TR and high surgical risk who underwent CAVI procedures, both of them complicated with device migration to the right atrium (one inferior vena cava device and one superior vena cava device). Both cases were treated with a caval valve-in-valve procedure, with good technical and clinical results.
Discussion: With the recent development of several percutaneous interventions for high-risk patients with severe TR, the rate of some possible complications is not well established, and neither are the better managing strategies. Device embolization is a rare complication of transcatheter heart interventions but with potential catastrophic consequences. Less invasive strategies such as the valve-in-valve procedure may be preferable in order to avoid the exposure of these patients to complex heart surgeries with extracorporeal circulation.info:eu-repo/semantics/publishedVersio
Optimizing the Use of Systemic Corticosteroids in Severe Ssthma (ROSA II Project): a National Delphi Consensus Study
No full textinfo:eu-repo/semantics/publishedVersio