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Enablers, Barriers and Strategies to Build Resilience Among Cancer Survivors: a Qualitative Study Protocol
No full textCancer is a life-threatening illness affecting all dimensions of a person's health. Cancer survivors must build resilience to face this adversity and continue their life projects. The present study explores the enablers, barriers, and strategies to build resilience among cancer survivors. This qualitative, descriptive exploratory study will use purposive sampling to recruit cancer survivors and healthcare professionals from two hospital centers in Lisbon and Tagus Valley. Interviews will be conducted until data saturation occurs. Data analysis will be performed using an inductive content analysis process with the help of the QDA Miner Lite database. The findings from this study will generate knowledge that may help stakeholders to identify effective strategies to build resilience among cancer survivors. By implementing strategies to foster resilience, healthcare professionals can potentially promote positive adaptations to cancer by strengthening resilience enablers and reducing the impact of barriers.info:eu-repo/semantics/publishedVersio
Hypomagnesemia: a Potential Underlooked Cause of Persistent Vitamin D Deficiency in Chronic Kidney Disease
No full textMagnesium and vitamin D play important roles in most cells of the body. These nutrients act in a coordinated fashion to maintain physiologic functions of various organs, and their abnormal balance could adversely affect these functions. Therefore, deficient states of both nutrients may lead to several chronic medical conditions and increased cardiovascular and all-cause mortality. Chronic kidney disease (CKD) patients have altered metabolism of both magnesium and vitamin D. Some studies indicate that magnesium could have a role in the synthesis and metabolism of vitamin D, and that magnesium supplementation substantially reversed the resistance to vitamin D treatment in some clinical situations. Recent observational studies also found that magnesium intake significantly interacted with vitamin D status and, particularly with the risk of cardiovascular mortality. It is therefore essential to ensure adequate levels of magnesium to obtain the optimal benefits of vitamin D supplementation in CKD patients. In this review, we discuss magnesium physiology, magnesium and vitamin D metabolism in CKD, potential metabolic interactions between magnesium and vitamin D and its clinical relevance, as well as the possible role of magnesium supplementation to assure adequate vitamin D levels.info:eu-repo/semantics/publishedVersio
Mineral and Bone Metabolism Markers and Mortality in Diabetic Patients on Haemodialysis
No full textBackground: Diabetic patients on haemodialysis have a higher risk of mortality than non-diabetic patients. The aim of this COSMOS (Current management of secondary hyperparathyroidism: a multicentre observational study) analysis was to assess whether bone and mineral laboratory values [calcium, phosphorus and parathyroid hormone (PTH)] contribute to this risk.
Methods: COSMOS is a multicentre, open-cohort, 3-year prospective study, which includes 6797 patients from 227 randomly selected dialysis centres in 20 European countries. The association between mortality and calcium, phosphate or PTH was assessed using Cox proportional hazard regression models using both penalized splines smoothing and categorization according to KDIGO guidelines. The effect modification of the association between the relative risk of mortality and serum calcium, phosphate or PTH by diabetes was assessed.
Results: There was a statistically significant effect modification of the association between the relative risk of mortality and serum PTH by diabetes (P = .011). The slope of the curve of the association between increasing values of PTH and relative risk of mortality was steeper for diabetic compared with non-diabetic patients, mainly for high levels of PTH. In addition, high serum PTH (>9 times the normal values) was significantly associated with a higher relative risk of mortality in diabetic patients but not in non-diabetic patients [1.53 (95% confidence interval 1.07-2.19) and 1.17 (95% confidence interval 0.91-1.52)]. No significant effect modification of the association between the relative risk of mortality and serum calcium or phosphate by diabetes was found (P = .2 and P = .059, respectively).
Conclusion: The results show a different association of PTH with the relative risk of mortality in diabetic and non-diabetic patients. These findings could have relevant implications for the diagnosis and treatment of chronic kidney disease-mineral and bone disorders.info:eu-repo/semantics/publishedVersio
Adverse Childhood Experiences and Attention Deficit Hyperactivity Disorder: Decoding the Association
No full textA perturbação de hiperatividade e défice de atenção (PHDA) é a perturbação do neurodesenvolvimento mais frequente na faixa etária pediátrica, podendo ter um marcado impacto no funcionamento do indivíduo. Nos últimos anos,tem vindo a ser estudada a associação entre esta patologia e a exposição a adverse childhood experiences (ACEs), i.e.,eventos adversos potencialmente traumáticos vividos antes dos 18 anos. Neste artigo de revisão, apresentamos os resultados da literatura mais recentes relativos a este tema, abordando a relação com o trauma, hipóteses explicativas e alterações cerebrais associadas.info:eu-repo/semantics/publishedVersio
Scientific Societies, Medical Conferences and Postgraduate Medical Education in Anesthesiology
No full textinfo:eu-repo/semantics/publishedVersio
Residency in Anaesthesiology: A Current Perspective on the Group I Hospital Internships
No full textIntrodução: A especialidade de Anestesiologia prima pela prática baseada na evidência e cuidado com a formação. Os estágios de grupo I são a mais recente alteração ao programa formativo da especialidade, tendo-se realizado pela primeira vez em janeiro de 2020.
Material e Métodos: Realizou-se um estudo observacional transversal descritivo com base num inquérito on-line com o objetivo de definir, segundo a perceção dos Médicos Internos, a qualidade, utilidade e recursos logísticos do estágio. O inquérito era composto por 14 questões, divididas em dois grupos: um bloco relativo à componente formativa e laboral e um bloco relativo à componente logística do estágio.
Resultados: De um universo de 160 Internos de Formação
Especializada em Anestesiologia foram obtidas 75 respostas (46,9%). Os estágios de grupo I demonstraram ser uma mais-valia no Internato de Anestesiologia. Os médicos internos, na sua grande maioria, apresentam um elevado grau de satisfação com o estágio, autonomia e variedade de funções desempenhadas, que culminam na vontade de exercer futuramente funções em hospitais distritais.
Conclusão: Esta análise dos dois primeiros anos do estágio de grupo I pode servir de base para uma discussão alargada que poderá conduzir a um processo de contínua melhoria de condições e eventual introdução de novos elementos num estágio que já demonstrou ser vantajoso para os elementos envolvidos.info:eu-repo/semantics/publishedVersio
Adenovirus Infection in a Kidney–Pancreatic Transplant Recipient: Case Report
No full textAdenovirus infection in transplant recipients may present from asymptomatic viremia to multisystemic involvement. Most frequently, it occurs in the first year after a kidney transplant, and it is secondary to the reactivation of latent disease. However, primary infection may occur, and disseminated disease is more common when related to primary infection. Kidney involvement may be confirmed by biopsy, although diagnosis may be presumptive. Reduction of immunosuppression and supportive care are important components of therapy. CASE DESCRIPTION: A 41-year-old female renal-pancreatic recipient 12 years before with chronic renal graft dysfunction and a functional pancreatic graft had a history of cytomegalovirus and polyoma virus infection 2 years after transplantation. She was taking tacrolimus, mycophenolate mofetil, and prednisolone. The patient was admitted after persistent uncharacteristic diarrhea 3 weeks before hospitalization without any relevant epidemiologic context. She was dehydrated, and the lab results showed worsened kidney function and leucocytosis. The viral culture revealed adenovirus. Vigorous hydration was implemented, and the mycophenolate mofetil dose was reduced. The patient was discharged, and renal function returned to previous values. DISCUSSION AND CONCLUSION: Adenovirus infection has a wide clinical presentation, and multisystemic involvement may occur in transplant recipients. Supportive care is paramount. The clinical features and viral culture confirm the diagnosis, although tissue samples and quantitative polymerase chain reaction may be required in more severe cases.info:eu-repo/semantics/publishedVersio
Invasive Bacterial Infections in Children With Sickle Cell Disease: 2014–2019
No full textBackground: Children with sickle cell disease (SCD) are at a high risk of invasive bacterial infections (IBI). Universal penicillin prophylaxis and vaccination, especially against Streptococcus pneumoniae, have deeply changed its epidemiology. Analysis of IBI in children with SCD in a post-13-valent pneumococcal vaccine era is limited.
Methods: Twenty-eight pediatric hospitals from 5 European countries retrospectively collected IBI episodes in SCD children aged 1 month to 18 years between 2014 and 2019. IBI was defined as a positive bacterial culture or polymerase chain reaction from a normally sterile fluid: blood, cerebrospinal, joint, or pleural fluid and deep surgical specimen.
Results: We recorded 169 IBI episodes. Salmonella spp. was the main isolated bacteria (n = 44, 26%), followed by Streptococcus pneumonia (Sp; n = 31, 18%) and Staphylococcus aureus (n = 20, 12%). Salmonella prevailed in osteoarticular infections and in primary bacteremia (45% and 23% of episodes, respectively) and Sp in meningitis and acute chest syndrome (88% and 50%, respectively). All Sp IBI occurred in children ≤10 years old, including 35% in children 5 to 10 years old. Twenty-seven (17%) children had complications of infection and 3 died: 2 because of Sp, and 1 because of Salmonella. The main risk factors for a severe IBI were a previous IBI and pneumococcal infection (17 Sp/51 cases).
Conclusions: In a post-13-valent pneumococcal vaccine era, Salmonella was the leading cause of bacteremia in IBI in children with SCD in Europe. Sp came second, was isolated in children ≤10 years old, and was more likely to cause severe and fatal cases.info:eu-repo/semantics/publishedVersio
Pancreas Rejection in the Artificial Intelligence Era: New Tool for Signal Patients at Risk
No full textIntroduction: Pancreas transplantation is currently the only treatment that can re-establish normal endocrine pancreatic function. Despite all efforts, pancreas allograft survival and rejection remain major clinical problems. The purpose of this study was to identify features that could signal patients at risk of pancreas allograft rejection.
Methods: We collected 74 features from 79 patients who underwent simultaneous pancreas-kidney transplantation (SPK) and used two widely-applicable classification methods, the Naive Bayesian Classifier and Support Vector Machine, to build predictive models. We used the area under the receiver operating characteristic curve and classification accuracy to evaluate the predictive performance via leave-one-out cross-validation.
Results: Rejection events were identified in 13 SPK patients (17.8%). In feature selection approach, it was possible to identify 10 features, namely: previous treatment for diabetes mellitus with long-term Insulin (U/I/day), type of dialysis (peritoneal dialysis, hemodialysis, or pre-emptive), de novo DSA, vPRA_Pre-Transplant (%), donor blood glucose, pancreas donor risk index (pDRI), recipient height, dialysis time (days), warm ischemia (minutes), recipient of intensive care (days). The results showed that the Naive Bayes and Support Vector Machine classifiers prediction performed very well, with an AUROC and classification accuracy of 0.97 and 0.87, respectively, in the first model and 0.96 and 0.94 in the second model.
Conclusion: Our results indicated that it is feasible to develop successful classifiers for the prediction of graft rejection. The Naive Bayesian generated nomogram can be used for rejection probability prediction, thus supporting clinical decision making.info:eu-repo/semantics/publishedVersio
Imunofenotipagem de Amígdalas Palatinas em Crianças com SAOS Versus Amigdalites de Repetição
No full textIntrodução: Síndrome de Apneia Obstrutiva do Sono (SAOS) e Amigdalites de Repetição (AR) são as principais indicações para a realização de amigdalectomia em idade pediátrica. Apesar do crescente conhecimento em imunologia tecidual das amígdalas palatinas, a fisiopatologia que leva ao desenvolvimento de SAOS ou AR não é totalmente conhecida.
Objetivos: Análise imunofenotípica comparativa de crianças com SAOS versus AR. O estudo epidemiológico dos doentes selecionados foi ainda realizado.
Material e Métodos: Análise por citometria de fluxo de amígdalas palatinas de crianças com SAOS versus AR. No processamento das amígdalas
palatinas são isoladas as células mononucleadas (MNCs) e, a partir destas, as células T CD4 e as células
T foliculares auxiliares (TFH). Foi também avaliado o tamanho e viabilidade celular e o Inducible T-cell
costimulator (ICOS), marcador de ligação das células TFH às células B, durante a produção de
anticorpos. Foram incluídos 69 doentes do Hospital Dona Estefânia, com idade inferior a 18 anos, entre
novembro de 2018 e novembro de 2022.
Resultados: As amígdalas palatinas foram removidas por dissecção extracapsular de 54 crianças com diagnóstico de SAOS e 15 com AR. Nos doentes com SAOS, a média de idades foi de 4.7 (± 2.2) anos, sendo 24 do sexo masculino e 30 do sexo feminino. Nos doentes com AR, a média de idades foi de 6.1 (± 2.5) anos, sendo 7 do sexo masculino e 8 do sexo feminino. As crianças submetidas a amigdalectomia por SAOS eram significativamente mais novas que as por AR (p = 0.035). Não existiram diferenças significativas entre sexos nos dois grupos (p = 0.881). Foram encontradas diferenças significativas no grau das amígdalas palatinas, pela Classificação de Brodsky, entre os dois grupos de doentes (p = 0.031). As crianças com SAOS eram
mais propensas a apresentarem otite média com efusão com necessidade de miringotomia e colocação de tubos de ventilação transtimpânicos no mesmo momento cirúrgico (p = 0.034). Não existiram diferenças estatisticamente significativas nas complicações cirúrgicas da amigdalectomia entre os dois grupos de doentes (p = 0.456).Pela análise de citometria de fluxo, a contagem de MNCs e células T CD4 não se encontrou alterada entre os dois grupos. As amígdalas palatinas de doentes com AR apresentaram menos células
TFH quando comparadas com amígdalas de doentes com SAOS, mas de forma não significativa (p = 0.07). O tamanho das células T CD4 não mostrou diferenças significativas entre grupos (p=0.840), porém, a viabilidade destas células foi significativamente superior nos doentes com AR (p=0.015). Nos doentes estudados, existiu uma maior intensidade na expressão de ICOS nos doentes com AR face aos doentes com SAOS.
Conclusões: Os nossos resultados apontam para diferenças na resposta linfocitária local entre doentes com SAOS e AR, porém, são ainda necessários estudos adicionais de citometria de fluxo destinados a investigar os mecanismos imunológicos na base destas duas patologias.info:eu-repo/semantics/publishedVersio