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A Rare Case of Pleural Empyema Caused by Campylobacter Rectus
No full textCampylobacter rectus is considered to be a primary periodontal pathogen that is rarely identified in extraoral specimens. We report a case of pleural empyema caused by Campylobacter rectus: the pathogen was isolated in the drained pleural fluid sample. Since the patient had previously undergone multiple antibiotic treatments, oral cultures were highly unlikely to be positive, although poor dental hygiene appears to be the leading risk factor for C. rectus systemic infections. The present case illustrates that C. rectus can be a cause of not only periodontal disease but also pulmonary infection.info:eu-repo/semantics/publishedVersio
Gynecological History Up to Diagnosis and Pregnancy Outcomes in Diagnosed Wilson's Disease Under Therapy - a Bicentric Matched Control Cohort Study
No full textIntroduction: most studies narrowly focus on pregnancy outcome comparisons between Wilson’s disease (WD)
patients on and off treatment. We aimed to identify menses irregularities in untreated WD, and to evaluate pregnancy outcomes in treated WD patients as compared to matched controls (with and without liver disease).
Methods: females with WD, hepatitis C (liver disease controls), and other gastrointestinal conditions (controls without liver disease) were identified at two tertiary hospital
gastroenterology departments. Gynecological and obstetric data were retrospectively collected. A comparison of gynecological and obstetric outcomes was performed between the groups, and regression models were used to further assess obstetric outcomes.
Results: a total of 18 females with WD were identified, comprising 19 pregnancies under treatment in 11 patients, and 20 females were included in each control group. Age and liver disease stage were adjusted between groups. The incidence of menses irregularities was higher for WD (late menarche, 83 % vs. 10 % vs. 10 %, p < 0.01; irregular cycles, 100 % vs. 20 % vs. 20 %, p < 0.01; amenorrhea, 67 % vs. 10 % vs. 5 %, p < 0.01). Logistic regression models identified WD as a predictor of miscarriage and low birth weight (OR:
6.0; CI: 1.1-33.3; p < 0.05) but not of birth defects. Neither therapies (D-penicillamine 300 mg or zinc acetate 150 mg) nor disease presentation (hepatic and/or neurological) were associated with obstetric complications in WD subjects.
Conclusion: there was a higher incidence of menses irregularities in untreated females with WD. In addition, our data suggest that treated WD still carries a higher risk of spontaneous abortion and low birth weight when compared to matched control groups with and without liver disease.info:eu-repo/semantics/publishedVersio
The Percentage of [−2]Pro–Prostate-Specific Antigen and the Prostate Health Index Outperform Prostate-Specific Antigen and the Percentage of Free Prostate-Specific Antigen in the Detection of Clinically Significant Prostate Cancer and Can Be Used as Reflex Tests
No full textContext.—: There is a need to avoid the overdiagnosis of prostate cancer (PCa) and to find more specific biomarkers.
Objective.—: To evaluate the clinical utility of [-2]pro-prostate-specific antigen ([-2]proPSA) derivatives in detecting clinically significant PCa (csPCa) and to compare it with prostate-specific antigen (PSA) and with the percentage of free PSA (%fPSA).
Design.—: Two hundred thirty-seven men (PSA: 2-10 ng/mL) scheduled for a prostate biopsy were enrolled. Parametric and nonparametric tests, receiver operating characteristic curves, and logistic regression analysis were applied. Outcomes were csPCa and overall PCa.
Results.—: Both [-2]proPSA derivatives were significantly higher in csPCa and overall PCa (P < .001). The areas under the curves for the prediction of csPCa were higher for the percentage of [-2]proPSA (%[-2]proPSA) (0.781) and the prostate health index (PHI) (0.814) than for PSA (0.651) and %fPSA (0.724). There was a gain of 11% in diagnostic accuracy when %[-2]proPSA or PHI were added to a base model with PSA and %fPSA. Twenty-five percent to 29% of biopsies could have been spared with %[-2]proPSA (cutoff: ≥1.25%) and PHI (cutoff: ≥27), missing 10% of csPCas. The same results could have been achieved by using [-2]proPSA as a reflex test, when %fPSA was 25% or less (cutoffs: ≥1.12% and ≥24 for %[-2]proPSA and PHI, respectively).
Conclusions.—: The [-2]proPSA derivatives improve the diagnostic accuracy of csPCa when the PSA value is between 2 and 10 ng/mL, sparing unnecessary biopsies and selecting patients for active surveillance. [-2]proPSA can be used as a reflex test when %fPSA is 25% or less, without reducing the diagnostic accuracy for csPCa and the number of spared biopsies.info:eu-repo/semantics/publishedVersio
Development and Validation of the Metric-Based Assessment of a Robotic Vessel Dissection, Vessel Loop Positioning, Clip Applying and Bipolar Coagulation Task on an Avian Model
No full textThe evolution of robotic technology and its diffusion does not seem to have been adequately accompanied by the development and implementation of surgeon training programs that ensure skilled and safe device use at the start of the learning curve. The objective of the study is to develop and validate performance metrics for vessel dissection, vessel loop positioning, clip applying and bipolar coagulation using an avian model. Three robotic surgeons and a behavioral scientist characterized the performance metrics of the task according to the proficiency-based progression methodology. Fourteen experienced robotic surgeons from different European countries participated in a modified online Delphi consensus. Eight experienced surgeons and eight novices performed the robotic task twice. In the Delphi meeting, 100% consensus was reached on the performance metrics. Novice surgeons took 26 min to complete the entire task on trial 1 and 20 min on trial 2. Experts took 10.1 min and 9.5 min. On average the Expert Group completed the task 137% faster than the Novice Group. The amount of time to reach the vessel part of the task was also calculated. Novice surgeons took 26 min on trial 1 and 20 min on trial 2. Experts took 5.5 min and 4.8 min. On average the experts reached the vessel 200% faster than the novices. The Expert Group made 155% fewer performance errors than the Novice Group. The mean IRR of video-recorded performance assessments for all metrics was 0.96 (95% confidence intervals (CI) lower = 0.94-upper = 0.98). We report the development and validation for a standard and replicable basic robotic vessel dissection, vessel loop positioning, clip applying and bipolar coagulation task on an avian model. The development of objective performance metrics, based on a transparent and fair methodology (i.e., PBP), is the first fundamental step toward quality assured training. This task developed on the avian model proved to have good results in the validation study.info:eu-repo/semantics/publishedVersio
Predictive Factors of Relapse After Methotrexate Discontinuation in Juvenile Idiopathic Arthritis Patients With Inactive Disease
No full textObjective: To identify predictive factors of relapse after discontinuation of Methotrexate (MTX) in Juvenile Idiopathic Arthritis (JIA) patients with inactive disease.
Methods: We conducted a prospective multicenter cohort study of patients diagnosed with JIA using real world data from the Portuguese national register database, Reuma.pt. Patients with JIA who have reached JADAS27 inactive disease and discontinued MTX before the age of 18 were evaluated.
Results: A total of 1470 patients with JIA were registered in Reuma.pt. Of the 119 bionaive patients who discontinued MTX due to inactive disease, 32.8% have relapsed. Median time of persistence (using the Kaplan-Meier method and log-rank tests) with inactive disease was significantly higher in patients with more than two years of remission before MTX discontinuation and in those who did not use NSAIDs at time of MTX discontinuation. In Cox regression analyses and after adjustment for age at diagnosis, MTX tapering and JIA category, the use of NSAIDs at the time of MTX discontinuation (HR, 1.98 95%CI 1.03-3.82) and remission time of less than two years before suspension (HR, 3.12 95%CI 1.35-7.13) remained associated with relapse. No association was found between JIA category or the regimen of MTX discontinuation and the risk of relapse.
Conclusions: In this large cohort we found that the use of NSAIDs at the time of MTX discontinuation was associated with a two times higher likelihood of relapse. In addition, longer duration of remission before MTX withdrawal reduces the chance of relapse in bionaive JIA patients.info:eu-repo/semantics/publishedVersio
A Aterosclerose nos Cuidados de Saúde Primários: Estudo da Vida Real
No full textIntroduction and objectives: To characterize patients with atherosclerosis, a disease with a high socioeconomic impact, in the Lisbon and Tagus Valley Health Region.
Methods: A cross-sectional observational study was carried out through the Lisbon and Tagus Valley Regional Health Administration primary health care database, extracting data on the clinical and demographic characteristics and resource use of adult primary health care users with atherosclerosis during 2016. Different criteria were used to define atherosclerosis (presence of clinical manifestations, atherothrombotic risk factors and/or consumption of drugs related to atherosclerosis). Comparisons between different subpopulations were performed using parametric tests.
Results: A total of 318 692 users were identified, most of whom (n=224 845 users; 71%) had no recorded clinical manifestations. The subpopulation with clinical manifestations were older (72.0±11.5 vs. 71.3±11.0 years), with a higher proportion of men (58.0% vs. 45.9%), recorded hypertension (78.3% vs. 73.5%) and dyslipidemia (55.8% vs. 53.5%), and a lower proportion of recorded obesity (18.2% vs. 20.8%), compared to those without clinical manifestations (p<0.001). Mean blood pressure, LDL-C and glycated hemoglobin values were lower in the subpopulation with manifestations (142/74 vs. 146/76 mmHg, 101 vs. 108 mg/dl, and 6.80 vs. 6.84%, respectively; p<0.001). Each user with atherosclerosis attended 4.1±2.9 face-to-face medical consultations and underwent 8.6±10.0 laboratory test panels, with differences in subpopulations with and without clinical manifestations (4.4±3.2 vs. 4.0±2.8 and 8.3±10.3 vs. 8.7±9.8, respectively; p<0.001).
Conclusions: About one in three adult primary health care users with atherosclerosis have clinical manifestations. The results suggest that control of cardiovascular risk factors is suboptimal in patients with atherosclerosis.info:eu-repo/semantics/publishedVersio
Hepatite Sifilítica: uma Complicação Rara da Sífilis Secundária. O Reporte de um Caso
No full textSyphilis is a sexually transmitted disease caused by Treponema pallidum, progressing through active and latent stages if left untreated. Hepatic involvement can occur in secondary syphilis, but this is an uncommon complication, with few published case reports. A 34-year-old man without significant medical history was admitted to the gastroenterology department with a 2-week history of unexplained jaundice and acute cholestatic hepatitis. He also presented with erythematous papules and plaques in the genital area, suggestive of secondary syphilis. T. pallidum hemaglutination assay and venereal disease research laboratory test were both positive, the latter with a 1:16 titer. The diagnosis of secondary syphilis with hepatic involvement was considered. The improvement of cutaneous and laboratory findings after intramuscular benzathine penicillin injection supported this hypothesis. Symptomatic cholestatic hepatitis is a rare feature of the systemic spectrum of secondary syphilis. The clinical and laboratorial response after penicillin treatment is a strong clue for this diagnosis.info:eu-repo/semantics/publishedVersio
Fisiopatologia da Hidradenite Supurativa: uma Revisão Sistemática da Literatura
No full textHidradenitis suppurative (HS) is a multifactorial, recurrent, chronic inflammatory disease with a significant impact on patient’s quality of life. The etiopathogenesis of this complex condition is not fully understood. In this systematic review, we aimed to address and clarify the role of genetics, immunity, endocrinology, and skin microbiome together with risk factors in HS etio pathogenesis. A systematic review, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, was performed using PubMed® and Web of ScienceTM databases on December 3rd, 2021, using patient/population, intervention, comparison and outcomes (PICO) criteria, limited to the last 10 years and English. Reports were analyzed by
two independent reviewers. A total of 123 reports were included and divided into five sections: genetics, immunity, endocrino logy, microbiome, and risk factors. Regarding genetics, up to 30-40% of patients have a positive family history of HS but only a small subset of these harbor genetic variants in components of the gamma-secretase complex. In fact, in more than 90% of HS patients, the genetic features contributing to disease development remain largely unknown. The immune response is also crucial for HS; it is characterized by antimicrobial peptide and proinflammatory cytokine dysregulation, namely interleukin (IL)—IL-23, IL-12, and Th17 immune response. This immune response in local and, consequently, systemic inflammation is amplified in patients with metabolic syndrome. The relationship between metabolic syndrome and HS is clear, and patients with metabolic syndrome have a higher risk of developing HS. The most recent evidence also associates skin microbiota dysbiosis with HS pathogenesis, contributing to local and systemic inflammation. Besides these intrinsic factors, the role of lifestyle in the development of HS is well accepted. Tobacco smoking and obesity are the main risk factors identified as con tributing to HS pathogenesis. Chronic inflammation characterizes HS, a debilitating condition with a complex and multifactorial etiopathogenesis. The current model integrates genetics, immunity, endocrinology, and skin microbiome. Notwithstanding, efforts should be made to improve our comprehension of HS etiopathogenesis, hopefully leading to the development of more
effective treatments.A hidradenite supurativa (HS) é uma doença inflamatória, multifatorial, recorrente e crónica com um impacto significativo
na qualidade de vida dos doentes. A etiologia desta condição complexa não é totalmente compreendida. Nesta revisão
sistemática, pretende-se abordar e clarificar o papel da genética, imunidade, endocrinologia, microbioma cutâneo e fatores
de risco que contribuem para o desenvolvimento da HS. A revisão sistemática, seguindo as orientações PRISMA, foi rea lizada através de uma pesquisa bibliográfica nas bases de dados PubMed® e da Web of ScienceTM a 3 de dezembro
de 2021, utilizando critérios do PICO, e limitada aos últimos 10 anos e inglês. Os estudos a serem incluídos foram anali sados por dois revisores independentes. Um total de 123 estudos foram selecionados e divididos em cinco secções:
genética, imunidade, endocrinologia, microbioma e fatores de risco. Em relação à genética, cerca de 30-40% dos doentes
têm uma história familiar positiva de HS, mas as variantes genéticas das componentes do complexo da gama secretase
só estão identificadas num número reduzido de doentes. De facto, em mais de 90% dos doentes com HS, a componente
genética que contribui para o desenvolvimento da doença permanece desconhecida. A resposta imunitária é também
crucial para a HS: caracteriza-se pela desregulação dos péptidos anti-microbianos assim como das citocinas pró-inflamatórias,
nomeadamente IL-23, IL-12 e resposta Th17. Esta resposta que ocorre na inflamação local e consequentemente sistémica
é exacerbada em doentes com síndrome metabólica. A relação entre a síndrome metabólica e a HS é clara, e os doentes
com síndrome metabólica tem um risco elevado para o desenvolvimento de HS. As evidências mais recentes correlacionam
também a disbiose do microbioma cutâneo com a patogénese da HS, contribuindo para a inflamação local e sistémica.
Além destes fatores intrínsecos, o papel do estilo de vida no desenvolvimento da HS está bem estabelecido. O tabagismo
e a obesidade são os principais fatores de risco identificados que contribuem para a patogénese da HS. A inflamação
crónica caracteriza a HS, uma condição debilitante com uma etiologia complexa e multifatorial. O presente modelo integra
a genética, a imunidade, a endocrinologia e o microbioma cutâneo, e poderá contribuir para o desenvolvimento de tratamentos mais eficazes.info:eu-repo/semantics/publishedVersio
First Trimester Examination of Fetal Anatomy: Clinical Practice Guideline by the World Association of Perinatal Medicine (WAPM) and the Perinatal Medicine Foundation (PMF)
No full textThis recommendation document follows the mission of the World Association of Perinatal Medicine in collaboration with the Perinatal Medicine Foundation. We aim to bring together groups and individuals throughout the world for precise standardization to implement the ultrasound evaluation of the fetus in the first trimester of pregnancy and improve the early detection of anomalies and the clinical management of the pregnancy. The aim is to present a document that includes statements and recommendations on the standard evaluation of the fetal anatomy in the first trimester, based on quality evidence in the peer-reviewed literature as well as the experience of perinatal experts around the world.info:eu-repo/semantics/publishedVersio