Browsing by Issue Date, starting with "2017-01"
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- Pre-operative predictors of red blood cell transfusion in liver transplantationPublication . Fernandes, D.; Real, C.; Romão, P.; Barros, F.; Aragão, I.; Fonseca, L.; Aguiar, J.; Branco, T.; Moreira, Z.; Esteves, S.
- Rotterdam Prostate Cancer Risk Calculator: Development and Usability Testing of the Mobile Phone AppPublication . Pereira-Azevedo, N.; Osório, L.; Fraga, A.; Roobol, M.BACKGROUND: The use of prostate cancer screening tools that take into account relevant prebiopsy information (ie, risk calculators) is recommended as a way of determining the risk of cancer and the subsequent need for a prostate biopsy. This has the potential to limit prostate cancer overdiagnosis and subsequent overtreatment. mHealth apps are gaining traction in urological practice and are used by both practitioners and patients for a variety of purposes. OBJECTIVE: The impetus of the study was to design, develop, and assess a smartphone app for prostate cancer screening, based on the Rotterdam Prostate Cancer Risk Calculator (RPCRC). METHODS: The results of the Rotterdam arm of the European Randomized Study of Screening for Prostate Cancer (ERSPC) study were used to elaborate several algorithms that allowed the risk of prostate cancer to be estimated. A step-by-step workflow was established to ensure that depending on the available clinical information the most complete risk model of the RPCRC was used. The user interface was designed and then the app was developed as a native app for iOS. The usability of the app was assessed using the Post-Study System Usability Questionnaire (PSSUQ) developed by IBM, in a group of 92 participants comprising urologists, general practitioners, and medical students. RESULTS: A total of 11 questions were built into the app, and, depending on the answers, one of the different algorithms of the RPCRC could be used to predict the risk of prostate cancer and of clinically significant prostate cancer (Gleason score ≥7 and clinical stage >T2b). The system usefulness, information quality, and interface quality scores were high-92% (27.7/30), 87% (26.2/30), and 89% (13.4/15), respectively. No usability problems were identified. CONCLUSIONS: The RPCRC app is helpful in predicting the risk of prostate cancer and, even more importantly, clinically significant prostate cancer. Its algorithms have been externally validated before and the usability score shows the app's interface is well designed. Further usability testing is required in different populations to verify these results and ensure that it is easy to use, to warrant a broad appeal, and to provide better patient care.
- Toxoplasmosis-associated IRIS involving the CNS: a case report with longitudinal analysis of T cell subsetsPublication . Rb-Silva, R.; Nobrega, C.; Reiriz, E.; Almeida, S.; Sarmento-Castro, R.; Correia-Neves, M.; Horta, A.BACKGROUND: HIV-infected patients may present an unforeseen clinical worsening after initiating antiretroviral therapy known as immune reconstitution inflammatory syndrome (IRIS). This syndrome is characterized by a heightened inflammatory response toward infectious or non-infectious triggers, and it may affect different organs. Diagnosis of IRIS involving the central nervous system (CNS-IRIS) is challenging due to heterogeneous manifestations, absence of biomarkers to identify this condition, risk of long-term sequelae and high mortality. Hence, a deeper knowledge of CNS-IRIS pathogenesis is needed. CASE PRESENTATION: A 37-year-old man was diagnosed with AIDS and cerebral toxoplasmosis. Anti-toxoplasma treatment was initiated immediately, followed by active antiretroviral therapy (HAART) 1 month later. At 2 months of HAART, he presented with progressive hyposensitivity of the right lower limb associated with brain and dorsal spinal cord lesions, compatible with paradoxical toxoplasmosis-associated CNS-IRIS, a condition with very few reported cases. A stereotactic biopsy was planned but was postponed based on its inherent risks. Patient showed clinical improvement with no requirement of corticosteroid therapy. Routine laboratorial analysis was complemented with longitudinal evaluation of blood T cell subsets at 0, 1, 2, 3 and 6 months upon HAART initiation. A control group composed by 9 HIV-infected patients from the same hospital but with no IRIS was analysed for comparison. The CNS-IRIS patient showed lower percentage of memory CD4+ T cells and higher percentage of activated CD4+ T cells at HAART initiation. The percentage of memory CD4+ T cells drastically increased at 1 month after HAART initiation and became higher in comparison to the control group until clinical recovery onset; the percentage of memory CD8+ T cells was consistently lower throughout follow-up. Interestingly, the percentage of regulatory T cells (Treg) on the CNS-IRIS patient reached a minimum around 1 month before symptoms onset. CONCLUSION: Although both stereotactic biopsies and steroid therapy might be of use in CNS-IRIS cases and should be considered for these patients, they might be unnecessary to achieve clinical improvement as shown in this case. Immunological characterization of more CNS-IRIS cases is essential to shed some light on the pathogenesis of this condition.
- PROTOCOLO DE AVALIAÇÃO E CONTROLO DA DOR AGUDA NO DOENTE PEDIÁTRICOPublication . Amaral-Bastos, M.; Vilela, B.; Cardoso, C.INTRODUÇÃO: a prevenção, avaliação e controlo da dor em pediatria, pelas caraterísticas próprias dos seus utentes, constitui um desafio para os profissionais de saúde, pelo que constituímos uma equipa com a missão de elaborar um Protocolo de Orientação Clínica (POC) para a avaliação e controlo da dor aguda no doente pediátrico. OBJETIVOS: apresentar o percurso para elaboração e implementação do POC na instituição;divulgar alguns conteúdos do POC; apresentar resultados da última monitorização. MATERIAIS E MÉTODOS: constituiu-se uma equipa com médicos e enfermeiros, com representação de pediatria, anestesiologia, cirurgia e cuidados intensivos; foi elaborado e implementado o POC da dor aguda no doente pediátrico e efetuada monitorização dos registos. RESULTADOS: o POC apresenta as escalas de avaliação da dor, define critérios de seleção, metodologia de avaliação, registo de intensidade, intervenções farmacológicas e não farmacológicas e define estratégias de atuação em procedimentos dolorosos. Efetuada formação às diversas equipas médicas e de enfermagem e várias monitorizações pontuais. O início do registo informático aconteceu no dia 01/06/2013. O POC foi revisto em 2015. Efetuamos um levantamento retrospetivo dos registos da dor dos dias 4, 12, 20 e 28/01/2016 no Serviço de Cuidados Intensivos Pediátricos (SCIP) a um total de 29 crianças e no Serviço de Cuidados Intensivos Neonatais (SCIN) a um total de 79 recém-nascidos. Definimos 3 indicadores: (i) intervenção avaliar dor - no SCIP 93.3% das crianças tinham a intervenção programada e no SCIN 96.2%; (ii) avaliação da dor em 3 turnos nas 24h - no SCIP foi avaliada a dor a 66.8% das crianças e no SCIN a 90%; (iii) intensidade da dor - no SCIP 29.6% das crianças tiveram dor ligeira, 22.2% moderada e 11.1% intensa, no SCIN 78.9% tiveram dor ligeira e 12.7% moderada. Relativamente às escalas utilizadas verificamos que no SCIP a FLACC-R foi aplicada a 38.4% das crianças, a EDIN a 30.8%, a FLACC a 15.4% e Escalas de Autoavaliação a 15.4%. No SCIN, a 95.9% das crianças foi aplicada a escala de EDIN e a 4.1% a N-PASS. CONCLUSÃO: A avaliação e controlo da dor aguda é uma mais valia para a instituição e para as crianças/família a quem disponibiliza cuidados de saúde. Embora não tenhamos crianças com dor muito intensa, os resultados encontram-se aquém das expectativas, contudo, resultam do percurso efetuado e revelam potencial para desenvolver este projeto de melhoria da qualidade
- Neuropsychiatric Systemic Lupus Erythematosus Involvement: Towards a Tailored Approach to Our Patients?Publication . Faria, R.; Gonçalves, J.; Dias, R.Neuropsychiatric involvement in systemic lupus erythematosus (NPSLE) is a complex condition that remains poorly understood, and includes heterogeneous manifestations involving both the central and peripheral nervous system, with disabling effects. There are several models to improve NPSLE diagnosis when a neurological syndrome is present. In the last couple of years, the growing knowledge of the role of cytokines and antibodies in NPSLE, as well as the development of new functional imaging techniques, has brought some insights into the physiopathology of the disease, but their validation for clinical use remains undetermined. Furthermore, besides the classic clinical approach, a new tool for screening the 19 NPSLE syndromes has also been developed. Regarding NPSLE therapeutics, there is still no evidence-based treatment approach, but some data support the safety of biological medication when classic treatment fails. Despite the tendency to reclassify SLE patients in clinical and immunological subsets, we hope that these data will inspire medical professionals to approach NPSLE in a manner more tailored to the individual patient.
- Genetic polymorphisms in key hypoxia-regulated downstream molecules and phenotypic correlation in prostate cancerPublication . Fraga, A.; Ribeiro, R.; Coelho, A.; Vizcaíno, J.; Coutinho, H.; Lopes, J.; Príncipe, P.; Lobato, C.; Lopes, C.; Medeiros, R.Background In this study we sought if, in their quest to handle hypoxia, prostate tumors express target hypoxia-associated molecules and their correlation with putative functional genetic polymorphisms. Methods Representative areas of prostate carcinoma (n = 51) and of nodular prostate hyperplasia (n = 20) were analysed for hypoxia-inducible factor 1 alpha (HIF-1α), carbonic anhydrase IX (CAIX), lysyl oxidase (LOX) and vascular endothelial growth factor (VEGFR2) immunohistochemistry expression using a tissue microarray. DNA was isolated from peripheral blood and used to genotype functional polymorphisms at the corresponding genes (HIF1A +1772 C > T, rs11549465; CA9 + 201 A > G; rs2071676; LOX +473 G > A, rs1800449; KDR – 604 T > C, rs2071559). Results Immunohistochemistry analyses disclosed predominance of positive CAIX and VEGFR2 expression in epithelial cells of prostate carcinomas compared to nodular prostate hyperplasia (P = 0.043 and P = 0.035, respectively). In addition, the VEGFR2 expression score in prostate epithelial cells was higher in organ-confined and extra prostatic carcinoma compared to nodular prostate hyperplasia (P = 0.031 and P = 0.004, respectively). Notably, for LOX protein the immunoreactivity score was significantly higher in organ-confined carcinomas compared to nodular prostate hyperplasia (P = 0.015). The genotype-phenotype analyses showed higher LOX staining intensity for carriers of the homozygous LOX +473 G-allele (P = 0.011). Still, carriers of the KDR−604 T-allele were more prone to have higher VEGFR2 expression in prostate epithelial cells (P < 0.006). Conclusions Protein expression of hypoxia markers (VEGFR2, CAIX and LOX) on prostate epithelial cells was different between malignant and benign prostate disease. Two genetic polymorphisms (LOX +473 G > A and KDR−604 T > C) were correlated with protein level, accounting for a potential gene-environment effect in the activation of hypoxia-driven pathways in prostate carcinoma. Further research in larger series is warranted to validate present findings.