Porto biomedical journal最新文献

{"title":"Cold snare unmasking as a one-stop-shop procedure for an unequivocal (tissue) diagnosis of gastric lipomas lacking characteristic findings on standard endoscopy.","authors":"Vincent Zimmer","doi":"10.1097/j.pbj.0000000000000229","DOIUrl":"10.1097/j.pbj.0000000000000229","url":null,"abstract":"To the Editor: Gastric subepithelial lesions (SELs) are common in endoscopy practice. Clinical management depends on multiple factors including tissue diagnosis and thus assessment of malignant potential. While current guideline recommendations prioritize endoscopic ultrasound (EUS) characterization with or without puncture, a one-stop-shop approach to be implemented during index esophagogastroduodenoscopy (EGD) may streamline","PeriodicalId":74479,"journal":{"name":"Porto biomedical journal","volume":"8 5","pages":"e229"},"PeriodicalIF":0.0,"publicationDate":"2023-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10575347/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41241934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosis and referral of patients with AL amyloidosis in Portugal: results from a Delphi panel.","authors":"Rui Bergantim,&nbsp;André Caetano,&nbsp;Francisco F Silva,&nbsp;Isabel Tavares,&nbsp;Manuela Ferreira,&nbsp;Ana R Jaime,&nbsp;Graça V Esteves","doi":"10.1097/j.pbj.0000000000000231","DOIUrl":"10.1097/j.pbj.0000000000000231","url":null,"abstract":"<p><p>Light chain amyloidosis (AL) is a complex disorder defined by the extracellular deposition of insoluble amyloid fibrils formed by intact or fragmented immunoglobulin light chains, leading to cell dysfunction, rapid organ deterioration, and, ultimately, death. Although the clinical presentation of AL is directly connected to organ involvement, signs and symptoms of AL are frequently nonspecific, misinterpreted, and late recognized. Thus, an early diagnosis combined with effective therapies to cease disease progression and rescue organ function is essential. The aim of this study was to assess the knowledge and characterize the current clinical practice regarding AL diagnosis and referral among Portuguese physicians. A Delphi-like panel (one round only) with a group of national experts from different medical specialties (cardiology, hematology, internal medicine, nephrology, and neurology) was carried out online, in which 30 statements were classified using a 4-point Likert scale. For each statement, the consensus level was set at 70% for \"fully agree/disagree\" and the majority level was defined as >70% in agreement or disagreement. Although the results suggest the existence of adequate general knowledge of AL amyloidosis, they also disclosed the necessity to raise awareness for this disease. Overall, this Delphi panel revealed a high lack of consensus regarding the diagnosis and early management of patients with AL among different specialties despite the qualified majority obtained in 26 statements. An optimized strategy for AL early diagnosis, transversal to several medical fields, is urgently needed. Moreover, referral centers with access to diagnostic technology and a network of diverse specialties should be established to foster an early diagnosis and better disease approach to boost the possibility of a better outcome for patients with AL.</p>","PeriodicalId":74479,"journal":{"name":"Porto biomedical journal","volume":"8 5","pages":"e231"},"PeriodicalIF":0.0,"publicationDate":"2023-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a8/c5/pj9-8-e231.PMC10575365.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41241935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sixty years of the Bruce protocol: reappraising the contemporary role of exercise stress testing with electrocardiographic monitoring.","authors":"Eduardo M Vilela, Cátia Oliveira, Cláudia Oliveira, Susana Torres, Francisco Sampaio, João Primo, José Ribeiro, Madalena Teixeira, Marco Oliveira, Nuno Bettencourt, Sofia Viamonte, Ricardo Fontes-Carvalho","doi":"10.1097/j.pbj.0000000000000235","DOIUrl":"10.1097/j.pbj.0000000000000235","url":null,"abstract":"<p><p>The cardiovascular response to exercise has long been a focus of interest. Over a century ago, the first descriptions of electrocardiographic changes occurring during exercise highlighted the possible relevance of this dynamic assessment. In this background, the inception of the Bruce protocol circa 60 years ago allowed for a major leap in this field by providing a standardized framework with which to address this issue, by means of an integrated and structured methodology. Since then, exercise stress testing with electrocardiographic monitoring (ExECG) has become one of the most widely appraised tests in cardiovascular medicine. Notably, past few decades have been profoundly marked by substantial advances in the approach to cardiovascular disease, challenging prior notions concerning both its physiopathology and overall management. Among these, the ever-evolving presentations of cardiovascular disease coupled with the development and implementation of several novel diagnostic modalities (both invasive and noninvasive) has led to a shifting paradigm in the application of ExECG. This technique, however, has continuously shown to be of added value across various momentums of the cardiovascular continuum, as depicted in several contemporary guidelines. This review provides a pragmatical reflexion on the development of ExECG, presenting a comprehensive overview concerning the current role of this modality, its challenges, and its future perspectives.</p>","PeriodicalId":74479,"journal":{"name":"Porto biomedical journal","volume":"8 5","pages":"e235"},"PeriodicalIF":0.0,"publicationDate":"2023-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/44/84/pj9-8-e235.PMC10575366.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41241939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The clinical challenge of refractory eosinophilic fasciitis.","authors":"Daniela Oliveira,&nbsp;Ana Martins,&nbsp;Filipe Pinheiro,&nbsp;Maria Rato,&nbsp;Diogo Fonseca,&nbsp;Carlos Vaz,&nbsp;Pedro Madureira,&nbsp;Lúcia Costa","doi":"10.1097/j.pbj.0000000000000230","DOIUrl":"10.1097/j.pbj.0000000000000230","url":null,"abstract":"To the Editor: Eosinophilic fasciitis (EF) is a rare connective tissue disease, with unclear etiology, characterized by hardening and thickening of the skin, mainly affecting the upper and lower extremities. This condition is associated with peripheral eosinophilia, elevated erythrocyte sedimentation rate (ESR), and hypergammaglobuli-nemia. Most patients with EF respond to high-dose corticosteroids. Thus, a case of EF is being reported for its rarity and partial response to prednisolone. We report a case of a 47-year-old woman with a personal history of multinodular goiter and no usual medication. This patient was admitted to the rheumatology service because of pain and skin hardening of right upper and lower limbs for the past 5 months. There were no systemic complaints; skin rash; Raynaud phenomenon; genital or oral ulcers; and respiratory, gastrointestinal, or genitourinary manifestations. No trauma or exacerbated physical activity was reported. During these months, the patient was medicated with an anti-inflammatory drug and low-dose corticosteroid for a small period, without significant relief. General physical examination was normal. On physical examination, skin thickening was observed on the right leg and forearm. On the forearm, the groove sign was visible when the patient raised the upper limb (Fig. 1). Left limbs, hands, and fingers were unaffected. There were no other mucocutaneous changes or peripheral arthritis. On investigation, she had peripheral eosinophilia (0.8 3 10 9 /L, normal range, , 0.5 3 10 9 /L), an elevated ESR (43 mm in the first hour), and proteinogram with a polyclonal hypergammaglobu-linemia","PeriodicalId":74479,"journal":{"name":"Porto biomedical journal","volume":"8 5","pages":"e230"},"PeriodicalIF":0.0,"publicationDate":"2023-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10575353/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41241941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of obesity on liver function tests: is nonalcoholic fatty liver disease the only player? A review article.","authors":"Mervat M El-Eshmawy","doi":"10.1097/j.pbj.0000000000000228","DOIUrl":"10.1097/j.pbj.0000000000000228","url":null,"abstract":"<p><strong>Objectives: </strong>Obesity and nonalcoholic fatty liver disease (NAFLD) are common worldwide health problems with a strong relationship in between. NAFLD is currently the most common cause of abnormal liver function tests (LFT) because of obesity pandemic. The question is NAFLD the only player of abnormal LFT in obesity?</p><p><strong>Methodology: </strong>This article reviews the most important topics regarding the derangements of LFT in obesity through a PubMed search strategy for all English-language literature.</p><p><strong>Results: </strong>The reported abnormal LFT in obesity were increased serum levels of transaminases (alanine aminotransaminase, aspartate aminotransaminase), gamma glutamyl transferase, and alkaline phosphatase and decreased serum levels of bilirubin and albumin. Besides novel potential hepatic markers of NAFLD/NASH such as triglycerides/high-density lipoprotein cholesterol ratio, sex hormone-binding globulin, fibroblast growth factor 21, and markers of hepatocyte apoptosis i.e. cytokeratin 18 and microribonucleic acids (miRNAs). Beyond NAFLD, there are other underlying players for the abnormal LFT in obesity such as oxidative stress, inflammation, and insulin resistance.</p><p><strong>Conclusion: </strong>Derangements of LFT in obesity are attributed to NAFLD but also to obesity itself and its related oxidative stress, insulin resistance, and chronic inflammatory state. Abnormal LFT predict more than just liver disease.</p>","PeriodicalId":74479,"journal":{"name":"Porto biomedical journal","volume":"8 5","pages":"e228"},"PeriodicalIF":0.0,"publicationDate":"2023-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/56/20/pj9-8-e228.PMC10575409.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41241936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spinal cord infarction after supraventricular tachycardia-A diagnosis not to be forgotten.","authors":"Marta D Martins,&nbsp;Ana Rocha,&nbsp;Marina Mendes,&nbsp;João Rocha,&nbsp;Inês Ferreira","doi":"10.1097/j.pbj.0000000000000232","DOIUrl":"10.1097/j.pbj.0000000000000232","url":null,"abstract":".","PeriodicalId":74479,"journal":{"name":"Porto biomedical journal","volume":"8 5","pages":"e232"},"PeriodicalIF":0.0,"publicationDate":"2023-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10575348/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41241940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Portuguese consensus on the prevention and treatment of nausea and vomiting induced by cancer treatments.","authors":"Cláudia Vieira,&nbsp;Rui Bergantim,&nbsp;Elsa Madureira,&nbsp;Juan C M Barroso,&nbsp;Miguel Labareda,&nbsp;Sara T Parreira,&nbsp;Ana Castro,&nbsp;Ana Macedo,&nbsp;Sandra Custódio","doi":"10.1097/j.pbj.0000000000000234","DOIUrl":"10.1097/j.pbj.0000000000000234","url":null,"abstract":"<p><p>Chemotherapy-induced nausea and vomiting (CINV) and radiotherapy-induced nausea and vomiting (RINV) strongly affect the quality of life of patients with cancer. Inadequate antiemetic control leads to the decline of patients' quality of life, increases rescue interventions, and may even compromise adherence to cancer treatment. Although there are international recommendations for controlling CINV and RINV, these recommendations focus mainly on pharmacological management, with scarce information on additional measures that patients may adopt. Moreover, the prophylaxis and management of CINV/RINV are not always applied. Thus, we identified the need to systematize the strategies for preventing and managing CINV/RINV and the associated risk factors to implement and promote effective prophylactic antiemetic regimens therapy in patients with cancer. This review sought to create a set of practical recommendations for managing and controlling CINV/RINV, according to the current international recommendations for antiemetic therapy and the main risk factors. Conclusively, we intended to produce a patient-centered guidance document for health care professionals focused on the awareness, monitoring, and treatment of CINV/RINV.</p>","PeriodicalId":74479,"journal":{"name":"Porto biomedical journal","volume":"8 5","pages":"e234"},"PeriodicalIF":0.0,"publicationDate":"2023-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/08/0b/pj9-8-e234.PMC10575355.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41241937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence of postoperative residual neuromuscular blockade - A multicenter, observational study in Portugal (INSPIRE 2).","authors":"Simão Esteves,&nbsp;Filinto Correia de Barros,&nbsp;Catarina S Nunes,&nbsp;Andreia Puga,&nbsp;Blandina Gomes,&nbsp;Fernando Abelha,&nbsp;Humberto Machado,&nbsp;Milene Ferreira,&nbsp;Nuno Fernandes,&nbsp;Paula Vítor,&nbsp;Sandra Pereira,&nbsp;Teresa A Lapa,&nbsp;Vítor Pinho-Oliveira","doi":"10.1097/j.pbj.0000000000000225","DOIUrl":"https://doi.org/10.1097/j.pbj.0000000000000225","url":null,"abstract":"<p><strong>Background: </strong>Although the use of neuromuscular blocking agents (NMBAs) optimizes surgical conditions and facilitates tracheal intubation, it can lead to residual neuromuscular blockade (RNMB), with postoperative complications. This study aimed to assess RNMB incidence and management in Portugal.</p><p><strong>Methods: </strong>Prospective observational study of patients admitted for elective surgery requiring general anesthesia with nondepolarizing NMBAs between July 2018 and July 2019 at 10 Portuguese hospitals. The primary endpoint was the proportion of patients arriving at postanesthesia care unit (PACU) with a TOF ratio <0.9.</p><p><strong>Results: </strong>A total of 366 patients were included, with a median age of 59 years, and 89.1% classified as ASA II or III. Rocuronium was the most used NMBA (99.5%). A total of 96.2% of patients received a reversal agent, 96.6% of which sugammadex and 3.4% neostigmine. Twenty patients displayed a TOF ratio <0.9 at PACU arrival, representing an RNMB incidence of 5.5% (95% CI, 3.1%-7.8%). Only two patients displayed a TOF ratio <0.7. RNMB incidence was 16.7% with neostigmine and 5.3% with sugammadex (<i>P</i> = .114). In patients with intraoperative neuromuscular blockade (NMB) monitoring, RNMB incidence was 5% (95% CI, 2%-8%), which varied significantly according to the type of monitoring (<i>P</i> = .018). Incidence of adverse events was 3.3% (2 severe and 10 moderate).</p><p><strong>Conclusions: </strong>The reported overall incidence of 5.5% is numerically lower than results from similar observational studies. An appropriate pharmacological neuromuscular reversal strategy, guided by quantitative neuromuscular monitoring, has the potential to achieve even better results, converting RNMB from an unusual to a very rare or even inexistent event.</p>","PeriodicalId":74479,"journal":{"name":"Porto biomedical journal","volume":"8 4","pages":"e225"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/7f/c1/pj9-8-e225.PMC10400047.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10309311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic treatment of gastroesophageal reflux: a narrative review.","authors":"Samuel Oliveira Lopes,&nbsp;Ana Raquel Gonçalves,&nbsp;Guilherme Macedo,&nbsp;João Santos-Antunes","doi":"10.1097/j.pbj.0000000000000226","DOIUrl":"https://doi.org/10.1097/j.pbj.0000000000000226","url":null,"abstract":"<p><p>Gastroesophageal reflux disease (GERD) is a common chronic disease that affects one-third of the population worldwide. In recent years, there have been significant advances for diagnostic workup, which leads to better identification of reflux-related complications. Classically, the mainstay of therapy has been proton pump inhibitor and lifestyle and dietary modifications. For refractory GERD the gold-standard therapies are surgical antireflux procedures. Recently, endoscopic procedures have emerged as safe and efficient alternatives to surgery. These could represent a less invasive approach, with scarce morbidity and with a well-tolerated profile. Each of the existing endoscopic techniques for the treatment of GERD are addressed in this report, highlighting their potential advantages, aiming at helping decide the best management of these patients. Future studies, with larger numbers of patients, may allow a definitive role for these techniques in the management of GERD to be established.</p>","PeriodicalId":74479,"journal":{"name":"Porto biomedical journal","volume":"8 4","pages":"e226"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e9/f8/pj9-8-e226.PMC10400068.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10309312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of repetitive influenza vaccination against SARS-CoV-2 infection among a cohort of health care workers in Portugal.","authors":"Susana Sá Silva,&nbsp;Milton Severo,&nbsp;Pedro Norton,&nbsp;André Moreira","doi":"10.1097/j.pbj.0000000000000223","DOIUrl":"https://doi.org/10.1097/j.pbj.0000000000000223","url":null,"abstract":"<p><p>Vaccination for influenza has been essential over the years to protect the most vulnerable populations. Moreover, it was recently suggested that influenza vaccination might confer some nonspecific immunity to other viruses and be associated with a lower risk for coronavirus disease 2019 (COVID-19) morbidity and mortality. Therefore, we aimed to assess the effectiveness of repetitive influenza vaccination against SARS-CoV-2 infection in a cohort of health care workers (HCWs). This study was conducted among HCWs at São João University Hospital Center (CHUSJ), Porto, Portugal, a tertiary reference hospital for diagnosis and therapy, one of the largest hospitals in the country with approximately 6000 HCWs. We analyzed databases for influenza vaccination conducted between 2012 and 2019 and COVID-19 laboratory testing retrieved from the first and last registered positive COVID test date before HCW's COVID-19 vaccination started. The study outcome was the incidence of the first SARS-CoV-2 infection, as determined by reverse transcription polymerase chain reaction (RT-PCR). Age and sex were considered potential confounders. We used multivariable Cox regression to estimate odds ratios. Neither the absolute number nor the proportion of influenza shots influenced the risk of getting infected by SARS-CoV-2 (adjusted odds ratio 1.02, 95% CI: 0.9-1.06 and 1.17 95% CI: 0.86-1.58, respectively). Similar findings were observed in most cases when the analysis was restricted by year. The findings from our retrospective observational analysis of a HCWs cohort failed to support any protective effect between repetitive influenza vaccination and SARS-CoV-2 infection.</p>","PeriodicalId":74479,"journal":{"name":"Porto biomedical journal","volume":"8 4","pages":"e223"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e8/4f/pj9-8-e223.PMC10400066.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10007369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}