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Embryonal Sarcoma of the Liver in the Adult: Challenges in the Diagnosis of a Rare Entity
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Fontinha, Guilherme Nogueira

; Gama, João Martins

; Oliveira, Rui Caetano

; Cipriano, Augusta

GE-Portuguese Journal of Gastroenterology

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feb 2024, Volume 31 N. 1 Pages 54 - 59

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Introdução: O sarcoma embrionário do fígado (SEF) é uma neoplasia rara do fígado que ocorre principalmente em idades pediátricas. Fazer o diagnóstico correto pode ser um desafio, uma vez que os achados laboratoriais e radiológicos são muitas vezes inespecíficos e o imunofenótipo desta entidade é mal definido e algo variável. Apresentação do caso: Foi detetada em tomografia computorizada (CT) abdominal uma massa epigástrica volumosa numa mulher de 43 anos apresentando dor abdom-inal e distensão abdominal. A massa foi biopsada e submetida a estudo histopatológico. Microscopicamente, o tumor tinha características sarcomatoides e apresentava células multinucleadas com glóbulos hialinos com positividade para ácido periódico Schiff (APS). O estudo imunohistoquímico revelou positividade para vimentina, CD10, glipicano-3 e α1-antitripsina e negatividade para queratinas e marcadores de diferenciação muscular, adipocítica e melanocítica. Discussão/Conclusão: O SEF no adulto é uma raridade e o seu diagnóstico requer a ex-clusão de outras entidades. Embora algumas características microscópicas sejam muito comuns, estas permane-cem inespecíficas. A principal característica é a presença de células multinucleadas com glóbulos hialinos positivos para APS. Ainda que o estudo imunohistoquímico seja fundamental, o imunofenótipo também carece de especificidade e o SEF pode ter marcação variável para glipicano-3 e marcadores de diferenciação epitelial ou muscular. Apesar de ter sido descrito há mais de três décadas, o prognóstico e o tratamento ideal ainda não estão bem definidos, mas a cirurgia tem apresentado resultados favoráveis.

Abstract Introduction: Embryonal sarcoma of the liver (ESL) is a rare neoplasm of the liver occurring mainly in paediatric ages. Making the correct diagnosis can be challenging as the laboratory and radiological findings that are often nonspecific, and the tumour immunophenotype is poorly defined and even somewhat variable. Case Presentation: A large epigastric mass was detected in a computerized tomography scan of a 43-year-old woman presenting with abdominal pain and bloating. The mass was biopsied and submitted to histo-pathological study. Microscopically the tumour had sarcomatoid features and showed multinucleated cells with periodic acid-Schiff (PAS)-positive globules. Immunostaining revealed positivity for vimentin, CD10, glypican-3, and α1-antitrypsin and negativity for keratins, muscle, adipocytic, and melanocytic differentiation markers. The patient was then submitted to a left hepatectomy with similar histological findings. Discussion: ESL in adults is a rarity and its diagnosis requires the exclusion of other entities. While some microscopic features are very common, they remain nonspecific. The main feature is the presence of multinucleated cells with PAS-positive hyaline globules. While ancillary testing is key, the immunophenotype also lacks specificity and ESL may have variable staining for glypican-3 and epithelial or muscle differentiation markers. Although it has been described for more than 3 decades, the prognosis and optimal treatment are still not well defined, but surgery has yielded favourable results.

https://doi.org/10.1159/000528121

CETP gene polymorphisms and haplotypes are explanatory variables for HDL cholesterol level in sickle cell disease
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Cruz, N.R.C.

; Valente, T.N.S.

; Ferreira, F.O.

; Macedo, L.R.

; Belisário, A.R.

; Silva, C.M. da

; Oliveira, N.S.

; Gomides, A.F.F.

; Velloso-Rodrigues, C.

Brazilian Journal of Medical and Biological Research

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2024, Volume 57 elocation e12879

Abstract: En | Text: En | PDF: En

Variations in lipid profile have been observed in sickle cell disease (SCD) and understanding their relationship with disease severity is crucial. This study aimed to investigate the association of polymorphisms of the CETP gene and laboratory markers of disease severity with lipid profile in a pediatric population with SCD. Biochemical and anthropometric analyses and CETP and alpha-thalassemia genotyping were performed. The study included 133 children and adolescents with sickle cell anemia (SCA) or hemoglobin SC disease (SCC), in steady-state. The SCA and no hydroxyurea (no HU) groups had higher values of ApoB, total cholesterol, low-density lipoprotein cholesterol (LDL-C), and non-high-density lipoprotein cholesterol (non-HDL-C) compared to the SCC and HU groups. However, there were no significant differences in ApoA1 and HDL-C levels between the groups based on genotype. Furthermore, the groups with altered levels of ApoA1, HDL-C, and the triglyceride/HDL ratio exhibited lower hemoglobin (Hb) levels and higher white blood cell counts. Hb level was associated to HDL-C levels. Analysis of CETP gene variants showed that the minor alleles of rs3764261 (C>A), rs247616 (C>T), and rs183130 (C>T), as well as the TTA haplotype, are explanatory variables for HDL-C levels. These findings suggested that dyslipidemia in SCD, specifically related to HDL-C levels, may be influenced by individual genetic background. Additionally, further investigation is needed to determine if clinical manifestations are impacted by CETP gene variants.

https://doi.org/10.1590/1414-431x2023e12879

Health literacy and diabetic retinopathy
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Breder, J.C.

; Breder, I.

; Barreto, J.

; Fernandes, V.

; Zanchetta, F.

; Oliveira, B.A.

; Chaves, F.

; Sposito, A.

; Lima, M.H.M.

Brazilian Journal of Medical and Biological Research

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2024, Volume 57 elocation e13066

Abstract: En | Text: En | PDF: En

Health literacy (HL) is defined as a cognitive and social skill that determines the motivation and ability of individuals to understand and use information to promote and maintain proper health. Inadequate HL has been associated with worse outcomes in diabetes control, poor self-care, and higher hospitalization rates for some chronic diseases. We hypothesized that HL influences the prevalence of diabetic retinopathy (DR) among individuals with type 2 diabetes mellitus (T2DM) and that inadequate glycemic control would mediate this association. This was a cross-sectional study carried out with 288 participants of the “Brazilian Diabetes Study” cohort. Inclusion criteria were people diagnosed with T2DM aged between 40 and 70 years and ability to read and write. In the adequate HL group, DR was found in 16.5% of participants and in the inadequate HL group, it was found in 32.8% (P=0.0081). Individuals with inadequate HL had a higher risk of having DR, and this association was still statistically significant after adjusting for HbA1c, low-density lipoprotein cholesterol, systolic blood pressure, and diastolic blood pressure. In conclusion, HL is related to DR without the mediation of classical clinical variables.

https://doi.org/10.1590/1414-431x2023e13066

Assessing the reaction to and efficacy of the Screener drug discovery and development board game as a pedagogical tool in postgraduate courses
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Noël, F.

; Xexéo, G.

; Martins, M.A.

; Silva, E.J.R.

; Pupo, A.S.

; Magalhães, P.J.C.

; Lima-Júnior, R.C.P.

; Gadelha, K.K.L.

; Lima-Silva, K.

; Raimundo, J.M.

; Ghedini, P.C.

; Crespo-Lopez, M.E.

; Arrifano, G.P.

; Ferreira, J.

; Prediger, R.D.

; Militão, G.C.G.

; Oliveira, R.B.

; Hollais, A.W.

; Rodrigues, L.C.M.

; Carvalho, D.T.

; Costa, S.K.P.

; Martins, D.T.O.

Brazilian Journal of Medical and Biological Research

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2024, Volume 57 elocation e13258

Abstract: En | Text: En | PDF: En

Screener, a board game supplemented with online resources, was introduced and distributed by the Brazilian Society of Pharmacology and Experimental Therapeutics to postgraduate programs as an instructional tool for the process of drug discovery and development (DDD). In this study, we provided a comprehensive analysis of five critical aspects for evaluating the quality of educational games, namely: 1) description of the intervention; 2) underlying pedagogical theory; 3) identification of local educational gaps; 4) impact on diverse stakeholders; and 5) elucidation of iterative quality enhancement processes. We also present qualitative and quantitative assessments of the effectiveness of this game in 11 postgraduate courses. We employed the MEEGA+ online survey, comprising thirty-three close-ended unipolar items with 5-point Likert-type response scales, to assess student perceptions of the quality and utility of Screener. Based on 115 responses, the results indicated a highly positive outlook among students. In addition, we performed a preliminary evaluation of learning outcomes in two courses involving 28 students. Pre- and post-quizzes were applied, each consisting of 20 True/False questions directly aligned with the game's content. The analysis revealed significant improvement in students' performance following engagement with the game, with scores rising from 8.4 to 13.3 (P<0.0001, paired t-test) and 9.7 to 12.7 (P<0.0001, paired t-test). These findings underscore the utility of Screener as an enjoyable and effective tool for facilitating a positive learning experience in the DDD process. Notably, the game can also reduce the educational disparities across different regions of our continental country.

https://doi.org/10.1590/1414-431x2023e13258

Incidence of childhood cancer in Latin America and the Caribbean: coverage, patterns, and time trends
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de Paula Silva, Neimar

; Colombet, Murielle

; Moreno, Florencia

; Erdmann, Friederike

; Dolya, Anastasia

; Piñeros, Marion

; Stiller, Charles A

; Steliarova-Foucher, Eva

; Steliarova-Foucher, E

; Colombet, M

; Gloeckler Ries, LA

; Moreno, F

; Dolya, A

; Shin, HY

; Hesseling, P

; Stiller, CA

; Moreno, F

; Laura, EA

; Duarte, MA

; Alonso, M

; Prince, MA

; Diumenjo, MC

; Arias Ondicol, N

; Lima, CA

; Mundim Pena, GP

; Asturian Laporte, C

; de Oliveira, JC

; Pontes de Aquino, JA

; Vallebuona, C

; Galaz, JC

; Umaña, ME

; Espinoza, C

; Vargas Gallagher, SM

; Uribe, CJ

; Bravo, LE

; Arias Ortiz, NE

; Yepez Chamorro, MC

; Torres Alvarado, G

; Galán Alvarez, YH

; Martinez Reyes, FC

; Tanca Campozano, J

; Castillo Calvas, JC

; Mendoza Alava, M

; Cueva Ayala, P

; Roué, T

; Deloumeaux, J

; Joachim, C

; Duarte Muñoz, F

; Hanchard, B

; Fajardo-Gutiérrez, A

; Payet, E

; Albújar, PF

; Zavala Zegarra, DE

; Barrios, E

Revista Panamericana de Salud Pública

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2024, Volume 48 elocation e11

Abstract: Es En Pt | Text: Es En Pt | PDF: Es | PDF: En | PDF: Pt

resumen está disponible en el texto completo

ABSTRACT Objective. To provide a comprehensive overview of geographical patterns (2001–2010) and time trends (1993–2012) of cancer incidence in children aged 0–19 years in Latin America and the Caribbean (LAC) and interpret the findings in the context of global patterns. Methods. Geographical variations in 2001–2010 and incidence trends over 1993–2012 in the population of LAC younger than 20 years were described using the database of the third volume of the International Incidence of Childhood Cancer study containing comparable data. Age-specific incidence per million person-years (ASR) was calculated for population subgroups and age-standardized (WSR) using the world standard population. Results. Overall, 36 744 unique cases were included in this study. In 2001–2010 the overall WSR in age 0–14 years was 132.6. The most frequent were leukemia (WSR 48.7), central nervous system neoplasms (WSR 23.0), and lymphoma (WSR 16.6). The overall ASR in age group 15–19 years was 152.3 with lymphoma ranking first (ASR 30.2). Incidence was higher in males than in females, and higher in South America than in Central America and the Caribbean. Compared with global data LAC incidence was lower overall, except for leukemia and lymphoma at age 0–14 years and the other and unspecified tumors at any age. Overall incidence at age 0–19 years increased by 1.0% per year (95% CI [0.6, 1.3]) over 1993–2012. The included registries covered 16% of population aged 0–14 years and 10% of population aged 15–19 years. Conclusions. The observed patterns provide a baseline to assess the status and evolution of childhood cancer occurrence in the region. Extended and sustained support of cancer registration is required to improve representativeness and timeliness of data for childhood cancer control in LAC.

RESUMO Objetivo. Apresentar uma visão abrangente dos padrões geográficos (2001 a 2010) e das tendências temporais (1993 a 2012) da incidência de câncer em crianças e jovens de 0 a 19 anos na América Latina e no Caribe (ALC) e interpretar os resultados no contexto de padrões mundiais. Métodos. Foram descritas variações geográficas de 2001 a 2010 e tendências de incidência de 1993 a 2012 na população com menos de 20 anos da ALC usando informações comparáveis da base de dados do terceiro volume do estudo International Incidence of Childhood Cancer. Foram calculadas taxas de incidência específica por idade por milhão de pessoas-ano (ASR, na sigla em inglês) para subgrupos populacionais e taxas padronizadas por idade usando a população padrão mundial (WSR, na sigla em inglês). Resultados. No total, foram incluídos 36 744 casos únicos. No período de 2001 a 2010, a WSR para todos os tumores combinados na faixa etária de 0 a 14 anos foi de 132,6. Os diagnósticos mais frequentes foram leucemia (WSR de 48,7), neoplasias do sistema nervoso central (WSR de 23,0) e linfoma (WSR de 16,6). A ASR para todos os tumores combinados na faixa etária de 15 a 19 anos foi de 152,3, e a maior taxa foi a de linfoma (ASR de 30,2). A incidência foi maior no sexo masculino do que no sexo feminino e maior na América do Sul do que na América Central e no Caribe. De modo geral, em comparação com as estimativas mundiais, a incidência na ALC foi menor, exceto para leucemia e linfoma entre 0 e 14 anos e para outros tumores e tumores não especificados em qualquer idade. A taxa de incidência na faixa etária de 0 a 19 anos aumentou em 1,0% ao ano (IC de 95% [0,6, 1,3]) entre 1993 e 2012. Os registros incluídos cobriam 16% da população de 0 a 14 anos e 10% da população de 15 a 19 anos. Conclusões. Os padrões observados servem de referência para avaliar o status e a evolução da ocorrência de câncer infantil na região. É necessário garantir um apoio ampliado e consistente aos registros de câncer para aprimorar a representatividade e a disponibilidade das informações em tempo adequado para o controle do câncer infantil na ALC.

https://doi.org/10.26633/rpsp.2024.11

“Hepatologia em Rede”: A Portuguese Association for the Study of the Liver (APEF) Initiative for the Improvement of Research in Liver Disease in Portugal
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Oliveira, Rui Caetano

; Rodrigues, Susana

; Santo, Joana Espírito

GE-Portuguese Journal of Gastroenterology

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dec 2023, Volume 30 N. 6 Pages 72 - 74

Abstract: En | Text: En | PDF: En

https://doi.org/10.1159/000531270

Postoperative Neutrophil to Lymphocyte and Platelet Ratio and Delayed Graft Function
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Oliveira, João

; Missa, João

; Gameiro, Joana

; Santana, Alice

; Lopes, José António

; Neves, Marta

Portuguese Journal of Nephrology & Hypertension

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dec 2023, Volume 37 N. 4 Pages 185 - 191

Abstract: En | Text: En | PDF: En

ABSTRACT Introduction: Delayed graft function (DGF), an outcome for which inflammation is critical, has been associated with worse outcomes after kidney transplantation (KT). The neutrophil to lymphocyte and platelet (NLP) ratio is a biomarker of systemic inflammation. We assessed postoperative NLP ratio applicability as an early predictor of DGF in KT patients. Methods: Retrospective cohort of adult patients submitted to KT at our unit, between 1 January 2010 and 31 December 2020. NLP was calculated at 24 hours post-KT. Primary outcome was development of DGF. Logistic regression was calculated to determine significant factos which may have contributed to DGF. Results: We included 527 patients with a mean age of 49.9 ± 12.8 years. In 47.8% of patients expanded criteria donors were used, and in 3.6% non-heart-beating donors. DGF occurred in 17.8% of patients. Mean post-KT NLP was higher in patients submitted to induction therapy with lymphocyte depleting antibodies (50.2±40.3 vs 11.9±7.4 with basiliximab, p<0.001), but it was found to be higher even before KT (5.2±1.8 vs 1.9±1.2, p=0.001). Grafts from non-heart-beating donors (OR 13.989, 95% CI 4.741, 41.274, p=0.000), longer warm ischemia time (OR 1.035, 95% CI 1.007, 1.064, p=0.014) and higher NLP ratio 24 hours after transplantation (OR 1.009, 95% CI 1.002, 1.016, p=0.015) were independently associated with DGF. Conclusion: Higher NLP ratio at 24 hours after KT was independently associated with DGF. This reflects the impact of inflammation on KT outcomes and highlights the role of the NLP ratio as a sensitive marker of systemic inflammatory response after KT.

https://doi.org/10.32932/pjnh.2023.11.261

Sodium Intake Targets in Peritoneal Dialysis Patients: A Real-Life Challenge
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Castro, Pedro Almiro e

; Correia, Ana Luísa

; Mira, Filipe

; Cerqueira, Sofia

; Oliveira, Nuno Afonso

; Maia, Pedro

; Alves, Rui

Portuguese Journal of Nephrology & Hypertension

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dec 2023, Volume 37 N. 4 Pages 207 - 211

Abstract: En | Text: En | PDF: En

ABSTRACT Introduction: Optimal fluid balance in peritoneal dialysis requires adequate urinary and peritoneal water and sodium removal and restriction of dietary sodium intake (<2 g/day). We aim to study the relationship between sodium intake, blood pressure control and medication burden in peritoneal dialysis patients. Methods: Observational, cross-sectional study of chronic peritoneal dialysis patients followed in our hospital in March 2022. We estimated patient’s sodium intake according to the equations proposed by Kim et al. Mean ambulatory blood pressure was categorized in controlled, stage one, stage two and stage three hypertension. A qualitative evaluation of sodium intake was done by asking patients about their compliance with a low-salt diet. Results: Eighty-two patients: mostly men, with a mean age of 54.1±14.7 years and dialysis vintage of 26.2±18.7 months. Most patients were on continuous ambulatory peritoneal dialysis (63.4%) and the mean weekly Kt/V was 2.2±0.4. A percentage of 85.4% of our patients had residual diuresis, averaged at 1257±867 mL/day. Mean dietary sodium intake was 3.5±1.1 g; it was higher in men and patients with uncontrolled hypertension, regardless of age, dialysis vintage and other comorbidities. We found a strong correlation between dietary sodium intake and residual diuresis, systolic blood pressure, diastolic blood pressure and the number of anti-hypertensive drugs. Patients with a sodium intake ≥ 3.3 g had higher risk of uncontrolled BP and higher medication burden. Qualitative evaluation of this sub-population revealed that only 2.3% (n=1) admitted non-compliance with a low-sodium diet. Conclusion: We found a strong correlation between estimated dietary sodium consumption, blood pressure control and medication burden. Most importantly, there was a striking difference between patient’s perception of sodium consumption and the actual results. Our results highlight the importance of dietary salt restriction in blood pressure control and reinforce the need for a dietary consultation in peritoneal dialysis patients.

https://doi.org/10.32932/pjnh.2023.11.265

Severe Hypercholesterolemia Mediated by Lipoprotein X in an Immunosuppressed Patient: A Case Report
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Sequeira, Cristiana

; Coelho, Mariana

; Santos, Inês Costa

; Lopes, Sara Ramos

; Mangualde, João

; Oliveira, Ana Paula

GE-Portuguese Journal of Gastroenterology

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oct 2023, Volume 30 N. 5 Pages 72 - 76

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo As doenças hepáticas colestáticas podem associar-se a um aumento do colesterol à custa de uma lipoproteína anómala, a lipoproteína X (LpX). Os agentes hipolipemiantes convencionais não apresentam benefício nesta entidade, pelo que o tratamento da hipercolesterolemia associada de LpX baseia-se na correção da causa subjacente da colestase. A plasmaferese pode ser necessária para evitar complicações, como a síndrome de hiperviscosidade. Os autores apresentam o caso de um homem de 44 anos com antecedentes de pseudotumor inflamatório da órbita sob prednisolona, admitido por lesão hepatocelular e colestática e hipercolesterolemia grave. A investigação laboratorial permitiu estabelecer a hepatite E aguda como responsável da lesão hepática e mostrou que a hipercolesterolemia grave foi mediada pela LpX. A redução da carga imunossupressora facilitou a eliminação do vírus da hepatite E. A consequente resolução da colestase coadjuvada pela remoção de colesterol por plasmaferese, permitiu a normalização mantida do perfil lipídico. Os autores relatam o primeiro caso de hipercolesterolemia associada a LpX em contexto de colestase induzida pelo vírus da hepatite E, e revisitam a importância do fígado no metabolismo dos lípidos.

Abstract Cholestatic liver diseases may be associated with increased plasmatic cholesterol due to an abnormal lipoprotein - lipoprotein X (LpX). Correcting the underlying cause of cholestasis is the critical treatment of LpX-associated hypercholesterolemia without any proven benefit from conventional lipidlowering agents. In some situations, plasma exchange may apply to prevent associated complications, such as hyperviscosity syndrome. The authors present the case of a 44-year-old man with orbital inflammatory pseudotumor on prednisolone, admitted due to hepatocellular and cholestatic lesion and severe hypercholesterolemia. Laboratory investigation established that hepatitis E virus was responsible for liver injury and showed that LpX mediated the severe hypercholesterolemia. Reduction of the immunosuppressive load contributed to virus clearance. The consequent resolution of cholestasis and cholesterol removal by plasmapheresis allowed lipid profile normalization. The authors report the first case of LpX-associated hypercholesterolemia in a patient with hepatitis E-induced cholestasis and revisit the role of the liver in lipid metabolism.

https://doi.org/10.1159/000526854

10.

Narrow Band Imaging versus White Light for the Detection of Sessile Serrated Colorectal Lesions: A Randomized Clinical Trial
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Ferreira, Alexandre Oliveira

; Reves, Joana Branco

; Nascimento, Catarina

; Frias-Gomes, Catarina

; Costa-Santos, Maria Pia

; Ramos, Lídia Roque

; Palmela, Carolina

; Gloria, Luísa

; Cravo, Marília

; Dinis-Ribeiro, Mário

; Canena, Jorge

GE-Portuguese Journal of Gastroenterology

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oct 2023, Volume 30 N. 5 Pages 42 - 48

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Introdução: O cancro do cólon e reto é a neoplasia mais frequente considerando os dois géneros. . A deteção de lesões pré-malignas por colonoscopia está associada a uma redução da incidência e da mortalidade. Estudos sobre a utilização da luz de banda estreita (NBI) na deteção de lesões serreadas tiveram resultados promissores, mas heterogéneos. Métodos: Realizámos um ensaio clínico randomizado para comparar o número médio de lesões serreadas e lesões hiperplásicas ≥10 mm com NBI ou luz branca de alta-definição (HD-WL). Como resultados secundários comparámos a prevalência e as taxas de deteção de lesões serreadas sésseis, adenomas e todas as lesões. Resultados: Foram randomizados 782 doentes (392 no grupo HD-WL e 390 no grupo NBI). O número médio de lesões serreadas e hiperplásicas ≥10 mm não apresentou diferença estatisticamente significativa entre dois grupos (0.118 vs. 0.156, p = 0.44). A taxa de deteção de adenomas (55.2% vs. 53.2%, p = 0.58) e a taxa de deteção de lesões serreadas sésseis (6.8% vs. 7.5%, p = 0.502) também não foram diferentes. O tempo de retirada foi maior no grupo NBI (10.88 vs. 9.47 min, p = 0.004) e o tempo total de procedimento teve um ligeiro aumento não atingindo significância estatística (20.97 vs. 19.30 min, p = 0.052). Conclusão: A utilização da luz NBI por rotina não aumenta a deteção de lesões serreadas nem de qualquer lesão pré-maligna e aumenta o tempo de retirada na colo-noscopia.

Abstract Background: Colorectal cancer (CRC) is a leading cause of cancer. The detection of premalignant lesions by colonoscopy is associated with reduced CRC incidence and mortality. Narrow band imaging has shown promising but conflicting results for the detection of serrated lesions. Methods: We performed a randomized clinical trial to compare the mean detection of serrated lesions and hyperplastic polyps ≥10 mm with NBI or high-definition white light (HD-WL) withdrawal. We also compared all sessile serrated lesions (SSLs), adenoma, and polyp prevalence and rates. Results: Overall, 782 patients were randomized (WL group 392 patients; NBI group 390 patients). The average number of serrated lesions and hyperplastic polyps ≥10 mm detected per colonoscopy (primary endpoint) was similar between the HD-WL and NBI group (0.118 vs. 0.156, p = 0.44). Likewise, the adenoma detection rate (55.2% vs. 53.2%, p = 0.58) and SSL detection rate (6.8% vs. 7.5%, p = 0.502) were not different between the two study groups. Withdrawal time was higher in the NBI group (10.88 vs. 9.47 min, p = 0.004), with a statistically nonsignificant higher total procedure time (20.97 vs. 19.30 min, p = 0.052). Conclusions: The routine utilization of narrow band imaging does not improve the detection of serrated class lesions or any pre-malignant lesion and increases the with-drawal time.

https://doi.org/10.1159/000526606

11.

Treating asthma in patients with enuresis: repercussions on urinary symptoms
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Dahan, Patricia

; Oliveira, Pricila Mara Novais de

; Brum, Aparecida Regina

; Ribeiro, André Costa Pinto

; Figueiredo, André Avarese

; Bessa Jr., José de

; Murillo B. Netto, José

International braz j urol

Journal Metrics
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oct 2023, Volume 49 N. 5 Pages 590 - 598

Abstract: En | Text: En | PDF: En

ABSTRACT Background: Children presenting enuresis are more likely to be asthmatics. The association between enuresis and sleep-disordered breathing has already been demonstrated and several studies have shown at least partial improvement of two thirds or more of the cases of enuresis adenoidectomy. Studies have already described associations between enuresis and allergies but do not assess the repercussions of allergy treatment in enuretics. Objective: This study aims to evaluated whether asthma treatment alters the course of enuresis and whether there is any predictive factor associated with this improvement. Materials and Methods: Twenty patients (5 - 12 years old) with uncontrolled enuresis and asthma, received treatment for asthma. Children were also assessed for the presence of rhinitis and other allergies. The control of asthma was confirmed by a validated questionnaire and primary enuresis by clinical history and wet night diaries. Patients received only asthma treatment. Results: At least partial improvement of enuresis was observed in 55% of the patients with an increase in 64.4% in the number of dry nights at the end of the study (p=0.01). The “presence of other allergies” and “obstruction seen in nasal endoscopy” positively influenced the improvement of urinary symptoms (OR = 3.350; CI 0.844–13.306) and (OR=1.272; CI 0.480-3.370), respectively. Discussion: Until now, only patients presenting upper airway obstruction were known to benefit from the improvement of urinary symptoms when undergoing treatment for their respiratory problems. In our study, we found at least partial improvement in enuresis in 55% of our patients, with only clinical asthma treatment. Conclusion: Controlling asthma in children with primary enuresis resulted in a significant increase in dry nights.

https://doi.org/10.1590/s1677-5538.ibju.2023.0101

12.

Experience and Learning from the COVID-19 Pandemic in Portugal: Perceptions of
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Advinha, Ana Margarida

; Santos, Margarida C.

; Duarte-Ramos, Filipa

; Perdigão, Margarida

; Santos, Patrícia

; Oliveira-Martinsa, Sofia

Portuguese Journal of Public Health

Journal Metrics
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sep 2023, Volume 41 N. 2 Pages 122 - 131

Abstract: En Pt | Text: En Pt | PDF: En | PDF: Pt

Abstract Background: During the COVID-19 pandemic, community pharmacy (CP) professionals were among those who experienced the greatest risk of contracting SARS-CoV-2, which forced major adaptations. Objectives: The objectives of the study were to describe the changes implemented in CP professionals during the pandemic, understand the perception of professionals about their experience, and explore changes to remain. Methods: An observational and cross-sectional study was conducted via an online questionnaire (June-September 2020). The target population was CP professionals working in Portugal for >2 years and serving the public during the pandemic. Results: Of a total of 353 participants, 84% were female (mean age of 37.6 years), and 81% were pharmacists (mean professional experience of 12.9 years). In the management and organizational dimensions, the most mentioned changes were adaptation to legislative changes (90%), fluctuations in the treasury (82%), and reduction of working hours (46%). Only 2% resorted to simplified layoff. In the back office, there was a need to adapt stock management (93%) and purchase personal protective equipment (99%). In the front office, there was a change in service policies - wicket or conditional opening (92%), routes of the arrival of user requests (91%), and home delivery (82%). Physical changes occurred in 100% of pharmacies. The most frequently implemented procedures were the use of protection systems and PPE, articulation with hospital pharmacies for dispensing in proximity (75%), and training in this area (55%). Regarding interpersonal climate, improvements in the connection between team members are evident: increase in mutual help (57%), solidarity (54%), and group cohesion (50%); in the relationship with clients, the majority indicated the replacement of the usual user by third parties (71%), and changes in communication channels (increase in use of technological means 68%). Conclusions: Results illustrate the profound impact of the pandemic on CP professionals, both professionally and personally. It also highlights the importance of their roles in proximity and community support.

Resumo Introdução: Durante a pandemia de COVID-19, os profissionais de farmácia comunitária (FC) estiveram entre os que apresentaram maior risco de contrair SARS-CoV-2, o que obrigou a grandes adaptações. Objetivos: Descrever as alterações implementadas nas FC durante a pandemia, compreender a percepção dos profissionais sobre as suas vivências e explorar as mudanças a serem mantidas. Metodologia: estudo observacional e transversal (junho-setembro de 2020). A população alvo foram os profissionais de FC a trabalhar em Portugal há >2 anos e atender o público durante a pandemia. Resultados: 353 participantes, 84% do sexo feminino (idade média - 37,6 anos) e 81% eram farmacêuticos (média de experiência profissional de 12,9 anos). Nas dimensões “gestão e organização”, as mudanças mais referidas foram a adaptação a alterações legislativas (90%), flutuações de tesouraria (82%) e redução do horário de trabalho (46%). Apenas 2% recorreram ao lay-off simplificado. No back office: necessidade de adequação do stock (93%) e aquisição de equipamentos de proteção individual (99%). No front office: alteração das políticas de atendimento - atendimento ao postigo ou abertura condicional (92%), vias de chegada dos pedidos dos utentes (91%) e entrega ao domicílio (82%). Alterações físicas ocorreram em 100% das farmácias. Os procedimentos implementados com maior frequência foram a utilização de sistemas de proteção e EPI, a articulação com farmácias hospitalares para dispensa de medicamentos de proximidade (75%) e formação nesta área (55%). Em relação ao clima interpessoal, foram evidentes as melhorias na ligação entre os membros da equipa: aumento da inter-ajuda (57%), solidariedade (54%) e coesão do grupo (50%); no relacionamento com os utentes, a maioria referiu a substituição do utente habitual por terceiros (71%) e alterações nos canais de comunicação (aumento da utilização de meios tecnológicos 68%). Conclusões: Os resultados ilustram o profundo impacto da pandemia nos profissionais de FC, tanto a nível profissional como pessoal. Também de destacar a importância do papel da FC como espaço de saúde de proximidade e apoio à comunidade.

https://doi.org/10.1159/000531446

13.

Clinical, Economic, and Humanistic Impact of Short-Bowel Syndrome/Chronic Intestinal Failure in Portugal (PARENTERAL Study)
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Silva, Raul

; Guerra, Paula

; Rocha, Anabela

; Correia, Miguel

; Ferreira, Ricardo

; Fonseca, Jorge

; Lima, Eduardo

; Oliveira, António

; Gomes, Marta Vargas

; Ramos, Diogo

; Andreozzi, Valeska

; Santos, Marisa D.

GE-Portuguese Journal of Gastroenterology

Journal Metrics
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aug 2023, Volume 30 N. 4 Pages 41 - 52

Abstract: En Pt | Text: En Pt | PDF: En | PDF: Pt

Abstract Introduction: 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.

Resumo Introdução: Este estudo teve como objetivo avaliar o impacto clínico, económico e social da síndrome do intestino curto/falência intestinal crónica (SIC/FIC) em Portugal. Métodos: Estudo de coorte retrospectivo e multicêntrico de revisão dos processos clínicos incluindo uma componente transversal para avaliação da qualidade de vida (QV). Os critérios de elegibilidade incluíram doentes com SIC/FIC, idade ≥1 ano, em nutrição parenteral (NP) e clinicamente estáveis. A recolha de dados incluiu a revisão dos processos clínicos ao longo de um período de 12 meses e a aplicação de questionários auto-administrados a doentes e cuidadores e de questionários de QV (SF-36/ PedsQL™). Os indicadores principais foram a caracterização clínica e da NP, a utilização de recursos de saúde, custos diretos e QV dos doentes. Resultados: Foram incluídos 31 doentes (11 adultos e 20 crianças). A idade média (desvio padrão: DP) foi de 57.9 (14.3) anos nos adultos e de 7.5 (5.0) nas crianças com um tempo médio desde o diagnóstico de 10.2 (5.9) e 6.6 (4.2) anos, respetivamente. A NP foi administrada durante uma média de 5.2 e 6.6 dias por semana, em adultos e crianças respetivamente, em 81.8% e 90.0% dos adultos/crianças foi feita em casa durante uma média de 9.6 ou 10.8 meses por ano, respetivamente. O número médio anual de hospitalizações foi de 1.9 (1.6) e 2.0 (1.5) com uma duração média de 34.0 (47.4) e 29.4 (32.3) dias, em adultos e crianças, respetivamente. Foram reportados 21 e 40 episódios de hospitalização em adultos/crianças, dos quais 71.4% e 85.0% foram devido a complicações relacionadas ao uso de cateter. Os custos diretos anuais médios por doente ascenderam a 47,857.53 EUR nos adultos e a 74,734.50 EUR nas crianças, sendo que os maiores responsáveis foram a NP e as hospitalizações. A avaliação da QV mostrou um comprometimento clinicamente significativo da componente física nos adultos e uma deterioração relevante da dimensão escolar nas crianças. Conclusões: A gestão dos doentes com SIC/FIC em Portugal é caracterizada por uma sobrecarga substancial a nível terapêutico e de utilização de recursos de saúde, o que se traduz em elevados custos diretos e comprometimento substancial da componente física nos adultos e do desempenho escolar nas crianças.

https://doi.org/10.1159/000526059

14.

Niti-S Esophageal Mega-Stent: An Emerging Endoscopic Tool with Different Applications in the Management of Surgical Anastomotic Leaks
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Brito, Mariana

; Nunes, Gonçalo

; Luz, Carlos

; Oliveira, Gabriel

; Marques, Pedro Pinto

; Fonseca, Jorge

GE-Portuguese Journal of Gastroenterology

Journal Metrics
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aug 2023, Volume 30 Suppl. 1 Pages 45 - 51

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Introdução: A deiscência anastomótica (DA) é uma complicação grave no pós-operatório precoce da esofagectomia e gastrectomia total, pela sua elevada mortalidade. As próteses metálicas autoexpansíveis (PMAE) desempenham um papel fundamental no tratamento das DA. Na literatura, há apenas um caso descrito sobre a utilização de um Mega-Stent no contexto de DA, que não complicação bariátrica. Os autores reportam uma série de dois casos com diferente aplicação do Mega-Stent esofágico no tratamento de DA. Descrição do caso: Caso 1: Homem de 67 anos, submetido a esofagectomia por carcinoma epidermóide do esófago distal. O período pós-operatório precoce foi complicado de DA com fístula gastro-pleural. Inicialmente foi colocado um clip OTSC no orifício da deiscência com insucesso técnico e clínico, sendo posteriormente utilizado o Mega-Stent, posicionado desde o esófago até ao bulbo duodenal. Estudos contrastados posteriores confirmaram resolução da DA. Caso 2: Mulher de 86 anos, submetida a gastrectomia total com reconstrução em Y-Roux e esofagojejunostomia por adenocarcinoma gástrico, complicada de DA. Neste contexto foi colocada uma PMAE parcialmente coberta (PMAE-PC) sobre a área da anastomose. A tomografia computorizada subsequente demonstrou persistência de extravasamento. Foi colocada uma segunda PMAE-PC, com posterior resolução da DA. Semanas depois, ambas as PMAE-PC apresentavam tecido de granulação nos topos, tendo sido colocado o Mega-Stent (técnica stent-in-stent) e decorridas duas semanas, todas as próteses foram facilmente extraídas, confirmando-se sucesso no tratamento da DA. Discussão/conclusão: A utilização de PMAE nas DA constitui uma técnica terapêutica segura e bem estabelecida, contudo passível de apresentar limitações tais como a migração ou incapacidade de cobrir totalmente DA de maiores dimensões. O Mega-Stent esofágico pode constituir uma ferramenta útil na terapêutica endoscópica destes doentes.

Abstract Introduction: Anastomotic leak (AL) is a dangerous complication in the early postoperative period after total gastrectomy or esophagectomy being associated with high mortality. Self-expandable metal stents (SEMS) play a significant role in AL management. Only one case report described the use of Mega-Stent in AL setting. The authors report a two-case series with different applications of a Niti-S esophageal Mega-Stent in AL management. Case Report: Case 1 is a 67-year-old male who underwent an esophagectomy due to a squamous cell carcinoma of the distal esophagus. The early postoperative period was complicated with AL and gastropleural fistula. Initially, an OTSC was deployed in the dehiscence but failed to resolve AL. The esophageal Mega-Stent was further placed in-between the esophagus and the bulbus. Post-stenting contrast studies confirmed no further AL. Case 2 is an 86-year-old woman who underwent total gastrectomy with roux-en-y esophagojejunostomy due to a gastric adenocarcinoma, complicated with AL. A partially covered metal stent (PCMS) was placed to cover the anastomosis. Computed tomography confirmed leakage persistence and a second PCMS was deployed, resolving the AL. Several weeks later, both PCMSs presented ingrowth from granulation tissue. An esophageal Mega-Stent was placed (stent-in-stent technique) and 2 weeks later, all stents were removed, with no AL recurrence. Discussion/Conclusion: SEMS placement for AL is a safe, well-established therapeutic technique. Limitations include stent migration and incomplete cover of large AL. Mega-Stent can be an emerging tool for endoscopic AL management.

https://doi.org/10.1159/000524420

15.

Laparoscopic pyeloplasty proficiency during a residency program after adoption of a standardized simulation training program is maintained during the COVID pandemic despite reduced surgery volume
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Gorgen, Antonio Rebello Horta

; Abreu, Fernando Jahn da Silva

; Paludo, Artur de Oliveira

; Menegolla, Mauricio Picolo

; Oliveira, Renan Timóteo de

; Tavares, Patric Machado

; Rosito, Tiago Elias

International braz j urol

Journal Metrics
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aug 2023, Volume 49 N. 4 Pages 462 - 468

Abstract: En | Text: En | PDF: En

ABSTRACT Purpose: To evaluate the effect of the standardized laparoscopic simulation training program in pyeloplasty, following its implementation and during the COVID-19 pandemic. Material and Methods: A retrospective chart review was performed at Hospital de Clínicas de Porto Alegre, a tertiary referral center in south Brazil, in which 151 patients underwent laparoscopic pyeloplasty performed by residents between 2006-2021. They were divided into three groups: before and after adoption of a standardized laparoscopic simulation training program and during the COVID-19 pandemic. The main outcome was a combined negative outcome of conversion to open surgery, major postoperative complications (Clavien-Dindo III or higher) or unsuccessful procedure, defined as need for redo pyeloplasty. Results: There was a significant reduction in the combined negative outcome (21.1% vs 6.3%), surgical time (mean 200.0 min vs 177.4 min) and length of stay (median 5 days vs 3 days) after the adoption of simulation training program. These results were maintained during the COVID-19 pandemic (combined negative outcome of 6.3%, mean surgical time of 160.1 min and median length of stay of 3 days) despite a reduction in 55.4% of the surgical volume. Conclusion: A structured laparoscopic simulation program can improve outcomes of laparoscopic pyeloplasty during the learning curve.

https://doi.org/10.1590/s1677-5538.ibju.2023.0021

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