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Anti-Melanoma Differentiation-Associated Protein 5 (MDA5)-Positive Dermatomyositis With Rapidly Progressive Interstitial Lung Disease (ILD): A Rare and Lethal Entity to Recognize Early.
Publication . Bernardino, Rita; Ferreira, Inês; Valente, André; Loureiro, Conceição
Anti-melanoma differentiation-associated protein 5 (anti-MDA5) clinically linked amyopathic dermatomyositis (CADM) is a rare autoimmune condition strongly linked to rapidly progressive interstitial lung disease (RP-ILD), a life-threatening complication. We present a 63-year-old female patient with anti-MDA5-positive CADM, who developed RP-ILD with an imaging pattern consistent with organizing pneumonia. She presented with Gottron's papules, periungual erythema, progressive dyspnea, and anorexia. Despite timely initiation of combination immunosuppressive therapy with corticosteroids, rituximab, and mycophenolate, her disease progressed rapidly, complicated by infections and treatment intolerance, culminating in acute respiratory failure. This case underscores the aggressive nature of anti-MDA5-positive CADM with RP-ILD, highlighting the critical need for prompt recognition and comprehensive multidisciplinary care. Urgent research efforts are essential to develop and refine treatment strategies for this life-threatening disease.
Cuidados de Saúde Primários e o Potencial de Coordenação com os Bancos de Leite Humano
Publication . Fabrício de Almeida, Mafalda; Torgal, Ana Lúcia; Macedo, Israel; Figueiredo, Cristiano
Barriers to Prescription of Hormonal Contraception and Hormone Replacement Therapy in Gynecological Cancer Survivors: Results of a Survey and Literature Review.
Publication . Teves, Mariana; Palma, Fátima; Fatela, Ana; Correia, Lúcia
Background: The incidence of gynecological cancers in premenopausal women is increasing, highlighting issues related to Hormonal Contraception (HC) and Hormone Replacement Therapy (HRT). However, the presence of hormonal receptors in many gynecological cancers complicates HC and HRT prescriptions.
Objective: To identify barriers experienced by gynecologists in prescribing HC and HRT to gynecological cancer survivors, with a secondary objective of conducting a literature review on the safety of these prescriptions.
Methods: A nationwide survey was conducted among Portuguese gynecologists, including questions about their prescribing practices for HC and HRT in gynecological cancer survivors. For the narrative review, the authors searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and SCOPUS from January 2019 to April 2024. The included studies encompassed gynecological cancer survivors using HC or HRT, detailing tumor histologic type and clinical outcomes.
Results: 185 gynecologists participated in the questionnaire: 151 general gynecologists (81.6 %) and 34 oncology gynecologists (18.4 %). Of these, 49.7 % and 55.1 % had prescribed HC and HRT, respectively. Cervical cancer had the highest prescription rate, followed by vulvar and vaginal cancer, with fewer prescriptions for ovarian/fallopian tube, endometrial, and uterine corpus (non-endometrial) cancers. Older age and specialization in gynecologic oncology significantly predicted HC and HRT prescriptions (p < 0.05). Uncertainty was the main reason for not prescribing HC/HRT. A narrative review confirmed the safety of prescribing for specific tumor subtypes.
Conclusion: The survey findings highlight an occasionally unfounded apprehension regarding the use of HC and HRT among gynecological cancer survivors. This underscores the crucial need for enhanced education on these matters.
Consensus-Based Guidelines for Best Practices in the Selection and Use of Examination Gloves in Healthcare Settings.
Publication . Freitas, Jorge; Lomba, Alexandre; Sousa, Samuel; Gonçalves, Viviana; Brois, Paulo; Nunes, Esmeralda; Veloso, Isabel; Peres, David; Alves, Paulo
Background/objectives: Healthcare-associated infections (HAIs) and antimicrobial resistance (AMR) present significant challenges in modern healthcare, leading to increased morbidity, mortality, and healthcare costs. Examination gloves play a critical role in infection prevention by serving as a barrier to reduce the risk of cross-contamination between healthcare workers and patients. This manuscript aims to provide consensus-based guidelines for the optimal selection, use, and disposal of examination gloves in healthcare settings, addressing both infection prevention and environmental sustainability.
Methods: The guidelines were developed using a multi-stage Delphi process involving healthcare experts from various disciplines. Recommendations were structured to ensure compliance with international regulations and sustainability frameworks aligned with the One Health approach and Sustainable Development Goals (SDGs).
Results: Key recommendations emphasize selecting gloves based on clinical needs and compliance with EN 455 standards. Sterile gloves are recommended for surgical and invasive procedures, while non-sterile gloves are suitable for routine care involving contact with blood and other body fluids or contaminated surfaces. Proper practices include performing hand hygiene before and after glove use, avoiding glove reuse, and training healthcare providers on donning and removal techniques to minimize cross-contamination. Disposal protocols should follow local clinical waste management regulations, promoting sustainability through recyclable or biodegradable materials whenever feasible.
Conclusions: These consensus-based guidelines aim to enhance infection control, improve the safety of patients and healthcare workers, and minimize environmental impact. By adhering to these evidence-based practices, grounded in European regulations, healthcare settings can establish safe and sustainable glove management systems that serve as a model for global practices.
Endoscopic Repair of Congenital Ethmoidal Meningoencephalocele in a 17-Month-Old Child: a Case Report.
Publication . Rebelo, Francisco Almeida; Mexia, Jorge; Forte, Dalila; Matos, Mário; Iraneta, Amets
Background: Congenital meningoencephaloceles are rare malformations involving the herniation of intracranial contents through skull base defects. Endoscopic endonasal surgery (EES) is now standard, although transnasal repair is particularly challenging in infants due to small nasal cavities and immature skull-base anatomy. This case highlights early endoscopic repair of a congenital meningoencephalocele in an infant, contributing to the limited pediatric literature.
Case description: A 17-month-old girl with extreme prematurity presented with noisy breathing and persistent clear rhinorrhea, later confirmed as a cerebrospinal fluid leakage. Imaging identified a right ethmoidal meningoencephalocele originating from a cribriform plate defect, confirmed on computed tomography (CT) and magnetic resonance imaging (MRI). She underwent endoscopic resection and multilayer skull base repair using a fat graft as a plug, reinforced with oxidized regenerated cellulose, a right nasoseptal mucosal flap, and fibrin glue. Recovery was uneventful, and follow-up MRI confirmed closure without recurrence. Surgical planning involved coordination among neurosurgery, otolaryngology, and neuroradiology teams to optimize access and repair strategy.
Conclusion: EES is considered the gold-standard approach for anterior skull base meningoencephaloceles, although anatomical constraints make the procedure challenging in infants. In this patient, EES was successfully performed using tailored techniques and materials, illustrating that the approach can be reproduced in other young children. Transcranial approaches remain an alternative when endonasal access is limited. Early surgery in symptomatic cases prevents complications such as meningitis. Careful planning and coordination among specialties support optimal outcomes in complex pediatric skull base surgery.