Browsing by Issue Date, starting with "2021-08"
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- Lymphogranuloma Venereum: a Retrospective Analysis of an Emerging Sexually Transmitted Disease in a Lisbon Tertiary CenterPublication . Neves, JM; Ramos Pinheiro, R; Côrte‐Real, R; Borrego, MJ; Rodrigues, A; Fernandes, CBackground: Lymphogranuloma venereum (LGV) is a sexual transmitted infection (STI), currently endemic within the population of men who have sex with men (MSM) of Western Countries. L2B variant has been reported as the predominant strain in the current LGV epidemics, although a shift towards L2-434 has been observed in some European countries. Objectives: To evaluate and characterize the population with LGV infection diagnosed in Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal. Methods: A retrospective analysis of all LGV diagnoses between 2016 and 2019 was performed. The diagnosis was established through ompA-genotyping of samples yielding a positive result to Chlamydia trachomatis (CT). All considered samples were retrieved from the clinician activity, through swabbing and urine analysis and CT infection diagnosis was obtained using real-time PCR. Results: During the period studied 16 279 CT diagnostics tests were employed, with a striking increase from 2016 (n = 467) to 2019 (n = 9362). A total of 1602 diagnoses of CT were established, from which 168 (10.5%) corresponded to LGV, with both infections showing a rising evolution, between 2016 and 2019, of 2.9 and 2.7 times, respectively. The majority of the LGV strains were genotyped as L2/434 (67.3%; n = 113). LGV predominantly affected MSM and men who have sex with men and women (97.0%; n = 163). Anorectal infection was the most prevalent one (90.5%; n = 152), being proctitis the main clinical presentation (76.2%; n = 128). Absence of symptoms was reported in almost 15% of the cases (n = 24). The presence of concomitant infection with human immunodeficiency virus was dominant (73.2%; n = 123) and the prevalence of one or more STI co-infections was about 60.1% (n = 99). Conclusions: An increasing evolution of CT and LGV testing and diagnosing was observable throughout the studied period. Characteristics of the population are similar with those described within LGV epidemics. In accordance with recent European studies, predominance towards L2 genotype was identified.
- Hyperleukocytosis in Solid Tumors: a Rare Paraneoplastic Syndrome Associated with Poor PrognosisPublication . Ferrão, J; Sardinha, M; Dutra, EHematological paraneoplastic syndromes are fairly uncommon. While mild leukocytosis in solid tumors is well reported, white blood cell (WBC) count over 50,000 u/L, described as paraneoplastic leukemoid reaction (PLR), is not. Indeed, when found, it is usually associated with a higher burden of disease, tumor activity and worse clinical outcomes. We report the case of a challenging and burdensome diagnosis of a presumptive hematological paraneoplastic syndrome in a patient with a locally advanced lung cancer admitted in the Internal Medicine ward. After the end of chemotherapy, clinical and laboratory benefit was observed; however, the aggressive course of the disease became clear, with progression and downhill course that was unresponsive to treatment.
- Protein Intake, Adherence to Vitamin–Mineral Supplementation, and Dumping Syndrome in Patients Undergoing One Anastomosis Gastric BypassPublication . Andrade, L; Chiote, I; Santos-Cruz, A; Brito-Costa, A; Mendes, L; Silva-Nunes, J; Pereira, JIntroduction: One anastomosis gastric bypass (OAGB) is an effective bariatric procedure. However, nutritional deficiencies or dumping syndrome (DS) may occur. The aim of this study was to assess adherence to nutritional recommendations and development of DS in a 3-year OAGB patient follow-up. Methods: For 150 OAGB patients, in our center, data were collected through the electronic platform and by an individual telephone interview. The inclusion criterion is OAGB as a primary bariatric procedure, no revisional surgery, or no pregnancy. The adequacy of daily protein intake cutoff was defined as 60 g. Adherence to micronutrient supplementation protocol was considered if a minimum of 5 takes/week were reported. To evaluate the occurrence of DS, the Sigstad score questionnaire was used. For statistical analysis, a significance level less than 5% (p < 0.05) was considered. Results: A total of 150 patients (80% females), BMI 44.3 ± 21.3 kg/m2, were subjected to the OAGB procedure. Of those, 128 fulfilled the study inclusion criteria. After 3 years, the mean %EBMIL was 78.4 ± 14.4. During the 3-year follow-up, the average protein intake was 60 g/day, and 48% reported an adequate daily protein intake. Adherence to the micronutrient supplementation protocol was reported by 70%. According to the Sigstad score questionnaire, DS was present in 24% of patients. Conclusion: A significant part of OAGB patients does not comply with the nutrition prescription assessed, emphasizing the need to improve team/patient communication strategies. Long-term studies are needed to characterize and assess the health impact of protein, vitamin, and mineral malnutrition in patients undergoing OAGB.
- Evaluation and Calibration of SAPS 3 in Patients with COVID-19 Admitted to Intensive Care UnitsPublication . Metnitz, P; Moreno, R; Fellinger, T; Posch, M; Zajic, P
- Medial Collateral Ligament Release During Knee Arthroscopy: Key ConceptsPublication . Silva Campos, V; Guerra Pinto, F; Constantino, D; Andrade, R; Espregueira-Mendes, JComplete access to the posterior medial compartment of the knee may represent a technical challenge during arthroscopy in patients with a tight tibiofemoral joint space.Medial collateral release reduces direct iatrogenic cartilage damage in the medial compartment of the knee through manipulation with instruments.We recommend performing medial collateral release in surgeries that access the posteromedial compartment (e.g. partial meniscectomy for ruptures of the posterior horn of medial meniscus or posterior root repairs) when the patient has a tight tibiofemoral joint space.There are two main techniques to perform medial collateral release: inside-out and outside-in. Regardless of the technique used, releasing medial ligament structures is a safe and effective method to be used in the diagnosis and treatment of injuries to the medial compartment.
- Protecting Older Patients with Cardiovascular Diseases from COVID-19 Complications Using Current MedicationsPublication . Alves, M; Fernandes, M; Bahat, G; Benetos, A; Clemente, H; Grodzicki, T; Martínez-Sellés, M; Mattace-Raso, F; Rajkumar, C; Ungar, A; Werner, N; Strandberg, T; EuGMS Special Interest Group in Cardiovascular MedicinePurpose: In the pathogenesis of severe COVID-19 complications, derangements of renin-angiotensin-aldosterone system (RAAS), vascular endothelial dysfunction leading to inflammation and coagulopathy, and arrhythmias play an important role. Therefore, it is worth considering the use of currently available drugs to protect COVID-19 patients with cardiovascular diseases. Methods: We review the current experience of conventional cardiovascular drugs [angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers, anticoagulants, acetosalicylic acid, antiarrhythmic drugs, statins] as well as some other drug classes (antidiabetic drugs, vitamin D and NSAIDs) frequently used by older patients with cardiovascular diseases. Data were sought from clinical databases for COVID-19 and appropriate key words. Conclusions and recommendations are based on a consensus among all authors. Results: Several cardiovascular drugs have a potential to protect patients with COVID-19, although evidence is largely based on retrospective, observational studies. Despite propensity score adjustments used in many analyses observational studies are not equivalent to randomised controlled trials (RCTs). Ongoing RCTs include treatment with antithrombotics, pulmonary vasodilators, RAAS-related drugs, and colchicine. RCTs in the acute phase of COVID-19 may not, however, recognise the benefits of long term anti-atherogenic therapies, such as statins. Conclusions: Most current cardiovascular drugs can be safely continued during COVID-19. Some drug classes may even be protective. Age-specific data are scarce, though, and conditions which are common in older patients (frailty, comorbidities, polypharmacy) must be individually considered for each drug group.