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- Intervenções de Enfermagem à Pessoa Muçulmana Adulta submetida a uma Ostomia de Eliminação: uma Revisão ScopingPublication . Leite, Catarina; Tavares, Neuza; Rodrigues, SílviaIntrodução: O aumento da multiculturalidade acarreta uma maior exigência dos profissionais de saúde, com necessidade de aquisição de conhecimentos do meio sociocultural da pessoa. Os muçulmanos regem a sua vida e tomam decisões com base nos cinco pilares do Islão, sendo essencial adequar as intervenções de enfermagem de modo a prestar um cuidado culturalmente competente. Objetivos: Mapear a literatura existente com o objetivo de compreender quais são as intervenções de enfermagem à pessoa muçulmana adulta submetida a uma ostomia de eliminação. Método: Foi realizada uma revisão scoping com base na metodologia proposta pelo The Joanna Briggs Institute (JBI). A revisão foi baseada na questão de investigação: “Quais as intervenções de enfermagem à pessoa muçulmana adulta submetida a uma ostomia de eliminação?”. Esta foi formulada tendo em conta a estratégia de definição da população (pessoas muçulmanas adultas submetidas a uma ostomia de eliminação), conceito (intervenções de enfermagem e religião muçulmana) e contexto (internamento ou consulta), ou seja, utilizando a mnemónica PCC. A pesquisa foi realizada em dezembro de 2025 nas bases de dados MEDLINE e CINAHL, através da plataforma EBSCO e recorrendo à literatura cinzenta. Resultados: Foram incluídos quatorze estudos na revisão, tendo sido elaborado o fluxograma PRISMA-ScR, de modo a apresentar o processo de seleção dos estudos. De forma a sistematizar os dados, as intervenções de enfermagem foram agrupadas de acordo com os cinco pilares do Islão. Os pilares mais afetados foram o jejuar no mês do Ramadão e as cinco orações diárias em direção a Meca. Discussão/Conclusão: Os artigos incluídos permitiram identificar intervenções de enfermagem em todos os pilares do Islão. Estas consistem, na sua maioria, em realizar educação para a saúde aos utentes de modo a dotá-los de conhecimentos adequados e promover a sua autonomia e tomada de decisão consciente e informada. O estilo de vida, decisões e hábitos dos muçulmanos são fortemente influenciados pelas suas crenças religiosas. Assim, tendo em conta que a fé é uma parte central das suas vidas, os enfermeiros devem compreender e estar conscientes das crenças culturais e religiosas desta população de modo a planear os cuidados de forma adequada, fornecendo estratégias de coping eficazes e utilizando os fatawas como orientadores do cuidado, através da educação para a saúde.
- The International, Prospective COSMOS (CytOSorb® TreatMent Of Critically Ill PatientS) Registry: Interim Results in Patients with Septic Shock.Publication . Ferrer, Ricard; Kirschning, Thomas; Unglaube, Moritz; Guenther, Ulf; Kreutz, Julian; Thielmann, Matthias; Baumann, Andreas; Kribben, Andreas; Henzler, Dietrich; Germano, Nuno; El-Essawi, Aschraf; Aucella, Filippo; Guenther, Thomas; Bellgardt, Martin; Tyczynski, Bartosz; Christian Schulze, P; Bottari, Gabriella; Hidalgo, Jorge; Teboul, Jean-Louis; Tomescu, Dana; Klaus, Teresa; Fan, Weihong; Scheier, Joerg; Deliargyris, Efthymios N; Taccone, Fabio SilvioBackground: The international prospective COSMOS Registry (NCT05146336) collects real-world data on CytoSorb® (CS) hemoadsorption utilization patterns and outcomes in critically ill patients. This analysis focuses on patients with septic shock. Methods: Following informed consent, data was systematically collected before, during, and after CS treatment. Time frame of data collection was from the initiation of COSMOS study enrollment (July 15, 2022) to date of data extraction (May 7, 2025). Study follow-up extended to 90 days. We compared details on vasopressor requirements, fluid balance, and P/F ratio before and after CS treatment. APACHE II was assessed at ICU admission, while SOFA scores were determined at the start and end of CS therapy. Safety of the device was assessed based on investigator-reported device-related adverse effects. Data are presented as either mean ± standard deviation or as median with interquartile ranges (IQR). Results: A total of 140 patients (mean age of 61 ± 15 years, 33% female) at 18 study sites treated for septic shock was analyzed. On admission, median APACHE II score was 24 [18,30], SOFA score was 13 [11,15] and Charlson scores of 4 [2,6]. CS therapy was applied as part of kidney replacement therapy (KRT, 85%), standalone hemoperfusion (10%) or extracorporeal membrane oxygenation (ECMO, 5%). On average, each patient received 2.8 ± 2.2 adsorbers, with 47% receiving three or more. CS therapy was associated with a significant reduction in interleukin (IL)-6 levels (from 2,013 [219, 39,988] to 108 [75, 1,662] pg/mL, p < 0.0001) and noradrenaline requirement (0.23 [0.09, 0.43] to 0.07 [0.02, 0.22] µg/kg/min, p < 0.0001), reduced fluid balance (+1,386 [-15, 2,960] to +59 [-738, 1,614] mL, p < 0.0001), and improved oxygenation (P/F ratio 120 [70, 208] to 172 [114, 257], p = 0.0003). CS therapy was also associated with a significantly reduced platelet count (123 [86, 182] to 66 [37, 121] ×109/L, p < 0.0001). Overall SOFA score did not change significantly (p = 0.65), however, system-specific SOFA scores improved significantly for respiratory, cardiovascular and renal sub-scores, while coagulation worsened. Observed ICU mortality was 32.4%. No serious adverse device effects or dysfunctions were reported. Conclusions: In this Registry, CytoSorb® therapy was associated with significant early clinical benefits in patients with septic shock, including hemodynamic stabilization and improved fluid balance. Further systematic research is needed to optimize its use and identify patient populations that benefit most.
- 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, AmetsBackground: 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.
- Técnicas Cirúrgicas Bariátricas e Ganho MetabólicoPublication . Nabais, Celso; Borges, Nuno; Manaças, Leonor; Vaz Rodrigues, Sara; Rego de Figueiredo, Inês; Dhanani, Anjum; Paula, Filipa; Oliveira Torres, João; Silva-Nunes, José; Albuquerque, António; Guerra, AnabelaA cirurgia bariátrica é a intervenção mais eficaz no tratamento da obesidade, permitindo uma perda ponderal sustentada, elevadas taxas de remissão da diabetes mellitus tipo 2, redução do risco cardiovascular e mortalidade. Este artigo de revisão aborda as principais técnicas cirúrgicas e enquadra os respetivos ganhos metabólicos, que se iniciam muito precocemente após cirurgia, e se mantêm a longo prazo. Os mecanismos fisiopatológicos associados, e que extrapolam os componentes restritivo e malabsortivo classicamente descritos, são sumariamente explanados neste artigo, e que incluem, a exclusão do intestino proximal, a chegada precoce dos nutrientes ao intestino distal, a modulação neuroendócrina e de hormonas reguladoras do apetite, as modificações no metabolismo dos ácidos biliares e no microbioma intestinal. Conclui-se, sublinhando que a escolha da técnica deve ser individualizada, ponderando a eficácia metabólica que pode proporcionar, face ao risco de complicações cirúrgicas e nutricionais, e sempre no âmbito de um programa multidisciplinar.
- Proximal Junctional Kyphosis Following Spinal Thoracic Deformity Correction in a Patient with Kabuki Syndrome: A Case Report.Publication . Nóbrega, João; Almeida, Ricardo; Rasteiro, Pedro; Rosado, João; Botelho, Tiago; Carvalho, NelsonIntroduction: Kabuki syndrome (KS) is a rare congenital disorder characterized by distinctive facial features, intellectual disability, and multiple musculoskeletal anomalies, including scoliosis, kyphosis, and generalized ligamentous laxity. The combination of connective tissue fragility and complex spinal deformity may predispose these patients to post-operative complications, such as proximal junctional kyphosis (PJK), though this association has not previously been reported. Case report: We report a 15-year-old male with genetically confirmed KS who presented with severe thoracic hyperkyphosis (95°). Posterior spinal fusion and correction were performed, resulting in initial improvement. Within 8 months, the patient developed PJK above the upper instrumented vertebra, requiring multiple revision procedures. Post-operative infection with Staphylococcus aureus and rapid recurrent kyphosis further complicated management. A staged revision strategy, combining halo-gravitational traction followed by extended fusion and careful sagittal realignment, achieved stable correction and functional improvement at 1-year follow-up. Conclusion: The association between these conditions has, to our knowledge, not yet been reported in literature. This case highlights the multifactorial etiology of PJK in KS, where intrinsic ligamentous laxity, immune dysfunction, and extensive deformity correction converge to increase mechanical vulnerability. Soft-tissue preservation at the upper instrumented level, careful sagittal contouring, and infection control are key preventive strategies. Due to inherent ligamentous laxity and connective tissue abnormalities, patients with KS could be predisposed to proximal junctional failure after spinal deformity correction. Pre-operative recognition of connective tissue and immunologic abnormalities, together with detailed surgical planning, is essential to minimize complications and optimize long-term outcomes.
- Academic Primary Care Units: From Dream to RealityPublication . Correia, Gil; Pereira, António; Bulhões, Cláudia; Outeirinho, Conceição; Prazeres, Filipe; Rosendo, Inês; Antunes, José Pedro; Monteiro, Luís; Jacinto, Nuno; Broeiro-Gonçalves, Paula; Santos, Paulo; Simões, Pedro; Resendes Martins, Raquel; Correia, Rubina; Maricoto, Tiago; Santiago, Luiz Miguel
- Quantifying In Vivo Arterial Deformation from CT and MRI: a Systematic Review of Segmentation, Motion Tracking, and Kinematic Metrics.Publication . Valente, Rodrigo; Henriques, Bernardo; Mourato, André; Xavier, José; Brito, Moisés; Avril, Stéphane; Tomás, António; Fragata, JoséThis article presents a systematic review on methods for quantifying three-dimensional, time-resolved (3D+t) deformation and motion of human arteries from Computed Tomography (CT) and Magnetic Resonance Imaging (MRI). Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched Scopus, Web of Science, IEEE Xplore, Google Scholar, and PubMed on 19 December 2025 for in vivo, patient-specific CT or MRI studies reporting motion or deformation of large human arteries. We included studies that quantified arterial deformation or motion tracking and excluded non-vascular tissues, in vitro or purely computational work. Thirty-five studies were included in the qualitative synthesis; most were small, single-centre observational cohorts. Articles were analysed qualitatively, and results were synthesised narratively. Across the 35 studies, the most common segmentation approaches are active contours and threshold, while temporal motion is tracked using either voxel registration or surface methods. These kinematic data are used to compute metrics such as circumferential and longitudinal strain, distensibility, and curvature. Several studies also employ inverse methods to estimate wall stiffness. The findings consistently show that arterial strain decreases with age (on the order of 20% per decade in some cases) and in the presence of disease, that stiffness correlates with geometric remodelling, and that deformation is spatially heterogeneous. However, insufficient data prevents meaningful comparison across methods.
- Enhancing Risk Prediction for Cerebral Venous Thrombosis: Evaluation of an Integrated Approach With Clinical CVT Probability Score and D-Dimer Levels.Publication . Dahl, Iselin T Syberg; Dhami, Sanpreet K G; Aguiar de Sousa, Diana; Nakken, Ola; Zarnovicky, Svetozar; Faiz, Kashif Waqar; Sandset, Else Charlotte; Vetvik, Kjersti Grøtta; Kristoffersen, Espen SaxhaugBackground: Diagnosing cerebral venous thrombosis (CVT) is challenging due to varied symptoms. Computed tomography venography (CTV) or magnetic resonance venography (MRV) are the gold standard, but resource-demanding with potential side effects. We evaluated the diagnostic properties of a previously proposed CVT probability score combined with D-dimer levels in detecting CVT. Methods: Medical records of consecutive adults who underwent CTV or MRV due to suspicion of CVT at a Norwegian primary hospital were retrospectively analyzed. The CVT probability score was calculated based on previous medical history and clinical findings/symptoms at presentation to stratify patients into low, moderate or high CVT probability groups. Performance characteristics were calculated for the CVT probability score with and without D-dimer levels. Results: Among 578 patients evaluated from 2016 to 2019, CVT was confirmed in 6.6%. The CVT probability score was available for 444 patients and distributed one-third of CVT patients across each CVT probability group, with a 0.33 sensitivity for each group. A negative predictive value (NPV) of 0.96 was noted for the high CVT probability group. The NPV was 0.99 for the combined low/moderate CVT probability group including D-dimer > 500 µg/L. The positive predictive values were all fairly low. Conclusion: Our results indicate that using a CVT probability score and D-dimer levels can help exclude CVT; however, false positive cases present a clinical challenge and carry the risk of excessive advanced imaging.
- Prediction of Survival After Fetoscopic Laser Surgery for Early-Onset Twin-to-Twin Transfusion Syndrome.Publication . Prasad, S; Sileo, F G; Binder, J; Brunelli, E; Chianchiano, N; Coutinho, C M; D'Antonio, F; Döbert, M; Fichera, A; Gielchinsky, Y; Hecher, K; Iacovella, C; Malone, S; Martinez-Varea, A; Nørgaard, L N; Rodo, C; Simões, T; Slaghekke, F; Yinon, Y; Khalil, AObjective: Data on early-onset twin-to-twin transfusion syndrome (TTTS) are scarce and, therefore, evidence-based counseling and management of these pregnancies are challenging. This study aimed to investigate survival rates and establish predictors of survival after fetoscopic laser surgery (FLS) for early-onset TTTS. Methods: This was an international multicenter retrospective cohort study of monochorionic diamniotic twin pregnancies complicated by TTTS diagnosed before 18 + 0 weeks' gestation that underwent FLS. The primary outcome was dual-twin survival at 28 days after birth. Secondary outcomes included survival of at least one twin and dual-twin demise at 28 days after birth. Monoamniotic twin, triplet and higher-order multiple pregnancies, pregnancies with chromosomal or structural fetal anomaly and TTTS cases not treated by FLS were excluded. Pre-, intra- and postoperative characteristics were analyzed using multivariable logistic regression analysis. Discriminative performance was assessed using receiver-operating-characteristics-curve analysis. Results: A total of 485 cases of early-onset TTTS that underwent FLS were included. The rates of dual-twin survival and survival of at least one twin at 28 days after birth were 51.5% (250/485) and 76.7% (372/485), respectively, while 23.3% (113/485) of cases resulted in dual-twin demise. Multivariable logistic regression analysis showed that absent or reversed end-diastolic flow (AREDF) in the donor umbilical artery (adjusted odds ratio (aOR), 0.487 (95% CI, 0.273-0.867)) and absent or reversed a-wave in the donor ductus venosus (aOR, 0.299 (95% CI, 0.110-0.810)) at the time of TTTS diagnosis were associated independently with decreased odds of dual-twin survival, while higher gestational age at birth was associated with increased odds of both dual-twin survival (aOR, 1.172 (95% CI, 1.117-1.229)) and survival of at least one twin (aOR, 2.053 (95% CI, 1.699-2.481)). The model for dual-twin survival showed modest discriminative performance with poor overall fit. Conclusions: The presence of AREDF in the donor umbilical artery and absent or reversed a-wave in the donor ductus venosus, at the time of diagnosis of TTTS, and lower gestational age at birth were independent adverse predictors for dual-twin survival following FLS in cases of TTTS diagnosed before 18 weeks. Future studies should explore the impact of surgical technique on survival rates. © 2026 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
- A 17-Year-Old Boy With Hemifacial Flushing and Anhidrosis.Publication . Farinha, Pedro Simões; Ferreirinha, Ana; Vilela, Beatriz; Duarte, Bruno