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- 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.
- Flexible Bronchoscopy in the Intensive Care Unit: the FLEXICARE Survey.Publication . Fisser, Christoph; Sicker, Nina; Crimi, Claudia; Karagiannidis, Christian; Winck, Joao Carlos; Duiverman, Marieke; Azevedo, Ariana; Cysneiros, Ana; Martin-Loeches, IgnacioBackground: Flexible bronchoscopy (FB) is a key diagnostic and therapeutic procedure in the intensive care unit (ICU). However, significant heterogeneity exists regarding indications, peri-procedural management, training and safety practices across ICUs. Data on real-world practices remain limited. Methods: An international, online cross-sectional survey was conducted by the European Respiratory Society's Acute Critical Care Group between May and December 2023. The questionnaire, designed according to Checklist for Reporting Of Survey Studies (CROSS) and Academy of Critical Care: Development, Evaluation and Methodology (ACCADEMY) standards, targeted healthcare professionals performing FB in ICUs. It addressed procedural protocols, sedation, ventilation strategies, complications, microbiologic sampling, tracheostomy practices and training. Only fully completed responses were included in the analysis. Results: Data from 266 respondents across 73 countries were analysed. Training in FB varied widely: 41% reported no formal training, and only 61% had access to a 24/7 bronchoscopy service. Sedation practices were heterogeneous. Ventilator settings were adjusted differently based on ICU certification, with ICU-certified physicians more likely to reduce positive end-expiratory pressure during FB (55% versus 42%; p=0.031). Bronchoalveolar lavage was the most common sampling method, with a median saline volume of 60-120 mL and a recovery rate of 48±18%. Microbiological findings led to therapeutic changes in 48±21% of cases. FB guidance during percutaneous tracheostomy was applied in only 56% of cases. Conclusion: Substantial variability exists in FB practices across ICUs, particularly in training, sedation, ventilation adjustments and microbiologic sampling. Despite frequent therapeutic consequences, standardised approaches are lacking. These findings underscore the need for international consensus guidelines and structured training programmes to harmonise FB practices in critical care settings.
- Extreme Hyperhemolysis Syndrome in a Patient With Sickle Cell Disease Successfully Managed With Eculizumab: A Case of Survival at 1.2 g/dL Hemoglobin.Publication . Cordeiro, Isa; Cerca, Carolina; Pinheiro, Marta; Pratas, Claudia; Germano, NunoThis case presents a 26-year-old male with sickle cell disease (SCD) who experienced a catastrophic hyperhemolysis syndrome (HHS) triggered by red blood cell (RBC) transfusion. The patient was initially hospitalized for a vaso-occlusive crisis and fever; the patient's clinical status deteriorated rapidly as his hemoglobin (Hb) plummeted from 7.5 g/dL to a nadir of 1.2 g/dL. Despite treatment with corticosteroid and intravenous immunoglobulin (IVIG) therapy, the hemolytic process persisted. To manage the critical imbalance between oxygen delivery and demand, invasive mechanical ventilation was initiated as a supportive metabolic measure. Due to the failure of conventional therapies, eculizumab was administered on the third day of intensive care unit (ICU) admission. This intervention resulted in the cessation of hyperhemolysis, followed by gradual hematological stabilization and recovery. This report underscores the severity of HHS and demonstrates the successful use of terminal complement inhibition as a life-saving rescue strategy in extreme cases.
- Vaccination of Older Adults in Portugal: Recommendations from the Geriatrics Study Group of the Portuguese Society of Internal Medicine.Publication . Sousa Almeida, Paulo Ricardo; Sarmento, Gonçalo; Gruner, Heidi; Veríssimo, Rafaela; Duque, SofiaOlder persons are more susceptible to infections and have a higher risk of serious complications, with a worse functional and vital prognosis. Vaccination is an effective strategy with a favorable safety profile for preventing infections and promoting healthy aging. In view of the clinical evidence and the vaccines available in Portugal in the first half of 2025, the Geriatrics Study Group of the Portuguese Society of Internal Medicine presents a proposal for vaccination of adults aged 65 years or older. The experts also point out the need to create a national lifelong vaccination program that includes older people to increase vaccination coverage and reduce the impact of infections in this population. Although the document focuses on people aged 65 years or older, vaccination against some diseases should start earlier. This article outlines five main recommendations: 1) Annual influenza and COVID-19 vaccination for all adults aged 50 years or older, with those aged 65 years or older receiving the high-dose trivalent influenza vaccine; 2) Respiratory syncytial virus vaccination for all adults aged 60 years or older and adults aged 18 - 59 years with risk factors, prioritizing people aged 75 years or older and those aged 50 years or older with risk factors; 3) Pneumococcal vaccination with the 20-valent or 21-valent pneumococcal conjugate vaccine for all adults aged 50 years or older and adults aged 18 - 49 years with risk factors; 4) Herpes zoster vaccination with the recombinant vaccine for all adults aged 50 years or older and adults aged 18 - 49 years at high risk of herpes zoster; 5) From the age of 65 years, booster vaccination against tetanus, diphtheria and pertussis every 10 years.
- Inflammatory Biomarkers in Diabetic Macular Edema.Publication . Campos, António; Furtado, Maria João; Carneiro, Ângela; Meireles, Angelina; Neves, Carlos; Ambrósio, António Francisco; Leal, Inês; Figueira, João; Marques, João Pedro; Henriques, José; Falcão, Manuel; Gomes, Nuno; Flores, Rita; Silva, Rufino; Pessoa, BernardeteDiabetic retinopathy (DR) is a major complication of both Type 1 and Type 2 diabetes mellitus (T1DM and T2DM). Disease progression can result in visual impairment, primarily due to diabetic macular edema (DME) or proliferative diabetic retinopathy (PDR). Although several ocular treatments are available for DME, a subset of patients fails to respond, reflecting the multifactorial, complex, and systemic nature of DR. Inflammatory biomarkers can be classified according to different characteristics, including imaging biomarkers-most commonly assessed using optical coherence tomography (OCT)-and molecular biomarkers, which are defined by their biochemical and biophysical properties. Pro- and anti-inflammatory cytokines, chemokines, adipokines, and inflammation-related enzymes are recognized as key inflammatory biomarkers and can be detected in the vitreous humour, aqueous humour, tears, serum, and other biological tissues. The identification and characterization of reliable biomarkers may help determine disease severity, monitor disease progression, and predict the risk of specific outcomes, thereby aiding in the prevention of end-stage disease (prognostic biomarkers). In addition, biomarkers may serve as predictive tools for therapeutic response, guiding personalized treatment strategies and enabling ongoing monitoring. This review provides a comprehensive overview of the role of inflammatory biomarkers in the diagnosis and management of DR and DME.
- Breast Adipose Tissue's Xenobiotics and Fatty Acid Profile-A Preliminary Study in Portuguese Women with Breast Cancer.Publication . Sousa, Sara; Paíga, Paula; Araújo, Bárbara; Coelho, Francisca; Castela, Inês; Vasques, Miguel; Sampaio, Clara; Duarte, Marta; Correia, Ana; Teixeira, Diana; Pestana, Diogo; Faria, Ana; Delerue-Matos, Cristina; Ramalhosa, Maria João; Calhau, Conceição; Fernandes Domingues, ValentinaCountless environmental pollutants and xenobiotics, are widespread and linked to hazardous effects, including breast cancer. Due to their lipophilic properties, these accumulate in fat tissue, such as breast adipose tissue. However, little is still known about their combined effects and distribution within the breast microenvironment. Alterations in fatty acid metabolism can be a biomarker for cancer progression and a potential bioindicator of pollutant exposure. In this study, the fatty acid profile and levels of organochlorine and organophosphate pesticides (OCPs and OPPs), polychlorinated biphenyls (PCBs), brominated flame retardants (BFRs), organophosphate esters (OPEs), polycyclic aromatic hydrocarbons (PAHs) and synthetic musks (SMs) were measured in 48 breast adipose tissue samples from breast cancer and healthy patients (controls). Twelve xenobiotics were detected at high frequency rates, and the distribution profile of these pollutants differed between cohorts. In total, 163 correlations were identified between specific fatty acids and breast cancer patients' data, with distinct correlation patterns between cohorts. Fatty acids show the potential to be biomarkers of the presence of lipophilic xenobiotics in the breast microenvironment; however, more studies are needed. This preliminary study is the first to analyze OPPs, OPEs, and PAHs in breast adipose tissue and report associations between xenobiotics and specific fatty acids.
- One-Minute Sit-to-Stand Test Versus Six-Minute-Walk Test in Post-COVID-19 Patients: A Cross-Sectional Observational Study.Publication . Duarte-Silva, Marta; Fiúza, Pedro; Reis, Neuza; Toscano-Rico, MiguelSimplified field tests have gained increasing interest for the assessment of functional capacity in patients with post-COVID-19 condition; however, direct comparisons of functional performance and physiological responses between the 1-min sit-to-stand test (1MSTST) and the 6-min walk test (6MWT) remain limited. This study aimed to examine the associations between the two tests by evaluating functional performance, cardiopulmonary responses, oxygen desaturation, perceived exertion, and peripheral muscle strength. Furthermore, we explored whether the 1MSTST can be used as a complementary assessment, particularly within telerehabilitation pathways and in contexts where resource-intensive testing is not feasible. We conducted a cross-sectional observational study of adults recovering from moderate to severe COVID-19 between May and July 2021. Participants performed both the 1MSTST and 6MWT on the same day. Functional performance, peak heart rate, nadir peripheral oxygen saturation (SpO), perceived exertion, and handgrip dynamometry were recorded. Associations between test performances were assessed using correlation and partial correlation analyses, including adjustment for peripheral muscle strength. Fifty-four patients were included. A moderate correlation was observed between 1MSTST repetitions and 6MWT distance (Spearman's ρ = 0.47, < 0.001), which was attenuated after adjustment for muscle strength and demographic variables. Peak heart rate and nadir SpO responses were strongly correlated between tests (r = 0.75 and ρ = 0.83, respectively; both < 0.001), with no significant differences in magnitude. Exercise-induced oxygen desaturation (≥4% SpO drop) occurred at similar frequencies during both tests. Perceived exertion increased similarly following the 1MSTST and the 6MWT. : In post-COVID-19 patients, the 1 min sit-to-stand test shows moderate concordance with the 6 min walk test for functional performance and strong agreement in cardiopulmonary responses. These findings suggest that the two tests assess overlapping but distinct aspects of functional capacity. This supports the use of the 1MSTST as a pragmatic complementary assessment when standard walking tests are not feasible, particularly within telerehabilitation pathways, primary care, and resource-limited settings.