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- Portuguese and the biobanks: profiles and attitudes of the Portuguese population towards biobanks for health researchPublication . Riso, Brígida; Santos, Mário J. D. S.; Ávila, PatríciaBiobanks for clinical research collect human biological samples and associated data for biomedical research. The establishment of biobanks in Portugal is still an understudied phenomenon, although there are signs of a growing trend in setting up these repositories to support biomedical research. Among another factors, individuals’ willingness to donate samples and public trust in biobanks play a crucial role in sustaining biobanking activities. In this article, we analyse public attitudes in Portugal towards biobanking, based on data from the biotechnology survey conducted by Eurobarometer in 2010. Different assumptions about science and technology enabled profiling the Portuguese population into four distinct groups: the optimistic, the cautious, the sceptical and the pessimistic. Each profile implies a diverse range of intentions and attitudes regarding biobanks. Furthermore, we found that previous study of science could be an important predictor of the willingness to donate information to biobanks.
- Síndromes de fadiga pós-infeção na era da COVID longa: o caso da encefalomielite miálgica/síndrome de fadiga crónicaPublication . Sepulveda, Nuno; Malato, João; Winck, João Carlos; Carneiro, António Vaz; Hoffman, Joan Serra; Branco, JaimeFaz mais de quatro anos que a Organização Mundial da Saúde (OMS) declarou o início da pandemia de COVID-19. Agora, a doença já não é considerada uma prioridade de saúde pública em Portugal. Contudo, este período de maior acalmia tem revelado um outro problema já reconhecido pelo Serviço Nacional de Saúde (SNS) e pela comunidade médica portuguesa: alguns indivíduos continuam a manifestar vários sintomas após a aparente resolução da infeção pelo novo coronavírus. Alguns desses indivíduos parecem entrar numa fase crónica dos seus sintomas. Quando a duração dos sintomas atinge a barreira dos três meses, esses indivíduos recebem um diagnóstico de ‘COVID longa’ ou de ‘condição pós-COVID-19’. O quadro clínico desses pacientes é bastante variável, podendo prevalecer um cansaço persistente e profundo sem razão aparente e um mal-estar após atividades físicas, mentais e emocionais. Em particular, esse mal-estar pós-esforço (post-exertional malaise ou PEM) só desaparece ao fim de mais de 24 horas, o que sugere um processo lento de recuperação por parte do organismo. Os doentes de COVID longa podem também relatar a presença de cefaleias, problemas de concentração, perdas de memória, dispneia, entre outros sintomas.
- Three misconceptions in medical education: student evaluation of teaching, curricular repetition, and assessment objectivityPublication . Hanscheid, Thomas; Valadas, Emília; Costa, JoãoThree widely held assumptions in medical education may inadvertently hinder effective learning. First, student evaluations of teaching (SETs) are often treated as proxies for educational quality, yet they are shaped by factors unrelated to actual learning and provide limited actionable insight. Second, repetition in the curriculum is frequently dismissed as poor design rather than recognised as essential for mastery, reinforcing knowledge, developing fluency, and enabling long-term retention. Third, the overemphasis on objectivity in assessment, exemplified by multiple-choice questions (MCQs) and objective structured clinical examinations (OSCEs), may obscure important dimensions of clinical reasoning and are weak predictors of real-world clinical competence. Reconsidering these three assumptions may help realign educational strategies with their central goal: preparing students to become competent, reflective, and effective physicians.
- Multimodal endoscopic management of fistula after sleeve gastrectomy involving a novel esophageal stentPublication . Fortunato, Claudia; Ferreira, Carlos; Moura, Miguel; Almeida, Amélia; Marinho, Rui; Correia, LuísIntroduction: Laparoscopic sleeve gastrectomy (LSG) is a bariatric surgical procedure associated with a non-negligible risk of postoperative adverse events, especially fistulas, the majority of which occur at the angle of His. This adverse event requires a multidisciplinary approach involving intensive care, surgery, interventional endoscopy, and radiology. Despite the absence of an algorithmic endoscopic approach, a primarily endoscopic management of fistulas after LSG is now standard of care in most institutions. Case report: A 66-year-old female with grade III obesity, obstructive sleep apnea, type 2 diabetes, and hypertension underwent LSG. She developed abdominal pain, hypovolemic shock, and severe anemia (Hb 6.5 g/dL). A computed tomography (CT) scan revealed hemoperitoneum without active bleeding, managed with transfusion of packed blood cells. A week later, a new CT scan performed for leukocytosis and abdominal pain revealed pneumoperitoneum. An esophagogastroduodenoscopy revealed a 20-mm fistula orifice at the angle of His. A novel esophageal covered metallic stent was placed for a period of 5 weeks. The fistula orifice decreased to 4 mm and communicated through a fistulous tract with a residual subphrenic abscess measuring 62 × 20 mm. Pus was collected from the abscess and drained internally with a 10-Fr double pigtail plastic stent through the fistula orifice. Following an initial period of improvement, clinical deterioration required percutaneous subphrenic abscess drainage. Two weeks later, the double pigtail plastic stent was removed, the fistula orifice was ablated with argon plasma 40W/1L and closed with an over-the-scope clip of 10 mm. Patient improved and was discharged 4 months after the LSG. Conclusion: The Luso-Cor esophageal stent is a specifically designed covered metallic stent with a 5-mm uncovered ring near the proximal edge, which reduces the risk of migration. Two articulating zones in the middle portion allow better adaptation to altered anatomy after LSG and a distal flare reduces retrograde reflux of fluid. This stent overcomes strictures in the gastric tube, concomitantly present in nearly 50% of patients with fistulas after LSG. The novel Luso-Cor esophageal stent provided a bridge to clinical stability with a significant reduction in the size of the fistula orifice which was closed with complementary therapeutic endoscopic procedures.
- Recurrent syncope during migraine attacksPublication . Dias Da Costa, Mariana; Nunes Vicente, Beatriz; Dourado Sotero, Filipa; Martins, Isabel PavãoMigraine is a cyclic condition with attacks consisting mainly of intense headaches, sensory intolerance, and nausea or vomiting. Loss of consciousness during attacks is often attributed exclusively to a neurally mediated reflex to pain, although it may also be due to migraine's autonomic impairment, with cardiac conduction abnormalities, probably in relation to a degree of reduced sympathetic function. We report the case of a 51-year-old woman presenting episodes of syncope exclusively after vomiting during migraine attacks. A 24-hour Holter monitoring performed during a migraine attack disclosed an intermittent complete atrioventricular block coincident with an episode of syncope. The patient was implanted with a pacemaker without further syncopes on subsequent attacks. This case highlights the importance of clinical suspicion and investigation of syncope during migraine attacks. Recurrent syncope during migraine should not be attributed to pain to avoid misdiagnosis and ensure the treatment of other important causes of syncope.
- Transjugular liver biopsy: the key to a rare etiology of cholestatic hepatitis after bone marrow transplantationPublication . Pestana, Inês; Pedro, Juliana; Simões, Carolina; Ferreira, Carlos; da Mata, Sara; Claro, IsabelIntroduction: Hematopoietic stem cell transplantation (HSCT) is associated with multiple complications, such as sinusoidal obstruction syndrome (SOS) (hepatomegaly, ascites, jaundice, and thrombocytopenia) and graft-versus-host disease (GVHD) (with the skin, gastrointestinal tract, and liver being the main targets). These entities may present overlapping clinical findings, being considered differential diagnoses, but their coexistence is rare. Case presentation: A 29-year-old male with acute myeloid leukemia underwent HSCT. On day (D)+20, he developed hyperbilirubinemia, pleural effusion, ascites, and painful hepatomegaly. Abdominal ultrasound was suggestive of SOS, and defibrotide was initiated. On D+44, acute cutaneous, intestinal, and hepatic GVHD developed which improved after treatment with methylprednisolone. On D+132, there was worsening cholestasis and abdominal pain. MRCP revealed strictures in several segments of the intrahepatic bile ducts and irregularity of the main bile duct. Due to aggravation of liver enzyme changes and clinical worsening, he was admitted to the Intensive Care Unit. Due to persistence of severe hyperbilirubinemia (30 mg/dL) and thrombocytopenia (30,000 cell/uL), he underwent a hepatic hemodynamic study which revealed a hepatic venous pressure gradient of 10 mm Hg. The transjugular liver biopsy revealed canalicular hepatic cholestasis, bile duct injury, and focal hepatocellular necrosis suggestive of GVHD as well as injury to centrilobular veins and centrilobular necrosis compatible with possible SOS. Mycophenolate mofetil was started, but on D+195, the patient died of septic shock. Discussion/conclusion: This case is notable for its complexity and for demonstrating the rare coexistence of histological features of SOS and GVHD. Although the clinical and laboratory findings may be sufficient for the diagnosis, it is important to highlight the importance of liver hemodynamic study and transjugular liver biopsy in these patients who often have severe thrombocytopenia, for the characterization and histological confirmation of cholestatic hepatitis, especially when the etiology may be multifactorial.
- The SAFEST study: the crucial role of primary health care in the diagnosis and management of atrial fibrillationPublication . Gonçalves Teixeira, Pedro; Caldeira, Daniel; Baptista, Rui; Zimbarra Cabrita, Inês; Nogueira, Margarida; Fontes-Carvalho, RicardoAtrial fibrillation (AF) is the most prevalent cardiac arrhythmia in the developed world and is associated with impaired quality of life, a five-fold higher risk of stroke, a three-fold increased incidence of heart failure, and a nearly two-fold higher risk of hospitalization and overall mortality. AF is known to be exponentially more prevalent among the elderly, but is frequently asymptomatic and therefore undiagnosed. This results in suboptimal rates of anticoagulation and effective control of other cardiovascular risk factors. The clinical and economic burden posed by AF is therefore substantial, and this scenario is set to worsen in the coming years,1 mainly driven by population aging, and its association with various comorbidities. In FAMA, a large-scale epidemiological study conducted in 2009 in Portugal, the prevalence of AF among individuals aged over 40 years was estimated to be 2.5%. The SAFIRA study estimated a 9.0% prevalence in patients aged over 65 years, as did another Portuguese study.
- Effectiveness of neuropsychological rehabilitation in the recovery of executive deficits in patients with alcohol use disorder: a systematic review protocolPublication . Ferreira, Sónia; Virgolino, Ana; Ribeiro, Cristina; Pombo, Samuel; Bacelar-Nicolau, LeonorIntroduction: Changes in executive functions associated with alcohol consumption are frequently found in alcohol use disorder. Neuropsychological rehabilitation can play an essential role as an effective treatment in the recovery from these deficits, leading to the maintenance of abstinence. However, there are still some uncertainties regarding its impact on the recovery of deficits in executive functions. Our purpose is to present a protocol for a systematic review aiming to assess which neuropsychological rehabilitation programs are effective in the recovery of executive deficits in patients with alcohol use disorder. Methods: We will search the following databases: PubMed, Cochrane Library (CENTRAL), Web of Science, and Scopus, as well as the list of references of the identified studies. Screening, data extraction, and synthesis, as well as evaluation of the risk of bias, will be carried out by two reviewers independently, using ROBINS-I and RoB 2. Disagreements will be resolved using a third additional reviewer. Primary outcomes will correspond to changes in executive functions, following a neuropsychological rehabilitation program in patients with alcohol use disorder. The evidence will be synthesized using a narrative description of neuropsychological rehabilitation programs and the indicators of their effectiveness will be identified. The neuropsychological rehabilitation programs for executive functions will be assessed considering their different components and their impact on the recovery of these functions. The review described in this protocol will allow the development of guidelines for the design of more effective rehabilitation programs for clinical populations with alcohol use disorder.
- Influence of COVID-19 on patients with esophageal varices under prophylactic endoscopic band ligation therapyPublication . Craciun, Ana; Botto, Inês; Lopes, Joao; Moura, Miguel; Carvalhana, Sofia; Cortez-Pinto, Helena; Marinho, RuiBackground and objectives: Endoscopic band ligation (EBL) plays a critical role in patients with clinically significant portal hypertension, as variceal eradication (VE) is essential to prevent further variceal upper gastrointestinal bleeding (GI). The emergence of COVID-19 has led to a dramatic reduction in endoscopic activity. Our study aimed to evaluate the effect of COVID-19 on VE, GI, and 6-month mortality of patients treated with prophylactic EBL therapy. In addition, our goal was to identify the risk factors for our proposed outcomes. Methods: A single-center retrospective cohort study included patients with esophageal varices treated with prophylactic EBL therapy between 2017 and 2021. To demonstrate the impact of COVID-19 on two independent groups on prophylactic EBL therapy with 1 year of follow-up, March 2019 was selected as the cut-off date. Clinical, laboratory, and endoscopic data were recovered from electronic reports. Results: Ninety-seven patients underwent 398 prophylactic EBL sessions, 75 men (77.3%) with mean age 59 ± 12 years. Most achieved VE (60.8%), 14.4% had GI bleeding post-therapy, and 15.5% died at 6 months. The rate of variceal obliteration was significantly lower in the pandemic group (40.9% vs. 77.4% in the pre-pandemic group, p = 0.001). Mean number of EBL sessions and pandemic group were independently associated with incomplete VE, while MELD-Na, portal vein thrombosis and failed VE were identified as risk factors associated with mortality at 6 months. Conclusions: Almost 60% of patients in the pandemic group failed to eradicate esophageal varices. Failure to achieve this result conferred a higher risk of GI bleeding and death at 6 months, the latter also significantly associated with the MELD-Na score and portal vein thrombosis. Our study is among the first to demonstrate the impact of COVID-19 in patients receiving prophylactic EBL therapy.
- Revistas médicas: uma reflexãoPublication . Oliveira, VictorAs revistas médicas são publicações periódicas que têm por objetivo a divulgação de trabalhos científicos, traduzindo os progressos da Medicina e mantendo os seus leitores atualizados. A sua origem decorreu da necessidade de divulgação de conhecimentos entre pares, como veículo de comunicação alargado, aos profissionais de saúde, chegando aos que, exercendo em zonas mais recônditas, teriam nestas publicações o principal, senão o único, veículo de atualização