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A 54-year-old patient with a medical history of hypertension, dyslipidemia, and diabetes underwent mitral valve replacement surgery with a biologic valve. During a chest computed tomography scan for breast neoplasia staging, a reduced luminal filling in the left atrium (3.6 cm) was unexpectedly found, prompting further cardiac evaluation. The patient was referred to the emergency department experiencing shortness of breath and fatigue, which improved after furosemide administration, and remaining stable throughout hospitalization. A transesophageal echocardiogram was performed the following day and revealed a biologic mitral valve prosthesis slightly displaced toward the left ventricle with an average transprosthetic gradient of 7 mmHg. Notably, a sizable intermediate echogenic mass measuring 3.0 cm × 3.5 cm was detected and attached to the prosthesis ring in a lateral and posterior position, within the left atrium. A mild degree of periprosthetic regurgitation was also noted. Given the substantial suspicion that the observed mass was a thrombus, the patient was commenced on anticoagulation therapy while awaiting cardiac magnetic resonance imaging for better characterization of the mass. Over 4 weeks, the thrombus notably decreased in size, disappearing entirely by the 6th week. This case highlights the significance of employing multiple imaging techniques in managing cardiac masses. The incidental discovery of the mass, its characterization, and subsequent management through anticoagulation, followed by confirmation and monitoring through echocardiogram, underscore the importance of a multimodal approach in diagnosing and treating such conditions.
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Cardiovascular disease and cancer constitute the most prevalent illnesses worldwide. Cancer patients show an increased risk of coronary artery disease not only due to shared cardiovascular risk factors, a pro-inflammatory and prothrombotic state induced by cancer itself, the cardiovascular toxicity of cancer therapy, or rarely, due to extrinsic compression of a coronary artery by the primary tumor or a metastatic lesion. Here, we present the case of a 59-year-old man with squamous cell carcinoma of the lung presented with asymptomatic diffuse ST segment depression and troponin T increase. Echocardiography revealed a large mass adjacent to the right atrium, atrioventricular groove, and basal segment of the anterior wall of the left ventricle, which the computed tomography scan showed to encase and probably compress the anterior descending coronary artery. Thus, the patient was diagnosed with acute coronary syndrome due to anterior descendent coronary artery compression by a neoplastic lung mass.
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OBJECTIVE: To adapt four dietary patterns for children and adolescents, and study their associations with sustainability (greenhouse-gas emissions-GHGE and land use-LU), and health (body mass index-BMI) indicators. RESEARCH METHODS & PROCEDURES: Dietary intake of children (3-9y) and adolescents (10-17y) from the National Food, Nutrition and Physical Activity Survey 2015-2016, Portugal (n = 1153) was assessed through two non-consecutive interviews: one-day food diaries (children), and 24-h recalls (adolescents), using an automated multiple-pass method, including a picture book for portion sizes estimation. Adherence to the Eat-Lancet and World Health Organization (WHO) recommendations, Mediterranean and Atlantic diets were evaluated using adapted versions for pediatrics of the World Index for Sustainability and Health (WISH), Diet Quality Index (DQI), Mediterranean Diet Score (MDS) and Southern-European Atlantic Diet (SEAD), respectively. Diet-related GHGE and LU were estimated using the SHARP-Indicators database. BMI (measured) z-scores were classified according to WHO criteria. A standardized weighted health-sustainability composite index was created (BMI + 0.5*GHGE+0.5*LU). Adjusted linear regression models were computed. RESULTS: WISH, DQI, MDS, and SEAD had weighted mean scores (range) of 50 (0-130), 24 (9-36), 20 (8-32), and 17 (8-32), respectively. All dietary patterns were associated with lower environmental impact, particularly in children, but not with BMI. Only MDS explained both health and sustainability indicators in childhood (composite index: sd.ß = -0·223,95%CI:-0·347,-0·072,R2 = 25.1 %), and adolescence (composite index: sd.ß = -0·159,95%CI:-0·315,-0·003,R2 = 31.3 %). CONCLUSION: The Mediterranean diet was the most related to (higher) environmental sustainability and (lower) BMI. However, in children (not adolescents), the WISH, DQI, and SEAD showed then same associations.
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Índice de Massa Corporal , Dieta , Exercício Físico , Humanos , Criança , Adolescente , Masculino , Feminino , Portugal , Dieta/estatística & dados numéricos , Pré-Escolar , Inquéritos Nutricionais , Dieta Mediterrânea/estatística & dados numéricos , Conservação dos Recursos Naturais , Padrões DietéticosRESUMO
OBJECTIVE: To estimate, in a cohort of young Portuguese adults, the environmental impact (greenhouse gas (GHG) emissions, land use, energy used, acidification and potential eutrophication) of diet according to adherence to the Mediterranean Diet (MD). METHODS: Data from 1554 participants of the Epidemiologic Health Investigation of Teenagers in Porto (EPITeen) were analysed. Food intake and MD adherence were determined using validated questionnaires. The environmental impact was evaluated with the EAT-Lancet Commission tables, and the link between MD adherence and environmental impact was calculated using adjusted multivariate linear regression models. RESULTS: Higher adherence (high vs. low) to the MD was associated with lower environmental impact in terms of land use (7.8 vs. 8.5 m2, p = 0.002), potential acidification (57.8 vs. 62.4 g SO2-eq, p = 0.001) and eutrophication (21.7 vs. 23.5 g PO4-eq, p < 0.001). Energy use decreased only in the calorie-adjusted model (9689.5 vs. 10,265.9 kJ, p < 0.001), and GHG emissions were reduced only in a complementary model where fish consumption was eliminated (3035.3 vs. 3281.2 g CO2-eq, p < 0.001). Meat products had the greatest environmental impact for all five environmental factors analysed: 35.7% in GHG emissions, 60.9% in energy use, 72.8% in land use, 70% in acidification and 61.8% in eutrophication. CONCLUSIONS: Higher adherence to the MD is associated with lower environmental impact, particularly in terms of acidification, eutrophication, and land use. Reducing meat consumption can contribute to greater environmental sustainability.
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This study aimed to identify the sociodemographic and health-related factors associated with the consumption of voluntarily fortified foods with micronutrients (Mn-FF) by the Portuguese population, using data from the National Food, Nutrition and Physical Activity Survey (IAN-AF 2015-2016). Food consumption, sociodemographic and other health-related factors, and physical activity data were computerised using the You Eat & Move e-platform. Foods consumed by participants and labelled foods reported as consumed were included in the database. Mn-FF were considered all foods containing added micronutrients legally authorised, and MN-FF users were those who consumed at least one Mn-FF on at least one of the dietary recall days. Approximately 57% of the population consumed at least one Mn-FF. Children and adolescents consumed significantly more Mn-FF than older age groups. The primary contributors to Mn-FF consumption were breakfast cereals and fat spreads. Being a child (female OR 2.07 [95% CI: 1.52, 2.83]; male OR 4.80 [95% CI: 3.23, 7.14]) or adolescent (female OR 1.62 [95% CI: 1.78, 2.22]; male OR 4.59 [95% CI: 3.26, 6.47]), having a higher level of education (female OR 1.52 [95% CI: 1.17, 1.99]; male OR 1.85 [95% CI: 1.42, 2.42]) and engaging in regular physical activity (female OR 1.31 [95% CI: 1.09, 1.58]; male OR 1.36 [95% CI: 1.11, 1.68]) were factors positively associated with Mn-FF consumption. Conversely, obesity (female OR 0.76 [95% CI: 0.60, 0.96]), living in predominantly rural areas (male OR 0.70 [95% CI: 0.49, 0.91]) and eating fewer mid-meals per day (female OR 0.60 [95% CI: 0.48, 0.76]; male OR 0.64 [95% CI: 0.49, 0.84]) were associated with lower Mn-FF consumption. Younger age, higher education and physical activity practice were positively associated with Mn-FF consumption. These findings provide important insights on priority factors to be considered when deciding on nutrient fortification policies from both public health and food industry perspectives.
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Alimentos Fortificados , Micronutrientes , Humanos , Portugal , Masculino , Feminino , Adolescente , Micronutrientes/administração & dosagem , Criança , Adulto , Adulto Jovem , Pré-Escolar , Pessoa de Meia-Idade , Dieta , Inquéritos Nutricionais , Idoso , Exercício Físico , Fatores Socioeconômicos , Fatores SociodemográficosRESUMO
Acute gastric variceal bleeding is a life-threatening condition that could be effectively treated with endoscopic cyanoacrylate injection diluted with lipiodol. The mixture acts as a tissue adhesive that polymerizes when in contact with blood in a gastric varix. This work reports a patient that presented to the emergency department with upper gastrointestinal bleeding due to acute variceal bleeding, who developed systemic embolization following cyanoacrylate injection therapy. This complication culminated in cerebral, splenic and renal infarctions with a fatal outcome. Systemic embolization is a very rare, but the most severe complication associated with endoscopic cyanoacrylate injection and should be considered in patients undergoing this treatment.
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Cianoacrilatos , Varizes Esofágicas e Gástricas , Hemorragia Gastrointestinal , Adesivos Teciduais , Humanos , Cianoacrilatos/uso terapêutico , Cianoacrilatos/administração & dosagem , Cianoacrilatos/efeitos adversos , Embolia/etiologia , Embolia/terapia , Embolização Terapêutica/métodos , Varizes Esofágicas e Gástricas/terapia , Varizes Esofágicas e Gástricas/etiologia , Evolução Fatal , Hemorragia Gastrointestinal/terapia , Hemorragia Gastrointestinal/etiologia , Adesivos Teciduais/uso terapêutico , Adesivos Teciduais/administração & dosagemRESUMO
BACKGROUND AND AIMS: Bisphenol A (BPA), an endocrine disruptor widely used in food contact materials, has been linked to a worse health profile. This study intends to estimate the association between BPA exposure and cardiometabolic patterns at adolescence. METHODS AND RESULTS: Data from the Portuguese population-based birth cohort Generation XXI at the age of 13 were used (n = 2386 providing 3-day food diaries and fasting blood samples). BPA exposure was measured in 24-h urine from a subsample (n = 206) and then predicted in all participants using a random forest method and considering dietary intake from diaries. Three cardiometabolic patterns were identified (normal, modified lipid profile and higher cardiometabolic risk) using a probabilistic Gaussian mixture model. Multinomial regression models were applied to associate BPA exposure (lower, medium, higher) and cardiometabolic patterns, adjusting for confounders. The median BPA exposure was 1532 ng/d, corresponding to 29.4 ng/kg/d. Adolescents higher exposed to BPA (compared to medium and lower levels) had higher BMI z-score (kg/m2) (0.68 vs. 0.39 and 0.52, respectively; p = 0.008), higher levels of body fat (kg) (16.3 vs. 13.8 and 14.6, respectively; p = 0.002), waist circumference (76.2 vs. 73.7 and 74.9, respectively; p = 0.026), insulinemia (ug/mL) (14.1 vs. 12.7 and 13.1, respectively; p = 0.039) and triglyceridemia (mg/dL) (72.7 vs. 66.1 and 66.5, respectively; p = 0.030). After adjustment, a significant association between higher BPA and a higher cardiometabolic risk pattern was observed (OR: 2.55; 95%CI: 1.41, 4.63). CONCLUSION: Higher BPA exposure was associated with a higher cardiometabolic risk pattern in adolescents, evidencing the role of food contaminants in health.
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Doenças Cardiovasculares , Disruptores Endócrinos , Humanos , Adolescente , Compostos Benzidrílicos/efeitos adversos , Compostos Benzidrílicos/urina , Fenóis/efeitos adversos , Fenóis/urina , Disruptores Endócrinos/efeitos adversos , Disruptores Endócrinos/urina , Doenças Cardiovasculares/induzido quimicamente , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologiaRESUMO
BACKGROUND: The shock index (SI), reflecting heart rate (HR) to SBP ratio, is established for predicting adverse outcomes in acute coronary syndrome (ACS) patients. Exploring the age shock index (ASI), obtained by multiplying SI with age, could offer further insights into ACS prognosis. OBJECTIVES: Assess ASI's effectiveness in predicting in-hospital death in individuals with ACS. METHODS: This study encompassed patients with acute myocardial infarction, drawn from a national registry spanning October 2010 to January 2022. The optimal ASI threshold was established using receiver operating characteristic (ROC) curve analysis. The primary outcome was in-hospital mortality. RESULTS: A total of 27 312 patients were enrolled, exhibiting a mean age of 66â ±â 13 years, with 72.3% being male and 47.5% having ST-elevation myocardial infarction. ROC analysis yielded an area under the curve (AUC) of 0.80, identifying the optimal ASI cutoff as 44. Multivariate regression analysis, adjusting for potential confounders, established ASIâ ≥â 44 as an independent predictor of in-hospital death [hazard ratio: 3.09, 95% confidence interval: 2.56-3.71, P â <â 0.001]. Furthermore, ASI emerged as a notably superior predictor of in-hospital death compared to the SI (AUC ASI â =â 0.80 vs. AUC SI â =â 0.72, P â <â 0.0001), though it did not outperform the Global Registry of Acute Coronary Events (GRACE) score (AUC ASI â =â 0.80 vs. AUC GRACE â =â 0.85, P â <â 0.001) or thrombolysis in myocardial infarction (TIMI) risk index (AUC ASI â =â 0.80 vs. AUC TIMI â =â 0.84, P â <â 0.001). CONCLUSION: The ASI offers an expedient mean to promptly identify ACS patients at elevated risk of in-hospital death. Its simplicity and effectiveness could render it a valuable tool for early risk stratification in this population.
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Síndrome Coronariana Aguda , Mortalidade Hospitalar , Sistema de Registros , Humanos , Masculino , Feminino , Síndrome Coronariana Aguda/mortalidade , Síndrome Coronariana Aguda/complicações , Síndrome Coronariana Aguda/diagnóstico , Idoso , Pessoa de Meia-Idade , Medição de Risco/métodos , Prognóstico , Fatores Etários , Fatores de Risco , Frequência Cardíaca/fisiologia , Valor Preditivo dos Testes , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Curva ROC , Pressão SanguíneaRESUMO
OBJECTIVE: To assess a potential efficacy signal, safety and feasibility of neuromuscular electrical stimulation (NMES) therapy as an adjunct to standard care in patients with diabetic sensorimotor polyneuropathy (DSPN). METHODS: In this single-centre, prospective, cohort, proof-of-concept study, 25 patients with DSPN consented to at least one daily 30-minute NMES therapy session (Revitive® IX) for 10 weeks, with 20 patients completing the study. The primary outcome measure was nerve conductivity assessed using a nerve conduction study of the sural, superficial peroneal, common peroneal and tibial nerves at 10 weeks compared to baseline. Secondary outcomes included superficial femoral artery (SFA) haemodynamics during NMES therapy compared to rest and quality-of-life at 10 weeks compared to baseline. RESULTS: At 10 weeks, there were significant increases in sural sensory nerve action potential amplitude and conduction velocity (p < 0.001), superficial peroneal sensory nerve action potential amplitude (p = 0.001) and conduction velocity (p = 0.002), common peroneal nerve conduction velocity (p = 0.004) and tibial nerve compound muscle action potential amplitude (p = 0.002) compared to baseline. SFA volume flow and time-averaged mean velocity significantly increased (p ≤ 0.003) during NMES compared to rest. Patient-reported Michigan Neuropathy Screening Instrument scores significantly decreased (p = 0.028) at 10 weeks compared to baseline. Three unrelated adverse events occurred, and 15 participants adhered to treatment. CONCLUSIONS: NMES therapy as an adjunct to standard care for 10 weeks significantly increased lower limb nerve conductivity in patients with DSPN and may be beneficial in the treatment of DSPN.
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Neuropatias Diabéticas , Terapia por Estimulação Elétrica , Condução Nervosa , Estudo de Prova de Conceito , Humanos , Masculino , Pessoa de Meia-Idade , Feminino , Neuropatias Diabéticas/terapia , Neuropatias Diabéticas/fisiopatologia , Estudos Prospectivos , Idoso , Terapia por Estimulação Elétrica/métodos , Condução Nervosa/fisiologia , Adulto , Estudos de Coortes , Resultado do Tratamento , Nervo Fibular/fisiopatologiaRESUMO
PURPOSE: All types of cloacal malformations may be associated with anatomic variations of the external genitalia, including hypoplasia of the labia minora and enlarged clitoris; these variations could be even higher in posterior cloacas (PCs). If a careful physical examination is not performed, patients may be misdiagnosed with ambiguous genitalia (AG), leading to subsequent unnecessary testing, surgeries, or even wrong gender assignment. The aim was to analyze data of patients with PC within the ARM-Net registry, focusing on the description of the genitalia, gender assignment, and its consequences. Additionally, we investigated the presence of AG diagnosis in utero or at birth in patients with PC in the literature. METHODS: The ARM-Net registry was scanned for PC cases and data on diagnosis were collected. A systematic literature search was conducted using the PubMed, EMbase, and Web-of-Science databases. Descriptive statistics was used to report data. RESULTS: Nine patients with PC were identified in the ARM-Net registry. Five patients (55%) were diagnosed with AG, two (22%) were assigned as males and only two patients were correctly assigned as females and diagnosed with PC with respective variations of external genitalia. All patients diagnosed with AG had extensive blood testing including karyotype and hormonal studies. One of the patients who was diagnosed as a male, had surgery for pelvic cystic mass removal, which ultimately led to unaware salpingo-oophorectomy, hysterectomy, and vaginectomy. In the literature we identified 60 patients, 14 (23%) with AG, 1 with clitorolabial transposition and 1 with undeveloped vulva and vagina; 4 patients had normal anatomy. In 40 (67%) patients the anatomy of genitalia was not mentioned. CONCLUSION: Patients with PC are at high risk of being diagnosed with AG or even assigned the wrong gender at birth. In our series two patients were assigned as males, and consequently one of them underwent a highly mutilating surgery. A thorough physical examination together with a high index of suspicion and laboratory workup are mandatory to identify these variations, avoiding further investigations, unnecessary surgeries, and parental stress.
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OBJECTIVE: Intestinal intussusception (II) is a common cause for acute abdomen in children, occurring in 0.33 to 0.71 per 1000 children per year. Early diagnosis and treatment are fundamental for prevention of irreversible intestinal damage. The first line of treatment is conservative, with saline reduction enema or air reduction enema. Our goal is to evaluate results with conservative treatment of II in children. METHODS: A retrospective single-center review of all patients with diagnosis of II from January 2014 to December 2019 was performed. Demographics, clinical data, treatment option, and results were assessed. RESULTS: Thirty-eight cases were identified. The mean age was 26 months, and 68% were males. Most presented with abdominal pain (95%) and vomiting (66%), after an average of 30 hours. Rectal bleeding was present in 32% of patients. Abdominal ultrasound was performed in all patients for diagnosis. Conservative treatment was first option in 95% of patients, with a global effectiveness of 83% after 1 attempt. Saline reduction enema was more effective than air reduction enema (88% vs 70%), and patients with successful reduction were younger (24 vs 33 months), but neither reached statistical significance. Two patients had a subsequent II episode within 1 week after hospital discharge. Neither age, sex, symptoms and respective duration, rotavirus inoculation, intussuscepted bowel length, nor technique used was predictive of treatment failure or II relapse. CONCLUSIONS: Conservative treatment in II is a safe and effective option, preventing invasive surgical procedures. Effectiveness of such treatments may be as high as 88% after 1 attempt, with rapid diet reintroduction. Same-day discharge after oral feeding toleration is safe.
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Intussuscepção , Criança , Masculino , Humanos , Lactente , Pré-Escolar , Feminino , Estudos Retrospectivos , Resultado do Tratamento , Intussuscepção/diagnóstico , Tratamento Conservador , Falha de Tratamento , Enema/métodosRESUMO
ABSTRACT Acute gastric variceal bleeding is a life-threatening condition that could be effectively treated with endoscopic cyanoacrylate injection diluted with lipiodol. The mixture acts as a tissue adhesive that polymerizes when in contact with blood in a gastric varix. This work reports a patient that presented to the emergency department with upper gastrointestinal bleeding due to acute variceal bleeding, who developed systemic embolization following cyanoacrylate injection therapy. This complication culminated in cerebral, splenic and renal infarctions with a fatal outcome. Systemic embolization is a very rare, but the most severe complication associated with endoscopic cyanoacrylate injection and should be considered in patients undergoing this treatment.
RESUMEN La hemorragia digestiva por várices gástricas es una afección potencialmente mortal que puede tratarse eficazmente con la inyección endoscópica de cianoacrilato diluida con lipiodol. La mezcla actúa como un adhesivo tisular que se polimeriza cuando entra en contacto con la sangre de la várice gástrica. Este trabajo nos reporta un paciente que acudió al servicio de urgencias con hemorragia digestiva alta debido a hemorragia aguda por várices, que desarrolló embolización sistémica después de la terapia con inyección de cianoacrilato. Esta complicación culminó en infartos cerebrales, esplénicos y renales con desenlace fatal. La embolización sistémica es una complicación muy rara, pero con alta mortalidad, asociada con la inyección endoscópica de cianoacrilato y debe considerarse en pacientes sometidos a este tratamiento.
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Carcinoma de Células Renais , Átrios do Coração , Neoplasias Cardíacas , Neoplasias Renais , Invasividade Neoplásica , Idoso , Humanos , Masculino , Carcinoma de Células Renais/patologia , Carcinoma de Células Renais/diagnóstico por imagem , Átrios do Coração/patologia , Átrios do Coração/diagnóstico por imagem , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/patologia , Neoplasias Renais/patologia , Neoplasias Renais/diagnóstico por imagemRESUMO
Uterine incarceration (UI) is a rare complication in non-pregnant women. A woman in her 50s presented to the emergency department with acute urinary retention and paresis of the right inferior limb. A neurological exam suggested a decrease in the right lower limb strength. On gynaecological exam, the cervix was displaced anteriorly and the cul de sac was obliterated with a pelvic mass. CA 19.9 and CA 125 levels were increased. The MRI of the pelvis confirmed an elongated and anteriorly displaced cervix compressing the urethra and the vesical neck due to a uterine mass. A diagnosis of UI was made and an abdominal hysterectomy with adhesiolysis was suggested as the treatment option. Six months after surgery the patient had no urinary complaints and the neurological exam was normal. UI should be considered in women with urinary and neurological symptoms. A delay in diagnosis may lead to significant morbidity.
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Retenção Urinária , Neoplasias Uterinas , Feminino , Humanos , Histerectomia , Pelve , Bexiga Urinária , Retenção Urinária/etiologia , Pessoa de Meia-Idade , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/cirurgiaRESUMO
This study examined the relationship between two variables of the psychological future [future time orientation (FTO) and life project (LP)] and their relationship with career self-efficacy in unemployed individuals. Participants were 216 unemployed adults (151 women, 65 men), aged from 18 to 67 years old (M = 42.8, SD = 10.57), who responded to measures of distance and impact of future time orientation, identification and involvement in life project and career exploration and decision-making self-efficacy. Results of latent mediation analysis and correlational analysis indicated that there is a direct effect between FTO and LP, but also an indirect (i.e., mediating) effect between them through career self-efficacy beliefs. These findings suggest that unemployed individuals with a stronger sense of future time orientation are more likely to identify and engage with their life projects, and that this organization of their life projects is mediated by their levels of career self-efficacy. Overall, the study provides important insights into the psychological factors that can impact the careers behaviors of unemployed individuals, as well as on the characteristics of career psychological interventions with this public.
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Bisphenol A (BPA) is an endocrine disruptor used in food contact materials, by the application of polycarbonate plastics and epoxy resins. The main objective of this study is to compare the estimate of daily BPA exposure at 13 years of age and in the adult Portuguese population, using different methodological approaches, and assess the associations between this exposure and sociodemographic characteristics. METHODOLOGY: Cross-sectional data of 13-years follow-up from a population-based birth cohort Generation XXI (GXXI) (n = 2804) and from the National Food, Nutrition and Physical Activity Survey (IAN-AF 2015-2016) (n = 3845, ≥18 years old) was used. Dietary information was collected through three food diaries for adolescents and two non-consecutive 24-hour-recalls for adults. To estimate the daily exposure to BPA, three methodological approaches were used. "Food groups attribution" merged the food consumption data with the concentration of BPA in food groups. "Regression tree model" and "random forest" combined food consumption information with urinary BPA, measured in a subsample of 24-hour urine (in adolescents n = 216, and in adults n = 82), both used to predict BPA exposure in the remaining sample. The fit-index of the methodologies was assessed through the root mean square error (RMSE), mean absolute error (MAE) and Spearman correlation coefficient (ρ). Associations between BPA exposure and sociodemographic variables were tested by linear regression models, adjusted for sex, age groups (in adults) and educational level. Tolerable Daily Intake (TDI) of 0.2 ng/kg body weight (bw), recently proposed by the European Food Safety Authority (EFSA), was used for the risk characterization of BPA exposure. RESULTS: The "random forest" was found as the best methodology to estimate the daily BPA exposure (adolescents: RMSE = 0.989, MAE = 0.727, ρ = 0.168; adults: RMSE = 0.193, MAE = 0.147, ρ = 0.250). The median dietary BPA exposure, calculated by "food groups attribution", was 79.1 and 46.1 ng/kg bw/day for adolescents and adults, respectively, while "random forest" estimated a BPA exposure of 26.7 and 38.0 ng/kg bw/day. 99.9% of the Portuguese population presented a daily exposure above TDI. Male adolescents, females and higher educated adults, were those more exposed to BPA. CONCLUSIONS: The estimated daily BPA exposure strongly depends on the methodological approach. Food groups attribution may overestimate the exposure while the random forest appears to be a better methodological approach to estimate BPA exposure. Nevertheless, for all methods, the Portuguese population presented an unsafe BPA exposure by largely exceeding the safe levels proposed by EFSA.
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Compostos Benzidrílicos , Fenóis , Adulto , Feminino , Adolescente , Humanos , Estudos Transversais , Fenóis/urina , Dieta , Peso CorporalRESUMO
In pulmonary oligometastases from colorectal cancer (POM-CRC), metastasectomy is the primarily recommended treatment. Stereotactic body radiotherapy (SBRT) has been suggested as a viable alternative therapy. SBRT efficacy for POM-CRC is poorly delineated compared to selected non-CRC primaries. This perspective article aims to critically summarize the existing evidence regarding efficacy of SBRT in terms of overall survival (OS) and local control (LC), and factors modulating this, in the treatment of POM-CRC. Overall, reasonable LC and OS rates were observed. The wide range of expansions in planning target volume margins introduced variation in pretreatment protocols. Dose-fractionation schedules varied according to patient and tumor characteristics, though leverage of BED10 in select studies enabled standardization. An association between SBRT dose and improved OS and LC was observed across multiple studies. Prognostic factors that were associated with improved LC included: fewer oligometastases, absence of extra-pulmonary metastases, primary tumor histology, and smaller gross tumor volume. Differences in SBRT modality and techniques over time further confounded results. Many studies included patients receiving additional systemic therapies; preprotocol and adjuvant chemotherapies were identified as prognostic factors for LC. SBRT compared with metastasectomy showed no differences in short-term OS and LC outcomes. In conclusion, SBRT is an efficacious treatment for POM-CRC, in terms of OS and LC. Heterogeneity in study design, particularly pertaining to dose protocols, patient selection, and additional therapies should be controlled for future randomized studies to further validate SBRT efficacy.
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Neoplasias Colorretais , Neoplasias Pulmonares , Radiocirurgia , Humanos , Radiocirurgia/métodos , Resultado do Tratamento , Neoplasias Colorretais/radioterapia , Neoplasias Colorretais/etiologia , Neoplasias Pulmonares/secundário , Fracionamento da Dose de Radiação , Estudos RetrospectivosRESUMO
This study compared the psychological future of unemployed individuals and workers during the Covid-19 pandemic. It used the data from two previous data collections, one with unemployed individuals and another with workers. Participants from the two datasets were paired considering the same gender and similar age and education degree. The analyzed sample consisted of 352 participants, of which 176 were unemployed individuals and 176 were workers. The psychological future was measured by the Future Time Orientation Scale and the Life Project Scale. Both scales fit the sample of unemployed individuals and were invariant at the metric level across occupation status. Partial scalar model met good fit after freeing the intercepts of one item in each scale. In contrast to the hypothesis, compared to workers, unemployed individuals did not have lower rates in the assessed features of their psychological future. Conversely, for some variables, the rates were even higher among unemployed individuals. Unexpected results and limitations are discussed. Supplementary Information: The online version contains supplementary material available at 10.1007/s12144-023-04565-6.
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The consumption of plant-based drinks (PBDs) in substitution for cow's milk (CM) is increasing due to concerns for human and planet health and animal welfare. The present review aims to analyze the main findings from intervention trials investigating the effect of PBDs in comparison with CM on markers of human health. Suitable articles published up to July 2022 were sourced from PubMed and Scopus databases. A total of 29 papers were collected, with 27 focusing on soy drinks (1 of which also evaluated the effects of an almond drink), while only 2 focused on rice drinks. Among studies focused on soy drinks, the most investigated factors were anthropometric parameters (n = 13), the lipid profile (n = 8), markers of inflammation and/or oxidative stress (n = 7), glucose and insulin responses (n = 6) and blood pressure (n = 4). Despite some evidence of a beneficial effect of PBDs, especially for the lipid profile, it was not possible to draw any overall conclusions due to some conflicting results. As well as the low number of studies, a wide heterogeneity was found in terms of the characteristics of subjects, duration and markers, which reduces the strength of the available results. In conclusion, further studies are needed to better elucidate the effects of substituting CM with PBDs, especially in the long term.
Assuntos
Glucose , Leite , Animais , Feminino , Bovinos , Humanos , Adulto , Antropometria , Pressão Sanguínea , LipídeosRESUMO
O presente relatório emerge no âmbito do curso de Mestrado em Enfermagem Médico-Cirúrgica na área de Especialização em Enfermagem à Pessoa em Situação Crítica, da Escola Superior de Saúde de Leiria, que visa a obtenção de grau de Mestre, assim como a obtenção do título de Enfermeiro Especialista em Enfermagem Médico-Cirúrgica. O relatório encontra-se divido em duas partes. Na primeira parte é realizada a contextualização dos locais onde decorreram os ensinos clínicos, bem como a reflexão sobre o processo de aquisição das competências Comuns e Específicas do Enfermeiro Especialista em Enfermagem Médico-Cirúrgica, ao longo dos mesmos. Na segunda parte do relatório, é apresentada uma Scoping Review, nomeada de Cuidados de Enfermagem na Transferência Inter-Hospitalar de Doentes Críticos, que pretende dar resposta às questões de investigação: "Quais os dados clínicos na checklist do transporte inter-hospitalar? e Quais os recursos que devem ser verificados antes do transporte inter-hospitalar e integrados na checklist?", que suportou a elaboração de um documento, do tipo checklist, alvo de análise por peritos na área, pelo método de grupo focal.
This report emerges as part of the Master's Degree course in Medical-Surgical Nursing, in the area of Specialisation in Nursing for the Critically Ill Person, at the Escola Superior de Saúde de Leiria, which aims to obtain a Master's degree, as well as the title of Specialist Nurse in Medical-Surgical Nursing. The report is divided into two parts. The first part contextualises the places where the clinical training took place, as well as reflecting on the process of acquiring the Common and Specific competences of the Specialist Nurse in Medical-Surgical Nursing. The second part of the report presents a Scoping Review, entitled Nursing Care in the Inter-Hospital Transfer of Critically Ill Patients, which aims to answer the research questions: "What clinical data is included in the inter-hospital transport checklist? and What resources should be checked before inter-hospital transport and included in the checklist?", which supported the creation of a checklist-type document that was analysed by experts in the field using the focus group method.