Clinical findings and prognostic factors for mortality in hospitalized dogs with leishmaniosis: aretrospective study.

This retrospective study evaluated factors responsible for mortality of dogs hospitalized for Canine Leishmaniosis. Medical records of 31 dogs with leishmaniosis from a Portuguese Veterinary Teaching Hospital were examined between August 2018 and January 2022. Females (n = 18) and pure breed dogs (n = 27) were overrepresented, with higher frequency of Labrador Retriever (n = 4). Median age was 7 years (interquartile range=7). Most had historical findings of lethargy (n = 26) and the commonest clinicopathological abnormality was hypoalbuminemia (n = 26). Eleven dogs were classified as LeishVet stage II, 10 stage III and 10 stage IV. Fourteen dogs (45.2%) died or were euthanized, with azotemia, leukocytosis, stage IV, absence of diagnosis before hospitalization and lack of leishmaniosis specific treatment during hospitalization contributing to mortality. Absence of hypoalbuminemia and stages II/III increased survival. Mean hospitalization length prior to discharge was 5.41days ( ± 1.84) and diarrhea prolonged hospital stay.

Association analysis between symptomology and herpesvirus IgG antibody concentrations in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and multiple sclerosis.

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and multiple sclerosis (MS) are two complex and multifactorial diseases whose patients experience persistent fatigue, cognitive impairment, among other shared symptoms. The onset of these diseases has also been linked to acute herpesvirus infections or their reactivations. In this work, we re-analyzed a previously-described dataset related to IgG antibody responses to 6 herpesviruses (CMV - cytomegalovirus; EBV - Epstein-Barr virus; HHV6 - human herpesvirus-6; HSV1 and HSV2 - herpes simplex virus-1 and -2, respectively; VZV - varicella-zoster virus) from the United Kingdom ME/CFS biobank. The primary goal was to report the underlying symptomology and its association with herpesvirus IgG antibodies using data from 4 disease-trigger-based subgroups of ME/CFS patients (n = 222) and patients with MS (n = 46). The secondary objective was to assess whether serological data could distinguish ME/CFS and its subgroup from MS using a SuperLearner (SL) algorithm. There was evidence for a significant negative association between temporary eye insight disturbance and CMV antibody concentrations and for a significant positive association between bladder problems and EBV antibody concentrations in the MS group. In the ME/CFS or its subgroups, the most significant antibody-symptom association was obtained for increasing HSV1 antibody concentration and brain fog, a finding in line with a negative impact of HSV1 exposure on cognitive outcomes in both healthy and disease conditions. There was also evidence for a higher number of significant antibody-symptom associations in the MS group than in the ME/CFS group. When we combined all the serological data in an SL algorithm, we could distinguish three ME/CFS subgroups (unknown disease trigger, non-infection trigger, and an infection disease trigger confirmed in the lab at the time of the event) from the MS group. However, we could not find the same for the remaining ME/CFS group (related to an unconfirmed infection disease). In conclusion, IgG antibody data explains more the symptomology of MS patients than the one of ME/CFS patients. Given the fluctuating nature of symptoms in ME/CFS patients, the clinical implication of these findings remains to be determined with a longitudinal study. This study is likely to ascertain the robustness of the associations during natural disease course.

Nursing diagnoses disturbed body image (00118) and situational low self-esteem (00120) in patients with head and neck cancer: Differential clinical validation using Q methodology.

PURPOSE: When submitted to mutilating surgery, patients with head and neck cancer may present profound physical and psychosocial changes, temporary or definitive, with an individual impact and family. The most frequent human responses to this health condition are subjective, particularly concerning body image and self-esteem. Differential validation emerges to provide nurses with clinical indicators for clinical reasoning and planning of effective interventions, considering the specific defining characteristics of each diagnosis. This study aimed at conducting a differential clinical validation of the nursing diagnoses of disturbed body image and low situational self-esteem in patients with head and neck cancer using Q methodology. METHOD: We performed an observational cross-sectional study using Q methodology. Thirty-eight participants were included. Data were analyzed using Q methodology procedures. The research and ethics committee approved the study. FINDINGS: Factor analysis was performed, and eight defining characteristics were identified for the diagnosis of disturbed body image and one for situational low self-esteem: avoiding looking at one's body, avoiding touching one's body, the behavior of monitoring one's body, depersonalization of body part by use of impersonal pronouns, focus on past appearance, focus on past function, negative feeling about body, and refusal at acknowledging change and helplessness. CONCLUSIONS: The use of the Q methodology in this process of differential validation allowed the study of two diagnoses of a subjective nature, disclosing the most specific defining characteristics of each and contributing to increasing the knowledge of these human responses. IMPLICATIONS FOR NURSING PRACTICE: This study contributes to a better understanding of the predominant defining characteristics of the diagnoses under study. In terms of the NANDA-I taxonomy, it helps to raise the levels of evidence for diagnoses. Using a qualitative and quantitative methodology allows for maintaining a more holistic research approach and greater rigor and acceptance of the results.

OBJETIVO: Os doentes com cancro de cabeça e pescoço, submetidos a cirurgias mutilantes, apresentam profundas alterações físicas e psicossociais, temporárias ou definitivas, com impacto no indivíduo e na família. As respostas humanas mais frequentes nestes processos de doença são de natureza subjetiva, principalmente relacionados à imagem corporal e à autoestima. A validação diferencial surge com o objetivo de fornecer aos enfermeiros indicadores clínicos para raciocínio clínico e planeamento de intervenções efetivas, considerando as características definidoras específicas de cada diagnóstico. Realizar validação clínica diferencial dos diagnósticos de enfermagem distúrbio da imagem corporal e baixa autoestima situacional em doentes com câncer de cabeça e pescoço, utilizando a metodologia Q. MÉTODO: Estudo observacional transversal com metodologia Q. Trinta e oito participantes foram incluídos. Foi usada a metodologia Q para analisar os dados. A comissão de ética e de investigação aprovou o estudo. RESULTADOS: Foi realizada análise fatorial, sendo identificadas oito características definidoras para o diagnóstico de imagem corporal perturbada e uma para baixa autoestima situacional: Evitar olhar para o seu corpo, evitar tocar no corpo, comportamento de monitorização do corpo, despersonalização da perda através do uso de pronomes impessoais, foco na aparência passada, foco em função do passado, sentimento negativo acerca do corpo, recusa em reconhecer a mudança e desamparo. CONCLUSÕES: A utilização da metodologia Q, neste processo de validação diferencial, permitiu o estudo de dois diagnósticos de natureza subjetiva numa população vulnerável, contribuindo para aumentar o conhecimento das suas necessidades. IMPLICAÇÕES PARA A PRÁTICA DE ENFERMAGEM: Contribuir para uma melhor compreensão das características definidoras predominantes dos diagnósticos em estudo. Em termos da taxonomia NANDA - I, ajuda a elevar os níveis de evidência para diagnósticos. A utilização de uma metodologia qualitativa e quantitativa permite manter uma abordagem de investigação mais holística e um maior rigor e aceitação dos resultados.

Attitudes and Behaviors towards Vaccination in Portuguese Nursing Students.

Knowing the attitudes and behaviors of nursing students in relation to vaccination is important because they will soon be determinant for the health literacy of the population. Vaccination remains the most effective response in the fight against communicable diseases, including COVID-19 and influenza. The objective of this study is to analyze the attitudes and behaviors of Portuguese nursing students with regard to vaccination. A cross-sectional study was carried out, with data collection from nursing students at a university in Lisbon, Portugal. A sample of 216 nursing students was obtained, representing 67.1% of the students enrolled in this university. What stands out from the results of the questionnaire "Attitudes and Behaviors in Relation to Vaccination among Students of Health Sciences" is that for the majority of students the answers were positive; in addition, 84.7% had a completed vaccination schedule for COVID-19. Being a nursing student, being in the final years of the course and being a woman are the factors that most influence the positive attitude of the students. The results obtained are motivating, because these students will be the future health professionals most likely to integrate health promotion programs through vaccination.

Prevalence, defining characteristics, and predictors of the nursing diagnosis of spiritual distress in cancer patients undergoing chemotherapy: A longitudinal study.

INTRODUCTION: Cancer patients are exposed to several types of treatments, including chemotherapy. In this context, patients experience several nursing diagnoses, including spiritual distress. The definition of the diagnosis of spiritual distress is grounded in lack of meaning and purpose in life, a sense of suffering, and a feeling of disconnected. PURPOSE: The aim of this study was to determine the prevalence, sensitivity, specificity, and predictors of the nursing diagnosis of spiritual distress of cancer patients undergoing chemotherapy. DESIGNS: The study used a longitudinal questionnaire design with quarterly data collection points over a 12-month period. Participants were recruited through random sampling, in an outpatients' setting in one oncology day unit in Portugal. FINDINGS: The highest prevalence of spiritual distress was found at 3 months after patients started chemotherapy. The highest value of specificity was lack of meaning in life and express suffering, and the highest values of sensitivity concerned spiritual distress diagnosis. The predictors of spiritual distress were express suffering, alienation, questioning meaning in life, lack of serenity, questioning the meaning of suffering, hopelessness, and lack of meaning in life. CONCLUSIONS: Spiritual distress is a human response that is current in patients undergoing chemotherapy, and the highest prevalence seems to occur at 3 months after commencing chemotherapy. Express suffering and lack of meaning in life play the role not only of defining characteristics (DC) in this study, but also of predictors in the diagnosis of spiritual distress. CLINICAL RELEVANCE: The identification of the prevalence, predictors, sensitivity, and specificity of the DC of the nursing diagnosis of spiritual distress in cancer patients undergoing chemotherapy may facilitate nurses' clinical reasoning and improve the planning of nursing care in clinical practice in order to improve spiritual well-being in cancer patients.

Validation of the Nurse Spiritual Care Therapeutics Scale in Portuguese palliative care settings: a methodological study.

BACKGROUND: Spirituality is a critical dimension in palliative care, but difficulties have been described in literature concerning the effective implementation and measuring of spiritual care. AIM: To translate, adapt and validate the Nurse Spiritual Care Therapeutics Scale (NSCTS) in Portuguese palliative care settings. METHODS: A methodological study was conducted. A final version of the questionnaire included the scale and was submitted to full psychometric testing using nurses working in Portuguese palliative care settings. FINDINGS: A total of 88 nurses participated. The average age of the sample was 36.1 ± 8.93 years (range 23-60 years), and 92.0% were women. A Cronbach alpha value of 0.88; Kaiser-Meyer-Olkin measure of sampling adequacy 0.80; and Bartlett's Test of Sphericity were adequate. An exploratory factor analysis was conducted using principal axis factoring with an oblimin rotation that resulted in a three-factors solution. CONCLUSION: The European Portuguese NSCTS questionnaire is a valid and reliable tool to assess the frequency of nurses' activities concerning spirituality in palliative care.

Switch to EGFR-TKI after upfront platinum doublet induction therapy in non-small cell lung cancer (NSCLC) patients with EGFR (Epidermal Growth Factor Receptor) mutation: A multicentre retrospective study.

Introduction of EGFR-TKI has changed the treatment paradigm for NSCLC patient with activating mutations of EGFR exons 18-21, replacing chemotherapy as standard first line treatment. Given the delays in molecular study results we sometimes face the need to start treatment in very symptomatic patients with high tumor burden. The reason for this retrospective study is to analyze the survival impact of performing an induction cytotoxic therapy until obtaining the molecular profile (EGFR mutation), followed by targeted therapy. This is a retrospective analysis of 31 patients who did upfront chemotherapy (ChT) before switching to EGFR TKI upon the molecular profile result. The calculated survival endpoints were progression-free survival (PFS), duration of TKI response and overall survival (OS). All patients were treated with upfront chemotherapy with a median of one cycle (range 1-3) followed by a first generation EGFR-TKI. Median PFS was 13 months (95% CI, 6.6-19.4) and median OS 33 months (95% CI, 11.9-54.0). After first line progression 14 patients were treated with Osimertinib. In this subgroup median OS was 52 months (95% CI, 34.0-69.9). In the multivariable Cox model, only body mass index retained independent prognostic significance for progression-free survival (p = 0.045). Survival outcomes in this cohort are in line with published data regarding first generation EGFR-TKI, both in terms of PFS and OS. Despite the limitations of this study, starting with upfront chemotherapy doesn't seem detrimental in terms of survival outcomes, with the potential advantage of symptomatic control. To our knowledge, this is the first study to address this strategy, which requires further confirmation.

Herpesviruses Serology Distinguishes Different Subgroups of Patients From the United Kingdom Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Biobank.

The evidence of an association between Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) and chronic herpesviruses infections remains inconclusive. Two reasons for the lack of consistent evidence are the large heterogeneity of the patients' population with different disease triggers and the use of arbitrary cutoffs for defining seropositivity. In this work we re-analyzed previously published serological data related to 7 herpesvirus antigens. Patients with ME/CFS were subdivided into four subgroups related to the disease triggers: S0-42 patients who did not know their disease trigger; S1-43 patients who reported a non-infection trigger; S2-93 patients who reported an infection trigger, but that infection was not confirmed by a lab test; and S3-48 patients who reported an infection trigger and that infection was confirmed by a lab test. In accordance with a sensitivity analysis, the data were compared to those from 99 healthy controls allowing the seropositivity cutoffs to vary within a wide range of possible values. We found a negative association between S1 and seropositivity to Epstein-Barr virus (VCA and EBNA1 antigens) and Varicella-Zoster virus using specific seropositivity cutoff. However, this association was not significant when controlling for multiple testing. We also found that S3 had a lower seroprevalence to the human cytomegalovirus when compared to healthy controls for all cutoffs used for seropositivity and after adjusting for multiple testing using the Benjamini-Hochberg procedure. However, this association did not reach statistical significance when using Benjamini-Yekutieli procedure. In summary, herpesviruses serology could distinguish subgroups of ME/CFS patients according to their disease trigger, but this finding could be eventually affected by the problem of multiple testing.

Validation of the Duke University Religion Index (DUREL) in Portuguese Cancer Patients Undergoing Chemotherapy.

Religion is one of the strategies used to cope with life stressful events, particularly in cancer patients. This study aimed to translate, adapt and validate the 5-item Duke University Religion Index (DUREL) into European Portuguese. This is a cross-sectional study in a sample of cancer patients receiving chemotherapy. Data were collected in July-October 2018, and the study was approved by the ethics committee of the institution. A sample of 150 participants was included (64.7% female and 35.3% male), aged 35-83 years, and mainly Catholic (86.7%). Participants who were females, older, had lower education and from evangelical religious traditions scored higher on the total score. The Cronbach's alpha was 0.89. Factor analysis revealed a one-factor solution. Convergent validity was achieved between DUREL and BIAC (r = 0.78; p < 0.01). The DUREL European Portuguese version is a valid and reliable tool for measuring religious commitment in cancer patients undergoing chemotherapy.

Detection and modeling of anti-Leptospira IgG prevalence in cats from Lisbon area and its correlation to retroviral infections, lifestyle, clinical and hematologic changes.

Leptospirosis is a zoonosis of global importance caused by Leptospira species. Rodents are the main reservoirs, known to shed the bacteria in urine, thus contaminating water and soil and infecting other animals and people. Leptospirosis has been re-emerging in both developing and developed countries including Europe. It has been hypothesized that cats could be asymptomatic carriers of Leptospira. This study aims to evaluate cats' exposure to Leptospira in Lisbon, Portugal, by measuring IgG titres and correlating them with possible factors that may increase the risk of exposure in urban cats. Two hundred and forty-three samples were collected from the biobank. An ELISA test followed by a seroprevalence analysis using a finite mixture model was performed to detect and measure anti-Leptospira IgG antibodies titres. In parallel, a survey was conducted to identify possible risk factors for seropositivity. According to the ELISA test protocol, only twenty-three cats (9.5%; 95% CI =(6.1%;13.9%)) could be considered as seropositive to Leptospira antigens. However, when the same data were analysed by the best different mixture models, one hundred and forty-four cats (59.3%; 95%CI = (52.8%; 65.5%)) could be classified as intermediate and high antibody responders to Leptospira antigens. Seropositivity to Feline Immunodeficiency Virus infection (FIV) was found to be the only significant risk factor associated with anti-Leptospira IgG antibodies. In conclusion, the present studies raises the possibility of a higher exposure of cats to Leptospira than previously thought due to the identification of a subpopulation of cats with intermediate antibody levels.

Endoscopy Timing in Patients with Acute Upper Gastrointestinal Bleeding.

BACKGROUND/AIMS: The role of very early (≤12 hours) endoscopy in nonvariceal upper gastrointestinal bleeding is controversial. We aimed to compare results of very early and early (12-24 hours) endoscopy in patients with upper gastrointestinal bleeding demonstrating low-risk versus high-risk features and nonvariceal versus variceal bleeding. METHODS: This retrospective study included patients with nonvariceal and variceal upper gastrointestinal bleeding. The primary outcome was a composite of inpatient death, rebleeding, or need for surgery or intensive care unit admission. Endoscopy timing was defined as very early and early. We performed the analysis in two subgroups: (1) high-risk vs. low-risk patients and (2) variceal vs. nonvariceal bleeding. RESULTS: A total of 102 patients were included, of whom 59.8% underwent urgent endoscopy. Patients who underwent very early endoscopy received endoscopic therapy more frequently (p=0.001), but there was no improvement in other clinical outcomes. Furthermore, patients at low risk and with nonvariceal bleeding who underwent very early endoscopy had a higher risk of the composite outcome. CONCLUSION: Very early endoscopy does not seem to be associated with improved clinical outcomes and may lead to poorer outcomes in specific populations with upper gastrointestinal bleeding. The actual benefit of very early endoscopy remains controversial and should be further clarified.