Revisiting the psychometric properties of the McArthur admission experience survey: Validating the Portuguese version using a bifactor approach.

Cultural factors play a significant role in shaping the perception of coercion during psychiatric admissions. The present study aimed to assess the psychometric properties of the Portuguese Admission Experience Survey(P-AES). The study employed a cross-sectional approach in five psychiatric departments in three regions of Portugal. A total of 208 patients participated in the survey. Reliability was assessed through internal consistency and test-retest procedures. Internal validity was analyzed using a two-parameter logistic item response model, exploring three models, including a bifactor model. Convergent validity was determined by correlating AES scores with the Coercion Ladder (CL), Client Assessment of Satisfaction (CAT), and Global Assessment of Functioning (GAF) scale. Discriminatory power was assessed by comparing scores between patients with voluntary and involuntary admission status. The P-AES demonstrated satisfactory internal consistency and test-retest reliability. The bifactor model exhibited superior fit compared to the one-factor and three-factor models. Correlations between P-AES and CL, as well as CAT scores, indicated good convergent validity. Additionally, P-AES scores were notably higher in patients with compulsory psychiatric hospital admission compared to those admitted voluntarily, confirming its discriminatory power. The bifactor model suggests that all three domains of the AES should be used to measure the subjective experience of coercion.

Klotho and lean mass as novel cardiovascular risk factors in hemodialysis patients.

Background: Patients with chronic kidney disease (CKD) present a higher risk of cardiovascular (CV) morbidity and mortality compared with the general population. While there are several well-established traditional CV risk factors, few studies have addressed novel potential risk factors such as α-Klotho, asymmetric dimethylarginine (ADMA) and lean mass. Methods: This was an observational, prospective, single-center, cohort study that included prevalent hemodialysis (online hemodiafiltration) adult patients. By univariate logistic regression models, univariate and multivariate Cox proportional hazards models, and Kaplan-Meier analysis, we evaluated the association between the levels of α-Klotho, ADMA and lean mass, with the risk of peripheral vascular disease (PVD), CV events and all-cause mortality in these patients. Results: A total of 200 HD patients was included. We found that increased levels of log-α-Klotho were significantly associated with decreased odds of both PVD [odds ratio (OR) 0.521, 95% confidence interval (CI) 0.270-0.954, P = .034] and CV events (OR 0.415, 95% CI 0.203-0.790, P = .01), whereas increased levels of log-ADMA were only significantly associated with increased odds of PVD (OR 13.482, 95% CI 5.055-41.606, P < .001). We also found that the levels of log-α-Klotho (HR 0.357, 95% CI 0.140-0.906, P < .05) and lean mass (HR 0.187, 95% CI 0.042-0.829, P < .05), but not log-ADMA, were significantly associated with the risk of all-cause mortality, even after adjusting for possible confounding variables. Conclusions: Novel long-term clinical associations were generated that support α-Klotho and lean mass as novel CV risk factors in hemodialysis patients.

Fibrosis of Peritoneal Membrane, Molecular Indicators of Aging and Frailty Unveil Vulnerable Patients in Long-Term Peritoneal Dialysis.

Peritoneal membrane status, clinical data and aging-related molecules were investigated as predictors of long-term peritoneal dialysis (PD) outcomes. A 5-year prospective study was conducted with the following endpoints: (a) PD failure and time until PD failure, (b) major cardiovascular event (MACE) and time until MACE. A total of 58 incident patients with peritoneal biopsy at study baseline were included. Peritoneal membrane histomorphology and aging-related indicators were assessed before the start of PD and investigated as predictors of study endpoints. Fibrosis of the peritoneal membrane was associated with MACE occurrence and earlier MACE, but not with the patient or membrane survival. Serum α-Klotho bellow 742 pg/mL was related to the submesothelial thickness of the peritoneal membrane. This cutoff stratified the patients according to the risk of MACE and time until MACE. Uremic levels of galectin-3 were associated with PD failure and time until PD failure. This work unveils peritoneal membrane fibrosis as a window to the vulnerability of the cardiovascular system, whose mechanisms and links to biological aging need to be better investigated. Galectin-3 and α-Klotho are putative tools to tailor patient management in this home-based renal replacement therapy.

Membranous nephropathy after a recent SARS-CoV-2 infection.

SARS-CoV-2 infections can induce kidney injury and glomerulopathy, with the most common pathology findings being acute tubular injury and collapsing glomerulopathy.Here we describe a rare case of membranous nephropathy in a man in his late 70s presented with nephrotic syndrome and rapidly progressive kidney dysfunction 1 month after SARS-CoV-2 infection. Phospholipase A2 receptor antibodies were positive. He was treated with rituximab, with proteinuria control. We review the cases reported in the literature.

Alpha-klotho and peritoneal membrane status: A hypothesis generating study.

BACKGROUND: Long-term success of peritoneal dialysis relies on the integrity of the peritoneal membrane. This proof-of-concept study addressed the hypothesis that fibrosis is already present in the membrane at pre-dialysis and that the membrane status is related to the individual's uraemic fingerprint. METHODS: A clinical-mechanistic, transversal, single-centre study was conducted. Pre-dialysis peritoneal biopsies were scored considering the submesothelial compact zone thickness (STM), vasculopathy and inflammation. We investigated if the membrane status could be inferred from a panel of proteins (α-Klotho, Galectin-3, FGF21, FGF23, Tweak, TNFα and hsPCR) in blood. RESULTS: A total 58 incident patients aged 56 ± 15 years old were included, 31% female, 55% hypertension, 29% diabetic and 24% obese. Person-to-person STM was found to be highly variable and 38% of patients were fibrosis positive. Both α-Klotho (Spearman r = -.7491, p < 0.001) and FGF21 (Spearman r = -.5102, p < 0.001) were negatively associated with STM. α-Klotho, but not FGF21, was able to discriminate fibrosis from nonfibrosis with/without inflammation and vasculopathy. PLS models identified α-Klotho as the protein most relevant for fibrosis. α-Klotho was independently associated with fibrosis of the peritoneal membrane (OR = .991 (.896-.997), p = 0.002). CONCLUSION: Before the start of dialysis in incident patients, some patients already present fibrosis of the peritoneal membrane and other patients do not. Our findings suggest that α-Klotho may be implicated in fibrosis of the peritoneal membrane.

Pantoea in Peritoneal Dialysis: A Rare Cause of Peritonitis.

Peritonitis is the most common complication of peritoneal dialysis (PD) and an important cause of PD failure. There are numerous etiological agents, mostly bacteria. Pantoea spp is a rare cause of peritonitis. We describe three cases of Pantoea peritonitis in three PD patients. Previous reports have identified risk factors such as close contact with plants and animals. We review the typical clinical presentation and prognosis. It is fulcral to teach patients about the risks regarding proximity to plants and animals to prevent this type of infection.

Atypical Presentation of a Urachal Carcinoma as an Enterocutaneous Fistula.

Urachal carcinoma is a rare and aggressive tumor, involving the urachus and the bladder. Symptoms of urachal carcinoma usually appear at later stages of the disease; therefore, these tumors are diagnosed in advanced stages, providing limited options for curative treatment. We report the clinical case of a 60-year-old man with a urachal carcinoma which presented as a mass of the abdominal wall invading the transverse colon, creating an enterocutaneous fistula. The patient underwent an en-bloc resection of the mass, segmentary resection of the transverse colon, and partial cystectomy.

Abdominal Cocoon Syndrome: A Rare Cause of Intestinal Obstruction.

Abdominal cocoon syndrome, also known as Sclerosing Encapsulating Peritonitis, is characterized by a fibro-collagenous membrane that involves abdominal viscera and it's a rare cause of intestinal obstruction. We present here two cases. Two male patients, 29 and 75 years old, were admitted to our emergency department with abdominal pain, vomiting, tender and painful abdomen but without changes in intestinal transit or peritoneal reaction. They were treated surgically and diagnosed with abdominal cocoon syndrome. Patients with abdominal cocoon syndrome usually present with recurrent episodes of intestinal obstruction, which result from the compression of the bowel within the constricting cocoon. Most of the time, this clinical picture resolves with conservative measures, delaying the diagnosis. The definitive treatment consists of excision of the membrane with lysis of adhesions, which is usually reserved for more severe cases of obstruction. This is a rare disease, where a high suspicion index is of paramount importance, especially considering that most of the diagnoses are made at the surgery.

Peritoneal dialysis-associated peritonitis caused by Enterococcus avium.

Peritonitis remains a common and serious complication of peritoneal dialysis. Peritonitis caused by gram-positive organisms includes coagulase-negative staphylococci, Streptococcus spp and Enterococcus spp. We present a rare case of peritoneal dialysis-associated peritonitis, where persisting abdominal pain and worsening laboratory findings despite antibiotic therapy led to the identification of Enterococcus avium, requiring Tenckoff catheter removal and temporary transfer to haemodialysis. The available literature reports only few cases where peritonitis is caused by this agent, underlining the need to consider atypical microbial agents when heterogeneous clinical course is presented.

Avaliação do impacto das abordagens bottomup e top-down nas atividades da vida diária em pessoas com neglect ­ revisão sistemática / Evaluation of the impact of bottom-up and topdown approaches on daily activities in people with neglet ­ a systematic review

Atualmente não existe um consenso entre quais as caraterísticas das abordagens (bottom-up ou top-down) mais eficazes na reabilitação das Atividades da Vida Diária (AVDs) em pessoas com Síndrome de Neglect (SN). OBJETIVO: Caracterizar as abordagens (bottom-up ou top-down) e o seu impacto nas AVDs em adultos e idosos com SN. MÉTODOS: Esta revisão sistemática foi realizada de acordo com a recomendação PRISMA - Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A pesquisa bibliográfica foi realizada nas bases de dados PubMed, Web of Science, PEDro e Cochrane. Foram considerados estudos experimentais em que pelo menos uma técnica das abordagens bottom-up e top-down fosse utilizada. A ferramenta Joanna Briggs Institute Critical Appraisal Checklist for RCTs foi utilizada para avaliar a qualidade metodológica dos estudos. Foi usada a seguinte combinação de palavras chave: Neglect Syndrome OR Unilateral Syndrome OR Neglect (…) AND Activities of Daily Living OR Daily (…) AND Treatment OR Intervention OR Technique (…). RESULTADOS: Foram incluídos 16 estudos, dos quais 9 incluem técnicas de abordagem bottom-up, 6 incluem técnicas de abordagem top-down e 1 artigo inclui técnicas das duas abordagens. As técnicas da abordagem bottom-up que aumentaram a independência nas AVDs foram Visuomotor Feedback Training, Smooth Pursuit Eye Movement Training e a combinação de Eye Patching com Constraint-induced Therapy. Na abordagem top-down as técnicas com os mesmos resultados foram Visual Scanning, Mental Practice, Continuous Theta Burst Stimulation e Transcranial Direct Current Stimulation. CONCLUSÃO: As abordagens bottom-up e top-down aumentam a independência nas AVDs e cada uma contém técnicas com significativo impacto positivo, como Visuomotor Feedback Training e Continuous Theta Burst Stimulation. O presente trabalho permitiu uma análise crítica à classificação das abordagens em bottom-up e top-down, uma vez que não são sensíveis à distinção dos mecanismos de reabilitação envolvidos.

Currently there is no consensus on which are the characteristics of rehabilitation approaches (bottom-up or top-down) most effective in the rehabilitation of ADLs in people with Neglet Syndrome (NS). AIM: To characterize the approaches (bottomup or top-down) with more impact on ADLs in adults and elderly with NS. METHODS: This systematic review was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Metaanalyses (PRISMA) recommendation. A bibliographic search was carried out in PubMed, Web of Science, PEDro and Cochrane databases. Experimental studies were considered in which at least one technique of the bottom-up and top-down approaches was used. The Joanna Briggs Institute Critical Appraisal Checklist for RCTs tool was used to assess the methodological quality of the studies. The following combination of keywords was used: Negligence Syndrome OR Unilateral Syndrome OR Negligence (...) AND Activities OF Daily OR Daily Life (...) AND Treatment OR Intervention OR Technique (...). RESULTS: 16 studies were included, which 9 include techniques from the bottom-up approach, 6 include techniques from the top-down approach and 1 article includes two techniques, each belonging to each approach. The techniques of the bottom-up approach that increased independence in the ADLs were Visuomotor Feedback Training, Smooth Pursuit Eye Movement Training and the combination of Eye Patching with Constraint-induced Therapy. In the top-down approach, the techniques with the same results were Visual Scanning, Mental Practice, Continuous Theta Burst Stimulation and Transcranial Direct Current Stimulation. CONCLUSION: Both bottom-up and top-down approaches increase independence in ADLs. Each approach contains techniques with a significant positive impact on ADLs such as Visuomotor Feedback Training and Continuous Theta Burst Stimulation. The present work also allowed a critical analysis to the classification of the approaches in bottom-up and top-down, since they are not different to the category of rehabilitation mechanisms.

Sorption/Diffusion Contributions to the Gas Permeation Properties of Bi-Soft Segment Polyurethane/Polycaprolactone Membranes for Membrane Blood Oxygenators.

Due to their high hemocompatibility and gas permeation capacity, bi-soft segment polyurethane/polycaprolactone (PU/PCL) polymers are promising materials for use in membrane blood oxygenators. In this work, both nonporous symmetric and integral asymmetric PU/PCL membranes were synthesized, and the permeation properties of the atmospheric gases N2, O2, and CO2 through these membranes were experimentally determined using a new custom-built gas permeation apparatus. Permeate pressure vs. time curves were obtained at 37.0 °C and gas feed pressures up to 5 bar. Fluxes, permeances, and permeability coefficients were determined from the steady-state part of the curves, and the diffusion and sorption coefficients were estimated from the analysis of the transient state using the time-lag method. Independent measurements of the sorption coefficients of the three gases were performed, under equilibrium conditions, in order to validate the new setup and procedure. This work shows that the gas sorption in the PU/PCL polymers is the dominant factor for the permeation properties of the atmospheric gases in these membranes.

Chryseobacterium indologenes peritonitis in a peritoneal dialysis patient.

Peritonitis remains an important complication of peritoneal dialysis. The Gram-negative bacillus Chryseobacterium indologenes causes infection mostly in immunocompromised patients with severe underlying disease, mainly in Asia. Herein, we report the first case in Europe and the second case in an immunocompetent patient of peritoneal dialysis-associated C. indologenes peritonitis. Our patient presented with abdominal pain and a cloudy effluent and was started on intraperitoneal antibiotics. The organism cultured from the peritoneal fluid was later identified as C. indologenes and antibiotic therapy was adjusted accordingly. Despite this, the peritonitis followed a relapsing course, requiring Tenckhoff catheter removal, temporary transfer to haemodialysis and intravenous antibiotics. Subsequently, a new Tenckhoff catheter was inserted and peritoneal dialysis was restarted. The patient remains peritonitis free after 18 months of follow-up. This case highlights the need to consider rare causes of peritonitis in peritoneal dialysis patients as well as the heterogeneous clinical course of C. indologenes peritonitis.

A literacia da pessoa com enfarte agudo do miocardio / The literacy of the person with acute myocardial infarction

O Enfarte Agudo do Miocárdio, de entre as doenças não transmissíveis, é a que mais influência sofre por parte de comportamentos e hábitos de vida diária. Fazer escolhas, e principalmente escolhas acertadas na área da saúde constitui-se como a pedra basilar no controlo desta patologia. Saber quais as capacidades reais do utente para fazer estas escolhas permite-nos, a nós, enfermeiros, como educadores, esclarecer e dotar os utentes desta capacidade crucial para o seu bem estar e qualidade de vida. Como tal, sentimos necessidade de analisar a literacia da pessoa que sofreu um enfarte agudo do miocárdio no domínio da saúde e que recorre às consultas neste centro hospitalar, qual a sua relação com as variáveis sociodemográficas e com a alteração dos estilo de vida. Trata-se de um estudo de natureza quantitativa, descritiva e correlacional em que foram aplicados questionários a utentes da consulta de Enfarte Agudo do Miocárdio, numa unidade da região centro de Portugal, totalizando 81 utentes. São maioritariamente homens, casados, com uma média de idade de 37 anos, reformados em que o nível de ensino se enquadra no ensino primário. 71% já tomava medicação previamente e como fatores de risco mais conhecidos da doença coronária referiram a obesidade, o colesterol, e o stress. 40,7% sabe que o hábito regular de exercício físico e uma alimentação cuidada contribuem muito para a prevenção desta patologia. Os resultados encontrados permitem afirmar que não há relação estatisticamente significativa entre a literacia e a idade, o sexo, o número de enfartes, o grau de adesão às mudanças nos hábitos de vida e o manuseamento do regime terapêutico e medicamentoso. Mas verificou-se relação estatisticamente significativa entre a literacia e as habilitações literárias, a área de residência, o conhecimento dos fatores de risco, o rendimento líquido mensal e o conhecimento do regime terapêutico e medicamentoso, no entanto, o que mais influencia a literacia é o conhecimento do regime terapêutico e medicamentoso e as habilitações literárias.

Does Hope Matter? Associations Among Self-Reported Hope, Anxiety, and Health-Related Quality of Life in Children and Adolescents with Cancer.

This study aimed to examine the direct and indirect effects of hope on health-related quality of life (HRQoL) via anxiety of children/adolescents with cancer. We proposed to test if the mediation model was moderated by the child/adolescent's treatment status. The participants were 211 children/adolescents diagnosed with cancer, divided into two clinical groups according to treatment status: 97 patients on-treatment and 114 off-treatment. Self-reported questionnaires measured the youths' hope, anxiety, and HRQoL perceptions. The results revealed that children/adolescents on- and off-treatment only differed in levels of HRQoL, with a more compromised HRQoL found for the on-treatment group. Hope was positively associated with HRQoL, directly and indirectly via anxiety reduction. Moreover, only the association between anxiety and HRQoL was moderated by clinical group, revealing stronger associations for on-treatment patients. Findings highlight the importance of hope as a decisive resource in pediatric cancer adaptation, which may be strategically targeted in psycho-oncological interventions.