Cross-Sectional Study to Assess Endoscopic Ultrasound Practice in Portugal.

BACKGROUND: Despite the increasing number of national departments performing endoscopic ultrasound (EUS), there are no official data regarding clinical EUS practice in Portugal. OBJECTIVES: We aimed to evaluate the current practice of EUS in Portugal. METHODS: By email, we invited 1 physician of each one of the 26 national Gastroenterology Departments which perform EUS to complete a survey questionnaire available on the Google Forms platform. The online questionnaire was available from September 2017 until February 2018 and was answered only by physicians who perform EUS. RESULTS: A total of 21/26 (80.8%) national Gastroenterology Departments answered the questionnaire. In Portugal, there are 42 echoendoscopes in total; most of the echoendoscopy units have only 1 EUS processor (81%), 1 radial echoendoscope (66.7%), 1 linear echoendoscope (76.2%), 1 anorectal probe (57.1%), but no miniprobes (85.7%). About 81% have histological core acquisition needles. In 81% of the units, there are at least 2 ultrasonographers who perform echoendoscopy together (at least 2 ultrasonographers per EUS) in 47.6% of these departments. The ultrasonographers also performed abdominal ultrasound (US), anal US, and endoscopic retrograde cholangiopancreatography in 71.4, 66.7, and 42.9%, respectively. The echoendoscopy units have 2.4 ± 1.1 periods of echoendoscopy per week and 4 ± 1.5 EUS per period (499.2 ± 416.8 EUS per year). Subepithelial lesions and biliopancreatic lesion evaluation as well as gastrointestinal neoplasia staging were the most common EUS indications. The number of FNA (fine-needle aspirations) ranges from 10 to 160/year. Rapid on-site evaluation (ROSE) is available in 60% of units and is performed by the cytopathologist (66.7%) in the majority of cases. The main reason for omitting ROSE is the limited pathology staff. Cytopathological material is prepared by the ultrasonographer in 25% of the units. Air drying (50%) and formalin (50%) are most frequently used to fix and preserve smears, respectively. Pancreatic pseudocyst drainage (66.7%), celiac plexus neurolysis (52.4%) and pancreatic necrosectomy (42.9%) are the most widespread therapeutic procedures. CONCLUSIONS: This survey provides the first insight into the current status of digestive echoendoscopy in Portugal. There is a great variability in diagnostic and therapeutic echoendoscopy practice.

INTRODUÇÃO: Apesar do crescente número de serviços nacionais a realizar ecoendoscopia digestiva, não existem dados sobre a prática da ecoendoscopia no nosso país. OBJETIVOS: Pretendemos avaliar a prática da ecoendoscopia em Portugal. MÉTODOS: Por e-mail convidámos um elemento de cada dos 26 serviços nacionais de Gastrenterologia que realizam ecoendoscopia a preencher um questionário disponível na plataforma google forms. O questionário esteve disponível via online de setembro de 2017 a fevereiro de 2018 e foi respondido apenas por médicos que realizam ecoendoscopia. RESULTADOS: Obtivemos resposta de 21 dos 26 serviços convidados (80.8%). Em Portugal existe um total de 42 ecoendoscópios. A maioria das unidades possui 1 ecógrafo (81%), 1 ecoendoscópio radial (66.7%), 1 eco endoscópio linear (76.2%), 1 sonda rectal (57.1%) mas não dispõem de mini-sondas (85.7%). 81% dispõem de agulhas de aquisição de core histológico. Em 81% dos serviços existem pelo menos 2 ecoendoscopistas que realizam ecoendoscopia em conjunto em 47.6% dos serviços. Os ecoendoscopistas também realizam ecografia abdominal, ecografia anal e colangiopancreatografia retrógrada endoscópica em 71.4, 66.7 e 42.9% respectivamente. Os serviços têm em média 2.4 ± 1.1 períodos de ecoendoscopia/ semana realizando em média 4 ± 1.5 ecoendoscopia/ período (499.2 ± 416.8 ecoendoscopias/ano). A avaliação de lesões subepiteliais e bilio-pancreática, assim como o estadiamento de neoplasias do tubo digestivo são as indicações mais frequentes para a realização de ecoendoscopia. O número de punções diagnósticas guiadas por ecoendoscopia varia entre 10 e 160/ano. A maioria dos serviços (60%) dispõe de rapid on-site pathological evaluation (ROSE) que é realizada pelo citopatologista na maioria das vezes (66.7%). A carência de funcionários nas unidades de Anatomia Patológica é o principal motivo para a ausência de ROSE. A preparação do material citopatológico é realizada pelo ecoendoscopista em 25% dos serviços. A secagem ao ar (50%) e o formol (50%) são o método de fixação dos esfregaços e o meio de preservação mais usados, respetivamente. A drenagem de pseudocisto pancreático (66.7%), neurólise do plexo celíaco (52.4%) e necrosectomia pancreática (42.9%) são os procedimentos terapêuticos mais disseminados. CONCLUSÕES: Este trabalho fornece os primeiros dados sobre a prática de ecoendoscopia digestiva em Portugal. Existe uma grande variabilidade nos exames diagnósticos e terapêuticos.

The main determinants of disability in IBD and its relationship to optimism

Background and aim: inflammatory bowel disease (IBD) is a potentially disabling chronic disease that negatively affects many aspects of the patients' life. This study aimed to assess the IBD-associated disability in the outpatient setting and analyze how optimism and disability are related. Methods: a cross-sectional study was performed via the application of the Portuguese version of the IBD-Disability Index (PT-IBD-DI) and the Revised Life Orientation Test (PT-LOT-R) for the assessment of disability and optimism, respectively. Results: a total of 143 patients were analyzed, the mean age was 38 +/- 13 years, 50% were females and 51% had UC. The mean PT-IBD-DI score was 22 +/- 17, which was classified as follows: 0-20: no disability; 20-35: mild disability; 35-50: moderate disability; and 50-100: severe disability. There were no significant differences between Crohn's disease (CD) and ulcerative colitis (UC) (p = 0.944). Female gender (p = 0.001), low level of education (p = 0.018), the number of days out of work (p = 0.020), rheumatologic manifestations (p = 0.005), the number of comorbidities (p = 0.002), the use psychotropic drugs (p = 0.043) and low PT-LOT-R scores (p < 0.001) were associated with higher IBD-DI scores according to the univariate analysis. According to the linear regression analysis, only female sex (p = 0.001), the number of comorbidities (p = 0.034) and low PT-LOT-R scores (p < 0.001) were associated with higher PT-IBD-DI scores. Optimism correlated inversely with PT-IBD-DI scores (ρ = -0.345, p < 0.001). Conclusion: IBD outpatients reported low levels of IBD-disability (mild disability: PT-IBD-DI score 20-35). Comorbidities and psychological factors (optimism) emerged as the main predictive factors of increased disability, reinforcing the importance of a multidisciplinary approach for these patients

No disponible

Mirizzi syndrome: when the gallbladder meets bile ducts.

A 64-year-old female presented to the Emergency Department with jaundice, choluria, fever and abdominal pain over the last few days. The abdomen was tender with epigastric pain on palpation.

The main determinants of disability in IBD and its relationship to optimism.

BACKGROUND AND AIM: inflammatory bowel disease (IBD) is a potentially disabling chronic disease that negatively affects many aspects of the patients' life. This study aimed to assess the IBD-associated disability in the outpatient setting and analyze how optimism and disability are related. METHODS: a cross-sectional study was performed via the application of the Portuguese version of the IBD-Disability Index (PT-IBD-DI) and the Revised Life Orientation Test (PT-LOT-R) for the assessment of disability and optimism, respectively. RESULTS: a total of 143 patients were analyzed, the mean age was 38 ± 13 years, 50% were females and 51% had UC. The mean PT-IBD-DI score was 22 ± 17, which was classified as follows: 0-20: no disability; 20-35: mild disability; 35-50: moderate disability; and 50-100: severe disability. There were no significant differences between Crohn's disease (CD) and ulcerative colitis (UC) (p = 0.944). Female gender (p = 0.001), low level of education (p = 0.018), the number of days out of work (p = 0.020), rheumatologic manifestations (p = 0.005), the number of comorbidities (p = 0.002), the use psychotropic drugs (p = 0.043) and low PT-LOT-R scores (p < 0.001) were associated with higher IBD-DI scores according to the univariate analysis. According to the linear regression analysis, only female sex (p = 0.001), the number of comorbidities (p = 0.034) and low PT-LOT-R scores (p < 0.001) were associated with higher PT-IBD-DI scores. Optimism correlated inversely with PT-IBD-DI scores (ρ = -0.345, p < 0.001). CONCLUSION: IBD outpatients reported low levels of IBD-disability (mild disability: PT-IBD-DI score 20-35). Comorbidities and psychological factors (optimism) emerged as the main predictive factors of increased disability, reinforcing the importance of a multidisciplinary approach for these patients.

Mirizzi syndrome: when the gallbladder meets bile ducts

No disponible

Accuracy of endoscopic ultrasound in gastric adenocarcinoma patient selection for neoadjuvant therapy.

Background: Recent studies demonstrated the positive impact of neoadjuvant treatment in locally advanced gastric cancer. Objective: To assess the accuracy of endoscopic ultrasound (EUS) in the selection of patients with gastric adenocarcinoma for neoadjuvant therapy (T ≥ 2 and/or N+). Methods: Retrospective analysis of patients with an anatomopathological diagnosis of gastric adenocarcinoma between January 2011 and June 2017, who had EUS for staging and underwent surgery as a first therapeutic attempt. The concordance (k) and accuracy (area under the curve (AUC)) of EUS for T ≥ 2 and/or N+ were assessed using the anatomopathological staging of the resected surgical specimen as the gold standard. Results: The final sample included 152 patients (66.4% male, 67.1 ± 12.2 years). The concordance, accuracy, sensitivity and specificity of the EUS for T ≥ 2 and/or N+ were 0.72, 0.86 ± 0.03, 88.5% and 83.1%, respectively. The results were higher in proximal (k = 0.93, AUC = 0.96 ± 0.05, sensitivity (S) = 99.0% and specificity (E) = 90.9%) compared with distal lesions (k = 0.67, AUC = 0.84 ± 0.04, S = 85.7% and E = 81.5%), and in intestinal subtype (k = 0.77, AUC = 0.88 ± 0.04, S = 92.6% and E = 84.1%) compared with diffuse (k = 0.58, AUC = 0.79 ± 0.10, S = 85.0% and E = 72.7%) or mixed-subtype tumours (k = 0.65, AUC = 0.84 ± 0.10, S = 76.9% and E = 90.0%). Conclusion: In one of the largest series of patients, we showed that EUS has overall high agreement and accuracy in the selection of patients with gastric adenocarcinoma for neoadjuvant therapy, although the agreement and accuracy are greater for proximal and intestinal lesions.

A granular cell tumor: an unusual colon polyp

No disponible

A granular cell tumor: an unusual colon polyp.

We read with interest the article by Sevilla Ribota et al1 that described an unexpected finding of a granular cell tumour (GCT) of the rectum, which was removed by band ligation-assisted mucosectomy. We present a similar case of a GCT of the cecum, which was resected using a different endoscopic procedure.

Tender red subcutaneous nodules in an adult female: a challenging diagnosis

No disponible

Fishing Into the MicroRNA Transcriptome.

In the last decade, several studies have been focused on revealing the microRNA (miRNA) repertoire and determining their functions in farm animals such as poultry, pigs, cattle, and fish. These small non-protein coding RNA molecules (18-25 nucleotides) are capable of controlling gene expression by binding to messenger RNA (mRNA) targets, thus interfering in the final protein output. MiRNAs have been recognized as the main regulators of biological features of economic interest, including body growth, muscle development, fat deposition, and immunology, among other highly valuable traits, in aquatic livestock. Currently, the miRNA repertoire of some farmed fish species has been identified and characterized, bringing insights about miRNA functions, and novel perspectives for improving health and productivity. In this review, we summarize the current advances in miRNA research by examining available data on Neotropical and other key species exploited by fisheries and in aquaculture worldwide and discuss how future studies on Neotropical fish could benefit from this knowledge. We also make a horizontal comparison of major results and discuss forefront strategies for miRNA manipulation in aquaculture focusing on forward-looking ideas for forthcoming research.

Inadequate Dietary Phosphorus Levels Cause Skeletal Anomalies and Alter Osteocalcin Gene Expression in Zebrafish.

Phosphorus (P) is an essential mineral for the development and maintenance of the vertebrate skeletal system. Modulation of P levels is believed to influence metabolism and the physiological responses of gene expression. In this study, we investigated the influence of dietary P on skeletal deformities and osteocalcin gene expression in zebrafish (Danio rerio), and sought to determine appropriate levels in a diet. We analyzed a total of 450 zebrafish within 31 days of hatching. Animals were distributed in a completely randomized experimental design that consisted of five replications. After an eight-week experiment, fish were diaphanized to evaluate cranial and spinal bone deformities. Increases in dietary phosphorus were inversely proportional to the occurrence of partial spine fusions, the absence of spine fusions, absence of parallelism between spines, intervertebral spacing, vertebral compression, scoliosis, lordosis, ankylosis, fin caudal insertion, and craniofacial deformities. Additionally, osteocalcin expression was inversely correlated to P levels, suggesting a physiological recovery response for bone mineralization deficiency. Our data showed that dietary P concentration was a critical factor in the occurrence of zebrafish skeletal abnormalities. We concluded that 1.55% P in the diet significantly reduces the appearance of skeletal deformities and favors adequate bone mineralization through the adjustment of osteocalcin expression.

Synchronous intraductal papillary mucinous neoplasm and a pancreatic neuroendocrine tumor: more than a coincidence?

Background: Although the association between intraductal papillary mucinous neoplasm of the pancreas (IPMN) and pancreatic neuroendocrine tumor (PNET) has been increasingly reported, whether this association is real or coincidence remains unclear. We report a case of synchronous IPMN and a PNET which were diagnosed preoperatively and discuss the tumorigenesis, clinicopathological features and management of these rare tumors based on the published literature. Case report: A 56-year-old male was incidentally diagnosed with a 14 mm branch duct IPMN and a 3.6 mm non-functional PNET during an evaluation due to persistent upper abdominal pain via endoscopic ultrasound. Close follow-up of the patient was decided as the IPMN had no worrisome features. A review of twenty-two previously reported cases of synchronous IPMN and PNET indicated that: a) only seven cases were diagnosed preoperatively; b) abdominal pain was the main presenting symptom; c) IPMN was the dominant tumor and presented with low grade dysplasia; d) the PNET was small and non-functional and had an indolent behavior; and e) only one case underwent radiologic follow-up. Discussion: IPMN are associated with other pancreatic and extrapancreatic malignancies. Thus, the entire pancreatic parenchyma should be examined closely during the evaluation of an IPMN in order to exclude other pancreatic lesions, for example, a PNET (AU)

No disponible

Synchronous intraductal papillary mucinous neoplasm and a pancreatic neuroendocrine tumor: more than a coincidence?

BACKGROUND: Although the association between intraductal papillary mucinous neoplasm of the pancreas (IPMN) and pancreatic neuroendocrine tumor (PNET) has been increasingly reported, whether this association is real or coincidence remains unclear. We report a case of synchronous IPMN and a PNET which were diagnosed preoperatively and discuss the tumorigenesis, clinicopathological features and management of these rare tumors based on the published literature. CASE REPORT: A 56-year-old male was incidentally diagnosed with a 14 mm branch duct IPMN and a 3.6 mm non-functional PNET during an evaluation due to persistent upper abdominal pain via endoscopic ultrasound. Close follow-up of the patient was decided as the IPMN had no worrisome features. A review of twenty-two previously reported cases of synchronous IPMN and PNET indicated that: a) only seven cases were diagnosed preoperatively; b) abdominal pain was the main presenting symptom; c) IPMN was the dominant tumor and presented with low grade dysplasia; d) the PNET was small and non-functional and had an indolent behavior; and e) only one case underwent radiologic follow-up. DISCUSSION: IPMN are associated with other pancreatic and extrapancreatic malignancies. Thus, the entire pancreatic parenchyma should be examined closely during the evaluation of an IPMN in order to exclude other pancreatic lesions, for example, a PNET.

The Inflammatory Bowel Disease-Disability Index: validation of the Portuguese version according to the COSMIN checklist.

BACKGROUND AND AIM: Recently, the Inflammatory Bowel Disease-Disability Index (IBD-DI) was developed to assess disability in inflammatory bowel disease (IBD). Our aim was to validate the Portuguese version of IBD-DI according to the COnsensus-based Standards for the selection of the health Measurement INstruments (COSMIN) recommendations. MATERIALS AND METHODS: After translation into Portuguese, the IBD-DI was administered by two interviewers to IBD patients at baseline and after 4 weeks and 4 months. We evaluated reliability (internal consistency, test-retest, and inter-rater reliability and measurement error), construct validity, responsiveness, and interpretability. RESULTS: At baseline, 129 patients (73=Crohn's disease; 56=ulcerative colitis) completed the IBD-DI. After 4 weeks and 4 months, 118 and 89 patients repeated the questionnaire, respectively. Factor analysis confirmed the unidimensionality of the scale and reduced the final version to 14 items. The Cronbach's α was 0.88. The intraclass correlation coefficients were 0.87 and 0.99 for test-retest (baseline and 4 weeks) and inter-rater reliability, respectively. The smallest detectable change was 18.64 at the individual level and 1.87 at the group level. IBD-DI scores correlated negatively with the total, physical, and mental scores of Short Form-36 items. The change score of IBD-DI between baseline and 4 months correlated negatively with the clinical evolution of patients. The minimal important change was 16.96. IBD-DI scores ranged from 0 to 78.6, with a mean of 21.8±18.1. Female sex, professional inactivity, and clinical disease activity were associated with higher IBD-DI scores. CONCLUSION: The Portuguese version of IBD-DI obtained is a reliable, valid, responsive, and interpretable (at the group level) tool to assess disability in Portuguese IBD patients.