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Urinary incontinence in women who practice recreational exercise: A cross-sectional study

Fri, 01 Jan 2021 00:00:00 GMT

Title: Urinary incontinence in women who practice recreational exercise: A cross-sectional study Abstract: Introduction: Urinary incontinence affects up to one third of women in Portugal. Exercise can be a precipitating/aggravating factor but also protective, if appropriate. The aim of this study was to determine the prevalence of urinary incontinence in women who practice recreational exercise, to assess its relationship with the type of exercise and other coexisting risk factors, and assess whether the topic is addressed in gyms. Material and Methods: Cross-sectional study using self-reported questionnaires in gyms in Porto and Vila Nova de Gaia, Portugal. Results: Two hundred and ninety women completed the questionnaires. From these, 67.6% were under 40 years old, 25.2% reported incontinence, and 53.4% had at least one risk factor unrelated to exercise. There was a statistically significant association (p < 0.05) between incontinence, obesity and constipation. High impact exercises were included in the training of 62.1% continent and 50.9% incontinent women. The topic of incontinence and strengthening of the pelvic floor muscles was addressed in only 5.5% in the initial assessment, 9.7% in collective training, and in 13.5% of the 37 women with individualized training. Discussion: The higher proportion of continent women - compared to incontinent - who practiced strenuous exercise suggests that this might be a provocative factor for some, although there was no statistically significant association between incontinence and type of exercise. Conclusion: Urinary incontinence affects women who practice recreational exercise, regardless of age and exercise characteristics. It is rarely addressed in gyms, and it is necessary to raise the awareness of professionals to enhance the preventive/therapeutic effects of exercise on the function of the pelvic floor and in the control of modifiable risk factors.

Guidelines on: COVID-19 vaccine induced thrombosis, bleeding, and thrombocytopenia

Fri, 01 Jan 2021 00:00:00 GMT

Title: Guidelines on: COVID-19 vaccine induced thrombosis, bleeding, and thrombocytopenia Abstract: After widespread vaccination with COVID-19 vaccines, there have been worldwide reports on thrombosis, bleeding, and thrombocytopenia. Recently, a rare syndrome with a high mortality rate consisting of an unusual combination of thrombocytopenia and thrombosis, in particular cerebral venous sinus thrombosis, which clinically resembles heparin-induced thrombocytopenia, was reported following vaccination. Different statements and recommendations were developed regarding the definition, diagnosis, and treatment of these rare complications. We present here a protocol with recommendations, based on current evidence.

Recommendations for genetic testing in cardiology: Review of major international guidelines

Wed, 01 Jan 2020 00:00:00 GMT

Title: Recommendations for genetic testing in cardiology: Review of major international guidelines Abstract: In recent years, the importance of genetic causes of cardiovascular diseases has been increasingly recognized, as the result of significant advances in molecular diagnosis techniques. This growing knowledge has enabled the identification of new phenotypes and the subclassification of clinical syndromes, impacting the therapeutic approach and genetic counseling offered to affected families. This paper describes the state of the art of genetic testing in the main cardiovascular diseases, aiming to provide a useful tool to help cardiologists and other health professionals involved in the care of individuals with hereditary heart diseases and their families.

Association between serum Vitamin D and diabetic retinopathy in Portuguese patients with type 1 diabetes

Wed, 01 Jan 2020 00:00:00 GMT

Title: Association between serum Vitamin D and diabetic retinopathy in Portuguese patients with type 1 diabetes Abstract: Introduction: Recently, vitamin D has gained importance as a diabetes risk modifier. Our aim was to assess the association between serum vitamin D levels and the prevalence of diabetic retinopathy in patients with type 1 diabetes. Material and Methods: Retrospective review of a population of patients with type 1 diabetes followed in a Portuguese tertiary center. Patients were included if they had an ophthalmological evaluation and a serum 25-hydroxyvitamin D level determination within the same year. Logistic regression analysis was used to adjust for possible confounders. Results: We included 182 patients (47% male), and 57% (n = 103) had signs of diabetic retinopathy. We found a significant association between lower circulating levels of 25-hydroxyvitamin D levels and a greater prevalence of diabetic retinopathy after adjusting for confounders (duration of diabetes, estimated glomerular filtration rate, age, sex, metabolic control, season, dyslipidemia and hypertension) (OR = 0.94; 95% CI 0.90 - 0.99, p = 0.023). Longer duration of diabetes and worse metabolic control also remained associated with diabetic retinopathy in the multivariate analysis (OR = 1.20; 95% CI 1.13 - 1.27, p < 0.001 and OR = 4.13; 95% CI 1.34 - 12.7, p = 0.013, respectively). Conclusion: Lower levels of vitamin D were associated with an increased prevalence of diabetic retinopathy in patients with type 1 diabetes, after adjusting for possible confounders. Future controlled studies may elucidate the molecular routes for this association as well as the role of supplementation in the prevention of diabetes microvascular complications.

Chronic and Refractory Migraine: How to Diagnose and Treat

Wed, 01 Jan 2020 00:00:00 GMT

Title: Chronic and Refractory Migraine: How to Diagnose and Treat Abstract: Migraine is highly prevalent and carries a significant personal, social and economic burden. It is the second cause of disability (years living with disability) worldwide and the first cause under 50 years of age. Chronic migraine (occurring for more than 15 days a month) and refractory migraine (treatment resistant), especially when there is also analgesic overuse, are the most disabling forms of migraine. These three disorders (chronic migraine, refractory migraine and medication overuse headache) are particularly difficult to treat. This article reviews their epidemiology, clinical presentation, diagnostic criteria, risk factors, comorbidities and social and personal impact. The therapeutic options available are discussed and focused on a multidisciplinary approach, non-pharmacological interventions treatment of comorbidities and avoiding analgesic overuse. Prophylactic treatments are mandatory and include the oral prophylactic treatments (topiramate), botulinum toxin type A and the novel monoclonal antibodies against calcitonin gene related peptide or its receptor, which are the first migraine preventive medicines developed specifically to target migraine pathogenesis. In refractory cases, multiple therapies are required including neurostimulation.

Human rabies: Optimization of prevention and paths towards the cure

Wed, 01 Jan 2020 00:00:00 GMT

Title: Human rabies: Optimization of prevention and paths towards the cure Abstract: Introduction: Rabies is one of the oldest and deadliest infectious diseases known by human beings and is commonly transmitted by animal bites. Dogs have a major role in the transmission of the virus. Rabies has no approved curative therapy, and its prevention, even though it is highly effective, it is complex, expensive and challenging in terms of accessibility, particularly regarding immunoglobulin. This review aims to provide a practical approach to cost-effective prevention as well as the future perspectives regarding the development of an effective and secure cure. Material and Methods: This review article was based on a search in PubMed using the following MeSH terms: rabies, preexposure and postexposure prophylaxis, rabies immune globulin, treatment, Milwaukee Protocol. Results: Concerning rabies infection, it's important to apply the prevention protocols effectively as early as possible due the unpredictable time window between infection and the appearance of symptoms. The literature shows that is possible to reduce the vaccination dosage and maintain the efficiency of the immunization, and booster vaccination is only required in specific risk groups/populations. Discussion: The current philosophy of cost-effective prevention which consists of canine vaccination, restriction of vaccine overdosage used in humans and the appropriate use of rabies immunoglobulin - could make the prevention of the disease accessible for those countries that need it the most. There are several therapies in development but they're all in early stages of development. Conclusion: The development of new and more effective therapeutic and prophylactic approaches is a goal not yet achieved and relies on a better understanding of the disease pathophysiology.

The influence of the genetic and immunologic context in the development of colorectal adenoma: A case series report

Wed, 01 Jan 2020 00:00:00 GMT

Title: The influence of the genetic and immunologic context in the development of colorectal adenoma: A case series report Abstract: Introduction: Overcoming immunosurveillance is a major step in the progression of many types of tumors. Several immune escape strategies have been identified, including immunoediting and the establishment of an immune suppressive microenvironment. The aim of the present study was to determine whether the hereditary or sporadic context has any influence in the relationship between immune surveillance and tumor development, using sporadic and familial adenomatous polyposis related colorectal adenomas as a model. Material and Methods: The immune tumor-infiltrating cells of a total of 58 low-grade and 18 high-grade colorectal adenomas were examined and compared, using immunostaining for CD3, CD4, CD8, CD57, CD68 and FoxP3. Results: FoxP3 and CD68 counts were significantly higher in sporadic low-grade dysplasia (p = 0.0003 and p = 0.0103, respectively), and FoxP3 and CD4 counts were found to be significantly higher in high-grade sporadic dysplasia (p = 0.0008 and p = 0.0018, respectively) when compared with corresponding lesions in patients with familial adenomatous polyposis. Discussion: This study suggests that the immune microenvironment of sporadic and hereditary lesions is different. Sporadic lesions contain a higher number of immune suppressive Treg cells, which suggests a stronger immune selective pressure. In contrast, hereditary lesions seem to benefit from a more tolerant immune microenvironment, allowing for the development of lesions with lower immune cell infiltration. Conclusion: This study shows that sporadic lesions harbor higher tumor-infiltrating immune cell counts, which might reflect a higher immune tolerance towards hereditary lesions.

Dyslipidemia secondary to hypothyroidism and cholestasis

Wed, 01 Jan 2020 00:00:00 GMT

Title: Dyslipidemia secondary to hypothyroidism and cholestasis Abstract: In about 28% of patients, dyslipidemia has a secondary cause. Many times, the treatment of these causes can lead to the total correction of dyslipidemia. We describe the case of a 50-year-old female patient with class II obesity and primary biliary cirrhosis, evaluated for mixed dyslipidemia with poor control (statins and fibrates were being administered) as well as abnormal liver tests. The investigation carried out revealed primary auto-immune hypothyroidism. After normalisation of thyroid function by treatment with levothyroxine, as well as suspending the administration of statins and fibrates, there was an improvement in the lipid profile, although hypercholesterolemia continued. During this time, the patient was diagnosed with diabetes and she re-commenced statin therapy (atorvastatin 10 mg), which resulted in a normal lipid profile being achieved. In this case, the authors set out to highlight the importance of excluding secondary causes of dyslipidemia - including hypothyroidism, and then go on to discuss particular aspects of statin therapy for liver disease.

What do Portuguese travellers know about malaria? Pre-travel medicine appointment evaluation

Mon, 01 Jan 2018 00:00:00 GMT

Title: What do Portuguese travellers know about malaria? Pre-travel medicine appointment evaluation Abstract: Introduction: The knowledge of transmission, prevention and symptoms of malaria is essential for travellers’ safety. In real life, what do Portuguese travellers know about malaria before a Travel Medicine consultation? How can we, through this consultation, improve their knowledge? Material and Methods: Before an appointment with a specialist in Travel Medicine, 80 adult travellers filled a questionnaire that included demographic aspects, characteristics of the trip and knowledge about malaria. Data were analysed using descriptive statistics and multifactorial variance analysis. Results: The travellers’ ages fell in the range 20-80 years, 51% were male and 74% of the travellers had a university degree level of education. For 74% of the travellers, this was the first Travel Medicine consultation. Half of the travellers planed trips lasting no more than 14 days, mainly for tourism. The average percentage of correct answers about malaria given by a traveller was 63%. Travellers who had previously attended a Travel Medicine appointment exhibit a statistically significant difference in knowledge comparing to those who attend Travel Medicine appointment for the first time, and this was more evident in the sample composed of travellers without higher education. The clinical manifestations and prevention had the lowest number of correct answers among the travellers. Discussion: These travellers appear to have good knowledge about malaria but some misconceptions prevail. Conclusion: The Travel Medicine consultation seems important to raise awareness in the population about malaria, particularly for travellers without higher education. The prevention and the recognition of malaria symptoms must be prioritized during Travel Medicine consultations and the information given adapted to the traveller’s characteristics.

Overview of drug allergy: From immunogenetic basis to practice

Mon, 01 Jan 2018 00:00:00 GMT

Title: Overview of drug allergy: From immunogenetic basis to practice Abstract: Drug therapy is often a balance between the beneficial and harmful effects of drugs. Drug allergic reactions are adverse reactions mediated by immunological mechanisms and usually not related to the pharmacological actions of the drug. They can be classified based either on the clinical presentation or the underlying immunological mechanism. Although uncommon, drug allergic reactions are unpredictable and can be very severe, even life threatening. The aim of this review was to provide clinicians from different medical specialties with a working tool to improve management of their patients with suspected drug allergy. It was conducted as a non-systematic review, and attempts to describe the complexity of drug allergy. The information included ranges from pathophysiology to the heterogeneous clinical presentation, with a special focus on the drugs most frequently involved, as well as a classification of reactions and risk factors. Despite all advances in this challenging and complex field of allergy and clinical immunology, drug allergy is not yet fully established and understood. An exceptional contribution was brought by pharmacogenomics, even though a specific pharmacogenetic association has only been defined for a very limited number of drugs. Further studies are needed to obtain clearer answers when managing each individual case of drug allergy.

Proposal of a portuguese tool for quality assessment of genetic counselling: A new tool for healthcare professionals

Mon, 01 Jan 2018 00:00:00 GMT

Title: Proposal of a portuguese tool for quality assessment of genetic counselling: A new tool for healthcare professionals Abstract: Introduction: The lack of tools for quality assessment of genetic counselling is recognized in national and international studies. The correlation of quality of healthcare practice with greater satisfaction of patients and affected families is also well established. The present study describes the development and validation of the first Portuguese scale for quality assessment of genetic counselling practice. It encompasses a proposal of a new tool for the evaluation of the process by professionals. Material and Methods: The definition of an initial pool of items and their organization was based on a literature review and identification of the main genetic counselling dimensions as well as the theoretical dimensions of the Reciprocal Engagement Model. After a pre-test validation the scale was submitted to psychometric validation using a sample of 30 participants who evaluated 81 genetic counselling sessions. Results: Based on statistical and empirical criteria the best items were selected. The final 50 items-version comprises five dimensions: education, counselees’ characteristics and decision-making, therapeutic relationship, effects of the process on the counselees and services organization. Discussion: Results showed consistent psychometric properties of the scale supported on theoretical and practice concepts of genetic counseling. The reduced number of participants involved in psychometric validation is a limitation of the study, which reflected the reduced number of professionals in genetic healthcare services. Conclusion: The scale proposed at this study is a novel and multidimensional instrument that aimed to contribute to the improvement of genetic counselling practice in Portugal.

New insights into the role of tissue eosinophils in the progression of colorectal cancer: A literature review

Mon, 01 Jan 2018 00:00:00 GMT

Title: New insights into the role of tissue eosinophils in the progression of colorectal cancer: A literature review Abstract: Introduction: Amongst the inflammatory cells implicated in the immune surveillance of colorectal cancer, a growing body of evidence suggests a role for eosinophils in carcinogenesis. We aimed to review the value of tumour-associated tissue eosinophilia (TATE) in the prognosis of colorectal cancer emphasizing the identification and measurement of tissue-infiltrating eosinophils and their association with the clinicopathological features of the disease. Material and Methods: We used PubMed and Web of Science search engines to retrieve studies that looked at the association between tissue eosinophils and colorectal cancer prognosis. Results: We selected 15 studies for our review. In the majority of the studies, eosinophils were identified in hematoxylin-eosin stained sections and scores were generated for analysis. Most of the studies pointed to tumour-associated tissue eosinophilia as a favourable prognostic marker in colorectal cancer and found an inverse association between eosinophil count and the metastatic potential of these neoplasms. The association between tumour-associated tissue eosinophilia and established prognostic markers of colorectal cancer was assessed in some studies, with inconsistent results. Additionally, tumour-associated tissue eosinophilia decreased with the adenoma-carcinoma progression of colorectal lesions. Discussion: Several mechanisms have been proposed regarding eosinophil chemoatraction to tumour tissues and eosinophil-cancer cell cross-talk, suggesting that eosinophils are actively involved in colorectal cancer progression. Although a scoring system is still lacking, tumour-associated tissue eosinophilia meets the criteria of a convenient histopathological prognosticator in colorectal cancer. Conclusion: Collectively, current evidence associates the presence of eosinophils in the colorectal cancer microenvironment with the modulation of tumour progression. The clinical impact of this finding deserves future research.

Protocol for the prevention of infections related to the treatment of hematological malignancies

Mon, 01 Jan 2018 00:00:00 GMT

Title: Protocol for the prevention of infections related to the treatment of hematological malignancies Abstract: Patients with haematological malignancies have a higher incidence of infection compared with the general population. Several factors contribute to this but specially chemotherapy drugs carry different and specific infectious risks. This protocol discusses the prevention of infections in patients who will undergo chemotherapy for the treatment of haematological malignancies. It is divided into: study prior to the initiation of chemotherapy; vaccination and eradication prior to initiation of chemotherapy; antimicrobial prophylaxis during chemotherapy; special situations. The main aims of this protocol are to serve as support to a more systematic and individualized approach to patients undergoing chemotherapy for the treatment of haematological malignancies and by doing so prevent the infectious complications that may arise.