Acta medica portuguesa最新文献

The aim of this study was to translate, culturally adapt, and conduct a preliminary validation of the "Palliative Care and Rapid Emergency Screening Tool" into European Portuguese for use in the emergency department. The tool was developed to assist healthcare professionals in identifying patients with palliative needs, ensuring timely referrals for palliative care consultation. The translation and adaptation process followed established guidelines for cross-cultural adaptation. Content validity was assessed by eight experts in palliative care, who confirmed that the tool was clear, relevant, and easy to understand. Face validity was evaluated by ten emergency department professionals, who rated the tool highly in terms of clarity and applicability to the target population. The study found that the tool effectively addresses key domains in palliative care, offering a simple and practical approach for use in the emergency care setting. These findings suggest that the "Instrumento de Triagem Rápida para Cuidados Paliativos no Serviço de Urgência" (PALinSU) can potentially enhance the identification of palliative care needs, leading to improved patient care and timely referrals.

Introduction: The COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), resulted in significant disease burden and mortality. Despite vaccination successes, new virus variants persist, affecting unvaccinated and immunocompromised individuals (ICI) severely. These high-risk groups face elevated mortality and hospitalization rates. Vigilance and targeted health measures remain crucial post-pandemic. The aim of this study was to develop consensus on the unmet needs in COVID-19 prevention among ICI.

Methods: We performed a Delphi study involving 45 experts, including physicians, health managers, policymakers, public health experts, members of medical societies and patient organizations. Consensus was achieved at 65% for each identified strategy using a scale ranging from "strongly agree" to "strongly disagree." Three Delphi rounds were conducted to address four key questions: identifying unmet needs in COVID-19 prevention for ICI; identifying the characteristics that distinguish ICI as a susceptible group; determining the main outcomes of COVID-19 in ICI; and indicating action plans for protecting ICI. The first round involved voting on pre-identified indicators. The second and third rounds involved analyzing the gathered information and voting on each indicator to achieve consensus.

Results: A retention rate of 80% was achieved. Out of 89 valid indicators analyzed, 23 achieved consensus. These included: eight indicators highlighting the importance of raising awareness about COVID-19 and vaccination outcomes, ensuring safety and understanding, and developing targeted immunization strategies for ICI; five indicators identifying susceptible groups within ICI, such as individuals undergoing chemotherapy or radiotherapy, those with primary immunodeficiencies, solid organ transplant recipients, patients with chronic kidney disease, and bone marrow transplant recipients; two indicators showing improvements in clinical outcomes and reduced hospitalizations; and eight indicators recommending the development of effective therapies, more immunogenic vaccines, and treatments for viral infections in ICI.

Conclusion: The study emphasized the importance of targeted immunization strategies, monitoring, and tailored education to address diverse needs of ICI. These findings provide a foundation for future policies to effectively manage and protect ICI during and beyond the COVID-19 pandemic.

Skin melanoma is very rarely found in the genital region. Additionally, out of all penile skin malignancies, melanoma is one of the rarest, with no cases reported before in the Balkan region. A 68-year-old male presented with atypical and irregular pigmented skin lesions on his left flank and penile shaft. After dermoscopy and radiological work-up, both lesions were completely excised, with pathological examination revealing a high-grade dysplastic nevus with nodular melanoma in the penile location. Wide re-excision was performed one month later, followed by skin reconstruction with a rotation cutaneous flap. No postoperative complications, long-term recurrence signs, nor local or distant metastases were observed. As a very rare case of this kind of condition in the Balkan region and globally, this is the first case of penile skin melanoma described in Serbia, additionally emphasizing the importance of thorough systematic clinical examination and conducting organ-preserving surgery.

Infections caused by multidrug-resistant Gram-negative bacteria, including carbapenem-resistant Enterobacterales, are a global threat and their gradual increase is alarming. They represent a major challenge to public health because of limited therapeutic options and high case-fatality rates. Hemato-oncological patients represent a high-risk subpopulation for these types of infections, more specifically in previous carbapenem-resistant Enterobacterales colonized patients, because of severe immunosuppression not only due to the disease itself but also due to treatment like intensive chemotherapy or allogeneic hematopoietic stem cell transplant. Selective digestive decontamination is a prophylactic intervention with the purpose of reducing or eliminating gut colonization by pathogenic agents, preserving beneficial endogenous flora but its application remains controversial due to great heterogeneity amongst studies. However, in this review we intend to examine the role of selective digestive decontamination in context of high-risk patients such as hemato-oncological carbapenem-resistant Enterobacterales carriers who will receive highly immunosuppressive treatments, as it appears to be an appealing short-term strategy for the prevention of difficult-to-treat infections.