Porto biomedical journal最新文献

Background: The performance of regional anesthesia (RA) in a block room (BR) may have an impact on the efficiency of the orthopaedics operating room (OR). The aim of this study was to understand the knowledge of healthcare professionals regarding RA and BR.

Methods: Two types of pilot surveys were developed and applied in three independent hospitals. Statistical validation of the survey was performed (Cronbach alpha coefficient and factor analysis), followed by its restructuring. Validated surveys were randomly delivered to orthopaedists and OR nurses from our institution, and a descriptive analysis was performed.

Results: The pilot surveys presented a Cronbach alpha of 0.533 and 0.417 in the orthopaedic and OR nurse groups, respectively. Two questions in each survey were removed, increasing the internal consistency of the final restructured surveys. There was a total of 126 validated surveys completed (46 by orthopaedists and 76 by OR nurses). Both groups consider that, compared with general anesthesia, RA is associated with better pain control (95.7%/93.4%), fewer side effects (63%/73.7%), and improved patient satisfaction (84.7%/69.7%). Both groups would choose RA for themselves (89.1%/89.5%) and recommend it to a family member (89.1%/92.1%). Regarding BR, 80.4% of orthopaedists agreed that it is associated with less time wasted in anesthetic preparation, higher productivity (65.2%), and greater efficacy (65.2%).

Conclusions: Most orthopaedists and OR nurses recognized the various benefits of RA. Orthopaedists agreed that BR improves outcomes and provides efficiency gains in the OR. Genuine support from the entire OR team can play a critical role in the change.

Background: Ankle injuries, often involving the syndesmotic complex, are common and may lead to acute instability. The syndesmosis, comprising several key ligaments, provides critical support for ankle function. This study assesses the efficacy and safety of the suture button system for isolated syndesmotic injuries, a treatment method that is gaining popularity over traditional transsyndesmotic screws.

Methods: A retrospective review was conducted on patients treated surgically with the suture button system for isolated syndesmotic injuries from January 2018 to December 2023. Key outcomes measured included time to full weight-bearing, returning of daily activities, and complications. The study also compared these outcomes with historical data from screw fixation methods.

Results: Thirty-two patients (20 men, 12 women; mean age 41.66 ± 16.57 years [range 16-72 years]) were analyzed over an average follow-up of 9.94 ± 5.49 months (range 3-28 months). Patients achieved full weight-bearing at 1.23 ± 0.31 months postoperatively, resumed daily activities with restrictions at 3 ± 1.09 months, and without restrictions at 6.67 ± 2.55 months. No major complications were reported; minor complications included implant removal due to irritation in two patients (6.25%) and minor wound issues in one patient (3.13%).

Conclusion: The suture button system demonstrated good outcomes in allowing physiological motion, low malreduction rates, and minimizing reoperation needs. The present results indicate a promising safety profile and functional recovery, despite limitations such as small sample size and lack of patient-reported outcome measures.

Background: Anemia is frequent in palliative care, and transfusions are often used to correct it. Research indicates that transfusions are sometimes based solely on hemoglobin levels rather than patients' symptoms and administered in those with very short survival.

Objective: To survey the transfusion practice of Portuguese palliative teams.

Methods: This is a multicentric and retrospective study involving patients who received red blood cell transfusions in 2021, followed by palliative care teams.

Results: Five palliative care teams participated and included 86 patients who underwent 122 transfusion episodes; 49 (57%) were male, and the median age was 76 years (43-100). The median hemoglobin level before transfusion was 7.4 g/dL (3.7-11.5). Symptomatic improvement was observed in 30 (25%) episodes; in 19 (16%), there was no improvement; and the outcome was not recorded in 73 (60%). Fatigue (38%) and low hemoglobin level (37%) were the most common reasons for transfusion. Decisions to transfuse, recorded primarily by one palliative care team, were often made by nonpalliative care doctors concurrently treating these patients, mostly in the emergency department. Those patients had more complications and significantly shorter survival compared with those whose transfusions were decided by palliative care physicians.

Conclusion: The decisions made by palliative care physicians regarding red blood cell transfusion deviated from the recommendations as seen in other similar studies.

Background: The coronavirus disease 2019 (COVID-19) pandemic has profoundly affected global health, emphasizing the need to assess specific populations such as university students to better understand the prevalence of the infection and its determinants. This study investigated the prevalence and associated factors of COVID-19 among biomedical science students at Rivers State University, Port Harcourt, Nigeria.

Methods: A cross-sectional study was conducted among 220 students from March to August 2022. Data collection was performed using interviewer-administered questionnaires while COVID-19 infection was screened using the Panbio™ COVID-19 Ag Rapid Test Device. Data analysis involved both descriptive and inferential statistics, with statistical significance set at P ≤ .05.

Results: The prevalence of COVID-19 was 11.4% (95% CI: 7.8-16.2). Significant associations were observed between COVID-19 prevalence and facemask use, handwashing practices, use of sanitizers, and nature of accommodation. However, in the multivariable analysis, only noncompliance with facemask use was identified as a significant independent predictor of COVID-19 infection (aOR = 4.350, 95% CI: 1.379-14.13, P = .0124).

Conclusion: The study highlights a concerning prevalence of COVID-19 among biomedical science students. Tailored public health strategies are essential, emphasizing compliance with preventive measures as a means to mitigate COVID-19 transmission within this crucial demographic.

Background: The impact of systolic blood pressure (SBP) variation on chronic heart failure (HF) is largely unknown. We assessed the impact of SBP variation in patients with chronic HF.

Methods: This is a retrospective analysis of adult ambulatory patients with HF with left ventricular systolic dysfunction (LVSD). SBP variation = SBP at the index visit - SBP at the 1-year visit. Patients dying in the first year or with missing data concerning SBP were excluded. Patients with SBP increase ≥10 mmHg during the first year were compared with the remaining. Determinants of SBP increase were assessed by binary logistic regression analysis. The patients were followed up from the 1-year visit up to 5 years. The primary end point was all-cause mortality. A Cox regression analysis was used to determine the association of SBP variation with mortality.

Results: We studied 787 patients (68% male), with a mean age of 70 years. SBP increased by ≥10 mmHg in 277 patients (35.2%) and remained stable or decreased in 510. Patients in whom SBP increased more often presented severe LVSD and nonischemic HF; they had lower baseline SBP and were more medicated with loop diuretics. Independent predictors of SBP increase were lower basal SBP and loop diuretic use. Patients with a SBP increase ≥10 mmHg had a crude hazard ratio (HR) of all-cause mortality of 0.74 (0.59-0.94), and the multivariate-adjusted HR was 0.61 (0.46-0.79).

Conclusions: Patients with chronic HF with SBP increase ≥10 mmHg over the first year have a 39% reduction in the all-cause mortality risk irrespective of basal SBP, severity of ventricular dysfunction, and evidence-based drug use. Patients with SBP stability or decrease have a similarly poor prognosis.

Objectives: The increasing practice of antibiotic use in children without proper guidance, driven by easy availability of medications and limited understanding of the risks, is a significant health concern. The aim of this study was to understand the knowledge and consequences of parental misuse of antibiotics for children.

Methods: This is a community-based cross-sectional study served by the Urban Health Training Center of Indira Gandhi Institute of Medical Sciences, Patna, involving 173 parents of children younger than 12 years over a 12-month period. Participants were selected through simple random sampling and were interviewed using a questionnaire. Data analysis was performed using logistic regression and expressed in terms of both counts and percentages along with odd ratios and confidence intervals.

Result: Of the total, 70 parents (40.46%) were aware of the consequences of antibiotic misuse. Mothers, parents aged 40 years and older, and those having secondary/higher secondary education normally stopped giving antibiotics when their child started feeling better, whereas parents younger than 30 years, doing service, and having a family member working in medical field were seen keeping antibiotic stock at home for later use. Participants were confused whether antibiotic effectiveness is reduced if a full course of antibiotics is not completed. Allergic reaction was the consequence known by most of the parents. Cough/cold was the major reason for antibiotic use in children without medical supervision. Most parents typically wait 1-2 days before beginning antibiotics. Minor illness was the leading reason for improper antibiotic use.

Conclusion: It is crucial to launch extensive campaigns to inform parents about the dangers of antibiotic misuse, including the risks of resistance and potential side effects, especially for those who practice over-the-counter antibiotic use in children.

In Portugal, open consultations (OCs) in primary health care address urgent medical needs, constituting 40-50% of family doctor activity. Frequent attenders (FAs), often presenting nonacute issues, significantly contribute to health care overuse. This study aimed to identify factors associated with frequent OC use in a primary health care unit during 2022. A retrospective cross-sectional analysis was conducted on 4,269 adult patients, with frequent attendance defined as four or more consultations (≥90th percentile). Sociodemographic and clinical factors, including age, sex, employment, chronic conditions, and multimorbidity, were examined using binomial logistic regression. FAs (n = 570, 13.4%) accounted for 36.2% of all consultations. Significant associated variables included female sex (OR = 1.417), economic insufficiency (OR = 1.323), and multimorbidity (OR = 1.678). Conditions such as musculoskeletal (OR = 2.146), psychological (OR = 2.040), and neurological (OR = 1.550) disorders were strongly linked to frequent attendance. While FAs represent a minority of patients, their disproportionate use of OC services underscores the need for targeted interventions, such as individualized care plans and resource optimization, to balance demand and availability. These findings highlight critical areas for policy and practice to enhance health care efficiency.

Background/aim: Medical students are subjected to the risk of obesity due to various factors. Understanding behavioral issues may provide an important insight into obesity development, prevention, and treatment. Emotional, uncontrolled, and restrictive eating practices are problematic eating behaviors characterized by food intake independent of hunger but based on emotional state. Limited data from Egypt are currently available; therefore, this study was undertaken with the objective to find the frequency of overweight and obesity among medical students at Mansoura University, Egypt. Eating behavior and physical activity in relation to overweight/obesity were also assessed.

Methods: A total of 368 undergraduate medical students were included in this study. Eating behavior was described using the French translation of Three-Factor Eating Questionnaire-R18. Obesity and physical activity were assessed according to WHO recommendations.

Results: Among the total students, 54% were normal weight, 32% were overweight, 9% were obese class I, 2% were obese class II, 1% were obese class III, and 2% were underweight. Overweight/obese students had significantly lower physical activity than nonoverweight/obese. Cognitive restraint, uncontrolled eating, and emotional eating were significantly higher in overweight/obese compared with nonoverweight/obese students. Cognitive restraint, uncontrolled eating, and emotional eating were significantly correlated with body mass index. Uncontrolled eating was negatively correlated with sex and residence, whereas emotional eating was negatively correlated with physical activity. Female sex, physical inactivity, increased cognitive restraint, and increased emotional eating scores were significant predictors of obesity in the studied medical students.

Conclusion: Medical students are likely to be overweight or obese. The main risk factors associated with overweight and obesity are female sex, lack of physical activity, and cognitive and emotional restraint but not uncontrolled eating.

Objectives: Prostate cancer (PCa) is the most common malignancy in men. Geography and environmental factors have been associated with varying incidence and mortalities in different groups. Vitamin D has antiproliferative effect on PCa cells, and its effect is mediated through vitamin D receptor (VDR). This study reported the correlation of VDR expression with some clinicopathological and biological features among a cohort of patients with PCa.

Methods: Genomic and clinicopathological data of 497 patients with PCa reposited in The Cancer Genome Atlas were retrieved using Linux command in running codes and scripts and extrapolated onto SPSS version 28 for statistical analysis. Descriptive and inferential statistics were conducted to determine the proportions and associations of VDR expression with genomic variables and clinicopathological indices. The mechanism of VDR dysregulation was also interrogated.

Results: Our results showed that high VDR expression was positively correlated with a high Gleason score (P < 0.001), poorer prognostic International Society of Urological Pathology grade groups (P < 0.001), advanced tumor stage (P = 0.01), and poorer response to androgen deprivation therapy (ADT). Age, race, and overall and disease-free survival did not show any correlation with VDR expression (P > 0.05). Furthermore, the major mechanism of dysregulation of VDR in PCa was by aberrant methylation of the VDR promoter region (P < 0.001), and not by copy number alterations (P = 0.42).

Conclusion: VDR expression is associated with adverse clinicopathological indices, including late-stage disease profile, high-grade indices, and poorer response to ADT. VDR is also mainly deregulated by aberrant epigenetic mechanism. The study is limited by absence of some clinical information such as sunlight exposure.