Porto biomedical journal最新文献

Exercise is an important physiological activity with several health benefits. In the setting of ischemic heart disease (IHD), the view toward exercise has greatly evolved throughout the years, concurrently to several major advances in the management of this complex entity. Currently, exercise training has broad applications across the IHD continuum as a powerful tool in its overall management, being a core component of comprehensive cardiac rehabilitation programs. Beyond this, exercise has also been incorporated as an integral part of contemporary methodologies aiming to provide diagnostic and prognostic data, such as cardiopulmonary exercise stress testing or stress echocardiography. In this article, we provide a pragmatic overview concerning the role of exercise in IHD, with a focus on its incorporation in cardiac rehabilitation frameworks, while also discussing some of the challenges and unmet needs concerning these interventions.

Background/aim: The link between serum total bilirubin and metabolic syndrome and its components has been previously proposed. However, it is unknown whether total bilirubin is a risk factor of metabolic syndrome and its components in obese Egyptians. Therefore, this study was conducted to clarify the association of total bilirubin levels with metabolic syndrome and its components in obese Egyptians.

Methods: A total of 200 adults with obesity were enrolled in this study. Obese participants were evaluated for metabolic syndrome; there were 92 obese participants with metabolic syndrome and 108 obese participants without metabolic syndrome. Anthropometric measurements, fasting blood glucose (FBG), fasting insulin, homeostasis model assessment of insulin resistance (HOMA-IR), HOMA-β (%), lipid profile, uric acid, alanine aminotransferase, aspartate aminotransferase, and serum total bilirubin were assessed.

Results: Total bilirubin was significantly lower in obese participants with metabolic syndrome than in those without metabolic syndrome. Compared with middle bilirubin tertile, high and low bilirubin tertiles were independently associated with metabolic syndrome. Regarding metabolic syndrome components, a significant positive association between low bilirubin tertile and hypertension was found independent of the all studied confounding factors, whereas the association of total bilirubin level with waist circumference (WC), FBG, high-density lipoprotein cholesterol, and triglycerides was dependent on body mass index (BMI), HOMA-IR, and high sensitive C-reactive protein (hs-CRP).

Conclusion: Total bilirubin is an independent risk factor of metabolic syndrome in obese Egyptians. We have found an independent association between high bilirubin level and reduced risk of metabolic syndrome, whereas low bilirubin level was associated with increased risk of metabolic syndrome. Bilirubin is also independently associated with hypertension, but its association with other components of metabolic syndrome is mainly dependent on BMI, HOMA-IR, and hs-CRP.

IgA nephropathy (IgAN) is the most prevalent form of primary glomerulonephritis worldwide and a leading cause of chronic kidney disease and renal failure. This disorder is characterized by the deposition of immune complexes containing galactose-deficient forms of IgA and complement C3 in the glomeruli. Until now, disease management relied mainly on optimized supportive care. Systemic corticosteroid therapy is proposed for patients at high risk of disease progression, but the effectiveness and safety of this approach are under debate. A significant proportion of patients do not respond to current therapies and require kidney replacement therapy at a young age, with substantial costs and impact on quality of life. Recently, there have been multiple joint efforts to improve the understanding of IgAN pathophysiology. International collaborations resulted in multiple ongoing clinical trials that are providing new insights toward innovative therapeutic options such as SGLT2 inhibitors, dual endothelin and angiotensin receptor blockers, targeted-release budesonide, B-cell proliferation and differentiation inhibitors, and complement system blockers. Based on this new evidence, revision of the guidelines to manage IgAN is expected to occur in the near future. In addition to the novelty in therapeutic agents, there is also a growing interest in new noninvasive biomarkers for IgAN screening, risk stratification to monitor the course of the disease, and the response to treatment. In this review, we discuss current knowledge on the pathophysiology of IgAN, disease management, and emerging advances in clinical translation of IgAN research.

Background: Urinary tract infections (UTIs) and urinary tract colonizations (UTCs) are common in patients with spinal cord injury (SCI). The aim of this study was to characterize the microbiological profile of urine cultures in patients with SCI and to determine the antibiotic susceptibility profile of most common microorganisms, to track antibiotic resistance and facilitate empiric antibiotic selection.

Methods: A retrospective observational study was conducted on 235 urine culture results of 29 patients with SCI followed at a Physical and Rehabilitation Medicine outpatient consultation between January 2016 and April 2024. Data regarding sociodemographics, cause of SCI, American Spinal Injury Association Impairment Scale classification, voiding method, microbiological urine culture profile, and antimicrobial resistance were collected and statistically analyzed. UTIs (defined as bacteriuria, leukocyturia, positive urine culture, and new onset of signs and/or symptoms) were differentiated from UTCs.

Results: Patients were mostly men (86%), with a mean age of 52.1 years. UTIs occurred in 134 specimens (57%) and UTCs in 101 (43%). In both UTIs and UTCs, microbiological agents were mostly bacteria; Escherichia coli was the commonest overall (39%) and more frequent in indwelling catheterization (in UTIs) and intermittent self-catheterization (in UTCs); more frequently identified microorganisms were E. coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Proteus mirabilis, and Enterococcus faecalis. For these 5 more frequent bacteria, antibiotic susceptibility profiles were determined. High resistance to fluoroquinolones, low resistance to cephalosporins, and very low resistance to nitrofurantoin were found. Specific multidrug-resistant organisms (MDROs) accounted for 11.2%, mostly identified in patients with indwelling catheters. Antibiotic prescriptions in UTIs were according to antibiograms.

Conclusions: In UTIs and UTCs, E. coli was the most common microorganism; microorganisms were distinct on different types of voiding methods. Antibiotic susceptibility profiles were determined for the more frequent bacteria. Very low resistance to nitrofurantoin of E. coli and E. faecalis, low resistance to cephalosporins, and high resistance to fluoroquinolones were found. The data now reported can, in selected cases, facilitate empiric antibiotic selection.

Flaxseed is an emerging allergen, and a detailed clinical history is crucial for diagnosis. Flaxseed allergens identified are associated with severe reactions. Providing clear advice on food avoidance might be challenging as there are no reports of clinical cross-reactivity to other foods published.

Background/aims: Although studies correlating idiopathic sensorineural hearing loss (SNHL) to whole blood viscosity (WBV) have been conducted, no such study has been done in diabetic patients in whom WBV is said to be altered. Therefore, we aimed to investigate the potential association between calculated WBV and the presence and severity of SNHL and other microangiopathies in Indian patients with type 2 diabetes mellitus (T2DM).

Methods: A cross-sectional study was carried out in the Kasturba Medical College (KMC) group of hospitals among individuals who were older than 18 years and had T2DM. The included patients underwent pure-tone audiometry, ophthalmoscopy, monofilament test, and routine blood investigations for diabetes. WBV was derived using hematocrit and total protein with a validated formula.

Results: Of the total 60 participants, 73.3% had SNHL, which was predominantly bilateral and moderate. There was a statistically significant association between glycemic control and the degree of SNHL. The associations between SNHL and HbA1C levels and random plasma glucose were both statistically significant (P = .001). The statistical association between WBV and the degree of SNHL was not significant (P = .056). Although higher mean blood viscosity was noted in individuals with diabetic retinopathy and neuropathy than those without, the associations between blood viscosity and the presence of retinopathy, neuropathy, and nephropathy were not statistically significant (P = .238, P = .621, and P = .656; respectively). Finally, the associations between WBV and glycemic control were also not significant (P = .652 for random plasma glucose and P = .928 for HbA1C).

Conclusion: This study concludes that SNHL is highly prevalent in diabetes, and poor glycemic control is associated with its worsening. Elevations in WBV, if present, are not affected by poor glycemic control and do not appear to significantly contribute to the development of complications of the microvasculature in T2DM.

Acute myeloid leukemia (AML) treated with intensive chemotherapy carries a high risk of severe infection. The development of reliable assessment tools to promptly identify patients at risk of developing critical illness is essential to prevent delays in intensive care unit (ICU) admission. This study evaluated the accuracy of quick Sequential Organ Failure Assessment (qSOFA) score, National Early Warning Score (NEWS), and NEWS2 score in predicting ICU admission and sepsis-related mortality in this population. A retrospective analysis was conducted, including 365 episodes of febrile neutropenia in 126 patients. The results showed that all three scores-qSOFA, NEWS, and NEWS2-demonstrated good accuracy for all outcomes, with area under the receiver-operating characteristic curve values for sepsis-related mortality of 0.812, 0.858, and 0.848, respectively. In addition, the scores exhibited excellent accuracy in predicting ICU admission and the composite outcome of ICU admission or sepsis-related mortality. To our knowledge, this is the first study to evaluate the accuracy of NEWS in a population of patients with AML who did not undergo stem cell transplantation. These findings suggest that NEWS and NEWS2 are effective tools for identifying patients with AML at high risk of clinical deterioration during febrile neutropenia, supporting their use in clinical practice.