Porto biomedical journal最新文献

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.

Background: Small bowel capsule endoscopy (SBCE) is an essential tool for evaluation of small bowel (SB) Crohn disease (CD). Fecal calprotectin (FC) represents an important biomarker of intestinal inflammation, widely used in ulcerative colitis and CD. Our aim was to evaluate the role of FC for diagnosing inflammatory activity in patients with isolated SB CD and how it correlates with SBCE findings.

Methods: This is a retrospective study conducted in a tertiary inflammatory bowel disease referral center that included patients with SB CD who underwent SBCE between January 2017 and February 2023. FC value was obtained from the closest stool examination to SBCE.

Results: One hundred ninety-six patients were included: 123 were women (63%) with a mean age of 44.2 years. In the SBCE, 127 (65%) patients had a Lewis Score ≥135 and, among the 94 patients with FC >200 μg/g, 23 had LS <135, 36 had LS between 135 and 790, and 35 had LS ≥790. FC levels were predictive of endoscopic lesions in SBCE, with significant correlation between FC level and total LS (Pearson correlation coefficient 0.43, P<.001). The sensitivity and specificity were calculated for each cut-off value being respectively 78% and 45% for FC = 100 μg/g, 69% and 59% for FC = 150 μg/g and 67% and 67% for FC = 200 μg/g.

Conclusion: FC showed moderate correlation with endoscopic findings in SBCE in SB CD. It is, therefore, a reasonable marker for predicting significant inflammatory lesions in SBCE; however, none of the cut-off had a high sensitivity or specificity.

Preimplantation genetic testing (PGT) is a diagnostic procedure that has become a powerful complement to assisted reproduction techniques. PGT has numerous indications, and there is a wide range of techniques that can be used, each with advantages and limitations that should be considered before choosing the more adequate one. In this article, it is reviewed the indications for PGT, biopsy and diagnostic technologies, along with their evolution, while also broaching new emerging methods.

Objectives: Despite the discrepancy between demand and availability of organs for transplantation, controlled circulatory death donation has not been implemented in Portugal. This study aimed to estimate the potential increase in organ donation from implementing such a program.

Material and methods: All deceased patients within the intensive care medicine department at Centro Hospitalar Universitário de São João, throughout the year 2019, were subjected to retrospective analysis. Potential gain was estimated comparing the results with the number of donors and organs collected during the same period at this hospital center. Differences in variables between groups were assessed using t tests for independent samples or Mann-Whitney U tests for continuous variables, and chi-squared tests were used for categorical variables.

Results: During 2019, 152 deaths occurred after withdrawal of life-sustaining therapies, 10 of which would have been potentially eligible for donation after controlled circulatory death. We can anticipate a potential increase of 10 prospective donors, a maximum 21% growth in yearly transplantation activity, with a greater impact on kidney transplantation. For most patients, the time between withdrawal of organ support and death surpassed 120 minutes, an outcome explained by variations in withdrawal of life-sustaining measures and insufficient clinical records, underestimating the potential for controlled circulatory arrest donation.

Conclusion: This study effectively highlights public health benefits of controlled circulatory arrest donation. Legislation allowing donation through this method represents a social gain and enables patients who will never meet brain death criteria to donate organs as part of the end-of-life process in intensive care medicine, within a framework of complete ethical alignment.