Pub Date : 2023-05-01DOI: 10.1097/j.pbj.0000000000000218
Luís Fabião, Ana Ribau, Carolina Lemos, Ricardo Rodrigues-Pinto
Background: While fluoroscopy is widely used in orthopedic trauma surgeries, it is associated with harmful effects and should, therefore, be minimized. However, reference values for these surgeries have not been defined, and it is not known how surgeon experience affects these factors. The aims of this study were to analyze the radiation emitted and exposure time for common orthopedic trauma surgeries and to assess whether they are affected by surgeon experience.
Methods: Data from 1842 trauma orthopedic procedures were retrospectively analyzed. A total of 1421 procedures were included in the analysis. Radiation dose and time were collected to identify reference values for each surgery and compared for when the lead surgeon was a young resident, a senior resident, or a specialist.
Results: The most performed surgeries requiring fluoroscopy were proximal femur short intramedullary nailing (n = 401), ankle open reduction and internal fixation (ORIF) (n = 141), distal radius ORIF (n = 125), and proximal femur dynamic hip screw (DHS) (n = 114). Surgeries using higher radiation dose were proximal femur long intramedullary nailing (mean dose area [DAP]): 1361.35 mGycm2), proximal femur DHS (1094.81 mGycm2), and proximal femur short intramedullary nailing (891.41 mGycm2). Surgeries requiring longer radiation time were proximal humerus and/or humeral shaft intramedullary nailing (02 mm:20 ss), proximal femur long intramedullary nailing (02 mm:04 ss), and tibial shaft/distal tibia intramedullary nailing (01 mm:49 ss). Senior residents required shorter radiation time when performing short intramedullary nailing of the proximal femur than young residents. Specialists required more radiation dose than residents when performing tibial nailing and tibial plateau ORIF and required longer radiation time than young residents when performing tibial nailing.
Conclusions: This study presents mean values of radiation dose and time for common orthopedic trauma surgeries. Orthopedic surgeon experience influences radiation dose and time values. Contrary to expected, less experience is associated with lower values in some of the cases analyzed.
{"title":"Intraoperative fluoroscopic radiation in orthopedic trauma: correlation with surgery type and surgeon experience.","authors":"Luís Fabião, Ana Ribau, Carolina Lemos, Ricardo Rodrigues-Pinto","doi":"10.1097/j.pbj.0000000000000218","DOIUrl":"https://doi.org/10.1097/j.pbj.0000000000000218","url":null,"abstract":"<p><strong>Background: </strong>While fluoroscopy is widely used in orthopedic trauma surgeries, it is associated with harmful effects and should, therefore, be minimized. However, reference values for these surgeries have not been defined, and it is not known how surgeon experience affects these factors. The aims of this study were to analyze the radiation emitted and exposure time for common orthopedic trauma surgeries and to assess whether they are affected by surgeon experience.</p><p><strong>Methods: </strong>Data from 1842 trauma orthopedic procedures were retrospectively analyzed. A total of 1421 procedures were included in the analysis. Radiation dose and time were collected to identify reference values for each surgery and compared for when the lead surgeon was a young resident, a senior resident, or a specialist.</p><p><strong>Results: </strong>The most performed surgeries requiring fluoroscopy were proximal femur short intramedullary nailing (n = 401), ankle open reduction and internal fixation (ORIF) (n = 141), distal radius ORIF (n = 125), and proximal femur dynamic hip screw (DHS) (n = 114). Surgeries using higher radiation dose were proximal femur long intramedullary nailing (mean dose area [DAP]): 1361.35 mGycm<sup>2</sup>), proximal femur DHS (1094.81 mGycm<sup>2</sup>), and proximal femur short intramedullary nailing (891.41 mGycm<sup>2</sup>). Surgeries requiring longer radiation time were proximal humerus and/or humeral shaft intramedullary nailing (02 mm:20 ss), proximal femur long intramedullary nailing (02 mm:04 ss), and tibial shaft/distal tibia intramedullary nailing (01 mm:49 ss). Senior residents required shorter radiation time when performing short intramedullary nailing of the proximal femur than young residents. Specialists required more radiation dose than residents when performing tibial nailing and tibial plateau ORIF and required longer radiation time than young residents when performing tibial nailing.</p><p><strong>Conclusions: </strong>This study presents mean values of radiation dose and time for common orthopedic trauma surgeries. Orthopedic surgeon experience influences radiation dose and time values. Contrary to expected, less experience is associated with lower values in some of the cases analyzed.</p>","PeriodicalId":74479,"journal":{"name":"Porto biomedical journal","volume":"8 3","pages":"e218"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/0e/26/pj9-8-e218.PMC10289723.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10093491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-01DOI: 10.1097/j.pbj.0000000000000219
Vanessa S G Teófilo, Paulo R A Pinho, Gonçalo J Cordeiro, Nuno A F Saldanha, Pedro M M Matos, Rui A M Ribeiro, Salomé M Moreira, Mariana S F Miller, Andreia R M Dias, Marta F R Couto, Pedro M P N S Norton
Background: The coronavirus disease 2019 (COVID-19) was classified as a pandemic in March 2020 by the World Health Organization. The Pfizer-BioNTech COVID-19 vaccine was the first to be authorized in the European Union, based on data from phase 1, 2, and 3 clinical trials of limited duration. Concerns have been raised regarding the vaccine's safety profile. Some of the adverse drug reactions (ADRs) associated with vaccines may not have been identified during clinical trials. This study aimed to identify ADRs associated with the Pfizer-BioNTech vaccine in health care professionals at a Portuguese tertiary university hospital.
Methods: The data used in this analysis consist of ADRs reported through a spontaneous notification system from vaccines administered between December 27, 2020, and January 31, 2021. ADRs were categorized according to the MedDRA terminology.
Results: A total of 8,605 Pfizer-BioNTech vaccines were administered to 4568 health care professionals. ADRs were reported among 520 of the vaccines, with an incidence of 13.56% in women and 5.31% in men. The mean age of the population reporting ADRs was 41.52 years, with a standard deviation of 9.83 years. The most frequent ADRs were myalgia (n = 274), headache (n = 199), pyrexia (n = 164), injection site pain (n = 160), fatigue (n = 84), nausea (n = 81), chills (n = 65), lymphadenopathy (n = 64), and arthralgia (n = 53). Hypersensitivity reactions occurred in 15 health care professionals, with no anaphylactic reactions observed. A total of four Important Medical Events were observed, which consisted of two cases of syncope, one case of sudden hearing loss, and one case of transverse myelitis.
Conclusion: The vaccine was well-tolerated among the study participants. Reactogenicity was greater after the second dose. The incidence of ADRs was higher in women and individuals aged between 40 to 49 years. Systemic adverse reactions were most frequently reported. Systematic monitoring of ADRs of COVID-19 vaccines in real-life context is essential for a more robust establishment of its safety profile.
{"title":"Spontaneous reporting of adverse reactions associated with the COVID-19 vaccine in health care professionals: A descriptive observational study conducted in a Portuguese hospital.","authors":"Vanessa S G Teófilo, Paulo R A Pinho, Gonçalo J Cordeiro, Nuno A F Saldanha, Pedro M M Matos, Rui A M Ribeiro, Salomé M Moreira, Mariana S F Miller, Andreia R M Dias, Marta F R Couto, Pedro M P N S Norton","doi":"10.1097/j.pbj.0000000000000219","DOIUrl":"https://doi.org/10.1097/j.pbj.0000000000000219","url":null,"abstract":"<p><strong>Background: </strong>The coronavirus disease 2019 (COVID-19) was classified as a pandemic in March 2020 by the World Health Organization. The Pfizer-BioNTech COVID-19 vaccine was the first to be authorized in the European Union, based on data from phase 1, 2, and 3 clinical trials of limited duration. Concerns have been raised regarding the vaccine's safety profile. Some of the adverse drug reactions (ADRs) associated with vaccines may not have been identified during clinical trials. This study aimed to identify ADRs associated with the Pfizer-BioNTech vaccine in health care professionals at a Portuguese tertiary university hospital.</p><p><strong>Methods: </strong>The data used in this analysis consist of ADRs reported through a spontaneous notification system from vaccines administered between December 27, 2020, and January 31, 2021. ADRs were categorized according to the MedDRA terminology.</p><p><strong>Results: </strong>A total of 8,605 Pfizer-BioNTech vaccines were administered to 4568 health care professionals. ADRs were reported among 520 of the vaccines, with an incidence of 13.56% in women and 5.31% in men. The mean age of the population reporting ADRs was 41.52 years, with a standard deviation of 9.83 years. The most frequent ADRs were myalgia (n = 274), headache (n = 199), pyrexia (n = 164), injection site pain (n = 160), fatigue (n = 84), nausea (n = 81), chills (n = 65), lymphadenopathy (n = 64), and arthralgia (n = 53). Hypersensitivity reactions occurred in 15 health care professionals, with no anaphylactic reactions observed. A total of four Important Medical Events were observed, which consisted of two cases of syncope, one case of sudden hearing loss, and one case of transverse myelitis.</p><p><strong>Conclusion: </strong>The vaccine was well-tolerated among the study participants. Reactogenicity was greater after the second dose. The incidence of ADRs was higher in women and individuals aged between 40 to 49 years. Systemic adverse reactions were most frequently reported. Systematic monitoring of ADRs of COVID-19 vaccines in real-life context is essential for a more robust establishment of its safety profile.</p>","PeriodicalId":74479,"journal":{"name":"Porto biomedical journal","volume":"8 3","pages":"e219"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/36/f8/pj9-8-e219.PMC10299789.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10096403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-01DOI: 10.1097/j.pbj.0000000000000211
Vincent Zimmer
To the Editor: A 61-year-old male patient with critical alcohol consumption presented with progressive dysphagia and several self-resolved bolus impactions. Index endoscopy indicated a high-grade stricture at 22 cm, warranting passage with a pediatric gastroscope, along with small openings consistent with esophageal intramural pseudodiverticulosis (EIPD). In the distal esophagus, a Schatzki ring emerged with additional pseudodiverticulae. The patient underwent esophageal bougienage to 14 mm. Image-enhanced endoscopy before scheduled repeat bougienage was perfomed, highlighting proximal EIPD on linked color imaging (Fig. 1A). Furthermore, linked color imaging illustrated diffuse spots correlating with what has been designated as the “faux uni” pattern on white light endoscopy. Apart from illustrating active movements with variations of orifice sizes, further characterization using blue laser imaging (BLI) confirmed absent submucosal vessels, while dot-shaped and line-shaped congested intrapapillary capillary loops (IPCL) were clearly appreciated (Fig. 1B). This finding was accentuated in scarred and pseudodiverticula-bearing segments, suggesting EIPD inflammation-driven microvascular alterations (Fig. 1C). Notwithstanding that IPCL changes notably on magnification endoscopy have been reported in other benign esophageal diseases, such as eosinophilic and/or lymphocytic esophagitis (both excluded in this patient), IPCL alterations have never been reported in EIPD nor in any other chronic inflammatory esophageal disorder on nonmagnified conditions (Fig. 1D). Of note, pathology indicating unspecific chronic inflammation did exclude dysplastic changes. While the concept of IPCLs, relying on magnification imageenhanced endoscopy, has been developed to highlight early squamous cell dysplasia and neoplasia, its potential role in chronic inflammatory esophageal diseases awaits further evolution. Albeit not validated for nonenhanced endoscopic assessment, the findings in this patient may suggest IPLC type 2 with uniform dilation and elongation, likewise suggesting a benign condition.
{"title":"Intrapapillary capillary loop abundance on nonmagnified blue laser imaging in esophageal intramural pseudodiverticulosis.","authors":"Vincent Zimmer","doi":"10.1097/j.pbj.0000000000000211","DOIUrl":"https://doi.org/10.1097/j.pbj.0000000000000211","url":null,"abstract":"To the Editor: A 61-year-old male patient with critical alcohol consumption presented with progressive dysphagia and several self-resolved bolus impactions. Index endoscopy indicated a high-grade stricture at 22 cm, warranting passage with a pediatric gastroscope, along with small openings consistent with esophageal intramural pseudodiverticulosis (EIPD). In the distal esophagus, a Schatzki ring emerged with additional pseudodiverticulae. The patient underwent esophageal bougienage to 14 mm. Image-enhanced endoscopy before scheduled repeat bougienage was perfomed, highlighting proximal EIPD on linked color imaging (Fig. 1A). Furthermore, linked color imaging illustrated diffuse spots correlating with what has been designated as the “faux uni” pattern on white light endoscopy. Apart from illustrating active movements with variations of orifice sizes, further characterization using blue laser imaging (BLI) confirmed absent submucosal vessels, while dot-shaped and line-shaped congested intrapapillary capillary loops (IPCL) were clearly appreciated (Fig. 1B). This finding was accentuated in scarred and pseudodiverticula-bearing segments, suggesting EIPD inflammation-driven microvascular alterations (Fig. 1C). Notwithstanding that IPCL changes notably on magnification endoscopy have been reported in other benign esophageal diseases, such as eosinophilic and/or lymphocytic esophagitis (both excluded in this patient), IPCL alterations have never been reported in EIPD nor in any other chronic inflammatory esophageal disorder on nonmagnified conditions (Fig. 1D). Of note, pathology indicating unspecific chronic inflammation did exclude dysplastic changes. While the concept of IPCLs, relying on magnification imageenhanced endoscopy, has been developed to highlight early squamous cell dysplasia and neoplasia, its potential role in chronic inflammatory esophageal diseases awaits further evolution. Albeit not validated for nonenhanced endoscopic assessment, the findings in this patient may suggest IPLC type 2 with uniform dilation and elongation, likewise suggesting a benign condition.","PeriodicalId":74479,"journal":{"name":"Porto biomedical journal","volume":"8 3","pages":"e211"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/4f/06/pj9-8-e211.PMC10289579.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9715989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-01DOI: 10.1097/j.pbj.0000000000000200
Sofia Tavares-Almeida, Diana Moura, Nuno Madeira, Margarida Figueiredo-Braga
Background: University students are a risk population for mental health problems. This study aims to evaluate the psychological burden of the COVID-19 pandemic in Portuguese university students and to uncover factors associated with worse psychological indicators.
Methods: We used an online survey to perform a cross-sectional study that evaluated students' perceptions, lifestyle, and psychological well-being during the pandemic. Depression symptoms and risk were measured by the Patient Health Questionnaire-9, and resilience levels were quantified by the 9-item Resilience Evaluation Scale. Self-perceived levels of anxiety and current mental health status were evaluated.
Results: From a population of around 30,000 students invited to participate, 1751 responses were obtained and 1447 were included. Most students were female (72.3%) and were taking a master's degree (58.4%). The course with more responses was engineering (25.5%), followed by medicine (13.2%). The prevalence rates for higher anxiety levels, depression risk, and low resilience levels were 66.7%, 37.3%, and 24.9%, respectively. The factors associated with better psychological outcomes were being male, spending more time studying, having a job, performing extracurricular activities, physical exercise, and relaxing activities. By contrast, spending more time watching news, difficulty accessing online lectures, and absence of contact with family or friends were associated with worse psychological indicators. Although all courses presented substantial levels of depressive symptoms, architectures/arts, sciences, and humanities scored significantly more in the depression scale. Medicine students had significantly higher resilience levels compared with other courses.
Conclusions: Our findings identify factors associated with worse psychological outcomes and can be used to create protective measures for the mental health of university students during current and future pandemics.
{"title":"Psychological burden in Portuguese university students during the COVID-19 pandemic.","authors":"Sofia Tavares-Almeida, Diana Moura, Nuno Madeira, Margarida Figueiredo-Braga","doi":"10.1097/j.pbj.0000000000000200","DOIUrl":"https://doi.org/10.1097/j.pbj.0000000000000200","url":null,"abstract":"<p><strong>Background: </strong>University students are a risk population for mental health problems. This study aims to evaluate the psychological burden of the COVID-19 pandemic in Portuguese university students and to uncover factors associated with worse psychological indicators.</p><p><strong>Methods: </strong>We used an online survey to perform a cross-sectional study that evaluated students' perceptions, lifestyle, and psychological well-being during the pandemic. Depression symptoms and risk were measured by the Patient Health Questionnaire-9, and resilience levels were quantified by the 9-item Resilience Evaluation Scale. Self-perceived levels of anxiety and current mental health status were evaluated.</p><p><strong>Results: </strong>From a population of around 30,000 students invited to participate, 1751 responses were obtained and 1447 were included. Most students were female (72.3%) and were taking a master's degree (58.4%). The course with more responses was engineering (25.5%), followed by medicine (13.2%). The prevalence rates for higher anxiety levels, depression risk, and low resilience levels were 66.7%, 37.3%, and 24.9%, respectively. The factors associated with better psychological outcomes were being male, spending more time studying, having a job, performing extracurricular activities, physical exercise, and relaxing activities. By contrast, spending more time watching news, difficulty accessing online lectures, and absence of contact with family or friends were associated with worse psychological indicators. Although all courses presented substantial levels of depressive symptoms, architectures/arts, sciences, and humanities scored significantly more in the depression scale. Medicine students had significantly higher resilience levels compared with other courses.</p><p><strong>Conclusions: </strong>Our findings identify factors associated with worse psychological outcomes and can be used to create protective measures for the mental health of university students during current and future pandemics.</p>","PeriodicalId":74479,"journal":{"name":"Porto biomedical journal","volume":"8 2","pages":"e200"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a9/0c/pj9-8-e200.PMC10158877.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9783547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-01DOI: 10.1097/j.pbj.0000000000000212
Rita Rego, Margarida Madeira, Eugeniu Gisca, Daniela Brigas, Ana Vigário, Arsénio Barbosa, Sílvia Pereira, Marta Soares, Ana Macedo
{"title":"Characterization and prognosis of very elderly patients with anemia, cardio-cerebrovascular disease, and iron deficiency in four Portuguese hospitals.","authors":"Rita Rego, Margarida Madeira, Eugeniu Gisca, Daniela Brigas, Ana Vigário, Arsénio Barbosa, Sílvia Pereira, Marta Soares, Ana Macedo","doi":"10.1097/j.pbj.0000000000000212","DOIUrl":"https://doi.org/10.1097/j.pbj.0000000000000212","url":null,"abstract":"","PeriodicalId":74479,"journal":{"name":"Porto biomedical journal","volume":"8 2","pages":"e212"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10158853/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9799452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-01DOI: 10.1097/j.pbj.0000000000000206
Habeeb Salami
Antimicrobial resistance (AMR) is a global health problem. Antibiotics that were once very efficient in treating bacterial infections are now inactive. When antibiotics were discovered about, we believed the battle against infectious diseases has been won but the age of antibiotics, spanning only 80 years, is now entering a period of progressive and widespread emergence of drugresistant organisms that threaten to bring this era to an end. The problem of AMR is serious because bacteria are almost resistant to all available classes of antibiotics, and a new pipeline of antibiotics is not produced. Although AMR is a natural phenomenon, we are responsible for accelerating it. The increased and unguided use of antibiotics across multiple sectors, that is, humans, animals, and agriculture, has further exacerbated this problem. When microorganisms are facedwith antibiotics selection pressure, they enhance their fitness by acquiring resistance determinants through mechanisms such as horizontal gene transfer (transduction, conjugation, and transformation) and then sharing them with other bacteria and by other mechanisms, for example, gene overexpression and silencing and phase variation. The effect of AMR in Africa could be catastrophic because of the poor health systems and infrastructure, inadequate surveillance of infectious diseases, and the inadequate health personnel, which is motivated partly by the mass exodus of health practitioners from Africa to foreign continents to seek greener pastures. The higher burden of AMR in low-resource health systems highlights the importance—both for themanagement of individual patients and for the surveillance of AMR—of welldeveloped national action plans and laboratory infrastructure in all African regions and countries. Surprisingly,Africawas one of the least affected continents indirect morbidity, mortality, and absolute cumulative cases of COVID-19. This is because most countries in Africa reacted quickly and imposed tough restrictions such as banning local and international travel, closing industries, schools and universities, banning public transportation, and restricting healthcare to emergency mode. Some of these countries in Africa adopted guidance from the WHO, stratifying their COVID-19 public health responses into several pillars, including surveillance, case management, infection prevention and control, ports of entry, logistics, security, risk communication and community engagement, and laboratory. Taking a cue fromhowAfrica handled theCOVID-19 pandemic, AMR can also be tackled effectively by adopting the strategies used in combating the COVID-19 pandemic. The report byMurray et al estimated that Africa had the highest number of deaths attributable to AMR infections, that is, 27.3 deaths per 100,000 compared with other continents, and surprisingly, Africa had a lower number of COVID-19 deaths. If the strategies such as surveillance, infection prevention, community engagement, collaborative research an
{"title":"Tackling antimicrobial resistance in Africa, adopting lessons from Africa's success in navigating the COVID-19 pandemic.","authors":"Habeeb Salami","doi":"10.1097/j.pbj.0000000000000206","DOIUrl":"https://doi.org/10.1097/j.pbj.0000000000000206","url":null,"abstract":"Antimicrobial resistance (AMR) is a global health problem. Antibiotics that were once very efficient in treating bacterial infections are now inactive. When antibiotics were discovered about, we believed the battle against infectious diseases has been won but the age of antibiotics, spanning only 80 years, is now entering a period of progressive and widespread emergence of drugresistant organisms that threaten to bring this era to an end. The problem of AMR is serious because bacteria are almost resistant to all available classes of antibiotics, and a new pipeline of antibiotics is not produced. Although AMR is a natural phenomenon, we are responsible for accelerating it. The increased and unguided use of antibiotics across multiple sectors, that is, humans, animals, and agriculture, has further exacerbated this problem. When microorganisms are facedwith antibiotics selection pressure, they enhance their fitness by acquiring resistance determinants through mechanisms such as horizontal gene transfer (transduction, conjugation, and transformation) and then sharing them with other bacteria and by other mechanisms, for example, gene overexpression and silencing and phase variation. The effect of AMR in Africa could be catastrophic because of the poor health systems and infrastructure, inadequate surveillance of infectious diseases, and the inadequate health personnel, which is motivated partly by the mass exodus of health practitioners from Africa to foreign continents to seek greener pastures. The higher burden of AMR in low-resource health systems highlights the importance—both for themanagement of individual patients and for the surveillance of AMR—of welldeveloped national action plans and laboratory infrastructure in all African regions and countries. Surprisingly,Africawas one of the least affected continents indirect morbidity, mortality, and absolute cumulative cases of COVID-19. This is because most countries in Africa reacted quickly and imposed tough restrictions such as banning local and international travel, closing industries, schools and universities, banning public transportation, and restricting healthcare to emergency mode. Some of these countries in Africa adopted guidance from the WHO, stratifying their COVID-19 public health responses into several pillars, including surveillance, case management, infection prevention and control, ports of entry, logistics, security, risk communication and community engagement, and laboratory. Taking a cue fromhowAfrica handled theCOVID-19 pandemic, AMR can also be tackled effectively by adopting the strategies used in combating the COVID-19 pandemic. The report byMurray et al estimated that Africa had the highest number of deaths attributable to AMR infections, that is, 27.3 deaths per 100,000 compared with other continents, and surprisingly, Africa had a lower number of COVID-19 deaths. If the strategies such as surveillance, infection prevention, community engagement, collaborative research an","PeriodicalId":74479,"journal":{"name":"Porto biomedical journal","volume":"8 2","pages":"e206"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ce/73/pj9-8-e206.PMC10158896.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9485686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-01DOI: 10.1097/j.pbj.0000000000000205
Mariana L Matos, Paula C F Matias, Carlos M S P M Grijó, Rita B Gouveia, Marta F S Patacho, António J S Almeida
Introduction Epipericardial fat necrosis (EFN), first described in 1957, is an inflammatory process that affects the epipericardial fat. It is a benign and self-limited cause of acute chest pain. Chest computed tomography (CT) is the preferred imaging method to diagnose this condition. Its noninvasive treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) leads to the resolution of the symptoms. This case report illustrates the clinical presentation of this disease.
{"title":"Epipericardial fat necrosis: a case report of an underdiagnosed disease.","authors":"Mariana L Matos, Paula C F Matias, Carlos M S P M Grijó, Rita B Gouveia, Marta F S Patacho, António J S Almeida","doi":"10.1097/j.pbj.0000000000000205","DOIUrl":"https://doi.org/10.1097/j.pbj.0000000000000205","url":null,"abstract":"Introduction Epipericardial fat necrosis (EFN), first described in 1957, is an inflammatory process that affects the epipericardial fat. It is a benign and self-limited cause of acute chest pain. Chest computed tomography (CT) is the preferred imaging method to diagnose this condition. Its noninvasive treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) leads to the resolution of the symptoms. This case report illustrates the clinical presentation of this disease.","PeriodicalId":74479,"journal":{"name":"Porto biomedical journal","volume":"8 2","pages":"e205"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/08/65/pj9-8-e205.PMC10158854.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9799443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-01DOI: 10.1097/j.pbj.0000000000000209
Miguel Martins de Carvalho, Ricardo Alves Pinto, Tânia Proença, Delfim Souteiro, Luís Adão, Filipe Macedo, Manuel Campelo
The authors present a clinical case of a 54-year-old woman without relevant medical history other than Brugada type 1 pattern in the electrocardiogram, without chronic medica-tion, who was referred for the cardiology outpatient clinic with palpitations. She had a strong family history of Brugada syndrome, but no history of sudden death, and she never had syncope. A transthoracic echocardiogram was performed, ruling out structural heart disease. Blood samples were analyzed, without thyroid function or electrolyte abnormalities. A 24-hour Holter examination was performed (digital Philips Zymed Holter, Model 1810 Plus Software, Philips Medical Systems) that revealed nocturnal periods of first-degree atrio-ventricular block (AVB) with a markedly variable PR interval and without nonconducted P waves; no other abnormalities were seen; the patient was asymptomatic. The P wave and QRS morphology were the same throughout the examination. The PR interval either increased or decreased, but it was always followed by a QRS complex. The number of P waves was the same as the QRS complexes. There was no relation between the PR interval variability and heart rate or circadian predomi-nance. The patient is kept under follow-up in the outpatient clinic, uneventful. No genetic test was performed. First-degree AVB is typically a benign situation 1 ; however, it is associated with increased incidence of atrial fibrillation, heart failure, and mortality during follow-up. 2 In some clinical settings, it can even be associated with markedly decreased survival. 3 Some data point out that first-degree AVB on a basal ECG is an independent predictor of malignant arrhythmic events in Brugada syndrome
{"title":"Marked PR interval variability in a patient with Brugada syndrome.","authors":"Miguel Martins de Carvalho, Ricardo Alves Pinto, Tânia Proença, Delfim Souteiro, Luís Adão, Filipe Macedo, Manuel Campelo","doi":"10.1097/j.pbj.0000000000000209","DOIUrl":"https://doi.org/10.1097/j.pbj.0000000000000209","url":null,"abstract":"The authors present a clinical case of a 54-year-old woman without relevant medical history other than Brugada type 1 pattern in the electrocardiogram, without chronic medica-tion, who was referred for the cardiology outpatient clinic with palpitations. She had a strong family history of Brugada syndrome, but no history of sudden death, and she never had syncope. A transthoracic echocardiogram was performed, ruling out structural heart disease. Blood samples were analyzed, without thyroid function or electrolyte abnormalities. A 24-hour Holter examination was performed (digital Philips Zymed Holter, Model 1810 Plus Software, Philips Medical Systems) that revealed nocturnal periods of first-degree atrio-ventricular block (AVB) with a markedly variable PR interval and without nonconducted P waves; no other abnormalities were seen; the patient was asymptomatic. The P wave and QRS morphology were the same throughout the examination. The PR interval either increased or decreased, but it was always followed by a QRS complex. The number of P waves was the same as the QRS complexes. There was no relation between the PR interval variability and heart rate or circadian predomi-nance. The patient is kept under follow-up in the outpatient clinic, uneventful. No genetic test was performed. First-degree AVB is typically a benign situation 1 ; however, it is associated with increased incidence of atrial fibrillation, heart failure, and mortality during follow-up. 2 In some clinical settings, it can even be associated with markedly decreased survival. 3 Some data point out that first-degree AVB on a basal ECG is an independent predictor of malignant arrhythmic events in Brugada syndrome","PeriodicalId":74479,"journal":{"name":"Porto biomedical journal","volume":"8 2","pages":"e209"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10158892/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9485688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-01DOI: 10.1097/j.pbj.0000000000000202
Pedro Brandão, Nathan Ceschin
The ROPA (Reception of Oocytes from PArtner) method, also known as lesbian shared IVF (in vitro fertilization), is an assisted reproduction technique for female couples, in which one of the women provides the oocytes (genetic mother) and the other receives the embryo and gestates (gestational mother). As a double parented method, it is the only way lesbian women may biologically share motherhood. This is a narrative review of data concerning ROPA published in PubMed, Scopus, and Cochrane Library. A total of 35 articles were included, 10 about motivations for undergoing ROPA, 13 about ethics or legislation, 4 about motherhood, and 8 studies reporting clinical outcomes. Despite being used for more than a decade, there is a paucity of data regarding this technique in scientific literature. Most women choose this technique to share biological motherhood, but medical issues may also justify its use. Many ethical and legal issues are still to be solved. Despite the small number of studies, data regarding the outcomes of this technique and the resulting motherhood are reassuring.
{"title":"Lesbian shared IVF: the ROPA method: a systematic review.","authors":"Pedro Brandão, Nathan Ceschin","doi":"10.1097/j.pbj.0000000000000202","DOIUrl":"https://doi.org/10.1097/j.pbj.0000000000000202","url":null,"abstract":"<p><p>The ROPA (Reception of Oocytes from PArtner) method, also known as lesbian shared IVF (in vitro fertilization), is an assisted reproduction technique for female couples, in which one of the women provides the oocytes (genetic mother) and the other receives the embryo and gestates (gestational mother). As a double parented method, it is the only way lesbian women may biologically share motherhood. This is a narrative review of data concerning ROPA published in PubMed, Scopus, and Cochrane Library. A total of 35 articles were included, 10 about motivations for undergoing ROPA, 13 about ethics or legislation, 4 about motherhood, and 8 studies reporting clinical outcomes. Despite being used for more than a decade, there is a paucity of data regarding this technique in scientific literature. Most women choose this technique to share biological motherhood, but medical issues may also justify its use. Many ethical and legal issues are still to be solved. Despite the small number of studies, data regarding the outcomes of this technique and the resulting motherhood are reassuring.</p>","PeriodicalId":74479,"journal":{"name":"Porto biomedical journal","volume":"8 2","pages":"e202"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10158901/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9809991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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