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Abstract Introduction Cancer, malnutrition, and surgery negatively impact patient’s immune system. Despite standardized surgical technique and the development of new perioperative care protocols, morbidity after cystectomy remains a serious challenge for urologists. Most common postoperative complications, such as infections and ileus, often lead to longer length of stay and worse survival. The immune system and its interaction with the gut microbiota play a pivotal role in cancer immunosurveillance and in patient’s response to surgical stress. Malnutrition has been identified as an independent and modifiable risk factor for both mortality and morbidity. Immunonutrition (IN) may improve the nutritional status, immunological function, and clinical outcome of surgical patients. Aims of the study are (1) to evaluate the impact of IN on morbidity and mortality at 30 and 90 days after cystectomy and (2) to determine immune and microbiota signature that would predict IN effect. Methods This is a randomized, multicentric, controlled, pragmatic, parallel-group comparative study, supported by the Swiss National Science Foundation. A total of 232 patients is planned to be enrolled between April 2023 and June 2026. Three participating centers (Lausanne, Bern, and Riviera-Chablais) have been selected. All patients undergoing elective radical and simple cystectomy will be randomly assigned to receive 7 days of preoperative IN (Oral Impact®, Nestlé, Switzerland) versus standard of care (control group) and followed for 90 days after surgery. For the exploratory outcomes, blood, serum, urine, and stool samples will be collected in patients treated at Lausanne. In order to determine the impact of IN on immune fitness, patients enrolled at Lausanne will be vaccinated against influenza and the establishment of the vaccine-specific immune response will be followed. Analysis of the microbiota and expression of argininosuccinate synthetase 1 as potential biomarker will also be performed. Discussion and conclusion Strengths of the INCyst study include the randomized, multicenter, prospective design, the large number of patients studied, and the translational investigation. This study will challenge the added value of preoperative IN in patients undergoing cystectomy, assessing the clinical effect of IN on the onset of postoperative morbidity and mortality after cystectomy. Furthermore, it will provide invaluable data on the host immune response and microbiota composition. Trial registration ClinicalTrials.gov NCT05726786. Registered on March 9, 2023.

The elderly group is the age group that is most susceptible to geriatric syndromes, one of which is sarcopenia. Sarcopenia is a syndrome characterized by a progressive and overall decrease in muscle mass and skeletal muscle strength with an increased risk of disability, decreased quality of life, and death. Currently, research on sarcopenia profiles, particularly in Indonesia, is still limited. This research data is expected to help determine policies to improve the quality of services in the health sector. This study used the SARC-F questionnaire and the risk factor questionnaire for sarcopenia in elderly patients at the Medical Rehabilitation Outpatient Department RSUD Dr. Soetomo and has been permitted by the Penelitian dan Pengembangan (LitBang) section RSUD Dr. Soetomo, Surabaya. Several variables used in this study were gender, age, weight, height, body mass index (BMI), other diseases, physical activity, mood, and sarcopenia. There were 25 elderly patients at the Medical Rehabilitation Outpatient Department at RSUD Dr. Soetomo, Surabaya in November 2022”January 2023 which met the research inclusion criteria. The age of elderly patients at the Medical Rehabilitation Outpatient Department at RSUD Dr. Soetomo ranged from 60”81 years old, with an average of 60.48 years old. Female is the most common gender among the elderly patients at the Medical Rehabilitation Outpatient Department RSUD Dr. Soetomo, there are 17 (68%) female elderly patients. 80% of the elderly patients were in the young elderly group (60”69 years old), 16% in the middle elderly group (70”79 years old), and 4% in the old elderly group (≥80 years old). Age, gender, other diseases, and physical activity are risk factors that have a significant correlation with sarcopenia among elderly patients at the Medical Rehabilitation Outpatient Department RSUD Dr. Soetomo.

Summary: Background: Perivascular spaces (PVS) on brain MRI are surrogates for small parenchymal blood vessels and their perivascular compartment, and may relate to brain health. However, it is unknown whether PVS can predict dementia risk and brain atrophy trajectories in participants without dementia, as longitudinal studies on PVS are scarce and current methods for PVS assessment lack robustness and inter-scanner reproducibility. Methods: We developed a robust algorithm to automatically assess PVS count and size on clinical MRI, and investigated 1) their relationship with dementia risk and brain atrophy in participants without dementia, 2) their longitudinal evolution, and 3) their potential use as a screening tool in simulated clinical trials. We analysed 46,478 clinical measurements of cognitive functioning and 20,845 brain MRI scans from 10,004 participants (71.1 ± 9.7 years-old, 56.6% women) from three publicly available observational studies on ageing and dementia (the Alzheimer’s Disease Neuroimaging Initiative, the National Alzheimer’s Coordinating Centre database, and the Open Access Series of Imaging Studies). Clinical and MRI data collected between 2004 and 2022 were analysed with consistent methods, controlling for confounding factors, and combined using mixed-effects models. Findings: Our fully-automated method for PVS assessment showed excellent inter-scanner reproducibility (intraclass correlation coefficients >0.8). Fewer PVS and larger PVS diameter at baseline predicted higher dementia risk and accelerated brain atrophy. Longitudinal trajectories of PVS markers differed significantly in participants without dementia who converted to dementia compared with non-converters. In simulated placebo-controlled trials for treatments targeting cognitive decline, screening out participants at low risk of dementia based on our PVS markers enhanced the power of the trial independently of Alzheimer’s disease biomarkers. Interpretation: These robust cerebrovascular markers predict dementia risk and brain atrophy and may improve risk-stratification of patients, potentially reducing cost and increasing throughput of clinical trials to combat dementia. Funding: US National Institutes of Health.

Summary: Background: Previous prediction models for adiposity gain have not yet achieved sufficient predictive ability for clinical relevance. We investigated whether traditional and genetic factors accurately predict adiposity gain. Methods: A 5-year gain of ≥5% in body mass index (BMI) and waist-to-hip ratio (WHR) from baseline were predicted in mid-late adulthood individuals (median of 55 years old at baseline). Proportional hazards models were fitted in 245,699 participants from the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort to identify robust environmental predictors. Polygenic risk scores (PRS) of 5 proxies of adiposity [BMI, WHR, and three body shape phenotypes (PCs)] were computed using genetic weights from an independent cohort (UK Biobank). Environmental and genetic models were validated in 29,953 EPIC participants. Findings: Environmental models presented a remarkable predictive ability (AUCBMI: 0.69, 95% CI: 0.68–0.70; AUCWHR: 0.75, 95% CI: 0.74–0.77). The genetic geographic distribution for WHR and PC1 (overall adiposity) showed higher predisposition in North than South Europe. Predictive ability of PRSs was null (AUC: ∼0.52) and did not improve when combined with environmental models. However, PRSs of BMI and PC1 showed some prediction ability for BMI gain from self-reported BMI at 20 years old to baseline observation (early adulthood) (AUC: 0.60–0.62). Interpretation: Our study indicates that environmental models to discriminate European individuals at higher risk of adiposity gain can be integrated in standard prevention protocols. PRSs may play a robust role in predicting adiposity gain at early rather than mid-late adulthood suggesting a more important role of genetic factors in this life period. Funding: French National Cancer Institute (INCA_N°2019-176) 1220, German Research Foundation (BA 5459/2-1), Instituto de Salud Carlos III (Miguel Servet Program CP21/00058).

Enquadramento: da longevidade, emergem desafios em diversos domínios, como a saúde e a prestação de cuidados. Com o envelhecimento muitas são as morbilidades e comorbilidades que surgem, conduzindo a um maior índice de dependência e uma maior necessidade de cuidados formais ou informais. Objetivo: avaliar a perceção de um grupo de enfermeiros especialistas sobre o papel do prestador de cuidados. Metodologia: estudo qualitativo exploratório e descritivo. Como técnica de recolha de dados recorreu-se a grupo focal através de uma amostra intencional constituída por 13 enfermeiros especialistas em enfermagem médico-cirúrgica (EEEMC). Os dados foram categorizados por consenso com base na técnica de análise de conteúdo e pressupostos de Bardin. Resultados: com análise de conteúdo, criaram-se seis categorias e duas subcategorias. Em todas foram obtidas validações concordantes, revelando valorização por parte dos enfermeiros dos referidos domínios. Papel de prestador de cuidados, stress de prestador de cuidados e potencial do cuidador para tomar conta foram referidos como domínios chave no processo de tomada de decisão. Já os domínios processo familiar, suporte e continuidade de cuidados foram entendidos como secundários, mas, essenciais para a continuidade dos cuidados. Conclusão: os resultados revelam que os EEEMC são unânimes na valorização e capacitação dos prestadores de cuidados em contexto de internamento hospitalar.

Enquadramento: a inteligência emocional na prática do enfermeiro em cuidados intensivos intervém na capacidade em regular as suas próprias respostas emocionais e do doente. Objetivo: compreender a relação entre a inteligência emocional e o impacto no desempenho do enfermeiro de cuidados intensivos, através de uma revisão integrativa da literatura. Metodologia: realizou-se uma revisão integrativa da literatura no primeiro semestre de 2022, nas bases de dados: Web of Science, Scopus e PubMed, onde se efetuou um levantamento das produções científicas, publicadas entre 2018 - 2022, sobre a temática escolhida. Resultados: a revisão integrativa incluiu a análise de 3 artigos selecionados entre 52 inicialmente identificados. A gestão adequada das emoções dos enfermeiros e dos doentes aos quais prestam cuidados tem um impacto positivo nos cuidados prestados. O otimismo irreal e níveis de frustração elevados dos enfermeiros, levam frequentemente a condições de burnout, com impacto negativo nos cuidados ao doente. A inteligência emocional e o mindfulness detêm um papel protetor do burnout nos enfermeiros. Conclusão: a inteligência emocional e o mindfulness podem melhorar o bem-estar individual dos enfermeiros e equipa, em unidades de cuidados intensivos.

Enquadramento: O sedentarismo é um problema atual da sociedade moderna, potenciando o aparecimento de problemas de saúde. O bem-estar psicológico está associado a problemas de foro mental que são por vezes incapacitantes, podendo ser influenciado pelo padrão de atividade física. Objetivos: Analisar o padrão de atividade física em estudantes de uma instituição do ensino superior e a sua relação com o bem-estar psicológico. Metodologia: Estudo correlacional quantitativo transversal com recurso a amostra não probabilística de conveniência. Resultados: Amostra constituída por 48 estudantes do ensino superior, com idades entre os 18 e os 25 anos. Foi estudada a relação entre o padrão de atividade física e o bem-estar psicológico dos estudantes e a relação destes com as variáveis sóciodemográficas. Apesar de não existirem relações com significado estatístico verificaram-se diferenças, pois os estudantes que realizam uma atividade física com maior intensidade têm tendencionalmente um melhor bem-estar psicológico. Verificou-se ainda que existe uma tendência para os estudantes com mais idade apresentarem uma menor sensação de saúde e que os estudantes que possuem um melhor coeficiente de bem-estar psicológico possuam uma melhor sensação de saúde e menos tempo de atividades sedentárias. Conclusão: Verifica-se que tendencionalmente quem pratica mais atividade física demonstra um melhor bem-estar psicológico. Sugere-se um maior investimento em literacia em saúde sobre o que é a atividade física, os seus padrões e as orientações da OMS para reduzir o sedentarismo e melhorar os índices de prática de atividade física.

Warthin’s tumor is the second most common benign neoplasm of the parotid gland and frequently presents with multifocal and bilateral involvement, either synchronously or metachronously, up to 20% - 30% of cases. More rarely, extraparotid locations may also occur. This case report describes a Warthin’s tumor presenting synchronously as a multifocal bilateral parotid tumor in association with an extraparotid localization, which, according to the existing literature, appears to be a rare event. This low incidence is likely underestimated and could be explained by several reasons. Increased awareness of this potentially higher incidence may aid physicians in better evaluating and treating their patients.

Summary: Variation in outcomes definitions and reporting limit the utility of clinical trial results. The Core Outcome Research Measures in Anal Cancer (CORMAC) project developed a core outcome set (COS) for chemoradiotherapy trials for anal squamous cell carcinoma (ASCC) through an international healthcare professional and patient consensus process. The CORMAC-COS comprises 19 outcomes across 4 domains (disease activity, survival, toxicity, life impact). In CORMAC-2 we have established standardised definitions for the 11 disease activity and survival outcomes in the CORMAC COS. Definitions were agreed through a 3 step process, initially identifying existing definitions through systematic review (registered with PROSPERO, CRD42016036540), using these to populate a two-round Delphi questionnaire completed by 51 experts from 13 countries, and finally ratification through an online consensus meeting. Standardising the definitions for these core outcomes facilitates real world utilisation of the CORMAC-COS, thereby increasing the quality of data available for clinical decision-making and ultimately enhancing patient care.

Introduction: The scope of medical education (ME) as an autonomous field of study is still under debate. The present study aimed to identify publications addressing the topic of ME, published in international medical journals, by Portuguese authors, alone or in collaboration with foreign colleagues. Methods: Publications were retrieved from Scopus and Web of Science, between 2013 and 2022. Each publication was identified by title, name, and affiliation of the corresponding author. Affiliation of all authors was also taken into consideration to detect networks. Titles were used to identify subjects, complemented by keywords and abstract. Journal Citation Reports and Scimago Journal Rank indexed journals in the education category were identified and from these ME journals were selected.We chose 29 journals from which 17 had publications from Portuguese’s authors in a total of 80 publications. Results: The top journals in terms of productivity were BMC Medical Education, Medical Teacher, and Advances in Health Sciences Education. The Portuguese international cooperation involved Europe (United Kingdom, Spain, the Netherlands, and Ireland), North America (USA and Canada) and Oceania (Australia). Outside the Northen Hemisphere, cooperation involved mostly Brazil. Nationally, the dominant networks involved the Universities of Porto and Minho.Five core areas were identified namely “medical education”, “medical student”, “health care personnel”, “medical school”, and “undergraduate medical education”. Conclusion: Despite the limitations of this study because the search was only focused on ME journals it showed a trend towards internationalisation of some Portuguese authors, particularly those who were also involved in established national networks. Resumen: Introducción: El alcance de la educación médica como campo de estudio autónomo sigue siendo objeto de debate. El presente estudio tuvo como objetivo identificar las publicaciones que abordan el tema de la educación médica (EM), publicadas en revistas médicas internacionales, por autores portugueses, solos o en colaboración con colegas extranjeros. Métodos: Las publicaciones fueron recuperadas de Scopus y Web of Science, entre 2013 y 2022. Cada publicación fue identificada por título, nombre y afiliación del autor correspondiente. También se tuvo en cuenta la afiliación de todos los autores para detectar redes. Los títulos se utilizaron para identificar los temas, complementados por las palabras clave y el resumen. Se identificaron las revistas indexadas en Journal Citation Reports y Scimago Journal Rank en la categoría de educación y de ellas se seleccionaron las revistas de EM.Se seleccionaron 29 revistas de las cuales 17 tenían publicaciones de autores portugueses en un total de 80 publicaciones. Resultados: Las principales revistas en términos de productividad fueron BMC Medical Education, Medical Teacher y Advances in Health Sciences Education. La cooperación internacional portuguesa se centró en Europa (principalmente Reino Unido, España, Países Bajos e Irlanda), Norteamérica (EE.UU. y Canadá) y Oceanía (Australia). Fuera del hemisferio norte, la cooperación se centró principalmente en Brasil. A nivel nacional, las redes predominantes son las de las universidades de Oporto y Minho.

Introduction: Motivation plays a crucial role in the academic success and professional development of medical students. Understanding the intricacies of motivation within the context of medical education is essential for designing effective interventions and support systems. The aim of this study was to explore the adaptation of the Academic Motivation Scale within the framework of the self-determination theory and of the self-efficacy theory to assess motivation among medical students. Methods: The study adapted the Academic Motivation Scale to the Portuguese context, drawing upon insights from the self-determination theory. Two existing Portuguese scales, MATAMS and Ribeiro et al scale, served as foundational frameworks for the adaptation process. The study included qualitative interviews, which informed the creation of the Minho Medical Academic Motivation Scale – Minho-MEDAMS. This scale was applied to 281 medical students. To assess the scale’s validity, we used the exploratory and confirmatory factor analyses, and the Cronbach’s alpha to measure internal consistency. Results: The exploratory factor analysis showed strong results with a KMO of 0.862, leading to five factors and the removal of two items. The initial confirmatory factor analysis indicated poor fit, prompting the removal of items with low R-squared values. The final Minho-MEDAMS includes 18 items: six for intrinsic motivation, nine for extrinsic motivation and three for amotivation. This refined scale demonstrates high internal consistency (α = 0.831), making it a reliable tool for assessing medical students’ motivation. Conclusion: The successful adaptation of the Academic Motivation Scale within the self-determination theory framework presents a valuable instrument for assessing motivation in medical students. The Minho-MEDAMS offers a comprehensive understanding of motivational dynamics, facilitating targeted interventions and support mechanisms to enhance student engagement and success. Its validity and reliability render it a practical tool for educators, administrators, and researchers in the field of medical education. Ultimately, the Minho-MEDAMS contributes to the advancement of strategies aimed at cultivating motivated and proficient healthcare professionals.

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Erectile dysfunction (ED) poses a significant challenge in clinical practice, necessitating accurate diagnostic strategies to distinguish between organic and psychogenic causes. Current guidelines advocate a comprehensive approach involving medical history, physical examination and blood tests, with second-level analyses like the intracavernous injection of vasoactive drugs (ICI test) and penile duplex ultrasound (PDU) reserved for specific cases. A survey involving 24 urologists experienced in ED was conducted to assess their opinions on the appropriateness of the ICI test and PDU in six clinical scenarios. Results were analyzed using pie charts, revealing varied preferences among experts. The responses indicated diverse viewpoints, with preferences for the ICI test or PDU depending on the patient’s age, comorbidities, response to phosphodiesterase type 5 inhibitors (PDE5i) and concomitant Peyronie’s disease. In some cases, a significant proportion of experts opted for neither test. The study highlights the lack of consensus among experts regarding the routine use of PDU in ED management. Despite its diagnostic capabilities, the clinical utility of PDU remains unclear, and its role may be more justified in certain populations with anatomical abnormalities or specific conditions. The need for rigorous research to determine the impact of PDU on ED management decision-making is emphasized.

Paulo Cruchinho,1 María Dolores López-Franco,2 Manuel Luís Capelas,3 Sofia Almeida,4 Phillippa May Bennett,5– 7 Marcelle Miranda da Silva,1,8 Gisela Teixeira,1 Elisabete Nunes,1 Pedro Lucas,1 Filomena Gaspar1 On Behalf of the Handovers4SafeCare1Nursing Research, Innovation and Development Center (CIDNUR) of Lisbon, Nursing School of Lisbon, Lisboa, Portugal; 2CTS-464 Nursing and Innovation in Healthcare, University of Jaén, Jaén, Spain; 3Universidade Católica Portuguesa, Faculty of Health Sciences and Nursing, Center for Interdisciplinary Research in Health (CIIS), Lisboa, Portugal; 4Universidade Católica Portuguesa, Faculty of Health Sciences and Nursing, Center for Interdisciplinary Research in Health (CIIS), Porto, Portugal; 5Center for English, Translation, and Anglo-Portuguese Studies (CETAPS), Lisboa, Portugal; 6Faculty of Social Sciences and Humanities of the New University of Lisbon, Lisboa, Portugal; 7Faculty of Arts and Humanities of the University of Coimbra, Department of Languages, Literatures and Cultures, Coimbra, Portugal; 8Federal University of Rio de Janeiro, Anna Nery Nursing School, Rio de Janeiro, BrazilCorrespondence: Paulo Cruchinho, Nursing School of Lisbon, Avenida Prof. Egas Moniz, Lisboa, 1600-190, Portugal, Tel +351 217913400, Email pjcruchinho@esel.ptAbstract: Cross-cultural validation of self-reported measurement instruments for research is a long and complex process, which involves specific risks of bias that could affect the research process and results. Furthermore, it requires researchers to have a wide range of technical knowledge about the translation, adaptation and pre-test aspects, their purposes and options, about the different psychometric properties, and the required evidence for their assessment and knowledge about the quantitative data processing and analysis using statistical software. This article aimed: 1) identify all guidelines and recommendations for translation, cross-cultural adaptation, and validation within the healthcare sciences; 2) describe the methodological approaches established in these guidelines for conducting translation, adaptation, and cross-cultural validation; and 3) provide a practical guideline featuring various methodological options for novice researchers involved in translating, adapting, and validating measurement instruments. Forty-two guidelines on translation, adaptation, or cross-cultural validation of measurement instruments were obtained from “CINAHL with Full Text” (via EBSCO) and “MEDLINE with Full Text”. A content analysis was conducted to identify the similarities and differences in the methodological approaches recommended. Bases on these similarities and differences, we proposed an eight-step guideline that includes: a) forward translation; 2) synthesis of translations; 3) back translation; 4) harmonization; 5) pre-testing; 6) field testing; 7) psychometric validation, and 8) analysis of psychometric properties. It is a practical guideline because it provides extensive and comprehensive information on the methodological approaches available to researchers. This is the first methodological literature review carried out in the healthcare sciences regarding the methodological approaches recommended by existing guidelines.Keywords: cross-cultural comparison, decision-making, psychometric properties, research design, validation studies, health services research

The inflammatory response to wear particles derived from hip prothesis is considered a hallmark of periprosthetic osteolysis, which can ultimately lead to the need for revision surgery. Exosomes (Exos) have been associated with various bone pathologies, and there is increasing recognition in the literature that they actively transport molecules throughout the body. The role of wear particles in osteoblast-derived Exos is unknown, and the potential contribution of Exos to osteoimmune communication and periprosthetic osteolysis niche is still in its infancy. Given this, we investigate how titanium dioxide nanoparticles (TiO2 NPs), similar in size and composition to prosthetic wear particles, affect Exos biogenesis. Two osteoblastic cell models commonly used to study the response of osteoblasts to wear particles were selected as a proof of concept. The contribution of Exos to periprosthetic osteolysis was assessed by functional assays in which primary human macrophages were stimulated with bone-derived Exos. We demonstrated that TiO2 NPs enter multivesicular bodies, the nascent of Exos, altering osteoblast-derived Exos secretion and molecular cargo. No significant differences were observed in Exos morphology and size. However, functional assays reveal that Exos cargo enriched in uPA stimulates macrophages to a mixed M1 and M2 phenotype, inducing the release of pro- and anti-inflammatory signals characteristic of periprosthetic osteolysis. In addition, we demonstrated the expression of uPA in exosomes derived from the urine of patients with osteolysis. These results suggest that uPA can be a potential biomarker of osteolysis. In the future, uPa may serve as a possible non-invasive biomarker to identify patients at risk for peri-implant osteolysis.

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Activation of Gonadotropin-Releasing Hormone type II Receptors (GnRHR-II) exhibits antiproliferative activity. GnRHR-II is not only expressed exclusively in the pituitary, but also in a variety of tumors. To date, the clinical relevance of GnRHR-II in ovarian tumors is unclear. In addition, there is a lack of literature addressing GnRHR-II in ovarian tumors, especially rare types. This study was conducted to investigare the correlation between GnRHR-II expression with clinicopathology and proliferative activity of rare ovarian tumors. The purpose of this study was an analytic observational study with a cross-sectional design that utilized 18 ovarian tumor samples on tissue microarray (TMA). The expression of GnRHR-II and Ki67 was assessed using immunohistochemical staining (IHC) and observed using the IHC profiler plugin ImageJ software to obtain their respective H-scores. The data was analyzed using independent t-test, ANOVA, Pearson's test, and Fisher's exact test based on data types. The value of p

ObjectiveDry eye disease (DED) is a condition associated with a myriad of systemic disorders. According to recent preliminary data, axial spondylarthritis (axial-SpA) could represent a new entity associated with DED. Therefore, this study aimed to assess DED in patients with axial SpA by performing quantitative and qualitative specific tests to investigate the potential association between DED and ocular surface damage in patients with axial-SpA and to identify potential variables associated with DED.MethodsA total of 71 patients with axial-SpA who fulfilled the Assessment of SpondyloArthritis International Society (ASAS) classification criteria and 19 healthy controls were enrolled in this study. Both the patients and the controls underwent a complete ocular assessment aimed at evaluating the tear film and ocular surface, which included the Schirmer test, tear break-up time (TBUT), fluorescein staining, and lissamine green staining. The Ocular Surface Disease Index (OSDI) questionnaire was administered to all patients.ResultsDED symptoms were reported in 46 (64.8%) patients and three (15.8%) healthy controls (p = 0.0004). The odds ratio for receiving a diagnosis of axial-SpA based on the presence of dry-eye-related symptoms was 9.2 (95% C.I. 2.72–42.52, p = 0.001). The Schirmer test values of < 6 mm/5 min were observed in 31 (43.7%) patients with axial-SpA and two (10.5%) healthy controls (p = 0.013); a TBUT of

A aptidão para o início da escolaridade (AIE) depende de fatores pessoais, socioculturais, familiares, do meio escolar, da legislação em vigor e das políticas de inclusão. O objetivo foi identificar competências pré-escolares preditoras da AIE em consulta médica e sintetizar recomendações gerais a ter em conta. Foi efectuada uma pesquisa na base de dados PubMed com as palavras-chave: “preschool”, “school readiness”, “social functioning”, “motor skills”, “mathematics”, “language”, “comprehension of the world”, “attention”. Também foram consultadas as Orientações Curriculares para a Educação Pré-Escolar da DGE e da Norma Técnica da DGS para o PNSIJ. As competências socio-emocionais no pré-escolar têm um impacto positivo nas competências académicas. A perceção visual, a integração visuo-motora e a coordenação motora são fundamentais para AIE, da Leitura, Escrita e Matemática. A motricidade global demonstrou efeitos longitudinais ao nível da Linguagem, Leitura e Matemática. A consciência fonológica parece predizer o sucesso na Leitura. A acuidade do sistema numérico aproximado, a precisão de mapeamento e a capacidade de controlar e manter a atenção, têm um carácter preditivo de sucesso escolar. O conhecimento geral do mundo é o preditor mais forte para as competências futuras em Ciências e Leitura. A avaliação da AIE deve ser feita em várias ocasiões ao longo do desenvolvimento da criança, de forma multidisciplinar. Quanto mais precoce for a identificação de dificuldades e a intervenção dirigida, melhor o prognóstico. A decisão de optar pelo adiamento do início da escolaridade deve ter em consideração as variáveis biopsicossociais da criança e os recursos do meio escolar.

A aptidão para o início da escolaridade (AIE) depende de fatores pessoais, socioculturais, familiares, do meio escolar, da legislação em vigor e das políticas de inclusão. O objetivo foi identificar competências pré-escolares preditoras da AIE em consulta médica e sintetizar recomendações gerais a ter em conta. Foi efectuada uma pesquisa na base de dados PubMed com as palavras-chave: “preschool”, “school readiness”, “social functioning”, “motor skills”, “mathematics”, “language”, “comprehension of the world”, “attention”. Também foram consultadas as Orientações Curriculares para a Educação Pré-Escolar da DGE e da Norma Técnica da DGS para o PNSIJ. As competências socio-emocionais no pré-escolar têm um impacto positivo nas competências académicas. A perceção visual, a integração visuo-motora e a coordenação motora são fundamentais para AIE, da Leitura, Escrita e Matemática. A motricidade global demonstrou efeitos longitudinais ao nível da Linguagem, Leitura e Matemática. A consciência fonológica parece predizer o sucesso na Leitura. A acuidade do sistema numérico aproximado, a precisão de mapeamento e a capacidade de controlar e manter a atenção, têm um carácter preditivo de sucesso escolar. O conhecimento geral do mundo é o preditor mais forte para as competências futuras em Ciências e Leitura. A avaliação da AIE deve ser feita em várias ocasiões ao longo do desenvolvimento da criança, de forma multidisciplinar. Quanto mais precoce for a identificação de dificuldades e a intervenção dirigida, melhor o prognóstico. A decisão de optar pelo adiamento do início da escolaridade deve ter em consideração as variáveis biopsicossociais da criança e os recursos do meio escolar.

A aptidão para o início da escolaridade (AIE) depende de fatores pessoais, socioculturais, familiares, do meio escolar, da legislação em vigor e das políticas de inclusão. O objetivo foi identificar competências pré-escolares preditoras da AIE em consulta médica e sintetizar recomendações gerais a ter em conta. Foi efectuada uma pesquisa na base de dados PubMed com as palavras-chave: “preschool”, “school readiness”, “social functioning”, “motor skills”, “mathematics”, “language”, “comprehension of the world”, “attention”. Também foram consultadas as Orientações Curriculares para a Educação Pré-Escolar da DGE e da Norma Técnica da DGS para o PNSIJ. As competências socio-emocionais no pré-escolar têm um impacto positivo nas competências académicas. A perceção visual, a integração visuo-motora e a coordenação motora são fundamentais para AIE, da Leitura, Escrita e Matemática. A motricidade global demonstrou efeitos longitudinais ao nível da Linguagem, Leitura e Matemática. A consciência fonológica parece predizer o sucesso na Leitura. A acuidade do sistema numérico aproximado, a precisão de mapeamento e a capacidade de controlar e manter a atenção, têm um carácter preditivo de sucesso escolar. O conhecimento geral do mundo é o preditor mais forte para as competências futuras em Ciências e Leitura. A avaliação da AIE deve ser feita em várias ocasiões ao longo do desenvolvimento da criança, de forma multidisciplinar. Quanto mais precoce for a identificação de dificuldades e a intervenção dirigida, melhor o prognóstico. A decisão de optar pelo adiamento do início da escolaridade deve ter em consideração as variáveis biopsicossociais da criança e os recursos do meio escolar.

Bronchial asthma is a chronic pathology and a global public health problem. However, asthma can be controlled and treated for the most part by patients, so the Portuguese General Directorate of Health recommends shared medical appointments in primary health care (PHC). The present study aims to identify the role of PHC nurses in the control and treatment of asthma in adults. Using the MeSH platform, the following descriptors were validated: asthma, nurses, adults. An individual search was carried out in the following databases: CINAHL (ESBSCO host), MEDLINE (Pubmed host), Web of Science, and Scopus. Out of a total of 280 publications, 79 of which were duplicates and 185 publications which did not meet the inclusion criteria, 16 publications remained readable. Of the eligible articles, there were 13 specialist reports, one mixed study, one quasi-experimental study, and one randomized trial. Education was the intervention most identified in the scientific evidence analyzed, and patient assessment, application of an asthma control questionnaire, verification and training of inhalation technique, empowerment for self-management of the disease, support, promotion of seasonal influenza vaccination, and use of written action plans were also identified. The results reveal that, although the scientific evidence on the intervention of these professionals is poorly developed, nurses play a crucial role in the control and treatment of asthma. The scientific evidence analyzed allowed the identification of interventions that can help the organization of a nursing health appointment, providing nurses with a crucial role in the control and treatment of asthma in adults in the context of PHC.

Introdução: A trombocitemia essencial (TE) é uma condição pouco comum e assintomática na maioria dos casos. No entanto, podem surgir sintomas como cefaleias, síncope, vertigem, dor torácica, eritromelalgia e distúrbios visuais transitórios. Os eventos hemorrágicos e tromboembólicos são os grandes riscos desta patologia. O objetivo da partilha deste caso clínico é alertar para uma patologia rara que pode passar despercebida e causar eventos potencialmente graves. Descrição do caso: Sexo feminino, 43 anos, raça caucasiana, antecedentes de hepatite B crónica, sem antecedentes cirúrgicos nem medicação habitual, incluindo método contracetivo hormonal. Recorreu a consulta com queixas de enfartamento precoce, dispepsia e epigastralgia com três dias de evolução, negando alterações do trânsito intestinal, características das fezes, náuseas ou vómitos. Exame físico e endoscopia digestiva alta recente sem alterações de relevo. Foi consultado o estudo analítico que a utente realizava regularmente no hospital, verificando-se que o valor do número de plaquetas se encontrava consistentemente a rondar os 500.000/uL desde há três anos. Pediu-se ecografia abdominal que descrevia trombose parcial da veia porta e do seu ramo esquerdo. A doente foi medicada com enoxaparina 60mg 12h/12h. Foi realizado angio-TC abdominal, estudo pró-trombótico e estudo genético e iniciou varfarina 5mg 1x/dia, inicialmente sobreposta com enoxaparina 60mg 12/12h. O angio-TC viria a confirmar a trombose da veia porta e confirmou-se positiva a mutação JAK2 V617F. Assumido o diagnóstico de TE e iniciado tratamento citorredutor com hidroxiureia 500mg em dias alternados. Comentário: Este caso chama a atenção pelo excesso de plaquetas secundário à TE, ainda que ligeiramente acima do valor de referência, ter originado uma trombose da veia porta. Pretende-se alertar os médicos de família para a importância de realizar um estudo atento, valorizando pequenas variações sustentadas fora dos intervalos da normalidade e fazer uma referenciação correta e atempada quando necessário.

Iliotibial Band (ITB) Syndrome is common among athletes, such as runners and cyclists. There are several theories regarding the etiology of ITB Syndrome, including friction, compression, and chronic inflammation. We report a rare case of ITB Syndrome induced by traditional massage after a history of chronic knee pain. A 63-year-old female visited our Pysical Medicine and Rehabilitation Department with the pain of the lateral side of the right knee for four months after traditional massage. The physical examination showed a positive Ober test and Noble compression test. We performed an ultrasonography on the lateral right knee and found fluid effusion beneath the ITB confirming the diagnosis of ITB Syndrome. A pain intervention was performed with ultrasound-guided aspiration and injection of steroid beneath the ITB. After the procedure and rehabilitation program of cryotherapy and ultrasound therapy, the pain was reduced greatly and there was no need for further management.

The rapid progress in nanotechnology has introduced multifunctional iron oxide nanoparticles as promising agents in cancer treatment. This research focused on the synthesis and assessment of citric-acid-coated, folic-acid-conjugated nanoparticles loaded with doxorubicin, evaluating their therapeutic potential in tumor models. An advanced automated continuous technology line (CTL) utilizing a controlled co-precipitation method was employed to produce highly dispersive, multifunctional nanofluids with a narrow size distribution. Various techniques, including dynamic light scattering (DLS), electrophoretic light scattering (ELS), X-ray diffraction (XRD), and transmission electron microscopy (TEM), were employed to examine the particle size, zeta potential, structure, and morphology. Magnetic properties were analyzed through vibrating sample magnetometry (VSM), and surface modifications were confirmed via UV-visible (UV-Vis) and Fourier-Transform Infrared (FTIR) spectroscopy. Cytotoxicity and drug delivery efficiency were evaluated in vitro using RM1 (prostate cancer) and MEC1 (chronic lymphocytic leukemia) cell lines. Fluorescence microscopy demonstrated the successful intracellular delivery of doxorubicin, showcasing the nanoparticles’ potential for targeted cancer therapy. However, folic-acid-conjugated nanoparticles exhibited diminished effectiveness over time. This study highlights the importance of nanoparticle optimization for enhancing therapeutic performance. Further research should aim to improve nanoparticle formulations and explore their long-term impacts for the development of safe, targeted cancer treatments.

Introdução: A qualidade e rapidez do socorro pré-hospitalar à pessoa vítima de trauma major é vital para diminuir a sua elevada mortalidade. Contudo, desconhece-se a efetividade desta resposta em Portugal. O objetivo deste estudo foi analisar os tempos de resposta e as intervenções realizadas às vítimas de trauma major na região centro de Portugal. Métodos: Estudo retrospetivo, descritivo, utilizando os registos clínicos de 2022 dos meios diferenciados do Instituto Nacional de Emergência Médica. Casos de óbito pré-chegada ao hospital e outras situações de não transporte foram excluídos. Determinaram-se cinco tempos, entre os quais o tempo de resposta (T1, decorrente entre acionamento e chegada ao local), o tempo no local (T2) e o tempo de transporte (T5, intervalo entre a decisão de transporte e a chegada ao serviço de urgência). Foram calculadas médias e medidas de dispersão para cada meio, bem como a proporção de casos em que foram cumpridos os tempos recomendados nacional e internacionalmente. Avaliou-se também a frequência de registo de seis intervenções chave. Resultados: Dos 3366 registos, eliminaram-se 602 (384 por óbito), resultando em 2764 casos [suporte imediato de vida (SIV) = 36,0%, viaturas médicas de emergência e reanimação (VMER) = 62,2%, helicóptero de emergência médica (HEM) = 1,8%]. Num elevado número de registos não foi possível determinar tempos de socorro: por exemplo, o tempo de transporte (T5) foi determinável em apenas 29%, 13%, e 8% dos casos, respetivamente para SIV, VMER e HEM. O tempo recomendado para a estabilização (T2 ≤ 20 min), foi cumprido em 19,8% (SIV), 36,5% (VMER), e 18,2% (HEM) dos regis- tos. Já o tempo de transporte (T5 ≤ 45 min) foi cumprido em 80,0% (SIV), 93,1% (VMER) e 75,0% (HEM) dos registos (avaliáveis). A administração de analgesia (42% na SIV) e as medidas de prevenção de hipotermia (23,5% na SIV) foram as intervenções mais registadas. Conclusão: Observaram-se muitos status omissos e falta de informação nos registos, sobretudo na VMER e HEM. De acordo com os registos, o tempo no local superou frequentemente as recomendações, enquanto o tempo de transporte tende a estar dentro das normas.

The objective of this study is to provide a comprehensive overview of the utilization of magnetic resonance imaging (MRI) in the identification, characterization, and monitoring of liver metastatic disease, in contrast to alternative imaging modalities, through a bibliographical review and illustrative examples from the author’s clinical practice. The advantages of MRI in this specific context will be explored, emphasizing the utility of hepatospecific contrast agents and the limitations associated with alternative imaging modalities. A comparative analysis of these methods shows that MRI is the most sensitive and specific modality, even more so when using hepatospecific contrast agents, proving to have cost-effectiveness benefits in patient management. It is the authors’ opinion that, provided the technique is available, oncological patient staging where hepatic metastatic disease is a concern should include an abdominal MRI, if possible, with hepatospecific contrast.

The objective of this study is to provide a comprehensive overview of the utilization of magnetic resonance imaging (MRI) in the identification, characterization, and monitoring of liver metastatic disease, in contrast to alternative imaging modalities, through a bibliographical review and illustrative examples from the author’s clinical practice. The advantages of MRI in this specific context will be explored, emphasizing the utility of hepatospecific contrast agents and the limitations associated with alternative imaging modalities. A comparative analysis of these methods shows that MRI is the most sensitive and specific modality, even more so when using hepatospecific contrast agents, proving to have cost-effectiveness benefits in patient management. It is the authors’ opinion that, provided the technique is available, oncological patient staging where hepatic metastatic disease is a concern should include an abdominal MRI, if possible, with hepatospecific contrast.

N/a.

O artigo 206.º da Lei do Orçamento de Estado de 2022 prevê a contratação de médicos sem especialidade para o exercício de funções destinadas a médicos especialistas em Medicina Geral e Familiar (MGF), sendo previsível um impacto nefasto desta medida no sistema de saúde português e na saúde da população portuguesa. Os médicos de família criam uma aliança terapêutica na relação médico-doente e cuidam da saúde dos seus utentes de uma forma abrangente ao longo de toda a vida. Com a presente Lei, o governo desvaloriza o papel e a formação especializada do médico de família, descredibilizando a especialidade. Acreditamos que nesta Lei figura mais um retrocesso no caminho da especialidade de Medicina Geral e Familiar, praticada por profissionais altamente diferenciados. Pela lente dos médicos de família, ao invés do referido no artigo 206.º, a aposta do governo deverá ser na contratação de médicos de família em número suficiente para os centros de saúde, na redução drástica da burocracia a que estão sujeitos, na simplificação dos indicadores de desempenho orientados para verdadeiros benefícios em saúde dos utentes e na contratação de outros profissionais para as equipas, também em número suficiente para responder às necessidades.

Abstract Background Human mesenchymal stem cells (hMSCs) utilize discrete biosynthetic pathways to self-renew and differentiate into specific cell lineages, with undifferentiated hMSCs harbouring reliance on glycolysis and hMSCs differentiating towards an osteogenic phenotype relying on oxidative phosphorylation as an energy source. Methods In this study, the osteogenic differentiation of hMSCs was assessed and classified over 14 days using a non-invasive live-cell imaging modality—two-photon fluorescence lifetime imaging microscopy (2P-FLIM). This technique images and measures NADH fluorescence from which cellular metabolism is inferred. Results During osteogenesis, we observe a higher dependence on oxidative phosphorylation (OxPhos) for cellular energy, concomitant with an increased reliance on anabolic pathways. Guided by these non-invasive observations, we validated this metabolic profile using qPCR and extracellular metabolite analysis and observed a higher reliance on glutaminolysis in the earlier time points of osteogenic differentiation. Based on the results obtained, we sought to promote glutaminolysis further by using lactate, to improve the osteogenic potential of hMSCs. Higher levels of mineral deposition and osteogenic gene expression were achieved when treating hMSCs with lactate, in addition to an upregulation of lactate metabolism and transmembrane cellular lactate transporters. To further clarify the interplay between glutaminolysis and lactate metabolism in osteogenic differentiation, we blocked these pathways using BPTES and α-CHC respectively. A reduction in mineralization was found after treatment with BPTES and α-CHC, demonstrating the reliance of hMSC osteogenesis on glutaminolysis and lactate metabolism. Conclusion In summary, we demonstrate that the osteogenic differentiation of hMSCs has a temporal metabolic profile and shift that is observed as early as day 3 of cell culture using 2P-FLIM. Furthermore, extracellular lactate is shown as an essential metabolite and metabolic fuel to ensure efficient osteogenic differentiation and as a signalling molecule to promote glutaminolysis. These findings have significant impact in the use of 2P-FLIM to discover potent approaches towards bone tissue engineering in vitro and in vivo by engaging directly with metabolite-driven osteogenesis. Graphical Abstract

Introduction. Direct-acting antivirals (DAAs) has been developed for treatment hepatitis C virus (HCV). Therapy of HCV using DAA has shown high sustained virologic response (SVR) and shortening duration of therapy. Sofosbuvir-ledipasvir (SOF/LDV) is fixed dose combination tablet of DAAs which recommended for genotype 1, 4, 5, and 6 infected patients. In developing countries, SOF/LDV still can be used as cost-effective regimen in all genotype compared with sofosbuvir-daclatasvir (SOF/ DCV). This study aimed to evaluate the efficacy of combination sofosbuvir-ledipasvir in all genotypes of HCV patients compared with available DAA in Indonesia (sofosbuvir- daclatasvir). Methods. A retrospective study was conducted among patients who received HCV therapy in Klinik Hati and Cipto Mangunkusumo Hospital during January until December 2017. Demographic data, baseline characteristics virus, and baseline characteristics laboratory were collected from medical record. Quantitative polymerase chain reaction (PCR) for Jurnal Penyakit Dalam IndonesiaJurnal Penyakit Dalam Indonesia Volume 10 Issue 4 Article 3 12-31-2023 Kombinasi Sofosbuvir-Ledipasvir dan Sofosbuvir- DaclatasvirKombinasi Sofosbuvir-Ledipasvir dan Sofosbuvir- Daclatasvir pada Pengobatan Pasien Hepatitis C di Indonesiapada Pengobatan Pasien Hepatitis C di Indonesia Andri Sanityoso Sulaiman DrHepatobiliary Division, Medical Staff Group of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia., andri_sani@yahoo.com Irsan Hasan DrHepatobiliary Division, Medical Staff Group of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia., irsan_h@yahoo.com Cosmas Rinaldi Adithya Lesmana DrHepatobiliary Division, Medical Staff Group of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia., medicaldr2001id@yahoo.com Juferdy Kurniawan DrHepatobiliary Division, Medical Staff Group of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia., juferdy.k@gmail.com Gita ApriliciaHepatobiliary Division, Medical Staff Group of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia., gita.2a3@gmail.com See next page for additional authors Follow this and additional works at: https://scholarhub.ui.ac.id/jpdi Part of the Internal Medicine Commons, and the Virus Diseases Commons Recommended CitationRecommended Citation Sulaiman, Andri Sanityoso Dr; Hasan, Irsan Dr; Lesmana, Cosmas Rinaldi Adithya Dr; Kurniawan, Juferdy Dr; Aprilicia, Gita; Nugroho, Yayah Dr; Wahyuni, Nunuk Tri Dr; and Sulaiman, Budiman Sujatmika (2023) "Kombinasi Sofosbuvir-Ledipasvir dan Sofosbuvir- Daclatasvir pada Pengobatan Pasien Hepatitis C di Indonesia," Jurnal Penyakit Dalam Indonesia: Vol. 10: Iss. 4, Article 3. DOI: 10.7454/jpdi.v10i4.1501 Available at: https://scholarhub.ui.ac.id/jpdi/vol10/iss4/3 This Original Article is brought to you for free and open access by the Faculty of Medicine at UI Scholars Hub. It has been accepted for inclusion in Jurnal Penyakit Dalam Indonesia by an authorized editor of UI Scholars Hub. Kombinasi Sofosbuvir-Ledipasvir dan Sofosbuvir- Daclatasvir pada PengobatanKombinasi Sofosbuvir-Ledipasvir dan Sofosbuvir- Daclatasvir pada Pengobatan Pasien Hepatitis C di IndonesiaPasien Hepatitis C di Indonesia AuthorsAuthors Andri Sanityoso Sulaiman Dr, Irsan Hasan Dr, Cosmas Rinaldi Adithya Lesmana Dr, Juferdy Kurniawan Dr, Gita Aprilicia, Yayah Nugroho Dr, Nunuk Tri Wahyuni Dr, and Budiman Sujatmika Sulaiman This original article is available in Jurnal Penyakit Dalam Indonesia: https://scholarhub.ui.ac.id/jpdi/vol10/iss4/3 LAPORAN PENELITIAN183Jurnal Penyakit Dalam Indonesia | V o l . 10, No. 4 | Desember 2 0 2 3 | Kombinasi Sofosbuvir-Ledipasvir dan Sofosbuvir- Daclatasvir pada Pengobatan Pasien Hepatitis C di Indonesia Combination of Sofosbuvir-Ledipasvir and Sofosbuvir- Daclatasvir for Treatment HCV Patients in Indonesia Andri Sanityoso Sulaiman1,2, Irsan Hasan1, Cosmas Rinaldi Adithya Lesmana1, Juferdy Kurniawan1, Gita Aprilicia1, Yayah Nugroho2, Nunuk Tri Wahyuni2, Budiman Sujatmika Sulaiman2 1Divisi Hepatobilier, Departemen Ilmu Penyakit Dalam, Fakultas Kedokteran Universitas Indonesia/RSUPN Dr. Cipto Mangunkusumo, Jakarta 2Klinik Hati Prof Ali Sulaiman, Jakarta Korespondensi: Andri Sanityoso Sulaiman. Divisi Hepatobilier, Departemen Ilmu Penyakit Dalam, Fakultas Kedokteran Universitas Indonesia/RSUPN Dr. Cipto Mangunkusumo, Jakarta, Indonesia. Email: andri_sani@yahoo.com ABSTRAK Pendahuluan. Direct-acting antivirals (DAAs) telah dikembangkan untuk pengobatan virus hepatitis C (VHC). Terapi hepatitis C dengan menggunakan DAA telah menunjukkan respons virologis berkelanjutan yang tinggi (sustained virologic response/SVR) dan durasi terapi yang lebih singkat. Sofosbuvir-ledipasvir (SOF/LDV) adalah tablet kombinasi DAA dengan dosis tetap yang direkomendasikan untuk pasien yang terinfeksi genotipe 1, 4, 5, dan 6. Di negara berkembang, SOF/LDV masih dapat digunakan sebagai obat paduan dengan biaya yang lebih ekonomis untuk semua genotipe dibandingkan dengan sofosbuvir-daclatasvir (SOF/DCV). Tujuan dari penelitian ini adalah untuk mengevaluasi efikasi kombinasi sofosbuvir- ledipasvir pada semua genotipe pasien hepatitis C dibandingkan dengan DAA yang tersedia di Indonesia (sofosbuvir- daclatasvir). Metode. Penelitian ini merupakan penelitian retrospektif terhadap pasien yang mendapatkan terapi hepatitis C di Klinik Hati dan Rumah Sakit Cipto Mangunkusumo pada periode Januari hingga Desember 2017. Data demografi, karakteristik awal virus, dan karakteristik awal laboratorium dikumpulkan dari rekam medis. Polymerase chain reaction (PCR) kuantitatif untuk muatan virus hepatitis C dinilai pada titik akhir penelitian. Efikasi SOF/LDV dan SOF/DCV dilakukan dengan respons virologis yang berkelanjutan pada minggu ke-12 (SVR-12). Hasil. Sebanyak 214 pasien hepatitis C diikutsertakan dalam penelitian ini. Sebanyak 69 pasien diobati dengan SOF/LDV, sedangkan 145 pasien diobati dengan SOF/DCV. Pada kelompok SOF/LDV, sebanyak 20 (29%) pasien memiliki pengalaman terapi, 9 (13%) menerima terapi 24 minggu, dan 26 (37,7%) pasien memiliki sirosis. Pada kelompok SOF/DCV, 24 (16,6%) pasien memiliki pengalaman terapi, 38 (26,2%) menerima terapi 24 minggu, dan 41 (28,3%) pasien memiliki sirosis. Pasien hepatitis C didominasi oleh genotipe 1 pada kedua kelompok SOF/LDV dan SOF/DCV (63,7 vs. 67,6%). Virus hepatitis C tidak terdeteksi pada seluruh pasien setelah terapi kombinasi SOF/LDV, dengan angka SVR-12 adalah 69/69 (100%). Sementara itu, angka SVR-12 mencapai 142/145 (97,9%) pada kelompok SOF/DCV. Kesimpulan. SOF/LDV efektif pada semua genotipe pasien hepatitis C dan biaya kombinasi dosis tunggal SOF/LDV lebih terjangkau bagi pasien di negara berkembang dibandingkan dengan rejimen SOF/DCV. Kata Kunci: Direct-acting antivirals (DAAs), sofosbuvir-daclatasvir (SOF/DCV), sofosbuvir-ledipasvir (SOF/LDV), SVR-12, virus hepatitis C ABSTRACT Introduction. Direct-acting antivirals (DAAs) has been developed for treatment hepatitis C virus (HCV). Therapy of HCV using DAA has shown high sustained virologic response (SVR) and shortening duration of therapy. Sofosbuvir-ledipasvir (SOF/LDV) is fixed dose combination tablet of DAAs which recommended for genotype 1, 4, 5, and 6 infected patients. In developing countries, SOF/LDV still can be used as cost-effective regimen in all genotype compared with sofosbuvir-daclatasvir (SOF/ DCV). This study aimed to evaluate the efficacy of combination sofosbuvir-ledipasvir in all genotypes of HCV patients compared with available DAA in Indonesia (sofosbuvir- daclatasvir). Methods. A retrospective study was conducted among patients who received HCV therapy in Klinik Hati and Cipto Mangunkusumo Hospital during January until December 2017. Demographic data, baseline characteristics virus, and baseline characteristics laboratory were collected from medical record. Quantitative polymerase chain reaction (PCR) for 184| Jurnal Penyakit Dalam Indonesia | V o l . 10, No. 4 | Desember 2 0 2 3 Andri S. Sulaiman, Irsan Hasan, C.R.A Lesmana, Juferdy Kurniawan, Gita Aprilicia,Yayah Nugroho, Nunuk Tri Wahyuni, Budiman S. Sulaiman HCV RNA were assessed at the end point of study. The efficacy of SOF/LDV and SOF/DCV were carried out by sustained virological response at 12 weeks (SVR-12). Results. A total of 214 HCV patients were include in this study. Sixty-nine patients treated with SOF/LDV, whereas 145 patients treated with SOF/DCV. In group of SOF/LDV, 20 (29%) patients had an experience therapy, 9 (13%) received 24-week therapy, 26 (37.7%) patients observed with cirrhosis. In group of SOF/DCV, 24 (16.6%) patients had an experience therapy, 38 (26.2%) received 24-week therapy, 41 (28.3%) patients observed with cirrhosis. The patients were dominated by HCV genotype 1 in both of group SOF/LDV and SOF/DCV (63.7% vs. 67.6%). All patients had undetected HCV RNA virus after the combination therapy of SOF/LDV, with the SVR-12 rate was 69 (100%) patients. Meanwhile, SVR-12 rate was achieved in 142 (97.9%) patients in group SOF/DCV. Conclusion. SOF/LDV is effective in all genotype of HCV patients and the cost fix dose combination of SOF/LDV more affordable to patients in developing countries compared with SOF/DCV regimen. Keywords: Direct acting antiviral agents (DAAs), HCV, sofosbuvir-daclatasvir (SOF/DCV), sofosbuvir-ledipasvir (SOF/LDV), SVR-12 PENDAHULUAN Infeksi hepatitis C telah menjadi epidemi global. Pada tahun 2015, World Health International (WHO) memperkirakan bahwa 71 juta penduduk dunia terinfeksi hepatitis C kronis.1 Total kematian terkait hepatitis C mencapai 399.000 penduduk pada tahun 2018, yang sebagian besar disebabkan oleh karsinoma hepatoseluler dan sirosis akibat infeksi virus hepatitis C.2 Virus hepatitis C (VHC) ditandai dengan variabilitas genetik yang beragam. Terdapat 7 genotipe dan lebih dari 67 subtipe VHC yang telah teridentifikasi di seluruh dunia.3 Genotipe yang paling banyak ditemukan di Indonesia adalah genotipe 1, dengan prevalensi diperkirakan 62,7%, diikuti oleh genotipe 2 (16,4%), genotipe 3 (13,0%), dan sebagian kecil genotipe 4 (2,7%), genotipe 5 (0,9%), dan genotipe 6 (1,3%).4 Genotipe 1 adalah genotipe yang paling sulit diobati dengan obat paduan pegylated interferon/ ribavirin (Peg-IFN/RBV). Sebuah studi oleh Juniastuti5 di Indonesia melaporkan bahwa hanya 73,5% pasien mencapai early virological response (EVR) dan sustained virological response (SVR) setelah pengobatan dengan Peg-IFN/RB. Sejak tahun 2016, direct acting antiviral agent (DAA) diusulkan menjadi pengobatan standar baru untuk pasien hepatitis C di Indonesia. Penemuan DAA telah mengubah pengobatan hepatitis C dengan meningkatkan sustained virologic response (SVR) dan memperpendek durasi pengobatan.6 Pencapaian SVR setelah pengobatan dengan DAA dikaitkan dengan berkurangnya risiko penyakit hati dan komplikasinya, termasuk dekompensasi sirosis, karsinoma hepatoseluler, dan kematian.7 Beberapa obat paduan kombinasi sofosbuvir (SOF) telah menunjukkan efektivitas dan keamanan yang unggul untuk mengobati infeksi VHC kronis. Secara khusus, kombinasi SOF dengan inhibitor protein nonstruktural 5A (NS5A), misalnya ledipasvir (LDV), daclatasvir (DCV), atau velpatasvir (VEL) telah menunjukkan efektivitas tinggi dengan tingkat SVR pada 12 minggu pasca pengobatan mencapai 80-90%.8 Sebagian besar data tentang efektivitas DAA pada pasien hepatitis C berasal dari negara barat, hanya sedikit data yang diperoleh dari negara di Asia, khususnya Indonesia. Penelitian ini bertujuan untuk mengetahui efektivitas kombinasi Sofosbuvir-Ledipasvir pada semua genotipe pasien hepatitis C dibandingkan dengan DAA yang tersedia di Indonesia (sofosbuvir- daclatasvir). METODE Semua pasien dewasa dengan hepatitis C positif berusia di atas 18 tahun yang diobati dengan sofosbuvir di Klinik Hati Prof Ali Sulaiman dan Rumah Sakit Cipto Mangunkusumo pada periode Januari hingga Desember 2017 diikutsertakan dalam penelitian ini secara retrospektif. Kriteria eksklusi adalah pasien dalam masa kehamilan, pasien dengan keganasan, dan pasien dengan adanya gangguan ginjal. Sumber data serial kasus SOF/ LDV hanya diperoleh dari Klinik Hati Prof Ali Sulaiman, sedangkan data serial kasus SOF/DCV diperoleh dari Klinik Hati Prof Ali Sulaiman dan Rumah Sakit Cipto Mangunkusumo. Pada kelompok pertama, pasien menerima kombinasi SOF/LDV dengan dosis tetap tunggal secara oral (90 mg ledipasvir dan 400 mg sofosbuvir). Pada kelompok lain, pasien menerima SOF/DCV (60 mg daclatasvir dan 400 mg sofosbuvir). Jika pasien memiliki koinfeksi dengan human immunodeficiency virus (HIV), pasien menerima penyesuaian dosis daclatasvir 90 mg. Durasi pemberian DAA pada regimen SOF/DCV diberikan selama 12 minggu atau 24 minggu tergantung pada adanya sirosis hati. Sementara pada regimen SOF/LDV, sebagian besar pasien diberikan terapi selama 12 minggu dan ditambahkan menjadi 24 minggu pengobatan sesuai dengan kesanggupan pembiayaan pasien. Sebelum terapi, beberapa pemeriksaan klinis dan laboratorium dilakukan. Viral load HCV RNA, genotipe, riwayat terapi sebelumnya, ada tidaknya sirosis, riwayat diabetes melitus, dan kekakuan hati dikumpulkan 185Jurnal Penyakit Dalam Indonesia | V o l . 10, No. 4 | Desember 2 0 2 3| Kombinasi Sofosbuvir-Ledipasvir dan Sofosbuvir-Daclatasvir pada Pengobatan Pasien Hepatitis C di Indonesia sebelum terapi. Efikasi utama SOF/LDV dan SOF/DCV dilakukan dengan SVR-12 (tingkat SVR pada 12-minggu paska pengobatan). SVR didefinisikan sebagai virus yang tidak terdeteksi setelah dinilai dengan polymerase chain reaction (PCR) kuantitatif untuk RNA HCV. Analisis statistik dilakukan dengan menggunakan SPSS versi 25. Data dinyatakan sebagai rerata [simpang baku (SB)] atau median (rentang) untuk data kontinu dan dinyatakan sebagai proporsi n (%) untuk data kategorikal. Perbandingan antarkelompok dinilai dengan uji t-test independent atau uji Man-Whitney untuk data kontinu dan uji chi square untuk data kategorik. Nilai p

Background and Objectives: Observational studies with data from real-world clinical practice with patients with difficult-to-treat depression (DTD) are rare. This study aims to collect observational data from the real-world clinical practice of a Portuguese community mental health team (CMHT) on the prevalence of DTD and to explore differences between DTD and non-DTD groups. Materials and Methods: We conducted a retrospective chart review study using data from Electronic Health Records (EHRs) of adult patients with psychiatric disorders followed by a CMHT from the Department of Psychiatry of the Coimbra Local Health Unit (between 1 December 2020–31 December 2022). The Dutch Measure for quantification of Treatment Resistance in Depression (DM-TRD) was used to assess the degree of treatment resistance and the Charlson Comorbidity Index (CCI) to measure medical comorbidity. Results: A quantity of 473 patients were referred to Cantanhede CMHT for a first assessment. Of these, 219 patients met the criteria for a primary diagnosis of any depressive disorder. Assistant psychiatrists identified 57 patients with DTD during follow-up (approximately 26%). The DTD group had higher rates of depressive episodes, greater depression severity, increased service use, higher DM-TRD scores, and a higher prevalence of comorbid anxiety symptoms, personality disorders, and severe medical comorbidities. The DTD group also had a higher prescription rate of antidepressants. Differences were observed in the use of antidepressant augmentation strategies and in the prescription of anticoagulant/antiplatelet drugs and analgesics, with higher prescription rates in the DTD group. We found correlations between DM-TRD and CCI scores, and between DM-TRD scores and all service use variables. Conclusions: Our results are consistent with a similar study in the United Kingdom, highlighting the need for a different approach to the management of DTD patients, who continue to live with a significant burden despite usual pharmacological and non-pharmacological treatments.

Background/Objectives: The interest in processing human speech and other human-generated audio signals as a diagnostic tool has increased due to the COVID-19 pandemic. The project OSCAR (vOice Screening of CoronA viRus) aimed to develop an algorithm to screen for COVID-19 using a dataset of Portuguese participants with voice recordings and clinical data. Methods: This cross-sectional study aimed to characterise the pattern of sounds produced by the vocal apparatus in patients with SARS-CoV-2 infection documented by a positive RT-PCR test, and to develop and validate a screening algorithm. In Phase II, the algorithm developed in Phase I was tested in a real-world setting. Results: In Phase I, after filtering, the training group consisted of 166 subjects who were effectively available to train the classification model (34.3% SARS-CoV-2 positive/65.7% SARS-CoV-2 negative). Phase II enrolled 58 participants (69.0% SARS-CoV-2 positive/31.0% SARS-CoV-2 negative). The final model achieved a sensitivity of 85%, a specificity of 88.9%, and an F1-score of 84.7%, suggesting voice screening algorithms as an attractive strategy for COVID-19 diagnosis. Conclusions: Our findings highlight the potential of a voice-based detection strategy as an alternative method for respiratory tract screening.

الملخص: أهداف البحث: توصيف قدرة الالتصاق لتسع سلالات من الملوية البوابية وثمانية بروبيوتيك في خلايا الخلايا الكيراتينية الفموية البشرية (خلايا اتش٣٥٧) مقارنة بالخلايا المعوية (خلايا كاكو-٢ و خلايا هيك-٦). بعد ذلك، تم فحص القدرات المضادة للالتصاق والتجميع المشترك لسلالات الكائنات الحية المجهرية المختارة على سلالات الملوية البوابية. طرق البحث: تسع سلالات من الملوية البوابية تضمنت الملوية البوابية أ،ت،س،س،٤٣٥٠٤ (سلالة من النوع)، وتم عزل ٨ سلالات إكلينيكية من عينات فموية لثلاثة مرضى (واحد غير مصاب، ومريض التهاب معدي، ومريض سرطان معدي). تم استخدام سلالات الكائنات الحية المجهرية الثمانية المختارة على النحو التالي: لاكتوباسيلس باراكاسي (اس دي1) و لاكتوباسيلس رامنوساس (اس دي4) و لاكتوباسيلس رامنوساس (اس دي11) و ليموسيلاكتوباسيلوس فيرمنتوم (اس دي7) و لاكتوباسيلس رامنوساس (ج ج) و ليموزيلاكتياز5؛ تم فحص قدرات التصاق الملوية البوابية وسلالات البروبيوتيك المضادة للالتصاق في خلايا اتش٣٥٧ وخلايا كاكو-٢ و خلايا هيك-٦. تم فحص التجميع المشترك عند مختلف الأس الهيدروجيني، والكراهية للماء والمستقبلات السطحية لخطوط الخلايا لسلالات الملوية البوابية. النتائج: جميع سلالات الكائنات الحية المجهرية والملوية البوابية يمكن أن تلتصق بـ خلايا اتش٣٥٧ أفضل بكثير من خلايا كاكو-٢ و خلايا هيك-٦. أظهرت ثلاث سلالات بروبيوتيك (اس دي7 و اس دي4 و اس دي11) التصاق أعلى بكثير من سلالات أخرى. من بين سلالات الملوية البوابية السريرية، كان لعزلات مريض سرطان المعدة أعلى قدرة على الالتصاق لجميع سلالات الخلايا المختبرة. سلالات البروبيوتيك التي أظهرت قدرة عالية على الالتصاق، يمكن أن توفر مقاومة عالية للالتصاق وتجمع مشترك ضد سلالات الملوية البوابية. يمكن أن تشجع الظروف الحمضية تكتل البروبيوتيك لسلالات الملوية البوابية. الاستنتاجات: تقدم هذه الدراسة معلومات عن قدرات التصاق الملوية البوابية وسلالات الكائنات الحية المجهرية في الغشاء المخاطي للفم مقارنة بالغشاء المخاطي المعوي. قد تكون سلالات معينة من الكائنات الحية المجهرية مفيدة في القضاء الناجح على عدوى الملوية البوابية عن طريق منع الالتصاق والتجميع المشترك. Abstract: Objectives: To characterize the adhesion ability of nine Helicobacter pylori strains and eight probiotics in human oral keratinocyte cells (H357 cells) in comparison to intestinal cells (Caco-2 and HIEC-6 cells). Subsequently, the anti-adhesion and co-aggregation abilities of the selected probiotic strains on H. pylori strains were investigated. Methods: Nine H. pylori strains, including H. pylori ATCC43504 (type strain), and 8 clinical strains, were isolated from oral samples of three patients (one non-disease, one gastritis patient, and one gastric cancer patient). Eight selected probiotic strains were used, as follows: Lacticaseibacillus paracasei SD1, Lacticaseibacillus rhamnosus SD4, L. rhamnosus SD11, Limosilactobacillus fermentum SD7, L. rhamnosus GG, Limosilactobacillus reuteri ATCC-PTA6475, Lacticaseibacillus casei Shirota, and L. paracasei CNCM I-1572. The adhesion and anti-adhesion abilities of H. pylori and the probiotic strains were investigated in H357, Caco-2, and HIEC-6 cells. Co-aggregation at various pHs, hydrophobicity, and surface receptors of the cell lines for H. pylori strains were examined. Results: All probiotic and H. pylori strains adhered to H357 significantly better than Caco-2, and HIEC-6 cells. Three probiotic strains (SD7, SD4, SD11) showed significantly higher adhesion than others. Of the clinical H. pylori strains, isolates from a gastric cancer patient had the highest adhesion ability to all of the cell lines tested. Probiotic strains that exhibited high adhesion ability provided high anti-adhesion and co-aggregation against H. pylori strains. Acidic conditions encouraged the co-aggregation of probiotics to H. pylori strains. Conclusion: This study provides information relating to the adhesion abilities of clinical H. pylori and probiotic strains to the oral mucosa when compared to the intestinal mucosa. Certain probiotic strains may be useful for the successful eradication of H. pylori infection via anti-adhesion and co-aggregation.

The purpose of this study was two-fold: (i) to analyze the relationship between motor competence (i.e., a person’s ability to be proficient in different gross motor skills) and the rating of perceived exertion (RPE), which represents the physiological and psychological responses during training, in young adults, and (ii) to compare RPE between participants with high and low motor competence. Forty-eight male young adults (22.01 ± 2.43 years) participated in this study. Participants were randomly divided into several teams of three players to perform a small-sided game for 25 min (Goalkeeper + 2 × 2 + Goalkeeper) in which the RPE was collected. Then, motor competence was assessed through six tests assessing three main components: stability (Jumping Sideways and Shifting Platforms); locomotor (Standing Long Jump and Shuttle Run), and manipulative (Velocity of Ball Kicking and Throwing). Motor competence was negatively associated with RPE (r = −0.64; p < 0.001). Moreover, locomotor, stability, and manipulative components were negatively associated with RPE (all, p < 0.05). Furthermore, upon comparing groups with low and high levels of motor competence, we observed significantly higher RPE values (p < 0.001; d = 0.32) in the low motor competence group. The findings from this study suggest that individuals with higher levels of motor competence may report a lower RPE during exercise. This information is valuable for coaches as improving levels of motor competence may potentially lead to increases in on-field performance.

Abstract Background Critically ill patients with cirrhosis and ascites are at high risk for intra-abdominal hypertension (IAH) which increases mortality. Clinical guidelines recommend maintaining intra-abdominal pressure (IAP) below 16 mmHg; nonetheless, more than three quarters of critically ill patients with cirrhosis develop IAH during their first week of ICU stay. Standard-of-care intermittent large-volume paracentesis (LVP) relieves abdominal wall tension, reduces IAP, optimizes abdominal perfusion pressure, and is associated with short-term improvement in renal and pulmonary dysfunction. However, there is no evidence of the superiority of different paracentesis strategies in the prevention and treatment of IAH in critically ill patients with cirrhosis. This trial aims to compare the outcomes of continuous passive paracentesis versus LVP in the prevention and treatment of IAH in patients with cirrhosis and ascites. Methods An investigator-initiated, open label, randomized controlled trial, set in a general ICU specialized in liver disease, was initiated in August 2022, with an expected duration of 36 months. Seventy patients with cirrhosis and ascites will be randomly assigned, in a 1:1 ratio, to receive one of two methods of therapeutic paracentesis. A stratified randomization method, with maximum creatinine and IAP values as strata, will homogenize patient baseline characteristics before trial group allocation, within 24 h of admission. In the control group, LVP will be performed intermittently according to clinical practice, with a maximum duration of 8 h, while, in the intervention group, continuous passive paracentesis will drain ascitic fluid for up to 7 days. The primary endpoint is serum creatinine concentration, and secondary endpoints include IAP, measured creatinine clearance, daily urine output, stage 3 acute kidney injury and multiorgan dysfunction assessed at day 7 after enrollment, as well as 28-day mortality rate and renal replacement therapy-free days, and length-of-stay. Prespecified values will be used in case of renal replacement therapy or, beforehand ICU discharge, liver transplant and death. Safety analysis will include paracentesis-related complication rate and harm. Data will be analyzed with an intention-to-treat approach. Discussion This is the first trial to compare the impact of different therapeutic paracentesis strategies on organ dysfunction and outcomes in the prevention and treatment of IAH in critically ill patients with cirrhosis and ascites. Trial registration ClinicalTrials.gov NCT04322201 . Registered on 20 December 2019

Introduction: Neurological involvement in immunoglobulin G4-related disease (IgG4-RD) is increasingly recognized. Its diagnosis can be challenging due to clinical mimics and difficulty in obtaining nervous system biopsies. The aim of this study was to describe a cohort of neurological IgG4-RD patients. Methods: Patients were recruited from a neuroimmunology tertiary center. Clinical, laboratory, neuroimaging and histological data were reviewed. Results: Fifteen patients (60% women), with a median age of 53 years (48.5 – 65.0) were included: 13 (86.7%) classified as possible IgG4-RD, one (6.7%) as probable and one (6.7%) as definitive. The most common neurological phenotypes were meningoencephalitis (26.7%), orbital pseudotumor (13.3%), cranial neuropathies (13.3%), peripheral neuropathy (13.3%), and longitudinally extensive transverse myelitis (LTEM) (13.3%). Median serum IgG4 concentration was 191.5 (145.0 – 212.0) mg/dL. Seven in 14 patients had CSF pleocytosis (50.0%) and oligoclonal bands restricted to the intrathecal compartment, while most cases presented elevated CSF proteins (64.3%). Magnetic resonance imaging abnormalities included white matter lesions in four (26.7%), hypertrophic pachymeningitis in two (13.3%), and LETM in two (13.3%). Two patients had biopsy-proven IgG4-RD in extra-neurological sites. Conclusion: This study highlights the phenotypical variability of the neurological IgG4-RD. Biopsy inaccessibility reinforces the importance of new criteria for the diagnosis of this subset of patients.

O objetivo deste estudo é recolher informações sobre os obstáculos, benefícios, principais práticas e lições aprendidas com a adoção e revisão do sistema de gestão da qualidade ISO 9001:2015, pelas indústrias do setor da metalomecânica, transformação de madeiras, construção civil e obras públicas sediadas em Portugal. Para o efeito adotou-se uma metodologia quantitativa, e foi utilizado o questionário de Fonseca et al., (2019). Foram contactadas 1105 empresas destes três setores de atividade tendo sido obtidas 114 respostas. Concluiu-se, comparativamente a estudos anteriores multissetoriais, que o recurso a formação e consultores externos para a implementação da ISO 9001:2015, facilitam o processo de implementação e certificação da norma nos três setores. Concluiu-se ainda que os recursos humanos devem merecer especial atenção pois revela-se que o planeamento das mudanças e resistência às mesmas surge como a principal dificuldade sentida pelas empresas em estudo, com a implementação das ferramentas da qualidade, seguida da determinação dos riscos e oportunidades que trazem as maiores dificuldades, porém também dos maiores benefícios, relativamente ao processo de certificação. Também aqui se reafirmam a adoção do pensamento baseado no risco e identificação das partes interessadas relevantes como as abordagens que as organizações consideraram mais benéficas. Sugerem-se investigações futuras sobre os critérios e requisitos de TIC que os sistemas informáticos de apoio à qualidade deveriam ter para dar suporte à documentação e processo dos sistemas de gestão da qualidade.

Key Clinical Message Neuroendocrine tumors (NETs) are a group of uncommon neoplasms derived from enterochromaffin or Kulchitsky cells (that secrete serotonin or other molecules into the bloodstream), which can manifest with symptoms of hormonal overproduction, namely carcinoid syndrome (CS). This can be the presenting feature in patients with advanced disease. We report the case of a 66‐year‐old woman presenting with chronic diarrhea, facial venous telangiectasia and elevated urinary 5‐hydrocyindoleacetic acid levels. A 68‐Ga DOTATOC PET/CT scan revealed an ileal mass and lesions consistent with liver, ovary and bone metastasis. A liver biopsy confirmed the diagnosis of well‐differentiated NET G1. Therapy with somatostatin analogs achieved symptom control, but the liver disease progressed and the patient passed away after 2 years of follow‐up. The challenge of diagnosing CS resides in its heterogeneous manifestations, which may range from mild to life‐threatening conditions. In this case, the cutaneous findings of venous telangiectasia strongly pointed to the correct diagnosis. Treatment can also be difficult due to refractory symptoms and inevitable progression of disease, highlighting the importance of early detection and thorough disease staging.

Patients who cannot fully comply with conventional clinic-based rehabilitation (CR) sessions after ACL reconstruction (ACLR) may find additional internet-based sessions beneficial. These remote sessions include therapeutic exercises that can be done at home, potentially extending the reach of rehabilitation services to underserved areas, prolonging the duration of care and providing improved supervision. The study’s main purpose is to determine if the Knee Care at Home (KC@H) programme is more effective than conventional CR alone in improving patient-reported, clinician-reported and physical functional performance outcome measures after ACLR. Additionally, the trial assesses the significance of changes in outcome measures for clinical practice.This protocol outlines a randomised controlled trial for postoperative recovery following ACLR. Adult participants of both sexes who meet specific criteria will be randomly assigned to either the CR group or the KC@H group. Only the latter group will receive internet-based sessions of therapeutic exercises at home and CR sessions. A follow-up evaluation will be conducted for both groups 12 weeks after the intervention ends.The trial protocol was approved by the Ethics Committee of the Universidade de Évora and complies with the Code of Ethics of the World Medical Association. All recordings will be stored on a secure server with limited access and deleted as soon as they are no longer needed.The KC@H programme is expected to be superior to conventional CR for patients recovering from ACLR across multiple outcome measures. Also, the programme has the potential to promote superior recovery and extend the reach and duration of care.Trial registration number: NCT05828355.

Introduction: Information about pan-genotypic treatments for hepatitis in Portugal is scarce. We aimed to evaluate the effectiveness and safety of glecaprevir plus pibrentasvir (GLE/PIB) treatment for hepatitis C virus (HCV) infection in real-world clinical practice. Methods: An observational prospective study was implemented in six hospitals with 121 adult HCV patients who initiated treatment with GLE/PIB between October 2018 and April 2019, according to clinical practice. Eligible patients had confirmed HCV infection genotype (GT) 1 to 6 and were either treatment-naïve or had experience with interferon-, ribavirin- or sofosbuvir-based regimens, with or without compensated cirrhosis. Baseline sociodemographic and safety data are described for the total population (N = 115). Effectiveness [sustained virologic response 12 weeks after treatment (SVR12)] and patient-reported outcomes are presented for the core population with sufficient follow-up data (n = 97). Results: Most patients were male (83.5%), aged < 65 years (94.8%), with current or former alcohol consumption (77.3%), illicit drug use (72.6%), and HCV acquisition through intravenous drug use (62.0%). HIV co-infection occurred in 22.6% of patients. The prevalence of each GT was: GT1 51.3%, GT2 1.7%, GT3 30.4%, GT4 16.5%, and GT5.6 0%. Most patients were non-cirrhotic (80.9%) and treatment-naïve (93.8%). The SVR12 rates were 97.9% (95% CI: 92.8 - 99.4), and > 95% across cirrhosis status, GT, illicit drug use, alcohol consumption, and HCV treatment experience. The adverse event rate was 2.6%, and no patient discontinued treatment due to adverse events related to GLE/PIB. Conclusion: Consistent with other real-world studies and clinical trials, treatment with GLE/PIB showed high effectiveness and tolerability overall and in difficult-to-treat subgroups (ClinicalTrials.gov: NCT03303599).

Tujuan: Tujuan dari penulisan artikel ini adalah untuk mencari adanya keterkaitan antara indeks massa tubuh dan usia terhadap grading histopatologi karsinoma mammae invasif NST di RSPAD Gatot Soebroto tahun 2021. Metode: Penelitian kuantitatif analitik observasional menggunakan cross sectional sebagai desain penelitian. Pasien karsinoma mammae invasif NST yang tercatat pada tahun 2021 dirawat di RSPAD Gatot Soebroto adalah populasi, sampel adalah pasien yang telah disesuaikan dengan kriteria inklusi. Teknik simple random sampling dipilih menjadi teknik pengambilan sampel yang berasal dari data sekunder berupa rekam medis pasien, sampel digunakan sampel sebanyak 84 pasien. Indeks massa tubuh dan usia adalah variabel bebas dan grading adalah variabel terikat. Analisis univariat dilakukan untuk mengetahui karakteristik pasien berdasarkan usia, IMT, dan grading. Analisis bivariat bertujuan untuk mencari adanya keterkaitan antara variabel independen dan variabel dependen. Hasil: Tidak adanya hubungan yang bermakna ditemukan pada penelitian ini antara variabel IMT dengan grading dengan nilai p=0,685 sementara pada analisis mengenai keterkaitan usia dengan grading juga ditemukan tidak adanya hubungan dengan p=1. Kesimpulan: hubungan antara IMT dan usia dengan grading tidak ditemukan, kemungkinan tidak adanya hubungan akibat terbatasnya sampel. Subtipe molekuler dan status menopause sebagai faktor pembias.

Introduction: The leaves of Pluchea indica (L.) Less is empirically used to enhance milk production. This study aimed to evaluate the lactogenic effect of ethanolic extract of P. indica leaves (EPI) on milk production, prolactin, cortisol, oxytocin levels, and histological changes of mammary tissue in lactating rats and weight gain of their pups. Methods: Twenty-five lactating rats with six pups were randomized into five groups. The groups were control (reverse osmosis water), standard (domperidone 2.5 mg/kg BW), and EPI (250, 500, and 750 mg/kg BW). The daily treatments were administered by oral gavage, starting from the second day until day 15 of parturition. Milk production and the weight of the pups were measured daily. Serum prolactin, cortisol, and oxytocin levels in the lactating rats were determined by enzyme immunoassay. Histomorphological alterations of mammary tissues were investigated by hematoxylin and eosin-stained slides. Data were analyzed by one-way ANOVA tests and P0.05). Conclusion: Pluchea indica leaves revealed lactogenic activity in lactating rats.

Chlamydial infections are one of the most common sexually transmitted bacterial infections worldwide, which is related to serious consequences for the mental, sexual, and reproductive health of women and men. The infection is commonly asymptomatic; consequently, screening programs for infection control have been introduced in some countries. The detection methods of Chlamydia trachomatis infections have evolved since the establishment of the first gold-standard detection method in the 1970s, the culture assay. Over the decades, many efforts were made to find methods with a higher sensitivity, until the 1990s, when, as a result of advances in molecular biology, nucleic acid amplification tests came into use with more sensitivity, and, currently, there are several available with which to detect infection. Therefore, herein, we will review the main methods used for CT detection and the differences between them, in terms of targets, infections that can be detected, sensitivity, and specificity. We will focus on some of the FDA-approved CT detection tests and highlight the major advantages and superiority of using molecular biology techniques. In addition, we will examine the larger challenges and limitations of the methods currently in use and discuss how they might be surpassed. Moreover, in this review, we will describe the next step to carry out after testing positive for CT infection.

(1) Background: The goal of this study was to analyze the reliability and validity of the Portuguese version of the SARC-F in older adults. (2) Methods: A total of 100 participants (77.1 ± 7.36 years, 73% women) were included in the study. In a first phase, the Portuguese SARC-F was adapted following the standardized forward–backward translation procedure, and internal consistency as well as inter-rater and test–retest reliability of the Portuguese SARC-F were analyzed. Secondly, clinical validation was evaluated by comparing the SARC-F total score with five operational definitions of sarcopenia and with other sarcopenia-related measurements. Discriminant validity, with respect to low muscle mass and strength and physical function were analyzed. (3) Results: The Portuguese SAR-F showed acceptable internal consistency (Cronbach α = 0.82), excellent inter-rater reliability (total score), and substantial to excellent test–retest reliability (ICC = 0.891 for the total score). Specificity ranged from 72.5% (FNIH) to 73.4 (IGWS), and negative predictive values went from 91.8% (EWGSOP1) to 97.3% (FNIH), but low sensitivity and positive predictive value were observed. The Portuguese SARC-F showed a moderate ability to discriminate people with low muscle strength (AUC = 0.78) and gait speed (AUC = 0.89). (4) Conclusions: The Portuguese SARC-F is a valid and reliable tool for ruling out sarcopenia in community-dwelling older adults and can discriminate between people with low handgrip strength and gait speed.

Aproxima-se a passos largos a 25ª Conferência Mundial da WONCA, que terá lugar em Lisboa em 2025. Num mundo em constante mudança, a Medicina Geral e Familiar vive também ela tempos de incerteza em vários locais do globo. A luta pela construção e afirmação da nossa especialidade em muitas nações contrasta com os vários ataques de que tem sido alvo em países onde pensávamos estar solidamente estabelecida, numa clara opção pelo facilitismo de quem apenas procura soluções imediatas (e erradas) para problemas complexos, tentando menorizar o valor e importância dos Médicos de Família ao promover falsas alternativas para uma função que todos sabemos ser insubstituível. Hoje, mais do que nunca, é chegada a hora de a Medicina Geral e Familiar se afirmar como essencial para a obtenção de um sistema de saúde forte, coeso e de qualidade, contribuindo assim de forma decisiva para o desenvolvimento sustentável da comunidade global onde nos inserimos.