The Centro Hospitalar de Coimbra is a hospital centre in Coimbra, Portugal. This complex has a broad range of clinical services and medical specialties distributed across three main hospitals: Hospital Geral (General Hospital), also known as Hospital dos Covões, Maternidade Bissaya Barreto (Maternity) and Hospital Pediátrico (Pediatric Hospital). It is a branch of the larger Centro Hospitalar e Universitário de Coimbra, a merged institution created during the eruption of the European sovereign debt crisis and the Portuguese economic and financial crisis in 2012, that reorganized both the Centro and the Coimbra University Hospitals..
IntroductionImmune-mediated thrombotic thrombocytopenic purpura (iTTP) is a life-threatening thrombotic microangiopathy resulting from severe ADAMTS13 deficiency. Caplacizumab accelerates platelet recovery, but ~15% of patients remain refractory, and endothelial/microvascular injury or low ADAMTS13 activity may persist despite remission, highlighting the need for biomarkers. We evaluated the Endothelial Activation and Stress Index (EASIX), an endothelial dysfunction surrogate, dynamics and ability to predict refractoriness and mortality in iTTP.MethodsFifty-five adults receiving ≥2 therapies (corticosteroids, plasma exchange, rituximab, and/or caplacizumab) were studied. Clinical and laboratory data were collected at baseline, days 1–2, 7, 14, 21, 28, 35, and at treatment discontinuation, including clinical or ADAMTS13 relapses. EASIX was calculated at each time point; logistic regression and ROC analyses evaluated its predictive performance for refractoriness and mortality. ResultsMedian age was 47 years; 13% were refractory, and 7% died. In responders, EASIX dropped below 1 by day 7, earlier than ADAMTS13 recovery (day 21). Clinical relapses showed EASIX spikes (median 13.2), unlike ADAMTS13-only relapses. Baseline EASIX was higher in refractory patients (752 vs. 91; p=0.007), remaining elevated at days 7 and 14. Higher pre-treatment EASIX predicted refractoriness (OR = 1.003; p=0.021; AUC = 0.811; sensitivity 100%; specificity 58.7%) and mortality (OR = 1.004; p=0.027). DiscussionEASIX may help predict refractoriness and death, improving monitoring in iTTP.
Introduction: Evidence regarding the benefit of endovascular therapy (EVT) in patients with acute ischemic stroke (AIS) due to isolated cervical internal carotid artery occlusion (c-ICA-O) is lacking. We assessed the outcomes and safety of EVT in patients with isolated c-ICA-O. Methods: Retrospective multicenter cohort study of patients with an AIS due to isolated c-ICA-O, within 24-h since last-seen-well. Comparisons were made between EVT and best medical therapy (BMT). The primary outcome was 3-months modified Rankin Scale (mRS) ordinal shift. Secondary outcomes included 3-month favorable outcome (mRS 0–2, or return to pre-stroke mRS), symptomatic intracranial hemorrhage (sICH) and any parenchymal hemorrhage. Outcomes were compared combining inverse probability of treatment weighting with regression models and propensity score matching (PSM) as sensitivity analysis. Results: We analyzed 998 patients (66.2% male, mean age 71.1 ± 13.2 years). 487 (48.8%) patients received EVT and 511 (51.2%) received BMT. Patients receiving EVT had a higher admission NIHSS [13 (7–18) vs 5 (2–13)] compared to BMT. There was no difference between EVT and BMT groups in 3-month mRS shift (adjusted common odds ratio [OR], 1.01 [95% CI 0.76–1.34]) and favorable outcome (adjusted OR [aOR] 1.16 [95% CI 0.84–1.60]). No patient (0%) in the BMT group had sICH versus 1.6% in the EVT group. Parenchymal hemorrhage was numerically higher in EVT patients (2.7% vs 0.6%; aOR 3.85 [95% CI 0.98–15.23]). PSM analysis revealed similar results. Discussion and conclusion: In patients with isolated c-ICA-O, EVT was associated with similar odds of disability and intracranial bleeding compared to BMT. Randomized-controlled clinical trials in patients with isolated c-ICA-O are warranted.
BACKGROUND:Morton's interdigital neuroma, caused by compression of the interdigital nerve, often requires surgery when conservative treatment fail. This study compared open neurectomy and percutaneous intermetatarsal ligament release (PILR), focusing on various predictive factors. METHODS:A retrospective study, comprising 46 patients (58 feet) with Morton's neuroma who underwent either open excision (n = 24) or PILR (n = 22) from 2012 to 2022. Data included demographics, MRI-measured neuroma size, complications, and revision surgery. Outcomes were assessed using the Visual Analog Scale (VAS), Foot and Ankle Ability Measure (FAAM), and satisfaction scores. RESULTS:Open excision yielded better outcomes than PILR for neuromas larger than 7.40 mm, with lower VAS scores (2.3 vs. 3.9), higher FAAM scores (87 vs. 72), and greater satisfaction (3.2 vs. 2.1). Neuroma width predicted outcomes in the PILR group. CONCLUSION:Open excision is superior for larger neuromas, while PILR may suit smaller ones (<7.40 mm). LEVEL OF EVIDENCE:Level III cohort study CLINICAL RELEVANCE: This study highlights the importance of neuroma width in determining the success of percutaneous intermetatarsal ligament release (PILR). Our findings suggest that PILR may be more appropriate for smaller neuromas (<7.40 mm), while open excision offers better outcomes for larger neuromas. This insight could guide surgeons in selecting the most suitable surgical approach, optimizing patient outcomes, and minimizing complications.
Purpose Health literacy is a current Public Health priority in Portugal. The participation of well-informed patients in their care and shared decision making are essential, especially in chronic aggressive and debilitating pathologies such as recurrent or metastatic (R/M) Head and Neck Squamous Cell Carcinoma (HNSCC). Aims This study aimed to characterize R/M HNSCC patients’ and caregivers’ information needs identified by healthcare professionals (HCPs). Methods Two online Focus Groups, one with only medical doctors and the other with other HCPs involved in the treatment of R/M HNSCC patients, were conducted, using a modified Metaplan, Lean or adapted PDCA methodology. The discussions were audio recorded in full and content analysis was performed using ATLAS.ti qualitative data analysis software. Results Topics addressed were diagnosis, treatment, quality of life, and global evaluation. In general, all experts agreed that only essential information should be cautiously given, according to patients’ and caregivers’ wishes. It was consensual that patients are given the necessary information to adhere to treatment. Two main barriers were identified: one barrier was associated with verbal communication due to the lack of health literacy of these patients, and the other barrier regarded healthcare access. It was also considered important to remind patients of the daily and social activities that they could and should maintain, as well as providing sufficient social resources and problem-solving training to caregivers. Conclusions This qualitative study highlights the complexity of R/M HNSCC patients’ care. Immediate availability of psychologists and psychiatrists should be implemented in all centers that treat HNSCC patients. The differences found between the physicians' Focus Group and other HCPs’ Focus Group in some of the addressed topics emphasize the importance of a multidisciplinary and holistic approach, in a biomedical model integrated with a biopsychosocial model.
