The Physical Activity Scale for the Elderly (PASE) assesses Physical Activity (PA) levels of older people, providing information on the frequency, duration, and intensity. AIMS:To translate, culturally adapt, and validate the PASE for the Portuguese population. METHODS:Translation and cross-cultural adaptation for the Portuguese population of the PASE, according to the Report of ISPOR Translation and Cultural Adaptation guidelines and metric validation was evaluated using the analysis of reliability and validity. RESULTS:The PASE-PT is a reliable and valid instrument to assess PA levels among the Portuguese population, with excellent test-retest reliability in the various domains and in total, with an ICC between 0.938 and 1.00, an acceptable internal consistency, with Cronbach's alpha of α = 0.695, and ω de McDonald was 0.63 and is significantly related to TUG (r = -0.303) and accelerometer AF levels (r = 0.416). CONCLUSIONS:The PASE-PT is an instrument that can be used in clinical practice and in research studies involving the older population.
Background:Adenotonsillar hypertrophy is a prevalent pediatric condition that may affect children's health due to its association with obstructive sleep-disordered breathing (OSDB). This can negatively affect sleep quality, daytime behavior, neurocognitive development, and growth. This study aimed to evaluate the impact of adenotonsillectomy on children's sleep habits and behavior. A secondary objective was to explore differences in outcomes between children undergoing surgery for recurrent upper respiratory tract infections (URTIs) versus those with OSDB. Methods:A prospective longitudinal observational study was conducted from December 2023 to December 2024, enrolling 28 children aged 2-10 years undergoing adenotonsillectomy. Sleep and behavioral changes were assessed preoperatively and postoperatively (3-6 months) using the validated Children's Sleep Habits Questionnaire-adapted Portuguese version and the Strengths and Difficulties Questionnaire-Portuguese version. Paired samples t-tests and general linear models were used for statistical analysis. Results:Significant improvements were observed in several sleep parameters: sleep duration, parasomnias, sleep-related breathing disorders, daytime sleepiness, and the total sleep disturbance index (P < 0.001 for all). In the behavioral domain, hyperactivity was the only subscale to show statistically significant improvement (P = 0.028). Surgical indication (OSDB vs. recurrent URTIs) did not significantly influence most outcomes, except for sleep-related breathing disorders, where greater improvement was noted in the OSDB group, as expected. Conclusion:Adenotonsillectomy positively affects multiple dimensions of sleep, particularly reducing parasomnia episodes and hyperactivity symptoms, regardless of surgical indication. These findings underscore the importance of early recognition and management of pediatric adenotonsillar disorders to promote healthy sleep, improved daytime functioning, and long-term psychosocial development.
Autoimmune thyroid disease (ATD), implicated in infertility and unfavorable outcomes in assisted reproductive technology (ART), is the most prevalent autoimmune disorder among women of reproductive age. This review summarizes the existing evidence on the impact of ATD on infertility and ART outcomes, with a particular focus on screening and therapeutic options. Subclinical hypothyroidism (SCH) frequently coexists with ATD. Thyroid-stimulating hormone (TSH) thresholds for SCH treatment in fertility range from 2.5 to 4.0 mIU/L, causing inconsistencies in clinical management. Although levothyroxine is widely recommended for TSH >4.0 mIU/L, benefits for lower thresholds remain controversial. Immunomodulatory therapies, such as glucocorticoids and intravenous immunoglobulin, have uncertain efficacy in improving ART outcomes. This review highlights the pressing need for standardized diagnostic criteria and therapeutic interventions to optimize fertility outcomes in ATD-positive women, particularly with SCH.
Porphyrias are rare genetic disorders caused by heme biosynthesis pathway enzyme mutations, leading to porphyrin precursors build up in various tissues and diverse symptoms. This review centers on acute hepatic porphyrias (AHP). A MEDLINE through PubMed database literature review was conducted. Systematic reviews, clinical trials, cohort studies, case-control studies, expert reviews, and guidelines were preferred for analysis. There are 4 types of AHP: acute intermittent porphyria, variegate porphyria, hereditary coproporphyria, and δ-aminolevulinic acid dehydratase deficiency porphyria. These conditions primarily present as neurovisceral attacks, characterized by severe abdominal pain, neuropsychiatric symptoms, or skin lesions, predominantly affecting women aged 15 to 50 years. The diagnostic methods include biochemical tests that assess urinary levels of aminolevulinic acid and porphobilinogen. In addition, measuring porphyrin levels in urine or feces can provide more insights into the type of AHP; however, a definitive diagnosis of the specific type is made through genetic testing. Treatment involves high-glucose diets, intravenous hemin for acute attacks, and givosiran for the prophylaxis of frequent attacks. Liver transplantation remains the only curative option. It is crucial to monitor chronic complications associated with hepatic porphyrias, particularly hepatocellular carcinoma, kidney disease, and arterial hypertension. AHP continues to be an underrecognized condition, warranting consideration in individuals experiencing unexplained abdominal pain, neuropathy, psychiatric symptoms, or skin lesions. There is a need for improved diagnostic techniques and treatment options.
Background:Snakebite envenoming is a critical public health issue, recognized as the second-deadliest neglected tropical disease by the World Health Organization. In India, it accounts for an estimated 35,000 to 50,000 deaths annually, exacerbated by reliance on traditional remedies and underreporting of fatalities. This retrospective study analyzes the epidemiological and clinical profiles of snakebite cases at a secondary care hospital in Karnataka. Methods:Snakebite cases reported from January 2020 to April 2023 were analyzed. Data on demographics, clinical manifestations, treatments, complications, and outcomes were collected using case record forms. Descriptive statistics were applied using IBM SPSS Statistics version 25.0. Results:A total of 366 snakebite cases were reported, of which 121 (33.1%) were classified as venomous bites. The common krait (Bungarus caeruleus) was the most frequently identified species. The mean age of victims was 29.50 ± 14.62 years, and men (58.2%) were more frequently affected. Most bites occurred in the morning (51.9%), and 33.3% of victims sought traditional treatment before arriving at the hospital. Among all cases, 78.4% showed improvement, 16.7% were referred to higher centers, 3.3% left against medical advice, and 1.6% succumbed to complications. Conclusions:Snakebite remains a major public health concern in India, particularly among young males. Neurotoxic envenoming, predominantly due to the common krait, was most common in this study area. The frequent use of traditional medicine before seeking medical care underscores the need for community education and early referral to health care facilities. Strengthening awareness, timely administration of antisnake venom, and improved documentation are essential to reduce morbidity and mortality from snakebites.
Background:Around 59,000 rabies deaths still occur annually. According to WHO, India accounts for 36% of the global deaths due to rabies and 65% of the deaths due to rabies in the Southeast Asia region. India, being highly endemic for rabies, has the largest number of animal bites in the World. So, this study will identify the high-risk areas for dog bites in India through geospatial analysis for better outcomes. Objectives:To analyze the trends in dog bite cases in India from 2018 to 2023 and to identify the high-risk areas using geospatial analysis. Methods:A retrospective analysis was conducted using open government data on dog bite cases across Indian states and union territories from 2018 to 2023. A geospatial analysis was done year-wise to identify high-risk areas for dog bites. Results:Dog bite cases peaked in 2018 (7.57 million), followed by a steady decline until 2022 (2.18 million), with an increase in 2023 (2.76 million). Uttar Pradesh, Bihar, and Maharashtra consistently reported the highest burden. Conclusions:While India has made progress in dog bite reduction through vaccination and sterilization programs, the increase in 2023 highlights the need for sustained efforts. Strengthening surveillance, improving public awareness, and ensuring widespread access to rabies prophylaxis are crucial for long-term control. Future research should focus on socioenvironmental determinants and intervention effectiveness to refine public health strategies.
Background:To assess the prevalence and indications for the use of benzodiazepines (BZDs) in patients admitted to an acute geriatric unit and to evaluate changes in their prescriptions. Methods:BZD indications were investigated using computerized clinical records. Changes in BZD prescriptions were assessed at the time of discharge. Results:Among the 165 patients included (mean age: 86.7 years, 71.5% women), 60 (36.4%) were taking BZD on admission, 58.3% of which were considered inappropriate. At discharge, BZD discontinuation was observed in 11.7% and dose reduction was initiated in 18.3%. Conclusions:Most patients using BZD had no clear medical indication. Admission to a geriatric ward resulted in successful discontinuation or dose reduction in a third of patients.
Background:Patients with aortic stenosis undergoing noncardiac surgery pose a dilemma to physicians as they are at an increased risk for complications. This study aims to investigate the effect of aortic stenosis on mortality and other complications in patients with pancreatic cancer undergoing pancreaticoduodenectomy. Methods:We investigated patients with pancreatic cancer undergoing pancreaticoduodenectomy between 2016 and 2019 using the National Inpatient Sample database. The study population was divided based on the presence or absence of aortic stenosis. Multivariate logistic regression analyses were performed to determine factors associated with in-hospital mortality and other complications. Results:Of the 16,150 patients with pancreatic cancer who underwent pancreaticoduodenectomy, 165 patients were diagnosed with aortic stenosis. The mean age of patients with aortic stenosis was significantly higher. Patients with aortic stenosis had a significantly higher in-hospital mortality, occurrence of cardiac arrest, and ICU admission compared with patients without aortic stenosis. There was no difference in mechanical ventilation, hospital charges, and length of stay between the two groups. Conclusions:Aortic stenosis was found to be associated with higher in-hospital mortality and worse outcomes in patients with pancreatic cancer undergoing pancreaticoduodenectomy. Preoperative risk stratification and a multidisciplinary approach to perioperative management, among other measures, should be considered to improve outcomes.
Aim of the study:Hypothermia as the major clinical feature at emergency admission poses a low-frequency yet complex and life-threatening challenge. Limited knowledge about its morbidity, mortality, and influencing factors contributes to the absence of standardized guidelines for rewarming treatments. This retrospective study, the first of its kind in Portugal, aims to fill this gap by examining hypothermic patients in a temperate climate, exploring rewarming treatments, mortality factors, and complications. Methods:Conducted at the Emergency Department of Centro Hospitalar Vila Nova de Gaia/Espinho, the study spanned from January 2008 to December 2020. Sixty-two patients with body temperatures below 35ºC were included. Data collection focused on patient background, clinical presentation, hypothermia mechanism, reperfusion treatment, and laboratory results. Clinical infection was defined based on symptoms and imaging findings. Results:The study revealed a diverse cohort, with an average age of 82 and a mortality rate of 33.9%. Clinical infection was prevalent in 51.6% of patients, mostly respiratory (59.4%). Rewarming treatments varied, and no specific method showed significant advantage. Complications included rhabdomyolysis, and late deaths were primarily attributed to infectious diseases, particularly pneumonia. Conclusions:Taking into account its high mortality rate, accidental hypothermia, demands further research and multicenter data collection for evidence-based treatment strategies. Clinical infection emerged as a significant factor in mortality, prompting a call for increased attention to infectious disease identification and treatment during hypothermic episodes.
Background:The demand for skill development in the surgical field is critical to achieve the best functional and aesthetic patient results. Therefore, the use of simulation models has become necessary and integrated in training, holding substantial importance in skin reconstruction in the head. These models, while varying for realism and training applications, offer a low-stress, safe, and replicable environment for interns and residents to enhance their surgical technique. Objective:The aim of this review was to analyze the various head simulators designed for skin flap and skin graft training. The anatomical representation, selected materials, manufacturing process, and validation approaches were examined to provide an overview of the characteristics of the models. In addition, their impact on training was assessed, categorizing the outcome as positive, negative, or with no effect, based on the findings of the reviewed studies. Methods:Published literature on PubMed and Scopus was gathered through relevant keywords and phrases related to dermatological facial surgery simulators. A narrative synthesis was conducted based on the reporting guidelines of the synthesis without meta-analysis method. The head models were evaluated with overall performance as the primary outcome and confidence, planning and design, and execution as the secondary outcomes. Results:Thirteen studies on head models for skin procedures were identified between 2004 and 2023. All the simulators reviewed demonstrated variability for supported techniques, composition, manufacturing methods, anatomical detail, and validation approach. Eleven studies demonstrated that the models improved at least one of the selected outcomes. No model was targeted for skin graft reconstruction. Furthermore, none of the models integrated objective feedback mechanisms. Conclusions:Simulation was proved to enhance the surgical training of dermatological reconstructions in the head, despite variations in realism, complexity and production process. Future efforts should prioritize higher anatomical accuracy, cost-efficiency, and integration of feedback mechanisms to improve the educational value of these tools.
Background:Young people are disproportionately affected by human immunodeficiency virus (HIV) despite recent improvements in biomedical prevention strategies. Pre-exposure prophylaxis (PrEP) is an innovative prevention method that has shown significant promise in the fight against HIV. However, there is limited understanding of young people's knowledge and use of PrEP. This study assessed the knowledge, attitude, and uptake of PrEP among students in tertiary institutions in Calabar Metropolis, Nigeria. Methods:This study used a cross-sectional descriptive design to assess the knowledge, attitude, and uptake of PrEP among 420 students who were recruited using a multistage sampling technique. A structured questionnaire was utilized to obtain relevant data from participants on PrEP. Data were exported to and analyzed using Statistical Product and Service Solution (SPSS) version 26 to produce descriptive and inferential statistics. Results:Among respondents who have heard about PrEP (51.7%), more than half (58.1%) had a high level of knowledge of PrEP. Most of the respondents (84.3%) were willing to use PrEP in the future. PrEP use among the sexually active participants was poor, as only 13 (6%) have ever used it. Factors affecting the uptake of PrEP include lack of information on where and how to access PrEP (48.3%), lack of PrEP knowledge (46.5%), friend's disapproval (44.6%), unavailability (45%), fear of side effects (38.2%), and perception that PrEP could be expensive. Chi-square analysis showed that age (P = 0.033) and tribe (P < 0.001) were significantly associated with uptake of PrEP among participants. Conclusion:This study highlights the need to address abysmal PrEP uptake among participants by improving awareness and knowledge and translating participants' willingness to use PrEP into service uptake. Equally critical is leveraging multifaceted approaches to tackle identified barriers mitigating the use of PrEP among this group, whose vulnerability to HIV infection remains high.
The COVID-19 pandemic impacted considerably university students' health and well-being, justifying the development and use of validated measuring tools to analyse and assess mental/physical health, and well-being throughout consecutive confinements (or lockdowns), or any other endured stressful periods. This study aims to describe the translation, the cultural adaptation, and the validation of a short questionnaire to assess changes in lifestyle-related behavior, due to the COVID-19 pandemic, in Portuguese university students. We enrolled 128 university students (mean age: 38.3 [13.0] studying at/attending the Portuguese Catholic University). The validation study included Cronbach alpha for the whole scale, corrected item-total correlations, and Cronbach alpha to evaluate the scale reliability whenever items were deleted. Exploratory factor analysis was performed, and 3 factors were extracted through the principal component extraction with varimax rotation. Communalities were also observed. The mean and standard deviation of the total questionnaire score was -1.73 (6.65). No difference was seen between genders. However, participants who already had COVID-19 symptoms, and participants who perceived their health as worse than in the prepandemic period, presented lower questionnaire scores. Internal consistency of 0.74, as measured by Cronbach alpha, was considered as acceptable. Exploratory factor analysis corroborated the validity of the tool. This short questionnaire could be applied to detect changes in lifestyle-related behavior throughout stressful situations in a Portuguese university student's population.
Intravenous (IV) fluid therapy plays a vital role in modern medical practice, particularly in critical care management. This review aims to summarize the composition, indications, and contraindications of IV fluids, serving as a useful resource for healthcare professionals. Review of the literature published in MEDLINE using PubMed and Web of Science, between 2009 and 2024. Systematic reviews, meta-analyses, expert reviews, and guidelines were preferred for analysis. IV fluids can be administered for various reasons, including resuscitation, correction of electrolyte imbalances, or more critical cases. They can be divided into 2 categories: crystalloids and colloids. Crystalloids, in turn, can be subdivided into unbalanced solutions, such as salines (0.45%, 0.9%, 3%, and 20%) and dextrose 5%, or balanced solutions, such as Ringer lactate and polyelectrolytic solutions. Colloids can be derived from plasma, such as 5% albumin, or semisynthetic, such as 4% modified fluid gelatin. Crystalloids are generally more cost-effective, have a lower risk of allergic reactions, and are more readily available than colloids. However, the use of each solution should be individualized based on the patient's specific needs and corresponding conditions. It is essential to have a thorough understanding of available IV fluid solutions to select the best option for each patient's condition at any given time. This review summarizes the most relevant information to guide these decisions. Future research should develop IV fluids that combine the benefits of colloids and crystalloids for safer, more personalized, and cost-effective treatments.
Background:Malignant mesothelioma is a rare, aggressive neoplasm arising from mesothelial cells of the pleura, peritoneum, pericardium, or tunica vaginalis. The primary risk factor is asbestos exposure, particularly occupational. Given its long latency period, the persistence of asbestos sources despite legislation, and recognition of other risk factors, new cases are expected to emerge annually. This study retrospectively analyses the incidence and characteristics of mesothelioma cases diagnosed over 36 years in a hospital in northern Portugal, along with a sociodemographic description of this population. Methods:Patients diagnosed with mesothelioma (International Classification of Diseases for Oncology morphological code M-905x/3) were identified through the National Oncological Registry. Collected data included sex, age at diagnosis, year of diagnosis, tumor location, and histological subtype. Medical records were reviewed for relevant personal and occupational histories. Results:A total of 82 patients were diagnosed with mesothelioma between 1988 and 2023: 11 cases up to 1999, 29 from 2000 to 2011, and 42 from 2012 to 2023. Of them, 69.51% (n = 57) were male, with a mean age at diagnosis of 67 ± 13 years [range: 28-85]. Diagnoses occurred in 12.20% (n = 10) younger than 50 years, 35.37% (n = 29) between 50-69, and 52.44% (n = 43) older than 70 years. Pleural involvement was observed in 86.59% (n = 71) and peritoneal in 13.41% (n = 11). Histological subtypes included epithelioid (34.15%; n = 28), biphasic (19.51%; n = 16), sarcomatoid (14.63%; n = 12), and unknown (31.71%; n = 26). Occupational history was identifiable in 40.24% (n = 33); 20 had probable asbestos exposure. Two cases were linked to nonoccupational causes. Conclusions:Despite asbestos bans, mesothelioma remains a public health concern due to its latency and persistent exposure sources. Cases in younger individuals or women highlight the need to investigate environmental contamination or alternative etiologies. Broader, prospective studies are needed to better understand the disease's evolution and determinants.
Background:Reducing stillbirth and infant mortality rates has become the primary focus of global public health initiatives to improve maternal and child health. This study aimed to investigate the temporal and spatial variations of stillbirth and infant mortality in Karnataka using the Civil Registration System (CRS) reports, examining trends from 1971 to 2022. Methods:District-wise summaries of stillbirth and infant mortality rates from CRS reports were analyzed using geospatial techniques, including choropleth mapping and spatial autocorrelation, to assess their distribution across Karnataka districts for selected years (2001, 2010, and 2022). Results:The findings reveal distinct temporal patterns in stillbirth rates over the study period, allowing for the identification of areas of concern. Dharwad district exhibited the highest stillbirth rate (16.67 per 1,000 total births), whereas Chamarajanagara reported highest infant mortality rate (21.88 infant deaths per 1,000 live births) in 2022. As per 2022 CRS reports, both stillbirth and infant mortality rates were highest in Dharwad, Gadag, Davangere, and Chitradurga districts. Spatial analysis techniques highlight clusters and disparities in stillbirth occurrences among different districts, providing valuable insights into regional variations. Conclusions:This study highlights a declining trend in the number of stillbirths and reveals substantial spatial disparities in both stillbirth and infant mortality rates across Karnataka. The identification of high-burden districts such as Dharwad, Gadag, Davangere, and Chitradurga emphasizes the need for geographically targeted strategies to improve maternal and child health outcomes.
