Abstract The healthcare context is undergoing a significant transformation, facing a series of complex and unprecedented challenges. This transformation is triggered by accessibility constraints to healthcare services, increased expectations from patients and sing financial burdens. Rather than being seen as unsolvable obstacles, these challenges can be perceived as powerful stimuli, encouraging the search for innovative and creative solutions, especially in a context where new digital technologies applicable to healthcare are emerging. In the context of this article, which shares a transformative vision of healthcare provision, we describe a pilot program developed for the Heart Failure ambulatory of the Internal Medicine Department at the Braga Local Health Unit (ULS-Braga). This proposal encompasses not only treatment, but also proactive health promotion, based on an approach that incorporates cutting-edge digital technology. The overall aim is to significantly expand the scope of outpatient services and provide innovative home care, bringing it closer to the specific needs of (healthy and sick) individuals.

Resumo O contexto da prestação de cuidados de saúde está a sofrer uma transformação significativa, enfrentando uma série de desafios complexos e sem precedentes. Esta transformação relaciona-se com preocupações prementes relacionadas com a acessibilidade aos serviços de saúde, a adaptação às expectativas dos doentes em constante evolução e aos crescentes encargos financeiros. Em vez de serem vistos como obstáculos intransponíveis, esses desafios podem ser percebidos como estímulos poderosos, estimulando a procura de soluções inovadoras e criativas, sobretudo num contexto onde existem novas tecnologias digitais com aplicabilidade à prestação de cuidados de saúde. No contexto deste artigo, que partilha uma visão transformadora da prestação de cuidados de saúde, descreve-se a proposta piloto desenvolvida para a consulta de Insufi-ciência Cardíaca do serviço de Medicina Interna, na Unidade Local de Saúde de Braga (ULS-Braga). Esta proposta engloba não só o tratamento, mas também a promoção proativa da saúde, assente numa abordagem que incorpora tecnologia digital de ponta. O objetivo global é expandir significativamente o alcance dos serviços de ambulatório e prestar cuidados domiciliares inovadores, aproximando-os mais das necessidades específicas das pessoas (saudáveis e com doença).

ABSTRACT Palliative care (PC) is a differentiated healthcare area focused on promoting comfort, and preventing and alleviating suffering. End-of-life (EOL) care is integrated into this branch of medicine and will have great relevance in the near future as a result of increased life expectancy and highly disabling chronic diseases. It is imperative that healthcare professionals have the capacity and preparation to guarantee this care. The objective of this work is to propose a model that relates spirituality, emotional intelligence, PC knowledge, self-efficacy, and the ability of doctors and nurses to provide EOL care. A questionnaire was applied to collect data. The relationships between these latent variables were evaluated using structural equation models. The results indicate that self-efficacy, spirituality and knowledge positively influence the ability to provide EOL care. Emotional intelligence and spirituality directly and positively affect self-efficacy. Emotional intelligence has an indirect effect, mediated by self-efficacy, on the ability to provide EOL care.

RESUMO Os cuidados paliativos (CP) são uma área diferenciada do cuidar em saúde, centrada na promoção do conforto, na prevenção e no alívio do sofrimento. Os cuidados em fim de vida (CFV) estão integrados neste ramo da medicina e terão num futuro próximo uma grande relevância, fruto do aumento da expectativa de vida e de doenças crónicas altamente incapacitantes. Torna-se imperativo que os profissionais de saúde tenham capacidade e preparação para assegurarem estes cuidados. O objetivo deste trabalho é propor um modelo que relacione a espiritualidade, a inteligência emocional, o conhecimento em CP, autoeficácia e capacidade para prestar CFV por médicos e enfermeiros. Para a recolha de dados foi utilizado um questionário. As relações entre estas variáveis latentes foram avaliadas utilizando modelos de equações estruturais. Os resultados indicam que a autoeficácia, a espiritualidade e o conhecimento influenciam positivamente a capacidade de prestação de CFV. A inteligência emocional e a espiritualidade afetam de forma direta e positiva a autoeficácia. A inteligência emocional tem um efeito indireto, mediado pela autoeficácia sobre a capacidade de prestação de CFV.

ABSTRACT This work aims to describe and analyse the telephone consultation (TC) for palliative care (PC) patients at home and their caregivers provided by a PC team in Portugal in 2020. This study is observational, retrospective, cross-sectional and correlational, conforming to the STROBE checklist. Records of calls between 01/01/20 and 31/12/20 and clinical process consultations were analysed for trend clearance, including cross-tabulations to look for associations between call characteristics. Call data included information on the caller, patient, problem, utility and choice of service. The data were analysed using the statistical program SPSS software (V.26). During 2020, 494 calls were answered. The majority of the contacts were made by relatives and answered by nurses. The main reason for the contact was symptom management. The TC solved 92.91% of the problems, allowing the patient to remain at home, which is associated with a decrease in the number of hospitalisation days and admissions to the emergency department. The identification of the causes that motivated the calls and who solved them allows us to anticipate some needs that may be less controlled at home. Call distribution time may help allocate human resources better. TC is a viable alternative to traditional hospital follow-ups.

Resumo Introdução: O sarcoma embrionário do fígado (SEF) é uma neoplasia rara do fígado que ocorre principalmente em idades pediátricas. Fazer o diagnóstico correto pode ser um desafio, uma vez que os achados laboratoriais e radiológicos são muitas vezes inespecíficos e o imunofenótipo desta entidade é mal definido e algo variável. Apresentação do caso: Foi detetada em tomografia computorizada (CT) abdominal uma massa epigástrica volumosa numa mulher de 43 anos apresentando dor abdom-inal e distensão abdominal. A massa foi biopsada e submetida a estudo histopatológico. Microscopicamente, o tumor tinha características sarcomatoides e apresentava células multinucleadas com glóbulos hialinos com positividade para ácido periódico Schiff (APS). O estudo imunohistoquímico revelou positividade para vimentina, CD10, glipicano-3 e α1-antitripsina e negatividade para queratinas e marcadores de diferenciação muscular, adipocítica e melanocítica. Discussão/Conclusão: O SEF no adulto é uma raridade e o seu diagnóstico requer a ex-clusão de outras entidades. Embora algumas características microscópicas sejam muito comuns, estas permane-cem inespecíficas. A principal característica é a presença de células multinucleadas com glóbulos hialinos positivos para APS. Ainda que o estudo imunohistoquímico seja fundamental, o imunofenótipo também carece de especificidade e o SEF pode ter marcação variável para glipicano-3 e marcadores de diferenciação epitelial ou muscular. Apesar de ter sido descrito há mais de três décadas, o prognóstico e o tratamento ideal ainda não estão bem definidos, mas a cirurgia tem apresentado resultados favoráveis.

Abstract Introduction: Embryonal sarcoma of the liver (ESL) is a rare neoplasm of the liver occurring mainly in paediatric ages. Making the correct diagnosis can be challenging as the laboratory and radiological findings that are often nonspecific, and the tumour immunophenotype is poorly defined and even somewhat variable. Case Presentation: A large epigastric mass was detected in a computerized tomography scan of a 43-year-old woman presenting with abdominal pain and bloating. The mass was biopsied and submitted to histo-pathological study. Microscopically the tumour had sarcomatoid features and showed multinucleated cells with periodic acid-Schiff (PAS)-positive globules. Immunostaining revealed positivity for vimentin, CD10, glypican-3, and α1-antitrypsin and negativity for keratins, muscle, adipocytic, and melanocytic differentiation markers. The patient was then submitted to a left hepatectomy with similar histological findings. Discussion: ESL in adults is a rarity and its diagnosis requires the exclusion of other entities. While some microscopic features are very common, they remain nonspecific. The main feature is the presence of multinucleated cells with PAS-positive hyaline globules. While ancillary testing is key, the immunophenotype also lacks specificity and ESL may have variable staining for glypican-3 and epithelial or muscle differentiation markers. Although it has been described for more than 3 decades, the prognosis and optimal treatment are still not well defined, but surgery has yielded favourable results.

RESUMO Objetivo Comparar o padrão de fala e voz de indivíduos com Miastenia Gravis (MG) em um intervalo de quatro anos e correlacionar com aspectos clínicos da doença. Método A coleta de dados foi realizada ao longo de 4 anos. A avaliação clínica foi composta pelo Quantitative Myasthenia Gravis Score (QMGS), pela Myasthenia Gravis Foundation of America Classification (MGFA) e pela escala de qualidade de vida para Miastenia Gravis (MG-QOL). A avaliação da fala foi composta por gravação de tarefas, análise perceptivo-auditiva e análise acústica. A amostra final foi composta por 10 indivíduos em MG e 10 indivíduos no grupo controle (GC), pareados por sexo (distribuição igualitária) e idade (p=0,949). Resultados Após 4 anos, os indivíduos com MG apresentaram estabilidade clínica, aumento do diagnóstico de disartria leve e moderada (de 40% para 90% dos sujeitos) e diminuição significativa no desempenho dos subsistemas da fala: respiração, fonação e articulação. Na análise acústica, houve declínio do padrão articulatório (taxa de fala p=0,047, taxa de articulação p=0,007, duração média das sílabas p=0,007) e qualidade vocal (jitter aumentado p=0,022). Houve diferença significativa nas variáveis fonatórias (shimmer e harmonic-to-noise ratio) entre os grupos MG e GC na comparação do seguimento. Conclusão Indivíduos com MG apresentaram declínio no padrão de fala em um intervalo de quatro anos, com aumento no número de disártricos (leve e moderado). Mesmo com a estabilidade da doença, houve piora dos subsistemas respiratório, fonatório e articulatório. Não houve correlação entre o padrão de fala e as características clínicas da doença (gravidade e escala motora). (MG QMGS, QMGS , (QMGS) MGFA (MGFA MGQOL. MGQOL QOL . (MG-QOL) tarefas perceptivoauditiva perceptivo auditiva acústica 1 GC, (GC) distribuição igualitária p=0,949. p0949 p p=0,949 0 949 (p=0,949) 40 90 sujeitos respiração p0047 047 p=0,047 p0007 007 p=0,007 jitter p=0,022. p0022 p=0,022 022 p=0,022) shimmer harmonictonoise harmonic to noise ratio seguimento moderado. moderado moderado) respiratório gravidade motora. motora motora) (QMGS (MG-QOL (GC p094 p=0,94 94 (p=0,949 9 p004 04 p=0,04 p000 00 p=0,00 p002 p=0,02 02 p09 p=0,9 (p=0,94 p00 p=0,0 p0 p=0, (p=0,9 p=0 (p=0, p= (p=0 (p= (p

ABSTRACT Purpose To compare the speech and voice patterns of myasthenia gravis (MG) patients over four years, and correlate the results with clinical aspects of the disease. Methods Data was collected for 4 years. The clinical assessment tools included the Quantitative Myasthenia Gravis (QMG) score, the Myasthenia Gravis Foundation of America (MGFA) clinical classification, and the Myasthenia Gravis Quality of Life 15-item Scale (MG-QoL). To assess speech, the recorded speaking tasks were analyzed acoustically and given auditory-perceptual ratings. Sex (equal distribution) and age (p=0.949) were used as matching criteria in the final sample, which consisted of 10 individuals in the MG group (MGG) and 10 individuals in the control group (CG). Results After 4 years, the MG participants presented stable health status, increased mild and moderate dysarthria (from 40% to 90% of the subjects), and a significant deterioration in the respiration, phonation, and articulation subsystems. The acoustic analysis showed a decline in articulatory patterns (speech rate p=0.047, articulation rate p=0.007, mean syllable duration p=0.007) and vocal quality (increased jitter p=0.022). In the follow-up comparison, there was a significant difference between the phonation variables (shimmer and harmonic-to-noise ratio) of the MGG and CG. Conclusion The MG patients presented a decline in speech over four years and an increase in mild and moderate dysarthria. Despite presenting stable health status, their respiratory, phonatory, and articulatory subsystems worsened. There was no correlation between speech patterns and clinical characteristics of the disease (severity and motor scale). (MG QMG (QMG score MGFA (MGFA classification 15item item 15 MGQoL. MGQoL QoL . (MG-QoL) auditoryperceptual auditory perceptual ratings equal distribution p=0.949 p0949 p 0 949 (p=0.949 sample 1 (MGG CG (CG) status from 40 90 subjects, subjects , subjects) respiration p0047 047 p=0.047 p0007 007 p=0.007 p=0.022. p0022 p=0.022 022 p=0.022) followup follow up comparison shimmer harmonictonoise harmonic noise ratio respiratory phonatory worsened severity scale. scale scale) (MG-QoL p=0.94 p094 94 (p=0.94 (CG 9 p004 04 p=0.04 p000 00 p=0.00 p002 p=0.02 02 p=0.9 p09 (p=0.9 p00 p=0.0 p=0. p0 (p=0. p=0 (p=0 p= (p= (p

ABSTRACT BACKGROUND: Advance Directive documents allow citizens to choose the treatments they want for end-of-life care without considering therapeutic futility. OBJECTIVES: To analyze patients’ and caregivers’ answers to Advance Directives and understand their expectations regarding their decisions. DESIGN AND SETTING: This study analyzed participants’ answers to a previously published trial, conceived to test the document’s efficacy as a communication tool. METHODS: Sixty palliative patients and 60 caregivers (n = 120) registered their preferences in the Advance Directive document and expressed their expectations regarding whether to receive the chosen treatments. RESULTS: In the patient and caregiver groups, 30% and 23.3% wanted to receive cardiorespiratory resuscitation; 23.3% and 25% wanted to receive artificial organ support; and 40% and 35% chose to receive artificial feeding and hydration, respectively. The participants ignored the concept of therapeutic futility and expected to receive invasive treatments. The concept of therapeutic futility should be addressed and discussed with both the patients and caregivers. Legal Advanced Directive documents should be made clear to reduce misinterpretations and potential legal conflicts. CONCLUSION: The authors suggest that all citizens should be clarified regarding the futility concept before filling out the Advance Directives and propose a grammatical change in the document, replacing the phrase “Health Care to Receive / Not to Receive” with the sentence “Health Care to Accept / Refuse” so that patients cannot demand treatments, but instead accept or refuse the proposed therapeutic plans. TRIAL REGISTRATION: ClinicalTrials.gov ID NCT05090072 URL: https://clinicaltrials.gov/ct2/show/NCT05090072. BACKGROUND endoflife end life OBJECTIVES decisions SETTING trial s tool METHODS 6 n 120 RESULTS groups 30 233 23 3 23.3 resuscitation 25 support 40 35 hydration respectively conflicts CONCLUSION Health Refuse plans REGISTRATION ClinicalTrialsgov ClinicalTrials gov NCT NCT0509007 URL https//clinicaltrials.gov/ct2/show/NCT05090072. httpsclinicaltrialsgovct2showNCT05090072 httpsclinicaltrialsgovctshowNCT https //clinicaltrials.gov/ct2/show/NCT05090072. clinicaltrials ct2 show ct https://clinicaltrials.gov/ct2/show/NCT05090072 12 2 23. 4 NCT050900 https//clinicaltrials.gov/ct2/show/NCT05090072 httpsclinicaltrialsgovct showNCT httpsclinicaltrialsgovct2showNCT0509007 clinicaltrialsgovct2showNCT05090072 clinicaltrialsgovctshowNCT //clinicaltrials.gov/ct2/show/NCT05090072 https://clinicaltrials.gov/ct2/show/NCT0509007 1 NCT05090 https//clinicaltrials.gov/ct2/show/NCT0509007 httpsclinicaltrialsgovct2showNCT050900 clinicaltrialsgovct clinicaltrialsgovct2showNCT0509007 //clinicaltrials.gov/ct2/show/NCT0509007 https://clinicaltrials.gov/ct2/show/NCT050900 NCT0509 https//clinicaltrials.gov/ct2/show/NCT050900 httpsclinicaltrialsgovct2showNCT05090 clinicaltrialsgovct2showNCT050900 //clinicaltrials.gov/ct2/show/NCT050900 https://clinicaltrials.gov/ct2/show/NCT05090 NCT050 https//clinicaltrials.gov/ct2/show/NCT05090 httpsclinicaltrialsgovct2showNCT0509 clinicaltrialsgovct2showNCT05090 //clinicaltrials.gov/ct2/show/NCT05090 https://clinicaltrials.gov/ct2/show/NCT0509 NCT05 https//clinicaltrials.gov/ct2/show/NCT0509 httpsclinicaltrialsgovct2showNCT050 clinicaltrialsgovct2showNCT0509 //clinicaltrials.gov/ct2/show/NCT0509 https://clinicaltrials.gov/ct2/show/NCT050 NCT0 https//clinicaltrials.gov/ct2/show/NCT050 httpsclinicaltrialsgovct2showNCT05 clinicaltrialsgovct2showNCT050 //clinicaltrials.gov/ct2/show/NCT050 https://clinicaltrials.gov/ct2/show/NCT05 https//clinicaltrials.gov/ct2/show/NCT05 httpsclinicaltrialsgovct2showNCT0 clinicaltrialsgovct2showNCT05 //clinicaltrials.gov/ct2/show/NCT05 https://clinicaltrials.gov/ct2/show/NCT0 https//clinicaltrials.gov/ct2/show/NCT0 httpsclinicaltrialsgovct2showNCT clinicaltrialsgovct2showNCT0 //clinicaltrials.gov/ct2/show/NCT0 https://clinicaltrials.gov/ct2/show/NCT https//clinicaltrials.gov/ct2/show/NCT clinicaltrialsgovct2showNCT //clinicaltrials.gov/ct2/show/NCT

ABSTRACT. Monosporascus cannonballus Pollack & Uecker and Macrophomina phaseolina Tassi (Goid) are phytopathogenic fungi responsible for causing "root rot and vine decline" in melon (Cucumis melo L.). Currently, cultural management practices are predominantly employed to control these pathogens, as the use of pesticides not only has detrimental environmental impacts but has also proven ineffective against them. These fungi have already undergone molecular characterization, and their genomes are now available, enabling the targeted search for protein targets. Therefore, this study aimed to identify novel target proteins that can serve as a foundation for the development of fungicides for effectively managing these pathogens. The genomes of M. cannonballus (assembly ASM415492v1) and M. phaseolina (assembly ASM2087553v1) were subjected to comprehensive analysis, filtration, and comparison. The proteomes of both fungi were clustered based on functional criteria, including putative and hypothetical functions, cell localization, and function-structure relationships. The selection process for homologs in the fungal genomes included a structural search. In the case of M. cannonballus, a total of 17,518 proteins were re-annotated, and among them, 13 candidate targets were identified. As for M. phaseolina, 30,226 initial proteins were analyzed, leading to the identification of 10 potential target proteins. This study thus provides new insights into the molecular functions of these potential targets, with the further validation of inhibitors through experimental methods holding promise for expanding our knowledge in this area. ABSTRACT Goid (Goid root decline Cucumis L.. L L. . L.) Currently pathogens them characterization available Therefore M assembly ASM415492v1 ASMv ASM v ASM2087553v1 analysis filtration comparison criteria localization functionstructure function structure relationships 17518 17 518 17,51 reannotated, reannotated re annotated, annotated re-annotated 1 identified 30226 30 226 30,22 analyzed area ASM415492v ASM2087553v 1751 51 17,5 3022 3 22 30,2 175 5 17, 302 2 30,

Abstract High-risk human papillomavirus (HPV) infection is associated with cervical cancer while low-risk HPV strains mostly cause benign lesions. Multiple studies have also associated HPV with coronary artery (CAD) disease in women. Furthermore, the climacteric period in women, triggers chronic inflammation and has major implications for CAD and associated lipid disorders. The association of HPV with coronary artery disease in climacteric women has few studies, and the objective of this review is to gather and analyse scientific data on the subject. This is an integrative review performed on PubMed and Google Scholar using the keywords “HPV”, “coronary heart disease” and “climacteric”, among these keywords the boolean operator AND and the publication date filter. (2018 onwards). Five articles were found, whose main results show presence of high-risk vaginal HPV in climacteric women. Climacterium and HPV were associated with a three-fold increased risk of CAD, as well as with factors related to menopause that promote atheroma formation, lipid disorders and chronic inflammation. Thus, these results support the association between HPV infection and CAD in climacteric women, possibly via chronic inflammation, hormonal factors related to menopause and dyslipidemia. Highrisk High (HPV lowrisk low lesions (CAD Furthermore subject HPV, , “HPV” climacteric, “climacteric” filter 2018 (201 onwards. onwards . onwards) found highrisk high threefold three fold formation Thus dyslipidemia “HPV “climacteric 201 (20 20 (2 2 (

Abstract Background: The COVID-19 pandemic demanded isolation measures in cases of high disease risk. Objective: To assess the impact of isolation on the anxiety, satisfaction with perceived support, learning and academic achievement of nursing students in the northern region of Portugal. Methodology: This exploratory and quantitative study was conducted with 56 students in isolation due to COVID-19. A self-completion questionnaire was applied to assess the evolution of the anxiety, the satisfaction with the perceived support at the pedagogical and emotional levels and from the Serviço Nacional de Saúde (SNS - National Health Service), and the impact of isolation on learning and academic achievement. Results: This study observed clinically significant levels of anxiety. The participants expressed greater satisfaction with the support received from the educational institution and less satisfaction with the SNS. The absence from school activities negatively impacted their learning and academic achievement. Conclusion: Student isolation impacted anxiety and learning. Higher education institutions must promote students’ mental health.

Resumen Marco contextual: La pandemia de COVID-19 requirió la aplicación de medidas de aislamiento en casos de alto riesgo de enfermedad. Objetivo: Evaluar el impacto del aislamiento en la ansiedad, la satisfacción con el apoyo recibido, el aprendizaje y el rendimiento académico entre los estudiantes de enfermería de la región norte de Portugal. Metodología: Estudio exploratorio y cuantitativo, realizado con 56 estudiantes en aislamiento por COVID-19. Se utilizó un cuestionario de autocumplimentación para evaluar la evolución de la ansiedad, la satisfacción con el apoyo recibido a nivel educativo, emocional y del Sistema Nacional de Salud, y el impacto del aislamiento en el aprendizaje y el rendimiento académico. Resultados: Se notificaron niveles de ansiedad con significancia clínica. Se registró una mayor satisfacción con el apoyo de la institución educativa y una menor satisfacción con el Servicio Nacional de Salud. El absentismo escolar tuvo un impacto negativo en el aprendizaje y el rendimiento académico. Conclusión: El aislamiento de los estudiantes repercutió en la ansiedad y el aprendizaje. Los centros de enseñanza superior deben promover la salud mental de los estudiantes.

Resumo Enquadramento: A pandemia de COVID-19 exigiu a implementação de medidas de isolamento nos casos de alto risco de doença. Objetivo: Avaliar o impacto do isolamento sobre a ansiedade, a satisfação com o apoio percebido, a aprendizagem e o aproveitamento escolar, de estudantes de enfermagem da região norte de Portugal. Metodologia: Estudo exploratório e quantitativo, realizado com 56 estudantes em isolamento devido à COVID-19. Foi aplicado um questionário de autopreenchimento para avaliação da evolução da ansiedade, da satisfação com o apoio percebido, ao nível pedagógico, emocional e do Serviço Nacional de Saúde e do impacto do isolamento na aprendizagem e aproveitamento escolar. Resultados: Foram reportados níveis de ansiedade com significado clínico. Foi referido maior satisfação com o apoio da instituição de ensino e menor com o Serviço Nacional de Saúde. A ausência às atividades letivas teve impacto negativo na aprendizagem e no aproveitamento escolar. Conclusão: O isolamento dos estudantes teve impacto na ansiedade e na aprendizagem. A saúde mental dos estudantes deve ser promovida pelas instituições de ensino superior.

Abstract Background: Mobile applications can be useful in diabetes self-management. Knowing the needs and preferences of users is essential for these tools to provide effective support in this process. Objective: To learn about the experiences, identify needs, and explore the preferences of people with type 2 diabetes mellitus regarding mobile applications to support diabetes self-management. Methodology: Qualitative descriptive study with 12 participants selected using the snowball sampling technique. Data was collected through semi-structured interviews and analyzed using the content analysis technique. Results: Six categories emerged from the analysis: functions and technical characteristics, informative content, self-determination, emotional management, health professional, and facilitating factors. The results suggest poor digital skills, need for access to information, and preference for multifunctional and interactive applications. Conclusion: Despite the limited use of health-related apps, people are interested and realize the benefit of using these tools to manage their diabetes.

Resumen Marco contextual: Las aplicaciones móviles pueden ser útiles para el autocontrol de la diabetes. Conocer las necesidades y preferencias de los usuarios es esencial para que estas herramientas sean un apoyo eficaz en este proceso. Objetivos: Conocer las experiencias, identificar las necesidades y explotar las preferencias de personas con diabetes mellitus tipo 2 relacionadas con las aplicaciones móviles de apoyo a la autogestión de la enfermedad y al régimen terapéutico. Metodología: Estudio descriptivo, de naturaleza cualitativa, con 12 participantes seleccionados por la técnica de muestra de bola de nieve. Datos recogidos por entrevistas semiestructuradas y analizados por la técnica de análisis de contenido. Resultados: Surgieron seis categorías (funciones y características técnicas, contenidos de información, autodeterminación, gestión de emociones, profesional sanitario y factores facilitadores). Los datos sugieren bajas competencias digitales, necesidad de acceso a la información y preferencia por aplicaciones multifuncionales e interactivas. Conclusión: A pesar de la escasa utilización de aplicaciones relacionadas con la salud, las personas muestran interés y perciben el beneficio de utilizar estas herramientas para gestionar su diabetes.

Resumo Enquadramento: As aplicações móveis podem ser úteis para a autogestão da diabetes. Conhecer as necessidades e preferências dos utilizadores é fundamental para que estas ferramentas sejam um suporte efetivo neste processo. Objetivos: Conhecer as experiências, identificar as necessidades e explorar as preferências de pessoas com diabetes mellitus tipo 2 relativamente a aplicações móveis de apoio à autogestão da doença e regime terapêutico. Metodologia: Estudo descritivo, de natureza qualitativa, com 12 participantes recrutados por técnica amostral de bola de neve. Dados recolhidos por entrevistas semiestruturadas e analisados pela técnica de análise de conteúdo. Resultados: Emergiram seis categorias (funções e características técnicas, conteúdos de informação, autodeterminação, gestão de emoções, profissional de saúde e fatores facilitadores). Os dados sugerem baixas competências digitais, necessidade de acesso à informação e a preferência por aplicações multifuncionais e interativas. Conclusão: Apesar da utilização parca de aplicações relacionadas com a saúde, as pessoas assumem interesse e percecionam o benefício de utilizar estas ferramentas para gerir a sua diabetes.

ABSTRACT INTRODUCTION: Sarcopenia is a disease characterized by a progressive and generalized musculoskeletal disorder, with personal, social and economic impacts if left untreated. It is associated with increased likelihood of falls, fractures, physical disability, mortality, and impaired performance of activities of daily living. OBJECTIVES: We aimed to study the frequency of sarcopenia in male patients admitted to the Internal Medicine department by objective (hand grip strength, mid-arm muscle circumference, and calf circumference) and subjective (SARC-F) evaluation and to study the relationship between both. METHODOLOGY: Weight (kg), height (m) were assessed and Body Mass Index was calculated, fat and muscle mass were assessed with skinfold measurement and tissue compressibility (Lipowise® digital skinfold caliper) and hand grip strength with Gripwise®. RESULTS: A total of 150 men were included, with a mean age of 72 years, mean Body Mass Index of 24.2kg/m2, body fat of 21.5%, mid-arm muscle circumference of 24.7cm, calf circumference of 32.0cm, and hand grip strength of 20.3kgF. According to the SARC-F about 52% had sarcopenia, and when evaluated the hand grip strength, mid-arm muscle circumference and calf circumference, 91.5%, 19.5% and 42.6% had criteria suggestive of sarcopenia, respectively. A negative and statistically significant correlation was found between SARC-F score and mid-arm muscle circumference (r=-0.241; p= 0.004), calf circumference (r=-0.269; p= 0.001) and hand grip strength (r=-0.400; p<0.001). CONCLUSIONS: The SARC-F identified fewer patients with the risk of sarcopenia when compared to the hand grip strength. It is concluded that SARC-F should ideally be used in conjunction with other criteria for better identification of sarcopenia.

RESUMO INTRODUÇÃO: A sarcopenia é uma doença que se caracteriza por um distúrbio músculo esquelético progressivo e generalizado, com impacto pessoal, social e económico, se não tratada. Associa-se a maior probabilidade de quedas, fraturas, deficiência física, mortalidade e incapacidade na realização de atividades de vida diárias. OBJETIVOS: Pretendeu-se estudar a frequência de sarcopenia em doentes internados no serviço de Medicina Interna-homens, por avaliação objetiva [força de pressão da mão, circunferência muscular do braço e perímetro geminal] e subjetiva (SARC-F) e estudar a relação entre ambas. METODOLOGIA: Avaliou-se peso (kg), estatura (m) e calculou-se o Índice de Massa Corporal (kg/m2), avaliou-se massa gorda e muscular com medição de pregas cutâneas e compressibilidade de tecidos (lipocalibrador digital Lipowise®) e a força de pressão da mão com o Gripwise®. RESULTADOS: Incluíram-se 150 homens, com idade média de 72 anos, Índice de Massa Corporal médio de 24,2kg/m2, gordura corporal de 21,5%, circunferência muscular do braço de 24,7cm, perímetro geminal de 32,0cm e força de pressão da mão esquerda de 20,3kgF. Segundo o SARC-F cerca de 52% tinha sarcopenia, e quando avaliada a força de pressão da mão, circunferência muscular do braço e perímetro geminal, 91,5%, 19,5% e 42,6% tinham critério sugestivo de sarcopenia, respetivamente. Encontrou-se correlação negativa e estatisticamente significativa entre a pontuação do SARC-F e a circunferência muscular do braço (r=-0,241; p= 0,004), perímetro geminal (r=- 0,269; p= 0,001) e força de pressão da mão (r=-0,400; p <0,001). O SARC-F identificou menor número de doentes com risco de sarcopenia quando comparado à força de pressão da mão. CONCLUSÕES: Conclui-se que o SARC-F deve, idealmente, ser utilizado conjuntamente com outros critérios para uma melhor identificação de sarcopenia.

Resumo Introdução: Incluir doentes com doença hepática asso-ciada ao álcool (DHA) em lista ativa de transplante hep-ático (TH) é desafiante, especialmente pelo risco de recidiva de consumo de álcool pós-TH. O objetivo foi avaliar o consumo de álcool pós-TH num centro de transplantação português. Métodos: Realizamos um estudo transver-sal incluindo doentes submetidos a TH em 2019 no Hospital Curry Cabral, Lisboa, Portugal. Foi realizado um questionário previamente testado e uma tradução validada para o português do Alcohol Use Disorder Identification Test (AUDIT), através de uma chamada telefónica. O consumo de álcool foi definido pelo autorrelato do doente ou por um AUDIT positivo. Resultados: Durante 2019, 122 doentes foram submetidos a TH e 99 responderam ao questionário (junho de 2021). A idade média (SD) foi de 57 (10) anos, 70 doentes (70,7%) eram do sexo masculino e 49 (49,5%) foram submetidos a TH relacionado com DHA. Com uma mediana (IQR) de follow-up de 24 (20-26) meses após o TH-índex, 22 (22,2%) doentes admitiram algum consumo de álcool: 14 beberam mensalmente ou menos e oito beberam 2-4 vezes/mês. Nos dias em que bebiam, 18 consumiam normalmente 1-2 bebidas e os restantes não mais do que 3-4 bebidas. Um doente reportou o consumo de ≥6 bebidas em uma ocasião. Todos os doentes transplantados com consumo alcoólico pós-TH foram considerados de baixo risco (pontuação <8) de acordo com o AUDIT (mediana [IQR] de 1 [1-2]). Nenhum doente reportou problemas relacionados com o álcool, tanto autoinfligido como a terceiros. Os indivíduos transplantados com consumo alcoólico eram mais jovens (53 vs. 59 anos, p = 0,020), o motivo de TH era mais frequentemente não relacionado com DHA (72,7 vs. 44,2%, p = 0,018) e apresentavam mais tabagismo ativo (31,8 vs. 10,4%, p = 0,037) quando comparado com os abstinentes. Conclusão: Na nossa coorte, cerca de um quarto dos doentes transplantados hepáticos consumiram álcool no período pós-transplante precoce, todos com um padrão de baixo risco, de acordo com o AUDIT.

Abstract Background: Listing patients with alcohol-associated liver disease (ALD) for liver transplant (LT) remains challenging especially due to the risk of alcohol resumption post-LT. We aimed to evaluate post-LT alcohol consumption at a Portuguese transplant center. Methods: We conducted a cross-sectional study including LT recipients from 2019 at Curry Cabral Hospital, Lisbon, Portugal. A pretested survey and a validated Portuguese translation of the Alcohol Use Disorder Identification Test (AUDIT) were applied via a telephone call. Alcohol consumption was defined by patients’ self-reports or a positive AUDIT. Results: In 2019, 122 patients underwent LT, and 99 patients answered the survey (June 2021). The mean (SD) age was 57 (10) years, 70 patients (70.7%) were males, and 49 (49.5%) underwent ALD-related LT. During a median (IQR) follow-up of 24 (20-26) months post-index LT, 22 (22.2%) recipients consumed any amount of alcohol: 14 had a drink monthly or less and 8 drank 2-4 times/ month. On drinking days, 18 patients usually consumed 1-2 drinks and the remainder no more than 3-4 drinks. One patient reported having drunk ≥6 drinks on one occasion. All post-LT drinking recipients were considered low risk (score <8) as per the AUDIT score (median [IQR] of 1 [1-2]). No patient reported alcohol-related problems, whether self-inflicted or toward others. Drinking recipients were younger (53 vs. 59 years, p = 0.020), had more non-ALD-related LT (72.7 vs. 44.2%, p = 0.018) and active smoking (31.8 vs. 10.4%, p = 0.037) than abstinent ones. Conclusion: In our cohort, about a quarter of LT recipients consumed alcohol early posttrans-plant, all with a low-risk pattern according to the AUDIT score.

Abstract Introduction: Chimney EVAR (ChEVAR) for the treatment of complex abdominal aortic aneurysm (AAA) has been largely relegated for when fenestrated endografts are unavailable, especially due to durability concerns. However, the off-the-shelf nature of ChEVAR makes it a good option for emergent AAA repair. We report our institutional experience in ChEVAR in an urgent setting. Methods: ChEVAR procedures were collected f rom 2019 to 2023 in a tertiary hospital, and a retrospective analysis was performed. This includes gathered information f rom electronic medical records, surgical reports and the picture archiving system. Descriptive statistics were applied. The main endpoints were technical success,30-day and 1-year survival. Results: Five patients were submitted to urgent aneurysm repair using the chEVAR technique. Average age was 73,4 years and all patients were male. Arterial hypertension was present in 100% patients and all patients were ASA 4. Indications for surgery were post EVAR type 1a endoleak with associated rupture or abdominal pain in two patients; symptomatic/contained rupture of pararenal AAA in two patients; and contained rupture of a thoracoabdominal aneurysm in one patient. A total of eight target vessels were catheterized: two patients required single-vessel chimney and the remainder two-vessel chimney. Target vessels were two superior mesenteric arteries and six renal arteries. Technical success rate was 100% and 30-day mortality was 0%. There were no major complications. Follow-up time is 20.2 months (4.7-38). Target vessel patency during the follow-up period was 87.5%. Three patients (60%) died due to non-aortic related pathologies, on average 18 months after surgery (4.7-38), with a 1-year survival of 80%. Conclusion: Our experience with ChEVAR for emergent AAA repair is satisfactory, with high technical success rates and low short-term mortality. Sac regression, low rates of target vessel occlusion and type 1a endoleaks reveal a favourable profile for aneurysm exclusion. ChEVAR is a viable option in emergent setting for patients unfit for open repair.

Resumo Antecedentes O acidente vascular cerebral (AVC) isquêmico é uma causa importante da morte em todo o mundo. O infarto maligno da artéria cerebral média (IMACM) tem mortalidade de até 80% quando tratado clinicamente. Nesse contexto, a craniectomia descompressiva é uma medida salvadora de vidas, apesar da alta morbidade entre os sobreviventes. Objetivo Avaliar os desfechos dos pacientes com IMACM tratados com craniectomia descompressiva em um centro acadêmico terciário de AVC no Brasil. Métodos Um banco de dados prospectivo de AVC foi avaliado retrospectivamente e todos os pacientes tratados com craniectomia descompressiva para IMACM entre janeiro de 2014 e dezembro de 2017 foram incluídos. As características clínicas e demográficas foram avaliadas. Os desfechos funcionais, medidos pela escala modificada da Rankin (mRS), foram avaliados na alta hospitalar, após 3 meses e após 1 ano de seguimento. Resultados Foram incluídos 53 pacientes na análise final. A idade média foi 54,6 ± 11,6 anos e 64,2% eram homens. A mediana do tempo dos sintomas à admissão foi 4,8 (3–9,7) horas e o tempo médio dos sintomas à cirurgia foi 36 ± 17 horas. O hemisfério esquerdo foi o afetado em 39,6%. A pontuação na escala de AVC do National Institute of Health (NIHSS) à admissão foi 20 (16–24). A mortalidade hospitalar foi 30,2%. Após uma mediana de 337 (157–393) dias, 47,1% dos pacientes tinham atingido um desfecho favorável (mRS ≤ 4) e 39,6% tinham morrido. Conclusão Craniectomia descompressiva é uma medida salvadora de vidas no contexto do IMACM e seus efeitos permanecem importantes no cenário de um país em desenvolvimento em situação de vida real. (AVC mundo (IMACM 80 clinicamente sobreviventes Brasil 201 avaliadas funcionais mRS, mRS , (mRS) seguimento 5 final 546 54 6 54, 116 11 11, 642 64 2 64,2 homens 48 4 8 4, 3–9,7 397 9 7 (3–9,7 396 39 NIHSS (NIHSS 16–24. 1624 16–24 . 16 24 (16–24) 302 30 30,2% 33 157–393 157393 157 393 (157–393 dias 471 47 47,1 39,6 morrido real 64, 3–9, (3–9, 162 16–2 (16–24 30,2 157–39 15739 15 (157–39 47, 39, 3–9 (3–9 16– (16–2 30, 157–3 1573 (157–3 3– (3– (16– 157– (157– (3 (16 (157 ( (1 (15

Abstract Background Ischemic stroke is an important cause of death in the world. The malignant middle cerebral artery infarction (MMCAI) has mortality as high as 80% when clinically treated. In this setting, decompressive craniectomy is a life-saving measure, in spite of high morbidity among survivors. Objective To evaluate the outcomes of patients with MMCAI treated with decompressive craniectomy in a Brazilian academic tertiary stroke center. Methods A prospective stroke database was retrospectively evaluated, and all patients treated with decompressive craniectomy for MMCAI between January 2014 and December 2017 were included. The demographics and clinical characteristics were evaluated. The functional outcome, measured by the modified Rankin Scale (mRS), was assessed at hospital discharge, after 3-months and 1-year of follow-up. Results We included 53 patients on the final analysis. The mean age was 54.6 ± 11.6 years and 64.2% were males. The median time from symptoms to admission was 4.8 (3–9.7) hours and the mean time from symptoms to surgery was 36 ± 17 hours. The left hemisphere was the affected in 39.6%. The median NIHSS at admission was 20 (16–24). The in-hospital mortality was 30.2%. After a median of 337 [157–393] days, 47.1% of patients had achieved favorable outcome (mRS ≤ 4) and 39.6% had died. Conclusion Decompressive craniectomy is a life-saving measure in the setting of MMCAI, and its effects remains important in the scenario of a middle-income country in real-world situations. world (MMCAI 80 lifesaving life saving survivors center evaluated 201 mRS, mRS , (mRS) discharge 3months months 3 1year year 1 followup. followup follow up. up follow-up 5 analysis 546 54 6 54. 116 11 11. 642 64 2 64.2 males 48 4 8 4. 3–9.7 397 9 7 (3–9.7 396 39 16–24. 1624 16–24 . 16 24 (16–24) inhospital 302 30 30.2% 33 157–393 157393 157 393 [157–393 days 471 47 47.1 39.6 died middleincome income realworld real situations 64. 3–9. (3–9. 162 16–2 (16–24 30.2 157–39 15739 15 [157–39 47. 39. 3–9 (3–9 16– (16–2 30. 157–3 1573 [157–3 3– (3– (16– 157– [157– (3 (16 [157 ( (1 [15 [1 [

Abstract Background and Aims: The donor risk index (DRI) quantifies donor-related characteristics potentially associated with increased risk of early graft failure. We aimed to assess the impact of the DRI, recipient and perioperative factors on post liver transplant (LT) outcomes. Methods: This was a single-center retrospective cohort study including all adult (≥18 years) patients who underwent LT from 01/2019 to 12/2019 at Curry Cabral Hospital, Lisbon, Portugal. Primary endpoint was 1-year graft failure post LT. Associations were studied with logistic regression. Results: A total of 131 cadaveric donor LT procedures were performed in 116 recipients. Recipients’ median (IQR) age was 57 (47-64) years and 101/131 (77.1%) were males. Cirrhosis was the underlying etiology in 95/131 (81.2%) transplants. Based on 8 predefined donors’ characteristics, median (IQR) DRI was 1.96 (1.67-2.16). Following adjustment for MELDNa score pre LT and SOFA score (adjusted odds ratio [aOR], 95% confidence interval [CI] =0.91 [0.56-1.47]) or lactate (aOR [95% CI] = 2.76 [0.71-10.7]) upon intensive care unit (ICU) admission post LT, DRI was not associated with 1-year graft failure. However, higher SOFA score (aOR [95% CI] = 1.20 [1.05-1.37]) or lactate (aOR [95% CI] = 1.27 [1.10-1.46]) upon ICU admission post LT were independently associated with higher odds of 1-year graft failure. Conclusions: In a recent cohort of patients who under-went LT, DRI, despite being high, was not associated with 1-year graft failure, but SOFA score or lactate upon ICU ad-mission post LT were.

Resumo Introdução: O índice de risco do dador (DRI) quantifica as características relacionadas com o dador potencialmente associadas com risco acrescido de falência precoce do enxerto. Procurou-se avaliar o impacto do DRI e factores relacionados com os receptores e cirurgia nos resultados clínicos após transplante hepático (LT). Materiais e Métodos: Estudo coorte retrospectivo de centro único incluindo todos os doentes adultos (≥18 anos) que receberam LT entre 01/2019 e 12/2019 no Hospital Curry Cabral, Lisboa, Portugal. O endpoint primário foi a falência do enx-erto após um ano do LT. As associações foram estudadas com regressão logística. Resultados: Um total de 131 transplantes de dadores cadavéricos foram realizados em 116 receptores. A idade mediana (IQR) destes foi 57 (47-64) anos e 101/131 (77.1%) eram homens. A cirrose foi a etiologia subjacente em 95/131 (81.2%) transplantes. Com base nas 8 características dos dadores predefinidas, o DRI mediano (IQR) foi 1.96 (1.67-2.16). Após ajuste para o score MELDNa pre LT e o score SOFA (odds ratio ajustado [aOR], intervalo de confiança 95% [CI] = 0.91 [0.56-1.47]) ou o lactato (aOR [95% CI] = 2.76 [0.71-10.7]) após admissão na unidade de cuidados intensivos (ICU) pós LT, o DRI não se associou com a falência do enxerto um ano depois do LT. Contudo, um maior score SOFA (aOR [95% CI] = 1.20 [1.05-1.37]) ou lactato (aOR [95% CI] = 1.27 [1.10-1.46]) após admissão na ICU depois do LT associaram-se independentemente com a falência do enxerto um ano depois do LT. Conclusões: Num coorte recente de doentes submetidos a LT, o DRI, apesar de alto, não se associou com a falência precoce do enxerto precoce. Contudo, o score SOFA ou lactato após admissão na ICU depois do LT associaram-se com a falência precoce do enxerto.