Revisão da literatura

A nível mundial, o Cancro do Colo do Útero, é o quarto cancro mais comum na mulher e o segundo em mulheres com idade entre os 15 e os 44 anos. O conhecimento sobre esta doença relevante para a saúde pública e as suas lesões precursoras sofreu avanços notáveis a partir do momento em que foi estabelecido o papel do vírus do papiloma humano na sua génese. Esta constante evolução do conhecimento conduziu ao desenvolvimento, ao longo dos anos, de novos testes de rastreio e vacinas capazes de reduzir a mortalidade atribuível ao cancro do colo. Continuamos a assistir, nos últimos anos, a uma procura de novos métodos de diagnóstico que permitam definir com maior precisão o risco individual de cada mulher, quantificando a probabilidade de regressão ou progressão das lesões e possibilitando, dessa forma, uma orientação terapêutica mais adequada. As novas evidências científicas levantam aos clínicos a questão de como atuar em determinadas situações, nomeadamente na orientação terapêutica de mulheres jovens com lesões cervicais de alto grau. No que diz respeito à abordagem perante um diagnóstico de CIN2 e CIN2/3, o consenso de 2012 da Sociedade Americana de Colposcopia e Patologia foi o primeiro a destacar o papel da idade nas linhas de orientação, introduzindo o conceito de “mulher jovem”, suscetível de conduta clínica diferente. Com esta monografia pretendemos analisar a literatura atual sobre o tratamento das neoplasias intraepiteliais de alto grau nas mulheres jovens com menos de 25 anos, qual a sua influência no prognóstico e qual o impacto das intervenções terapêuticas na saúde reprodutiva dessas mulheres.Globally, Cervical Cancer is the fourth most common cancer in women and the second in women aged 15-44. Knowledge about this relevant disease to public health and its precursor lesions has made remarkable advances since the role of human papillomavirus was established in its genesis. This constant evolution of knowledge has led to the development, over the years, of new screening tests and vaccines capable of reducing the mortality attributable to cervical cancer. In recent years, we have continued to look for new diagnostic methods that allow us to define more precisely the individual risk of each woman, quantifying the likelihood of regression or progression of the lesions and, in this way, providing a more adequate therapeutic orientation. The new scientific evidences raise to the clinicians the question of how to act in certain situations, namely in the therapeutic orientation of young women with cervical lesions of high degree. Regarding the approach to a diagnosis of CIN2 and CIN2/3, the 2012 consensus of the American Society of Colposcopy and Pathology highlighted the role of age in the guidelines, introducing the concept of "young woman", susceptible of different clinical conduct. With this monograph we intend to analyze the current literature about the treatment of high-grade intraepithelial neoplasias in young women under 25 years, its influence on prognosis and the impact of therapeutic interventions on the reproductive health of these women

Predictors of cardiac involvement in idiopathic inflammatory myopathies

Copyright © 2023 Bandeira, Dourado, Melo, Martins, Fraga, Ferraro, Saraiva, Sousa, Parente, Soares, Correia, Almeida, Dinis, Pinto, Oliveira Pinheiro, Rato, Beirão, Samões, Santos, Mazeda, Chícharo, Faria, Neto, Lourenço, Brites, Rodrigues, Silva-Dinis, Dias, Araújo, Martins, Couto, Valido, Santos, Barreira, Fonseca and Campanilho-Marques. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.Objectives: Idiopathic inflammatory myopathies (IIM) are a group of rare disorders that can affect the heart. This work aimed to find predictors of cardiac involvement in IIM. Methods: Multicenter, open cohort study, including patients registered in the IIM module of the Rheumatic Diseases Portuguese Register (Reuma.pt/Myositis) until January 2022. Patients without cardiac involvement information were excluded. Myo(peri)carditis, dilated cardiomyopathy, conduction abnormalities, and/or premature coronary artery disease were considered. Results: 230 patients were included, 163 (70.9%) of whom were females. Thirteen patients (5.7%) had cardiac involvement. Compared with IIM patients without cardiac involvement, these patients had a lower bilateral manual muscle testing score (MMT) at the peak of muscle weakness [108.0 ± 55.0 vs 147.5 ± 22.0, p=0.008] and more frequently had oesophageal [6/12 (50.0%) vs 33/207 (15.9%), p=0.009] and lung [10/13 (76.9%) vs 68/216 (31.5%), p=0.001] involvements. Anti-SRP antibodies were more commonly identified in patients with cardiac involvement [3/11 (27.3%) vs 9/174 (5.2%), p=0.026]. In the multivariate analysis, positivity for anti-SRP antibodies (OR 104.3, 95% CI: 2.5-4277.8, p=0.014) was a predictor of cardiac involvement, regardless of sex, ethnicity, age at diagnosis, and lung involvement. Sensitivity analysis confirmed these results. Conclusion: Anti-SRP antibodies were predictors of cardiac involvement in our cohort of IIM patients, irrespective of demographical characteristics and lung involvement. We suggest considering frequent screening for heart involvement in anti-SRP-positive IIM patients.info:eu-repo/semantics/publishedVersio

Systemic sclerosis and rheumatoid arthritis overlap syndrome – management of severe cardiac, pulmonary and articular involvement

Introduction The presence of another rheumatological condition in patients with systemic sclerosis (SSc) is not uncommon. To report a case of a patient with SSc-RA overlap and perform a review of the cases re-ported in the literature. Material and Methods A chart review of the present case report was performed. After, we performed a literature search in MEDLINE, EMBASE and Cochrane databases. Results We included 26 articles. Sixty-three patients were reviewed, 51 were female with a mean age of 45.03 years at the time of the first diagnosis. Sixty-three patients were diagnosed with limited cu-taneous SSc. Regarding organ involvement, the most frequently reported were cutaneous, vascular, pulmonary and gastrointestinal involvement. Erosions were presenting 65.08% of patients. A panoply of treatments was used. Conclusions The authors concluded that screening for an associated disease should be encouraged since the overlap with SSc may affect prognosis and treatment

Sleep duration, lifestyles and chronic diseases: a cross-sectional population-based study

Background: Adequate sleep is essential for health. Both, short and long sleep durations are associated to worse quality of life and poor health outcomes. Portugal represents a specific population model, since according to European statistics it has high rates of chronic diseases like depression, hypertension, diabetes and stroke; and low quality of life as well as low index of physical activity, while in parallel it has some other good health indicators such as: low age-standardized mortality for both genders, nutrition in terms of energy and fruit consumption, smoking and alcohol, obesity and overweight prevalence. The aim of this study was to characterize health and chronic diseases, lifestyles and quality of life in subjects with short and long sleep duration. Methods: A populationbased cross-sectional evaluation of the third wave of follow-up of the EpiDoC Cohort was carried between 2015-2016. A sample of 5,436 adults ≥18 years, representative of the national population, self-reported their daily total sleep time. Associations between short sleep duration (SSD ≤5h), long sleep duration (LSD≥9h) and independent variables were determined. Results: The prevalence for SSD was high (20.7%) and the LSD (5.9%) was low. Being older, with lower education, retired and unemployed were associated to SSD and LSD (p<0.01). Being obese was associated to SSD as well as hypertension, gastrointestinal disease and hypercholesterolemia (p<0.01). SSD and LSD, were associated with diabetes (p<0.01 and p=0.03) and depression (p<0.01 and p=0.02) respectively. Cardiovascular disease (p<0.01) was associated to LSD. Multimorbidity (p<0.01) was associated to SSD. Worse quality of life and bad physical function were associated to SSD and LSD, as well as being hospitalized in the previous 12 months (p<0.01). Conclusions: Socio-demographic, physical activity and chronic diseases were associated to reduction and extension of sleep duration. There was no association between rheumatic diseases and cancer with sleep duration, as found in other studies. This study emphasizes the burden of self-reported SSD for Portugal, its consequences to health and the need to increase sleep awareness campaigns enhancing the importance of sleep in health. Furthermore, it emphasizes that chronic diseases risks are dependent on multiple parameters which varying in different countries or regions, imply the need of regional studies and interventions

Functional progression in post-osteoporotic fracture: A case study

Introduction: Osteoporosis is characterized by a loss of bone mass along with alterations in its structure, with subsequent increase in bone fragility and susceptibility to fractures, ultimately reinforcing the importance of its prevention by the reduction of the risk of falling.In this paper we propose to analyze the functional progression of a patient, integrated in a multidisciplinary program (TOMBO-Therapeutic Occupational Multidisciplinary approach to the Benefit of Osteoporosis), after an osteoporotic fracture.Methods: Retrospective descriptive case-study of the first patient included in the TOMBO program. Data were gathered for Time Up and Go Test (TUGT), Sit to Stand in 30 secs. (SS-30), 10m Walking Test (10m-WT), Barthel Index (BI) and Morse Scale (MS) in 3 different moments: baseline (ward, at discharge: M0), 2 and 6-months after surgery (multidisciplinary appointments: MD2, MD6).Results: TUGT- M0: no capability; MD2: 18,8 secs.; MD6: 8 seg. SS-30 - M0: no capability; MD2: 9 stands; MD6: 10 stands. 10m-WT - M0: 30 secs.; MD2: 13 secs.; MD6: 8 secs. BI - M0: 60; MD2, 80; MD6: 100. MS - M0: 85, MD2: 50; MD6: 15.Conclusion: This case-study revealed us that the first patient admitted to this innovative multidisciplinary approach improved some functional parameters (level of dependency and risk of falling) as shown by its favorable progression on the tests and scales applied.</p

Long-term outcomes of COVID-19 vaccination in patients with rare and complex connective tissue diseases: The ERN-ReCONNET VACCINATE study

Background: Vaccination is one of the most important measures to contain the COVID-19 pandemic, especially for frail patients. VACCINATE is a multicentre prospective observational study promoted by the European Reference Network on Rare and Complex Connective Tissue and Musculoskeletal Diseases (ERN ReCONNET) aimed at assessing the long-term outcomes of COVID-19 vaccination in patients with rare and complex connective tissue diseases (rcCTDs) in terms of efficacy and safety. Methods: Adult rcCTDs patients were eligible for recruitment. Demographic, clinical and vaccination data were collected at enrolment. Follow-up visits were scheduled 4, 12, 24, 36 and 48 weeks after completion of the first vaccination cycle; data on adverse events, disease exacerbations and the occurrence of new SARS-CoV-2 in- fections were collected at these time-points. Findings: 365 rcCTDs patients (87 % female, mean age 51.8 ± 14.6 years) were recruited. Overall, 200 patients (54.8 %) experienced at least one adverse event, generally mild and in most cases occurring early after the vaccination. During follow-up, 55 disease exacerbations were recorded in 39 patients (10.7 %), distributed over the entire observation period, although most frequently within 4 weeks after completion of the vaccination cycle. The incidence of new SARS-CoV-2 infections was 8.9 per 1000 person-months, with no cases within 12 weeks from vaccine administration and an increasing trend of infections moving away from the primary vaccination cycle. Only one case of severe COVID-19 was reported during the study period. Interpretation: COVID-19 vaccination seems effective and safe in rcCTDs patients. The rate of new infections was rather low and serious infections were uncommon in our cohort. No increased risk of disease flares was observed compared to previous disease history; however, such exacerbations may be potentially severe, emphasising the need for close monitoring of our patients