Anemia na ectasia vascular do antro gástrico

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2018A ectasia vascular do antro gástrico (GAVE) é caracterizada por malformações vasculares da mucosa e da submucosa gástrica, que se associam a hemorragia recorrente e consequentemente a anemia crónica. O tratamento eficaz desta patologia continua a ser um desafio e tem vindo a sofrer alterações ao longo do tempo. Descreve-se um caso clínico de uma doente com cirrose hepática associada ao vírus da hepatite C e com GAVE que se apresentou com anemia ferropénica grave. Após a insuficiência da terapêutica com coagulação árgon-plasma, foi decidido iniciar terapêutica com laqueação elástica com bom sucesso terapêutico.Gastric antral vascular ectasia (GAVE) is characterized by vascular malformations of the gastric mucosa and submucosa that are associated with recurrent hemorrhage and thus chronic anemia. It is still a challenge to efficiently treat this condition and many changes in treatment have occurred over time. Here we discuss a clinical case of a patient that presented with severe iron deficient anemia, hepatic cirrhosis associated with HVC and GAVE. Given that argon-plasma coagulation was insufficient, elastic band ligation was also performed, with better results

Assessment of nutritional status of oncology patients at hospital admission : A Portuguese real-world study

BackgroundNutritional status in patients with cancer has a determining role in the evolution of the disease and tolerance to treatments. Severity of undernutrition impacts morbidity and mortality in cancer patients and can limit patient response to the optimal therapies if nutritional issues are not appropriately addressed and managed. Despite the importance of malnutrition for the clinical evolution of oncology patients, there is not yet a universally accepted standard method for evaluating malnutrition in such patients. The aim of this study was to stratify the nutritional status of inpatients at an Oncology Department. MethodsThis is an observational study with 561 cancer patients, assessed at admission to a Medical Oncology Department from November 2016 to February 2020. All patients were considered eligible. Non-compliant and/or comatose patients were excluded. Nutritional status was assessed using the PG-SGA, BMI classified with the WHO criteria, and calculation of the percentage of weight loss in the previous 3-6 months. ResultsA total of 561 patients (303 F: 258 M; mean age 65 +/- 13 years) were included. One-third of the patients, n=191/561 (34%), lost 6% of their weight in the month prior to admission and 297/561 (53%) patients lost 10.2% of weight in the previous 6 months. Mean BMI was 24.1 +/- 5.8 kg/m(2); N = 280/561 (50%) patients had regular BMI according to the WHO criteria. N = 331/561 (59%) patients reported eating less in the month prior to admission. N = 303/561 (54%) had moderate/severe deficits of muscle and adipose compartments. The PG-SGA identified 499/561 (89%) patients as moderately/severely malnourished, of which 466/561 (83%) patients scored >= 9 points, meeting criteria for a critical need for nutritional support. Fifteen percent of patients scored >4 points, indicating a need for directed therapy for symptom control and only 1% scoredPeer reviewe

An Incidental Finding of a Cardiac Sarcoma

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Impact of anthropogenic noise on the survival and development of meagre (Argyrosomus regius) early life stages

The growth of human populations has been driving an unprecedent and widespread increase in marine traffic, posing a real threat to marine biodiversity. Even though we are now aware of the negative effects of shipping noise exposure on fish, information about the impact on their early life stages continues to lack. Meagre (Argyrosomus regius) is a vocal fish that uses estuaries with high levels of anthropogenic noise pollution as both breeding areas and nurseries. Here, the effects of boat noise exposure on the development and survival of meagre larvae were studied. Embryos and larvae were exposed to either noise (boat noise playback) or control treatments (coils producing a similar electric field to the speakers) and hatching rate, survival rate, morphometric traits and stress-related biomarkers, at hatching and at 2 days-post-hatching (dph) were analyzed. Results showed no conclusive effects of the impact of boat noise playback, even though there was an increased lipid droplet consumption and a decrease in body depth at 2dph larvae under this stressor. The assessment of oxidative stress and energy metabolism-related biomarkers at hatching showed a marginal decrease in superoxide dismutase (SOD) activity and no changes in DNA damage or electron transport system activity (ETS), although it cannot be disregarded that those effects could only be visible at later stages of larval development. Whether these morphological and developmental results have implications in later stages remains to be investigated. Further studies with longer exposure and wild meagre could help deepen this knowledge and provide a better understanding of how anthropogenic noise can impact meagre early stagesFundação para a Ciência e Tecnologia - FCTinfo:eu-repo/semantics/publishedVersio

Bioengineered 3D models of human pancreatic cancer recapitulate in vivo tumour biology

Patient-derived in vivo models of human cancer have become a reality, yet their turnaround time is inadequate for clinical applications. Therefore, tailored ex vivo models that faithfully recapitulate in vivo tumour biology are urgently needed. These may especially benefit the management of pancreatic ductal adenocarcinoma (PDAC), where therapy failure has been ascribed to its high cancer stem cell (CSC) content and high density of stromal cells and extracellular matrix (ECM). To date, these features are only partially reproduced ex vivo using organoid and sphere cultures. We have now developed a more comprehensive and highly tuneable ex vivo model of PDAC based on the 3D co-assembly of peptide amphiphiles (PAs) with custom ECM components (PA-ECM). These cultures maintain patient-specific transcriptional profiles and exhibit CSC functionality, including strong in vivo tumourigenicity. User-defined modification of the system enables control over niche-dependent phenotypes such as epithelial-to-mesenchymal transition and matrix deposition. Indeed, proteomic analysis of these cultures reveals improved matrisome recapitulation compared to organoids. Most importantly, patient-specific in vivo drug responses are better reproduced in self-assembled cultures than in other models. These findings support the use of tuneable self-assembling platforms in cancer research and pave the way for future precision medicine approaches

Impacto de ruído antropogénico no desenvolvimento, sobrevivência e comportamento de estádios iniciais de corvina, Argyrosumus regius

Dissertação de Mestrado apresentada no ISPA – Instituto Universitário para obtenção de grau de Mestre na especialidade de Biologia Marinha e ConservaçãoA corvina (Argyrosumus regius) é um peixe vocal que utiliza o Estuário do Tejo, área com tráfego marinho intenso, como zona reprodutiva. Procurámos estudar o efeito da exposição a ruído de barco na sobrevivência e desenvolvimento de larvas, e no comportamento – nomeadamente aproximação e perseguição – de juvenis de corvina. Para tal, expusemos ovos e larvas a tratamentos de ruído (playback de ruído de barco) ou de controlo (bobines produzindo um campo eletromagnético semelhante ao gerado pelas colunas) e analisámos as suas características morfométricas à eclosão e dois dias depois da eclosão (dph). Os resultados mostraram que existe impacto do ruído na gestão das reservas energéticas das larvas, que aumentaram o consumo da gota lipídica sob este stressor. Verificou-se, ainda, um condicionamento do desenvolvimento das larvas apresentando, aos 2dph, uma altura máxima de corpo inferior quando expostas a ruído de embarcação. Expusemos, ainda, juvenis a condições de tratamento e de controlo semelhantes, durante 2 ou 7 dias, analisando o seu comportamento antes e depois da alimentação. O rácio de aproximação pós/pré alimentação diminuiu do dia 2 ao 7 no grupo de ruído, mas aumentou no controlo, sugerindo uma influência negativa do ruído na sua estimulação social. Implicações destes resultados em estádios mais avançados ainda não foram investigados. Importa salientar que estes peixes provêm de ambiente de aquacultura onde o ruído é superior ao do ambiente natural. Estudos complementares com corvina selvagem podem contribuir para aprofundar o conhecimento atual, ajudando a compreender o impacto do ruído antropogénico nos estádios inicias da corvina.Meagre (Argyrosumus regius) is a vocal fish that uses the Tagus estuary, an area with intense marine traffic, as breeding grounds. Here, we studied the effects of boat noise exposure on the development and survival of larvae, and on the behaviour – namely approach and pursuit – of meagre juveniles . We exposed eggs and larvae to either noise (boat noise playback) or control treatments (coils producing a similar electric field to the speakers) and analysed their morphometric characteristics at hatching and 2 days-post-hatching (dph). Our results showed an impact of boat noise playback on the management of energy reserves by meagre larvae, which increased their lipid droplet consumption when under this stressor. There was also a conditioning of their development illustrated by the smaller body depth achieved by larvae exposed to boat noise at 2 dph. We further exposed juveniles to similar treatment and control conditions and recorded their pre- and post-feeding behaviour after 2 and 7 days of exposure. Post/pre-feeding approach ratio decreased from day 2 to day 7 in the noise group but increased in the control, suggesting that the arousal or search behaviour with feeding is being affected by prolonged noise exposure. Whether these results have implications in later stages remains to be investigated. Also, tested fish were reared in an aquaculture facility, i.e. in a much noisier environment than the natural one. Further studies with wild meagre could help deepen this knowledge and give us a better understanding of how anthropogenic noise can impact meagre early stages

Atingimento das Metas de Colesterol LDL em Pacientes com Histórico de Infarto Agudo do Miocárdio: Estudo Transversal do Mundo Real

Resumo Fundamento: As diretrizes da Sociedade Europeia de Cardiologia recomendam um nível de colesterol LDL (LDL-C) < 55 mg/dL para pacientes com doença cardiovascular estabelecida. Embora a fórmula de Friedewald ainda seja amplamente utilizada para estimar o LDL-C, a fórmula mais recente de Martin-Hopkins mostrou maior precisão. Objetivos: Nosso objetivo foi avaliar: A) a proporção de pacientes que atingiram a meta de LDL-C e as terapias utilizadas em um centro terciário; B) o impacto da utilização do método de Martin-Hopkins em vez do método de Friedewald na proporção de pacientes controlados. Métodos: Estudo transversal monocêntrico, incluindo pacientes consecutivos pós-infarto do miocárdio, acompanhados por 20 cardiologistas, em um hospital terciário. Os dados foram coletados retrospectivamente de consultas clínicas realizadas após abril de 2022. Para cada paciente, os níveis de LDL-C e o atingimento das metas foram estimados a partir de um perfil lipídico ambulatorial, utilizando as fórmulas de Friedewald e Martin-Hopkins. Um valor-p bicaudal < 0,05 foi considerado estatisticamente significativo para todos os testes. Resultados: Foram incluídos 400 pacientes (com 67 ± 13 anos, 77% do sexo masculino). Utilizando a fórmula de Friedewald, a mediana de LDL-C sob terapia foi de 64 (50-81) mg/dL, e 31% tinham LDL-C dentro da meta. Estatinas de alta intensidade foram usadas em 64% dos pacientes, 37% estavam em uso de ezetimiba e 0,5% estavam em uso de inibidores de PCSK9. A terapia combinada de estatina de alta intensidade + ezetimiba foi utilizada em 102 pacientes (26%). A aplicação do método de Martin-Hopkins reclassificaria um total de 31 pacientes (7,8%). Entre aqueles considerados controlados pela fórmula de Friedewald, 27 (21,6%) teriam LDL-C estimado por Martin-Hopkins acima da meta. Conclusões: Menos de um terço dos pacientes pós-infarto do miocárdio apresentaram LDL-C dentro da meta. A aplicação da fórmula de Martin-Hopkins reclassificaria um quinto dos pacientes presumivelmente controlados no grupo de pacientes não controlados

Impact of anthropogenic noise on the survival and development of meagre (Argyrosomus regius) early life stages

We are grateful to IPMA-EPPO for the test subjects. We also thank Joaquim Tapisso for the assistance in the bioterium and Marta Bolgan for helping with the preliminary work. This study had the support of FCT through the strategic project UIDB/04292/2020 awarded to MARE, and through project LA/P/0069/2020 granted to the Associate Laboratory ARNET, through the strategic project UIDB/00006/2020 awarded to CE3C; and through project PTDC/BIA-BMA/29662/2017. FCT also attributed individual PhD grant to M.V (SFRH/BD/115562/2016).The growth of human populations has been driving an unprecedent and widespread increase in marine traffic, posing a real threat to marine biodiversity. Even though we are now aware of the negative effects of shipping noise exposure on fish, information about the impact on their early life stages continues to lack. Meagre (Argyrosomus regius) is a vocal fish that uses estuaries with high levels of anthropogenic noise pollution as both breeding areas and nurseries. Here, the effects of boat noise exposure on the development and survival of meagre larvae were studied. Embryos and larvae were exposed to either noise (boat noise playback) or control treatments (coils producing a similar electric field to the speakers) and hatching rate, survival rate, morphometric traits and stress-related biomarkers, at hatching and at 2 days-post-hatching (dph) were analyzed. Results showed no conclusive effects of the impact of boat noise playback, even though there was an increased lipid droplet consumption and a decrease in body depth at 2dph larvae under this stressor. The assessment of oxidative stress and energy metabolism-related biomarkers at hatching showed a marginal decrease in superoxide dismutase (SOD) activity and no changes in DNA damage or electron transport system activity (ETS), although it cannot be disregarded that those effects could only be visible at later stages of larval development. Whether these morphological and developmental results have implications in later stages remains to be investigated. Further studies with longer exposure and wild meagre could help deepen this knowledge and provide a better understanding of how anthropogenic noise can impact meagre early stages.info:eu-repo/semantics/publishedVersio

Impact of early surgery and immunosuppression on Crohn's disease disabling outcomes

Background and Aims: The definition of early therapeutic strategies to control Crohn's disease aggressiveness and prevent recurrence is key to improve clinical practice. This study explores the impact of early surgery and immunosuppression onset in the occurrence of disabling outcomes. Methods: This was a multicentric and retrospective study with 754 patients with Crohn's disease, who were stratified according to the need for an early surgery (group S) or not (group I) and further divided according to the time elapsed from the beginning of the follow-up to the start of immunosuppression therapy. Results: The rate of disabling events was similar in both groups (S: 77% versus I: 76%, P = 0.700). The percentage of patients who needed surgery after or during immunosuppression therapy was higher among group S, both for first surgeries after the index event (38% of groups S versus 21% of group I, P, 0.001) and for reoperations (38% of groups S versus 12% of group I, P < 0.001). The time elapsed to reoperation was shorter in group I (HR = 2.340 [1.367-4.005]), stratified for the onset of immunosuppression. Moreover, reoperation was far more common among patients who had a late start of immunosuppression (S-36: 50% versus S0-6: 27% and S6-36: 25%, P < 0.001) and (I-36: 16% versus I0-6: 5% and I6-36: 7%, P, 0.001). Conclusions: Although neither early surgery nor immunosuppression seem to be able to prevent global disabling disease, an early start of immunosuppression by itself is associated with fewer surgeries and should be considered in daily practice as a preventive strategy.GEDII-Grupo de Estudo da Doenca Inflamatoria Intestina

A self‐assembled 3D model demonstrates how stiffness educates tumor cell phenotypes and therapy resistance in pancreatic cancer

Pancreatic ductal adenocarcinoma (PDAC) is characterized by a dense and stiff extracellular matrix (ECM) associated with tumor progression and therapy resistance. To further the understanding of how stiffening of the tumor microenvironment (TME) contributes to aggressiveness, a three‐dimensional (3D) self‐assembling hydrogel disease model is developed based on peptide amphiphiles (PAs, PA‐E3Y) designed to tailor stiffness. The model displays nanofibrous architectures reminiscent of native TME and enables the study of the invasive behavior of PDAC cells. Enhanced tuneability of stiffness is demonstrated by interacting thermally annealed aqueous solutions of PA‐E3Y (PA‐E3Yh) with divalent cations to create hydrogels with mechanical properties and ultrastructure similar to native tumor ECM. It is shown that stiffening of PA‐E3Yh hydrogels to levels found in PDAC induces ECM deposition, promotes epithelial‐to‐mesenchymal transition (EMT), enriches CD133+/CXCR4+ cancer stem cells (CSCs), and subsequently enhances drug resistance. The findings reveal how a stiff 3D environment renders PDAC cells more aggressive and therefore more faithfully recapitulates in vivo tumors