A Hybrid-Telerehabilitation Versus a Conventional Program for Urinary Incontinence: a Randomized Trial during COVID-19 Pandemic

Introduction and hypothesis This study aimed to compare the effectiveness of a hybrid telerehabilitation program with a traditional face to face model in women with stress urinary incontinence (SUI) and mixed incontinence (MUI) with a predominance of SUI. The authors hypothesized that home pelvic floor muscle training (PFMT) would have a similar benefit to outpatient PFMT. Methods Parallel randomized controlled trial including 58 patients consecutively admitted to a tertiary academic hospital for pelvic floor rehabilitation consultation from 1 January to 30 April 2021 for conservative treatment of UI. Participants randomized to the intervention were submitted to a 12-week PFMT program: (1) a hybrid telerehabilitation program of two individual face-to-face sessions followed by 2-weekly sessions of video-telerehabilitation with a follow-up by a specialized physiotherapist, including one individual face-to-face session at 8 weeks; (2) a re-evaluation teleconsultation at 6 and 16 weeks; (3) a face-to-face consultation at 12 weeks. The control group had two initial individual sessions followed by twice-weekly group classes, and consultations were face to face. The primary outcome measure (at baseline and 12 weeks) was UI-related quality of life using the Portuguese Version of the King's Health Questionnaire. Results At baseline the intervention (n = 18) and control (n = 17) groups were similar. UI-related quality of life significantly improved in both the intervention and control groups betweenbaseline (T0) and the end of the 12-week PFMT program (T12) (p = 0.002, p < 0.001, respectively), although the magnitude of the improvement was not significantly different between groups (–10.0 vs. –9.5 points, p = 0.918, respectively). Conclusion This hybrid telerehabilitation protocol showed effectiveness comparable to the traditional model in improving UI-related quality of life. Trial registration at www.ClinicalTrials.gov, no. NCT05114395

Astigmatism management in cataract surgery with Precizon(®) toric intraocular lens: a prospective study

PURPOSE: The purpose of this study was to evaluate the visual and refractive outcomes and rotational stability of the new aspheric Precizon(®) toric intraocular lens (IOL) for the correction of corneal astigmatism in cataract surgery. SETTING: Department of Ophthalmology, Hospital Geral de Santo António - Centro Hospitalar do Porto, EPE and Hospital de Pedro Hispano, Matosinhos, Portugal. DESIGN: This was a prospective clinical study. PATIENTS AND METHODS: A total of 40 eyes of 27 patients with corneal astigmatism greater than 1.0 diopter (D) underwent cataract surgery with implantation of Precizon(®) toric IOL. IOL power calculation was performed using optical coherence biometry (IOLMaster(®)). Outcomes of uncorrected (UDVA) and best-spectacle corrected distance visual acuities (BCDVA), refraction, and IOL rotation were analyzed at the 1st week, 1st, 3rd, and 6th month's evaluations. RESULTS: The median postoperative UDVA was better than preoperative best-spectacle corrected distance visual acuity (0.02 [0.06] logMAR vs 0.19 [0.20] logMAR, P<0.001). At 6 months, postoperative UDVA was 0.1 logMAR or better in 95% of the eyes. At last follow-up, the mean spherical equivalent was reduced from -3.35±3.10 D to -0.02±0.30 D (P<0.001) with 97.5% of the eyes within ±0.50 D of emmetropia. The mean preoperative keratometric cylinder was 2.34±0.95 D and the mean postoperative refractive cylinder was 0.24±0.27 D (P<0.001). The mean IOL rotation was 2.43°±1.55°. None of the IOLs required realignment. CONCLUSION: Precizon(®) toric IOL revealed very good rotational stability and performance regarding predictability, efficacy, and safety in the correction of preexisting regular corneal astigmatism associated with cataract surgery.info:eu-repo/semantics/publishedVersio

A retrospective study in tumour characteristics and clinical outcomes of overweight and obese women with breast cancer

Introduction Obesity and breast cancer are two major pathologies closely associated with increasing incidence and mortality rates, especially amongst women. The association between both diseases have been thoroughly discussed but much is still to uncover. Aim The aim of this study is to analyse tumour characteristics and clinical outcomes of overweight and obese women to disclosure potential associations and better understand the impact of obesity in breast cancer. Materials and methods Clinicopathological information of 2246 women were extracted from the institutional database of comprehensive cancer centre in Portugal diagnosed between 2012 and 2016. Women were stratified according to body mass index as normal, overweight, and obese. Patients’ demographic information and tumour features (age, family history, topographic localization, laterality, histological type, and receptor status) were taken as independent variables and overall survival, tumour stage, differentiation grade and bilaterality were considered clinical outcomes. Results The main results reveal that overweight and obesity are predominantly associated with worse outcomes in breast cancer patients. Obese patients present larger (p-value: 0.002; OR 1.422; 95% CI 1.134–1.783) and more poorly differentiated tumours (p-value: 0.002; OR 1.480; 95% CI 1.154–1.898) and tend to have lower overall survival although without statistical significance (p-value: 0.117; OR 1.309; 95% CI 0.934–1.833). Overweighted women are more likely to have bilateral breast cancer (p-value: 0.017; OR 3.076; 95% CI 1.225–7.722) than obese women. The results also reveal that overweight women present less distant metastasis (p-value: 0.024; OR 0.525; 95%CI 0.299–0.920). Topographic localization and laterality did not achieve statistical significance.Open access funding provided by FCT|FCCN (b-on). Author C.L. has received research support by “FCT—Fundação para a Ciência e Tecnologia” (Grant number [SFRH/BD/146489/2019])

Low preoperative plasma cholinesterase activity as a risk marker of postoperative delirium in elderly patients.

BACKGROUND: delirium is a frequent neuropsychiatric syndrome affecting medical and surgical elderly patients. Cholinergic dysfunction has been implicated in delirium pathophysiology and plasmatic acetylcholinesterase (AChE) and butyrylcholinesterase (BuChE) activities are suppressed in patients with delirium. In this cohort study, we investigated whether these changes emerge during delirium or whether they are present before its onset. METHODS: plasma activities of AChE and BuChE were measured pre- and postoperatively in consecutive patients ≥60 years old undergoing elective total hip replacement surgery. In addition to a comprehensive clinical and demographic baseline evaluation, venous blood samples were collected from each subject in the morning of hospital admission's day and in the morning of the first postoperative day. Delirium was screened daily with confusion assessment method (confirmed with diagnostic and statistical manual of mental disorders (DSM-IV)-TR). RESULTS: preoperatively, plasma esterase activity was significantly lower in patients who developed delirium compared with the remaining subjects. Following surgery BuChE activity was lower in the delirium group but this difference disappeared after controlling for preoperative values. Plasma cholinesterase activity correlated positively with calcium and haemoglobin and negatively with total bilirubin and international normalised ratio. CONCLUSION: plasma cholinesterase activity can be a useful candidate biomarker to identify subjects at greater risk of developing postoperative delirium

Elaboração de extrudados não expandidos (pellets) de arroz e gergelim (Sesamum indicum L.) in natura.

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Obtenção de extrudados não expandidos (pellets) de milho e de gergelim integral (Sesamum indicum L.).

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