Braga Hospital Research Articles

Testicular prostheses - impact on quality of life and sexual function.

Orchiectomy is the recommended treatment for many testicular conditions. However, testicular prosthesis placement is not always performed for different reasons. In this study, we aimed to evaluate patients' opinions and the impact on sexual function and quality of life. This retrospective observational single-center study included patients who underwent orchiectomy between January 2014 and December 2020 at the Department of Urology, Braga's Hospital (Braga, Portugal), where testicular implants were always available and the decision to undergo the procedure was made fully independent of cost. Patients completed four questionnaires that assessed demographic data, satisfaction, self-esteem, and sexual function. Of the 96 patients who underwent orchidectomy, 59 replied to the questionnaires, and of these patients, 86.4% decided to undergo silicone-based testicular prostheses implantation. The remaining 13.6% refused the implant based on concerns about complications (37.5%), because they felt that it was unnecessary (37.5%), or because it was not offered by the doctor (25.0%). Overall, 96.1% of these patients were satisfied with the implant; however, 25.5% classified it as "too firm". No statistically significant differences were found in sexual function (all P > 0.05). However, it can be observed that there are more patients with prostheses presenting normal sexual activity compared to patients without prostheses (74.0% vs 50.0%), and none of them reported severe erectile dysfunction (0 vs 16.7%). Regarding self-esteem, both patients with and without prostheses present very similar average scores with no statistically significant differences. The present study highlights the highest level of satisfaction among patients who received testicular prostheses. Testicular prostheses implantation is a safe procedure that does not hamper sexual function after orchiectomy.

Perineal massage and warm compresses – Randomised controlled trial for reduce perineal trauma during labor

ObjectiveThe aim of this study is to evaluate the effect of perineal massage and warm compresses technique on the perineum integrity during second stage of labor. Design and settingA single-center, prospective, randomized controlled trial was conducted between March 1st, 2019, and December 31st, 2020, at Hospital of Braga. Participants: Women with 18 years or older, between 37 weeks and 41 weeks pregnant, in whom a vaginal birth of a fetus in the cephalic presentation was planned were recruited. Eight hundred forty-eight women were randomly assigned (Perineal massage and warm compresses group, n = 424 and control group, n = 424), and 800 women, both perineal massage and warm compresses group (n = 400) and control group (n = 400) were included in the strict per protocol analysis. Intervention: In the perineal massage and warm compresses group, women received perineal massage and warm compresses and in the control group, women received hands-on technique. ResultsThe incidence of intact perineum was significantly higher in the perineal massage and warm compresses group [perineal massage and warm compresses group: 47% vs control group: 26.3%; OR 2.53, 95% CI 1.86–3.45, p<0.001], whereas second-degree tears and episiotomy rate were significantly lower in this group [perineal massage and warm compresses group: 7.2% vs control group: 12.3%; OR 1.96, 95% CI 1.17–3.29, p = 0.010 and perineal massage and warm compresses group: 9.5% vs control group: 28.5%; OR 3.478, 95% CI 2.236–5.409, p<0.001, respectively]. Also, obstetric anal sphincter injury with and without episiotomy and second-degree tears with episiotomy were significantly lower in the perineal massage and warm compresses group [perineal massage and warm compresses group: 0.5% vs control group: 2.3%; OR 5.404, 95% CI 1.077–27.126, p = 0.040 and perineal massage and warm compresses group: 0.3% vs control group: 1.8%; OR 9.253, 95% CI 1.083–79.015, p = 0.042, respectively]. ConclusionsThe perineal massage and warm compresses technique increased the incidence of intact perineum and reduced the incidence of second-degree tear, episiotomy and obstetric anal sphincter injury. Implications for practice: Perineal massage and warm compresses technique is feasible, inexpensive and reproductible. Therefore, this technique should be taught and trained to midwives students and midwives team. Thus, women should have this information and have the option to decide whether they want to receive the perineal massage and warm compresses technique in the second stage of labor.

Evaluation of Fractionation Schemes in Breast Cancer Radiotherapy and Dosimetric Study of the Main Organs at Risk

The purpose of this work was to evaluate the impact of different breast cancer radiotherapy regimens on the acceptance of the tolerance criteria of the main organs at risk, the heart, and the ipsilateral lung.In this context, the dosimetric treatment plans of 20 breast cancer patients treated at the Radiotherapy Service of Braga Hospital were analyzed. The treatment planning system was the XiO (Elekta) and the dosimetric treatment plans were performed using with 3D-CRT technique (three-dimensional conformal radiation therapy) and the pencil beam algorithm for photon dose calculation.Two approaches to estimate the equivalence of different radiotherapy schedules have been proposed, the equivalent dose at 2Gy per fraction model and the biologically effective dose model. These models showed that the conventional radiotherapy course to 50Gy in 25 daily fractions is clinically equivalent to the hypofractionation course to 42,56Gy in 16 daily fractions.Obtained results showed that the tolerance criteria for the organs at risk, the heart and the ipsilateral lung, referring to the hypofractionation course to 42,56Gy in 16 daily fractions, are more restrictive than the tolerance criteria of conventional regimen. This means that if the same setup and the same dose coverage in the planning target-volume are used, the tolerance criteria for the organs at risk of hypofractionation regiment are more difficult to attain.These results can assist radiation oncologists in the evaluation of radiotherapy prescription doses for breast cancer, in compliance with the principles of radiation protection.

Iodine supplementation: compliance and association with adverse obstetric and neonatal outcomes.

ObjectivesOver 1.9 billion people worldwide are living in areas estimated to be iodine insufficient. Strategies for iodine supplementation include campaigns targeting vulnerable groups, such as women in pre-conception, pregnancy and lactation. Portuguese women of childbearing age and pregnant women were shown to be mildly-to-moderately iodine deficient. As a response, in 2013, the National Health Authority (NHA) issued a recommendation that all women considering pregnancy, pregnant or breastfeeding, take a daily supplement of 150–200 μg iodine. This study explored how the iodine supplementation recommendation has been fulfilled among pregnant and lactating women in Portugal, and whether the reported iodine supplements intake impacted on adverse obstetric and neonatal outcomes.Design and methodsObservational retrospective study on pregnant women who delivered or had a fetal loss in the Braga Hospital and had their pregnancies followed in Family Health Units.ResultsThe use of iodine supplements increased from 25% before the recommendation to 81% after the recommendation. This was mostly due to an increase in the use of supplements containing iodine only. Iodine supplementation was protective for the number of adverse obstetric outcomes (odds ratio (OR) = 0.791, P = 0.018) and for neonatal morbidities (OR = 0.528, P = 0.024) after controlling for relevant confounding variables.ConclusionThe recommendation seems to have succeeded in implementing iodine supplementation during pregnancy. National prospective studies are now needed to evaluate the impact of iodine supplementation on maternal thyroid homeostasis and offspring psychomotor development and on whether the time of the beginning of iodine supplementation (how early during preconception or pregnancy) is relevant to consider.

MO057REGIONAL IMPORTANCE OF FIBRINOGEN A Α-CHAIN MUTATION ON RENAL AMYLOIDOSIS

Abstract Background and Aims Renal amyloidosis include amyloid A (AA) and light chain (AL) as well as amyloidogenic leukocyte chemotactic factor 2 (ALECT2) and numerous hereditary forms. After identifying amyloidosis by its suggestive pale pink amorphous appearance in optic microscopy (OM) and Congo red positivity, a correct diagnosis of the amyloidogenic precursor protein is determinant to establish prognosis and treatment. Immunohistochemistry (IHC) and immunofluorescence (IF) studies use a limited number of antibodies to detect specific epitopes and may be difficult to interpret. The gold standard has become proteomics but laser microdissection and mass spectroscopy are not routinely available. Other options include electron microscopy with immunogold staining and complementary exams such as scintigraphy with 99mTc-DPD to detect transthyretin-related amyloidosis. Since the cause of amyloidosis vary among regions, analyzing local patterns can help establish a diagnostic procedure. We aimed at describing cases of kidney amyloidosis identified by biopsy during a 4-year interval and discuss possible implication for future diagnosis. Method We analyzed our kidney biopsy database and selected all cases of renal amyloidosis collecting clinical, laboratory and imaging data. Results From January 2016 until December 2019, 194 kidney biopsies were performed at the Hospital of Braga in the Portuguese province of Minho. Among these, 8 (4.1%) revealed amyloidosis. Mean age was 63.8±9.2 years of age, 5 were female, 6 were referred for nephrotic syndrome and 2 for what seemed like acute kidney injury. Mean creatinine at presentation was 3.2±2.3mg/dL. Among them, 2 had AL amyloidosis with light chain restriction by IF, 1 had AA amyloidosis with intense IHC stain and 5 patients had non-AL and non-AA forms of amyloidosis. Of these, 3 had probable fibrinogen A alpha-chain (AFib) amyloidosis, after a heterozygous mutation FGA p.Glu545Val was detected, 1, who did not have IHC performed, was assumed as having AA amyloidosis due to a history of serious recurrent infections and 1 is still under study. Four performed scintigraphy with 99mTc-DPD which was negative. The 2 patients with AL amyloidosis had, by OM, in one case glomerular and tubulointerstitial and on the other, glomerular and vascular involvement and, by IF, both had k light chain restriction. Both had additional cardiac and neurovegetative involvement, were treated with cyclophosphamide-bortezomib-dexamethasone and oral doxycycline with complete hematologic response and stabilization of kidney function. In 1 case, proteinuria only showed a slow decline 2 years after treatment. The 2 patients with AA amyloidosis had glomerular, vascular and tubular deposits. One had bronchiectasis and allergic bronchopulmonary aspergillosis and the other had common variable immunodeficiency with recurrent gastrointestinal and urinary infections with frequent bacteremia. None of them had confirmed extra-renal involvement, although the latter had hepatic fibrosis awaiting biopsy. Both progressed to dialysis soon after diagnosis. The 3 patients with AFib amyloidosis all had glomerular amyloidosis with additional amyloid deposition at tubular, vascular and both respectively. Two had had an increased creatinine and subnephrotic proteinuria for some years whereas 1 had kidney function decline and nephrotic syndrome in the course of few months. All were hypertensive and none had evident extra-renal deposits. Conclusion Identifying the amyloidogenic precursor may be difficult. Algorithms for diagnosis may vary according to local prevalence of specific types and available resources. AFib amyloidosis was very significant in our series. It was also described in 4.5% of hemodialysis patients in the district of Braga making it one of the first causes of amyloidosis in our region. This high prevalence may justify early genetic testing for the specific mutation in non-AL and non-AA forms.

MO654REAL LIFE EXPERIENCE AFTER 20 MONTHS USING SGLT2 INHIBITORS

Abstract Background and Aims Diabetic kidney disease (DKD) develops in almost half of diabetic patients and is the leading cause of chronic kidney disease (CKD). SGLT2 inhibitors (SGLT2i) have consistently shown to confer kidney protection in patients with type 2 diabetes (T2D). The recent KDIGO guidelines suggest their use as a first line medication along with metformin. After the study CREDENCE was published, in mid-2019, DKD patients at the Nephrology outpatient department of the Hospital of Braga were started on SGLT2i. We aimed at assessing these patients’ clinical and laboratory data after the introduction of the new drug. Method We collected data on age, gender, weight, blood pressure (BP) values, the use of renin-angiotension-aldosterone system inhibitors (RAASi), kidney function, glycated hemoglobin (HbA1c), glycosuria, proteinuria and albuminuria at baseline and during the two next patient assessments. Data was analyzed using SPSS®. Results Twenty-nine DKD patients who started SGLT2i between May 2019 and August 2020 were followed. Mean age was 71.2±13.5 years, 22 patients were male and their mean weight was 86.9±13.9 kg. They had had T2D for a mean of 15.9±10.3 years and a significant percent had end organ damage: 34% had diabetic retinopathy, 24% complaints suggestive of neuropathy, 51% had documented heart failure and 27% had cerebral vascular disease. Most were hypertensive with a mean BP of 156±19/83±11mmHg and 72.4% were taking RAASi. One third were treated with insulin. Most patients were started on canagliflozin (n=28) and one patient started empagliflozin. After starting the drug, patients were evaluated at a mean time of 141±55 days and had a second reevaluation at a mean time of 254±72 days. On the first evaluation they showed a significant reduction in the mean systolic BP to 140±15.1mmHg (p=0.001). Glycated hemoglobin decreased from a mean of 7.4±1.3% to 7.1±1.1% although this difference was not significant (p=0.4). Protein-creatinine urinary ratio was significantly reduced from a median value of 1.48 (IQR 0.24-1.85) to 0.93 (IQR 0.40-1.56). Mean serum creatinine increased significantly from baseline until the first evaluation at 1.96±0.49 to 2.27±0.66mg/dL (p=0.00) but remained stable on the second evaluation (2.29±0.79mg/dL). Seventy percent of the patients developed significant glycosuria (urinary concentration &amp;gt;500mg/dL) after starting SGLT2i. When asked about adherence, most non-glycosuric patients admitted not having started the drug. Conclusion Despite having a weak effect in the reduction of HbA1c, SGLT2i are an exciting drug for kidney protection in DKD. Patient adherence is easy to assess based on glycosuria. In our experience and based on this criterion drug compliance was acceptable (at least 70%) and we were able to reinforce instructions among non-compliant patients. Some of the benefits of SGLT2i were evident soon after they were started such as the improvement in BP and proteinuria. The initial increase in plasma creatinine was expected due to reduction in intraglomerular pressure and hyperfiltration and was noticeable only on the first assessment. We expect to continue SGLT2i use DKD patients.

COVID-19 patients on hemodialysis: a hospital experience

Introduction: SARS‑CoV2 represents a challenge for hemodialysis (HD). By August 24 2020, the disease had affected 55720 people in Portugal. The northern Minho province has had 4428 cases. The Minho has 870 HD patients among 11 ambulatory HD centers and the Nephrology Department of Braga Hospital. Braga Hospital centralized HD treatments of COVID‑19 patients. We describe our experience managing these patients. Results: We used a 2‑station room and dedicated nurse with PPE but, as numbers increased, HD was performed in the main HD room. Disinfection protocols and specific routes were created. Swabs were repeated 14 days after diagnosis and then weekly until recovery. A total of 17 HD COVID‑19 patients were diagnosed in the Minho, 16 of which performed HD in Braga Hospital. The first patient was diagnosed on March 16 and the last on May 5. Ten were males, mean age 60.6±13.2 years and median dialysis vintage 38.5 months (IQR 23.5‑85.8). Four patients were diabetic and 10 were hypertensive. Only 1 of the 5 hospitalized patients was admitted for symptoms attributable to COVID‑19. One developed severe respiratory insufficiency; 3 took hydroxychloroquine and 1 died. The 11 patients on ambulatory care had mild or no symptoms. At diagnosis, the mean hemoglobin was 10.1±1.8g/dL; mean leukocytes count 6.5±3.4x10/μL; mean platelet count 161±7x10/μL and mean LDH 241±148U/L. Median C reactive protein was 11.3mg/L (IQR 1.6‑ 23.8). Patients’ swabs turned negative after a mean of 22±10 days. No association was found between the duration of a positive swab and gender, diabetes or hypertension. Discussion: Compared with the general population, Minho HD patients had a higher incidence of cases, possibly due to an increased risk and more testing. Incidence and mortality were lower than in other series. Centralizing infected patients may help prevent the spread of the disease and reduce the burden on HD centers.

The Prevalence of iron deficiency anemia in infants in a Portuguese population

INTRODUCTION&#x0D; Iron deficiency is the world most prevalent nutritional disorder which is associated with impaired neurocognitive function in infants. The prevalence of iron deficiency anemia (IDA) in Portuguese infants remains unknown. The last study was performed by one of us (HA) in 1994 in a sample of 188 infants revealing a prevalence of IDA of 19%. The main objective of this study is to determine the current prevalence of IDA in a sample of infants nine months of age in Braga, Portugal.&#x0D; METHODS&#x0D; This was a cross-sectional study on a random sample of infants born from September 2016 to February 2017 at Braga Hospital. They were evaluated for anthropometry, socio-economic factors, feeding regime and a blood sample was taken for blood cell counts, serum ferritin and C reactive protein. RESULTS&#x0D; Forty-two infants were included. The prevalence of IDA was 7.1%. Nine infants were anemic (21%); moderate anemia was observed in 2/9 of infants and mild anemia in 7/9 infants. Of the 3 infants with IDA, 2 had been exclusively breastfed until 6 months.&#x0D; CONCLUSIONS&#x0D; Compared to a study from 1994, there may have been a reduction in the prevalence of IDA in this area in Portugal.

Sarcopenia as a Risk Factor of Morbimortality in Colorectal Cancer Surgery

Background: Colorectal cancer (CRC) surgery is associated with high rates of postoperative morbimortality. Sarcopenia has been identified as an independent predictor of these surgical outcomes. Methods: A sample of 272 patients who underwent CRC surgery between January 2005 and May 2010 at Braga Hospital, was selected. Sarcopenia was defined by the skeletal muscle mass index, measured by preoperative computed tomography (CT), at L3 level, using ImageJ® software. Associations between sarcopenia and qualitative variables were analyzed by Chi-Square Test (χ2) or Fisher’s Exact Test and, for quantitative variables, by Mann-Whitney Test. A multivariate logistic regression was performed to assess if sarcopenia was an independent predictor of major morbidity. The overall and recurrence-free survivals were analyzed by Kaplan-Meier method and multivariate Cox regression was performed for recurrence-free survival. Results: The prevalence of sarcopenia was 19.1%. Sarcopenia was associated with male gender, no CRC family history and colon tumour (p &lt; 0.001, p = 0.029 and p = 0.017, respectively). The presence of sarcopenia was associated with postoperative morbidity Clavien–Dindo classification (p = 0.003), and sarcopenia was an independent predictor for major complications (grade ≥ III) (p = 0.003). Conclusions: The evaluation of sarcopenia in patients undergoing CRC surgical resection allows to predict a higher probability of major postoperative morbimortality.

Human papillomavirus (HPV) 16 infection is not detected in rectal carcinoma

IntroductionPersistence of human papillomavirus (HPV) infections is associated with squamous cell carcinomas of different human anatomic sites. Several studies have suggested a potential role for HPV infection, particularly HPV16 genotype, in rectal cancer carcinogenesis.. The aim of this study was to assess the frequency of oncogenic HPV 16 viral DNA sequences in rectal carcinomas cases retrieved from the pathology archive of Braga Hospital, North Portuga.MethodsTaqMan-based type-specific real-time PCR for HPV 16 was performed using primers and probe targeting HPV16 E7 region.ResultsMost of the rectal cancer patients (88.5%, n = 206 patients), were symptomatic at diagnosis. The majority of the lesions (55.3%, n = 129) presented malignancies of polypoid/vegetant phenotype. 26.8% (n = 63) had synchronic metastasis at diagnosis. 26.2% (n = 61) patients had clinical indication for neoadjuvant therapy. Most patients with rectal cancer were stage IV (19.7% patients), followed by stage IIA (19.3%) and stage I (18.5%). All cases of the present series tested negative for HPV16.ConclusionThe total of negative tests for HPV 16 infection is a robust argument to support the assumption that HPV 16 infection, despite of previous evidences, is not involved in rectal cancer carcinogenesis and progression.

Dysregulation of glycerophospholipid metabolism during Behçet’s disease contributes to a pro-inflammatory phenotype of circulating monocytes

Behçet’s disease (BD) is a relapsing, multisystem and inflammatory condition characterized by systemic vasculitis of small and large vessels. Although the etiopathogenesis of BD remains unknown, immune-mediated mechanisms play a major role in the development of the disease. BD patients present leukocyte infiltration in the mucocutaneous lesions as well as neutrophil hyperactivation. In contrast to neutrophils, whose involvement in the pathogenesis of BD has been extensively studied, the biology of monocytes during BD is less well known. In this study, we analyzed the phenotype and function of circulating monocytes of 38 BD patients from Hospital of Braga. In addition, we evaluated the impact of inflammatory and metabolomic plasma environment on monocyte biology. We observed a worsening of mitochondrial function, with lower mitochondrial mass and increased ROS production, on circulating monocytes of BD patients. Incubation of monocytes from healthy donors with the plasma of BD patients mimicked the observed phenotype, strongly suggesting the involvement of serum mediators. BD patients, regardless of their symptoms, had higher serum pro-inflammatory TNF-α and IP-10 levels and IL-1β/IL-1RA ratio. Untargeted metabolomic analysis identified a dysregulation of glycerophospholipid metabolism on BD patients, where a significant reduction of phospholipids was observed concomitantly with an increase of lysophospholipids and fatty acids. These observations converged to an enhanced phospholipase A2 (PLA2) activation. Indeed, inhibition of PLA2 with dexamethasone or the downstream cyclooxygenase (COX) enzyme with ibuprofen was able to significantly revert the mitochondrial dysfunction observed on monocytes of BD patients. Our results show that the plasma inflammatory environment coupled with a dysregulation of glycerophospholipid metabolism in BD patients contribute to a dysfunction of circulating monocytes.

Role of a Micronized Purified Flavonoid Fraction as an Adjuvant Treatment to Rubber Band Ligation for the Treatment of Patients With Hemorrhoidal Disease: A Longitudinal Cohort Study.

PurposeNonsurgical treatment of hemorrhoidal disease (HD) includes medical and instrumental techniques. We aimed to compare the efficacy of the most frequently used nonsurgical strategies, either alone or in combination, applied in an ambulatory setting.MethodsPatients who received nonsurgical treatment for HD by proctology appointment at the Gastroenterology Department of Braga Hospital were evaluated. Isolated rubber band ligation (RBL) and a combination of RBL with a micronized purified flavonoid fraction (MPFF) were the 2 most frequently used strategies. Symptoms of HD (bleeding, pruritus, pain at rest, pain at defecation and prolapse) were assessed at days 0, 7, and 28 by using a severity grading scale (0 to 4/5). A Global Symptom score was constructed to assess the overall severity and compare the overall improvements of the HD symptoms between the 2 most frequently used strategies.ResultsNineteen patients underwent the combined treatment (RBL + MPFF group) and 25 the RBL treatment (RBL group). A comparison of the 2 treatment groups showed significant improvements in the combined treatment group in terms of bleeding at days 7 (P = 0.001) and 28 (P = 0.002) and in the pruritus intensity during the first week (P < 0.001). A trend toward clinical benefit was also verified in the combined treatment group for all other HD symptoms (pain at rest, pain at defecation and prolapse).ConclusionA combined treatment approach with MPFF and RBL significantly reduced the intensity of bleeding during the first month and the pruritus during the first week.

Late Ophthalmologic Referral of Anisometropic Amblyopia: A Retrospective Study of Different Amblyopia Subtypes.

Amblyopia requires a timely diagnosis and treatment to attain maximum vision recovery. Specialty literature is lacking onhow early amblyopia is referred. We aimed to understand if there are mean age differences at first referral for ophthalmologic tertiarycenter consultation among non-amblyopic and different types of amblyopia, in a context of lack of population screening. In this retrospective model, the sample corresponded to all children born in Braga Hospital during 1997 - 2012(3 - 18 years-old), with an ophthalmologic consultation in 2014. Data was collected from the clinical records and children were dividedin a non-amblyopic versus amblyopic group. The amblyopic group was subdivided in strabismic versus refractive (anisometropic/bilateral). The sample had a total of 1665 participants, 1369 (82.2%) without amblyopia and 296 (17.8%) with amblyopia. Amongamblyopia: 67.9% (n = 201) refractive, 32.1% (n = 95) strabismic. Within refractive amblyopia: 63.7% (n = 128) anisometropic and36.3% (n = 73) bilateral. The mean age at first consultation was 6.24 ± 3.90 years-old: 6.39 ± 3.98 for non-amblyopic and 5.76 ± 3.58for amblyopic. Among amblyopia subgroups, there were significant differences in mean age at first consultation (F3,1250 = 8.45; p < 0.001;η2 = 0.020). Strabismic and bilateral refractive amblyopia were referred earlier, when compared to non-amblyopia or anisometropicamblyopia (p < 0.05). Anisometropic amblyopia had the highest first consultation mean age: 6.92 ± 3.57 years-old. Without specific pre-school screening, children with amblyopia were referred to their first ophthalmologic evaluationsignificantly later than desired, especially anisometropic amblyopia, with a postschool mean age for first consultation. Recognizing high-risk children is essential for earlier referral and helps minimize future visual handicap.

Gliosarcomas: Analysis of Braga Hospital Cases and Review of the Literature

Background: Gliosarcomas are very rare tumors of central nervous system, as such, the data of the literature are scarce, which makes its characterization and therapeutic approach more difficult. Methods: A survey about gliosarcomas in Hospital de Braga was carried out between January 1995 and October 2013. A bibliographic review was also carried out. Results: We get a total of 18 cases and the main aim of this study was to evaluate survival according to different variables (age, gender, time symptoms to diagnose, karnofsky, MRI necrosis, MRI mass effect, MRI edema, proximity to the dura-mater, lobar location, hemispheric location, tumor size, gliosarcoma type, macroscopy, type of resection, adjuvant treatment and metastization). The factors associated with a better survival were: age inferior to 50 years old, female gender, karnofsky >80, time symptoms to diagnose <1 month, necrosis <50% tumor volume, midline shift <0.5 cm, edema<tumor volume, tumor not adjacent to the dura-mater, size <5 cm, occipital lobe, left hemisphere, primary type, macroscopy similar to glioblastoma, radical resection, adjuvant RT, non metastization. There were two factors with influence on survival and statistically significant p value: midline shift less than 0.5 cm and location in the left hemisphere. Conclusion: This sample presents some factors with effect on the survival and that can be taken into account in the approach of these tumors.

Smoking Cessation after Bladder Cancer Diagnosis

Smoking is an important risk factor for the development, recurrence and progression of bladder cancer. Our aim was toanalyze smoking habits after diagnosis in bladder cancer patients. Additionally, we evaluated patient knowledge about smoking as arisk factor and the urologist role in promoting abstinence. A cross-sectional, observational and descriptive study was performed in bladder cancer patients, diagnosedbetween January 2013 and September 2015 (n = 160) in Braga Hospital, in Portugal. Smoking history was present in 71.9% of the sample, with 21.9% current smokers, (40.7% of abstinence after diagnosis).Smoking was acknowledged as a risk factor by 74.4% of the sample, with only 51.3% of ever smokers and 24.4% of non-smokersrecognizing smoking as the leading risk factor (p = 0.008). The presence of other household smokers were significantly higher inpatients who continued smoking (40%) than in ex-smokers after diagnosis (4.2%) (p = 0.005). The majority of smokers at diagnosis(83.1%) were advised to quit by their urologist, but only one smoker (1.7%) was offered any specific intervention to aid in cessation. Smoking is not recognized as the leading risk factor for bladder cancer. This limited awareness, associated with the knowndifficulties in quitting smoking and the observed lack of smoking cessation interventions, may account for the high current smokingprevalence, albeit in line with other studies. This study highlights the need for efficient smoking cessation programs directed to bladder cancer patients.

Comportamentos suicidários: caracterização e discussão de fatores de vulnerabilidade

Objectives: To characterise the group of patients that had the first medical appointment in the Suicidal Behaviour Unit (SCU) of Braga Hospital (HB) psychiatric service during the years 2014-2015 and identify features associated with the higher risk of repeating behaviour and use of violent methods. Type of study: Observational, cross-sectional, descriptive and analytical. Location: Braga Hospital. Population: Patients who had the first appointment in HB psychiatry service UCS in the period between 01/01/2014 and 31/12/2015. Methods: Collection of routine data using de clinical file. Collection of sociodemographic, psychosocial, and clinical circumstances of suicidal behaviour. SPSS software, v. 21, was used to analyse and process the data. Univariate and bivariate descriptive analysis were performed. Then a binary logistic regression model was created to identify possible risk factors associated with repeated behaviours and more violent methods. Results: The study included 154 individuals, mostly women (70.8%) with average age of 39.7 years. Most of them were married (51.9%). A higher number of suicide attempts were observed during months whose days have less sun. Drug intake was the most frequently used method (68.2%). The most violent and lethal methods were more used by men (p=0.036). The use of substances was associated with the practice of more violent suicidal attempts (p=0.045). Personality disorder (p=0.001) and treatment with antidepressants (p=0.028) were risk factors for suicidal behaviour repetition. In this study, most of individuals (72%) had an appointment in primary care, in the 12 months prior to the suicidal attempt. Conclusions: In this study the most frequent diagnosis was depression. This study allowed to identify personality disorders and the use of antidepressant medication as risk factors associated with repetitive suicidal behaviour. Our results point male gender and substance abuse as risk factors to the use of more violent and lethal methods. This knowledge is essential for the prevention of mortality associated with suicidal behaviour, especially among family doctors. However, more studies are needed to strengthen the influence of the risk factors in the population.

Optimization of logistics services in hospitals

AbstractHealth‐care costs are increasing rapidly in the developed countries. For many years, logistics has been identified as one of the major cost factors. Such escalating cost is a serious concern for most hospitals as providers of affordable health care but many time‐sensitive logistics services are essential and indispensable. In this paper, we discuss various logistics issues that are cost concerns for most hospitals and address a particular hospital‐internal courier service logistics as an example. Applying optimization‐based approaches on real‐world data from a particular hospital in Portugal, we demonstrate how efficiency and effectiveness can be improved. Computational results show that solution approach based on optimization and process re‐engineering can not only improve the performance measure by more than 50% but also reduce resources necessary to maintain the same level of service as before by 16.67%. We have developed and implemented a fully functional decision‐support system that is now used daily at the Hospital of Braga in Portugal for not only handling the courier service function more efficiently but also for increased flexibility to manage urgent and high‐priority service needs that could not be handled before.

Prognostic impact of the number of resected lymph node on survival in Colorectal Cancer

IntroductionColorectal Cancer (CRC) is the third most common cancer and the second leading cause of death in Western countries. In Portugal, in the North, emerges as the second most common cancer. The presence of lymph node metastasis is an important predictor of overall and disease-free survival and several studies recommend the evaluation of at least 12–14 regional lymph nodes, as it contributes to improve cancer staging and patient outcomes. AimsEpidemiological characterization of the studied population and identify a possible relationship between the number of lymph nodes evaluated in the surgical specimen and survival. MethodsWe preceded to the study of 1065 CCR patients, submitted to surgical resection between 1 January 2000 and 31 August 2012, in Braga Hospital. Discussion/ConclusionThe results of the epidemiological characterization of this population are coincident with those described in the literature. It was observed a significant correlation between age, tumor size, serosal invasion, differentiation, tumor penetration, venous and lymphatic invasion, metastasis, TNM stage and the number of lymph nodes evaluated. However, we did not observe a statistically significant correlation between patient survival and number of lymph nodes evaluated (p>0.05). A possible explanation is the practice of oncologists, addressing patients with less than 12 nodes identified in the surgical specimen as “N-positive” and undergoing adjuvant therapy. A better harvest and careful analysis of lymph nodes would lead to more accurate staging, avoiding overtreatment and side effects associated, and allow better economic management of hospital resources, in real N0 patients.

Day and night surgery: is there any influence in the patient postoperative period of urgent colorectal intervention?

Medical activity performed outside regular work hours may increase risk for patients and professionals. There is few data with respect to urgent colorectal surgery. The aim of this work was to evaluate the impact of daytime versus nighttime surgery on postoperative period of patients with acute colorectal disease. A retrospective study was conducted in a sample of patients with acute colorectal disease who underwent urgent surgery at the General Surgery Unit of Braga Hospital, between January 2005 and March 2013. Patients were stratified by operative time of day into a daytime group (surgery between 8:00 and 20:59) and the nighttime group (21:00-7:59) and compared for clinical and surgical parameters. A questionnaire was distributed to surgeons, covering aspects related to the practice of urgent colorectal surgery and fatigue. A total of 330 patients were included, with 214 (64.8%) in the daytime group and 116 (35.2%) in the nighttime group. Colorectal cancer was the most frequent pathology. Waiting time (p < 0.001) and total length of hospital stay (p = 0.008) were significantly longer in the daytime group. There were no significant differences with respect to early or late complications. However, 100% of surgeons reported that they are less proficient during nighttime. Among patients with acute colorectal disease subjected to urgent surgery, there was no significant association between nighttime surgery and the presence of postoperative medical and surgical morbidities. Patients who were subjected to daytime surgery had longer length of stay at the hospital.

Assessment of prognosis in patients with stage II colon cancer

Pathologic staging is currently the most important prognostic factor in colon cancer, although individually this procedure does not provide a complete clinical outcome.This study aimed to determine the disease-specific survival of patients with colon cancer treated in the Braga Hospital from January 2005 to December 2013, according to the American Joint Committee on Cancer, 6th edition, and the disease-free survival and disease-specific survival of high- and low-risk stage II patients, whether in use, or not, of adjuvant chemotherapy.We obtained a total sample of 578 patients, with 145 and 65 high- and low-risk stage II patients, respectively. We observed a 5-year disease-specific survival rate of 93%, 27.4% and 75% for stage IIA, IIB and IIIA patients, respectively, where IIIA and IIB present statistically significant differences (p=0.001). In high-risk stage II patients, disease-free survival (p=0.107) and disease-specific survival (p=0.037) were higher in the group submitted to chemotherapy. In low- risk patients, disease-free survival was higher in the group submitted to chemotherapy (p=0.494), while disease-specific survival was lower (p=0.426).The differences observed between stage IIB and IIIA survival can be explained by the consensual use of adjuvant chemotherapy in stage IIIA, and by its controversial use in stage IIB. Adjuvant chemotherapy showed to be effective only in high-risk stage II patients in terms of disease-specific survival.In the future, other markers, namely molecular ones, may be used to stratify the risk of stage II patients and determine who will benefit from adjuvant chemotherapy.