Secondary orofacial granulomatosis due to Crohn's disease.

We report the case of a 34-year-old female with Crohn's disease (CD), was treated with infliximab and ileocecal resection after failure to anti-TNF. She started adalimumab for postoperative recurrence for two years, with sustained clinical and endoscopic remission. She presents with a 1.5-year history of a persistent, asymptomatic, rubbery swelling on the left half of the lower lip.

Efeito de um programa de relaxamento no bem-estar sócio emocional dos enfermeiros em medicina intensiva / Effect of a relaxation program on the socio-emotional well-being of intensive care nurses

A saúde mental dos enfermeiros é alvo de preocupação, pela posição decisiva que estes ocupam no desenvolvimento dos serviços de saúde. A evidência científica revela que os enfermeiros em Serviços de Medicina Intensiva, estão sujeitos a níveis de stresse ameaçadores do seu bem-estar, defendendo que os mesmos, devem ter um papel ativo na promoção do seu bem-estar, no sentido de alcançar a sua saúde mental, tanto em seu benefício próprio, como nos cuidados que prestam na sua prática clínica. O presente estudo tem como objetivo avaliar se o programa de relaxamento (PR) tem efeito positivo no bem-estar sócio emocional dos enfermeiros, que exercem funções no serviço de medicina intensiva de um hospital central. Desenvolveu-se um estudo longitudinal, com desenho de nível IV, de natureza quasi-experimental, com grupo experimental e grupo de controlo, em 65 participantes. A colheita de dados ocorreu entre abril e junho de 2022, através de questionário que integrou: consentimento informado, caraterização sociodemográfica e profissional, Inventário de Ansiedade-estado, Escala de Bem-estar Psicológico e Escala de Perceção de Stresse. O grupo experimental foi sujeito ao programa de relaxamento, constituído por seis sessões. A análise dos dados foi efetuada através do programa estatístico Statistical Package for the Social Sciences, na versão 25, recorrendo a medidas de estatística descritiva e análise inferencial. Os resultados revelam que as diferenças da evolução apresentadas pelos grupos, têm significância estatística, relativamente às variáveis ansiedade-estado e perceção de stresse. Em relação à variável bem-estar psicológico, o resultado do teste estatístico está no limiar de significância (p = 0,058). Estes resultados, sugerem uma evolução positiva e significativa como efeito do programa de relaxamento. Concluiu-se que, o PR revelou eficácia na redução da ansiedade e perceção de stresse, contribuindo para o bem-estar sócio emocional dos enfermeiros. Perante estes resultados e atendendo à necessidade de promover a saúde mental dos enfermeiros, sugere-se a sua continuidade, com o propósito de melhorar o bem-estar sócio emocional dos enfermeiros e consequente melhoria do seu desempenho, o qual será espelhado na qualidade e segurança dos cuidados prestados à Pessoa em Situação Crítica.

Standardization of a colorimetric technique for determination of enzymatic activity of diamine oxidase (DAO) and its application in patients with clinical diagnosis of histamine intolerance.

BACKGROUND: Diamine Oxidase (DAO) has an essential role for degradation of exogenous histamine in the intestine; thus, histamine intolerance (HI) mainly has been correlated to a low concentration and/or activity of this enzyme. The objective of the study was to standardize a colorimetric technique to measure the enzymatic activity (function) of hDAO to then apply it to a series of 22 patients with a clinical diagnosis of HI. METHODS: For the standardization variables such as volume and type of sample, incubation time, wavelength of maximum absorption, types of substrates, and concentration of oxidized ascorbate were evaluated. Then the activity and concentration of DAO was determined in 22 patients diagnosed with HI and 22 healthy subjects. RESULTS: The mean of serum DAO concentration in the 22 patients was of 9.268 ± 1.124 U/mL. The mean of serum DAO concentration in the 22 controls was of 20.710 ± 2.509 U/mL, being significantly higher (P value 0.0002) the mean of the samples. The mean of serum DAO activity of the patients was of 1.143 ± 0.085 U/L and the controls was 1.533 ± 0.119 U/L, significantly greater than the patients (P value 0.011). In addition, the sensitivity of both techniques was 0.63. In the measuring of DAO concentration the specificity was 0.9, constituting a good diagnostic test, especially to rule out the true negatives. The determination of DAO activity had a specificity of 0.68. CONCLUSIONS: Although we used a small number of patients and controls and the absorbance values were lower than expected, statistically significant differences were found in the levels of concentration and DAO activity between the patients with histamine intolerance and the controls. Therefore, the measuring of DAO concentration and DAO activity is a good diagnostic strategy for study suspect cases of HI. The simultaneous use of both assays allows to reduce positive and negative false results, for example, patients with normal DAO levels that could present a dysfunction in the activity of this enzyme.

Dependent person in self-care: analysis of care needs.

BACKGROUND: The aim of this study was to assess the self-care dependency levels of the dependent person at the time of home discharge and its relationship between (1) the degree of dependency of each self-care domain; (2) the previous dependency levels; and (3) the gender of the dependent person. It also aims to assess the relationship between the degree of dependency of each self-care domain, the length of admission, the length of dependency and the age of the dependent person at the time of discharge. METHODS: A cross-sectional study was conducted. The sample comprised hospitalised adults and elderly in the medical services of a Portuguese hospital during the months of March, April and May of 2018. The data were collected by an interview conducted at the time of home discharge from the hospital medical ward. RESULTS: The average age of dependent people of the sample is 80.7 years (±10.1) with the majority being women (51.7%), with no statistical difference in the mean age according to gender (U = 2205.500; p > 0.05). They were hospitalised on average 11.4 days (±33.2), most of them (44.0%) due to respiratory problems (85% of which were due to pneumonia). There were no statistically significant differences between the length of the hospital stay, the length of dependency and the participants' gender (U = 2200.500, p > 0.05; U = 1688.000, p > 0.05). Medication intake was the highest dependency domain amongst participants (41.3%), followed by instrumental activities of daily living (40.6%) and bathing (39.9%). CONCLUSION: The amount of support required may vary according to the domain that the person is dependent. Thus, it is important to use a robust and reliable assessment tool that will be able to assess the degree of dependency on the various domains of self-care.

Needs and skills of informal caregivers to care for a dependent person: a cross-sectional study.

BACKGROUND: The world is facing many socio-demographic changes, such as an increased average life expectancy and the presence of chronic and non-communicable diseases, which in turn, leads to an enhanced dependency on others. Consequently, the demand for informal caregivers has significantly increased during the past few years. Caring for a dependent person is linked to a series of burdens that often leads to physical, psychological and emotional difficulties. Taking into consideration the difficulties faced by informal caregivers, knowing in which areas of functioning they need more guidance may help to relieve their burden. Therefore, the main goal of this study is to better understand the needs and competencies of the informal caregiver when caring for a dependent person in the different self-care domains. METHODS: This cross-sectional study used a questionnaire administered on a single occasion by face-to-face interview. Descriptive and inferential statistics alongside non-parametric statistical techniques such as the Mann-Whitney test and Spearman's correlation were used. RESULTS: The average age of the 143 informal caregivers is 58 years old, with the youngest in our sample being 21 years of age. Most of them are female, and 50% of them are children taking care of one of their parents. Most of the dependent people are completely dependent in the areas of comfort and hygiene (53.8%) and medication management (55.9%). The female informal caregivers see themselves as having more competencies in sanitary hygiene than the male ones, with no significant differences in their competencies' perception in the other areas of self-care. Older caregivers see themselves as less competent in certain areas of self-care such as feeding, mobility, transfers, medication and symptoms management and communication. Most of the information given to the informal caregiver is about the disease (82.3%) and the medication management (80.4%). There are still a lot of areas of self-care, where no information, or almost none, is given to the informal caregivers. CONCLUSIONS: Before home discharge of a dependent person, it is important to acknowledge the needs and competencies of the informal caregiver, to capacitate them in looking after their relatives, to help decrease their burden and consequently, decrease the number of hospital readmissions.

Cost-effectiveness of primary antifungal prophylaxis with posaconazole versus itraconazole in allogeneic hematopoietic stem cell transplantation.

PURPOSE: To evaluate the cost-effectiveness of posaconazole vs itraconazole in the prevention of invasive fungal infections (IFIs) in recipients of allogeneic hematopoietic stem cell transplantation (allo-HSCT). METHODS: Total hospital-based costs from initial admission for allo-HSCT until day 100 after transplantation were evaluated for 49 patients in whom the clinical efficacy of antifungal prophylaxis with posaconazole vs itraconazole had been previously analyzed and reported. Clinical and economic data were used to determine the incremental costs per IFI avoided and per life-year gained for posaconazole compared with itraconazole. Confidence intervals for the incremental cost-effectiveness ratio (ICER) and a cost-effectiveness acceptability curve were estimated through bootstrapping with the bias-corrected percentile method. RESULTS: According to our analysis, the total cost of allo-HSCT per patient during the 100-day fixed-treatment period was €46,562 in the posaconazole group (n = 33) and €45,080 in the itraconazole group (n = 16). However, the reduction in the incidence of IFI and the improved outcome with posaconazole resulted in a favorable ICER of €11,856 per IFI avoided and €5218 per life-year gained. With the outcomes of the bootstrap procedure, the cost-effectiveness acceptability curve was constructed. Assuming a threshold of €30,000 per life-year gained, the ICER based on life-years gained is acceptable with 75% certainty. LIMITATIONS: This evaluation is based on data from a single-center, non-randomized study. Preference weights or utilities were not available to calculate quality-adjusted life-years. Extra-mural costs were only partially evaluated from a hospital perspective. Indirect costs and economic consequences are not included. CONCLUSIONS: This economic evaluation compared direct medical costs associated with posaconazole or itraconazole treatment; the data suggest that posaconazole may be cost-effective as antifungal prophylaxis during the early high-risk neutropenic period and up to 100 days after allo-HSCT.

Segurança do doente: Perspetiva dos profissionais de um hospital da região Centro / Patient Safety: Perspective of professionals from a hospital in the Central Region

A cultura de segurança do doente é a perceção que os profissionais de saúde têm sobre as características e ambiente da organização, que condicionam a segurança do doente. Conhecer essa cultura de segurança permite que os processos de melhoria contínua incidam nas áreas identificadas como prioritárias. Este estudo, descritivo-correlacional, teve como principais objetivos: conhecer a cultura de segurança do doente e a perceção dos profissionais sobre o contributo da implementação de normas da qualidade para a segurança. A amostra (n=323) é constituída pelos profissionais envolvidos diretamente na prestação de cuidados, nomeadamente enfermeiros (60,2%); assistentes operacionais (21,3%), médicos (9,5%); técnicos de diagnóstico e terapêutica (6%), assistentes técnicos e outros técnicos (0,8%). Destacam-se os seguintes resultados obtidos: as dimensões da segurança do doente com avaliação positiva, que constituem pontos fortes da instituição, são: "trabalho em equipa"; "aprendizagem organizacional/melhoria contínua"; "expetativas do supervisor/gestor e ações que promovam a segurança do doente" e "comunicação e feedback acerca do erro". As dimensões consideradas como oportunidade de melhoria são: "trabalho entre unidade"; "dotação de profissionais"; "frequência da notificação" e "resposta ao erro não punitiva". A cultura de segurança difere segundo a profissão, no entanto relativamente aos anos de experiência, só uma dimensão ("apoio à segurança do doente pela gestão") apresenta significância estatística. Existe correlação positiva fraca, estatisticamente significativa, entre a implementação de normas de qualidade e a cultura de segurança na maioria das suas dimensões. Conclusão: A positividade da dimensão "aprendizagem organizacional/melhoria contínua" evidencía a capacidade da instituição e das equipas para desenvolverem estratégias de melhoria, sobretudo nas áreas identificadas como "oportunidades de melhoria".

Dasatinib as salvage therapy for steroid refractory and imatinib resistant or intolerant sclerotic chronic graft-versus-host disease.

Sclerotic chronic graft-versus-host disease (scGVHD) is a severe form of this disease that resembles systemic sclerosis and has limited and disappointing treatment options. Tyrosine kinase inhibitors (TKI) targeting up-regulated profibrotic pathways, such as imatinib mesylate, have been proposed as a potential therapeutic approach for patients with scGVHD. Dasatinib, a second-generation TKI with a well-established safety and efficacy profile in chronic myeloid leukemia patients, who are refractory or intolerant to imatinib, has also shown potent antifibrotic effects. We present here the first direct clinical evidence, from 3 patients treated in a small single-center series, suggesting that dasatinib can be a therapeutic option for patients with severe scGVHD resistant or intolerant to imatinib. All patients achieved partial response, with improvement in scGHVD target organs severity, joint mobility, lung impairment, and deep fibrotic lesions. This clinical response has remained stable or continued to improve after a median of 22 months (20-25) on dasatinib treatment, with very good tolerance. In addition, corticosteroids could be discontinued or significantly reduced in all patients. This clinical evidence suggests that dasatinib could be a safe and effective alternative for scGVHD patients refractory to corticosteroids and resistant or intolerant to imatinib. Based on these preliminary findings, and in order to address appropriate patient selection, time of intervention, and choice of drug, future larger studies should more formally establish the efficacy and safety of second-generation TKI for the treatment of scGVHD.