Hospital Garcia de Orta

<h3>Background and Importance</h3> Age-related eye diseases, such as macular degeneration, diabetic macular oedema and venous occlusion, have increased significantly in recent decades, driving demand for anti-vascular endothelial growth factor (VEGF) therapies. Compounding these agents into prefilled syringes optimises resources, leading to significant savings. Ensuring the physicochemical integrity of each locally produced syringe, prepared from both reference biological product and biosimilars, is essential to maintain efficacy and patient safety throughout the assigned 28-day shelf life. <h3>Aim and Objectives</h3> To evaluate the stability and environmental impact of hospital compounding of intravitreal injections of aflibercept Eylea (8 and 40 mg/mL), bevacizumab MVASI (25 mg/mL), ranibizumab Ranivisio (0.6 mg/mL) and faricimab Vabysmo (120 mg/mL) stored in silicone-free and oil-free polypropylene syringes (Henke-Ject, ) with low dead space. <h3>Material and Methods</h3> Syringes were stored at 2-8°C under light protection and analysed after 0, 7, 28 and 90 days. Analyses, performed in triplicate, included VEGF-binding affinity and biophysical stability tests using dynamic light scattering (DLS) and thermal-ramp analysis (25-100°C) to assess particle size and thermal behaviour. For statistical analysis (p &lt; 0.01) one-way ANOVA was used. <h3>Results</h3> In 2025, 6015 injections were prepared for 991 patients, resulting in an estimated savings of EUR 1 494 584. No visual changes in colour, opalescence or particles were observed up to 90 days. Ranibizumab showed the best thermal stability (unfolding 75-79°C) with minimal particle variation (2.69-2.84 nm). Bevacizumab remained stable (7.75-7.86 nm; 64-70°C), and aflibercept 40 mg/mL showed better stability than 8 mg/mL (6.61-7.26 nm). Faricimab exhibited early aggregation (peak particle size at 187 nm after 1 week; 42-64°C) and progressive VEGF affinity loss after 7 days. The others showed ≤10% affinity variation within 28 days. <h3>Conclusion and Relevance</h3> Except for faricimab, all anti-VEGF injections seem to maintain their physical, chemical and biological stability throughout the 28-day shelf life, supporting the reliability of the hospital compounding and storage process. The analytical sensitivity applied enabled early detection of aggregation risk, justifying the decision to shorten faricimab’s validity period to one week. Continuous validation after any production change ensures consistent safety and efficacy. The demonstrated cost savings highlight the pharmacist’s role in promoting quality, sustainability and rational use of hospital prepared intravitreal preparations. <h3>Conflict of Interest</h3> No conflict of interest

Abstract Background Rheumatic heart disease (RHD) remains a major cause of valvular disease in low- and middle-income countries, with substantial public health and economic impact. Cardiac imaging, particularly echocardiography (echo), plays a pivotal role in diagnosing and managing RHD, particularly mitral stenosis (MS), yet practices vary across affected regions. Purpose To evaluate current use of cardiac imaging in the assessment and management of RHD – focusing on MS- in Brazil and Portuguese-speaking countries, through a collaborative survey coordinated by the Cardiovascular Imaging Department of the Brazilian Society of Cardiology. Methods An anonymous questionnaire was distributed via messaging platforms to cardiologists and cardiovascular imaging specialists. Data on clinical experience, imaging modalities, and decision-making strategies related to MS were collected and analyzed. Results A total of 439 participants completed the survey, predominantly from Brazil (89.7%) and Angola (67.4% of the remaining 10.3%). Most reported over 10 years of clinical experience (67.4%), worked in public hospitals (58.5%), and were based in tertiary centers (61.9%). Conventional parameters (2D planimetry, PHT, and transvalvular gradients) were the most frequently used methods to assess MS. In addition to conventional two-dimensional (2D) measurements, strain imaging is used in clinical routine by 77.7%, three-dimensional (3D) echo in 51.5% and exercise echo in 35.3%. Regarding the classification, 50.1% considered mitral valve area (MVA) between 2.0–2.5 cm² as mild. In cases of discordant clinical-echo scenarios, 3D planimetry and exercise echo were used by 35.5% and 36%, respectively. Left ventricular (LV) systolic function was primarily evaluated using biplanar ejection fraction (EF) by Simpson’s method (86.6%), followed by 2D longitudinal strain in selected cases (42.8%), LVEF by 3D echo (26%), and cardiac magnetic resonance (20%). Assessment of right ventricular function was most commonly performed using TAPSE and RV tissue Doppler (90.9%), followed by fractional area change (FAC) (62.2%), 2D RV strain (31.9%), RVEF by 3D echo (20.5%), and CMR (18.9%). Percutaneous balloon mitral valvuloplasty (PBMV) was primarily guided by the Block-Wilkins score (78.1%), with special consideration to subvalvular involvement (77.2%) and valve calcification (68.3%). Intraprocedural echo guidance was reported in 87.1% of centers performing PBMV with the use of 2D transesophageal echo (TOE) in 39.2%, 3D TOE in 45.6%, and 2D transthoracic echo in 15.2%. Conclusion 2D transthoracic echo remains the cornerstone for RHD assessment. Although access to advanced imaging techniques, such as strain and 3D echo is increasing, their integration into routine clinical-decision making is still limited. Furthermore, the variability in defining mild MS reveals a knowledge gap and reinforces the need for broader training and guideline standardization across Portuguese-speaking countries.

Abstract Background Crohn’s disease (CD) has a variable clinical course and a heterogeneous therapeutic response. Clinical decision support tools (CDSTs) for vedolizumab (VDZ) and ustekinumab (UST) have been developed to guide personalized treatment, but comparative evidence—particularly regarding the UST-CDST—remains limited. We aimed to compare the predictive performance of both CDSTs in CD. Methods We conducted a retrospective, multicenter study (9 centers), including CD patients treated with UST or VDZ. For each patient, the UST-CDST and VDZ-CDST were applied and categorized into low, intermediate, or high probability of response. The primary outcome was steroid-free clinical remission (SFCR) at week 52. Secondary outcomes included need for surgery, hospitalization and phenotypic progression. Model discrimination was evaluated with ROC/AUC, and predictors assessed via multivariable Cox regression. Results Of 711 screened patients, CDSTs were applicable in 440 [UST: 74.5% (n = 328); VDZ: 25.5% (n = 112)]. In multivariable Cox models, VDZ-CDST independently predicted SFCR only in VDZ-patients (HR 2.00; 95% CI 1.19–3.35), while UST-CDST predicted SFCR only in UST-patients (HR 1.54; 95% CI 1.23–1.94). VDZ-CDST identified SFCR with an AUC of 0.70 in VDZ-patients and 0.59 in UST-patients, whereas UST-CDST achieved an AUC of 0.63 and 0.68, respectively. Both scores significantly discriminated the risk of surgery, hospitalization and phenotypic progression in both biologics. Agreement between the two CDSTs was 75%. Conclusion Both UST-CDST and VDZ-CDST demonstrated significant predictive performance for clinical response and disease progression in CD, with superior performance for their target biologic. These findings support the integration of CDSTs into clinical practice promoting a personalized treatment in Crohn’s disease.

Abstract Background and Aims Managing nephropathy in human immunodeficiency virus (HIV) infected patients present unique challenges due to the interplay of various contributing factors. These include antiretroviral therapy (ART), prophylactic medication, comorbidities, concurrent infections, and other immune or non-immune associated nephropathies. HIV-associated nephropathy (HIVAN) incidence significantly decreased following the introduction of ART. Nevertheless, it remains a notable cause of kidney disease, particularly in patients who are undiagnosed or inadequately treated. Genetic predispositions also play a role, as shown by higher prevalence in African ancestry and APOL1 polymorphisms. While high viral loads are a recognized risk factor for HIVAN, it is uncertain whether it is a necessary condition. There are limited case reports documenting the occurrence of HIVAN in patients with low or undetectable HIV viral loads. Method This report details an atypical case of HIVAN in an HIV patient with an undetectable viral load. Results We present the case of a 52-year-old man of African descent with a history of HIV 1 infection and intermittent periods of nonadherence to ART. He was on a regimen of bictegravir/emtricitabine/tenofovir Alafenamide and had additional comorbidities, including chronic lung disease and active smoking. He had a basal serum creatinine (sCreat) of 1.2 mg/dL and urinalysis two months before admission showed de novo proteinuria ++. The patient presented to the emergency department with a 4-day history of fever, dyspnea and diarrhea. He was diagnosed with influenza A pneumonia and was hospitalized due to hypoxemia, initiating oseltamivir treatment. Other respiratory viruses, such as SARS-CoV-2, were negative. Initial laboratory tests revealed kidney function similar to his basal function, HIV 1 RNA &amp;lt;20 copies/mL, and CD4+ T-cell count of 116 cells/µL. Two days after admission, the patient developed bacterial pneumonia, and piperacillin-tazobactam was initiated. Although the patient showed clinical improvement after 7 days of treatment, he developed worsening renal function (sCreat 9.1 mg/dL, urea 152 mg/dL), reduced diuresis and metabolic acidosis. Urinalysis showed hematuria and nephrotic range proteinuria, with a protein-creatinine ratio of 30.7 g/g and an albumin-creatinine ratio of 13.9 g/g. Serum albumin was 2.5 mg/dL, cholesterol and triglycerides were in the reference range. ART was subsequently changed to ritonavir/darunavir and dolutegravir. Immunologic studies were negative. Complement C3 and C4 levels were normal. Serum protein electrophoresis and immunofixation ruled out monoclonal gammopathy, and serologies for hepatitis B and C were negative. Renal ultrasound revealed a right kidney measuring 12 cm and a left kidney measuring 14 cm, with increased echogenicity and reduced parenchymal-sinus differentiation. Doppler studies excluded renovascular lesions. Kidney biopsy was performed and showed a collapsing form of focal segmental glomerulosclerosis, confirming HIVAN, and 40% tubulointerstitial fibrosis. The patient required hemodialysis due to fluid overload. HIV 1 RNA testing was repeated two weeks after the initial test, revealing 23 copies/mL and CD4+ T-cell count of 338 cells/µL. At one year follow-up, the patient remained without renal recovery, maintained good adherence to ART with controlled viral load. APOL1 genotyping was not performed. Conclusion Nephropathy in HIV patients presents a multifactorial challenge. This case highlights the complexity of diagnosing HIVAN, emphasizing the importance of maintaining a high index of suspicion even in patients with undetectable or low HIV RNA levels, particularly in the presence of a history of nonadherence to ART and CD4+ T-cell counts below 200 cells/µL. We may hypothesize if the respiratory infection was the trigger for developing the disease, although the patient had prior de novo proteinuria. Renal biopsy remains the gold standard for confirming the diagnosis.

Background/Objectives: Age-related changes in the gastric mucosa remain incompletely understood. We aimed to assess and compare clinical, endoscopic and histologic changes in the gastric mucosa associated with aging, and to explore whether gastric aging is associated with a distinct histological pattern. Methods: Single-center observational study. Younger (18–45 years) and older (≥70 years) adults undergoing elective upper endoscopy were included and underwent gastric biopsies. The clinical, endoscopic and histologic features were analyzed and compared. Results: A total of 100 patients were included (45 men/55 women), 50 with 18–45 years and 50 with ≥70 years. Dyspepsia, gastro-esophageal reflux disease and peptic ulcer disease were the most common indications for upper endoscopy. Gastric lesions (erythema, erosions, ulceration and polyps) were more common in older patients (80% vs. 50%, p = 0.003), as well as histologic changes such as chronic gastritis (56% vs. 38%, p = 0.004), chronic atrophic gastritis (CAG; 28% vs. 4%, p < 0.001) and intestinal metaplasia (28% vs. 4%, p < 0.001). These findings persisted after adjusting for Helicobacter pylori (H. pylori) status and proton pump inhibitor intake on the multivariate analysis. Prevalence of H. pylori was similar between both groups (28% vs. 32%, p = 0.189). Conclusions: Aging is associated with clinical, endoscopic and histologic changes in the gastric mucosa including CAG and metaplasia, independent of the presence of H. pylori. These findings may result from several aging-related pathophysiological processes and decades of cumulative gastric injury and support the hypothesis of an aging stomach phenotype, underscoring the need for an age-adjusted interpretation of gastric biopsies.

University Social Responsibility (USR) integrates academic goals with ethics, civic engagement, and sustainability. This study assessed community service attitudes among 529 higher health sciences students using the Portuguese Community Service Attitudes Scale. Although 52.9% reported prior volunteer experience, 75.2% had not participated in community service during university. An association was found between academic programme and prior involvement, particularly among Dental Medicine and Physiotherapy students. While no sex differences were observed, programme-specific trends suggest that practical training fosters stronger civic responsibility. Integrating structured, discipline-specific community service into curricula may enhance civic identity and better align education with sustainable development goals.

Psoriatic arthritis (PsA) is a very heterogeneous disease with significant impact on health-related quality-of-life (HRQoL). Our objective was to assess and identify predictors of HRQoL in a 3-year follow-up period among PsA patients. Patients with PsA included in the Rheumatic Diseases Portuguese Register (Reuma.pt), with HRQoL data measured by the EuroQoL five Dimensions (EQ-5D) with at least two evaluations throughout a 3-year period, were analysed. Statistics included t-tests, logit and linear mixed models and univariable and multivariable linear regression. PsA patients' (n = 342) mean age 51.0 (12.2) years, 48.5% being female, mean disease duration 11.8 (9.3) years with a follow-up period of 3-years had a mean EQ-5D of 0.53 (0.28), 0.59 (0.29), and 0.58 (0.28) at baseline, 1-year and 3-year evaluations, respectively. During the follow-up period, EQ-5D score and EQ VAS, significantly improved at both time-point assessments, compared to baseline. Poorer HRQoL was significantly associated with older age (β=-0.004; p-value = 0.008), female sex (β=-0.092; p-value = 0.01), non-employment (β=-0.112; p-value = 0.018), higher disease activity (β=-0.005; p-value < 0.001), prior exposure of three or more biologics at baseline and switching of biologic therapy during the study follow-up [(β=-0.182; p-value = 0.04); (β=-0.150; p-value = 0.002), respectively]. Our study provides important insights into the long-term predictors of HRQoL in PsA patients, highlighting the influence of sociodemographic factors, disease activity and therapeutic approach (prior use and switch/cycle of biologic therapies) on HRQoL.