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- Comparação entre a gastroplastia endoscópica e a gastrectomia laparoscópica em termos de eficácia e segurança no controlo da síndrome metabólicaPublication . Falcão, Inês Rocha de Nazareth; Banhudo, António José Duarte; Craveiro, Filipe MoreiraIntrodução: A obesidade é um problema de saúde global associado a maior morbilidade e mortalidade, com impactos significativos nos sistemas de saúde. Endoscopic Sleeve Gastroplasty (ESG) e Laparoscopic Sleeve Gastrectomy (LSG) são duas intervenções bariátricas direcionadas para a obtenção de uma perda de peso sustentada e para melhoria das comorbilidades relacionadas com a obesidade. Objetivos: Avaliar se a gastroplastia endoscópica pode ser uma alternativa à gastrectomia laparoscópica no controlo da obesidade e melhoria do perfil metabólico. Métodos: Foi realizada uma revisão sistemática de estudos identificados na Medline (via PubMed) e Scopus, entre 2014 e 2024. Os outcomes primários incluíram a percentagem de perda total de peso (%TBWL), percentagem de perda de excesso de peso (%EWL) e melhoria de comorbilidades (como diabetes, hipertensão e dislipidemia), os outcomes secundários incluíram taxas de complicações e eventos adversos. Resultados: Foram incluídos oito estudos envolvendo 7045 doentes com obesidade (IMC = 30). Tanto a ESG como a LSG demonstraram perdas de peso superiores a 10% e alcançaram melhorias significativas relativamente ao perfil metabólico. A LSG atingiu perdas de peso superiores à ESG. No entanto, a ESG exibiu um perfil de segurança mais favorável, com menores taxas de complicações graves e tempos de recuperação mais rápidos, destacando-se como uma opção minimamente invasiva. Conclusão: A ESG, de modo análogo à LSG, revela-se eficaz e segura no tratamento da obesidade e das suas comorbilidades. A LSG demonstrou reduções no peso superiores, porém é uma técnica mais invasiva. A ESG, por outro lado, oferece uma alternativa segura e menos radical com benefícios significativos, particularmente para doentes com obesidade grau I e II. A escolha entre as duas técnicas deve ser, contudo, baseada no perfil do doente, nos objetivos de perda de peso e no risco cirúrgico.
- Acute Hepatic PorphyriasPublication . Marques, Inês Correia; Marcos, Pedro Miguel RibeiroIntroduction: Porphyrias are rare genetic disorders caused by heme biosynthesis pathway enzyme mutations, leading to porphyrin precursors build up in various tissues and diverse symptoms. This review centers on acute hepatic porphyrias (AHP). Methods: A MEDLINE via Pubmed database literature review was conducted. Systematic reviews, clinical trials, cohort studies, case-control studies, expert reviews, and guidelines were preferred for analysis. Results: There are four types of AHP: acute intermittent porphyria, variegate porphyria, hereditary coproporphyria, and d-aminolevulinic acid dehydratase deficiency porphyria. These conditions primarily present as neurovisceral attacks, characterized by severe abdominal pain, neuropsychiatric symptoms or skin lesions, predominantly affecting women aged 15 to 50. The diagnostic methods include biochemical tests that assess urinary levels of aminolevulinic acid and porphobilinogen. Additionally, measuring porphyrin levels in urine or feces can provide more insights into the type of AHP; however, a definitive diagnosis of the specific type is made through genetic testing. Treatment involves high-glucose diets, intravenous hemin for acute attacks, and givosiran for the prophylaxis of frequent attacks. Liver transplantation remains the only curative option. It is crucial to monitor chronic complications associated with hepatic porphyrias, particularly hepatocellular carcinoma, kidney disease, and arterial hypertension. Conclusion: AHP continues to be an underrecognized condition, warranting consideration in individuals experiencing unexplained abdominal pain, neuropathy, psychiatric symptoms, or skin lesions. There is a need for improved diagnostic techniques and treatment options.
- Intravenous Fluid Therapy: Essential Components and Key ConsiderationsPublication . Silva, Catarina Rocha Dias Tavares; Marcos, Pedro Miguel RibeiroIntroduction. Intravenous (IV) fluid therapy plays a vital role in modern medical practice, particularly in critical care management. This review aims to summarize the composition, indications, and contraindications of IV fluids, serving as a useful resource for healthcare professionals. Methods. Review of the literature published in MEDLINE via PubMed, and Web of Science, between 2009 and 2024. Systematic reviews, meta-analyses, expert reviews, and guidelines were preferred for analysis. The labels of IV fluids used at Pêro da Covilhã Hospital were reviewed. Results. IV fluids can be administered for various reasons, including resuscitation, correction of electrolyte imbalances, or more critical cases. They can be divided into two categories: crystalloids and colloids. Crystalloids, in turn, can be subdivided into unbalanced solutions, such as saline (0.45%, 0.9%, 3%), or balanced solutions, such as Ringer's lactate and polyelectrolytic solutions. Colloids can be derived from plasma, such as 5% albumin, or semi-synthetic, such as 4% modified fluid gelatin. Crystalloids are generally more cost-effective, have a lower risk of allergic reactions, and are more readily available than colloids. However, the use of each solution should be individualized based on the patient's specific needs and corresponding conditions. Conclusions. It is essential to have a thorough understanding of available IV fluid solutions to select the best option for each patient's condition at any given time. This review summarizes the most relevant information to guide these decisions. Future research should develop IV fluids that combine the benefits of colloids and crystalloids for safer, more personalized, and cost-effective treatments.