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Recent Submissions

Próteses totais primárias da anca com um recuo superior a 15 anos a propósito de 12 casos clínicos
Publication . Corte-Real, C; Ferreira, I; Mendes, J; Dias, P; Mendonça, A; Cura-Mariano, J; Lucas, F; Judas, F
O Ortopedista dispõe, atualmente, de um leque alargado de endopróteses articulares primárias da anca para o tratamento da artropatia degenerativa ou inflamatória e, bem assim para a cirurgia reconstrutiva da anca traumática, que incluem implantes cimentados, não cimentados, híbridos, revestidos ou não com biocerâmicos, com diversas cúpulas de fricção articular. A implantação de uma prótese total da anca representa uma das intervenções de maior sucesso clínico em Ortopedia, quiçá em Medicina, proporcionando o alívio/supressão da dor e o restabelecimento precoce da função articular a milhões de doentes em todo o mundo. Apesar de ser assim, a artroplastia total da anca não é uma solução definitiva, a médio ou a longo prazo assiste-se a uma falência mecânica originada, na maioria das situações, pela osteólise periprotética provocada pelas partículas de degaste dos biomateriais que constituem a cúpula de fricção articular, processo biológico que o melhor cirurgião não consegue evitar. Pode-se aceitar que o tempo médio de duração de uma prótese total da anca situa-se, nas melhores casuístas, acima dos 15 anos. O objetivo central deste trabalho é mostrar os resultados clínicos e radiológicos do tratamento de uma série de 12 diferentes situações clínicas em que foram implantadas próteses totais primárias da anca, com um recuo clínico superior a 15 anos.
2024Working paper Open access Show more
Total neoadjuvant therapy: A new standard of care for locally advanced rectal cancer?
Publication . Leite, J; Martins, S
Delivering chemotherapy before surgery is a newer treatment approach called total neoadjuvant therapy (TNT), and the National Comprehensive Cancer Network guidelines recommend it for locally advanced rectal cancer (LARC) with cT3 / cN+ / cT4, in contrast with the European Society for Medical Oncology guidelines, in which most rectal cancers can be treated with surgery alone if good quality mesorectal resection is assured. Neoadjuvant or adjuvant treatments are reserved for patients with high-risk tumours, including cT3c/d or cT4, or that threaten the mesorectal fascia. The favourable outcomes in the RAPIDO trial for high-risk rectal cancers with a lower incidence of distant metastasis in the TNT group were observed but with an unexpected increase in the local recurrence with more extended follow-up. This suggests early surgery for nonresponding tumours. The TNT approach was also evaluated in the OPRA trial with long-course chemoradiotherapy and induction versus consolidation chemotherapy. Half the patients presented complete clinical responses and were enrolled in the watch-and-wait (WW) approach. Given the high number of trials and guidelines in this subject, the multidisciplinary team's decision-making process in rectal cancer management is complex. Looking at the actual data, it was concluded that TNT is not for all patients with LARC and is an option if organ preservation is a priority, although with a high regrowth rate in a WW strategy and increasing risk of distant metastasis, questioning the deleterious effect of deferral of surgery.
2024Journal article Open access Show more
Early Mobilization Decision after an Acute Ischemic Stroke: Protocol for an Umbrella Review
Publication . Fernandes, C; Sousa, JA; Bernardo-Castro, S; Silva, F; Donato, H; Sargento-Freitas, J
Introduction: Stroke is considered one of the greatest public health challenges worldwide, with the ischemic subtype being the most prevalent. Various acute stroke clinical guidelines recommend early rehabilitation interventions, including very early mobilization. However, despite the studies conducted in recent years regarding when to initiate mobilization after an acute stroke, there are few systematic and personalized protocols based on the factors for which patient mobilization should ideally be performed. We aim to conduct an umbrella review of systematic reviews and meta-analyses to study the early mobilization decision after an acute ischemic stroke in comparison with conventional care and correlate the different approaches with patient clinical outcomes.Methods and analysis: We will perform a systematic search on PubMed/MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Episte-monikos and Web of Science Core Collection databases. Retrieved studies will be independently reviewed by two authors and any discrepancies will be resolved by consensus or with a third reviewer. Reviewers will extract the data and assess the risk of bias in the selected studies. We will use the 16-item Assessment of Multiple Systematic Reviews 2 (AMSTAR2) checklist as the critical appraisal tool to assess cumulative evidence and risk of bias of the different studies. This will be the first umbrella review that compares early mobilization approaches in post-acute ischemic stroke. This study may help to define the optimal early mobilization strategy in stroke patients. PROSPERO registration number: CRD42023430494
2024Journal article Open access Show more
Revisão das Revisões (Revisões Umbrella): Guia Passo a Passo
Publication . Donato, H; Donato, M
In recent years, as a result of the dramatic increase in the number of systematic reviews, a new type of systematic review, the ‘systematic reviews of systematic reviews’, also known as umbrella reviews, reviews of reviews, meta-reviews or synthesis of review, was developed. The aim of this article is to provide recommendations on how this type of systematic review should be conducted and reported to ensure its quality and usefulness. These reviews are designed to compile evidence from multiple systematic reviews of interventions into an accessible and usable document and are one of the highest levels of evidence synthesis
2024Journal article Open access Show more
2024Journal article Open access Show more