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BACKGROUND: Viral respiratory infections may precipitate type 1 diabetes (T1D). A possible association between the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for COVID-19, and the incidence of T1D is being determined. This study was carried out using Portuguese registries, aiming at examining temporal trends between COVID-19 and T1D. METHODS: Hospital data, comparing the incidence before and during the COVID-19 pandemic, from children and young adults diagnosed with new-onset T1D, was acquired beginning in 2017 and until the end of 2022. Data was obtained from nine different Portuguese hospital units. The impact of the COVID-19 pandemic, beginning in March 2020, was assessed comparing the annual numbers of new-onset T1D cases. The annual median levels of glucose, glycated hemoglobin (HbA1c) and fasting C-peptide at T1D diagnosis were compared. The annual number of diabetic ketoacidosis (DKA) episodes among new T1D cases was also assessed at two centers. RESULTS: In total, data from 574 newly diagnosed T1D patients was analyzed, including 530 (92.3%) children. The mean ages for child and adult patients were 9.1 (SD 4.4) and 32.8 (SD 13.6) years, respectively. 57.8% (331/573) were male, one patient had unknown sex. The overall median (25-75 percentiles) levels of glucose, HbA1c and fasting C-peptide at diagnosis were 454 mg/dL (356-568), 11.8% (10.1-13.4) and 0.50 µg/L (0.30-0.79), respectively. DKA at T1D diagnosis was present in 48.4% (76/157). For eight centers with complete 2018 to 2021 data (all calendar months), no overall significant increase in T1D cases was observed during the COVID-19 pandemic, i.e. 90 cases in 2018, 90 cases in 2019, 112 in 2020 and 100 in 2021 (P for trend = 0.36). Two of the centers, Faro (CHUA) and Dona Estefânia (CHULC) hospitals, did however see an increase in T1D from 2019 to 2020. No significant changes in glucose (P = 0.32), HbA1c (P = 0.68), fasting C-peptide (P = 0.20) or DKA frequency (P = 0.68) at the time of T1D diagnosis were observed over the entire study period. CONCLUSION: The T1D incidence did not increase significantly, when comparing the years before and during the COVID-19 pandemic, nor did key metabolic parameters or number of DKA episodes change.

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Objective Ultrasound-guided platelet-rich plasma (PRP) injections, as well as needle tenotomy, are becoming increasingly popular in the treatment of epicondylitis. Whether ultrasound (US) findings predict the clinical benefit of these techniques is unclear at the moment. This study aimed to investigate the relationship between the presence of tendon tear assessed by US and the therapeutic response of the PRP injection following needle microtenotomy in patients with epicondylitis. Methodology This is a retrospective observational study. Twenty-six patients with chronic (>three months) lateral epicondylitis recalcitrant to conservative treatment or corticosteroid injection. Patients underwent US-guided microtenotomy followed by PRP injection. Data regarding gender, age, US findings at baseline, and numeric pain rating scale (NPRS) scores before and after intervention were collected. Pain improvement rates were calculated at several follow-up time points, namely one, three, six, and 12 months post-intervention. Results are stated as mean ± standard deviation. Results At the time of intervention, the mean age was 47.6±6.5 years, and 57.7% of patients were men. Overall, the mean initial NPRS score was 7.5±1.2, and there were no statistically significant differences in mean initial NPRS scores between the groups with or without tendon tear on the US imaging. The mean improvement rate at one, three, and six months was similar between patients with and without tendon tear. However, a statistically significant difference was observed at 12 months (73.1±37.6% vs. 16.0±21.9, p=0.029).  Conclusions Patients with tendon tear demonstrated a higher pain improvement rate at 12 months follow-up. This finding could predict the clinical response to this technique, thus allowing a better selection of the candidates.

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The lateral pectoral nerve is often injured along with the brachial plexus, but its isolated lesions are rare. We report a clinical case of an isolated lateral pectoral nerve injury, presenting as a refractory right shoulder and pectoral pain, determining functional repercussion. After clinical assessment and imaging investigation, it was considered that the pain source was likely to be a lateral pectoral nerve mononeuropathy. Thus, a diagnostic ultrasound-guided nerve block was performed, with a major improvement in the patient's symptoms and functionality for two months. Thereafter, a long-lasting alternative was proposed - pulsed radiofrequency. As a form of neuromodulation, pulsed radiofrequency offers pain control without tissue damage or painful sequelae, which is usually associated with conventional radiofrequency.

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INTRODUCTION AND OBJECTIVE: Health education improves the prognosis of many diseases. A previous study in patients with atrial fibrillation (AF) showed that an educational intervention by nurses at discharge from the emergency room (ER) decreased AF-related complications at 3-month follow-up. Our objective was to determine whether this intervention had a long-term effect. PATIENTS AND METHODS: A prospective study assessed the outcomes of an intervention carried out upon discharge from the ER. Patients with a diagnosis of AF were randomized into two groups: the intervention group and the control group. The intervention consisted of a basic explanation about the arrhythmia and its treatment, precautions and warning signs, a training to take their pulse, and an individualized informational leaflet. At one year of follow-up, the clinical records for all participants were reviewed. The primary variable was the combined endpoint of AF-related or treatment-related complications and death. RESULTS: The study included 240 patients (116 intervention and 124 control), mean age 76.1±10.9years. The primary variable was significantly lower in the intervention group (31.9% vs 48.4%; p=0.005). CONCLUSION: Education by ER nurses at patient discharge helped to decrease AF-related complications at one year of follow-up.

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BACKGROUND AND OBJECTIVE: Gut decontamination (GD) may be used as a treatment for acute therapeutic drug overdose (ATDO) to reduce the absorption of the drug and thereby avoid the presence or worsening of signs and symptoms of intoxication. The objective of this study was to assess the efficacy and safety of GD in ATDO patients. PATIENTS AND METHOD: A 4-month prospective observational study was designed to include all patients admitted to the emergency department due to an ATDO. On admission, epidemiological data, vital signs and physical examination results were all recorded and a blood sample was taken for toxicological analysis. An algorithm was used to determine the GD method to be applied. A clinical reassessment was made at 3-6 hours and a further sample was taken for toxicological analysis. Patients were followed until hospital discharge, with all possible adverse events due to GD being recorded. RESULTS: Ninety-four patients were included. GD was indicated in 60 patients (63.8%): 3.3% received ipecacuana syrup, 8.3% gastric lavage, 21.6% gastric lavage followed by activated charcoal and 71.6% oral activated charcoal alone. The clinical state worsened in 19.1% of patients, usually on the basis of a diminished consciousness. Adverse events attributable to GD were observed in 8.3% of patients. A toxicological analysis was made in 50 patients and in 42% of them, drug concentrations were higher at 3 or 6 hours than on admission. An analysis of the method of decontamination used showed that the procedure recommended by the algorithm was applied in 70 patients (group A) while in the remaining 24 (group B) another decontamination technique was used. Clinical deterioration was seen in 14.3% of patients in group A and 33.3% in group B (p = 0.041). There was a favourable evolution of the analytic curve in 63.9% patients in group A and 42.9% in group B (p = NS); severe adverse events attributable to GD were suffered by 2.4% patients in group A and 11.1% in group B (p = NS). CONCLUSIONS: The efficacy and safety of GD in ATDO increases in patients in whom the decision-making algorithm is applied. However, this does not prevent clinical deterioration or continued drug absorption in all cases and may be accompanied by adverse events.

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