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The effects of hyperbaric oxygen therapy on insulin resistance-an approach to physiology
Publication . Sampaio-Alves, M; Alpuim Costa, D; Gomes-Alves, I; Neves, JS
Background: Diabetes mellitus (DM) is a severe, chronic and complex metabolic disease that leads to multiple dysfunctions, including micro and macrovascular complications, which are a major cause of morbidity and mortality. Type 2 DM (T2D) is highly preventable, and the stages that precede it are the ideal target for therapeutic intervention. Hyperbaric oxygen therapy (HBOT) is an established medical treatment for several clinical conditions. Because DM is one of the most prevalent comorbidities in patients under HBOT, it has allowed the observation and inference of some of its effects on DM, suggesting clinical benefit in different spectrums of the disease. Our main aim was to gather the existing evidence on the impact of HBOT on insulin resistance, as this is the best predictor for the development of T2D.
Materials and methods: The scoping review was the methodology chosen to include all available data. Exclusion criteria consisted of articles that did not mention the effects of HBOT on insulin resistance, described only the use of normobaric oxygen, or had no available translation to English, Spanish, or Portuguese. In addition, all data discussing any effects on insulin, insulin resistance, or insulin sensitivity were included.
Results: Two hundred and thirty studies were found, and 17 were eligible. The HBOT appears to improve fasting glycaemia and decrease insulin resistance in patients with DM, with effects appearing after 1 treatment session. Additionally, it reduces levels of proinflammatory cytokines that contribute to insulin resistance. The duration of this sensitisation effect remains unknown, as do the contributing molecular factors.
Conclusion: HBOT seems to improve glycaemic levels and insulin sensitivity, thus presenting a potential treatment approach to treat insulin resistance and its consequences. However, translation into clinical practice remains contingent on robust, yet unavailable, randomized clinical trials.
Spirituality in children with life-limiting, life-threatening and/or complex chronic conditions: A scoping review
Publication . Santos Ferreira, M; Pereira, DG; Caldeira, S
Purpose: To map available knowledge about spirituality in children with life-limiting, life-threatening and/or complex chronic conditions.
Methods: This review followed the Joanna Briggs Institute methodology for scoping reviews. Registration was done with the Open Science Framework. The searches were conducted in PubMed, CINAHL Complete, Psychology & Behavioral Sciences Collection, via EBSCOhost, and in the Portuguese Open Access Scientific Repository, in September 2024. The sample was composed of 48 studies.
Results: The concept of spirituality is represented by the relationship established with oneself, with the world, and the notion of transcendence. Spiritual needs relate to developmental stage, relationships, sense of normalcy, meaning, and purpose. The relationship established between spirituality and illness is bidirectional, represented by beliefs, practices, and mechanisms of spiritual adaptation. Spiritual care is about supporting children with insights about beliefs, values and behaviours, addressing needs inherent in the developmental process, setting achievable goals that can support a meaningful life and legacy, fostering connections, mediating communication, improving spiritual coping, alleviating spiritual suffering, managing losses, and redefining hope.
Conclusions: This review underlines the complexity, variability, and importance of spirituality while living within a complex, life-threatening or life-limiting paediatric context. However, there is still an urgent need to develop studies on the concept in specific subgroups of this paediatric population.
Clinical implications: Spirituality has an undeniable and aggregating role throughout the course of a life-limiting, life-threatening and/or complex chronic condition. Spiritual care and nurturing should be prioritised in care plans within these complex paediatric contexts.
Anterior Cruciate Ligament Reconstruction Using a Tibial-Pedicled Quadrupled Semitendinosus Autograft With Dual Adjustable-Loop Cortical Suspension
Publication . Rodeia, J; Alçada, R; Baptista, F; Goes, R
Anterior cruciate ligament reconstruction is one of the most commonly performed procedures in knee surgery. Despite its frequency, numerous technical variations exist, and several aspects remain controversial. Hamstring tendons are among the most frequently used autografts, and there is growing interest in techniques that preserve the gracilis tendon. Additionally, preservation of the tibial insertion of the hamstrings has recognized biological and mechanical advantages. In this technical note, we describe a technique that aims to combine the advantages of both approaches: the benefits of using a short single semitendinosus graft, preserving the gracilis tendon, which is associated with lower donor-site morbidity and improved flexion strength compared with traditional 2-tendon harvests, and the advantages of maintaining the tibial attachment of the semitendinosus, which include improved graft vascularization and a secondary point of tibial fixation. This method uses a tibial-pedicled, quadrupled semitendinosus graft combined with a dual adjustable-loop cortical suspension device. The technique is reproducible, is cost-effective, and may offer both biological and mechanical benefits over conventional approaches.
Extensive Myocardial Calcification Following Fulminant Neonatal Enteroviral Myocarditis
Publication . Noites, I; Guedes, S; Ferreira, M; Camilo, C; Abecasis, F
Myocardial calcification is a rare but important complication of fulminant neonatal myocarditis, a potentially life-threatening condition. Only a handful of neonatal cases have been reported in the literature. We present the case of a previously healthy seven-day-old term male neonate who developed cardiogenic shock secondary to enteroviral myocarditis with confirmed central nervous system involvement. Despite prompt initiation of inotropic therapy, he required venoarterial extracorporeal membrane oxygenation (VA-ECMO) within 48 hours of admission. While on mechanical circulatory support, serial imaging showed progressively increased myocardial echogenicity on echocardiography and later curvilinear myocardial calcification on chest radiograph. The clinical course was characterised by persistent cardiac dysfunction and progression to irreversible multiorgan failure. Heart transplantation was deemed unfeasible, and life-sustaining therapies were withdrawn, following multidisciplinary discussion and family consultation. An autopsy was not performed. This case highlights myocardial calcification as a potential imaging marker of irreversible myocardial injury in fulminant neonatal myocarditis. Early recognition of progressive myocardial echogenicity and subsequent calcification may provide valuable prognostic information, helping clinicians assess disease severity and support informed decision-making in cases of fulminant neonatal myocarditis.
Giant Cell Arteritis With Central Nervous System Vasculitis Presenting As Binocular Diplopia and Ptosis due to Third Cranial Nerve Palsy
Publication . Casanova Pinto, J; Costa, MG; Fernandes, B; Ramalheira, C
We report the case of a woman in her 60s with no notable comorbidities presented with a four-week history of bilateral temporal headache, scalp tenderness, jaw claudication, and sporadic fever. She also reported binocular diplopia for the previous 24 hours. Examination revealed tender superficial temporal arteries (TA) and right-sided third cranial nerve palsy with ptosis. Laboratory tests showed elevated inflammation markers. Cranial and cervical computed tomography (CT) and CT angiography (CTA) were unremarkable. She was treated with a single dose of intravenous methylprednisolone, followed by oral prednisolone. Subsequent TA duplex ultrasound demonstrated artery wall thickness, and TA biopsy confirmed chronic inflammation with disruption of the internal elastic lamina, both consistent with giant cell arteritis. Cranial magnetic resonance imaging (MRI) revealed scattered punctate areas on T2-weighted fluid-attenuated inversion recovery (FLAIR) sequences, consistent with small-vessel vasculitis. Under corticosteroid treatment, the patient achieved full clinical remission at the four-month follow-up. This case illustrates an uncommon neurological presentation of giant cell arteritis with oculomotor nerve involvement, associated with findings suggestive of central nervous system vasculitis, and highlights the importance of early recognition and prompt corticosteroid treatment to prevent irreversible complications.