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Trends in coronary angioplasty in Portugal from 2002 to 2013 according to the Portuguese National Registry of Interventional Cardiology
No full textINTRODUCTION AND OBJECTIVES:
The aim of the present paper was to report trends in coronary angioplasty for the treatment of ST-elevation myocardial infarction (STEMI) in Portugal.
METHODS:
Prospective multicenter data from the Portuguese National Registry of Interventional Cardiology (RNCI) and official data from the Directorate-General for Health (DGS) were studied to analyze percutaneous coronary intervention (PCI) procedures for STEMI from 2002 to 2013.
RESULTS:
In 2013, 3524 primary percutaneous coronary intervention (p-PCI) procedures were performed (25% of all procedures), an increase of 315% in comparison to 2002 (16% of all interventions). Between 2002 and 2013 the rate increased from 106 to 338 p-PCIs per million population per year. Rescue angioplasty decreased from 70.7% in 2002 to 2% in 2013. During this period, the use of drug-eluting stents grew from 9.9% to 69.5%. After 2008, the use of aspiration thrombectomy increased, reaching 46.7% in 2013. Glycoprotein IIb-IIIa inhibitor use decreased from 73.2% in 2002 to 23.6% in the last year of the study. Use of a radial approach increased steadily from 8.3% in 2008 to 54.6% in 2013.
CONCLUSION:
During the reporting period there was a three-fold increase in primary angioplasty rates per million population. Rescue angioplasty has been overtaken by p-PCI as the predominant procedure since 2006. New trends in the treatment of STEMI were observed, notably the use of drug-eluting stents and radial access as the predominant approach
Sexual dysfunction in women with Parkinson's disease
Get PDFBACKGROUND:
Sexual dysfunction in women with Parkinson's disease is poorly understood and research in this area is scarce. The objectives of this study were sexual function characterization in female Parkinson's disease patients, description of sexual dysfunctions, correlation with disease characteristics, and comparison with matched healthy controls.
METHODS:
Social and demographic data from consecutive female patients with Parkinson's disease and matched healthy controls were collected. The following instruments were used: UPDRS, the Hoehn and Yahr scale, the Beck Depression Inventory-II, the Female Sexual Function Index, and the Sexual Dysfunction Inventory. The only exclusion criterion was cognitive deterioration precluding comprehension of the study scope and its instruments.
RESULTS:
Of the 95 patients identified, 61 were included. Mean age was 66 years (range 40-89 years), and mean disease duration was seven years (range 1-18 years). Twenty-nine presented an akinetic-rigid syndrome, 25 tremoric disease, and, the remaining, a mixed type of disease. Mean "on" total/part III UPDRS scores were 46 ± 15.0 and 31 ± 8.9. Sexual dysfunction was present in 86.9% of patients and 79.0% of controls, according to the Female Sexual Function Index (p < .01), and in 57.4% of patients and 22.6% of controls, according to the Sexual Dysfunction Inventory (p < .001). Multivariate binary logistic regression identified age and depressive symptoms as positive predictors in the severity of sexual dysfunction. Disease duration, UPDRS part III score, Hoehn and Yahr stage, and antiparkinsonian medication did not show significant predictive value.
CONCLUSIONS:
Sexual dysfunction is more prevalent in women with Parkinson's disease than in controls and is predicted by older age and severity of depressive symptoms. © 2016 International Parkinson and Movement Disorder Society
Vigilância pós-operatória na septoplastia: regime de ambulatório com ou sem pernoita
Get PDFinfo:eu-repo/semantics/publishedVersio
Day and night surgery: is there any influence in the patient postoperative period of urgent colorectal intervention?
Get PDFBACKGROUND:
Medical activity performed outside regular work hours may increase risk for patients and professionals. There is few data with respect to urgent colorectal surgery. The aim of this work was to evaluate the impact of daytime versus nighttime surgery on postoperative period of patients with acute colorectal disease.
METHODS:
A retrospective study was conducted in a sample of patients with acute colorectal disease who underwent urgent surgery at the General Surgery Unit of Braga Hospital, between January 2005 and March 2013. Patients were stratified by operative time of day into a daytime group (surgery between 8:00 and 20:59) and the nighttime group (21:00-7:59) and compared for clinical and surgical parameters. A questionnaire was distributed to surgeons, covering aspects related to the practice of urgent colorectal surgery and fatigue.
RESULTS:
A total of 330 patients were included, with 214 (64.8%) in the daytime group and 116 (35.2%) in the nighttime group. Colorectal cancer was the most frequent pathology. Waiting time (p < 0.001) and total length of hospital stay (p = 0.008) were significantly longer in the daytime group. There were no significant differences with respect to early or late complications. However, 100% of surgeons reported that they are less proficient during nighttime.
CONCLUSIONS:
Among patients with acute colorectal disease subjected to urgent surgery, there was no significant association between nighttime surgery and the presence of postoperative medical and surgical morbidities. Patients who were subjected to daytime surgery had longer length of stay at the hospital.info:eu-repo/semantics/publishedVersio
Enuresis en niños del primer ciclo de una unidad de atención primaria en el norte de Portugal
No full textA 10-Year Retrospective Analysis of Methyl Aminolevulinate Photodynamic Therapy Consultation at the Hospital de Braga
Get PDFPhotodynamic therapy (PDT) is a well-established treatment for actinic keratosis (AK), basal cell carcinoma (BCC), and Bowen's disease (BD). The object of this study was to describe the results of a retrospective analysis of patients treated with methyl aminolevulinate PDT (MAL-PDT) with red light, over the past decade at the Hospital de Braga (Braga, Portugal)
Gaining competence in needle-knife fistulotomy - can I begin on my own?
Get PDFBACKGROUND:
While there are guidelines for appropriate training in ERCP, these are non-existent for needle-knife precut. The aim of this study was: (1) evaluate the experience curve of three endoscopists in needle-knife fistulotomy (NKF); (2) propose a minimum number of NKF procedures to attest proficiency.
METHODS:
Between November 1997 and March 2011, the first 120 consecutive NKF performed by three endoscopists (A, B, and C) were selected (360 patients) from three centers. Each group of 120 patients was chronologically ordered into three subgroups of 40. The main outcomes were: NKF use, NKF success, and post-ERCP adverse events.
RESULTS:
The need for NKF did not decrease over time. The NKF success rate in the first attempt for endoscopist A and C in each of the three subgroups was 85 %/85 %, 87.5 %/87.5 %, and 87.5 %/90 %, respectively. Furthermore, both demonstrated a high NKF success in their initial 20 NKFs (85 % and 80 %, respectively). Endoscopist B however presented a different pattern as the success rate initiated at 60 %, then rose to 82.5 % and 85 % for the last group (P = 0.03). Adverse events were mild (28 of the 32 occurrences) with no clear reduction with increased experience.
CONCLUSIONS:
A skillful endoscopist may expect to master NKF easily with few adverse events. While some endoscopists could begin on their own because of their innate skills, a minimal training is needed for all, as we cannot predict skills in advance. We propose a minimum of 20 NKF precuts to attest a trainee's competence in this procedure
Primary Aldosteronism: results from the first Portuguese multicentre study by the adrenal tumour study group
Get PDFIntroduction: Primary Aldosteronism (PA) is the most prevalent cause of secondary hypertension.
Nevertheless, there is no portuguese multicenter study characterizing PA patients.
Aims: To characterize the clinical presentation, diagnostic workup, treatment and follow-up of patients
with confirmed PA.
Methods: Retrospective multicenter study of PA patients followed in 9 portuguese hospitals.
Results: Sixty-three cases were selected with a mean age of diagnosis of 52.1 ± 13.1 years, 9.9 years
after the diagnosis of hypertension. At presentation, 37 cases (60.7%) had hypertension, 11 (22.9%) had
resistant hypertension and 20 (32.8%) of patients had hipokalemia (mean 3.2 mmol/L). Baseline laboratory
showed a mean serum aldosterone of 33.4ng/dL, plasmatic renin activity (PRA) of 0.2ng/mL/h with an
aldosterone/PRA ratio of 97.1. Confirmatory testing was performed with saline infusion in 55 patients
(positive in 84.4%) and captopril test in 14 (positive in 85.7%). Imaging showed adenomas in 55 cases,
hyperplasia in 2 and bilateral cases in 8. Arterial venous sampling (AVS) was performed in 9 patients
(14,5%) and was conclusive in 1. Iodocholesterol scintigraphy was done in 14 cases (22%) with unilateral
fixation in 9 and no fixation in 4. Patients were treated with laparoscopic adrenalectomy in 28 cases
(58.3%) and mineralocorticoid receptor antagonists in 20 cases (41.7%). The surgical treated group had
less duration of hypertension (8 versus 14 years, p = 0.002), higher prevalence of anti-hypertensive drugs
at presentation (100 versus 75% p = 0.009) and bigger tumour size (1.8 versus 1.5 cm, p = 0.022). During
follow-up there was a trend towards a greater proportion of patients with no hypertension improvement
in the medical treatment group (29.4% versus 7.4%, p = 0.089).
Conclusion: This is the first Portuguese PA multicenter study. It suggests that PA remains an under-
-diagnosed condition with a significant delay in diagnosis. Surgical treated patients had a more aggressive
disease and showed a trend towards better hypertension control