Centro Hospitalar do Porto
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Radiographic control of medical devices in neonatology: a narrative review
Get PDFIntrodução: A gestão clínica dos recém-nascidos nas unidades de cuidados intensivos neonatais implica a colocação de diversos dispositivos médicos invasivos que necessitam de controlo radiográfico. O principal objetivo deste trabalho consistiu em realizar uma revisão narrativa sobre as boas práticas a adotar na aquisição de imagens radiográficas, em unidades de cuidados intensivos neonatais, para o controlo de dispositivos médicos de acordo com a literatura publicada e a experiência dos autores.
Material e Métodos: Realizou-se uma revisão narrativa da literatura. Recorreu-se às bases de dados científicas PubMed; Science Direct; Google Scholar e Portal RCAAP, para a recolha de documentos de análise. Foram, ainda, consultados livros das coleções particulares dos autores.
Resultados: A revisão narrativa incidiu sobre 39 documentos, dos quais 26 artigos científicos, quatro guidelines/consensos/recomendações e
nove livros/capítulos de livro.
Desenvolvimento: A colocação de cateteres intravasculares, sondas nasogástricas e tubos endotraqueais são procedimentos interventivos habitualmente utilizados na prestação de cuidados a recém-nascidos prematuros internados nas unidades de cuidados intensivos neonatais. O posicionamento preciso destes dispositivos é essencial e a radiografia do tórax e abdómen desempenha um papel de extrema relevância no controlo e monitorização da colocação destes dispositivos. Os desafios técnicos inerentes à realização destes exames radiográficos assumem uma exigência suplementar atendendo aos ajustes ao posicionamento e parâmetros de exposição em relação à população adulta. Os parâmetros de aquisição, bem como o pós-processamento da imagem, deverão ser otimizados de forma a permitirem visualizar o trajeto dos dispositivos médicos em toda a sua extensão e demonstrarem inequivocamente a posição da sua extremidade distal. Ao mesmo tempo a imagem terá de apresentar leitura anatómica suficiente para a monitorização de eventuais lesões iatrogénicas.
Conclusão: O célere reconhecimento radiográfico de dispositivos incorretamente colocados, assim como, as complicações que podem originar, é essencial para uma rápida intervenção que permita a prevenção do agravamento do estado clínico do recém-nascido.info:eu-repo/semantics/publishedVersio
Reatividade cruzada entre penicilinas e cefalosporinas: mudança de paradigma
Get PDFAllergic reactions to beta-lactam antibiotics are the most common cause of allergic drug reactions. The incorrect diagnosis prevents patients from receiving a highly effective therapy.
The potential cross-reactivity between penicillin and cephalosporin has very significant therapeutic implications. Penicillins and cephalosporins share a common beta-lactam ring and side chains. A number of studies indicate that the R1 side chain, rather than the ring itself, is the determining factor for cross-reactivity.
Herein is presented a review of the immunologic mechanisms implicated in penicillin and cephalosporin cross-reactivity and a practical approach to the use of cephalosporins in patients allergic to penicillin.info:eu-repo/semantics/publishedVersio
Geriatric otorhinolaryngology: reasons for outpatient referrals from generalists to ENT specialists
Get PDFPurpose: To determine the main symptoms leading to referral of geriatric patients from primary care to otorhinolaryngology.
Methods: Retrospective, observational study performed on patients aged 65 and older, referred from Primary Care to the Otorhinolaryngology and Head and Neck Surgery department of a tertiary centre during 2019 and 2020. Symptoms leading to otorhinolaryngological referral were categorized as "Oto-neurological symptoms", "Nasal symptoms", "Pharyngolaryngeal symptoms", "Other Head and Neck symptoms" and "Other Reasons". Data regarding age, gender and whether patients maintain follow-up or have been discharged was also collected.
Results: The study population included a total of 1304 patients (697 female; 607 male). Oto-neurological symptoms were found to be the most prevalent symptoms, with 65% of patients reporting oto-neurological symptoms as at least one of the reasons for referral. Hearing loss was the most commonly reported symptom, with an association found between this symptom and age (p < 0.001). Results also showed an association between the female gender and vertigo/dizziness (p < 0.001) and tinnitus (p = 0.007). An association between the male gender and nasal symptoms was also found (p = 0.018), particularly nasal obstruction (p = 0.003) and epistaxis (p = 0.028). No statistically significant associations were found among the pharyngolaryngeal group.
Conclusions: This retrospective observational study allowed for a better understanding of the type of otorhinolaryngological symptoms affecting elderly patients and driving otorhinolaryngology evaluation, cementing hearing loss as one of the major complaints among older adults and allowing for a better preparation by otorhinolaryngologists for the changing needs of this subset of the population.info:eu-repo/semantics/publishedVersio
Caso clínico dermatológico
Get PDFThe case of a teenager with guttate psoriasis secondary to trauma and upper airway infection is reported. Guttate psoriasis is the second most common psoriasis variant in pediatric age. Infection and trauma (leading to Koebner phenomenon) seem to be major triggers of the condition. The diagnosis is clinical. Most cases with no previous history of psoriasis spontaneously remit. Topical corticosteroids and vitamin D analogs, as well as phototherapy, are the first-line treatments.info:eu-repo/semantics/publishedVersio
Pancreatite Aguda na Idade Pediátrica: casuística de 10 anos de um hospital nível II
Get PDFIntroduction: The incidence of acute pancreatitis (AP) in children is increasing, together with the awareness of the need for pediatric-specific management recommendations. This study aimed to assess the epidemiology, etiology, management, and clinical course of pediatric AP cases followed at a secondary hospital.
Methods: Retrospective analysis of all pediatric AP cases admitted to a level II hospital in the metropolitan area of Lisbon, Portugal, between January 2009 and December 2018.
Results: Eight cases of pediatric AP were identified, with an average age of 12 years (minimum 4 years, maximum 16 years) and classified according to etiology as drug-induced (n=3), biliary (n=1), infectious (n=1), and idiopathic (n=3). Recurrent AP was identified in one patient. The median hospital stay was 6.5 days. The main symptoms at presentation were abdominal pain (100.0%) and vomiting (75.0%). All patients had increased levels of amylase activity in serum (>3 times the upper limit of normal). Pancreatic image abnormalities were observed in five patients (62.5%), four in the abdominal ultrasound and one in computed tomography scan. One patient underwent endoscopic retrograde cholangiopancreatography. Two patients received a course of antibiotics. All cases were classified as mild, according to the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition classification.
Discussion: This series showed a predominance of secondary over idiopathic AP, in agreement with recently published studies reporting a reduction in the incidence of idiopathic AP due to increased efforts to identify the underlying causes of the disease. Since the incidence of AP is increasing in pediatric age, physicians should be aware of recent recommendations for the optimal management of the condition in this age group.info:eu-repo/semantics/publishedVersio
Efficacy and safety of vutrisiran for patients with hereditary transthyretin-mediated amyloidosis with polyneuropathy: a randomized clinical trial
Get PDFBackground: The study objective was to assess the effect of vutrisiran, an RNA interference therapeutic that reduces transthyretin (TTR) production, in patients with hereditary transthyretin (ATTRv) amyloidosis with polyneuropathy.
Methods: HELIOS-A was a phase 3, global, open-label study comparing the efficacy and safety of vutrisiran with an external placebo group (APOLLO study). Patients were randomized 3:1 to subcutaneous vutrisiran 25 mg every 3 months (Q3M) or intravenous patisiran 0.3 mg/kg every 3 weeks (Q3W) for 18 months.
Results: HELIOS-A enrolled 164 patients (vutrisiran, n = 122; patisiran reference group, n = 42); external placebo, n = 77. Vutrisiran met the primary endpoint of change from baseline in modified Neuropathy Impairment Score +7 (mNIS+7) at 9 months (p = 3.54 × 10-12), and all secondary efficacy endpoints; significant improvements versus external placebo were observed in Norfolk Quality of Life-Diabetic Neuropathy, 10-meter walk test (both at 9 and 18 months), mNIS+7, modified body-mass index, and Rasch-built Overall Disability Scale (all at 18 months). TTR reduction with vutrisiran Q3M was non-inferior to within-study patisiran Q3W. Most adverse events were mild or moderate in severity, and consistent with ATTRv amyloidosis natural history. There were no drug-related discontinuations or deaths.
Conclusions: Vutrisiran significantly improved multiple disease-relevant outcomes for ATTRv amyloidosis versus external placebo, with an acceptable safety profile.This study was funded by Alnylam Pharmaceuticals Inc. The fundercollaborated with authors during study design, data collection, dataanalysis, data interpretation, and writing of the report. All authors hadfull access to all the data in the study and had final responsibility forthe decision to submit for publication.info:eu-repo/semantics/publishedVersio
Vacinação Anti-Sarampo, Parotidite e Rubéola na criança com alergia ao ovo
Get PDFIntroduction: Egg allergy is one of the most common food allergies in childhood. Administration of the measles, mumps, and rubella (MMR) vaccine is recommended in pediatric age. Despite the presence of traces of egg protein in its composition, the literature recommends MMR vaccine administration regardless of the patient’s past egg allergy history, identifying cases in which the administration should occur in hospital setting.
Purpose: To characterize the pediatric population referred to the Allergy and Clinical Immunology Department of Centro Hospitalar Universitário do Porto for MMR vaccine administration and investigate vaccination safety in children with egg allergy or sensitization.
Methods: This was a retrospective observational study of clinical records of children with confirmed or suspected egg allergy referred to the Allergy and Clinical Immunology Department for administration of the MMR vaccine between January 1, 2013 and December 31, 2019.
Results: Among 60 children studied, 90% presented symptoms upon egg intake, with cutaneous reactions being the most prevalent (67%) and four reported cases of anaphylaxis. Allergy to cow’s milk protein (55%), followed by allergy to other foods (45%) were the most frequent personal histories of allergic diseases. Asthma was identified in 10% of patients and was controlled in all cases. Among children referred for vaccination booster dose, one had had a reaction to the previous MMR vaccine dose. Three children developed late local skin reactions, and one had a late systemic reaction after vaccination. All children had negative oral food challenge.
Conclusion: MMR vaccine administration is safe and recommended in pediatric age, regardless of egg allergy history. However, immunization should be performed in hospital setting in children with a history of anaphylaxis due to egg allergy, previous anaphylactic reaction to MMR vaccine or one of its constituents, uncontrolled asthma with documented egg allergy, and uncontrolled asthma with allergy to a previous MMR vaccine dose.info:eu-repo/semantics/publishedVersio
Anuário Científico do CHUP 2021
No full textO Anuário Científico de 2021 é um documento integrador da produção científica do Centro Hospitalar Universitário do Porto (CHUP). O Serviço de Investigação Clínica do Departamento de Ensino, Formação e Investigação (DEFI), com a edição deste anuário, pretende partilhar a atividade científica hospitalar com a comunidade e os seus profissionaisinfo:eu-repo/semantics/publishedVersio
CT volumetry performs better than nuclear renography in predicting estimated renal function one year after living donation
Get PDFThe evaluation of split renal function (SRF) is a critical issue in living kidney donations and can be evaluated using nuclear renography (NR) or computerized tomography (CT), with unclear comparative advantages. We conducted this retrospective study in 193 donors to examine the correlation of SRF assessed by NR and CT volumetry and compared their ability to predict remaining donor renal function at 1 year, through multiple approaches. A weak correlation between imaging techniques for evaluating the percentage of the remaining kidney volume was found in the global cohort, with an R2 = 0.15. However, the Bland-Altman plot showed an acceptable agreement (95% of the difference between techniques falling within - 8.51 to 6.11%). The predicted and observed eGFR one year after donation were calculated using the CKD-EPI, and CG/BSA equations. CT volume showed a better correlation than NR for both formulas (adjusted R2 of 0.42. and 0.61 vs 0.37 and 0.61 for CKD-EPI and CG/ BSA equations, respectively). In non-nested modeling tests, CT volumetry was significantly superior to NR for both equations. CT volumetry performed better than NR in predicting the estimated renal function of living donors at 1-year, independently from the eGFR equation.info:eu-repo/semantics/publishedVersio
Fluocinolone Acetonide 0.19 mg Implant in Patients with Cystoid Macular Edema Due To Irvine–Gass Syndrome
Get PDFBackground: Cystoid macular edema (CME) due to Irvine-Gass syndrome (IGS) is one of the common causes of painless visual impairment post-cataract extraction. The treatment of recurrent cases remains unstandardized.
Objective: To evaluate the effectiveness and safety of fluocinolone acetonide intravitreal implant (0.2 µg/day; ILUVIEN®) in the off-label treatment of recurrent CME due to IGS.
Methods: Retrospective 36-month case series in the Ophthalmology Department of Centro Hospitalar Universitário do Porto, Portugal. Consecutive eyes of patients with recurrent cystoid macular edema due to Irvine-Gass syndrome who underwent a single intravitreal injection of fluocinolone acetonide intravitreal implant were included. Best-corrected visual acuity (logMAR), central macular thickness (µm) and safety (intraocular pressure, mmHg) at baseline and at 6, 12, 24 and 36 months post-administration of the fluocinolone acetonide intravitreal implant were recorded.
Results: Five eyes from three patients were included. The duration of cystoid macular edema was 67.8±25.9 months and all five eyes received more than 2 intravitreal injections of a corticosteroid (triamcinolone and/or dexamethasone implant) prior to fluocinolone acetonide intravitreal implantation. At baseline (median - interquartile range), best-corrected visual acuity was 0.3-0.3; central macular thickness was 492.0-38.0; and intraocular pressure was 16.0-0. By Month 36, best-corrected visual acuity was 0.4 -0.3; central macular thickness was reduced to 369.0-324.0 and intraocular pressure was 17.0-3.0. Four of five eyes had increased intraocular pressure and were managed with intraocular pressure-lowering eye drops.
Conclusion: We report improved functional and anatomical outcomes after treatment with fluocinolone acetonide intravitreal implant, indicating its use as a therapeutic alternative in recurrent cases of cystoid macular edema due to Irvine-Gass syndrome. Additionally, in eyes with suboptimal response to intravitreal therapies, fluocinolone acetonide intravitreal implant may provide longer recurrence-free periods with reduced treatment burden.info:eu-repo/semantics/publishedVersio