Centro Hospitalar do Porto
Repositório Científico da Unidade Local de Saúde de Santo AntónioNot a member yet
2440 research outputs found
Sort by
Administração de soros - Que direção?
No full textIntroduction: Although fluid administration for intravenous hydration is a common practice in pediatric age, it is not devoid of risks.
Methods: This was a retrospective cohort study including all children admitted to surgical recovery and receiving intravenous hydration at a Pediatric Intensive Care Unit between January and December 2015. Sodium, chloride, and base excess values were registered on two occasions: after surgery and during Unit’s hospitalization.
Results: Two hundred and seven children were included in the study, 66% of which, male, with a median age of 6.7 years. Fluids used consisted of 0.9% saline solution, 0.45% saline solution, and polyelectrolyte solution. The most frequently used fluids were polyelectrolyte (62%) and 0.9% saline solution (48%) at the operating room, and 0.9% saline (63%) and 0.45% saline (44%) solutions at the Pediatric Intensive Care Unit. At the operating room, 0.9% saline solution led to higher chloride median values and more negative base excess (metabolic acidosis) values compared with polyelectrolyte solution. At the Pediatric Intensive Care Unit, 0.9% saline solution administration resulted in hyperchloremia (p=0.002) and more metabolic acidosis (p=0.019) compared with 0.45% saline solution. There was no statistically significant association between type of solution used and sodium values.
Discussion: This study shows that the use of 0.9% saline solution is associated with development of hyperchloremic acidosis. This suggests that replacement of 0.9% saline solution with a plasma-like electrolyte solution may improve patient outcomes.Introdução: A utilização de soros para hidratação endovenosa é uma prática comum em idade pediátrica, não sendo isenta de riscos.
Métodos: Este foi um estudo de coorte retrospetivo que incluiu todas as crianças admitidas para recobro cirúrgico com necessidade de hidratação endovenosa numa Unidade de Cuidados Intensivos Pediátricos, entre janeiro e dezembro de 2015. Foram registados os valores de sódio, cloro e excesso de bases em dois períodos: após a cirurgia e durante o internamento na Unidade.
Resultados: Foram incluídas 207 crianças, 66% das quais do sexo masculino, com idade mediana de 6,7 anos. Os soros utilizados foram soro fisiológico, NaCl 0,45% com 5% de dextrose e polieletrolítico. Os soros mais frequentemente utilizados foram polieletrolítico (62%) e soro fisiológico (48%) no bloco operatório e soro fisiológico (63%) e NaCl 0,45% (44%) na Unidade de Cuidados Intensivos Pediátricos. No bloco operatório, a utilização de soro fisiológico traduziu-se em valores medianos de cloro mais elevados e valores de excesso de bases (acidose metabólica) mais negativos do que os observados com soro polieletrolítico. Na Unidade de Cuidados Intensivos Pediátricos, a administração de soro fisiológico conduziu a hipercloremia (p=0,002) e acidose metabólica mais pronunciada (p=0,019) do que o observado com NaCl 0,45%. Não foi observada uma associação estatisticamente significativa entre o tipo de soro utilizado e os valores de sódio registados.
Discussão: Este estudo demonstra que a utilização de soro fisiológico se associa ao desenvolvimento de acidose hiperclorémica. Tal sugere que a substituição de soro fisiológico por um soro com valores de eletrólitos semelhantes ao plasma poderá ter benefícios para o doente
Distúrbios cognitivos adversos no pós‐operatório: uma pesquisa nacional de anestesiologistas portugueses
No full textBackground and objectives: Postoperative delirium and postoperative cognitive dysfunction are some of the most common complications in older surgical patients and are associated with adverse outcomes. The aim of this study was to evaluate portuguese anesthesiologists' perspectives and knowledge about adverse postoperative cognitive disorders, and routine clinical practice when caring for older surgical patients.
Methods: We used a prospective online survey with questions using a Likert scale from 1 to 5 (completely disagree to completely agree), or yes/no/don't know answer types. Potential participants were portuguese anesthesiologists working in hospitals affiliated with the portuguese national health system and private hospitals.
Results: We analyzed 234 surveys (17.7% of total potential respondents). The majority believed that the risk of cognitive side effects should be considered when choosing the type of anesthesia (87.6%) and that preoperative cognitive function should be routinely assessed (78.6%). When caring for an agitated and confused patient postoperatively, 62.4% would first administer an analgesic and 11.1% an anxiolytic. Protocols to screen and manage postoperative cognitive disorders are rarely used. Nearly all respondents believe that postoperative delirium and postoperative cognitive dysfunction are neglected areas in anesthesiology.
Conclusions: Overall, participants perceive postoperative cognitive disorders as important adverse outcomes following surgery and anesthesia are aware of the main risk factors for their development but may lack information on prevention and management of postoperative delirium. The majority of hospitals do not have protocols regarding preoperative cognitive assessment, diagnosis, management or follow-up of patients with delirium and postoperative cognitive dysfunction.Justificativa e objetivos
O delírio pós‐operatório e a disfunção cognitiva pós‐operatória são algumas das complicações mais comuns em pacientes cirúrgicos mais idosos e estão associados a desfechos adversos. O objetivo deste estudo foi avaliar as perspectivas e conhecimentos de anestesiologistas portugueses sobre distúrbios cognitivos pós‐operatórios e a prática clínica de rotina ao cuidar de pacientes cirúrgicos idosos.
Métodos
Pesquisa prospectiva on‐line com perguntas usando uma escala Likert de 1–5 (discordo completamente–concordo completamente), ou respostas como sim/não/não sei. Os potenciais participantes eram anestesiologistas portugueses que trabalhavam em hospitais afiliados ao sistema nacional de saúde português e hospitais privados.
Resultados
Analisamos 234 resultados (17,7% do total dos potenciais respondentes). A maioria acreditava que o risco de efeitos colaterais cognitivos deveria ser considerado ao escolher o tipo de anestesia (87,6%) e que a função cognitiva pré‐operatória deveria ser rotineiramente avaliada (78,6%). Ao cuidar de um paciente agitado e confuso no pós‐operatório, 62,4% administraram primeiro um analgésico e 11,1% um ansiolítico. Protocolos para detectar e tratar distúrbios cognitivos pós‐operatórios são raramente usados. Quase todos os entrevistados acreditam que o delírio pós‐operatório e a disfunção cognitiva pós‐operatória são áreas negligenciadas na anestesiologia.
Conclusões
Em geral, os participantes percebem os distúrbios cognitivos pós‐operatórios como importantes resultados adversos após a cirurgia e anestesia, estão cientes dos principais fatores de risco para seu desenvolvimento, mas podem não ter informações sobre como prevenir e tratar o delírio pós‐operatório. A maioria dos hospitais não possui protocolos de avaliação cognitiva pré‐operatória, diagnóstico, tratamento ou acompanhamento de pacientes com delírio e disfunção cognitiva no pós‐operatório.info:eu-repo/semantics/publishedVersio
Anaesthesiology trainees and their needs: a Romanian perspective. Results from a European survey
Get PDFAnaesthesiology training is going through continuous transformations worldwide. Recent data from a European Survey on anaesthesiology postgraduate trainees and their concerns have been published for the first time, following an initiative by the European Society of Anaesthesiology. Among the responders of this survey, 10.8% were represented by Romanian trainees. The main needs of the Romanian anaesthesiology trainees who completed the questionnaire were, in descending order educational contents/EDAIC, technical skills, exchange programmes, residency workload, residency costs and autonomy transition. Another observation coming from the analysed data is that Romanian anaesthesiologists in training are highly concerned and interested in the field of intensive care medicine. The results also pinpoint to the high costs associated with continuous medical education, leading to a high incentive for workforce migration.info:eu-repo/semantics/publishedVersio
Endoscopic Ultrasound-Guided Biliary Drainage in Two Patients with Difficult Biliary Access
Get PDFIntroduction: Endoscopic retrograde cholangiopancreatography is the method of choice for biliary drainage, although in some cases standard biliary access is difficult or even impossible. Endoscopic ultrasound (EUS)-guided endoluminal procedures are an alternative in these cases, although experience with these techniques is still limited. Clinical Case: We present two cases of successful EUS-guided biliary drainage. In the first case, a hepaticogastrostomy was performed in a patient with stage IV gastric adenocarcinoma with obstructive jaundice due to compression of the hilum, where malignant gastric stenosis and previous palliative gastrojejunostomy precluded access to the second part of the duodenum. In the second case, a patient with a pancreatic head adenocarcinoma with duodenal invasion that precluded major papillae identification was submitted to a choledochoduodenostomy. Both procedures occurred without immediate or delayed adverse events, with technical and clinical success. Discussion: Although experience with EUS-guided biliary drainage is still limited, its efficacy and safety is favorable when compared with percutaneous and surgical drainage, and should be considered an alternative to these techniques where sufficient expertise exists.Introdução: A colangiopancreatografia retrógrada endoscópica é o procedimento de escolha para a drenagem biliar, embora em alguns casos o acesso biliar convencional é difícil ou até impossível. As técnicas de drenagem guiadas por ecoendoscopia são uma alternativa nestes casos, embora a experiência seja ainda limitada. Caso: Apresentamos dois casos de drenagem biliar eficaz guiada por ecoendoscopia. No primeiro caso foi realizada hepaticogastrostomia numa doente com adenocarcinoma gástrico estadio IV, com icterícia obstrutiva devido a compressão hilar pela neoplasia, na qual o acesso à segunda porção duodenal se revelou impossível devido à neoplasia gástrica estenosante e a antecedentes de gastrojejunostomia paliativa. No segundo caso, uma doente com adenocarcinoma cefalo-pancreático com invasão duodenal que impedia a identificação da papila foi submetida a coledocoduodenostomia. Em ambos os procedimentos foi conseguida drenagem biliar eficaz e não ocorreram eventos adversos imediatos ou tardios. Discussão: Apesar de a experiência com técnicas de drenagem biliar guiadas por ecoendoscopia ser limitada, o seu perfil de eficácia e segurança parece ser favorável quando comparada com as alternativas (drenagem percutânea ou cirúrgica), pelo que devem ser consideradas quando exista equipamento e experiência necessária.info:eu-repo/semantics/publishedVersio
Implantation of intracorneal ring segments in pediatric patients: long-term follow-up
Get PDFPurpose:
To analyze the long-term outcomes of intracorneal ring segments (ICRS) implantation for keratoconus management in pediatric patients.
Methods:
Retrospective case series review of the long-term (>5 years) outcomes of Intacs® ICRS implantation for keratoconus in pediatric patients (age <18 years old at the time of surgery) between January 2008 and December 2011 at Ophthalmology Department of Hospital de Santo António. Demographic data, follow-up time, preoperative and postoperative uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA) in decimal scale, and corneal topography were evaluated. Statistical analysis was done using SPSS for windows (version 24). Significance was set at p<0.0125.
Results:
Fourteen eyes of 14 patients, with a mean age of 15.36 years (range 10-18 years), were included in this study. All patients had been diagnosed with keratoconus with reported progression in the 6 months prior to surgery. Follow-up time was 6.36±0.97 years. UCVA and BCVA improved after ICRS implantation (p<0.0125). Keratometry (K) minimum (Kmin) and K maximum (Kmax) decreased after surgery (p<0.0125). During follow-up, UCVA, BCVA, Kmin, and Kmax values ranged, showing a tendency to worsen at the end of follow-up. However, statistically significant differences were not observed.
Conclusion:
ICRS implantation showed good visual and topographic results in pediatric patients. Long-term follow-up suggests that, despite ICRS implantation, there is still progression of keratoconus. To the best of our knowledge, there are no reports regarding the long-term efficacy of ICRS implantation in pediatric patients.info:eu-repo/semantics/publishedVersio
Analysis of electroencephalogram-derived indexes for anesthetic depth monitoring in pediatric patients with intellectual disability undergoing dental surgery
Get PDFBackground:
Patients with intellectual disability (ID) often require general anesthesia during oral procedures. Anesthetic depth monitoring in these patients can be difficult due to their already altered mental state prior to anesthesia. In this study, the utility of electroencephalographic indexes to reflect anesthetic depth was evaluated in pediatric patients with ID.
Methods:
Seventeen patients (mean age, 9.6 ± 2.9 years) scheduled for dental procedures were enrolled in this study. After anesthesia induction with propofol or sevoflurane, a bilateral sensor was placed on the patient's forehead and the bispectral index (BIS) was recorded. Anesthesia was maintained with sevoflurane, which was adjusted according to the clinical signs by an anesthesiologist blinded to the BIS value. The index performance was accessed by correlation (with the end-tidal sevoflurane [EtSevo] concentration) and prediction probability (with a clinical scale of anesthesia). The asymmetry of the electroencephalogram between the left and right sides was also analyzed.
Results:
The BIS had good correlation and prediction probabilities (above 0.5) in the majority of patients; however, BIS was not correlated with EtSevo or the clinical scale of anesthesia in patients with Lennox-Gastaut, West syndrome, cerebral palsy, and epilepsy. BIS showed better correlations than SEF95 and TP. No significant differences were observed between the left- and right-side indexes.
Conclusion:
BIS may be able to reflect sevoflurane anesthetic depth in patients with some types of ID; however, more research is required to better define the neurological conditions and/or degrees of disability that may allow anesthesiologists to use the BIS.Aura Silva’s work was supported by Portuguese Foundation for Science and Technology, reference SFRH/BPD /75697/2011info:eu-repo/semantics/publishedVersio
WNT6 is a novel oncogenic prognostic biomarker in human glioblastoma
Get PDFGlioblastoma (GBM) is a universally fatal brain cancer, for which novel therapies targeting specific underlying oncogenic events are urgently needed. While the WNT pathway has been shown to be frequently activated in GBM, constituting a potential therapeutic target, the relevance of WNT6, an activator of this pathway, remains unknown. Methods: WNT6 protein and mRNA levels were evaluated in GBM. WNT6 levels were silenced or overexpressed in GBM cells to assess functional effects in vitro and in vivo. Phospho-kinase arrays and TCF/LEF reporter assays were used to identify WNT6-signaling pathways, and significant associations with stem cell features and cancer-related pathways were validated in patients. Survival analyses were performed with Cox regression and Log-rank tests. Meta-analyses were used to calculate the estimated pooled effect. Results: We show that WNT6 is significantly overexpressed in GBMs, as compared to lower-grade gliomas and normal brain, at mRNA and protein levels. Functionally, WNT6 increases typical oncogenic activities in GBM cells, including viability, proliferation, glioma stem cell capacity, invasion, migration, and resistance to temozolomide chemotherapy. Concordantly, in in vivo orthotopic GBM mice models, using both overexpressing and silencing models, WNT6 expression was associated with shorter overall survival, and increased features of tumor aggressiveness. Mechanistically, WNT6 contributes to activate typical oncogenic pathways, including Src and STAT, which intertwined with the WNT pathway may be critical effectors of WNT6-associated aggressiveness in GBM. Clinically, we establish WNT6 as an independent prognostic biomarker of shorter survival in GBM patients from several independent cohorts. Conclusion: Our findings establish WNT6 as a novel oncogene in GBM, opening opportunities to develop more rational therapies to treat this highly aggressive tumor.The authors extend their acknowledgments to the families who contributed to this study. Financial support was provided by grants from the FCT - Foundation for Science and Technology (PTDC/SAU-GMG/113795/2009 and IF/00601/2012 to B.M.C.; SFRH/BD/92786/2013 to C.S.G.; SFRH/BD/88121/2012 to J.V.C.; SFRH/BD/81042/2011 to M.P.; SFRH/BD/93443/2013 to S.Q.) and Fundação Calouste Gulbenkian (B.M.C.), by FEDER funds through the Operational Programme Competitiveness Factors - COMPETE and National Funds through FCT under the project POCI-01-0145-FEDER-007038; by the project NORTE-01-0145-FEDER-000013 and NORTE-01-0246-FEDER-000012, supported by Norte Portugal Regional Operational Programme (NORTE 2020), under the PORTUGAL 2020 Partnership Agreement, through the European Regional Development Fund (ERDF); and by the project NORTE-01-0145-FEDER-000023, supported by the Northern Portugal Regional Operational Programme (NORTE 2020), under the Portugal 2020 Partnership Agreement, through the European Regional Development Fund (FEDER).info:eu-repo/semantics/publishedVersio
Caso clínico dermatológico
No full textUlcus Vulvae Acutum or Lipschütz ulcer is a rare cause of acute vulvar ulcer that usually affects young, non-sexually active women and consists on the sudden emergence of vulvar ulcers some days after an influenza-like syndrome, usually caused by Epstein-Barr virus. Despite its exuberant presentation, such ulcers are benign and self-limited. Diagnosis is clinical and treatment, symptomatic. Lesions typical resolve within a few weeks, leaving no scars.
The authors describe the case of a 17-year-old, sexually active female adolescent with Lipschütz ulcers.Ulcus Vulvae Acutum, também conhecida como Úlcera de Lipschütz, é uma causa rara de úlceras vulvares que afeta mulheres jovens, habitualmente virgens, e consiste no aparecimento súbito de úlceras vulvares alguns dias após uma síndrome gripal, geralmente causada pelo vírus Epstein-Barr.
Apesar de exuberantes, são úlceras benignas e com resolução espontânea. O diagnóstico é baseado em achados clínicos e o tratamento, sintomático. As lesões tipicamente resolvem após algumas semanas sem deixar cicatriz.
Os autores descrevem o caso de uma adolescente de 17 anos, sexualmente ativa, com úlceras de Lipschütz
The Portuguese Severe Asthma Registry: Development, Features, and Data Sharing Policies
Get PDFThe Portuguese Severe Asthma Registry (Registo de Asma Grave Portugal, RAG) was developed by an open collaborative network of asthma specialists. RAG collects data from adults and pediatric severe asthma patients that despite treatment optimization and adequate management of comorbidities require step 4/5 treatment according to GINA recommendations. In this paper, we describe the development and implementation of RAG, its features, and data sharing policies. The contents and structure of RAG were defined in a multistep consensus process. A pilot version was pretested and iteratively improved. The selection of data elements for RAG considered other severe asthma registries, aiming at characterizing the patient's clinical status whilst avoiding overloading the standard workflow of the clinical appointment. Features of RAG include automatic assessment of eligibility, easy data input, and exportable data in natural language that can be pasted directly in patients' electronic health record and security features to enable data sharing (among researchers and with other international databases) without compromising patients' confidentiality. RAG is a national web-based disease registry of severe asthma patients, available at asmagrave.pt. It allows prospective clinical data collection, promotes standardized care and collaborative clinical research, and may contribute to inform evidence-based healthcare policies for severe asthma.The authors thank all members of the REAG (Rede de Especialistas em Asma Grave), namely, Ana Morete, Ana Sofia Barroso, António Reis, Aurora Carvalho, Carmen Botelho, Catarina Ferreira, Cláudia Pinto, Dolores Moniz, Elza Tomás, Emília Alvares, Eugénia Almeida, Filipe Inácio, Isabel Carrapatoso, Isabel Pereira, Jorge Romariz, José Pedro Moreira da Silva, Leonor Cunha, Luísa Barata, Luísa Geraldes, Luísa Semedo, Madalena Emiliano, Manuel Barbosa, Margarida Raposo, Maria José Silvestre, Mariana Mendes, Marta Dias Sousa, Nuno Sousa, Orlando Santos, Paula Duarte, Rosário Ferreira, Sofia Furtado, and Vítor Teixeira. RAG was financed by an unrestricted grant from Novartis Farma-Produtos Farmacêuticos, S.A., which had no participation in any part of the development and implementation of the registry and has no access to the stored data for any purpose. The first author is financed by a PhD Grant (PD/BD/113665/2015) and financed by the European Social Fund and national funds of MCTES (Ministério da Ciência, Tecnologia e Ensino Superior) through FCT (Fundação para a Ciência e Tecnologia, I.P) PhD Programme Ref. PD/0003/2013-Doctoral Programme in Clinical and Health Services Research (PDICSS). The publication of this article was supported by ERDF (European Regional Development Fund) through the operation POCI-01-0145-FEDER-007746 funded by the Programa Operacional Competitividade e Internacionalização – COMPETE2020 and by National Funds through FCT - Fundação para a Ciência e a Tecnologia within CINTESIS, R&D Unit (reference UID/IC/4255/2013).info:eu-repo/semantics/publishedVersio
Endoscopic Removal of Two Esophageal Over-The-Scope Clips with Cold Saline Solution Technique
Get PDFinfo:eu-repo/semantics/publishedVersio