Centro Hospitalar do Porto
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A importância da Comissão de Proteção Contra as Radiações Ionizantes no contexto da qualidade do Centro Hospitalar do Porto
No full textA Estratégia Nacional para a Qualidade na Saúde 2015 -2020 visa assegurar que as funções de governação, coordenação e ação local, centradas no doente, estão devidamente alinhadas pelo mesmo diapasão, com respeito pelas dimensões da efetividade, eficiência, acesso, segurança, equidade, adequação, oportunidade, continuidade e respeito pelo cidadão. A pesquisa da qualidade nos serviços de saúde deixou de ser um ato isolado e tornou-se hoje um dado adquirido e categórico. A Sociedade está cada vez mais exigente, no que se refere à qualidade dos serviços prestados, fundamentalmente nas instituições públicas. Esta exigência desenvolveu uma necessidade de criar normas e mecanismos de avaliação e controlo da qualidade nos serviços de saúde. Na última década os meios complementares de diagnóstico e terapêutica transformaram-se em ferramentas essenciais para todos os ramos e especialidades da medicina. O recurso a procedimentos radiológicos para diagnóstico e terapêutica tem determinado um aumento da dose de radiação nos pacientes, tornando-se numa preocupação constante dos utilizadores. Contudo, a sua quantificação e monitorização permite assegurar a segurança dos pacientes, assim como contribuir para a manutenção de serviços de qualidade no SNS. Este trabalho tem como objetivo apresentar a importância da Comissão de Proteção contra Radiações (CPCR), no contexto do Centro Hospitalar do Porto, na manutenção da qualidade e segurança de todos os pacientes e profissionais envolvidos em procedimentos radiológicos.info:eu-repo/semantics/draf
Tratamento de Infeções Protésicas com Desbridamento e Preservação do Implante - Resultados da Aplicação Prospetiva de um Protocolo Pré-estabelecido
Get PDFObjetivo: O tratamento de infeções protésicas é complexo e os resultados do desbridamento com preservação da prótese são frequentemente imprevisíveis. A nossa hipótese é que é possível oferecer uma boa probabilidade de sucesso desde que sejam cumpridas algumas regras simples para correta seleção e tratamento dos doentes. O objetivo deste estudo é apresentar os resultados obtidos com a aplicação prospetiva desses pressupostos ao longo dos últimos anos na nossa instituição.
Material e Métodos: Trata-se de um estudo clínico prospetivo que inclui todos os doentes com infeção protésica tratados desde Janeiro/2012 e com um seguimento mínimo de 12 meses após o fim do tratamento. Apenas foram candidatos ao desbridamento com preservação do implante doentes com prótese estável, sem sinais de descolamento, boa condição de partes moles e curta duração dos sintomas. O desbridamento cirúrgico foi realizado pelo mesmo cirurgião e incluiu sempre troca de partes móveis. Sempre que possível a antibioterapia incluiu fármacos com eficácia para bactérias no biofilme.
Resultados: Foram estudados 24 doentes (15 joelhos e 9 ancas) com uma idade média de 65 anos. Um doente foi excluído da analise dos resultados por morte não relacionada. Registaram-se três casos de falência do tratamento o que resulta numa taxa de sucesso de 87% (20/23) com um seguimento médio de 30 meses após o término da antibioterapia.
Conclusão: A aplicação de um protocolo pré-estabelecido de tratamento permite a obtenção de bons resultados no tratamento de infeções protésicas mesmo quando se opte pela preservação do implanteinfo:eu-repo/semantics/publishedVersio
Anuário Científico 2016
No full textO Anuário Científico de 2016 é um documento integrador da produção científica do Centro Hospitalar do Porto (CHP). O Gabinete Coordenador da Investigação 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
Incorporating Scoring Risk Models for Care Planning of the Elderly with Chronic Kidney Disease
Get PDFMortality in chronic kidney disease remains high, particularly among the elderly, who represent the most rapidly growing segment of the end-stage renal disease population in wealthier countries. The management of older adults with chronic kidney disease has become a clinical challenge, and care for those patients expected to progress to end-stage renal disease should focus on evaluating the overall benefit of offering renal replacement therapy to them. Predictive mortality models may help to inform shared decision-making in the trajectory of the elderly with chronic kidney disease. This review discusses current literature on the available predictive models for predicting survival in elderly chronic kidney disease patients and reflects the author's own interpretation and experience.info:eu-repo/semantics/publishedVersio
Nasolabial flap - alternative uses for a classic but versatile technique
Get PDFThe nasolabial flap is one of the most ancient techniques used in orofacial surgery. The authors report two cases of patients with skin cancer treated surgically with variations of the classic nasolabial flap by transposition (bilateral and folded) that highlight the broad applicability of this technique.info:eu-repo/semantics/publishedVersio
Galactose Epimerase Deficiency: Expanding the Phenotype
Get PDFGalactose epimerase deficiency is an inborn error of metabolism due to uridine diphosphate-galactose-4'-epimerase (GALE) deficiency. We report the clinical presentation, genetic and biochemical studies in two siblings with generalized GALE deficiency.Patient 1: The first child was born with a dysmorphic syndrome. Failure to thrive was noticed during the first year. Episodes of heart failure due to dilated cardiomyopathy, followed by liver failure, occurred between 12 and 42 months. The finding of a serum transferrin isoelectrofocusing (IEF) type 1 pattern led to the suspicion of a congenital disorder of glycosylation (CDG). Follow-up disclosed psychomotor disability, deafness, and nuclear cataracts.Patient 2: The sibling of patient 1 was born with short limbs and hip dysplasia. She is deceased in the neonatal period due to intraventricular hemorrhage in the context of liver failure. Investigation disclosed galactosuria and normal transferrin glycosylation.Next-generation sequence panel analysis for CDG syndrome revealed the previously reported c.280G>A (p.[V94M]) homozygous mutation in the GALE gene. Enzymatic studies in erythrocytes (patient 1) and fibroblasts (patients 1 and 2) revealed markedly reduced GALE activity confirming generalized GALE deficiency. This report describes the fourth family with generalized GALE deficiency, expanding the clinical spectrum of this disorder, since major cardiac involvement has not been reported before.info:eu-repo/semantics/publishedVersio
Mini-laparoscopic hysterectomy for adenocarcinoma in situ of the uterine cervix using interchangeable 5-mm end effectors: a way to cross the line of minimally invasive surgery in gynaecologic oncology
Get PDFThe incidence of adenocarcinoma of the uterine cervix is increasing. It poses the affected women in risk and the definitive treatment requires hysterectomy. Here we describe a case of adenocarcinoma in situ of the uterine cervix successfully managed by minilaparoscopic hysterectomy using interchangeable 5-mm end effectors.info:eu-repo/semantics/publishedVersio
Vacuum-assisted closure therapy after resection of giant basal cell carcinoma of the scalp
Get PDFManagement of complicated wounds is a challenge in head and neck reconstruction. Although the negative pressure wound therapy or wound vacuum-assisted closure has been widely used in complicated wounds and shows promising results, its application in the head and neck region after reconstruction for the head and neck cancer is rarely presented. A 77-year-old woman underwent a radical resection of an extensive basal cell carcinoma of the scalp and forehead involving the periosteum, where classic reconstruction was difficult, but successfully treated with negative pressure wound therapy. Negative pressure wound therapy is an efficacious tool in cases of complex and extensive defects, when we expect immediate reconstruction with poor results, as would be probable with this scalp lesion.info:eu-repo/semantics/publishedVersio
Predictive clinical model of tumor response after chemoradiation in rectal cancer
Get PDFSurvival improvement in rectal cancer treated with neoadjuvant chemoradiotherapy (nCRT) is achieved only if pathological response occurs. Mandard tumor regression grade (TRG) proved to be a valid system to measure nCRT response. The ability to predict tumor response before treatment may significantly have impact the selection of patients for nCRT in rectal cancer. The aim is to identify potential predictive pretreatment factors for Mandard response and build a clinical predictive model design. 167 patients with locally advanced rectal cancer were treated with nCRT and curative surgery. Blood cell counts in peripheral blood were analyzed. Pretreatment biopsies expression of cyclin D1, epidermal growth factor receptor (EGFR), vascular endothelial growth factor (VEGF) and protein 21 were assessed. A total of 61 single nucleotide polymorphisms were characterized using the Sequenom platform through multiplex amplification followed by mass-spectometric product separation. Surgical specimens were classified according to Mandard TRG. The patients were divided as: "good responders" (Mandard TRG1-2) and "poor responders" (Mandard TGR3-5). We examined predictive factors for Mandard response and performed statistical analysis. In univariate analysis, distance from anal verge, neutrophil lymphocyte ratio (NLR), cyclin D1, VEGF, EGFR, protein 21 and rs1810871 interleukin 10 (IL10) gene polymorphism are the pretreatment variables with predictive value for Mandard response. In multivariable analysis, NLR, cyclin D1, protein 21 and rs1800871 in IL10 gene maintain predictive value, allowing a clinical model design.This study was supported by a research grant from the Associação de Apoio ao Departamento de Cirurgia
do HSA and from DEFI/CHP. The funders had no role in study design, data collection and analysis, decision to
publish, or preparation of the manuscript.info:eu-repo/semantics/publishedVersio
Clinical performance of an infliximab rapid quantification assay
Get PDFBACKGROUND:
Therapeutic drug monitoring (TDM)-based algorithms can be used to guide infliximab (IFX) adjustments in inflammatory bowel disease (IBD) patients. This study aimed to explore a rapid IFX-quantification test from a clinical perspective.
METHODS:
This manuscript describes a prospective cohort study involving 110 ulcerative colitis (UC) patients on the maintenance phase of IFX. IFX trough levels were quantified using a rapid quantification assay and a commonly-used reference kit.
RESULTS:
Irrespective of the assay used to measure IFX, its through levels were statistically different between patients with and without endoscopic remission (Mayo endoscopic score = 0), as well as between patients stratified by their faecal calprotectin (FC) levels. Despite the fact that the two methods correlated well with each other [Spearman's rank correlation coefficient = 0.843, p < 0.001; intraclass correlation coefficients = 0.857, 95% confidence interval (CI): 0.791-0.903], there was a discernible systematic variation; values obtained with the reference kit were on average 2.62 units higher than those obtained with the rapid assay. Notwithstanding, 3 µg/ml was shown to be an acceptable cut-off to assess endoscopic status and inflammatory burden levels using both assays. The percentage of patients that had a positive outcome when the IFX concentration measured by the rapid assay ranked above 3 µg/ml was 88% both for a Mayo endoscopic score ⩽ 1 and for an FC concentration <250 µg/g.
CONCLUSIONS:
Based on this study, we concluded that using the rapid IFX assessment system with a 3 µg/ml threshold is a reliable alternative to the time-consuming enzyme-linked immunosorbent assays in patients on the maintenance phase of IFX.This work was supported by the Portuguese IBD Group (GEDII, Grupo de Estudo da Doença Inflamatória Intestinal)info:eu-repo/semantics/publishedVersio