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Classification of Events Contributing to Postneonatal cerebral palsy: Development, reliability, and recommendations for use.
No full textAim: This paper introduces the Surveillance of Cerebral Palsy in Europe (SCPE) classification of events contributing to postneonatally acquired cerebral palsy, presents its interrater reliability, and describes the cases identified in the SCPE database.
Method: The development of the classification, based on literature review and expert discussions, resulted in six main categories and 19 subcategories. The first chronological event designated as the primary event was mainly reported. Interrater reliability was assessed through online exercise providing 24 clinical vignettes representing single/complex pathways. Percent agreement and Gwet's AC1 index of reliability were estimated. Primary events were described using data of 221 children born between 2008 and 2012.
Results: Thirty-nine professionals (21 registries) participated in the reliability exercise. Substantial overall agreement was reached (0.75), with some contrast between complex (0.48, moderate agreement) and single events involved (0.89, almost perfect). The distribution of primary events showed that 32.1% were infections (category A), 23.1% head injuries (B), 15.4% related to surgery or medical interventions (C), 13.1% cerebrovascular accidents (D), 9.1% hypoxic brain damaging events of other origins (E), and 7.2% miscellaneous (F).
Interpretation: This classification allows all the events involved to be recorded while consistently reporting the primary event, and may be used in different settings.
What this paper adds: A standardized classification enables the description of the events contributing to postneonatal cerebral palsy (CP). The first chronological event in complex pathway leading to CP is coded. Category choice and coding of the primary event identify preventable situations. The detailed 2-level classification is easy to use in various settings. Substantial overall interrater reliability shows that main categories can be consistently differentiated
Seronegative Myasthenia Gravis: A Rare Disease Triggered by SARS-CoV-2 or a Coincidence?
No full textMyasthenia gravis (MG) results from the production of autoantibodies against the neuromuscular junction, leading to muscle weakness. Although the exact cause is not fully understood, it is known that the onset and exacerbations of MG can occur after viral infections. We present the case of a patient with no prior history of MG with new-onset proximal muscle weakness and ptosis, following SARS-CoV-2 infection, This case underscores the potential for autoimmune diseases to be triggered by SARS-CoV-2
Which Preschool Skills Predict School Readiness?
No full textA aptidão para o início da escolaridade (AIE) depende de fatores pessoais, socioculturais, familiares, do meio escolar, da legislação em vigor e das políticas de inclusão.
O objetivo foi identificar competências pré-escolares preditoras da AIE em consulta médica e sintetizar recomendações gerais a ter em conta. Foi efectuada uma pesquisa na base de dados PubMed com as palavras-chave: “preschool”, “school readiness”, “social functioning”, “motor skills”, “mathematics”, “language”, “comprehension of the world”, “attention”. Também foram consultadas as Orientações Curriculares para a Educação Pré-Escolar da DGE e da Norma Técnica da DGS
para o PNSIJ.
As competências socio-emocionais no pré-escolar têm um impacto positivo nas competências académicas. A perceção visual, a integração visuo-motora e a coordenação motora são fundamentais para AIE, da Leitura, Escrita e Matemática. A motricidade global demonstrou efeitos longitudinais ao nível da Linguagem, Leitura e Matemática. A consciência fonológica parece predizer o sucesso na Leitura. A acuidade do sistema numérico aproximado, a precisão de mapeamento e a capacidade de controlar e manter a atenção, têm um carácter preditivo de sucesso escolar. O conhecimento geral do mundo é o preditor mais forte para as competências futuras
em Ciências e Leitura.
A avaliação da AIE deve ser feita em várias ocasiões ao longo do desenvolvimento da criança, de forma multidisciplinar. Quanto mais precoce for a identificação de dificuldades e a intervenção dirigida, melhor o prognóstico. A decisão de optar pelo adiamento do início da escolaridade deve ter em consideração as variáveis biopsicossociais da criança e os recursos do meio escolar.School readiness (SR), the ability or preparedness of children to start schooling, depends on multiple factors, such as personal traits, sociocultural and familiar aspects, school context, education regulation and inclusion policies. Children who start schooling more prepared are most likely to achieve a higher academic level.
Our objectives was to identify which preschool skills predict SR and to summarize general recommendations to consider when assessing SR.
Research in data base PubMed, using the key words: “preschool”, “school readiness”, “social functioning”, “motor skills”, “mathematics”, “language”, “comprehension of the world”, “attention”. Consultation of the following Education and Health guidance: “Orientações Curriculares para a Educação Pré-Escolar da DGE”, “Norma Técnica da DGS para o PNSIJ”. Children’s social and emotional skills in preschool impact positively their academic skills.
Visual perception, visual motor integration and motor coordination are essential to SR, namely to Reading, Writing and Mathematics. Global and fine motor skills cause longitudinal effects to Speech, Reading and Mathematics. Phonological awareness predict success in learning how to read. Numeral system acuity, mapping accuracy and the ability to control and keep attention at preschool are predictable of school success. Comprehension of the world is the strongest predictor for Reading and Science skills.
It is important to assess SR on several occasions throughout children’s development, in a multidisciplinary approach. Prognosis is better when difficulties are detected at an early stage, thus allowing a directed intervention. The decision of delaying schooling must always consider biological, psychological and social variables, as well as school resources
Quality of Life and Performance Status after Cardiopulmonary Resuscitation: A Study in Cova da Beira University Hospital Center's Intensive Care Unit.
No full textIntroduction and objectives: Cardiac arrest (CA) is associated with high morbidity and mortality. Many studies focus on survival, but few explore the outcomes. The aim of this study is to analyze the survival curve, independence, quality of life, and performance status after CA.
Methods: This retrospective study included adults admitted to the intensive care unit of Cova da Beira University Hospital Center after CA between 2015 and 2019. We analyzed patient records and applied a questionnaire including EuroQoL's EQ-5D-3L and ECOG performance status.
Results: Ninety-seven patients were included (mean age 75.74 years). Thirty-one patients (32.0%) survived to hospital discharge. There was a significant loss of independence for activities of daily living, with 50.0% of those previously independent becoming dependent and 47.5% of those previously at home being institutionalized. Diabetes, female gender, and length of hospital stay were especially impactful on these findings. One year after CA, only 20.6% were alive and only 13.4% (65% of the one-year survivors) were independent. Nine patients answered our questionnaire. Mean EQ-5D quality of life index (0.528±0.297) and the most affected domains ('Pain/discomfort' and 'Anxiety/depression') were similar to the Portuguese population aged >30 years. However, 66.6% reported a decline in their quality of life. Lastly, seven respondents had a good performance status (ECOG 0-1).
Conclusions: There was a significant loss of independence after CA. Moreover, despite the acceptable performance status and the quality of life results being similar to the general population, there was a perceived deterioration post-CA. Ultimately, we emphasize the need to improve care for these patients
Spontaneous Tumor Lysis Syndrome in a Thoracic Burkitt Lymphoma: A Case Report.
No full textBurkitt lymphoma has a high proliferation rate and a significant risk of tumor lysis syndrome. Risk stratification and early identification are imperative since it is an oncological emergency. We report the case of a 20-year-old woman, without relevant past medical history, admitted to the Emergency Department with a three-week history of fatigue, chest discomfort, productive cough, night sweats, myalgia, odynophagia, and holocranial headache. Laboratory findings included lactic acidosis, elevation of inflammatory markers, and high D-dimer levels. Computed tomography angiography identified a large mediastinal mass with critical compression of the right pulmonary artery. Subsequently, the patient developed spontaneous tumor lysis syndrome with hemodynamic and metabolic instability. Biopsy of the lesion revealed a Burkitt lymphoma with a ki67 of 100%, an unexpected diagnosis since sporadic Burkitt Lymphoma is atypical in mediastinal location. Despite intensive hydration, rasburicase, and dexamethasone, progression to cardiogenic and obstructive shock required multiorgan support in the intensive care unit. After initial hemodynamic stabilization, targeted chemotherapy was initiated, but the patient's condition further worsened, followed by bone marrow aplasia, refractory shock, and death. The challenge of recognizing a serious illness in an apparently healthy young patient is highlighted, as well as maintaining a high level of suspicion of tumor lysis syndrome even in atypical circumstances
Fluocinolone Acetonide 0.2 µg/Day Intravitreal Implant in Non-Infectious Uveitis Affecting the Posterior Segment: EU Expert User Panel Consensus-Based Clinical Recommendations.
No full textBackground: Non-infectious uveitis affecting the posterior segment of the eye (NIU-PS) is an inflammatory disease, which can significantly impair visual acuity if not adequately treated. Fluocinolone-acetonide sustained-release-0.2 µg/day intravitreal (FAc) implants are indicated for prevention of relapse in recurrent NIU-PS. The aim here was to provide treating clinicians with some consensus-based-recommendations for the clinical management of patients with NIU-PS with 0.2 µg/day FAc implants.
Methods: A European-clinical-expert-group agreed to develop a consensus report on different issues related to the use of FAc implants in patients with NIU-PS.
Results: The Clinical-expert-panel provided specific recommendations focusing on clinical presentation (unilateral/bilateral) of the NIU-PS; systemic involvement of NIU-PS and the lens status. Treatment algorithms were developed; one that refers to the management of patients with NIU-PS in clinical practice and another that establishes the best clinical scenarios for the use of FAc implants, both as monotherapy and as adjuvant therapy. Additionally, the Clinical-expert-panel has provided recommendations about the use of the FAc implants in a clinical-setting. The Clinical-expert-panel also considered the safety profile of FAc implants and their possible implications in the daily practice.
Conclusions: As more clinical experience has been gained using FAc implants, it was necessary to update the clinical recommendations that guide patient management in the clinic. The current consensus document addresses relevant issues related to the use of FAc implants on different types of patients with various etiologies of NIU-PS, and was conducted to standardize approaches to help specialists obtain better clinical outcomes
European Society of Intensive Care Medicine Guidelines on End of Life and Palliative Care in the Intensive Care Unit.
No full textThe European Society of Intensive Care Medicine (ESICM) has developed evidence-based recommendations and expert opinions about end-of-life (EoL) and palliative care for critically ill adults to optimize patient-centered care, improving outcomes of relatives, and supporting intensive care unit (ICU) staff in delivering compassionate and effective EoL and palliative care. An international multi-disciplinary panel of clinical experts, a methodologist, and representatives of patients and families examined key domains, including variability across countries, decision-making, palliative-care integration, communication, family-centered care, and conflict management. Eight evidence-based recommendations (6 of low level of evidence and 2 of high level of evidence) and 19 expert opinions were presented. EoL legislation and the importance of respecting the autonomy and preferences of patients were given close attention. Differences in EoL care depending on country income and healthcare provision were considered. Structured EoL decision-making strategies are recommended to improve outcomes of patients and relatives, as well as staff satisfaction and mental health. Early integration of palliative care and the use of standardized tools for symptom assessment are suggested for patients at high risk of dying. Communication training for ICU staff and printed communication aids for families are advocated to improve outcomes and satisfaction. Methods for enhancing family-centeredness of care include structured family conferences and culturally sensitive interventions. Conflict-management protocols and strategies to prevent burnout among healthcare professionals are also considered. The work done to develop these guidelines highlights many areas requiring further research
NAU ‑ New Areas of Unifying Interest for CKD: A Multidisciplinary Expert Opinion Using the Jandhyala Method
No full textIntroduction: The global prevalence of chronic kidney disease (CKD) is rising exponentially. While patient awareness of
CKD remains low, we studied the physicians’ awareness and how globally it can be improved. We aimed to evaluate the
awareness and consensus of physicians on the screening, diagnosis and clinical management of CKD, thus identifying
which areas should be the subject of educational or research programs.
Methods: Participants experienced in scientific research and interested in CKD were divided into two groups: primary
and secondary care physicians. They underwent the Awareness Round with four open questions, followed by a Consen‑
sus Round to rate their level of agreement using a five‑point Likert scale ‑ Jandhyala method.
Results: Results showed varying levels of awareness and consensus among primary and secondary care physicians.
Both groups identified diabetes and hypertension as major risk factors for CKD development and progression, with
high consensus indexes (CI). However, glomerulopathies, polycystic kidney disease, and acute kidney injury had low awareness indexes (AI) but high CI, especially in secondary care. Key barriers to CKD diagnosis in primary care included
physician inertia (AI 100%) and lack of articulation between specialties (AI 77%). In secondary care, therapeutic inertia
(AI 100%) and socioeconomic factors (AI 84%) were significant limitations. Additionally, there was a notable disparity in
the management of CKD between primary and secondary care. Primary care showed lower AI for promoting a healthy
lifestyle (49%) and avoiding nephrotoxic drugs (25%) compared to secondary care (100% and 79%, respectively).
Conclusion: There is a need for educational programs for physicians exploring topics such as polycystic kidney disease,
glomerulopathies and acute kidney disease; as well as the implementation of initiatives focused on CKD referral and
management
Atopic Dermatitis and Multilocular Alopecia Areata Simultaneously Treated With Baricitinib
No full textinfo:eu-repo/semantics/publishedVersio