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Chronic Kidney Disease: Supportive and Conservative Care in Portugal in 2023
No full textIntroduction: Elderly patients with chronic kidney disease (CKD) present a higher risk of becoming frail, a consequence
of several comorbidities and worse functional status. This condition does not necessarily improve with the initiation of
dialysis. Conservative care offers an option to treat elderly and/or frail patients with advanced CKD, which focuses on
improving the patient’s quality of life, active symptom management and shared decision making. Conservative care has been recognized as an option for CKD patients in Portugal since 2011. Although it has been 12 years since “Norma 17”was published, not all Nephrology departments in Portugal offer this option.
Methods: The Conservative Care Working Group of the Portuguese Society of Nephrology is working on identifying
barriers to its implementation and possible solutions. A questionnaire was sent to all nephrology departments (n=26).
Results: The answers (n=15) were discussed at a meeting. The most common barriers were insufficient knowledge in
palliative care and a lack of regulation and/or reimbursement.
Conclusion: Solutions for these barriers were discussed and are here reported
A Reviewed Approach to Vitamin D Supplementation in Pediatric Age in Portugal
No full textVitamin D deficiency is a well-established cause of rickets in children and has been reported as associated to impacts on
other systems and organs. Vitamin D deficiency and insufficiency are pediatric worldwide global health problems. Although data on the prevalence of vitamin D deficiency and insufficiency in the Portuguese pediatric population are scarce, data for Portuguese subpopulations and equivalent regions allows us to speculate that the prevalence of vitamin D deficiency in Portugal should be also relevant. The current article focuses on vitamin D supplementation at pediatric age in Portugal reviewing the prevalence data of vitamin D insufficiency/deficiency for Portugal, the main groups and the risk factors for vitamin D deficiency and educational measures and vitamin D supplementation recommendations for different risk factors/groups.A deficiência de vitamina D é uma causa bem estabelecida de raquitismo em crianças e tem sido associada a compromisso funcional de outros órgãos e sistemas. A deficiência e insuficiência de vitamina D são um problema de saúde global, muito comum em crianças de todo o mundo. Embora os dados sobre a prevalência da deficiência/insuficiência de vitamina D na população pediátrica portuguesa sejam escassos, os dados relativos às subpopulações portuguesas e regiões equivalentes permitem-nos especular que a prevalência da deficiência de vitamina D em Portugal deverá ser relevante. O presente artigo centra-se na suplementação com vitamina D em idade pediátrica em Portugal, revendo os dados de prevalência da insuficiência/deficiência em vitamina D em Portugal, os principais grupos e os factores de risco de deficiência de vitamina D, bem como as medidas educativas e recomendações de suplementação de vitamina D para os diferentes factores/grupos de risco
Efficacy and Safety of Novel Left Ventricular Pacing Leads: 1-Year Analysis of the NAVIGATOR Trial
No full textObjectives: Assess safety and performance of novel quadripolar preshaped left ventricular (LV) leads: NAVIGO 4LV 2D ('S shaped') and NAVIGO 4LV ARC ('U shaped').
Methods: Patients indicated for cardiac resynchronisation therapy were enrolled in a multicentre, prospective, controlled study (NAVIGATOR, NCT03279484). Patients were implanted with either a NAVIGO 4LV 2D or ARC lead, and assessed at 10 weeks, 6, 12 and 24 months post-implant. Co-primary safety and performance endpoints were assessed at 10 weeks. Safety endpoint was the patients' rate free from lead-related complications. Performance endpoint was the rate of patients with successful lead performance, defined as LV pacing threshold ≤2.5 V at 0.5 ms on at least one pacing vector, and the absence of phrenic nerve stimulation at the final programmed configuration. Lead-related complications and electrical parameters were monitored throughout study.
Results: A NAVIGO 4LV lead was successfully implanted in 211 out of 217 patients (97.2%). The safety endpoint was met, with 100% and 96.1% of patients free from complications for NAVIGO 4LV 2D and ARC, respectively. The performance endpoint was met with 98.1% and 98.9% of patients with a successful lead performance for NAVIGO 4LV 2D and ARC, respectively. Over 12 months, the global complication-free rate for both leads was 97.1% (95% CI: 93.71% to 98.70%), with a mean pacing capture threshold of 1.23 V±0.73 V and a mean impedance of 951 Ω±300.1 Ω.
Conclusion: A high implantation success rate and low complication rate was reported for the novel NAVIGO 4LV 2D and ARC leads, along with successful performance up to 12 months.info:eu-repo/semantics/publishedVersio
A Efetividade de um Programa de Reabilitação na Melhoria de Sintomas da Pessoa com Hipertensão Pulmonar: Protocolo de Revisão Sistemática da Literatura
No full textIntrodução: A Hipertensão Arterial Pulmonar (HAP) é uma condição fisiopatológica que pode estar associada a várias doenças cardiorrespiratórias, pelo que a sua complexidade exige uma abordagem multidisciplinar, incluindo intervenções como treino de exercício, apoio psicológico, educação e programas de reabilitação pulmonar, melhorando sintomas e qualidade de vida (Humbert et al., 2022).
Objetivos: Avaliar a efetividade de programas de reabilitação na melhoria sintomática em pessoas com HAP.
Material e Métodos: Definiu-se como pergunta de investigação “Qual a efetividade (O) de programas de reabilitação (I) na melhoria sintomática em pessoas com HAP (P)?”. Consideraram se critérios de inclusão: adultos com HAP (participantes), submetidos a programas de reabilitação (intervenção), com avaliação do impacto na melhoria sintomática (resultados), em qualquer contexto. Incluem-se artigos integrais de estudos quantitativos experimentais (ensaios controlados randomizados), quasi-experimentais, analíticos/descritivos observacionais. Sem limite temporal ou linguístico. A revisão baseia-se na Metodologia JBI para Revisões Sistemáticas de Efetividade, com uma estratégia em três fases: pesquisa preliminar de revisões (PROSPERO, JBI Evidence Synthesis, Cochrane Database, Medline), pesquisa nos cabeçalhos da PubMed e CINAHL
(identificação de termos) e pesquisa completa na B-On, CINAHL e PubMed (Tufanaru et al., 2020).
Definiu-se como expressão booleana [AB]'effectiveness' OR [AB]'efficacy' OR [AB]'outcome*' OR [AB]'effect*' AND [AB]'rehabilitation*' AND [AB]'pulmonary arterial hypertension'). As referências introduzir-se-ão no Zotero®. Títulos e resumos serão selecionados por 2 revisores, incoporados no JBI SUMARI, seguido da avaliação da qualidade metodológica (incluindo-se limiares superiores a 70%), da síntese narrativa e da avaliação do nível de evidência (abordagem GRADE e criação de Resumo das Conclusões/SoF) (McMaster University and Evidence Prime, 2023; Schünemann et al., 2013).
Resultados: Os resultados incluirão impacto na qualidade de vida, dispneia, fadiga, capacidade/tolerância ao exercício, hemodinâmica cardiopulmonar ou consumo máximo de oxigénio (Tufanaru et al., 2020).Conclusões: É essencial pensar nas implicações clínicas do estabelecimento de programas de reabilitação especializados e efetivos.info:eu-repo/semantics/publishedVersio
An Analysis From a Tertiary Pediatric Hospital: Does Physical Activity Play a Role in the Management of Children and Young Adults With Osteogenesis Imperfecta?
No full textIntroduction: Osteogenesis imperfecta (OI) is a hereditary connective tissue disorder characterized by reduced bone density and increased proneness to fractures. It manifests across a varied clinical spectrum of expressions in children and young adults. It is crucial for children with OI to have a multidisciplinary follow-up, including orthopedics, pediatrics, and physical medicine and rehabilitation. Although exercise may have no effect on the disease itself, it might improve the autonomy, self-esteem, and fitness of these children. Methods: Retrospective cohort analysis of children and young adults aged three or more years old followed-up in a Level III Pediatric Hospital between 1995 and 2020. Demographic and clinical data were obtained from the hospital records and from the caregivers via phone calls. To our knowledge, this is the first national case series published assessing exercise habits in children with this condition.
Results: Among the 21 patients studied, the median age was 14 years, with no gender predominance. Eighteen (86%) practiced regular physical activity, while the remaining three (14%), all of whom were type III OI, were totally dependent. Of the aforementioned 18 children, 12 (67%) considered practicing the same level of physical activity compared to their healthy peers, although most of them needed adaptations. The most reported extracurricular activity was swimming, in 50% of the cases. About 39% engaged in physical activity two times or less per week, and 89% practiced for one hour or less per session.
Discussion: Over the years, it has become clear that physical activity is an important part of OI management. While awareness of the importance of exercise already exists, proper planning, follow-up, and monitoring are essential.info:eu-repo/semantics/publishedVersio
Nova Gestão Pública e Novo Serviço Público: uma Análise Comparativa
No full textA Administração Pública (AP) desempenha um papel vital na história humana, as suas práticas evoluíram ao longo do tempo, refletindo valores em constante mudança. Existem três categorias principais de modelos de governação pública: os modelos tradicionais, os gestionários e os pós-gestionários.
Este estudo descritivo tem como objetivo realizar uma análise comparativa entre um modelo gestionário - a Nova Gestão Pública (NGP) e um modelo pós-gestionário - o Novo Serviço Público (NSP). A NGP ao defender a aplicação de práticas de negócios no setor público, visando maior eficiência e responsabilização, enfrentou críticas de falta de substância, efeitos negativos na qualidade do serviço público e concentração de poder. Em contrapartida, o NSP valoriza a democracia, a responsabilidade pública e a ética na AP, promovendo uma abordagem centrada no cidadão. A comparação entre a NGP e o NSP destaca a importância dada a diferentes valores na AP, com a NGP enfatizando a eficiência e o NSP promovendo valores democráticos e de cidadania. No entanto, a tendência atual é para uma abordagem híbrida que combina eficiência com a responsabilidade pública e a participação cívica. O estudo comparativo entre a NGP e o NSP é relevante, pois oferece uma compreensão da evolução da gestão na AP, destacando como esses modelos aparentemente opostos podem coexistir e complementar-se para promover uma governança pública mais eficaz e centrada no cidadão. Isso é essencial para os gestores e decisores atuais enfrentarem os desafios contemporâneos da AP.info:eu-repo/semantics/publishedVersio
Recommendations for Reducing the Environmental Impact of Inhalers in Portugal: Consensus Document
No full textThis consensus document addresses the reduction of the environmental impact of inhalers in Portugal. It was prepared by the Portuguese Council for Health and the Environment and the societies representing the specialties that account for these drugs’ largest volume of prescriptions, namely the Portuguese Society of Pulmonology, the Portuguese Society of Allergology and Clinical Immunology, the Portuguese Society of Pediatrics, the Portuguese Society of Internal Medicine, the Portuguese Association of General and Family Medicine and also a patient association, the Respira Association. The document acknowledges the significant impact of pressurized metered-dose inhalers on greenhouse gas emissions and highlights the need to transition to more sustainable alternatives. The carbon footprint of pressurized metered-dose inhalers and dry powder inhalers in Portugal was calculated, and the level of awareness among prescribing physicians on this topic was also estimated. Finally, recommendations were developed to accelerate the reduction
of the ecological footprint of inhalers.info:eu-repo/semantics/publishedVersio
Multidisciplinary Approaches and Molecular Diagnostics in New-Onset Refractory Status Epilepticus and Nontuberculous Mycobacterial CNS Infections in the ICU: A Case Report.
No full textThe diagnosis and management of complex neurological conditions such as New-Onset Refractory Status Epilepticus (NORSE) and central nervous system (CNS) infections caused by non-tuberculous mycobacteria (NTM) pose substantial difficulties in intensive care units (ICUs). This article combines a case report and a literature review that explores the diagnostic dilemmas and therapeutic strategies for these critical conditions. We report the case of an 83-year-old female with chronic granulomatous meningitis secondary to NTM, presenting a challenging diagnostic and complex management complexity typical of such a rare disease through a period time of five years. Her case emphasized the importance of a multidisciplinary approach in such cases, as the interplay between neurology and intensive care was vital. The need for new molecular diagnostic technologies is shown to be of high significance in identifying the causative pathogens and improving patient outcomes in these rare but critical conditions
Organ Crosstalk and Dysfunction in Sepsis.
No full textSepsis is a dysregulated immune response to an infection that leads to organ dysfunction. Sepsis-associated organ dysfunction involves multiple inflammatory mechanisms and complex metabolic reprogramming of cellular function. These mechanisms cooperate through multiple organs and systems according to a complex set of long-distance communications mediated by cellular pathways, solutes, and neurohormonal actions. In sepsis, the concept of organ crosstalk involves the dysregulation of one system, which triggers compensatory mechanisms in other systems that can induce further damage. Despite the abundance of studies published on organ crosstalk in the last decade, there is a need to formulate a more comprehensive framework involving all organs to create a more detailed picture of sepsis. In this paper, we review the literature published on organ crosstalk in the last 10 years and explore how these relationships affect the progression of organ failure in patients with septic shock. We explored these relationships in terms of the heart-kidney-lung, gut-microbiome-liver-brain, and adipose tissue-muscle-bone crosstalk in sepsis patients. A deep connection exists among these organs based on crosstalk. We also review how multiple therapeutic interventions administered in intensive care units, such as mechanical ventilation, antibiotics, anesthesia, nutrition, and proton pump inhibitors, affect these systems and must be carefully considered when managing septic patients. The progression to multiple organ dysfunction syndrome in sepsis patients is still one of the most frequent causes of death in critically ill patients. A better understanding and monitoring of the mechanics of organ crosstalk will enable the anticipation of organ damage and the development of individualized therapeutic strategies