4940 research outputs found
Sort by
Under-Five Mortality and Associated Risk Factors in Children Hospitalized at David Bernardino Pediatric Hospital (DBPH), Angola: A Hierarchical Approach.
No full textReducing under-five mortality is a crucial indicator of overall development in a country. However, in Angola, understanding the factors contributing to hospital deaths in this vulnerable demographic remains incomplete despite improvements in healthcare infrastructure and public health policies. With one of the highest under-five mortality rates in sub-Saharan Africa, Angola faces significant challenges such as malaria, malnutrition, pneumonia, neonatal conditions, and intestinal infectious diseases, which are the leading causes of death among children. This study aimed to identify factors associated with hospital deaths among children aged 28 days to five years admitted to DBPH in Luanda between May 2022 and June 2023. Using a hospital-based case-control design, the study included 1020 children, among whom 340 experienced hospital deaths. Distal and intermediate determinants emerged as primary predictors of hospital mortality, showing significant associations with: mother without schooling (OR [95%CI] 4.3 [1.2-15.7], < 0.027); frequent alcohol consumption during pregnancy (OR [95%CI] 3.8 [2.5-5.9], < 0.001); hospital stay ≤24 h (OR [95%CI] 13.8 [6.2-30.8], < 0.001); poor nutritional status (OR [95%CI] 2.1 [1.4-3.2], < 0.001); short interbirth interval (OR [95%CI] 1.7 [1.1-2.5], < 0.014); maternal age ≤19 years (OR [95%CI] 5.6 [3.0-10.8], < 0.001); and maternal age ≥35 years (OR [95%CI] 2.1 [1.2-3.7], < 0.006). These findings highlight the preventable nature of most under-five hospital deaths and underscore the urgent need to address social inequities and improve the quality of primary healthcare services to effectively reduce child mortality in Angola
Recommendations for the Implementation of a National Lung Cancer Screening Program in Portugal- A Consensus Statement
No full textLung cancer (LC) is a leading cause of cancer-related mortality worldwide. Lung Cancer Screening (LCS) programs that use low-dose computed tomography (LDCT) have been shown to reduce LC mortality by up to 25 % and are considered cost-effective. The European Health Union has encouraged its Member States to explore the feasibility of LCS implementation in their respective countries. The task force conducted a comprehensive literature review and engaged in extensive discussions to provide recommendations. These recommendations encompass the essential components required to initiate pilot LCS programs following the guidelines established by the World Health Organization. They were tailored to align with the specific context of the Portuguese healthcare system. The document addresses critical aspects, including the eligible population, methods for issuing invitations, radiological prerequisites, procedures for reporting results, referral processes, diagnostic strategies, program implementation, and ongoing monitoring. Furthermore, the task force emphasized that pairing LCS with evidence-based smoking cessation should be the standard of care for a high-quality screening program. This document also identifies areas for further research. These recommendations aim to guarantee that the implementation of a Portuguese LCS program ensures high-quality standards, consistency, and uniformity across centres
Multiresistant Kawasaki Disease in a Young Infant with Giant Aneurysms Growing Fast.
No full textBackground: Kawasaki disease (KD) is a type of vasculitis in which giant coronary artery aneurysms (CAAs) can occur. There are no specific guidelines for managing giant CAAs that develop quickly and are at risk of rupture. Regarding cardiovascular drugs, only beta-blockers are formally recommended in the acute phase of KD.
Case presentation: A 6-month-old male patient with multiresistant Kawasaki disease and giant CAAs that continued to enlarge after controlling systemic inflammation was examined. The patient required three doses of intravenous immunoglobulin, methylprednisolone pulses, and anakinra and infliximab to normalize systemic inflammation. Due to the rapid increment of aneurysms' dimensions and the risk of rupture, we introduced anticoagulant therapy and propranolol plus captopril, and titration doses were introduced according to a tolerated decrease in heart rate and arterial pressure. CAAs increment stabilized and slowly reduced their dimensions.
Conclusions: The authors describe an atypical case of multiresistant KD with giant rapidly increasing CAAs even after controlling systemic inflammation. The introduction of a beta-blocker and an angiotensin-converting enzyme (ACE) inhibitor was demonstrated to be useful for stabilizing giant CAAs growth and reducing the potential risk of rupture
Acute Symptomatic Seizures in Patients with Recurrent Ischemic Stroke: A Multicentric Study.
No full textObjective: Epileptic seizures occur frequently after stroke due to changes in brain function and structure, and up to around 10% of stroke patients experience stroke recurrence in the first year. We aimed to establish the risk of acute symptomatic seizures in patients with recurrent stroke.
Methods: Retrospective cohort study including consecutive admissions to a Stroke Unit due to acute ischemic stroke, during a 5-year period. Additional inclusion of patients admitted to two centers in different countries to corroborate findings (confirmatory cohort). We aimed to compare acute symptomatic seizure incidence in patients with and without previous stroke. Patients with history of epilepsy were excluded. Logistic regression modeling was performed to identify predictors in middle cerebral artery (MCA) stroke.
Results: We included 1473 patients (1085 with MCA stroke), of which 117 had a recurrent ischemic stroke (84 with MCA stroke). Patients with recurrent stroke had a seizure risk during hospital stay similar to that of patients with a first-ever stroke (5.1% vs. 4.5%, OR 1.15, 95% CI .48-2.71, p = .75). Risk of acute symptomatic seizures was also similar (5.0% vs. 4.1, OR 1.22, 95% CI .29-5.27, p = .78). Older age, female sex, and hemorrhagic transformation were predictors of seizures in patients with a first MCA ischemic stroke, but not in recurrent stroke patients. Electrographic characteristics were similar between the two groups in patients who had an electroencephalogram (46 with first stroke, 5 with recurrent stroke). The low rate of seizures (1.5%) in the confirmatory cohort (n = 198) precluded full comparison with the initial cohort. Nevertheless, the rate of seizures was not higher in stroke recurrence.
Significance: History of previous stroke was not associated with an increased risk of acute symptomatic seizures during hospital stay. Larger, prospective studies, with prospective electrophysiological evaluation, are needed to explore the impact of stroke recurrence on seizure risk
Real-World Outcomes of Macular Buckling Surgery for Myopic Traction Maculopathy: A Decade of Clinical Experience
No full textINTRODUÇÃO: A maculopatia de tração miópica (MTM) é frequentemente um desafio terapêutico. Enquanto a vitrectomia pars plana (VPP) continua a ser o gold standard, o macular buckling (MB) - projetado para contrapor a tração do estafiloma - oferece uma alternativa promissora. O objetivo deste estudo é avaliar os resultados funcionais e estruturais do MB no tratamento da MTM.
MÉTODOS: Foi realizada uma revisão de doentes operados entre 2012 e 2023. Os resultados analisados incluem sucesso anatómico, melhor acuidade visual corrigida (MAVC) em escala decimal, comprimento axial (CA) e complicações cirúrgicas.
RESULTADOS: Dos 200 casos analisados, 75% eram mulheres e 52% de olhos direitos. Segundo o sistema de estadiamento da MTM, os estágios retinianos foram: Estágio 1 em 9,5%, Estágio 2 em 29%, Estágio 3 em 32%, e Estágio 4 em 24,5% dos olhos. Em relação aos estágios foveais, 44,5% estavam no estágio a, 33% no estágio b e 22,5% no estágio c, com 43,5% exibindo alterações epirretinianas. Sessenta e nove por cento dos olhos realizaram MB, enquanto 31% foram combinados com PPV. A MAVC aumentou 0,21 dioptrias entre o pré-operatório e 1 ano após a cirurgia (n=64, p=0,001). Comparando a MAVC 1 ano pós-cirurgia com a última consulta (n=56), diferença foi de -0,01, p=0,593. A acuidade visual melhorou em 76,6% dos olhos, permaneceu estável em 13,6% e diminuiu em 9,7%. As avaliações anatómicas revelaram o seguinte para a fóvea: 80,9% de resolução, 9,9% de melhoria, 8,0% sem alteração e 1,2% de deterioração. Para a retina, existiu 89,5% de resolução, 9,3% de melhoria e 1,8% sem alteração. O CA mostrou redução de 31,18 mm no pré-operatório para 29,78 mm pós-operatório (p <0,001). Nove ponto cinco por cento dos olhos necessitaram de revisão cirúrgica e 10% requereram PPV adicional. O MB foi removido em 7,4% dos pacientes. Foi observada progressão da atrofia em 41,3% dos olhos operados e em 51,1% dos contralaterais. A reaplicação macular foi alcançada em 100%. O encerramento do buraco macular foi alcançado em 92,9% dos casos com uma única intervenção.
CONCLUSÃO: O macular buckling destaca-se como uma técnica eficaz e segura para o tratamento da MTM em olhos altos míopes.INTRODUCTION: Myopic traction maculopathy (MTM) often presents as a therapeutic challenge. While pars plana vitrectomy (PPV) remains the mainstay treatment, macular buckling (MB) offers a promising alternative designed to counter the tractional force of the staphyloma. This study aims to evaluate the functional and structural outcomes of MB in treating MTM.
METHODS: A retrospective review was conducted on patients who underwent MB surgery between 2012 and 2023. Outcomes analyzed include anatomical success rates, best-corrected visual acuity (BCVA) expressed in decimal notation, axial length (AL), and surgical complications.
RESULTS: Of the 200 clinical files analyzed, 75% were female patients and 52% right eyes. According to the MTM staging system, retinal stages were stage 1 in 9.5%, stage 2 in 29%, stage 3 in 32%, and stage 4 in 24.5% of eyes. For the foveal stages, 44.5% of eyes were in stage a, 33% in stage b, and 22.5% in stage c, with 43.5% presenting epiretinal changes. Sixty nine percent underwent MB alone, while 31% had a combined procedure with PPV. There was a significant BCVA improvement of 0.21 diopters from preoperative to 1-year postoperative (n=64, p=0.001). When comparing the 1-year postoperative BCVA to the last appointment (n=56), the difference was only -0.01, with a mean follow-up of 41 months (p=0.593). BCVA improved in 76.6% of eyes, remained stable in 13.6%, and decreased in 9.7%. Anatomical assessments revealed the following for the fovea: 80.9% resolution, 9.9% improvement, and 8.0% no change and 1.2% deterioration. For the retina, there was 89.5% resolution, 9.3% improvement and 1.8% no change. The AL decreased from 31.18 mm preoperative to 29.78 mm postoperative (p <0.001). Postoperatively, 9.5% of eyes
required surgery revision and 10% of the eyes required a further PPV. MB was removed in 7.4% (n=14) of patients. Atrophy progression was seen in 41.3% of operated eyes and in 51.1% of the fellow eyes. Regarding retinal stage 3 and 4 (n=122), macular reattachment was achieved in 100%. Macular hole closure was achieved in 92.9% of the cases with one intervention.
CONCLUSION: MB stands out as an effective and safe technique for MTM treatment inhighly myopic eyes
Cold Agglutinin Syndrome and Hemophagocytic Lymphohistiocytosis: An Unusual Combination Caused by Epstein-Barr Virus Infection.
No full textAutoimmune hemolytic anemia (AIHA) and hemophagocytic lymphohistiocytosis (HLH) are rare complications of infectious mononucleosis. The authors describe a 12-year-old male with acute infectious mononucleosis, hepatitis, cholestasis, and an autoimmune hemolytic disorder caused by cold agglutinins IgM (anti-i specificity). Clinical deterioration with persistent fever, anemia, and hepatosplenomegaly was consistent with cold AIHA plus concomitant HLH. The patient was treated with corticosteroids and acyclovir, with an uneventful recovery. Although rare, cold agglutinin syndrome and HLH can complicate infectious mononucleosis and should be considered in a patient with clinical deterioration. Corticosteroids are the mainstay treatment of HLH and may be beneficial in infection-associated cold agglutinin syndrome
Modern Management of Cardiometabolic Continuum: From Overweight/Obesity to Prediabetes/Type 2 Diabetes Mellitus. Recommendations from the Eastern and Southern Europe Diabetes and Obesity Expert Group.
No full textThe increasing global incidence of obesity and type 2 diabetes mellitus (T2D) underscores the urgency of addressing these interconnected health challenges. Obesity enhances genetic and environmental influences on T2D, being not only a primary risk factor but also exacerbating its severity. The complex mechanisms linking obesity and T2D involve adiposity-driven changes in β-cell function, adipose tissue functioning, and multi-organ insulin resistance (IR). Early detection and tailored treatment of T2D and obesity are crucial to mitigate future complications. Moreover, personalized and early intensified therapy considering the presence of comorbidities can delay disease progression and diminish the risk of cardiorenal complications. Employing combination therapies and embracing a disease-modifying strategy are paramount. Clinical trials provide evidence confirming the efficacy and safety of glucagon-like peptide 1 receptor agonists (GLP-1 RAs). Their use is associated with substantial and durable body weight reduction, exceeding 15%, and improved glucose control which further translate into T2D prevention, possible disease remission, and improvement of cardiometabolic risk factors and associated complications. Therefore, on the basis of clinical experience and current evidence, the Eastern and Southern Europe Diabetes and Obesity Expert Group recommends a personalized, polymodal approach (comprising GLP-1 RAs) tailored to individual patient's disease phenotype to optimize diabetes and obesity therapy. We also expect that the increasing availability of dual GLP-1/glucose-dependent insulinotropic polypeptide (GIP) agonists will significantly contribute to the modern management of the cardiometabolic continuum
Meningovasculite Infeciosa Secundária a uma Fístula Reto-Tecal num Doente com Doença de Crohn
No full textEvoluindo na Cardiologia Desportiva: Direções para um Futuro Melhor
No full textinfo:eu-repo/semantics/publishedVersio
OPTImized Coronary Interventions EXplaIn the BEst CliNical OutcomEs (OPTI-XIENCE) Study. Rationale and Study Design
No full textIntroduction: Clinical events may occur after percutaneous coronary intervention (PCI), particularly in complex lesions and complex patients. The optimization of PCI result, using pressure guidewire and intracoronary imaging techniques, may reduce the risk of these events. The hypothesis of the present study is that the clinical outcome of patients with indication of PCI and coronary stent implantation that are at high risk of events can be improved with an unrestricted use of intracoronary tools that allow PCI optimization.
Methods and analysis: Observational prospective multicenter international study, with a follow-up of 12 months, including 1064 patients treated with a cobalt‑chromium everolimus-eluting stent. Inclusion criteria include any of the following: Lesion length > 28 mm; Reference vessel diameter 4.25 mm; Chronic total occlusion; Bifurcation with side branch ≥2.0 mm;Ostial lesion; Left main lesion; In-stent restenosis; >2 lesions stented in the same vessel; Treatment of >2 vessels; Acute myocardial infarction; Renal insufficiency; Left ventricular ejection fraction <30 %; Staged procedure. The control group will be comprised by a similar number of matched patients included in the "extended risk" cohort of the XIENCE V USA study. The primary endpoint will be the 1-year rate of target lesion failure (TLF) (composite of ischemia-driven TLR, myocardial infarction (MI) related to the target vessel, or cardiac death related to the target vessel). Secondary endpoints will include overall mortality, cardiovascular mortality, acute myocardial infarction, TVR, TLR, target vessel failure, and definitive or probable stent thrombosis at 1 year.
Implications: The ongoing OPTI-XIENCE study will contribute to the growing evidence supporting the use of intra-coronary imaging techniques for stent optimization in patients with complex coronary lesions.info:eu-repo/semantics/publishedVersio