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Sodium Bicarbonate In In-Hospital and Out-of-Hospital Cardiac Arrest: A Systematic Literature Review.
No full textCardiac arrest is a common cause of death worldwide. Sodium bicarbonate (SB) has commonly been used during cardiopulmonary resuscitation (CPR) to correct metabolic acidosis (MA). However, the existence of evidence about its administration remains controversial. This systematic review aimed to summarize the effectiveness of SB in patients with in-hospital and out-of-hospital cardiac arrest. We searched Medline, Scopus, and the Cochrane Central Register of Controlled Trials (CENTRAL) for studies that used SB in cardiac arrest, from November 1962 until December 2023. A total of 372 records were identified and 12 studies were included. Despite few studies suggesting that SB may improve outcomes in prolonged CPR, the overall data revealed that SB was associated with lower rates of ROSC and outcomes. This review conceded that there is limited evidence to warrant the use of SB during CPR other than under specific conditions, which include hyperkalemic cardiac arrest, severe cardiotoxicity, or overdose due to tricyclic antidepressants. In conclusion, SB is not recommended for conventional use in patients with cardiac arrest. Further studies should be performed to determine whether it has any benefit in these scenarios
Tuberculous Meningitis: an Endemic Cause of Intracranial Hypertension
No full textTuberculous meningitis (TBM) presents a complex clinical scenario, often marked by delayed recognition and high mortality. Our case involves a 27-year-old woman from Nepal with no significant medical history, presented with a two-week history of fatigue, altered consciousness, dizziness, vomiting, fever, holocranial headache, and photophobia. Initial examination revealed signs consistent with meningitis, including fever, hypertensive state, prostration, bilateral exophthalmos, sixth cranial nerve paresis, and positive Kernig/Brudzinski signs. Cerebrospinal fluid (CSF) exhibited characteristics typical of TBM: turbidity, lymphocytic-predominant pleocytosis, low glucose, and elevated protein. The patient was promptly started on meningeal doses of vancomycin, ceftriaxone, and acyclovir. However, persistent fever, neurological deterioration, and signs of increased intracranial pressure led to the decision to initiate conventional empiric treatment of tuberculosis (TB) with isoniazid, rifampicin, pyrazinamide, and ethambutol (HRZE) and dexamethasone 1 week before cultural positivity for Mycobacterium tuberculosis of CSF. The case underscores the importance of considering TBM in patients from endemic regions, interpreting CSF findings, and initiating empirical treatment in critical scenarios, contributing to a positive patient outcome despite the diagnostic challenges.info:eu-repo/semantics/publishedVersio
Projeto Investigação-Ação da Pessoa com Insuficiência Cardíaca: Fase I - Diagnóstico de Grupo
No full textIntrodução: A insuficiência cardíaca (IC) é uma síndrome caracterizada por sintomas (dispneia, fadiga) e sinais típicos (pressão venosa jugular aumentada, sons pulmonares, edema), com impacto na qualidade de vida (McDonagh et al., 2021).
Objetivo: capacitar a pessoa para a gestão da IC.
Material e métodos: o Projeto, com parecer da Comissão de Ética, tem como critérios de inclusão: internamento por IC, idade superior a 21 anos, nacionalidade portuguesa e cognição mantida. Usada Metodologia de Planeamento em Saúde: Fase I (Diagnóstico de grupo); Fase II (plano educacional/reabilitação) e Fase III (avaliação). No diagnóstico de situação, aplicado o Kansas City Cardiomyopathy Questionnaire (KCCQ) – versão portuguesa e a Escala Europeia de Autocuidado (EEAc) na IC, na admissão e 1 mês pós-alta (Fernanda Ávila da Costa Pereira, 2013) (Nave-Leal et al., 2009). Aplicada a escala de Barthel e Medical Research Council e a prova marcha de 6 minutos (PM6M), na admissão e alta. Dados analisados no Excel Office®
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Resultados: Procedeu-se à analise dos resultados, numa amostra constituída por 7 pessoas (n=7). Constatou-se pela escala de Barthel uma melhoria na realização das atividades de vida diária (AVD), bem como na força muscular. Na alta, a PM6M melhorou, mas a distância mantém-se inferior a 300metros. Da aplicação inicial da EEAc, concluiu-se que: 7 pessoas tomam a medicação (como prescrita), 7 referiram fazer uma pausa durante o dia, 7 referiram abrandar o ritmo na presença de dispneia, 6 referiram que fazem uma dieta hipossalina, 6 limitam a quantidade de ingestão hídrica, 6 sustentaram que sabem contactar um profissional se agudizarem, 5 tomam anualmente a vacina e 5 pesam-se diariamente. Após a alta, questões relacionadas com a dieta hipossalina, limitação da ingestão hídrica, peso diário e o contato com o profissional evidenciaram maior concordância. Ao KCCQ, 5 referiram que têm “mais ou menos certeza do que fazer”, se agudizarem, 4 referiram que a IC os tem limitado “moderadamente”, no que mais gostam de fazer e 3 referiram que “melhoraram muito”.
Conclusões: Verificou-se uma melhoria na realização das AVD, ao longo do internamento. Destaca-se a necessidade de desenvolver o conhecimento e a capacidade da pessoa na gestão da IC.info:eu-repo/semantics/publishedVersio
Vestibulo-Ocular Reflex Dynamics with Head-Impulses Discriminates Usher Patients Type 1 and 2
No full textUsher Syndrome classification takes into account the absence of vestibular function but its correlation with genotype is not well characterized. We intend to investigate whether video Head Impulse Test (vHIT) is useful in screening and to differentiate Usher Syndrome types. 29 Usher patients (USH) with a genetically confirmed diagnosis and 30 healthy controls were studied with vHIT and dizziness handicap inventory questionnaire (DHI). Statistical significant differences between USH1, USH2 and controls were found in the vestibulo-ocular-reflex (VOR) gain of all SCCs, with USH1 patients consistently presenting smaller gains. VOR gain of the right lateral SCC could discriminate controls from USH1, and USH2 from USH1 with an overall diagnostic accuracy of 90%. USH1 DHI correlated with VOR (ρ = - 0,971, p = 0.001). Occurrence rate of covert and overt lateral semicircular canals refixation saccades (RS) was significantly different between groups, being higher in USH1 patients (p < 0.001). USH1 peak velocity of covert and overt saccades was higher for lateral semicircular canals (p < 0.05 and p = 0.001) compared with USH2 and controls. Covert saccades occurrence rate for horizontal SCCs could discriminate USH1 from USH2 patients and controls with a diagnostic accuracy of 85%. vHIT is a fast and non-invasive instrument which allowed us to screen and distinguish Usher patients from controls with a high precision. Importantly, its use allowed further discrimination between USH1 from USH2 groups. Moreover, VOR gain seems to correlate with vertigo-related quality of life in more severe phenotypes.info:eu-repo/semantics/publishedVersio
What Every Intensivist Should Know About ... Ammonia in Liver Failure.
No full textPurpose: Acute liver failure (ALF) or acute-on-chronic liver failure (ACLF) patients have high short-term mortality and morbidity. In the context of liver failure, increased serum ammonia is associated with worse neurological outcomes, including high-grade hepatic encephalopathy (HE), cerebral edema, and intracranial hypertension. Besides its neurotoxicity, hyperammonemia may contribute to immune dysfunction and the risk of infection, a frequent trigger for multi-organ failure in these patients.
Material and methods: We performed a literature-based narrative review. Publications available in PubMed® up to June 2023 were considered.
Results: In the ICU management of liver failure patients, serum ammonia may play an important role. Accordingly, in this review, we focus on recent insights about ammonia metabolism, serum ammonia measurement strategies, hyperammonemia prognostic value, and ammonia-targeted therapeutic strategies.
Conclusions: Serum ammonia may have prognostic value in liver failure. Effective ammonia targeted therapeutic strategies are available, such as laxatives, rifaximin, L-ornithine-l-aspartate, and continuous renal replacement therapy
Genetic Testing of Patients with Inherited Retinal Diseases in the European Countries: An International Survey by the European Vision Institute.
No full textIntroduction: The purpose of this project was to explore the current standards of clinical care genetic testing and counseling for patients with inherited retinal diseases (IRDs) from the perspective of leading experts in selected European countries. Also, to gather opinions on current bottlenecks and future solutions to improve patient care.
Methods: On the initiative of the European Vision Institute, a survey questionnaire with 41 questions was designed and sent to experts in the field from ten European countries. Each participant was asked to answer with reference to the situation in their own country.
Results: Sixteen questionnaires were collected by November 2023. IRD genetic tests are performed in clinical care settings for 80% or more of tested patients in 9 countries, and the costs of genetic tests in clinical care are covered by the public health service to the extent of 90% or more in 8 countries. The median proportion of patients who are genetically tested, the median rate of genetically solved patients among those who are tested, and the median proportion of patients receiving counseling are 51-70%, 61-80%, and 61-80%, respectively. Improving the education of healthcare professionals who facilitate patient referrals to specialized centers, improving access of patients to more thorough genotyping, and increasing the number of available counselors were the most advocated solutions.
Conclusion: There is a significant proportion of IRD patients who are not genetically tested, whose genetic testing is inconclusive, or who do not receive counseling. Educational programs, greater availability of state-of-the-art genotyping and genetic counselors could improve healthcare for IRD patients
Knowledge About Basic Life Support Among University Students.
No full textBackground: Basic life support (BLS) is an essential skill set for responding to emergencies like cardiac arrest. However, the level of preparedness and interest in BLS among university students remains underexplored, especially in nonmedical populations.
Methods: This study surveyed 427 University of Beira Interior (UBI) students to assess their knowledge, confidence, and interest in BLS training. A cross-sectional questionnaire was used to gather data on previous BLS exposure, perceived competence, and preferences for further training.
Results: This study focused on a sample of 427 students from the UBI, where 246 (57.6%) had BLS training (group A), predominantly from health-related courses, while 181 (42.4%) had no such training (group B), primarily from non-health-related courses. The study revealed that students with BLS training had significantly higher confidence and preparedness in recognizing and responding to emergencies, such as performing cardiopulmonary resuscitation and using defibrillators, compared to those without training. Despite the overall interest in BLS training, particularly through practical sessions, there remains a disparity in access to such education, particularly among students in non-health-related fields. The findings highlight the need for integrating BLS training into the curriculum, potentially starting at the secondary education level, to ensure widespread competence in life- saving skills across the population.
Conclusions: The study highlights the critical need for integrating BLS training into earlier stages of education to improve preparedness across the population. The findings suggest that widespread, practical, and accessible BLS training could significantly enhance emergency response outcomes
Dupilumab in Patients with Atopic Dermatitis: A Multicentric, Long-Term, Real-World Portuguese Study.
No full textIntroduction: Several clinical trials have established the efficacy and safety of dupilumab for treating atopic dermatitis (AD). However, literature remains scarce in reporting the long-term effectiveness, safety, and drug survival of dupilumab in real-world settings. This study aimed to describe the latter outcomes of dupilumab in patients with AD.
Methods: This Portuguese, multicentric, observational, retrospective study included consecutive adult patients with AD who initiated dupilumab between January 2019 and September 2023, with a follow-up period up to 30 months. Drug discontinuation and adverse effects data were used to estimate drug survival. Clinical assessments included the Eczema Area and Severity Index (EASI), pruritus numerical rating scale (NRS), and Dermatology Life Quality Index (DLQI).
Results: A total of 312 patients were included in the study, with 56.4% being male (median age of 30 years, range 18-83). The 30-month drug survival rate was 82.0%. During the study period, 12.5% of the sample (n = 39 patients) discontinued treatment: 7.3% due to treatment failure, 2.9% due to safety concerns, 1.3% due to complete disease control, 0.6% due to pregnancy, and 0.3% due to lack of compliance. Adverse events not leading to drug discontinuation were noted in 25.6% of the sample (n = 80). Conjunctivitis was the most frequently reported adverse event (17%), followed by facial erythema (9%). At 30 months, the mean EASI decreased significantly from 27.30 ± 11.89 at baseline to 2.92 ± 3.96 (p < 0.001), reflecting an overall improvement of 89.3%. Similarly, pruritus NRS decreased from 7.36 ± 1.90 at baseline to 1.74 ± 2.16 at month 30 (p < 0.001), improving by 76.4%, and mean DLQI changed from 18.0 ± 7.09 at baseline to 2.67 ± 3.95 at month 30 (p < 0.001), decreasing by 85.2%.
Conclusions: This study increases our current understanding of dupilumab in real-world settings, demonstrating its long-term effectiveness and safety in treating AD
Licença Parental: Estado de Arte e Relevância para a Saúde da Família
No full textO direito à conciliação entre a vida profissional e familiar constitui uma das principais preocupações no desenvolvimento de políticas públicas de saúde a nível mundial, sendo a licença parental um direito dos pais na maioria dos países da União Europeia. O usufruto da licença permite a vivência da parentalidade e garante a prestação de cuidados à criança, com proteção laboral assegurada. Alguns países, como é o caso de Portugal, garantem a remuneração da licença parental. A investigação mais
recente relaciona diretamente a licença parental com consequências no bem-estar das famílias. Este artigo aborda a influência da licença da parentalidade em três dimensões: saúde do casal, amamentação e saúde da criança. Pretende-se conhecer a literatura mais recente relativa a esta temática, bem como explorar as suas lacunas existentes, que deverão constituir alvos de estudo no futuro
Cognitive Dysfunction in Chronic Kidney Disease Patients: Time to Prevent
No full textMild cognitive impairment (MCI) is a neurocognitive deterioration of at least one of the following six cognitive domains
in humans: complex attention, executive function, learning and memory, language, perceptual‑motor, and social cogni‑
tion. Patients with chronic kidney disease are at an increased risk of developing this disorder, with serious implications
for the patient, family, and society. In this article, we aim to increase awareness of the disorder and summarize the
existing evidence on the topic