4940 research outputs found
Sort by
Case Report: Fourth Branchial Cleft Cyst: A Case of Acute Suppurative Thyroiditis
No full textThis case report presents a 4 year-old-female patient with a neck mass who was diagnosed with an infected fourth branchial cleft cyst with left thyroid lobe involvement through fistulation. The case emphasizes the importance of considering uncommon etiologies, such as congenital anomalies, as a differential diagnosis when evaluating pediatric neck masses. The patient was prescribed broad-spectrum antibiotics, which led to the regression of the mass and inflammatory signs. Close follow-up in endocrinology and otorhinolaryngology appointments was maintained, and after 7 months, hypoplasia of the left lobe was observed. Thyroid function was reevaluated, and after two years, no recurrences were noted. The case highlights the significance of a comprehensive examination and assessment of corresponding clinical features, which can significantly reduce the rate of misdiagnoses and achieve an individualized diagnosis.info:eu-repo/semantics/publishedVersio
Prevalence and Factors Related to Anaemia in Children Aged 6–59 Months Attending a Quaternary Health Facility in Maputo, Mozambique
No full textGlobally, anaemia prevails as a public health issue, being also a concern in Mozambique, where about two-thirds of children 6-59 months of age are affected by this condition. We carried out this study to estimate anaemia prevalence and evaluate structural determinants and haematological parameters association among children aged 6-59 months attending pediatric inpatient and outpatient services in a Quaternary Health Facility in Maputo City Province, Mozambique. We collected data from 637 inpatients or outpatients who attended pediatric consultations at the Maputo Central Hospital. The overall rate of anaemia in children aged 6-59 months was 62.2% (396/637), with 30.9% moderate anaemia (197/637), 23.9% mild anaemia (152/637), and 7.4% severe anaemia (47/637). Among our study participants, critical factors for anaemia were those concerning the age group, child´s caregiver schooling, malaria and size of the liver.info:eu-repo/semantics/publishedVersio
Laringoscopia Contínua Durante o Exercício: Proposta de um Protocolo Clínico com Base em Revisão Bibliográfica
No full textObjetivos - Estabelecimento de um protocolo de Laringoscopia Contínua durante o Exercício (LCE).
Desenho do Estudo – Revisão Bibliográfca Sistemática.
Material e Métodos - Revisão bibliográfca nas bases de dados MEDLINE, Cochrane Central Register of Controlled Trials and Cumulative Index to Nursing and Allied Health Literature, baseada no modelo PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), entre 2001 e 2021. Os estudos incluídos na revisão bibliográfica analisaram protocolos de LCE tanto em idade pediátrica como em adultos e foram escritos em língua inglesa ou portuguesa. Foram excluídos os artigos que apenas discutiram a Obstrução Laríngea Induzida pelo Exercício, mas não o protocolo de LCE e os artigos cujo objetivo de estudo não foi o de investigar os resultados do protocolo de LCE. A partir dos resultados obtidos, foi elaborado um protocolo clínico para o Centro Hospitalar Universitário Lisboa Central e testado num grupo de 10 voluntários sadios.
Resultados – A pesquisa produziu um total de 679 artigos, sendo que após aplicação dos critérios de inclusão e exclusão foram selecionados 21 estudos. Nesses houve um total de 1026 doentes analisados, com um rácio masculino: feminino de 1:1.7. A idade média à realização da LCE variou de 9 a 45 anos. O método de exercício preferencial nos protocolos estudados foi a passadeira de corrida (n = 17; 81%), seguida da bicicleta estática (n = 4, 19%) e da máquina de remo (n = 1; 4.8%). O protocolo de LCE proposto incluí um protocolo de Bruce modificado, sendo a LCE terminada quando os doentes se encontravam em exaustão ou com sintomas respiratórios limitantes. Imediatamente antes e após a LCE foi realizada uma espirometria. Os movimentos glóticos e supraglóticos foram avaliados em repouso, com esforço moderado e esforço máximo, em cada fase do ciclo respiratório.
Conclusões - A partir dos dados de uma revisão bibliográfica, foi desenvolvido um protocolo para a realização de LCE, demonstrando viabilidade e adequação à realidade de uma instituição portuguesa quando testado em voluntários sadios. São necessários novos estudos com pacientes doentes para validar esses resultadosinfo:eu-repo/semantics/publishedVersio
Outcomes of Patients Aged ≥80 Years with Respiratory Failure Initially Treated with Non-Invasive Ventilation in European Intensive Care Units Before and During COVID-19 Pandemic.
No full textBackground: Non-invasive ventilation (NIV) has been commonly used to treat acute respiratory failure due to COVID-19. In this study we aimed to compare outcomes of older critically ill patients treated with NIV before and during the COVID-19 pandemic.
Methods: We analysed a merged cohort of older adults admitted to intensive care units (ICUs) due to respiratory failure. Patients were enrolled into one of two prospective observational studies: before COVID-19 (VIP2-2018 to 2019) and admitted due to COVID-19 (COVIP-March 2020 to January 2023). The outcomes included: 30-day mortality, intubation rate and NIV failure (death or intubation within 30 days).
Results: The final cohort included 1986 patients (1292 from VIP2, 694 from COVIP) with a median age of 83 years. NIV was used as a primary mode of respiratory support in 697 participants (35.1%). ICU admission due to COVID-19 was associated with an increased 30-day mortality (65.5% vs. 36.5%, HR 2.18, 95% CI 1.71 to 2.77), more frequent intubation (36.9% vs. 17.5%, OR 2.63, 95% CI 1.74 to 3.99) and NIV failure (76.2% vs. 45.3%, OR 4.21, 95% CI 2.84 to 6.34) compared to non-COVID causes of respiratory failure. Sensitivity analysis after exclusion of patients in whom life supporting treatment limitation was introduced during primary NIV confirmed higher 30-day mortality in patients with COVID-19 (52.5% vs. 23.4%, HR 2.64, 95% CI 1.83 to 3.80).
Conclusion: The outcomes of patients aged ≥80 years treated with NIV during COVID-19 pandemic were worse compared then those treated with NIV in the pre-pandemic era
Cognitive Disorders in Patients with Chronic Kidney Disease: Approaches to Prevention and Treatment
No full textBackground: Cognitive impairment is common in patients with chronic kidney disease (CKD), and early intervention may prevent the progression of this condition.
Methods: Here, we review interventions for the complications of CKD (anemia, secondary hyperparathyroidism, metabolic acidosis, harmful effects of dialysis, the accumulation of uremic toxins) and for prevention of vascular events, interventions that may potentially be protective against cognitive impairment. Furthermore, we discuss nonpharmacological and pharmacological methods to prevent cognitive impairment and/or minimize the latter's impact on CKD patients' daily lives.
Results: A particular attention on kidney function assessment is suggested during work-up for cognitive impairment. Different approaches are promising to reduce cognitive burden in patients with CKD but the availabe dedicated data are scarce.
Conclusions: There is a need for studies assessing the effect of interventions on the cognitive function of patients with CKD.info:eu-repo/semantics/publishedVersio
Personalizing Early-Stage Type 1 Diabetes in Children
No full textinfo:eu-repo/semantics/publishedVersio
Mycotic Aortic Aneurysm: a Ticking Time-Bomb!
No full textINTRODUCTION: Mycotic or primary infected aortic aneurysms comprise aproximately 1.3% of all aortic aneurysms and may be caused by septic emboli to the vasa vasorum, by haematogenous spread during bacteraemia or by direct extension of an adjacent infection leading to an infectious degeneration of the arterial wall and aneurysm formation. The objective of this report is to describe a clinical case of a complicated mycotic aortic aneurysm.
CASE REPORT: A male, 69-year-old patient, with medical background of diabetes, hypertension and a bladder
carcinoma (surgically ressected 5 years before, complicated at the time with an E.coli septicaemia), presented at the ER with generalised malaise, asthenia, anorexia, abdominal pain, diarrhea and fever, with 1 week of evolution.
At admission, clinical examination revealed poor general condition, fever (39ºC), noral blood pressure, and the
abdominal examination showed no abnormalities.
Laboratory results revealed an stable haemoglobin of 13 g/dL, leukocytosis (19850/UI) and neutrophilia (90%), an a C Reactive Protein of 350mg/dl.
A Computed Tomography Angiography (CTA) revealed a 3,5 cm saccular juxtarenal AAA, with peri and intraaortic gas, strongly suggestive of an mycotic AAA (MAA).
Hospitalization was indicated and a septic and immunologic screening was perfomed. The patient started
a broad-spectrum antibiotic with meropenem and vancomycin and clinical, laboratory and hemodynamic
surveillance. Blood and urine cultures revealed a E.Coli infection, and directed antibiotic was started.
After 10 days os hospitalization, the patient was haemodinamic stable, presented no fever or abdominal pain,
however inflammatory parameters remained elevated, and a new CTA that showed a daunting increase of 4 cm
of the AAA (7,5 cm) with signs of contained ruture.
An emergency intervention was decided and the patient underwent an thoracophrenolaparotomy and aortoaortic interposition with bovine pericardium patch. After 24h of surgery the patient died of septic shock.
CONCLUSION: MAA is a rare and threatening disease with rapid progression and high mortality. Even with
broad-spectrum antibiotic and rapid surgical response, the tragic outcome is often the unavoidable result.info:eu-repo/semantics/publishedVersio
Octopus Endograft Technique in Complex Aortic Pathologies - a Retrospective Single-Center Study
No full textINTRODUCTION: Fenestrated/branched EVAR (f/bEVAR) are associated with lower peri-operative major
complications, when compared to open repair in complex aortic pathologies. However, f/bEVAR is limited by
the waiting time for customized graft production and has specifc anatomic limitations. Alternatively, adapting
outside instructions-for-use, readily available off-the-shelf devices has been used with variable success. Among
these options is the Octopus technique, which consists of parallel stent grafts originating inside a larger external stent graft. Despite being an off-label combination of devices, it can play a role when f/bEVAR is unavailable or inapplicable.
METHODS: Single center retrospective study, including all consecutive patients treated with the Octopus
technique. Baseline characteristics, peri-procedural and follow-up data was obtained. Primary endpoint is clinical success. Secondary endpoints are complications and secondary interventions in follow-up.
RESULTS: Between 2015 and February 2022, six patients with a mean of 74±9 years were identifed. Treatment indications included three type 1A endoleaks and 3 thoracoabdominal aortic aneurysms (TAAA) without prior intervention, one of which was mycotic. Four procedures were elective and the remaining two emergent. In the elective cases, the Octopus technique was chosen due to anatomical constraints and because waiting time for customization was considered excessive. Excluder and Incraft endografts were used in 5 and 1 cases, respectively. Thirteen visceral branches were revascularized (6 superior mesenteric, 4 renal and 3 celiac arteries). Gutter endoleaks were observed in 2 patients. Mean blood loss, surgery and hospitalization duration was 483 (300) mL, 288 (73) minutes and 26 (19.5) days. One perioperative death occurred, in a patient treated in the context of post EVAR rupture due to type 1A endoleak. The most frequent postoperative complications were temporary acute renal failure (2/6), paraplegia (2/6) of which one was completely resolved, and non-graft related infection (2/6). One early reintervention, consisting of branch relining due to kinking and gutter embolization was necessary. On follow-up, there were no new endoleaks or endoleak-related interventions. Four patients died within two years, one with an aneurysm-related complication (spondylodiscitis in the context of a mycotic TAAA). The remaining deaths were not aneurysm related.
CONCLUSION: The Octopus technique may offer a valuable off-the-shelf solution for complex aortic diseases,
particularly due to anatomical constraints or in the emergent setting. Despite a high technical success rate,
there is signifcant early morbidity and high mid-term mortality. In our series, durability was reasonable for this
challenging group of patients, and our outcomes are in accordance with other reports.info:eu-repo/semantics/publishedVersio