4940 research outputs found
Sort by
Linfoma Difuso de Grandes Células B com Invasão Cutânea Axilar num Doente com Infeção VIH
No full textinfo:eu-repo/semantics/publishedVersio
Memorial da Serralharia - Arqueologia do Passado Recente no Hospital de São José
No full textEste artigo é um contributo para a memória operária da cidade de Lisboa a partir da identificação e levantamento de uma serralharia em risco de colapso no espaço do Hospital de São José. Situada numa área com necessidade de recuperação, a serralharia periclitante pela passagem das décadas, ainda alberga maquinaria industrial e é uma oficina de recurso para além de espaço de armazenamento de materiais.
Estando no horizonte, por questões de segurança, a eventual demolição do imóvel, os autores uniram esforços para preservar a memória histórica, antropológica, arqueológica e etnográfica de um edifício que no fundo reco lhe reacções silenciosas e momentos de ponderação e reflexão quando é mencionado este facto: José Saramago trabalhou aqui.info:eu-repo/semantics/publishedVersio
Patient Advocacy: Oportunidades Para a Segurança do Doente
No full textAs pessoas quando vivenciam um processo de doença encontram-se naturalmente mais vulneráveis e em muitas situações não são envolvidas de forma efetiva nos cuidados de saúde e nos processos de tomada de decisão, durante a sua jornada assistencial. A evolução e a inovação da tecnologia, bem como a diferenciação das especialidades e técnicas na área da saúde, têm contribuído para muitas melhorias e para aumentar a esperança média de vida, contudo aliada a esta evolução emergem vários dificuldades e obstáculos para a pessoa com doença. Neste âmbito, assiste-se a uma diversidade e variabilidade de processos, circuitos e opções de tratamento que trazem constrangimentos para os doentes e suas famílias, nomeadamente ao nível da navegabilidade no sistema de saúde e na capacidade para obtenção de informação fidedigna que oriente as suas tomadas de decisão.
A nível internacional os movimentos e as ações desenvolvidas no âmbito da PA têm ganho expressão nos últimos anos, sendo ainda um conceito e uma área em desenvolvimento e cujo contributo para cuidados de saúde mais seguros e mais humanizados, ainda não foi efetivamente valorizado. A PA vem reforçar a existência de uma figura que sirva de mediador entre o doente e os seus prestadores de cuidados de saúde, sendo o principal foco, a promoção e a proteção dos interesses e direitos das pessoas com doença. Um Patient Advocate é definido como um “defensor, promotor, ativista, apoiante ou porta-voz” do doente e deve ter conhecimento do funcionamento do sistema de saúde e competências comunicacionais para saber articular com os membros da equipa de saúde, acompanhando o doente, de forma integrada, no seu percurso de cuidados de saúde. Esta figura pode ser um membro da família do doente ou um amigo próximo ou outra pessoa em que o doente confia. Atualmente, em muitos países já existem Patient Advocates profissionais.
Na área da Segurança do Doente, os movimentos e desafios promovidos pela OMS e por várias entidades internacionais durantes vários anos, estão atualmente reforçados no Plano de Ação Global para a Segurança dos Doentes 2021-2030, com destaque para o empoderamento do doente e iniciativas da PA.
A constante mudança e evolução nos cuidados de saúde, deverão ser desde modo, uma preocupação constante dos profissionais de saúde e da sociedade em geral, sendo necessário capacitar as pessoas para “navegarem” com sucesso no sistema de saúde, tomarem decisões em saúde informadas e esclarecidas e obterem resultados positivos, sendo a área da PA um dos pilares importantes para aumentar segurança do doente e para o desenvolvimento de iniciativas nestas matérias, contribuindo para a integração de cuidados.info:eu-repo/semantics/publishedVersio
Unexpected Presentation of Tracheoesophageal Fistula During Intubation in a Pediatric Patient
No full textTracheoesophageal fistula (TEF) is an abnormal connection between the trachea and esophagus. This report presents a rare case of a pediatric patient who developed a TEF due to battery ingestion, which was diagnosed during intubation and resulted in cardiac arrest. A 4-year-old child with a two-year history of battery ingestion presented with severe dehydration, weight loss, and recurrent respiratory tract infections. Chest X-ray revealed a radiopaque foreign body in the esophagus. During general anesthesia for central venous line insertion and after endotracheal intubation, some difficulties in ventilation occurred, characterized by the inability to reach tidal volume, absence of capnography, and stomach distention which led to hypoxia and ultimately to cardiac arrest. Prompt resuscitation (CPR) was initiated, and selective right bronchial intubation during CPR improved the patient's condition. Subsequent bronchofibroscopy performed in the ICU confirmed the TEF, which was surgically corrected during the hospital stay. TEF poses challenges in anesthesia and airway management, particularly when positive pressure ventilation is used. In this case, the TEF was diagnosed during intubation, highlighting the critical role of clinical expertise and prompt intervention in managing this unexpected pediatric critical event.info:eu-repo/semantics/publishedVersio
Individualized Fortification Based on Measured Macronutrient Content of Human Milk Improves Growth and Body Composition in Infants Born Less than 33 Weeks: A Mixed-Cohort Study
No full textThe optimal method for human milk (HM) fortification has not yet been determined. This study assessed whether fortification relying on measured HM macronutrient content (Miris AB analyzer, Upsala, Sweden) composition is superior to fortification based on assumed HM macronutrient content, to optimize the nutrition support, growth, and body composition in infants born at <33 weeks' gestation. In a mixed-cohort study, 57 infants fed fortified HM based on its measured content were compared with 58 infants fed fortified HM based on its assumed content, for a median of 28 and 23 exposure days, respectively. The ESPGHAN 2010 guidelines for preterm enteral nutrition were followed. Growth assessment was based on body weight, length, and head circumference Δ z-scores, and the respective growth velocities until discharge. Body composition was assessed using air displacement plethysmography. Fortification based on measured HM content provided significantly higher energy, fat, and carbohydrate intakes, although with a lower protein intake in infants weighing ≥ 1 kg and lower protein-to-energy ratio in infants weighing < 1 kg. Infants fed fortified HM based on its measured content were discharged with significantly better weight gain, length, and head growth. These infants had significantly lower adiposity and greater lean mass near term-equivalent age, despite receiving higher in-hospital energy and fat intakes, with a mean fat intake higher than the maximum recommended and a median protein-to-energy ratio intake (in infants weighing < 1 kg) lower than the minimum recommended.info:eu-repo/semantics/publishedVersio
Associations of longitudinal Height and Weight with Clinical Outcomes in Pediatric Kidney Replacement Therapy: Results from the ESPN/ERA Registry
No full textBackground: Associations between anthropometric measures and patient outcomes in children are inconsistent and mainly based on data at kidney replacement therapy (KRT) initiation. We studied associations of height and body mass index (BMI) with access to kidney transplantation, graft failure, and death during childhood KRT.
Methods: We included patients 1.88. Underweight, overweight and obesity were calculated using age and sex-specific BMI for height-age criteria. Associations with outcomes were assessed using multivariable Cox models with time-dependent covariates.
Results: We included 11,873 patients. Likelihood of transplantation was lower for short (aHR: 0.82, 95% CI: 0.78-0.86), tall (aHR: 0.65, 95% CI: 0.56-0.75), and underweight patients (aHR: 0.79, 95%CI: 0.71-0.87). Compared with normal height, patients with short and tall statures showed higher graft failure risk. All-cause mortality risk was higher in short (aHR: 2.30, 95% CI: 1.92-2.74), but not in tall stature. Underweight (aHR: 1.76, 95% CI: 1.38-2.23) and obese (aHR: 1.49, 95% CI: 1.11-1.99) patients showed higher all-cause mortality risk than normal weight subjects.
Conclusions: Short and tall stature and being underweight were associated with a lower likelihood of receiving a kidney allograft. Mortality risk was higher among pediatric KRT patients with a short stature or those being underweight or obese. Our results highlight the need for careful nutritional management and multidisciplinary approach for these patients. A higher resolution version of the Graphical abstract is available as Supplementary information.info:eu-repo/semantics/publishedVersio
Pneumonectomy in a Child with Necrotic Lung after Ingestion of a Button Battery
No full textinfo:eu-repo/semantics/publishedVersio
Motivations for Paediatric Vaccine Trial Participation
No full textinfo:eu-repo/semantics/publishedVersio
Abdominal Perfusion Pressure in Critically Ill Cirrhotic Patients: a Prospective Observational Study
No full textIn critical patients, abdominal perfusion pressure (APP) has been shown to correlate with outcome. However, data from cirrhotic patients is scarce. We aimed to characterize APP in critically ill cirrhotic patients, analyze the prevalence and risk factors of abdominal hypoperfusion (AhP) and outcomes. A prospective cohort study in a general ICU specialized in liver disease at a tertiary hospital center recruited consecutive cirrhotic patients between October 2016 and December 2021. The study included 101 patients, with a mean age of 57.2 (± 10.4) years and a female gender proportion of 23.5%. The most frequent etiology of cirrhosis was alcohol (51.0%), and the precipitant event was infection (37.3%). ACLF grade (1-3) distribution was 8.9%, 26.7% and 52.5%, respectively. A total of 1274 measurements presented a mean APP of 63 (± 15) mmHg. Baseline AhP prevalence was 47%, independently associated with paracentesis (aOR 4.81, CI 95% 1.46-15.8, p = 0.01) and ACLF grade (aOR 2.41, CI 95% 1.20-4.85, p = 0.01). Similarly, AhP during the first week (64%) had baseline ACLF grade (aOR 2.09, CI 95% 1.29-3.39, p = 0.003) as a risk factor. Independent risk factors for 28-day mortality were bilirubin (aOR 1.10, CI 95% 1.04-1.16, p < 0.001) and SAPS II score (aOR 1.07, CI 95% 1.03-1.11, p = 0.001). There was a high prevalence of AhP in critical cirrhotic patients. Abdominal hypoperfusion was independently associated with higher ACLF grade and baseline paracentesis. Risk factors for 28-day mortality included clinical severity and total bilirubin. The prevention and treatment of AhP in the high-risk cirrhotic patient is prudential.info:eu-repo/semantics/publishedVersio
New Onset Nephrotic - Range Proteinuria in a Patient with Chronic Kidney Disease - Not Always What it Seems
No full textLight chain deposition disease (LCDD) is a rare condition that is characterized by the deposition of monoclonal
immunoglobulin light chains in glomerular and tubular basement membranes. We report the case of a 72-yearold male with long-standing and stable chronic kidney disease (CKD) presumably due to hypertension and
lithiasis who presented with new-onset nephrotic range proteinuria, anemia and rapidly worsening renal function that eventually led to end-stage renal disease (ESRD) requiring dialysis. Radiologic and laboratory workup found enlarged kidneys in the ultrasound and increased kappa/ lambda ratio (KLR) suggestive of a plasma cell dyscrasia.
The patient underwent bone marrow biopsy, confirming the diagnosis of kappa light chains multiple myeloma
(MM). Since exclusion of amyloidosis was essential for determining therapeutic strategies, a kidney biopsy was
performed, showing deposition of Periodic acid-Schiff (PAS) positive and silver-negative material in the glomeruli, tubular basement membrane, vessels and interstitium and kappa light chain restriction in the immunofluorescence staining. A diagnosis of kappa LCDD secondary to MM was made, and the patient received a Bortezomib-based regimen directed to the plasma cell disorder.info:eu-repo/semantics/publishedVersio