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Clinical Standards for Diagnosis, Treatment and Prevention of Post-COVID-19 Lung Disease
No full textBACKGROUND: The aim of these clinical standards is to provide guidance on 'best practice' care for the diagnosis, treatment and prevention of post-COVID-19 lung disease.METHODS: A panel of international experts representing scientific societies, associations and groups active in post-COVID-19 lung disease was identified; 45 completed a Delphi process. A 5-point Likert scale indicated level of agreement with the draft standards. The final version was approved by consensus (with 100% agreement).RESULTS: Four clinical standards were agreed for patients with a previous history of COVID-19: Standard 1, Patients with sequelae not explained by an alternative diagnosis should be evaluated for possible post-COVID-19 lung disease; Standard 2, Patients with lung function impairment, reduced exercise tolerance, reduced quality of life (QoL) or other relevant signs or ongoing symptoms ≥4 weeks after the onset of first symptoms should be evaluated for treatment and pulmonary rehabilitation (PR); Standard 3, The PR programme should be based on feasibility, effectiveness and cost-effectiveness criteria, organised according to local health services and tailored to an individual patient's needs; and Standard 4, Each patient undergoing and completing PR should be evaluated to determine its effectiveness and have access to a counselling/health education session.CONCLUSION: This is the first consensus-based set of clinical standards for the diagnosis, treatment and prevention of post-COVID-19 lung disease. Our aim is to improve patient care and QoL by guiding clinicians, programme managers and public health officers in planning and implementing a PR programme to manage post-COVID-19 lung disease.info:eu-repo/semantics/publishedVersio
Candy Cane Syndrome: A Systematic Review
No full textBackground: Candy cane syndrome (CCS) is a condition that occurs following gastrectomy or gastric bypass. CCS remains underrecognized, yet its prevalence is likely to rise due to the obesity epidemic and increased use of bariatric surgery. No previous literature review on this subject has been published.
Aim: To collate the current knowledge on CCS.
Methods: A literature search was conducted with PubMed and Google Scholar for studies from May 2007, until March 2023. The bibliographies of the retrieved articles were manually searched for additional relevant articles.
Results: Twenty-one articles were identified (135 patients). Abdominal pain, nausea/vomiting, and reflux were the most reported symptoms. Upper gastrointestinal (GI) series and endoscopy were performed for diagnosis. Surgical resection of the blind limb was performed in 13 studies with resolution of symptoms in 73%-100%. In surgical series, 9 complications were reported with no mortality. One study reported the surgical construction of a jejunal pouch with clinical success. Six studies described endoscopic approaches with 100% clinical success and no complications. In one case report, endoscopic dilation did not improve the patient's symptoms.
Conclusion: CCS remains underrecognized due to lack of knowledge about this condition. The growth of the obesity epidemic worldwide and the increase in bariatric surgery are likely to increase its prevalence. CCS can be prevented if an elongated blind loop is avoided or if a jejunal pouch is constructed after total gastrectomy. Diagnosis should be based on symptoms, endoscopy, and upper GI series. Blind loop resection is curative but complex and associated with significant complications. Endoscopic management using different approaches to divert flow is effective and should be further explored.info:eu-repo/semantics/publishedVersio
Sequential Use of High-Volume Plasma Exchange and Continuous Renal Replacement Therapy in Hepatitis B Virus-Related Acute Liver Failure: A Case Report
No full textBackground: Acute liver failure (ALF) may represent an indication for liver transplantation (LT). However, in patients who do not meet the criteria or who have contraindications for LT, support measures remain indicated since they may improve survival. Continuous renal replacement therapy (CRRT) can be considered in the presence of hyperammonemia, 3 times above the upper normal limit, and hepatic encephalopathy (HE), even in the absence of the classic indications. High-volume plasma exchange (HVPE) is an artificial liver support system with proven benefits in ALF, allowing ammonia and inflammatory mediator clearance. Both techniques, HVPE and CRRT, are associated with an increase in transplant-free survival.
Case summary: We share a case of a 51-year-old male, without relevant personal history, diagnosed with severe acute hepatitis B which progressed to ALF, with grade IV HE (West-Haven criteria) and hyperammonemia (423 μg/dL). Due to the simultaneously diagnosed malignant neoplasm, he was not a candidate for LT. After refractory to medical therapy, HVPE was started, followed by CRRT. There was a significant improvement in liver tests, allowing surgical treatment of malignancy. After recovery, the patient returned to his everyday life.
Conclusion: The authors present a successful case in which an early and invasive approach to ALF was revealed to be a game changer. The lack of response to the measures instituted, as well as the contraindication for LT, motivated the institution of HVPE and CRRT. Both techniques proved to be an asset, allowing complete clinical recovery, reaffirming their role in ALF.info:eu-repo/semantics/publishedVersio
Effects of an Aquatic Physiotherapy Program on the Risk of Falls in Patients with Chronic Stroke on Community: Case Series Report
No full textIntrodução e Objetivos – Aproximadamente 80% dos sobreviventes de acidente vascular cerebral (AVC) apresentam défices de equilíbrio e até 58% apresentam risco de queda no primeiro ano após AVC. Uma das intervenções que tem sido utilizada para o tratamento desta sequela é a fisioterapia aquática. O objetivo deste trabalho é identificar os efeitos de um plano de fisioterapia aquática em grupo no risco de queda, em doentes com AVC crónico. Métodos – Análise de série de casos de três sobreviventes de AVC crónico que apresentam risco de queda (tempo de instalação de 21 a 41 meses). Foram utilizados os instrumentos de avaliação: Escala de Equilíbrio de Berg (EEB), Timed Up and Go (TUG) e Escala de Confiança no Equilíbrio Específica para a Atividade (ECEEA). O programa teve a duração de oito semanas, frequência de duas vezes por
semana e a duração de 45 minutos por sessão. Resultados – Os participantes obtiveram diminuições que variam entre 14 e 36 segundos no TUG. Contrariamente, observou-se um aumento na EEB (valores entre 10 a 16 pontos) e da ECEEA (3,13 e 6,88%). Discussão e Conclusão – Todos melhoraram o equilíbrio. Foram obtidos resultados clinicamente significativos no TUG e na EEB, revelando uma diminuição significativa deste risco. Os resultados obtidos pela ECEEA mostram-nos que os participantes mantêm o medo de cair. O pequeno tamanho da amostra não permite generalização dos resultados.Introduction and Objectives – Approximately 80% of stroke survivors have balance impairments and 58% risk of falling in the first year after stroke. Aquatic physiotherapy is one of the interventions that has been used for this purpose. The main goal of this study is to identify the effects of an aquatic physiotherapy program on people with chronic stroke, with a risk of falls. Methods – This is a case series report, with three chronic stroke survivors (21 to 41 months). Outcome measures were: EEB, TUG, and ECEEA. The program had a duration of eight weeks, with a frequency of two times a week, for 45 minutes. Results – TUG results decreased
(14 to 36 seconds), EEB (10 to 16 points) and ECEEA increased (3.13 and 6.88%). Discussion and Conclusion – All participants improved their clinical status by increasing balance. TUG and EEB had clinical meaning, revealing a significant decrease in the risk of falls. Contrary to these results, those obtained by ECEEA show that participants maintain a fear of falling. Despite the results, the sample size is too small and doesn’t allow generalizations.info:eu-repo/semantics/publishedVersio
Intervenção do Enfermeiro de Reabilitação na Capacitação da Pessoa com Insuficiência Cardíaca
No full textA Insuficiência Cardíaca (IC) afeta 26 milhões de pessoas, com custos elevados devido à redução da qualidade de vida, aumento do sofrimento e mortalidade. A evidência científica realça que programas de capacitação e reabilitação cardiovascular diminuem hospitalizações (Fonseca 2018). Capacitar a pessoa para a gestão da IC (Geral), aumentar a literacia em saúde, implementar um plano educacional e de reabilitação. No Projeto definiram-se critérios de inclusão: pessoa internada por IC, idade superior a 21 anos,
portuguesa, capaz de ler, cognição mantida (amostra não probabilística). Adotou-se um metodologia de planeamento em saúde. A Fase de Diagnóstico de grupo (I) inclui aplicação do Kansas
City Cardiomyopathy Questionnaire e Escala Europeia de Autocuidado na IC, sem alteração nos cuidados (Ávila Costa Pereira, F., 2013; Nave-Leal et al., 2010). Na Fase de intervenção (II), na
admissão e alta, o Enfermeiro Reabilitação (ER) avalia a capacidade funcional - Escala de Barthel, Medical Council Research, Borg Modificada (Esforço), Teste Marcha 6 minutos – e prescreve um plano
de reabilitação (mobilização, treino respiratório, aeróbio, atividades vida diária e conservação de energia) (Delgado et al., 2019).
Aplicando-se os questionários, define-se o plano educacional em módulos: Compreensão da doença/gestão não-farmacológica, Gestão Farmacológica, Tratamento com dispositivos, Sexualidade/fatores psicoemocionais, Gestão da energia. Após a alta, procede-se ao follow-up telefónico, repetindo-se os questionários. Na Fase III, analisam-se dados através do Excel Office®. Protocolo aprovado pela comissão de ética. O Projeto de investigação encontra se na Fase I, o que não permite a análise de dados. Contudo, espera se que comprovem a necessidade da intervenção do ER na capacitação para a gestão da IC, através da melhoria da capacidade 89 funcional, exercício, autonomia e qualidade de vida, reduzindo o peso
económico da IC.info:eu-repo/semantics/publishedVersio
Idiopathic Spinal Cord Herniation - An Extremely Rare Cause of Paraparesis: Case Report
No full textIdiopathic spinal cord herniation is a rare disorder, consisting of a ventral displacement of the spinal cord through a dural defect.
The resulting adhesion and vascular compromise lead to neurological impairment. We report the case of a 54yearold male, with a previous urological surgery resulting in chronic vesical catheterization, with a worsening paraparesis associated with anesthesia below T10. The magnetic resonance imaging showed a ventral displacement of the spinal cord at T7/T8 with an enlarged posterior subarachnoid space at that level. A fourlevel laminotomy was performed followed by spinal cord herniation reduction and closure of the anterior dural defect with a dural replacement. The patient had a partial recovery of his motor deficits regaining his ability to walk with the support of a single crutch. The purpose of this study was to highlight the existence of this extremely rare cause of paraparesis, which is often misdiagnosed
Miocardiopatia Arritmogénica do Ventrículo Esquerdo: Um Caso de Sucesso de Ressuscitação Cardiopulmonar Extracorporal
No full textA 24-year-old man suffered a witnessed cardiac arrest after a padel game. Basic life support was immediately provided. The pre-hospital emergency services team continued the resuscitation efforts, and the patient was accepted for extracorporeal cardiopulmonary resuscitation. The return of spontaneous circulation was achieved in 45 minutes. The initial assessment revealed a ST-segment elevation in leads V4-V6 and a dilated left ventricle with severe systolic dysfunction. Coronary angiography was normal. An improvement in left ventricular systolic function was observed and extracorporeal cardiac support was discontinued after 48 hours. Cardiovascular magnetic resonance imaging demonstrated hypokinesia and subepicardial fatty infiltration of the left ventricle lateral wall. Genetic testing detected a variant of uncertain significance in the ANK2 gene. The diagnosis of arrhythmogenic left ventricular myocardiopathy did not fulfill all the current diagnostic criteria, but it is a very likely diagnosis. An implantable cardioverter-defibrillator was placed. The patient was discharged without physical or cognitive impairment.Homem de 24 anos sofreu uma paragem cardiorrespiratória presenciada após um jogo de padel. O suporte básico de vida foi imediatamente iniciado. A equipa de emergência pré-hospitalar manteve os esforços de ressuscitação e o doente foi aceite para ressuscitação cardiopulmonar extracorporal. O retorno da circulação espontânea foi atingido de imediato após 45 minutos. A avaliação inicial evidenciou elevação do segmento ST nas derivações V4-V6e dilatação do ventrículo esquerdo com disfunção sistólica grave. Angiografia coronária sem alterações. Foi observada uma melhoria da função sistólica do ventrículo esquerdo e a oxigenação por membrana extracorporal veno-arterial foi suspensa após 48 horas. A ressonância magnética cardiovascular demonstrou hipocinésia da parede lateral e infiltração gordurosa subepicárdica na parede lateral do ventrículo esquerdo. O teste genético revelou uma variante de significado incerto no gene ANK2. Apesar do diagnóstico de miocardiopatia arritmogénica do ventrículo esquerdo não preencher todos os critérios diagnósticos atuais, é, no entanto, um diagnóstico muito provável. Foi colocado um cardioversor desfibrilador implantável. O doente teve alta sem compromisso físico ou cognitiv
Percutaneous Closure of Patent Foramen Ovale after Anterior Spinal Cord Infarction
No full textIn patients with a patent foramen ovale (PFO) who have had a cryptogenic ischemic stroke, percutaneous closure reduces its recurrence risk. However, its role in spinal cord infarction (SCI) is less well-established. A few case reports describe the putative causative role of PFO in SCI. We present a case of a teenager with cryptogenic anterior SCI in the setting of a deep vein thrombosis and a high risk-PFO who underwent successful percutaneous closure.info:eu-repo/semantics/publishedVersio
COVID-19 in a Tertiary Paediatric Centre in Portugal: a Single-Centre Retrospective Study
No full textObjective: To describe the demographic, clinical, laboratory and imaging features of the first 300 SARS-CoV-2-infected children presenting to a tertiary paediatric centre in Portugal.
Design: Single-centre, retrospective, descriptive study of paediatric patients who had a confirmed SARS-CoV-2 infection from 7 March to 20 September 2020.
Setting: Tertiary paediatric referral centre (Hospital Dona Estefânia, Lisbon, Portugal).
Patients: 18 years or younger.
Main outcome measures: Incidence, mortality, age of infection, clinical characteristics, treatment prescribed and outcome.
Results: Three hundred patients with confirmed COVID-19 presented to the centre. One hundred and seventeen (39%) patients were admitted to the hospital: 69 with COVID-19 and 48 for other reasons. The most common symptoms in children admitted with COVID-19 were fever (49) and cough (38). Six patients required intensive care. Two children died and seven reported short-term sequelae.
Conclusions: COVID-19 is usually a mild disease in children, but a small proportion of patients develop severe and critical disease. Fatal outcomes were rare and only occurred in children with severe previous medical conditions.info:eu-repo/semantics/publishedVersio
