4940 research outputs found
Sort by
Ductus Arteriosus: the Coming of Age of a Fetal Vessel
No full textinfo:eu-repo/semantics/publishedVersio
Repercussions of the COVID-19 Pandemic in the Emergency Department of Gynecology and Obstetrics at a Referral Hospital in Portugal
No full textObjective. COVID-19 has spread worldwide and Portugal decreed the State of Emergency on March 18th, 2020. During this period, the population was encouraged to stay at home. Still, there were no restrictions on access to health care. Therefore, we aimed to compare the major causes for attending the Obstetrics
and Gynaecology Emergency Department (ED) from a referral centre (Maternidade Dr. Alfredo da Costa, in Lisbon).
Materials and Methods. Several variables were collected and compared between two periods of time: from 19th March to 2nd April 2020 and the same period of 2019.
Results. During the COVID-19 pandemic period, 49.4% fewer patients visited the ED. We observed a higher number of urgent patients and hospitalization rate than previous year.
Conclusions. We experienced a reduction number of admissions to the Obstetrics and Gynaecology ED, but apparently the severity of cases that visited the ED increased.info:eu-repo/semantics/publishedVersio
Congenital Malformations of the Female Genital Tract: a Review of Available Classification Systems
No full textCongenital malformations of the female genital tract are being diagnosed more frequently due to advances in imaging techniques. A broad international consensus on their classification is still lacking. This paper aimed to comparatively summarize the most frequently and widely used, as well as the most recently developed classification systems of congenital female genital malformations. A non-systematic review was done through a search on major databases with the medical subject heading (MeSH) term ‘‘congenital abnormalities” in combination with ‘‘classification” and ‘‘female genitalia”. All available systems, including, among others, the
American Fertility Society Classification (1988), the Acien and Acien classification (1992, 2004), the VCUAM system (2005), the European Society for Human Reproduction and Embryology - European Society for Gynecological Endoscopy classification (2013), the Congenital Uterine Malformation Experts (CUME) group recommendations, and the American Society for Reproductive Medicine Classification (2021) possess the advantages and disadvantages listed in this article. Regarding the most common situations, the criteria for differentiating physiologic arcuate and discrete partial septate uteri vary widely between classifications, while difficulties also persist with the rarer complex abnormalities that cannot be easily classified, contributing to
a gap in clinical and research protocols. The main factor compromising any attempt to reach an ideal classification system is the lack of evidence-based data, justifying the need for comparative multicenter international randomized control trials in this field. Pending new research data and a broad international consensus, it seems essential for adequate patient orientation to describe each detected malformation in detail and to correlate it with the clinical presentation, regardless the type of classification used.info:eu-repo/semantics/publishedVersio
Endovascular Treatment for Anterior Circulation Large-Vessel Occlusion Ischemic Stroke with Low ASPECTS: a Systematic Review and Meta-Analysis
No full textBackground: Endovascular treatment (EVT) for acute ischemic stroke (AIS) patients presenting with Alberta Stroke Program Early CT Score (ASPECTS) 0-5 has not yet proven safe and effective by clinical trials.
Objectives: The aim of the study was to assess whether EVT in AIS patients presenting with low ASPECTS is beneficial.
Design: Systematic review and meta-analysis of available studies in accordance with the PRISMA statement.
Data sources and methods: We have searched MEDLINE, the Cochrane Central Register of Controlled Trials, and reference lists of articles published until 28 May 2022 with the aim to calculate (1) modified Rankin scale (mRS) score 0-3 at 3 months, (2) mRS score 0-2 at 3 months, (3) symptomatic intracranial hemorrhage (sICH), and (3) mortality at 3 months.
Results: Overall, 24 eligible studies were included in the meta-analysis, comprising a total of 2539 AIS patients with ASPECTS 0-5 treated with EVT. The pooled proportion of EVT-treated patients achieving mRS 0-3 at 3 months was calculated at 38.4%. The pooled proportion of EVT-treated patients achieving mRS 0-2 at 3 months was 25.7%. Regarding safety outcomes, sICH occurred in 12.8% of patients. The 3-month pooled mortality was 30%. In pairwise meta-analysis, patients treated with EVT had a higher likelihood of achieving mRS 0-3 at 3 months compared with patients treated with best medical therapy (BMT, OR: 2.41). sICH occurred more frequently in EVT-treated patients compared with the BMT-treated patients (OR: 2.30). Mortality at 3 months was not different between the two treatment groups (OR: 0.71).
Conclusion: EVT may be beneficial for AIS patients with low baseline ASPECTS despite an increased risk for sICH. Further data from randomized-controlled clinical trials are needed to elucidate the role of EVT in this subgroup of AIS patients.
Registration: The protocol has been registered in the International Prospective Register of Ongoing Systematic Reviews PROSPERO; Registration Number: CRD42022334417.info:eu-repo/semantics/publishedVersio
The COVID-19 Pandemic Affects Seasonality, With Increasing Cases of New-Onset Type 1 Diabetes in Children, From the Worldwide SWEET Registry
No full textObjective: To analyze whether the coronavirus disease 2019 (COVID-19) pandemic increased the number of cases or impacted seasonality of new-onset type 1 diabetes (T1D) in large pediatric diabetes centers globally.
Research design and methods: We analyzed data on 17,280 cases of T1D diagnosed during 2018-2021 from 92 worldwide centers participating in the SWEET registry using hierarchic linear regression models.
Results: The average number of new-onset T1D cases per center adjusted for the total number of patients treated at the center per year and stratified by age-groups increased from 11.2 (95% CI 10.1-12.2) in 2018 to 21.7 (20.6-22.8) in 2021 for the youngest age-group, <6 years; from 13.1 (12.2-14.0) in 2018 to 26.7 (25.7-27.7) in 2021 for children ages 6 to <12 years; and from 12.2 (11.5-12.9) to 24.7 (24.0-25.5) for adolescents ages 12-18 years (all P < 0.001). These increases remained within the expected increase with the 95% CI of the regression line. However, in Europe and North America following the lockdown early in 2020, the typical seasonality of more cases during winter season was delayed, with a peak during the summer and autumn months. While the seasonal pattern in Europe returned to prepandemic times in 2021, this was not the case in North America. Compared with 2018-2019 (HbA1c 7.7%), higher average HbA1c levels (2020, 8.1%; 2021, 8.6%; P < 0.001) were present within the first year of T1D during the pandemic.
Conclusions: The slope of the rise in pediatric new-onset T1D in SWEET centers remained unchanged during the COVID-19 pandemic, but a change in the seasonality at onset became apparent.info:eu-repo/semantics/publishedVersio
Um Esqueleto no Armário ou Como a Arqueologia Não Vive Só do que se Descobre Debaixo da Terra
No full textUm esqueleto humano, que estava guardado e remetido ao esquecimento há várias décadas em arrecadações
do Hospital de Santa Marta, foi recentemente descoberto.
Certamente utilizado de forma didáctica no antigo Hospital Escolar que ali funcionou até 1953, o esqueleto
terá integrado a colecção do extinto Museu dos Hospitais Civis de Lisboa, tendo sido sucessivamente
guardado em outros espaços do hospital, após o encerramento daquele espaço museológico no final dos
anos 70.
Embora estejam ausentes alguns ossos, tratando-se de um esqueleto humano e não de um simples modelo,
considerou-se que poderia ser interessante efectuar a sua análise, tendo em vista apurar, como é
comum fazer-se com os esqueletos descobertos em escavações arqueológicas, dados biológicos sobre
esta inusitada descoberta. Por conseguinte, estimaram-se os perfis biológico e patológico deste indivíduo.
Trata-se de um homem adulto com cerca de 1,67 m de estatura, revelando apenas ligeiras alterações
degenerativas não articulares.Kept and consigned to oblivion for several decades in Santa Marta Hospital (Lisbon), a human skeleton
was recently discovered.
Used for teaching purposes in the former Escolar Hospital (Hospital Escolar), which operated there until
1953, the skeleton would have been part of the collection of the extinct Museu dos Hospitais Civis de Lisboa;
having been stored in other spaces of the hospital, after the closing of the museum in the end of the
70’s.
Since that it is a real human skeleton and not a simple model, although some bones are missing, it was
considered that it could be interesting to carry out its analysis, looking to ascertain biological data about
this unusual discovery, as is commonly done for skeletons discovered in archaeological excavations. Therefore,
we estimated the biological and pathological profiles of this individual, which is an adult male with
approximately 1.67 m of height, displaying slight non-articular degenerative changes
Atrésia Coanal - Os Últimos Anos de Prática do Hospital Dona Estefânia
No full textObjetivo: descrever e caraterizar o grupo de crianças com diagnóstico de atrésia coanal (AC) seguidas no Hospital Dona Estefânia (HDE) durante os últimos 13 anos.
Desenho do estudo: observacional descritivo.
Materiais e métodos: análise dos dados de 16 crianças com diagnóstico de AC submetidas a cirurgia.
Resultados: treze doentes são do sexo feminino e três do sexo masculino. Identificaram-se nove casos de bilateralidade e sete unilaterais. Quanto ao tipo de obstrução, doze são do tipo misto e quatro do tipo ósseo. Seis casos associavam-se a síndrome de CHARGE. Registaram-se seis casos de recidivas que foram reintervencionados.
Conclusões: Os dados demográficos são semelhantes aos da literatura. A taxa de sucesso cirúrgico foi superior nos casos de AC bilateral.info:eu-repo/semantics/publishedVersio
Cirurgia Aberta de Aneurisma da Aorta Abdominal por Internos de Cirurgia Vascular: à Beira da Extinção?
No full textINTRODUÇÃO: Nas últimas duas décadas, a abordagem de tratamento de aneurisma da aorta abdominal (AAA) mudou drasticamente de cirurgia aberta para cirurgia endovascular. A diminuição de cirurgia de AAA convencional , open aneurysm repair (OAR), levanta preocupações relativamente à competência dos futuros cirurgiões vasculares para executar este procedimento complexo e de alto risco. O principal objetivo deste estudo foi avaliar as tendências de tratamento de AAA entre internos de Cirurgia Vascular, ao longo de 15 anos, a nível nacional.MÉTODOS:Identificação dos médicos que terminaram o internato de Angiologia e Cirurgia Vascular entre 2002 e 2017, inclusive, a nível nacional e colheita dos dados através da consulta dos currículos para a prova final de conclusão do internato complementar. Foram avaliados o total de cirurgias por AAA, tanto por OAR e por EVAR e contabilizadas aquelas realizadas como 1º cirurgião. A correlação entre o número de cirurgias abertas de AAA e o ano de conclusão do internato complementar foi testada usando o coeficiente de correlação de Spearman. RESULTADOS:Em Portugal, de 2002-2017, apesar de não se verificar variabilidade no número total de OAR realizados, verificou-se um decréscimo marcado naqueles realizados como 1º cirurgião (rho=-0,363; P<0.02). No final do internato em 2007, um interno de Cirurgia Vascular realizava em média 15 casos de OAR e em 2007 a média foi de apenas 7 casos. Por outro lado, constatou-se um aumento marcado no número total de procedimentos de EVAR (rho=0,478; P<0.02) bem como aqueles realizados como 1ºcirurgião (rho=0,540; P<0.01).CONCLUSÃO:O presente estudo revela que os internos de Cirurgia Vascular, a nível nacional, se encontram expostos a progressivamente menos casos de OAR e verifica-se uma diminuição significativa nos procedimentos de OAR como 1º cirurgião.info:eu-repo/semantics/publishedVersio
A Rare but Real Necessity: Case Report of Coronary Artery Stenting in an Infant
No full textPercutaneous coronary intervention (PCI) is an extremely common and well-established procedure in adults which is rarely performed in children. We present a case of a successful left main coronary artery stenting in a small infant with a congenital coronary artery anomaly. We highlight the technical challenges of performing a PCI in a small patient, the risks of antithrombotic prophylaxis in this age group, and the importance of the combined work of the adult and pediatric interventional cardiologist.info:eu-repo/semantics/publishedVersio
A Preliminary Exploration of the Placental Position Influence on Uterine Electromyography Using Fractional Modelling
No full textThe uterine electromyogram, also called electrohysterogram (EHG), is the electrical signal generated by uterine contractile activity. The EHG has been considered an expanding technique for pregnancy monitoring and preterm risk evaluation. Data were collected on the abdominal surface. It has been speculated the effect of the placenta location on the characteristics of the EHG. In this work, a preliminary exploration method is proposed using the average spectra of Alvarez waves contractions of subjects with anterior and non-anterior placental position as a basis for the triple-dispersion Cole model that provides a best fit for these two cases. This leads to the uterine impedance estimation for these two study cases. Non-linear least square fitting (NLSF) was applied for this modelling process, which produces electric circuit fractional models' representations. A triple-dispersion Cole-impedance model was used to obtain the uterine impedance curve in a frequency band between 0.1 and 1 Hz. A proposal for the interpretation relating the model parameters and the placental influence on the myometrial contractile action is provided. This is the first report regarding in silico estimation of the uterine impedance for cases involving anterior or non-anterior placental positions.info:eu-repo/semantics/publishedVersio