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Depression Among Portuguese Pregnant Women During Covid-19 Lockdown: A Cross Sectional Study
No full textIntroduction: Coronavirus disease 2019 was declared as a pandemic on March 2020. Research on its psychological effects is still lacking. Perinatal depression is a medical complication of pregnancy, especially in situations of stress. In this study, we aimed to investigate the presence of symptoms of depression in pregnant women during the lockdown period in Portugal.
Methods: This study consisted in a cross-sectional study among Portuguese pregnant women, who completed an online self-report questionnaire between 25th April and 30th April 2020. An anonymous online questionnaire was developed to assess depression and concerns related to COVID-19. This study was approved by the IRB of Hospital Dona Estefânia and performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki. Eligibility criteria included pregnant women, ≥ 18 years and living in Portugal. The primary outcome was to evaluate the presence of depressive symptoms and its association to socio-demographic characteristics and to concerns related to COVID-19.
Results: A total of 1698 pregnant women were enrolled. The mean age was 31.9 years. 82.4% felt a negative impact of the pandemic in the surveillance of pregnancy and 43% felt insufficient support. 26.3% showed "possible depression" according to the EPDS. A regression analysis revealed the possibility of depression increased as the concerns about COVID increased and was lower for women with support. The possibility of depression was higher for women with psychiatric medical history.
Conclusion: This study demonstrated a significant increase in clinically significant depressive symptoms in pregnant women during the lockdown. It also revealed some of the socio-demographic characteristics of women at risk for depression. If left untreated, depression tends to persist, affecting the woman and also the child. Our findings suggest that COVID-19 represents a serious challenge for this population and reinforce the urgent need for early detection and intervention on mental health issues during pregnancy, especially during the pandemic.info:eu-repo/semantics/publishedVersio
Doentes Oncológicos com Síndrome Coronária Aguda Não Têm Maior Risco Hemorrágico Quando Comparados com Doentes com Características Similares - Uma Análise de Emparelhamento de Score de Propensão do Registo ProACS
No full textIntroduction: The management of acute coronary syndrome (ACS) in malignancy is challenging due to higher bleeding risk.
Methods: We analyzed patients with cancer (active or in the previous five years) prospectively included in the ProACS registry between 2010 and 2019. Our aim was to assess safety (major bleeding, primary endpoint) and secondary efficacy endpoints (in-hospital mortality and combined in-hospital mortality, reinfarction and ischemic stroke) of ACS treatment. Propensity score matching analysis (1:1) was further performed to better understand predictors of outcomes.
Results: We found 934 (5%) cancer patients out of a total of 18 845 patients with ACS. Cancer patients had more events: major bleeding (2.9% vs. 1.5%), in-hospital mortality (5.8% vs. 3.4%) and the combined endpoint (7.4% vs. 4.9%). The primary endpoint was related to cancer diagnosis (OR 1.97), previous bleeding (OR 7.09), hemoglobin level (OR 4.94), atrial fibrillation (OR 3.50), oral anticoagulation (OR 3.67) and renal dysfunction. Mortality and the combined secondary endpoint were associated with lower use of invasive coronary angiography and antiplatelet and neurohormonal blocker therapy. After propensity score matching (350 patients), there were no statistically significant differences in endpoints between the populations.
Conclusion: Bleeding risk was not significant higher in the cancer population compared to patients with similar characteristics, nor were mortality or ischemic risk. The presence of cancer should not preclude simultaneous ACS treatment.info:eu-repo/semantics/publishedVersio
Can PM20D1 Be a New Kid on the Block in Cardiovascular Risk Stratification? Do Not Run before You Can Walk
No full textinfo:eu-repo/semantics/publishedVersio
Does Reality Overcome the Expected? Survey on Informal Caregivers' Profile: A Nurse-Led Study in Times of COVID-19
No full textThe increasing overload of chronic conditions raises challenges for the health system.
Informal caregivers have a major role in ensuring the quality of life of the cared-for person, despite
the reported lack of working resources which can lead to unmet needs. This article reports on the
first part of a nurse-led research project entitled “Informal caregiver’ profiles in Lisbon county: a
health community approach.’ We aimed to support decision-making by developing an informal
caregiver profile to promote tailored interventions. A survey addressing the dyad was developed and
submitted to a convenient, network-based, stratified sample of carers aged 18 years or above. More
than thirty community partners supported the identification of caregivers. Data were submitted to
univariate descriptive analysis. A profile of the cared-for person and the informal caregiver was
uncovered by identifying 639 caregivers, of whom the majority lived with the cared-for person. Only
four percent planned the transition to a caregiver role, and no more than 10% had access to support
programs. Approximately half of the respondents found that COVID-19 negatively impacted their
performance in the caregiver role. Developing a local and tailored strategy with collaboration between
healthcare professionals, academics, and community partners is key to ensuring that meaningful
support is provided to caregivers.info:eu-repo/semantics/publishedVersio
Validation of Blood Gas Analysis in Arteriovenous Fistula for Hemodialysis
No full textIntroduction: Arterial blood gas analysis is a minimally invasive technique used in our daily practice but is not a complication free technique. The aim of this study was to validate results from blood gas analysis obtained from the arteriovenous fistula (AVF)/graft as a surrogate marker of the arterial blood gas analysis.
Methods: A prospective observational study was made in 45 patients. We performed arterial and AVF/graft blood gas analysis and results were compared by a paired sample t Student test.
Results: Most of our subjects was male (68.9%) and the mean age was 67 years (±14). Hemodialysis vintage was 63 months (±66), and vascular access age was 62 months (±56). The more prevalent vascular access was left radiocephalic AVF (n = 16; 35.6%) and the main puncture artery was right radial artery (n = 27; 60.0%). There were no statistically significant differences between the samples collected.
Conclusions: Our results suggest a possible alternative of arterial blood gas analysis in AVF/graft for hemodialysis patients. This could result in making an uncomfortable procedure almost painless and reducing complications. Future research should take place to include anatomical characteristics of the AVF or the circulation of recirculation.info:eu-repo/semantics/publishedVersio
Acute Treatment of Isolated Posterior Cerebral Artery Occlusion: Single Center Experience
No full textBackground and objectives: Randomized trials for mechanical thrombectomy (MT) excluded patients with ischemic strokes due to isolated posterior cerebral artery occlusion (IPCAO), and there is no evidence for best acute treatment strategy in these patients. We aimed to assess the effectiveness and safety of MT in acute IPCAO.
Methods: We retrospectively analyzed consecutive patients with acute stroke due to IPCAO submitted to MT and/or intravenous thrombolysis (IVT), between 2015-2019. Effectiveness outcomes (recanalization rate, first-pass effect, NIHSS 24h improvement and 3-month Modified Ranking Scale - mRS) and safety outcomes (complications, symptomatic intracranial hemorrhage (SICH) and 3-month mortality) were described and compared between groups.
Results: A total of 38 patients were included, 25 underwent MT and 13 had IVT alone. Successful and complete recanalization were achieved in 68% and 52% of MT patients, respectively. NIHSS improvement at 24h was found in 56% of MT patients versus 30.8% of patients submitted to IVT alone (OR [95% CI]=2.86 [0.69-11.82]) and excellent functional outcome at 3 months (mRS≤1) was achieved in 54.2% of MT patients versus 38.5% in the IVT group (OR [95% CI]=1.60 [0.41-6.32]). Complications occurred in 3 (12%) procedures and there were no SICH. Mortality at 3 months was 20% in the MT group and 15.4% in patients submitted to IVT alone.
Conclusions: Our results reflect a real-world scenario in a single center and seem to support the recently growing literature showing that MT is a feasible and safe treatment in IPCAO, with favorable effectiveness.info:eu-repo/semantics/publishedVersio
Displasias Ectodérmicas
No full textEctodermal dysplasias are a heterogeneous group of rare inherited disorders. Molecular findings and clarification of cell sig naling processes and ectodermal-mesenchyme interaction enabled the development of a clinical-functional model, which in turn helps to explain clinical signs, with variability in severity, associated non-ectodermal abnormalities and overlap seen in many patients. We herein review the current state of knowledge regarding this distinct entity and illustrate with an elucidative case report. The need for early multidisciplinary intervention is highlighted, and further studies will focus on genetically-target therapeutic approaches.As displasias ectodérmicas representam um grupo heterogéneo de doenças hereditárias raras. Os achados moleculares e o esclarecimento dos processos de sinalização celular e da interação ectoderme-mesênquima permitiram compreender os sinais clínicos. Estes caracterizam-se por gravidade variável, observando-se associação a anomalias não ectodérmicas e sobreposição clínica em muitos pacientes. No presente trabalho resumimos o estado atual do conhecimento sobre as displasias ectodérmicas e apresentamos ainda um relato de caso ilustrativo. Salientamos a necessidade de intervenção multidisciplinar precoce, sendo necessários estudos futuros com enfoque em abordagens terapêuticas geneticamente direcionadas.info:eu-repo/semantics/publishedVersio
Utilização de Rituximab em Doentes com Pênfigo Vulgar/Foliáceo Durante a Pandemia COVID-19
No full textinfo:eu-repo/semantics/publishedVersio
Early Versus Late Initiation of Direct Oral Anticoagulants in Post-Ischaemic Stroke Patients with Atrial FibrillatioN (ELAN): Protocol for an International, Multicentre, Randomised-Controlled, Two-Arm, Open, Assessor-Blinded Trial
No full textRationale: Direct oral anticoagulants (DOAC) are highly effective in preventing ischaemic strokes in people with atrial fibrillation (AF). However, it is unclear how soon they should be started after acute ischaemic stroke (AIS). Early initiation may reduce early risk of recurrence but might increase the risk of haemorrhagic complications.
Aim: To estimate the safety and efficacy of early initiation of DOACs compared to late guideline-based initiation in people with AIS related to AF.
Methods and design: An international, multicentre, randomised (1:1) controlled, two-arm, open, assessor-blinded trial is being conducted. Early treatment is defined as DOAC initiation within 48 h of a minor or moderate stroke, or at day 6-7 following major stroke. Late treatment is defined as DOAC initiation after day 3-4 following minor stroke, after day 6-7 following moderate stroke and after day 12-14 following major stroke. Severity of stroke is defined according to imaging assessment of infarct size.
Sample size: ELAN will randomise 2000 participants 1:1 to early versus late initiation of DOACs. This assumes a risk difference of 0.5% favouring the early arm, allowing an upper limit of the 95% confidence interval up to 1.5% based on the Miettinen & Nurminen formula.
Outcomes: The primary outcome is a composite of symptomatic intracranial haemorrhage, major extracranial bleeding, recurrent ischaemic stroke, systemic embolism or vascular death at 30 ± 3 days after randomisation. Secondary outcomes include the individual components of the primary outcome at 30 ± 3 and 90 ± 7 days and functional status at 90 ± 7 days.
Discussion: ELAN will estimate whether there is a clinically important difference in safety and efficacy outcomes following early anticoagulation with a DOAC compared to late guideline-based treatment in neuroimaging-selected people with an AIS due to AF.info:eu-repo/semantics/publishedVersio
Auditory Neuropathy Spectrum Disorder - 2 Different But Successfull Pediatric Cases
No full textAuditory Neuropathy Spectrum Disorder ( is a disorder characterized by disruption of the temporal coding of acoustic signals in auditory fibers with consequent impairment of auditory perceptions dependent on temporal cues ANSD is a rare condition, associated with several risk factors and its diagnosis and management are challenging
Objective
To compare 2 pediatric cases of ANSD and analyze its rehabilitation
Materials
and Methods Analysis of behavioral and electrophysiological test resultsinfo:eu-repo/semantics/publishedVersio