2224 research outputs found
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Obesidade e hipertensão arterial nas crianças: um problema à escala mundial
No full textinfo:eu-repo/semantics/publishedVersio
Fluid therapy and shock: an integrative literature review.
No full textBACKGROUND:
shock refers to a physiological situation that puts life at risk. Its early identification and the timely institution of therapeutic measures can avoid death. Despite the frequent administration of fluid therapy as a treatment for shock, the type and dose of fluids to be delivered remain undetermined.
AIM:
to determine the type of fluids to be administered and the type of approach to be performed in the different types of shock.
METHOD:
integrative literature review.
RESULTS:
data about fluid therapy in hypovolaemic and distributive shock were obtained, specifically in the haemorrhagic and the septic types. None of the articles addressed cardiogenic shock.
CONCLUSION:
hypotensive resuscitation, with blood, is the most appropriate approach in haemorrhagic shock. There remains a question regarding the best approach in septic shock. However, conservative fluid therapy seems to be appropriate, with preference given to the administration of balanced crystalloids or albumin as an alternative.info:eu-repo/semantics/publishedVersio
Editorial Comment on: Ureteroscopic High-Frequency Dusting Utilizing a 120-W Holmium Laser by Tracey et al.
No full textinfo:eu-repo/semantics/acceptedVersio
Comparison of different histological indexes in the assessment of UC activity and their accuracy regarding endoscopic outcomes and faecal calprotectin levels.
No full textOBJECTIVE:
Histological remission is being increasingly acknowledged as a therapeutic endpoint in patients with UC. The work hereafter described aimed to evaluate the concordance between three histological classification systems-Geboes Score (GS), Nancy Index (NI) and RobartsHistopathologyIndex (RHI), as well as to evaluate their association with the endoscopic outcomes and the faecal calprotectin (FC) levels.
DESIGN:
Biopsy samples from 377 patients with UC were blindly evaluated using GS, NI and RHI. The results were compared with the patients' Mayo Endoscopic Score and FC levels.
RESULT:
GS, NI and RHI have a good concordance concerning the distinction between patients in histological remission or activity. RHI was particularly close to NI, with 100% of all patients classified as being in remission with NI being identified as such with RHI and 100% of all patients classified as having activity with RHI being identified as such with NI. These scores could also predict the Mayo Endoscopic Score and the FC levels, with their sensitivity and specificity levels depending on the chosen cut-offs. Moreover, higher FC levels were statistically associated with the presence of neutrophils in the epithelium, as well as with ulceration or erosion of the intestinal mucosa.
CONCLUSIONS:
GS, NI and RHI histopathological scoring systems are comparable in what concerns patients' stratification into histological remission/activity. Additionally, FC levels are increased when neutrophils are present in the epithelium and the intestinal mucosa has erosions or ulcers. The presence of neutrophils in the epithelium is, indeed, the main marker of histological activity.info:eu-repo/semantics/publishedVersio
Sexuality, emotionality, healthy responsibility: take care of yourself A sexual education project
No full textINTRODUCTION. Adolescence is a period of doubt and discovery, during which the biggest problems related to the discovery of sexuality arise. Portugal is part of the European countries with the largest number of teenage mothers. Despite the rising availability of information in this area, this phenomenon still occurs with all the negative consequences involved. This project intends to develop and implement a Sexual Education project named "Sexuality, Emotionality, Responsibility: Take Care of Yourself", which aims at promoting healthy behaviours on an individual and group level (prevention, self-protection and protection of others).
METHODS. This is an action research project. During first phase, a questionnaire will be applied to teenagers (10 to 18 years of age), who attend a group of schools in Lisbon area. Subsequently, "Love Workshops" will be implemented, aiming at progressively developing self-responsibilization, promoting physical, psychological, and social health. In schools, dialogue and discussion areas between students, parents, teachers and, eventually, other professionals will be created. Peer education will be one of the used strategies because prevention messages will thus be adapted to different values and needs of each peer group, mediated by "Affection Ambassadors", facilitating behavioural change. At the final phase, people involved will assess the intervention process.
CONCLUSIONS. We hope to be able to promote prioritization of sexual education as a determinant of health, contributing to empowerment and emotional development of teenagers, aiming at healthy and responsible sexuality, through nursing interventions that use dynamic methods focused on the teenager and the group.info:eu-repo/semantics/publishedVersio
Sleep-related hypermotor epilepsy and peri-ictal hypotension in a patient with syntaxin-1B mutation.
No full textSTX1B is a gene that encodes syntaxin-1B. STX1B mutations have recently been implicated in fever-associated epilepsy syndromes. However, these have not previously been reported in sleep-related hypermotor epilepsy. A 20-year-old man with a strong family history of epilepsy was investigated in our epilepsy monitoring unit due to uncontrolled epilepsy, compatible with sleep-related hypermotor epilepsy. Electroclinical and polygraphic physiological recordings revealed left frontal epileptiform discharges and prominent peri-ictal hypotension. Normal MRI using an epilepsy protocol prompted a search for a genetic epilepsy, which revealed a likely pathogenic mutation in the STX1B gene. The patient remained seizure-free after treatment optimization with carbamazepine. This case suggests that a sleep-related hypermotor epilepsy phenotype can be associated with syntaxin-1B gene mutation, and testing for this gene should be considered in such patients. Furthermore, it may also be concluded that autonomic dysfunction, characterized by peri-ictal hypotension, can also occur in this discorder. [Published with video sequences on www.epilepticdisorders.com].info:eu-repo/semantics/publishedVersio
Ghost Infarct Core and Admission Computed Tomography Perfusion: Redefining the Role of Neuroimaging in Acute Ischemic Stroke
No full textBACKGROUND:
Determining the size of infarct extent is crucial to elect patients for reperfusion therapies. Computed tomography perfusion (CTP) based on cerebral blood volume may overestimate infarct core on admission and consequently include ghost infarct core (GIC) in a definitive lesional area.
PURPOSE:
Our goal was to confirm and better characterize the GIC phenomenon using CTP cerebral blood flow (CBF) as the reference parameter to determine infarct core.
METHODS:
We performed a retrospective, single-center analysis of consecutive thrombectomies of middle cerebral or intracranial internal carotid artery occlusions considering noncontrast CT Alberta Stroke Program Early CT Score ≥6 in patients with pretreatment CTP. We used the RAPID® software to measure admission infarct core based on initial CBF. The final infarct was extracted from follow-up CT. GIC was defined as initial core minus final infarct > 10 mL.
RESULTS:
A total of 123 patients were included. The median National Institutes of Health Stroke Scale score was 18 (13-20), the median time from symptoms to CTP was 188 (67-288) min, and the recanalization rate (Thrombolysis in Cerebral Infarction score 2b, 2c, or 3) was 83%. Twenty patients (16%) presented with GIC. GIC was associated with shorter time to recanalization (150 [105-291] vs. 255 [163-367] min, p = 0.05) and larger initial CBF core volume (38 [26-59] vs. 6 [0-27] mL, p < 0.001). An adjusted logistic regression model identified time to recanalization < 302 min (OR 4.598, 95% CI 1.143-18.495, p = 0.032) and initial infarct volume (OR 1.01, 95% CI 1.001-1.019, p = 0.032) as independent predictors of GIC. At 24 h, clinical improvement was more frequent in patients with GIC (80 vs. 49%, p = 0.01).
CONCLUSIONS:
CTP CBF < 30% may overestimate infarct core volume, especially in patients imaged in the very early time window and with fast complete reperfusion. Therefore, the CTP CBF technique may exclude patients who would benefit from endovascular treatment.info:eu-repo/semantics/publishedVersio
Impacto da terapêutica conservadora de órgão do carcinoma do pénis na função sexual e erétil
No full textPenile carcinoma is one of the less frequent tumors of the genitourinary system, however its effect on the patients' sex life and quality of life is of great impact. Studies about the influence on patients' sex life are scarce.
OBJECTIVES:
To characterize sexual activity with penetration of patients with penile carcinoma who underwent different conservative therapeutic approaches and to evaluate pre and post treatment erectile function. Secondarily, to compare the results between the patients who underwent partial penectomy to those subjected to other conservative therapies.
MATERIAL AND METHODS:
Review of patients' records diagnosed with penile carcinoma and observed at the Portuguese Institute of Oncology of Oporto between 2005 and 2015, to obtain demographic, clinical and histopathological data. Telephone interviews for the completion of the International Index of Erectile Function-5 (IIEF-5) questionnaire to patients undergoing treatment in that period.
RESULTS:
16 out of the 107 patients met the inclusion criteria (n=16), with an average IIEF-5 score of 23.44 (10-25), lowering this value to 16.56 (5-25) after therapy, p<0,05. Fifteen out of the 16 patients kept sexual activity (93.8%) and one (6.25%) suspended due to erectile dysfunction. IIEF-5 score after treatment in the subgroup that underwent partial penectomy was lower when compared to the other subgroup of patients subjected to others conservative therapies, without statistical significance.
CONCLUSION:
Although penile carcinoma treatment has an impact in erectile function with statistical significance, the majority of patients keeps an active sexual life with penetration after treatment. It's not possible to conclude that less invasive therapies are associated with better erectile function.info:eu-repo/semantics/publishedVersio
Advanced Directives and Living Will: A Case Report
Get PDFDescreve-se o caso de uma mulher de 61 anos, com diagnóstico de neoplasia da mama em estadio IV. Na altura, recusou
terapêutica. Recorre ao Serviço de Urgência, um ano após o
diagnóstico, em mutismo, sendo que os exames complementares de diagnóstico revelaram uma lesão cerebral, interpretada como nova metástase. No seu processo clínico, tem uma
diretiva antecipada de vontade. Este é um documento formal
que explicita quais os cuidados que pretende ou não receber
em final de vida. Apresentamos a descrição do caso, as indicações que a doente deixou expressas neste documento e
uma reflexão acerca das diretivas antecipadas de vontade e
de como estas devem ser integradas na prática clínica.info:eu-repo/semantics/publishedVersio