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Fractional Flow Reserve in Patients With Acute Coronary Syndrome: From Deferral to Risk Stratification.
No full textinfo:eu-repo/semantics/publishedVersio
Clinicopathologic predictors of renal outcomes in light chain cast nephropathy: a multicenter retrospective study
Full text linkLight chain cast nephropathy (LCCN) in multiple myeloma often leads to severe and poorly reversible acute kidney injury. Severe renal impairment influences the allocation of chemotherapy and its tolerability; it also affects patient survival. Whether renal biopsy findings add to the clinical assessment in predicting renal and patient outcomes in LCCN is uncertain. We retrospectively reviewed clinical presentation, chemotherapy regimens, hematologic response, and renal and patient outcomes in 178 patients with biopsy-proven LCCN from 10 centers in Europe and North America. A detailed pathology review, including assessment of the extent of cast formation, was performed to study correlations with initial presentation and outcomes. Patients presented with a mean estimated glomerular filtration rate (eGFR) of 13 ± 11 mL/min/1.73 m2, and 82% had stage 3 acute kidney injury. The mean number of casts was 3.2/mm2 in the cortex. Tubulointerstitial lesions were frequent: acute tubular injury (94%), tubulitis (82%), tubular rupture (62%), giant cell reaction (60%), and cortical and medullary inflammation (95% and 75%, respectively). Medullary inflammation, giant cell reaction, and the extent of cast formation correlated with eGFR value at LCCN diagnosis. During a median follow-up of 22 months, mean eGFR increased to 43 ± 30 mL/min/1.73 m2. Age, β2-microglobulin, best hematologic response, number of cortical casts per square millimeter, and degree of interstitial fibrosis/tubular atrophy (IFTA) were independently associated with a higher eGFR during follow-up. This eGFR value correlated with overall survival, independently of the hematologic response. This study shows that extent of cast formation and IFTA in LCCN predicts the quality of renal response, which, in turn, is associated with overall survival.info:eu-repo/semantics/publishedVersio
A Violência no Local de Trabalho em Instituições de Saúde: Um Estudo Monocêntrico sobre Causas, Consequências e Estratégias de Prevenção
Full text linkIntroduction: Workplace violence is one of the main risk factors in the professional world. Healthcare workers are at higher risk when
compared to other sectors. Our study aimed to characterize physical and verbal violence in a public hospital and to define occupational
health prevention and surveillance strategies.
Material and Methods: Single center observational cross-sectional study, carried amongst healthcare workers in a public hospital in
Lisbon. A qualitative survey was carried out through six in-depth interviews. A quantitative survey was carried through questionnaires
delivered to 32 workers. A significance level of 5% was accepted in the assessment of statistical differences. The Mann-Whitney test
and the Fisher’s exact test were used to calculate p values.
Results: The main results are: (1) 41 violence incidents were reported in the quantitative phase; (2) 5/21 [23.81%] victims notified
the incident to the occupational health department; (3) 18/21 [85.71%] victims reported a permanent state of hypervigilance; (4) 22/28
[78.57%] participants self-reported poor or no familiarity with internal reporting procedures; (5) 24/28 [85.71%] participants believed it
is possible to minimize workplace violence.
Discussion: Workplace violence is favored by unrestricted access to working areas, absence of security guards and police officers
or scarce intervention. The low notification rate contributes to organizational lack of action. The state of hypervigilance reported in our
study reflects the negative effects of threatening occupational stressors on mental health.
Conclusion: Our results show that workplace violence is a relevant risk factor that significantly impacts workers’ health in a noxious
manner, deserving a tailored occupational health approach whose priority areas and strategies have been determined.Introdução: A violência no local de trabalho é um dos principais fatores de risco no mundo do trabalho. Os trabalhadores da saúde
apresentam um risco superior. O nosso estudo teve como objetivo caracterizar a violência física e verbal num hospital público e definir
estratégias de prevenção e vigilância em saúde ocupacional.
Material e Métodos: Estudo observacional transversal monocêntrico, conduzido num hospital público em Lisboa com trabalhadores
da saúde. Foi realizado um inquérito qualitativo com entrevistas em profundidade a seis trabalhadores e um inquérito quantitativo
com questionários a 32 trabalhadores. Aceitou-se um nível de significância de 5% na avaliação das diferenças estatísticas. O teste de
Mann-Whitney e o teste exato de Fisher foram usados para calcular os valores de p.
Resultados: Os principais resultados são: (1) 41 episódios reportados na fase quantitativa; (2) 5/21 [23,81%] vítimas notificaram o incidente; (3) 18/21 [85.71%] vítimas reportaram estados de hipervigilância permanente; (4) 22/28 [78,57%] participantes não conheciam
ou conheciam mal os procedimentos de notificação; (5) 24/28 [85,71%] consideravam possível minimizar o problema.
Discussão: A violência é favorecida pelo acesso livre às zonas de trabalho, ausência de agentes de segurança e polícia ou falta da
respetiva intervenção. A baixa notificação contribui para a ausência de medidas organizacionais. O estado de hipervigilância relatado
reflete o efeito prejudicial da exposição a fontes de stress e ameaça.
Conclusão: A violência no local de trabalho é um fator de risco relevante, com impacto negativo na saúde dos trabalhadores e merece
uma abordagem individualizada no âmbito da saúde ocupacional, cujas áreas e estratégias prioritárias foram definidas neste estudo.
Palavras-chave: Fatores de Risco Profissionais; Prevenção; Saúde Ocupacional; Trabalhadores da Saúde; Violência no Local de trabalho.info:eu-repo/semantics/publishedVersio
SomosHFF (30): Newsletter do Hospital Prof. Dr. Fernando Fonseca, E.P.E.
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Surgical Training During and After COVID-19: A Joint Trainee and Trainers Manifesto
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Morgagni hernia in incremental peritoneal dialysis: Is it possible to continue with the technique?
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Ganglion Impar Neurolysis in the Management of Pelvic and Perineal Cancer-Related Pain.
Full text linkCancer-related pain is a very prevalent problem in all stages, with 10% of patients requiring invasive techniques for adequate pain management. Ganglion impar neurolysis has been used in the treatment of pelvic-perineal pain with efficacy and rare complications, but only a few case or series reports in cancer patients have been published. We report the case of a patient presenting with an ovarian carcinoma (FIGO stage IIIC), who had several disease relapses at the colorectal transition and need for palliative colic prosthesis. She presented later with anorectal pain associated with a rectovaginal fistula, which had an important impact on the activities of her daily life. She was submitted to two ganglion impar neurolyses, which resulted in improved pain control for a total of 5 months, an important improvement in her quality of life, and reduction of opioid consumption. The authors aim to alert to the importance of pain control and to address the fourth step of the WHO analgesic ladder as an option for cancer patients, including palliative patients.info:eu-repo/semantics/publishedVersio
Massive Hematometra With Bilateral Hematosalpinx
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Tendências Seculares na Mortalidade por Doenças Cerebrovasculares em Portugal: 1902-2012
Full text linkIntroduction: Cerebrovascular diseases (CVD) are one of
the main causes of death in Portugal. Research on the epidemiologic history might help to understand the phenomenon
and guide intervention strategies. Objectives: (1) Describe historic trends in mortality. (2) Estimate the impact of demographic variations on the registered number of cases.
Methods: (1) We calculated rates, specific and standardized, for deaths registered as CVD (ICD-10: I60-I69, G45; ICD8/9: 430-438; ICD-6/7: 330-334) by sex (1902-2012) and by
sex and age groups (1913-2012). We used Join point analysis to identify statistically significant changes in standardized
death rates, and multivariate regression models, Poisson and
negative binomial, controlling for demographic dynamics and
time trend, from 1913 to 2012. (2) We calculated the contribution of demographic variations using the application RiskDiff.
(3) We evaluated if changes in coding rules might have been
a source of bias. Data source: National Institute of Statistics.
Results: (1) We gathered the longest and most discriminated mortality series from CVD in Portugal with data since the
beginning of nationwide collection. Mortality increases exponentially with age and is higher in men. (2) We observed significant variations in age-standardized time trends (1913-1933:
APC 2.0%; 1933-1955: APC -0.9%; 1955-1974: 2.9%; 1974-
1996: -2.4%; 1996-2012: -6.5%). (3) Population ageing exerted a significant pressure to increase the number of deaths,
particularly in the second half of the twentieth century. However, this effect was counterweighted by protective factors.
Conclusion: CVD mortality in Portugal is particularly expressive when compared to other European countries, although significant gains have been observed in the last decades. Population ageing combined with a transition between the morbid
and mortality dimensions changed the public health paradigm.Introdução: As doenças cerebrovasculares (DCV) são uma
das principais causas de morte em Portugal. O estudo da
história epidemiológica deste fenómeno contribui para a sua
compreensão e ajuda a orientar estratégias de intervenção.
Objetivos: (1) Descrever tendências históricas na mortalidade.
(2) Estimar o impacto das variações demográficas no número
de casos registado.
Métodos: (1) Calculámos taxas, específicas e padronizadas, para as mortes registadas como resultantes de DCV
(CID-10: I60-I69, G45; ICD-8/9: 430-438; ICD-6/7: 330-334)
por sexo (1902-2012) e por sexo e grupos etários (1913-
2012). Utilizámos Joinpoint-analysis para identificar variações
estatisticamente significativas na tendência temporal e modelos multivariados de regressão, Poisson e binomial negativo,
controlando dinâmicas demográficas e tendências temporais,
constrangidos à população exposta, de 1913 a 2012. (2) Aferimos o peso relativo de variações demográficas recorrendo à aplicação RiskDiff. (3) Avaliámos se as interrupções na
continuidade das séries definidas por alterações nos critérios
de codificação da causa de morte podem ter constituído factores confundentes. Fontes dos dados: Instituto Nacional de
Estatística.
Resultados: (1) Elencámos a mais longa e discriminada
série de mortalidade por DCV em Portugal com dados desde
que há registo com abrangência nacional. A mortalidade aumenta exponencialmente com a idade e é superior nos homens. (2) Observámos variações significativas na direcção
e amplitude da tendência temporal das taxas padronizadas
(1913-1933: APC 2,0%; 1933-1955: APC -0,9%; 1955-1974:
2,9%; 1974-1996: -2,4%; 1996-2012: -6,5%). (3) O envelhecimento demográfico exerceu uma pressão significativa para
o aumento no número de casos particularmente na segunda
metade do século XX. No entanto este efeito foi neutralizado
por factores protectores.
Conclusão: Em Portugal a DCV é particularmente
expressiva quando comparada com outros países da Europa embora se tenham observado ganhos significativos nas
últimas décadas. O envelhecimento demográfico combinado
com uma eventual transição relativa entre as dimensões morbil e de mortalidade proporcionaram uma mudança no paradigma de saúde pública.info:eu-repo/semantics/publishedVersio