Hospital de Santa Maria
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Variação sazonal e influência de fatores meteorológicos na incidência de descolamentos regmatógenos da retina na zona centro de Portugal e na Madeira
Get PDFObjetivos: Analisar a variação sazonal e a influência de fatores meteorológicos na incidência
a 5 anos de descolamento regmatógeno da retina (DRR), na região centro do país e região autónoma
da Madeira (RAM).
Métodos: Série de casos consecutiva, retrospetiva e multicêntrica. Incluíram-se doentes submetidos
a cirurgia de DRR no Centro Hospitalar e Universitário de Coimbra e Hospital Doutor
Nélio Mendonça entre Janeiro’10 e Dezembro’14. A seleção de casos foi feita através codificação
ICD-9-CM e os critérios de inclusão foram: 1)idade ≥18 anos; 2)DRR de novo; 3)reparação
cirúrgica do DRR. Consideraram-se critérios de exclusão: 1)DR tracional, exsudativo ou misto;
2)DR antigo ou re-descolamento; 3)soluções de continuidade ou lesões regmatógenas tratadas
apenas com laser. Os dados meteorológicos diários das estações de Coimbra, Leiria, Aveiro,
Viseu, Guarda, Castelo Branco e Funchal, foram utilizados na análise estatística.
Resultados: Foram incluídos 1013 olhos (914 da região centro e 99 da RAM), com idade
média 61,84±14,00 anos. Através de um modelo cronológico de regressão linear constatou-se
a presença de sazonalidade com picos nos meses de Maio e Setembro. A temperatura média
apresentou uma associação marginalmente significativa com a incidência de DRR num modelo
biológico de regressão linear considerando os mais fortes preditores de DRR da amostra.
Conclusões: Os nossos resultados demonstram que a incidência de DRR se associa a um padrão
sazonal significativo que parece ser explicado pela temperatura. Este estudo alerta para a
necessidade de um eficaz planeamento em saúde que deverá passar por uma gestão harmoniosa
de recursos humanos em épocas de maior incidência
3D virtual planning in orthognathic surgery and CAD/CAM surgical splints generation in one patient with craniofacial microsomia: a case report
Get PDFOBJECTIVE:
In this case report, the feasibility and precision of tridimensional (3D) virtual planning in one patient with craniofacial microsomia is tested using Nemoceph 3D-OS software (Software Nemotec SL, Madrid, Spain) to predict postoperative outcomes on hard tissue and produce CAD/CAM (Computer Aided Design/Computer Aided Manufacturing) surgical splints.
METHODS:
The clinical protocol consists of 3D data acquisition of the craniofacial complex by cone-beam computed tomography (CBCT) and surface scanning of the plaster dental casts. The ''virtual patient'' created underwent virtual surgery and a simulation of postoperative results on hard tissues. Surgical splints were manufactured using CAD/CAM technology in order to transfer the virtual surgical plan to the operating room. Intraoperatively, both CAD/CAM and conventional surgical splints are comparable. A second set of 3D images was obtained after surgery to acquire linear measurements and compare them with measurements obtained when predicting postoperative results virtually.
RESULTS:
It was found a high similarity between both types of surgical splints with equal fitting on the dental arches. The linear measurements presented some discrepancies between the actual surgical outcomes and the predicted results from the 3D virtual simulation, but caution must be taken in the analysis of these results due to several variables.
CONCLUSIONS:
The reported case confirms the clinical feasibility of the described computer-assisted orthognathic surgical protocol. Further progress in the development of technologies for 3D image acquisition and improvements on software programs to simulate postoperative changes on soft tissue are requiredinfo:eu-repo/semantics/publishedVersio
A novel haemoglobin variant mimicking cyanotic congenital heart disease
Get PDFScreening for critical congenital heart defects in newborn babies can aid in early recognition, with the prospect of improved outcome. However, as this universal newborn screening is implemented, there will be an increasing number of false-positive results. In order to avoid multiple investigations and uncertainty, an haemoglobin (Hb) variant must be included in the differential diagnosis in otherwise well newborns with low oxygen saturation by pulse oximetry. We describe a novel fetal Hb variant (heterozygous γ-globin gene (HBG1) mutation in exon 2 c.202G>A (p.Val68Met)) identified in a newborn with positive pulse oximetry screening for congenital heart disease.info:eu-repo/semantics/publishedVersio
Acute Intoxications in an Intensive Care Department: Years 2002 to 2014
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Major Depressive Disorder: psychiatric nosology's 'black dog'
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Drug-Induced Acute Pancreatitis and Pseudoaneurysms: An Ominous Combination
Get PDFRupture of pseudoaneurysms is rare but can be life-threatening complications of acute or chronic pancreatitis, usually due to enzymatic digestion of vessel walls crossing peripancreatic fluid collections. We report the case of a 40 year-old female, with multisystemic lupus and anticoagulated for prior thrombotic events, admitted for probable cyclosporine-induced acute pancreatitis. Hemodynamic instability occurred due to abdominal hemorrhage from two pseudoaneurysms inside an acute peri-pancreatic collection. Selective angiography successfully embolized the gastroduodenal and pancreatoduodenal arteries. The hemorrhage recurred two weeks later and another successful embolization was performed and the patient remains well to date. The decision to restart anticoagulants and to suspend cyclosporine was challenging and required a multidisciplinary approach. Despite rare, bleeding from a pseudoaneurysm should be considered when facing a patient with pancreatitis and sudden signs of hemodynamic instability.info:eu-repo/semantics/publishedVersio
Total ruptures of the extensor apparatus of the knee
Get PDFOBJECTIVE:
This was a retrospective case-control study on total ruptures of the extensor apparatus of the knee, aimed to compare patella fractures with tendinous ruptures.
METHODS:
The sample included 190 patients and 198 total ruptures of the knee extensor apparatus. All patients were evaluated by the same examiner after a minimum one-year follow-up.
RESULTS:
Tendinous ruptures occurred most frequently in men, in younger patients, and had better clinical and functional outcomes when compared with patella fractures; however, the former presented higher levels of thigh atrophy. Patella fractures occurred most frequently in women and in older patients and caused most frequently caused residual pain, muscle weakness, and limitations in daily activities. Comminuted fractures were related to high-energy trauma, lower clinical and functional outcomes, and higher levels of residual pain and osteosynthesis failure. Early removal of osteosynthesis material was related to better outcomes. Regarding the tendinous ruptures, over half of the patients presented risk conditions for tendinous degeneration; a longer delay until surgery was related to lower Kujala scores.
CONCLUSION:
The surgical repair of bilateral ruptures of the knee extensor apparatus resulted in satisfactory clinical and functional outcomes, which were better for tendinous ruptures when compared with patella fractures. However, these lesions are associated with non-negligible levels of residual pain, muscle weakness, atrophy, and other complications.info:eu-repo/semantics/publishedVersio
Bibliographic search strategies for anesthetists
No full textA quantidade de nova informação disponível para médicos está a crescer a uma taxa
exponencial, contudo, a quantidade de tempo que os médicos podem dedicar a fazer
a sua triagem é que não.
Saber qual a ferramenta a usar para cada tipo de informação e estratégias para a
usar com eficácia pode economizar tempo valioso.
O objetivo deste artigo é dar a conhecer os principais recursos de informação e as
técnicas de pesquisa mais sofisticadas. Porque conhecendo as técnicas de pesquisa
mais “elaboradas”, a eficácia na investigação aumentará.
Os recursos listados permitem que a procura e publicação de informação em Medicina
se acelerem e simplifiquem radicalmente. É importante que reconheçam as
oportunidades e limitações dos recursos mencionados, assim como a sua utilidade.
É impossível ser exaustivo nesta abordagem