Hospital de Santa Maria
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Maternal and Fetal Outcomes in Pregnant Women with Psoriatic Arthritis: A Systematic Literature Review
Full text linkBackground/Purpose: The onset of psoriatic arthritis (PsA) often occurs between the ages of 30 and 50 years. Accordingly, many female patients are diagnosed during childbearing age, potentially impacting their pregnancy outcomes. However, there is a paucity of data concerning the fetal and maternal outcomes in this population and most of the information is extrapolated from studies on rheumatoid arthritis (RA). We aim to review the available evidence on the relationship between PsA and adverse pregnancy outcomes. Methods: We systematically searched two databases, PubMed and Embase, for original studies from inception of the databases until May 31, 2020, addressing fetal and maternal outcomes in pregnant women with PsA. A variety of terms adjusted to the specificities of the two databases and related to key subject areas of the review question were used. The search was filtered to only include human participants and publications in English. The eligible studies had to present a comparator group (healthy individuals or patients without known auto-immune rheumatic diseases -ARD's), as well as at least one clinical outcome of interest. Studies including patients with other ARD's were eligible only if results from patients with PsA were presented separately. Two authors independently selected studies and extracted data. Results: Of a total of 708 references, 5 observational studies fulfilled the inclusion criteria: 3 prospective and 2 retrospective studies (table 1). Concerning maternal outcomes, the odds of delivery by caesarian section was higher among PsA women compared with the control groups, in 3 out of 4 studies. However, the majority of studies did not find an increased risk of pre-eclampsia or gestational hypertension among PsA patients. Likewise, no study has found an increased risk of gestational diabetes in pregnant women with PsA. Maternal and fetal outcomes in PsA patients. Regarding fetal outcomes, 3 studies revealed an increased risk of preterm birth in PsA patients, out of 4 studies reporting this outcome. Spontaneous miscarriages, stillbirths, neonatal deaths and small for gestational age newborns occurred at similar rates in women with PsA and the comparator groups, across the different studies. Only one of the included studies, has assessed the influence of disease activity in the outcomes. Smith et al observed that active disease (defined as RAPID3 score ≥ 7 and HAQ >0.5) at 32 weeks of gestation increased the risk for preterm birth in PsA. Conclusion: Despite the limited available data, these studies suggest an increased risk for delivery by caesarian section and preterm births among pregnant women with PsA. Increased disease activity seems to contribute to a higher risk of preterm birth as in RA. Nonetheless, this effect should be further examined.info:eu-repo/semantics/publishedVersio
Anaphylaxis in an emergency department: a retrospective 10-year study in a tertiary hospital
Full text linkBackground. Anaphylaxis is a potentially fatal medical emergency. The frequency of hospital admissions for anaphylaxis seems to be increasing in the recent decades. Objective. Characterize the patients admitted for anaphylaxis to the adult emergency department (ED) of a tertiary care hospital over a 10-year period, discriminating aetiologies, clinical features and therapy administered. Methods. Retrospective, descriptive and inferential study, evaluating age, sex, Manchester triage system, suspected allergen, site of allergen exposure, comorbidities, cofactors, clinical findings and symptoms, treatment and management. Patients admitted between January 2007 and December 2016 were included. Results. Forty-three patients were enrolled: 23 males, mean age 54.3 ± 16.2 years, n = 22 had history of allergic disease. Two patients were triaged as non-urgent. The most frequently suspected causes of anaphylaxis were: drugs (33%, n = 14), Hymenoptera venoms (23%, n = 10), foods (21%, n = 9) and iodinated contrast products (12%, n = 5). Adrenaline was used in 88% of the episodes (n = 38), 55% of which (n = 21) intramuscularly. Mortality was registered in one case. At discharge, adrenaline auto-injector was prescribed in 7% (n = 3) of the patients, and Allergy and Clinical Immunology consultation (ACIC) was requested in 65% of the episodes (n = 28). Statistically significant associations (p minor 0.05) were established: a, anaphylaxis to drugs associated with a low intramuscular adrenaline use and with frequent oxygen therapy; b, anaphylaxis to food associated with intramuscular adrenaline administration; c, anaphylaxis to Hymenoptera venom associated with male sex; and d, anaphylaxis to iodinated contrasts associated with referral to ACIC and with shock. All obese patients developed shock. Conclusions. Anaphylaxis is a life-threatening condition that requires early recognition. Although most patients received adrenaline, administration was not always performed by the recommended route and only a few patients were prescribed adrenaline auto-injector.info:eu-repo/semantics/publishedVersio
Desartrodese de anca – relato de três casos
Full text linkHip desarthrodesis, which is the conversion of an arthrodesis or of a surgical bone fusion into a hip replacement arthroplasty, is a difficult and challenging operation because of the need of a joint reconstruction in cases with bone fusion and an often long-term immobilization between the femur and the acetabulum, with important anatomic changes, retractions of adjacent soft tissues, and an associated limb shortening. Hip arthrodesis is an operation performed less and less; consequently, its desarthrodesis is even rarer. The present report details three rare cases of patients with long-term hip arthrodesis who were submitted to hip replacement conversion arthroplasty; it describes the applied surgical techniques and their clinical and functional outcomes.info:eu-repo/semantics/publishedVersio
Mesa 1 – Oncologia Urológica: Caso clínico de hematúria; Cancro da bexiga; Aspectos práticos nos cuidados com as urostomias; Caso clínico de neoplasia do rim; Tumor do pénis
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A Vibrant Community of Readers, Authors and Reviewers: A Medical Editors' Necessity and a Challenge for Medical Education
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Mesa 8 – Disfunções vesicais:Como diagnosticar, tratar e seguir uma disfunção vesical......no feminino...no masculino...no doente neurológico
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Mesa 9 – Urologia pediátrica: Hidronefrose congénita; Hipospadias; Testículo mal-descido
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Vascular effects of a polyphenolic fraction from Oxalis pes-caprae L.: role of α-adrenergic receptors Sub-types
Full text linkOxalis pes-caprae L. is a plant of the Oxalidaceae family, from which several compounds have been previously identified. Recently, we showed that an Oxalis pes-caprae L. extract inhibits the vasopressor effect of noradrenaline. In this work we aimed to explore the mechanisms involved in this effect. The results confirmed that the flavonoid fraction present in the extract inhibits noradrenaline-induced contractions and that this effect is concentration-dependent. Also, a parallel shift to the right in the noradrenaline concentration-response curve was observed, suggesting a decrease in efficacy and also in potency. Together these results support the assumption that the extract could exert a non-competitive antagonism on the α-adrenergic receptors. However, experiments in the presence of competitive antagonists for α-adrenergic receptor sub-types (i.e. prazosin, yohimbine and phentolamine) showed that the effect may not be directly mediated by α-adrenergic receptors. Thus, the interaction of this extract with the adrenergic system remains to be confirmed.info:eu-repo/semantics/publishedVersio