Repositório da Unidade Local de Saúde São José
Institution's Scientific Repository
Recent Submissions
Dr. Fernando Matias dos Santos Silva.
Publication . Oliveira, Mário Martins
A Portuguese Expert Panel Position Paper on the Management of Heart Failure with Preserved Ejection Fraction - Part II: Unmet Needs and Organization of Care in Portugal.
Publication . Silva-Cardoso, José; Moreira, Emília; Tavares de Melo, Rachel; Moraes-Sarmento, Pedro; Cardim, Nuno; Oliveira, Mário; Gavina, Cristina; Moura, Brenda; Araújo, Inês; Santos, Paulo; Peres, Marisa; Fonseca, Cândida; Pedro Ferreira, João; Marques, Irene; Andrade, Aurora; Baptista, Rui; Brito, Dulce; Cernadas, Rui; Dos Santos, Jonathan; Leite-Moreira, Adelino; Gonçalves, Lino; Ferreira, Jorge; Aguiar, Carlos; Fonseca, Manuela; Fontes-Carvalho, Ricardo; Franco, Fátima; Lourenço, Carolina; Martins, Elisabete; Pereira, Hélder; Santos, Mário; Pimenta, Joana
In Portugal, a 15.2% prevalence of heart failure with preserved ejection fraction (HFpEF) was recently identified among those aged ≥50 years. HFpEF represents 90% of Portuguese heart failure patients. HFpEF management in Portugal is challenging due to patient heterogeneity, diagnostic and therapeutic complexity, and organizational constraints on the healthcare system. Considering the above, a panel of Portuguese experts convened to address HFpEF management within the national context. This was done in a two-paper set. This, the second paper, identifies unmet needs and suggests a set of measures to improve the current organization of HFpEF management in Portugal. Our purpose is to create a multidisciplinary integrated care system, ensuring a seamless connection between hospitals and primary care. Additionally, we propose a practical approach to the management of HFpEF, including a roadmap for screening, diagnosis, referral and treatment. The aim is to help clinicians improve HFpEF management throughout the disease trajectory.
Quality of Life and Performance Status after Cardiopulmonary Resuscitation: A Study in Cova da Beira University Hospital Center's Intensive Care Unit.
Publication . Rodrigues Pratas, Cláudia Raquel; Veiga do Coxo, Cristina Maria; Gonçalves Branco, Vítor Alexandre; Castelo-Branco, Miguel
Introduction and objectives: Cardiac arrest (CA) is associated with high morbidity and mortality. Many studies focus on survival, but few explore the outcomes. The aim of this study is to analyze the survival curve, independence, quality of life, and performance status after CA.
Methods: This retrospective study included adults admitted to the intensive care unit of Cova da Beira University Hospital Center after CA between 2015 and 2019. We analyzed patient records and applied a questionnaire including EuroQoL's EQ-5D-3L and ECOG performance status.
Results: Ninety-seven patients were included (mean age 75.74 years). Thirty-one patients (32.0%) survived to hospital discharge. There was a significant loss of independence for activities of daily living, with 50.0% of those previously independent becoming dependent and 47.5% of those previously at home being institutionalized. Diabetes, female gender, and length of hospital stay were especially impactful on these findings. One year after CA, only 20.6% were alive and only 13.4% (65% of the one-year survivors) were independent. Nine patients answered our questionnaire. Mean EQ-5D quality of life index (0.528±0.297) and the most affected domains ('Pain/discomfort' and 'Anxiety/depression') were similar to the Portuguese population aged >30 years. However, 66.6% reported a decline in their quality of life. Lastly, seven respondents had a good performance status (ECOG 0-1).
Conclusions: There was a significant loss of independence after CA. Moreover, despite the acceptable performance status and the quality of life results being similar to the general population, there was a perceived deterioration post-CA. Ultimately, we emphasize the need to improve care for these patients.
Consumo de Álcool na Perturbação de Hiperatividade e Défice de Atenção
Publication . Ramalheira, Filipa; Paulino, Luis; Vieira, Ana Sofia; Pereira, Madalena; Gonçalves, Filipe; Teixeira, Joana
A Perturbação de Hiperatividade e Défice de Atenção (PHDA) é uma doença do neurodesenvolvimento cujos sintomas e neurobiologia podem conferir risco aumentado de para o consumo abusivo de substâncias tóxicas incluindo o álcool.
A Perturbação de Uso de Álcool (PUA) e PHDA partilham fatores de risco e vários mecanismos neurobiológicos, não sendo de admirar que surjam frequentemente em comorbilidade familiar e no mesmo indivíduo. Por isso, recomenda-se o screening de PHDA nos doentes que procuram ajuda por abuso de substâncias e mesmo PUA.
Nos doentes com PHDA, a PUA inicia-se mais precocemente e associa-se a piores outcomes clínicos e de tratamento. O tratamento da PUA em comorbilidade com a PHDA deve englobar preferencialmente uma abordagem fármaco e psicoterapêutica dirigida a ambas as patologias
Balloon Atrioseptostomy for Transposition of the Great Arteries in Europe: Characteristics and Outcomes.
Publication . Lucron, Hugues; Malekzadeh-Milani, Sophie-Guiti; de Montclos, Thomas Perouse; Baruteau, Alban-Elouen; Mendoza Soto, Alberto; Butera, Gianfranco; Michel-Behnke, Ina; Ovaert, Caroline; Bautista-Rodriguez, Carles; Bentham, James; Jalal, Zakaria; Betrian Blasco, Pedro; Bouvaist, Hélène; Vincenti, Marie; Ferreira Matins, José Diego; Jellimann, Jean-Marc; Callegari, Alessia; Bonnemains, Laurent; Bonnefoy, Ronan; Castaldi, Biagio; Charbonneau, Anne; Dauphin, Claire; Lefort, Bruno; Schubert, Stephan; Brard, Mélanie; Domanski, Olivia; Denis, Charlotte; Wacker, Julie; Maragnes, Pascale; Karsenty, Clément; Loureiro, Petra; Jakob, André; Hascoët, Sébastien; Bonnet, Damien
Introduction and objectives: Balloon atrial septostomy (BAS) improves oxygenation in neonates with transposition of the great arteries (TGA) and restrictive foramen ovale. Currently, there is a global shortage of dedicated BAS catheters, while new unmarked catheters have recently become available at some European centers. This study aimed to characterize BAS outcomes using the currently available BAS catheters in Europe.
Methods: A 2-year multicenter observational registry was conducted, including all neonates undergoing BAS for TGA. We report preliminary results (September 2022-February 2024) focusing on BAS characteristics and outcomes.
Results: A total of 250 BAS procedures were performed in 29 centers. The median neonatal weight was 3.16kg, and 88% of neonates had a prenatal diagnosis. Most procedures were performed often on the first day of life during working hours (72.8%), mainly in catheterization laboratories (59.2%). Guidance primarily involved ultrasound with or without fluoroscopy. A guidewire was used in 41.2% of procedures. A total of 290 catheters (286 Z-5 or Z-6) were used, achieving an overall BAS success rate of 96%. Complete procedural failure was associated with the use of the umbilical venous route (OR, 3.62; P=.001) and lower-volume catheters (OR, 7.01; P<.001). The occurrence of significant complications (8%; OR, 9.33; P<.001) was associated with complete procedural failure. For complex procedures, significant risk factors were the absence of fluoroscopy (OR, 3.32; P=.001), use of the umbilical venous route (OR, 2.28; P=.005), and lower-volume catheters (OR, 2.43; P=.03).
Conclusions: In the current era, BAS can be challenging, and significant complications and complete failures are not uncommon. The use of the umbilical venous route, low-volume BAS catheters, absence of fluoroscopy guidance, and the occurrence of complications negatively impact procedural outcomes.