Browsing by Author "Carvalho, T"
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- A 7 Year Old Girl with Vaginal Burn from Exposure to an Alkaline BatteryPublication . Massa, AC; Tavares, M; Carvalho, T; Simões, MBackground: Vaginal burns resulting from alkaline batteries are a rare and potential serious complication which require a prompt intervention. Case: A 7-year-old girl presented to the emergency department with lower abdominal pain, dysuria and brownish vaginal discharge. Clinical history suggested a foreign body. Abdominal radiography showed two alkaline batteries inside the vagina that were removed. Vaginoscopy revealed severe vaginal burns with necrosis of a large area of posterior cul de sac. Two months after the girl was asymptomatic. Discussion: Vaginal foreign bodies should be considered in pre-pubertal girls presenting with vaginal bleeding. Its removal and assessment of direct effects should be immediately performed.
- Congenital Solitary Functioning Kidney and Other Associated Congenital MalformationsPublication . Carvalho, T; Francisco, T; Santos, R; Abranches, MIntroduction: Congenital solitary functioning kidney (CSFK) is associated to other congenital anomalies. Most of them involve urogenital tract, cardiac, skeletal and central nervous system. There are also some syndromes associated to renal malformations. Objective: To determine the prevalence of associated malformations in children with CSFK. Material and methods: We reviewed 134 electronic processes of children with CFSK followed in a terciary department of paediatric nephrology between 2012 and 2016. Results: Ages ranged from neonatal period to 18 years old (6.6±4.4 years). Prenatal diagnosis of solitary kidney was made in 89 cases (66.4%), and agenesia was the etiology in 33.5%. We found 41 children with at least one more malformation (30.6 %). One quarter of children with postnatal diagnosis of CSFK (7/28) had other anomalies. From all children with diagnosis of agenesia, 80% had at least one more malformation, whereas only 30% of other CSFK’s etiology had other anomaly indentified. Urological anomalies were the most frequent (34.1%); however, 27/41 children (65.8%) had at least one malformation of other system, without an urological anomaly. Gastrointestinal anomalies were identified 21.9%, cardiovascular anomalies 19.5%, genital malformations in 19.5%, neurological anomalies in 14.6% and other organ anomalies in 17%. The non-urological congenital malformation more frequent was single umbilical artery (12.2%). Fourteen children (34.1%) had their anomalies included in a syndrome, all them associated with renal anomalies in previous studies. Chronic kidney disease was seen in five of 134 children, three of which with another malformation. Conclusions: This study intends to recall that CSFK may not be the only congenital malformation in a child. It also highlights that there are other anomalies besides urological tract that may be present and must be investigated, especially if there is a diagnosis of true renal agenesia. A good prenatal care and careful follow-up of children with CSFK are essential.
- Levosimendan in Outpatients with Advanced Heart Failure: Single-Center Experience of 200 Intermittent PerfusionsPublication . Ferreira Reis, J; Gonçalves, A; Ilhão Moreira, R; Pereira-da-Silva, T; Timóteo, AT; Pombo, D; Carvalho, T; Correia, C; Santos, C; Cruz Ferreira, RIntroduction: Patients with advanced heart failure (HF) have high morbidity and mortality, with only a small proportion being eligible for advanced therapies. Intermittent outpatient levosimendan infusion has been shown to provide symptomatic relief and reduce the rate of HF events. Our aim was to assess the safety and efficacy of outpatient levosimendan administration in an advanced HF population. Methods: This is a report of a single-center experience of consecutive advanced HF patients referred for intermittent intravenous outpatient administration of levosimendan, between January 2018 and March 2021. Baseline and follow-up evaluation included clinical assessment, laboratory tests, transthoracic echocardiography and cardiopulmonary exercise testing. Baseline and clinical follow-up data were compared using the Wilcoxon signed-rank test. Results: A total of 24 patients (60.8 years, 83% male, mean left ventricular ejection fraction [LVEF] 24%), with a median of 1.5 HF hospitalizations in the previous six months, were referred for outpatient levosimendan pulses, the majority as a bridge to transplantation or due to clinical deterioration. At six-month follow-up there was a significant reduction in HF hospitalizations to 0.4±0.7 (p<0.001). NYHA class IV (52.2% to 12.5%, p=0.025) and NT-proBNP (8812.5 to 3807.4 pg/ml, p=0.038) were also significantly reduced. Exercise capacity was significantly improved, including peak oxygen uptake (p=0.043) and VE/VCO2 slope (p=0.040). LVEF improved from 24.0% to 29.7% (p=0.008). No serious adverse events were reported. Conclusion: Repeated levosimendan administration in advanced HF patients is a safe procedure and was associated with a reduction in HF hospitalizations, functional and LVEF improvement, and reduction in NT-proBNP levels during follow-up.
- Medical Escort of Critical Care Patients in the Pre-Hospital SettingPublication . Almeida, G; Gusmão, M; Santos, C; Carvalho, T; Amaral, TIntroduction: Pre-hospital emergency cases include the patient’s transportation to the hospital, with an adequate escort, when indicated. In Portugal, secondary transport’s escort is guided by an escort score published by the Portuguese Medical Association’s Guidelines on the Critical Care Patient’s Transport (2008). This score (TS) defines three levels of escort: no medical escort (level A), doctor or nurse escort (level B), doctor and nurse escort (level C). There is no published data on this score’s application to the pre-hospital setting. Such use could improve resource management in the pre-hospital emergency medical services, as it could support the need to involve a doctor and/or nurse in the patient’s escort to the hospital. Our study’s aim is the evaluate the TS application to the pre-hospital context. Study Methods: We gathered data from primary transports’ escorts between January 2015 and January 2017. We recorded whether the patient was taken to hospital or not, and if yes, the transport’s escort (Doctor, Doctor and Nurse, or only emergency technicians). Posteriorly, we calculated the TS for each of those transport records. Any records with incomplete escort data or where the score could not be calculated were excluded. Using this data, we calculated Sensibility (Ss), Specificity (Sp), positive predicitive value (PPV) and negative predictive value (NPV) of the TS for the following situations: Escort by emergency technicians only (level A), escort by doctor or nurse (level B) or escort by doctor and nurse (level C) Results and discussion: We found complete data regarding 556 primary transports 141 patients were escorted by emergency technicians only, 269 by doctor or nurse only, and 146 by a doctor and nurse. TS level A was found to have Ss 85,78%, Sp 70,92%, PPV 89,67% and NPV 62,89% regarding escort by emergency technicians only. These values support the decision of taking no medical escort in a primary transport in the pre-hospital setting when TS is level A. On the other hand, TS level C has Ss 78,08%, Sp 59,72%, PPV 40,57% and NPV 88,36% regarding escort by both a doctor and nurse. These numbers are less clear regarding a decision to take a medical escort. Conclusions: TS appears to be an indicator with enough Ss and Sp to help the pre-hospital team choose whether or not to escort the patient to the hospital with only emergency technicians or with a more differentiated escort, especially when the score’s result is Level A. But it cannot differentiate between doctor or nurse or both doctor and nurse when the result is level B or C. More figures are needed to understand if this score can be implemented as a decision tool regarding the kind of medical escort a patient needs in a primary transport.