Browsing by Author "Figueiredo, I"
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- Clinical Adverse Events in Elderly Hospitalized Patients in a Medical Ward - a Prospective StudyPublication . Vieira Alves, R; Fernandes, M; Figueiredo, I; Drummond Borges, D; Antunes, MIntroduction: Studies to date describe between 3% to 50% of patients experiencing one or more clinical adverse event (CAE) during their hospital admission and many preventable. The aim of this prospective study was to determine the frequency of medical CAEs in a medical ward. Also the study aimed to compare data between patient age groups and determine the effect on length of hospital stay and mortality. Methods: This is a prospective study, consulting patients’ electronic clinical notes over 6 months . Every week, all patient electronic processes were reviewed, and CAEs noted. The episode was only noted if the episode was clearly labeled as a CAEs by the medical team in the patient´s notes. If confounding factors were present, this episode was excluded. Patients were grouped by age; compared in terms of demographics, comorbidities, diagnosis at admission and readmission rate. Primary outcomes included mean length of stay and mortality. Results: 62 episodes were studied, 14.8% of those admitted to hospital experienced a CAE. The most frequent adverse events included analytical alterations, anemia and blood loss, infection and altered state of consciousness. The most commonly implicated therapies were anticoagulants (23%) which lead to episodes of bleeding, anti-hypertensive and diuretics (17%) immunosuppressive therapy (16%) beta blockers (1%) and insulin (1%). Mean length of stay in hospital was 17 days in all groups, longer than the average length of stay of this medical ward which is 11 days. Mortality rate within one year of hospitalization was 30% in total, again significantly higher than the 10% mortality rate calculated for the same period on the ward. Conclusion: This study demonstrates that CAEs are still far too common, probably underestimated, cause serious harm to patients and strains healthcare services further.
- Multidrug-Resistant Klebsiella Pneumoniae Meningitis Successfully Treated with Intrathecal ColistinPublication . Furtado, F; Figueiredo, I; Iraneta, A; Matos, M; Gouveia, C; Varandas, LBackground: Multidrug-resistant (MDR) gram negative bacteria meningitis has become a clinical entity with increasing importance in recent years. Intrathecal colistin (ITH) has been used in the treatment of this cases. Aims: To report one case of MDR Klebsiella pneumoniae meningitis and ventriculitis successfully treated with ITH colistin. Case Report: Nine months old boy, born at 28 weeks of gestational age, diagnosed with neonatal meningitis, complicated with tetraventricular hydrocephalus requiring ventriculo-peritoneal shunt (VPS) placement and multiple shunt revisions. Admitted for worsening hydrocephalus. Cerebrospinal fluid (CSF) cultures were positive for extended-spectrum β-lactamase (ESBL) Klebsiella pneumoniae, only sensitive to meropenem and amikacin. Intravenous meropenen was started but CSF cultures remained positive and shunt device could not be removed. Although susceptibility to colistin was not available, on day 24 intrathecal colistin(4mg/day) was started through an external shunt. CSF white blood cell count improved and cultures became negative. Colistin was stopped after 19 days because of CSF pleocitosis and meropenen maintained for a total of 2 months with clinical improvement. Conclusion: In Klebsiella pneumoniae meningitis with ventriculitis, ITH colistin can be considered a safe, effective, and practicable alternative treatment when parental administration fails.
- A Rare Variant of the Ulnar Artery with Important Clinical Implications: a Case ReportPublication . Casal, D; Pais, D; Toscano, T; Bilhim, T; Rodrigues, L; Figueiredo, I; Aradio, S; Almeida, MA; Goyri-O'Neill, JBACKGROUND: Variations in the major arteries of the upper limb are estimated to be present in up to one fifth of people, and may have significant clinical implications. CASE PRESENTATION: During routine cadaveric dissection of a 69-year-old fresh female cadaver, a superficial brachioulnar artery with an aberrant path was found bilaterally. The superficial brachioulnar artery originated at midarm level from the brachial artery, pierced the brachial fascia immediately proximal to the elbow, crossed superficial to the muscles that originated from the medial epicondyle, and ran over the pronator teres muscle in a doubling of the antebrachial fascia. It then dipped into the forearm fascia, in the gap between the flexor carpi radialis and the palmaris longus. Subsequently, it ran deep to the palmaris longus muscle belly, and superficially to the flexor digitorum superficialis muscle, reaching the gap between the latter and the flexor carpi ulnaris muscle, where it assumed is usual position lateral to the ulnar nerve. CONCLUSION: As far as the authors could determine, this variant of the superficial brachioulnar artery has only been described twice before in the literature. The existence of such a variant is of particular clinical significance, as these arteries are more susceptible to trauma, and can be easily confused with superficial veins during medical and surgical procedures, potentially leading to iatrogenic distal limb ischemia.
- Readmissions in Elderly Patients with Heart Failure. A Retrospective StudyPublication . Vieira Alves, R; Fernandes, M; Figueiredo, I; Drummond Borges, D; Lourenço, FHeart failure is a major cause of morbidity and mortality worldwide. The prevalence increases with age and usually progresses, leading to repeated hospital admissions and significant symptom burden for patients. The correct management of these patients may decrease readmissions and increase quality of life. Our aim is to compare elderly patients with and without 1-year readmissions in an internal medicine ward, particularly in terms of mortality. Retrospective study, consulting patient’s clinical records, with a diagnosis of heart failure. The patients were characterized and divided in groups: with (wR) and without readmission (woR) within 1 year. Mortality was the primary outcome. Eighty-nine patients were included; 60 woR and 29 wR. There was no gender dif ference between groups, the wR group had older patients. The most frequent comor bidities included atrial fibrillation, hyper tension and chronic renal failure stage 3 or higher. The most frequent cause of hospitalization was heart failure due to insufficient therapy or natural progression of the dis ease. The etiology of heart failure was mainly hypertensive and ischemic. The wR group had more patients classified as NYHA >III . In relation to the primary outcome; mortality at 12 months was higher in the group with repeated admissions . The characterization of this population allows us to highlight the causes of decompensation and to review medication in order to increase the quality of life.