Browsing by Author "Santos, C"
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- Abordagem Terapêutica na Perturbação de Hiperatividade com Défice de Atenção em Idade PediátricaPublication . Barrias, P; Nunes Filipe, C; Santos, C; Oliveira, G; Santos, I; Grujo, M; Freitas, PA Perturbação de Hiperatividade com Défice da Atenção (PHDA) é uma Perturbação do Neurodesenvolvimento com individualidade categorial reconhecida e que interfere significativamente com o funcionamento do indivíduo. A intervenção terapêutica deve ser, necessariamente, adaptada à idade e à condição do indivíduo. Quando está indicado o tratamento farmacológico, o metilfenidato tem sido o fármaco mais utilizado. A medicação, apesar da sua eficácia e da simplicidade do seu uso, não deve ser entendida como sendo a única medida a tomar. Tem sido demonstrado que, na maioria dos casos, está aconselhada uma abordagem multimodal, associando a medicação com intervenções psicoeducativas, intervenções comportamentais e mudanças e/ou ajustamentos educacionais. As intervenções não farmacológicas potenciam e complementam os resultados, podendo permitir a construção de estratégias adaptativas que, tanto a curto, como a longo prazo, podem beneficiar o desempenho do paciente.
- Disrafismo Espinhal Oculto - Quando Suspeitar?Publication . Chaves, M; Santos, C; Santos, M; Macedo, I; Miguens, J; Nascimento, O; Valido, AMO disrafismo espinhal oculto inclui todas as situações em que existe um defeito no encerramento do tubo neural ou no seu revestimento, mas cuja lesão resultante é coberta por pele intacta. A apresentação clínica é variável, podendo englobar alterações neurourológicas, malformações ortopédicas ou anomalias cutâneas. A sua incidência global é desconhecida, pois é muitas vezes sub-diagnosticado. Os autores apresentam o caso de um recém-nascido de termo com uma fosseta sagrada e tumefação subcutânea adjacente. A investigação imagiológica revelou lipomielomeningocelo com ancoramento medular e sinus dérmico associado. Como o risco de meningite ascendente não podia ser excluído, a lesão foi removida ao 10º dia de vida com evolução clínica favorável. Pretende-se assim reforçar a importância do exame objectivo rigoroso do recém-nascido e da investigação imagiológica, por ecografia e/ou RMN, de todas as lesões suspeitas da região sacro-coccígea, prevenindo alterações neurológicas graves.
- Effects of Sevelamer Hydrochloride and Calcium Carbonate on Renal Osteodystrophy in Hemodialysis PatientsPublication . Ferreira, A; Frazão, JM; Monier-Faugere, MC; Gil, C; Galvão, J; Oliveira, C; Baldaia, J; Rodrigues, I; Santos, C; Ribeiro, S; Hoenger, R; Duggal, A; Malluche, HHDisturbances in mineral metabolism play a central role in the development of renal bone disease. In a 54-wk, randomized, open-label study, 119 hemodialysis patients were enrolled to compare the effects of sevelamer hydrochloride and calcium carbonate on bone. Biopsy-proven adynamic bone disease was the most frequent bone abnormality at baseline (59%). Serum phosphorus, calcium, and intact parathyroid hormone were well controlled in both groups, although calcium was consistently lower and intact parathyroid hormone higher among patients who were randomly assigned to sevelamer. Compared with baseline values, there were no changes in mineralization lag time or measures of bone turnover (e.g., activation frequency) after 1 yr in either group. Osteoid thickness significantly increased in both groups, but there was no significant difference between them. Bone formation rate per bone surface, however, significantly increased from baseline only in the sevelamer group (P = 0.019). In addition, of those with abnormal microarchitecture at baseline (i.e., trabecular separation), seven of 10 in the sevelamer group normalized after 1 yr compared with zero of three in the calcium group. In summary, sevelamer resulted in no statistically significant changes in bone turnover or mineralization compared with calcium carbonate, but bone formation increased and trabecular architecture improved with sevelamer. Further studies are required to assess whether these changes affect clinical outcomes, such as rates of fracture.
- Epidemiology of Clostridioides Difficile Infection in Portugal: a Retrospective, Observational Study of Hospitalized PatientsPublication . Nazareth, C; Leitão, I; Reis, E; Inácio, H; Martins, F; Ramalheira, E; Cunha, F; Santos, C; Lino, S; Moreira, H; Kruptsala, N; Santos, A; Paixão, L; Pássaro, L; Oleastro, MIntroduction: Clostridioides difficile is the main cause of healthcare-associated diarrhea in Europe and North America. The aim of this study was to characterize the epidemiology and clinical burden of Clostridioides difficile infection among hospitalized patients in Portugal. Material and methods: Retrospective study conducted in six public hospital centers in Portugal. All primary Clostridioides difficile infection episodes and related recurrences occurring in 2017, as well as episodes developing two to eight weeks after the last episode diagnosed in that year, were documented. The National Reference Laboratory (National Institute of Health Dr. Ricardo Jorge) provided national surveillance data on Clostridioides difficile infection. Results: A total of 385 inpatients with at least one primary episode diagnosed in 2017 were included. Most patients were aged over 70 years-old (73.2%). The included patients developed 451 episodes during the observation period. Approximately 44% of primary episodes were community-associated. Most episodes (94.9%) occurred in patients with one or more risk factors, with recent antibiotic exposure being particularly common (86.0%). All-cause in-hospital mortality was 19.5%, being significantly higher in patients aged over 65 years-old versus those aged 18 to 64 years-old (22.4% vs 7.8%, respectively). Over 50 different ribotypes were observed among 206 Clostridioides difficile strains received by the National Reference Laboratory. Conclusion: In Portugal, hospitalized patients with Clostridioides difficile infection are mostly older patients presenting risk factors for the development of this infection, particularly recent antibiotic exposure. Mortality is disproportionately high among the older population. Community-associated Clostridioides difficile infection is common among inpatients with this infection.
- Expert Perspectives on the Management of Alpha 1-Antitrypsin DeficiencyPublication . Conde, B; Costa, F; Gomes, J; Lopes, AP; Mineiro, A; Rodrigues, O; Santos, C; Semedo, L; Sucena, M; Guimarães, CAlpha 1-antitrypsin deficiency is an inherited autosomal codominant disorder, which predisposes patients to lung and/or liver disease. Even though it is considered rare, it is one of the most frequent genetic disorders worldwide, albeit remaining underdiagnosed. Several organizations and societies, including the Portuguese Society of Pulmonology have been elaborating guidelines and recommendations for the diagnosis and management of alpha 1-antitrypsin deficiency. Nevertheless, some important matters are yet to be included in those, mainly due to lack of robust scientific evidence, and continue to represent a point of discussion. This article reviews some important scientific publications and expresses the perspectives of a group of Portuguese experts regarding the management of alpha 1-antitrypsin deficiency, namely in terms of the pre and neonatal diagnosis, the impact of the COVID-19 pandemic, the validity of replacement therapy in lung transplant-receiving, and finally, alternative strategies of alpha 1-antitrypsin deficiency treatment to improve the patients' quality of life.
- Hemodynamic Patterns in Obesity Associated HypertensionPublication . Santos, C; Marques da Silva, PObesity is a well-known condition of resistant hypertension (HT). Insights to the hemodynamic patterns that characterize obesity related hypertension may help guide therapeutic adjustments and shorten time to HT control.
- Internamento por Malária Importada em Crianças, em Dois Hospitais da Grande LisboaPublication . Freira, S; Luís, C; Brito, MJ; Santos, C; Carreiro, MH; Cordeiro Ferreira, G; Varandas, LIntrodução: Apesar de em Portugal não haver malária endógena,a crescente mobilidade das populações e os laços históricos com África possibilitam a importação de casos para o nosso país. O presente estudo pretende contribuir para melhorar o conhecimento epidemiológico e clínico da malária importada na região de Lisboa. Métodos: Realizou-se um estudo descritivo das crianças com malária, internadas em dois hospitais da Grande Lisboa, durante um período de seis anos (1999-2004). Resultados: Foram identificados 134 casos, sendo a mediana das idades de sete anos. A maioria (93,3%) era de origem africana e referia estadia em região endémica (90%). O Plasmodium falciparum foi o agente etiológico mais frequente (73%). A febre foi a manifestação clínica mais frequente, seguida de manifestações gastrointestinais e cefaleias. Ocorreram complicações em 42% dos doentes, sendo a trombocitopenia (19,4%) e a anemia grave (9%) as mais frequentes. A halofantrina e o quinino foram os anti-maláricos mais usados. Conclusões: A malária importada é uma patologia relativamente comum na Grande Lisboa e, dada a inespecificidade do quadro clínico, todas as crianças febris ou doentes com estadia recente num país endémico devem ser rastreadas para esta entidade.
- Intervenção do Enfermeiro de Reabilitação na Capacitação da Pessoa com Insuficiência CardíacaPublication . Varão, S; Mata, R; Aleixo, L; Silva, V; Santos, C; Silva, CA Insuficiência Cardíaca (IC) afeta 26 milhões de pessoas, com custos elevados devido à redução da qualidade de vida, aumento do sofrimento e mortalidade. A evidência científica realça que programas de capacitação e reabilitação cardiovascular diminuem hospitalizações (Fonseca 2018). Capacitar a pessoa para a gestão da IC (Geral), aumentar a literacia em saúde, implementar um plano educacional e de reabilitação. No Projeto definiram-se critérios de inclusão: pessoa internada por IC, idade superior a 21 anos, portuguesa, capaz de ler, cognição mantida (amostra não probabilística). Adotou-se um metodologia de planeamento em saúde. A Fase de Diagnóstico de grupo (I) inclui aplicação do Kansas City Cardiomyopathy Questionnaire e Escala Europeia de Autocuidado na IC, sem alteração nos cuidados (Ávila Costa Pereira, F., 2013; Nave-Leal et al., 2010). Na Fase de intervenção (II), na admissão e alta, o Enfermeiro Reabilitação (ER) avalia a capacidade funcional - Escala de Barthel, Medical Council Research, Borg Modificada (Esforço), Teste Marcha 6 minutos – e prescreve um plano de reabilitação (mobilização, treino respiratório, aeróbio, atividades vida diária e conservação de energia) (Delgado et al., 2019). Aplicando-se os questionários, define-se o plano educacional em módulos: Compreensão da doença/gestão não-farmacológica, Gestão Farmacológica, Tratamento com dispositivos, Sexualidade/fatores psicoemocionais, Gestão da energia. Após a alta, procede-se ao follow-up telefónico, repetindo-se os questionários. Na Fase III, analisam-se dados através do Excel Office®. Protocolo aprovado pela comissão de ética. O Projeto de investigação encontra se na Fase I, o que não permite a análise de dados. Contudo, espera se que comprovem a necessidade da intervenção do ER na capacitação para a gestão da IC, através da melhoria da capacidade 89 funcional, exercício, autonomia e qualidade de vida, reduzindo o peso económico da IC.
- 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.
- Measuring Adherence to Inhaled Control Medication in Patients with Asthma: Comparison Among an Asthma App, Patient Self‐Report and Physician AssessmentPublication . Cachim, A; Pereira, AM; Almeida, R; Amaral, R; Alves‐Correia, M; Vieira‐Marques, P; Chaves‐Loureiro, C; Ribeiro, C; Cardia, F; Gomes, J; Vidal, C; Silva, E; Rocha, S; Rocha, D; Marques, ML; Páscoa, R; Morais, D; Cruz, AM; Santalha, M; Simões, JA; da Silva, S; Silva, D; Gerardo, R; Todo Bom, F; Morete, A; Vieira, I; Vieira, P; Monteiro, R; Raimundo, MR; Monteiro, L; Neves, Â; Santos, C; Penas, AM; Regadas, R; Varanda Marques, J; Rosendo, I; Abreu Aguiar, M; Fernandes, S; Seiça Cardoso, C; Pimenta, F; Meireles, P; Gonçalves, M; Almeida Fonseca, J; Jácome, CBackground: Previous studies have demonstrated the feasibility of using an asthma app to support medication management and adherence but failed to compare with other measures currently used in clinical practice. However, in a clinical setting, any additional adherence measurement must be evaluated in the context of both the patient and physician perspectives so that it can also help improve the process of shared decision making. Thus, we aimed to compare different measures of adherence to asthma control inhalers in clinical practice, namely through an app, patient self-report and physician assessment. Methods: This study is a secondary analysis of three prospective multicentre observational studies with patients (≥13 years old) with persistent asthma recruited from 61 primary and secondary care centres in Portugal. Patients were invited to use the InspirerMundi app and register their inhaled medication. Adherence was measured by the app as the number of doses taken divided by the number of doses scheduled each day and two time points were considered for analysis: 1-week and 1-month. At baseline, patients and physicians independently assessed adherence to asthma control inhalers during the previous week using a Visual Analogue Scale (VAS 0-100). Results: A total of 193 patients (72% female; median [P25-P75] age 28 [19-41] years old) were included in the analysis. Adherence measured by the app was lower (1 week: 31 [0-71]%; 1 month: 18 [0-48]%) than patient self-report (80 [60-95]) and physician assessment (82 [51-94]) (p < 0.001). A negligible non-significant correlation was found between the app and subjective measurements (ρ 0.118-0.156, p > 0.05). There was a moderate correlation between patient self-report and physician assessment (ρ = 0.596, p < 0.001). Conclusions: Adherence measured by the app was lower than that reported by the patient or the physician. This was expected as objective measurements are commonly lower than subjective evaluations, which tend to overestimate adherence. Nevertheless, the low adherence measured by the app may also be influenced by the use of the app itself and this needs to be considered in future studies.