Browsing by Author "Silva, P"
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- Caminhos de Proximidade - Interculturalidade e Cuidados de Saúde, Realidades e DesafiosPublication . Silva, P; Namora, A; Monteiro, I
- Diversidade Cultural no Hospital: Crenças, Rituais e Práticas ...Publication . Silva, P; Namora, A; Monteiro, I
- HELLP Syndrome a Severe Form of Preeclampsia: a Comparative Study of Clinical and Laboratorial ParametersPublication . Campos, A; Gonçalves, A; Massa, AC; Amaral, P; Silva, P; Aguilar, SThe objective of this study was to compare clinical, laboratorial, maternal and perinatal results between HELLP Syndrome and severe Preeclampsia. An observational study comparing women with HELLP Syndrome (n=71) to women with severe preeclampsia (n=253) was done. The authors analyzed the early course of the pathologies and the outcomes in both groups. HELLP syndrome occurred in 28% of all the cases and was more frequent at gestational age before 32 weeks (n=39 – 55%) than severe preeclampsia (n=108 - 42%), with more newborns weighting less than 1500g (27 – 38.6% vs 65 – 25.6%; p=0.036). Thrombocytopenia below 100 000/μL (aOR, 2.14; 95% CI, 1.49 – 3.06) and LDH>1 000 UI/L (aOR: 5.17; 95% CI 2.19 – 12.16) were risk factors for HELLP. Maternal morbidity (eclampsia, abruptio placentae, and acute renal failure) was similar in both cohorts; eight stillbirths (6 in severe preeclampsia and 2 in HELLP Syndrome) occurred. There were no maternal deaths. In conclusion, in this study the authors confirmed that HELLP Syndrome is a severe form of preeclampsia with an earlier presentation in pregnancy, worst laboratorial findings and more prematurity rates.
- Maus Tratos na Primeira Infância – A Experiência de Um Hospital TerciárioPublication . Stilwell, MR; Oliveira, C; Silva, P; Sousa, S; Ismail, D; Sassetti, LIntrodução: Os maus tratos (MT) na infância, têm repercussões na vida da criança e das comunidades. A identificação, particularmente difícil em estádios precoces do desenvolvimento, é essencial para a interrupção precoce dos MT. Objectivo: Caracterizar os casos sinalizados como MT até aos 3 anos de idade, num hospital terciário. Material e métodos: Estudo retrospectivo descritivo das sinalizações de crianças dos 0 aos 2 anos, no período de 2015 a 2017, atendendo ao sexo, família, forma de MT, origem da sinalização, agressor e se este coabitava com a criança. Resultados: Dos 460 casos reportados como MT, 72 (16%) pertenciam à faixa etária avaliada. A distribuição foi semelhante entre os sexos (33M-39F). Na maioria, vinham de famílias nucleares (31) ou monoparentais (22); foram sinalizadas pela Urgência (58-80%); a principal forma de MT foi a negligência (43- 60%) – estas crianças residiam maioritariamente com os pais. As sinalizações associadas a violência (19 por agressão física, 8 de abuso sexual (AS) e 2 exposição a violência doméstica) distribuíram-se por famílias monoparentais (11) seguida das nucleares (10), reconstruídas (5) e alargadas (3). Em 21 casos o agressor pertencia à família, em 13 era coabitante. Das 8 notificação por AS, em 5 a família era monoparental, o agressor era familiar em 6, só em 2 eram coabitantes. Conclusões: A identificação e prevenção de MT neste grupo etário é delicada, pois os agressores tendem a ser próximos da criança, e são até, muitas vezes, quem a traz ao SU. Nos últimos anos, tem-se verificado um aumento das situações suspeitas de abuso sexual, algumas configurando casos de alienação parental. Todos estes aspectos exigem particular atenção dos profissionais de saúde, particularmente no SU, habitual porta de entrada destas situações.
- Outcome of Monochorionic Twins Conceived by Assisted ReproductionPublication . Simões, T; Queirós, A; Marujo, AT; Valdoleiros, S; Silva, P; Blickstein, IOBJECTIVE: To evaluate monochorionic twins conceived by assisted reproductive technology (ART). DESIGN: We compared perinatal outcomes of monochorionic twins conceived by ART with their dichorionic counterparts and with spontaneous monochorionic twins. SETTING: Referral center. PATIENT(S): Mothers to monochorionic and dichorionic twins conceived by ART and spontaneous monochorionic twins. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Maternal characteristics, pregnancy complications, and perinatal outcomes. RESULT(S): Monochorionic twin pregnancies (n = 25) comprise 7.2% of all ART twins and 4.9% of all monochorionic twins in this data set. Monochorionic pairs have a significantly worse outcome compared with dichorionic sets in terms of lower gestational age and birth weight. ART appears to increase the already high risk of monochorionicity compared with spontaneous conception: odds ratio (OR), 2.9 (1.1-7.3) for preterm birth at <32 weeks and OR, 5.9 (2.5-1.49) for birth weight <1,500 g. CONCLUSION(S): Monochorionic twins after ART are at increased risk of adverse perinatal outcomes compared with spontaneous monochorionic twins and with dichorionic twins conceived by ART.
- A Perturbação do Espetro do Autismo na Primeira Infância: O Modelo do Centro de Estudos do Bebé e da Criança de Avaliação Diagnóstica e Intervenção TerapêuticaPublication . Martins Halpern, C; Caldeira da Silva, P; Costa, D; Nascimento, MJ; Mesquita Reis, J; Martins, MT; Pinto Ferreira, B; Santos, I; Carvalho, L; Paiva Gomes, M; Martins, M; Pimentel, MJ; Lopes, P; Silva, P; Rapazote, R; Catarino, S; Aires Pereira, S; Pereira, S; Afonso, SIntroduction: The Centro de Estudos do Bebé e da Criança in Hospital Dona Estefânia has organized a multidisciplinary model for children under three with suspected autism spectrum disorder, thus implementing the recent guidelines established by the Directorate General for Health. The aim of this study is to describe this model and case series. Material and methods: A retrospective descriptive study of observed children with suspected ASD. They were observed according to the model of the Centro de Estudos do Bebé e da Criança and DC:0-5TM classification, between January 2018 and September 2019. Results: The study included 178 children. The average age at the initial assessment was 27 months. From the total sample, 116 children concluded the diagnostic sessions (axis I): Autism Spectrum Disorder/Early Atypical (36%), Developmental Language Disorder (18%), Other (19%). Factors of axes II, III, IV and V of DC:0-5TM were determinant for clinical diagnosis in 26%. Discussion: Of 116 children, 36% were diagnosed with Autism Spectrum Disorder. This highlights the diagnostic challenge posed by neurodevelopmental disorders in early infancy. The sample shows that the characteristics of the relationship with the caregiver (axis II), presence of physical conditions (axis III), psycho-social stressors (axis IV) and developmental trajectory (axis V) have a significant clinical impact. In the future, the initial assessment should take place well before the age of 27 months because of the impact on prognosis. Conclusion: This model is a pioneering approach in Portugal. It promotes a common approach of Child and Adolescent Psychiatry and Neuropediatrics/Developmental Pediatrics in early infancy. Moreover, it increases the diagnostic acuity of Autism Spectrum Disorders and early therapeutic intervention.
- A Perturbação do Espetro do Autismo na Primeira Infância: O Modelo do Centro de Estudos do Bebé e da Criança de Avaliação Diagnóstica e Intervenção TerapêuticaPublication . Halpern, CM; Caldeira da Silva, P; Costa, D; Nascimento, MJ; Mesquita Reis, J; Martins, MT; Pinto Ferreira, B; Santos, I; Carvalho, L; Paiva Gomes, M; Martins, M; Pimentel, MJ; Lopes, P; Silva, P; Rapazote, R; Catarino, S; Aires Pereira, S; Pereira, S; Afonso, SIntroduction: The Centro de Estudos do Bebé e da Criança in Hospital Dona Estefânia has organized a multidisciplinary model for children under three with suspected autism spectrum disorder, thus implementing the recent guidelines established by the Directorate General for Health. The aim of this study is to describe this model and case series. Material and methods: A retrospective descriptive study of observed children with suspected ASD. They were observed according to the model of the Centro de Estudos do Bebé e da Criança and DC:0-5TM classification, between January 2018 and September 2019. Results: The study included 178 children. The average age at the initial assessment was 27 months. From the total sample, 116 children concluded the diagnostic sessions (axis I): Autism Spectrum Disorder/Early Atypical (36%), Developmental Language Disorder (18%), Other (19%). Factors of axes II, III, IV and V of DC:0-5TM were determinant for clinical diagnosis in 26%. Discussion: Of 116 children, 36% were diagnosed with Autism Spectrum Disorder. This highlights the diagnostic challenge posed by neurodevelopmental disorders in early infancy. The sample shows that the characteristics of the relationship with the caregiver (axis II), presence of physical conditions (axis III), psycho-social stressors (axis IV) and developmental trajectory (axis V) have a significant clinical impact. In the future, the initial assessment should take place well before the age of 27 months because of the impact on prognosis. Conclusion: This model is a pioneering approach in Portugal. It promotes a common approach of Child and Adolescent Psychiatry and Neuropediatrics/Developmental Pediatrics in early infancy. Moreover, it increases the diagnostic acuity of Autism Spectrum Disorders and early therapeutic intervention.
- Prospective Risk of Intrauterine Death of Monochorionic Twins: UpdatePublication . Simões, T; Queirós, A; Marujo, AT; Valdoleiros, S; Silva, P; Blickstein, IObjective: To calculate an updated prospective risk of fetal death in monochorionic-biamniotic (MCBA) twins. Study design: We evaluated 520 MCBA twin pregnancies that had intensive prenatal surveillance and delivered in a single Portuguese referral center. The prospective risk of fetal death was calculated as the total number of deaths at the beginning of the gestational period divided by the number of continuing pregnancies at or beyond that period. Data were compared to the 2006 previous report. Results: Nearly 80% of the neonates weighed <2500 g, including 13.5% who weighed <1500 g. Half were born at <36 weeks, including 13.8% who were born at <32 weeks. The data indicate an increased IUFD rate over time - 16 fetal deaths per pregnancy (3.1%) and 22 IUFDs per fetus (2.1%). The rate of IUFD after 32-33 weeks, however, was halved (1/187 pregnancies and 1/365 fetuses, 0.5 and 0.3%, respectively). Conclusion: Intensive prenatal surveillance might decrease the unexpected fetal death rates after 33 week's gestation and our data do not support elective preterm birth for uncomplicated MCBA twins.