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- Chronic Respiratory Diseases and Quality of Life in Elderly Nursing Home ResidentsPublication . Carreiro-Martins, P; Gomes-Belo, J; Papoila, AL; Caires, I; Palmeiro, T; Gaspar-Marques, J; Leiria-Pinto, P; Mendes, AS; Paulo-Teixeira, J; Botelho, MA; Neuparth, NFew studies have assessed the quality of life (QOL) related to chronic respiratory diseases in the elderly. In the framework of the geriatric study on the health effects of air quality in elderly care centers (GERIA) study, a questionnaire was completed by elderly subjects from 53 selected nursing homes. It included various sections in order to assess respiratory complaints, QOL (World Health Organization QOL (WHOQOL)-BREF), and the cognitive and depression status. The outcome variables were the presence of a score lower than 50 (<50) in each of the WHOQOL-BREF domains (physical health, psychological health, social relationships, and environmental health). Chronic bronchitis, frequent cough, current wheezing, asthma, and allergic rhinitis were considered as potential risk factors. The surveyed sample was (n = 887) 79% female, with a mean age of 84 years (SD: 7 years). In the multivariable analysis, a score of <50 in the physical domain was associated with wheezing in the previous 12 months (odds ratio (OR): 2.03, confidence interval (CI): 1.25-3.31) and asthma (OR: 1.95, CI: 1.12-3.38). The psychological domain was related with a frequent cough (OR: 1.43, CI: 0.95-2.91). A score of <50 in the environmental domain was associated with chronic bronchitis (OR: 2.89, CI: 1.34-6.23) and emphysema (OR: 3.89, CI: 1.27-11.88). In view of these findings, the presence of respiratory diseases seems to be an important risk factor for a low QOL among elderly nursing home residents.
- Challenges in Diagnosis and Treatment of Pediatric Multiple SclerosisPublication . Lopes Silva, R
- The Kite Latissimus Dorsi Flap for Breast Reconstruction: An Attempt to Reduce Lateral Chest Wall Deformity and Axillary BulkingPublication . Correia Anacleto, J; Mavioso, C; Gouveia, PF; Magalhães, A; Bastos Martins, J; Moura, A; Pinto, D; Cardoso, MJThe latissimus dorsi flap is a commonly used tissue transfer for volume replacement in partial or total breast reconstruction. In this era of cosmetic awareness and oncoplastic breast surgery, two main defects are related to the conventional technique: the back scar and the bulkiness on the lateral chest wall, under the axilla. Axillary bulking, a disturbing defect for the majority of patients, is a persistent consequence, independent of the technique used, even when the proximal tendon is cut. We describe a new approach, the kite latissimus dorsi flap, consisting of harvesting the flap, partially or totally, with pedicle dissection from the muscle, extending dissection, perforator style if needed, until the external border of the breast (anterior axillary line) is reached. The muscle is then cut at that level, leaving no unnecessary volume under the axilla, which would cause bulkiness and chest wall deformity.
- Pulmonary Artery Sarcoma Masquerading As Subchronic Pulmonary ThromboembolismPublication . Kahlbau, H; Telles Antunes, H; Rodrigues, I; Carvalho, R; Fragata, J
- A Intervenção Humor em Enfermagem num Serviço de Ortopedia: Estratégias e BenefíciosPublication . Múrias dos Santos, C; Mota de Sousa, LM; Carvalho, ML; Severino, S; José, HObjetivos: Conhecer as estratégias e benefícios da intervenção humor em enfermagem num serviço de ortopedia. Materiais e Métodos: Pesquisa com abordagem qualitativa e descritiva, realizada num serviço de ortopedia de um hospital de Lisboa, no período de julho e agosto de 2013. Foram aplicadas entrevistas semiestruturadas. A análise foi baseada em Bardin. Resultados e Discussão: emergiram duas categorias, a intervenção humor e os benefícios da intervenção. Evidenciou-se os cuidados a ter na avaliação inicial, planeamento, implementação desta intervenção e seus benefícios indirectos e diretos. Considerações Finais: À semelhança de outras intervenções, o humor segue o raciocínio clínico de enfermagem e quando aplicado adequadamente tem benefícios na saúde e bem-estar dos doentes.
- Diabetic Choroidopathy: a Review of the Current LiteraturePublication . Melancia, D; Vicente, A; Cunha, JP; Abegão Pinto, L; Ferreira, JDiabetic retinopathy is an increasingly prevalent disease, and a leading contributor to the burden of all-cause blindness worldwide. In addition to retinal changes, choroidal abnormalities are common in patients with diabetes. The first studies concerning this vascular structure were based on histologic, indocyanine angiography and laser Doppler flowmetry techniques, but the development of new optical coherence tomography (OCT) technologies and imaging software for enhanced depth imaging (EDI)-OCT in recent years has made it possible to provide more detailed images of the choroidal anatomy and topography.In diabetic patients, several choroidal changes have been described in the literature throughout the years; the recent focus is choroidal thickness, which is significantly different from that in healthy patients. However, understanding choroidal manifestations of diabetic eye disease remains a real challenge, and this gap is hindering efforts towards better defining choroidal evaluation as a predictive factor for disease evolution and treatment response.This review aims to summarize the recent literature concerning changes in choroidal structure in diabetic patients, the relationship to diabetic retinal disease progression, and finally, the current and potential application of the measurement of variations in choroidal thickness for patient management.
- Upper Gastrointestinal Bleeding Due to Gastric Metastasis From a Primary Uterine LeiomyosarcomaPublication . Costa, M; Ivanova, E; Esteves, J
- Mechanical Thrombectomy for Stroke After Cardiac SurgeryPublication . Madeira, M; Martins, C; Koukoulis, G; Marques, M; Reis, J; Abecassis, MStroke after cardiac surgery remains a devastating complication and its treatment options are limited. Systemic fibrinolysis is a relative contraindication, because it raises the risk of systemic hemorrhage. Endovascular therapy, mechanical thrombectomy, and intra-arterial fibrinolysis have emerged as safer options. We present three patients who developed strokes following cardiac surgery who underwent successful mechanical thrombectomy and review the literature on this subject. doi: 10.1111/jocs.12776 (J Card Surg 2016;31:517-520).
- Adult Pancreatoblastoma - Case Report and Review of LiteraturePublication . Vilaverde, F; Reis, A; Rodrigues, P; Carvalho, A; Scigliano, HMost cases of pancreatoblastoma, a rare malignant epithelial tumor of the pancreas, are seen in the pediatric population. The rarity of pancreatoblastoma, the similar radiologic findings to those seen in other pancreatic lesions, and its histopathologic heterogeneity, make its preoperative diagnosis in adults a real challenge. We report ultrasound, computed tomography and magnetic resonance imaging correlative findings of a histologically proven pancreatoblastoma in a 37-year-old woman. Pancreatoblastoma should be considered in the differential diagnosis of a pancreatic mass presenting uncommon imaging features.
- External Prolonged Electrocardiogram Monitoring in Unexplained Syncope and Palpitations: Results of the SYNARR-Flash StudyPublication . Locati, ET; Moya, A; Oliveira, MM; Tanner, H; Willems, R; Lunati, M; Brignole, MAIMS: SYNARR-Flash study (Monitoring of SYNcopes and/or sustained palpitations of suspected ARRhythmic origin) is an international, multicentre, observational, prospective trial designed to evaluate the role of external 4-week electrocardiogram (ECG) monitoring in clinical work-up of unexplained syncope and/or sustained palpitations of suspected arrhythmic origin. METHODS AND RESULTS: Consecutive patients were enrolled within 1 month after unexplained syncope or palpitations (index event) after being discharged from emergency room or hospitalization without a conclusive diagnosis. A 4-week ECG monitoring was obtained by external high-capacity loop recorder (SpiderFlash-T(®), Sorin) storing patient-activated and auto-triggered tracings. Diagnostic monitorings included (i) conclusive events with reoccurrence of syncope or palpitation with concomitant ECG recording (with/without arrhythmias) and (ii) events with asymptomatic predefined significant arrhythmias (sustained supraventricular or ventricular tachycardia, advanced atrio-ventricular block, sinus bradycardia <30 b.p.m., pauses >6 s). SYNARR-Flash study enrolled 395 patients (57.7% females, 56.9 ± 18.7 years, 28.1% with syncope, and 71.9% with palpitations) from 10 European centres. For syncope, the 4-week diagnostic yield was 24.5%, and predictors of diagnostic events were early start of recording (0-15 vs. >15 days after index event) (OR 6.2, 95% CI 1.3-29.6, P = 0.021) and previous history of supraventricular arrhythmias (OR 3.6, 95% CI 1.4-9.7, P = 0.018). For palpitations, the 4-week diagnostic yield was 71.6% and predictors of diagnostic events were history of recurrent palpitations (P < 0.001) and early start of recording (P = 0.001). CONCLUSION: The 4-week external ECG monitoring can be considered as first-line tool in the diagnostic work-up of syncope and palpitation. Early recorder use, history of supraventricular arrhythmia, and frequent previous events increased the likelihood of diagnostic events during the 4-week external ECG monitoring.