Browsing by Issue Date, starting with "2022-09"
Now showing 1 - 7 of 7
Results Per Page
Sort Options
- A Realidade da Fisioterapia Vestibular em Portugal: Análise PreliminarPublication . Benzinho, T; Correia, A; Azevedo, AP; Costa, C; Jordão, J; Cabral, MA; Póvoa, RIntrodução: A Reabilitação Vestibular (RV) é uma abordagem terapêutica dirigida aos sinais e sintomas causados por disfunção vestibular, com o objetivo de acelerar o processo natural de compensação baseada nos mecanismos centrais de neuroplasticidade. Visando maximizar a autonomia e independência funcional, os fisioterapeutas integraram as equipas com os primeiros exercícios descritos em 1940 por Cawthorne & Cooksey, a manobra de diagnóstico da vertigem posicional paroxística benigna em 1952 por Dix Hallpike, muito embora a grande evolução desta área tenha ocorrido com as técnicas desenvolvidas por A. Sémont na década de 1970. Como área de intervenção muito específica importa caracterizar a oferta que existe a nível nacional. Objetivo: Identificar e caracterizar os Fisioterapeutas que intervêm na área de RV em Portugal. Métodos: Estudo de coorte transversal, realizado através de questionário online divulgado pela Associação Portuguesa de Fisioterapeutas e redes sociais. Foram incluídos Fisioterapeutas com prática clínica e/ou formação na área de RV. A participação voluntária foi validada com o consentimento informado. A análise dos dados foi realizada através de métodos analíticos, não se verificando missing data. Resultados: 44 (36 mulheres) Fisioterapeutas responderam ao questionário, permitindo caracterizar a formação académica, a formação específica e a Intervenção dos Fisioterapeutas nesta área. No que respeita ao grau académico, 1 é doutorado, 11 são mestres, 31 são licenciados e 1 é bacharel. 84.1% dos Fisioterapeutas responderam ter formação na área de RV dos quais 18.2% desde a licenciatura e 77.3% com formação pós graduada. 29.5% dos Fisioterapeutas realizaram estágios profissionais na área. Foi reportada uma mediana de 4±8 (0.08 27) anos de prática clínica em RV. A região Norte, Centro e Lisboa e Vale do Tejo concentram a grande maioria dos profissionais (85.4%). 68.2% identificaram como insuficiente a formação especifica na área de RV a nível nacional, sugerindo cursos de atualização, formação contínua e/ou pós graduada. Conclusão: A RV é identificada como uma área específica de interesse do fisioterapeuta, com necessidades de formação básica e avançada. A maioria dos fisioterapeutas que intervém nesta área apresenta formação específica, muito embora salientem que a mesma não seja de fácil acesso. Apesar de reduzida e não representativa, esta amostra identifica a necessidade de disponibilização de formação no ensino pré e pós graduado. Tendo sido demonstrado um crescente investimento na sensibilização para a área nos planos de estudos do ensino pré graduado dos cursos de Fisioterapia, não se refletindo ainda neste estudo. Desta forma, o reduzido número de profissionais a intervir nesta área em todo o país e as necessidades de formação/atualização expressas nesta área, justificam a aposta na formação na área de RV.
- Endovascular Therapy Versus No Endovascular Therapy in Patients Receiving Best Medical Management for Acute Isolated Occlusion of the Posterior Cerebral Artery: a Systematic Review and Meta-AnalysisPublication . Berberich, A; Finitsis, S; Strambo, D; Michel, P; Herweh, C; Meyer, L; Hanning, U; Strbian, D; Abdalkader, M; Nogueira, R; Puetz, V; Kaiser, D; Olive-Gadea, M; Ribo, M; Fragata, I; Marto, JP; Romoli, M; Ringleb, P; Nguyen, T; Nagel, SBackground and purpose: Endovascular therapy (EVT) is increasingly reported for treatment of isolated posterior cerebral artery (PCA) occlusions although its clinical benefit remains uncertain. This study-level meta-analysis investigated the functional outcomes and safety of EVT and best medical management (BMM) compared to BMM alone for treatment of PCA occlusion stroke. Methods: We conducted a literature search in PubMed, Web of Science and Embase for studies in patients with isolated PCA occlusion stroke treated with EVT + BMM or BMM including intravenous thrombolysis. There were no randomized trials and all studies were retrospective. The primary outcome was modified Rankin Scale score of 0-2 at 3 months, while safety outcomes included mortality rate and incidence of symptomatic intracranial hemorrhage (sICH). Results: Twelve studies with a total of 679 patients were included in the meta-analysis: 338 patients with EVT + BMM and 341 patients receiving BMM alone. Good functional outcome at 3 months was achieved in 58.0% (95% confidence interval [CI] 43.83-70.95) of patients receiving EVT + BMM and 48.1% (95% CI 40.35-55.92) of patients who received BMM alone, with respective mortality rates of 12.6% (95% CI 7.30-20.93) and 12.3% (95% CI 8.64-17.33). sICH occurred in 4.2% (95% CI 2.47-7.03) of patients treated with EVT + BMM and 3.2% (95% CI 1.75-5.92) of patients treated with BMM alone. Comparative analyses were performed on studies that included both treatments and these demonstrated no significant differences. Conclusions: Our results demonstrate that EVT represents a safe treatment for patients with isolated PCA occlusion stroke. There were no differences in clinical or safety outcomes between treatments, supporting randomization of future patients into distal vessel occlusion trials.
- Cerebrospinal Fluid Sex Steroid Hormones in Bacterial MeningitisPublication . Dias, S; Brouwer, M; Boelen, A; van de Beek, DUnfavorable outcome in bacterial meningitis is related to excessive inflammation and higher inflammatory markers have been reported in female than in male patients. Sex steroid hormones have immunomodulatory properties and can be found in the cerebrospinal fluid (CSF); however, their actions have not been studied in bacterial meningitis. We investigated the association between CSF sex steroid hormone levels and inflammatory parameters, disease severity, and outcome in pneumococcal meningitis. We identified adults with culture-proven pneumococcal meningitis in a prospective cohort study (2006-2014). We measured estradiol and testosterone in CSF using liquid chromatography-tandem mass spectrometry and sex hormone-binding globulin (SHBG) using an enzyme-linked immunoassay. Hormone levels were compared according to outcome, which was graded using the Glasgow Outcome Scale (a score of 5 indicating favorable, 1-4 unfavorable outcome). Correlation analysis was used to measure the association between hormone levels and inflammatory cytokines, chemokines, and complement factors as well as severity of illness, as measured by the Glasgow Coma Scale and the Dutch Meningitis Risk Score. We included 60 patients: 20 men, 20 premenopausal (<50 years), and 20 postmenopausal (>50 years) women. Twenty-one (35%) patients had an unfavorable outcome and 11 (18%) died. Cases with an unfavorable outcome exhibited higher estradiol (median 14.0 vs 5.0 pmol/L, P = .04) and lower SHBG (0.40 vs 1.0 nmol/L, P = .03) levels compared with those with a favorable outcome. Estradiol was positively correlated with C-reactive protein (R = 0.42, P = .001), CSF protein (R = 0.33, P = .01), and proinflammatory cytokine levels. CSF concentrations of the sex steroid hormone estradiol were associated with outcome and CSF inflammation. Understanding the dose and time-dependent interaction between sex steroid hormones and the inflammatory response in bacterial meningitis represents an important and understudied topic.
- Relato de Caso de Doença Coronariana e Vascular Não Aterosclerótica: em Busca de uma Entidade Clínica RaraPublication . Sá Mendes, G; Epifânio Mesquita, A; Rocha, B; Abecasis, J; Ramos, S; Trabulo, M
- Index of Microcirculatory Resistance in the Assessment of Coronary Microvascular Dysfunction in Hypertrophic CardiomyopathyPublication . Aguiar Rosa, S; Mota Carmo, M; Rocha Lopes, L; Oliveira, E; Thomas, B; Baquero, L; Cruz Ferreira, R; Fiarresga, AIntroduction and objectives: Coronary microvascular dysfunction (CMD) is one of the most important pathophysiological features in hypertrophic cardiomyopathy (HCM). The index of microcirculatory resistance (IMR) is an invasive method to assess the coronary microcirculation. The aim was to assess CMD in patients with HCM by IMR. Methods: Adult patients with HCM without epicardial coronary artery disease underwent cardiac catheterization for the assessment of CMD by IMR (normal cut-off value ≤22.0) and coronary flow reserve (CFR) (normal cut-off value ≥2). Cardiovascular magnetic resonance (CMR) was performed to assess the ischemic burden by perfusion imaging during regadenoson-induced hyperemia, and the extent of myocardial fibrosis was assessed by late gadolinium enhancement (LGE), native T1 mapping and extracellular volume (ECV). Results: Fourteen patients were enrolled with a mean age of 62.8±6.2years, 8 (57.1%) males, of whom 9 (64.3%) had obstructive HCM. Using IMR, CMD was detected in 4 (29%) patients. Among four patients with an IMR>22.0, all had non-obstructive HCM and two had angina. CFR<2 was reported in eight patients (57%). Concordance between IMR and CFR (both normal or both abnormal) was verified in 6 patients (43%). Among four patients with IMR>22.0, perfusion defects were found in two of the three patients who underwent stress CMR. Increased ECV (>28%) was documented in two of the patients with IMR>22 and in three of the patients with IMR≤22.0. LGE was >15% in 2 of the patients with IMR>22 and in 4 with IMR≤22.0. Conclusions: IMR assessment in HCM is feasible and safe. Patients with abnormal IMR seemed to have more significant tissue abnormalities on CMR.
- Quality of Life in Obese Patients from a Multidisciplinary Bariatric Consultation: a Cross-Sectional Study Comparing to a Non-Bariatric Population and to the General PopulationPublication . Rego de Figueiredo, I; Carvalho Vasques, M; Cunha, N; Martins, D; Silva-Nunes, JObesity is a chronic disease defined by a body mass index of ≥30 kg/m2, which can result in a decrease in quality of life (QoL). Our study aim was to assess the QoL of an obese population of bariatric surgery (BS) candidates, and to compare it to both that of a non-bariatric obese population (C) and that of the general population. This was a cross-sectional study using: (1) the EQ-5D-3L instrument: comparing BS with the C population and with the Portuguese general population; and (2) the Bariatric Quality of Life (BQL) Index: comparing the two groups of obese patients. We included 228 BS and 68 C obese patients. BS patients had higher BMI (44 ± 6 kg/m2 vs. 41 ± 6.5 kg/m2; p < 0.001), higher waist circumference (130 ± 13 cm vs. 123 ± 17 cm; p = 0.03), and higher total body fat mass (49.9 ± 6.7% vs. 45 ± 6.7%; p < 0.001). QoL as evaluated by EQ-5D-3L was similar, but the BQL index showed lower QoL in BS patients (40.9 ± 8.9 vs. 44.2 ± 11.2; p = 0.01). Compared to the Portuguese general population, BS patients had lower QoL (VAS: 55 ± 19 vs. 74.9; p < 0.001; index: 0.33 ± 0.2 vs. 0.76; p < 0.001). Despite higher adiposity in the BS group, QoL was similar between the groups by EQ-5D-3L. Nevertheless, there was a decrease in the QoL for the BS patients as determined using the BQL, a tool with higher sensitivity to bariatric patients.
- Impact of Preoperative Chemotherapy Features on Patient Outcomes after Hepatectomy for Initially Unresectable Colorectal Cancer Liver Metastases: A LiverMetSurvey AnalysisPublication . Innominato, P; Cailliez, V; Allard, MA; Lopez-Ben, S; Ferrero, A; Pinto Marques, H; Hubert, C; Giuliante, F; Pereira, F; Cugat, E; Mirza, D; Costa-Maia, J; Serrablo, A; Lapointe, R; Dopazo, C; Tralhao, J; Kaiser, G; Chen, JS; Garcia-Borobia, F; Regimbeau, JM; Skipenko, O; Lin, JK; Laurent, C; Opocher, E; Goto, Y; Chibaudel, B; de Gramont, A; Adam, RBackground: Prognostic factors have been extensively reported after resection of colorectal liver metastases (CLM); however, specific analyses of the impact of preoperative systemic anticancer therapy (PO-SACT) features on outcomes is lacking. Methods: For this real-world evidence study, we used prospectively collected data within the international surgical LiverMetSurvey database from all patients with initially-irresectable CLM. The main outcome was Overall Survival (OS) after surgery. Disease-free (DFS) and hepatic-specific relapse-free survival (HS-RFS) were secondary outcomes. PO-SACT features included duration (cumulative number of cycles), choice of the cytotoxic backbone (oxaliplatin- or irinotecan-based), fluoropyrimidine (infusional or oral) and addition or not of targeted monoclonal antibodies (anti-EGFR or anti-VEGF). Results: A total of 2793 patients in the database had received PO-SACT for initially irresectable diseases. Short (<7 or <13 cycles in 1st or 2nd line) PO-SACT duration was independently associated with longer OS (HR: 0.85 p = 0.046), DFS (HR: 0.81; p = 0.016) and HS-RFS (HR: 0.80; p = 0.05). All other PO-SACT features yielded basically comparable results. Conclusions: In this international cohort, provided that PO-SACT allowed conversion to resectability in initially irresectable CLM, surgery performed as soon as technically feasible resulted in the best outcomes. When resection was achieved, our findings indicate that the choice of PO-SACT regimen had a marginal if any, impact on outcomes.