Browsing by Issue Date, starting with "2023-01"
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- The Sequential Organ Failure Assessment (SOFA) Score: Has the Time Come for an Update?Publication . Moreno, R; Rhodes, A; Piquilloud, L; Hernandez, G; Takala, J; Gershengorn, H; Tavares, M; Coopersmith, C; Myatra, S; Singer, M; Rezende, E; Prescott, H; Soares, M; Timsit, JF; de Lange, D; Jung, C; De Waele, J; Martin, G; Summers, C; Azoulay, E; Fujii, T; McLean, A; Vincent, JLThe Sequential Organ Failure Assessment (SOFA) score was developed more than 25 years ago to provide a simple method of assessing and monitoring organ dysfunction in critically ill patients. Changes in clinical practice over the last few decades, with new interventions and a greater focus on non-invasive monitoring systems, mean it is time to update the SOFA score. As a first step in this process, we propose some possible new variables that could be included in a SOFA 2.0. By so doing, we hope to stimulate debate and discussion to move toward a new, properly validated score that will be fit for modern practice.
- Ventricular Septal Rupture—The Resurgence of a Post-Myocardial Infarction Dreadful Complication During COVID-19 PandemicPublication . Ferreira Reis, J; Almeida Morais, L; Sousa, L; Fiarresga, AIn the midst of the coronavirus disease-2019 (COVID-19) pandemic, an 84-year-old female patient was admitted due to non-exertional syncope preceded by retrosternal pain. She had experienced a prolonged episode of oppressive chest pain 6 days before her presentation, but due to the concern of contracting COVID-19, she did not present for medical care. Upon admission to the emergency department, the patient was in circulatory shock, with her physical examination being remarkable for the presence of a holosystolic murmur. Admission electrocardiogram revealed an inferior ST-segment elevation with Q waves with extension to the posterior wall, consistent with subacute infarct in the right coronary artery (RCA) territory, and the patient was transferred for primary percutaneous coronary intervention. Upon arrival to the catheterization laboratory, a summary transthoracic echocardiogram was performed, which revealed inferior wall and infero-septal akinesia with an 18 mm ventricular septal rupture. Coronary angiography documented occlusion of the proximal segment of a dominant RCA. Due to a high perioperative risk, the patient underwent successful retrograde percutaneous closure with a 24 mm MemoPart™ device, with mild to moderate residual shunt. Despite an immediate clinical improvement, the patient died 12 hours after the procedure due to refractory cardiogenic shock.
- Acute Coronary Syndrome and Stress: Is There a Relationship?Publication . Santos, H; Santos, M; Paula, S; Figueiredo, M; Almeida, I; Miranda, H; Chin, J; Sá, C; Neto, M; Almeida, S; Sousa, C; Almeida, LIntroduction: Acute coronary syndrome (ACS) is the result of a complex pathophysiological process with various dynamic factors. The 10-item Perceived Stress Scale (PSS-10) is a validated instrument for estimating stress levels in clinical practice and may be useful in the assessment of ACS. Methods: We carried out a single-center prospective study engaging patients hospitalized with ACS between March 20, 2019 and March 3, 2020. The PSS-10 was completed during the hospitalization period. The ACS group was compared to a control group (the general Portuguese population), and a subanalysis in the stress group were then performed. Results: A total of 171 patients with ACS were included, of whom 36.5% presented ST-elevation myocardial infarction (STEMI), 38.1% were female and the mean PSS score was 19.5±7.1. Females in the control group scored 16.6±6.3 on the PSS-10 and control males scored 13.4±6.5. The female population with ACS scored 22.8±9.8 on the PSS-10 (p<0.001). Similarly, ACS males scored a mean of 17.4±6.4 (p<0.001). Pathological stress levels were not a predictor of major adverse cardiovascular events or severity at admission. Conclusions: ACS patients had higher perceived stress levels compared to the control group. Perceived stress level was not associated with worse prognosis in ACS patients.
- Fatores de Risco de Burnout nos Profissionais de Saúde em Contexto HospitalarPublication . Oliveira, J; Ferreira, P; Gonçalves, VIntrodução – O burnout é um estado de esgotamento físico, resultante de stress crónico no trabalho não gerido com êxito (OMS, 2019). Existem inúmeras definições de burnout, sendo a mais atual e comummente utilizada pelos grandes investigadores do fenómeno como Maslach e Jackson, a que caracteriza a síndrome como sendo uma crise de caráter psicológico com elevada exaustão emocional, despersonalização e baixa realização profissional, provocada pela fadiga, stress, exaustão e falta de realização no mundo do trabalho (Schaufeli, 2017). Objetivo – Identificar os fatores de risco associados ao burnout nos profissionais de saúde em contexto hospitalar. Metodologia – Revisão sistemática da literatura. Bases de dados: CINAHL Complete, MEDLINE Complete e MEDIC LATINA, na EBSCOhost (2017-2021). Descritores: Health Personnel; Burnout, Professional; Burnout, Psychological; Stress, Psychological; Occupational Stress; Risk Factors; Risk; Hospitals; Hospital Units; Hospital Departments; Health facility departments. N=542 artigos, selecionados 10. Resultados – A síndrome de burnout constitui um processo multicausal, com fatores individuais, sociais e organizacionais. Discussão/Conclusão – Os ambientes em que os profissionais de saúde se inserem, assim como as suas características sociodemográficas e pessoais, constituem-se como fatores que podem levar a doença mental. Urge implementar estratégias que melhorem o seu bem-estar físico e psicológico.
- 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.
- Leaving (Almost) Nothing BehindPublication . Sousa, L