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- Vestibulo-Ocular Reflex Dynamics with Head-Impulses Discriminates Usher Patients Type 1 and 2Publication . Amorim, AM; Ramada, AB; Lopes, AC; Duarte Silva, E; Lemos, J; Ribeiro, JCUsher Syndrome classification takes into account the absence of vestibular function but its correlation with genotype is not well characterized. We intend to investigate whether video Head Impulse Test (vHIT) is useful in screening and to differentiate Usher Syndrome types. 29 Usher patients (USH) with a genetically confirmed diagnosis and 30 healthy controls were studied with vHIT and dizziness handicap inventory questionnaire (DHI). Statistical significant differences between USH1, USH2 and controls were found in the vestibulo-ocular-reflex (VOR) gain of all SCCs, with USH1 patients consistently presenting smaller gains. VOR gain of the right lateral SCC could discriminate controls from USH1, and USH2 from USH1 with an overall diagnostic accuracy of 90%. USH1 DHI correlated with VOR (ρ = - 0,971, p = 0.001). Occurrence rate of covert and overt lateral semicircular canals refixation saccades (RS) was significantly different between groups, being higher in USH1 patients (p < 0.001). USH1 peak velocity of covert and overt saccades was higher for lateral semicircular canals (p < 0.05 and p = 0.001) compared with USH2 and controls. Covert saccades occurrence rate for horizontal SCCs could discriminate USH1 from USH2 patients and controls with a diagnostic accuracy of 85%. vHIT is a fast and non-invasive instrument which allowed us to screen and distinguish Usher patients from controls with a high precision. Importantly, its use allowed further discrimination between USH1 from USH2 groups. Moreover, VOR gain seems to correlate with vertigo-related quality of life in more severe phenotypes.
- Higher Risk of Preterm Twin Delivery Among Shorter Nulliparous WomenPublication . Simões, T; Pereira, I; Gomes, L; Brás, S; Nogueira, I; Queirós, AObjective: To determine if maternal height in nulliparous women influences pregnancy results in twin pregnancies. Material and methods: Retrospective cohort analysis evaluating twin pregnancies followed at Centro Hospitalar Universitário Lisboa Central, between 1995 and 2020. Of the 2900 pregnancies followed in that period, 886 nulliparous women with dichorionic twin pregnancies were selected. Two groups were considered: A - maternal height <163 cm (
- Endocardite com Nódulos e Lesões JanewayPublication . Cruz, L; Pereira de Sousa, J
- Major Determinants of Primary Non Function From Kidney Donation After Maastricht II Circulatory Death: a Single Center ExperiencePublication . Gaspar, A; Gama, M; Nobre de Jesus, G; Querido, S; Damas, J; Oliveira, J; Neves, M; Santana, A; Ribeiro, JMPurpose: Organ shortage greatly limits treatment of patients with end-stage chronic kidney. Maastricht type 2 donation after circulatory death (DCD) has been shown to have similar results in long term outcomes in kidney transplantation, when compared with brain dead donation. Our main goal was to assess Maastricht type 2 DCD and evaluate factors that impact on early graft function. Methods: A retrospective study was conducted in an ECMO Referral Centre. All patients who received a kidney transplant from Maastricht type 2 DCD were included in study. Early graft function and short term outcomes were assessed. Results: From October 2017 to December 2022, 47 renal grafts were collected from 24 uDCD donors. Median warm ischemia time was 106 min (94-115), cannulation time was 10 min (8; 20) and duration of extracorporeal reperfusion (ANOR) was 180 min (126-214). Regarding early graft function, 25% had immediate graft function, 63.6% had delayed graft function and 11.4% had primary non-function (PNF). There was a correlation between cannulation time (p = 0.006) and ANOR with PNF (p = 0.016). Conclusions: Cannulation time and ANOR were the main factors that correlated with PNF. Better understanding of underlying mechanisms should be sought in future studies to reduce the incidence of PNF.
- Prognosticating the Outcome of Intensive Care in Older Patients - a Narrative ReviewPublication . Beil, M; Moreno, R; Fronczek, J; Kogan, Y; Moreno, R; Flaatten, H; Guidet, B; de Lange, D; Leaver, S; Nachshon, A; van Heerden, P; Joskowicz, L; Sviri, S; Jung, C; Szczeklik, WPrognosis determines major decisions regarding treatment for critically ill patients. Statistical models have been developed to predict the probability of survival and other outcomes of intensive care. Although they were trained on the characteristics of large patient cohorts, they often do not represent very old patients (age ≥ 80 years) appropriately. Moreover, the heterogeneity within this particular group impairs the utility of statistical predictions for informing decision-making in very old individuals. In addition to these methodological problems, the diversity of cultural attitudes, available resources as well as variations of legal and professional norms limit the generalisability of prediction models, especially in patients with complex multi-morbidity and pre-existing functional impairments. Thus, current approaches to prognosticating outcomes in very old patients are imperfect and can generate substantial uncertainty about optimal trajectories of critical care in the individual. This article presents the state of the art and new approaches to predicting outcomes of intensive care for these patients. Special emphasis has been given to the integration of predictions into the decision-making for individual patients. This requires quantification of prognostic uncertainty and a careful alignment of decisions with the preferences of patients, who might prioritise functional outcomes over survival. Since the performance of outcome predictions for the individual patient may improve over time, time-limited trials in intensive care may be an appropriate way to increase the confidence in decisions about life-sustaining treatment.
- Projeto Investigação-Ação da Pessoa com Insuficiência Cardíaca: Fase I - Diagnóstico de GrupoPublication . Aleixo, L; Pombo, D; Varão, S; Silva, V; Mata, RIntrodução: A insuficiência cardíaca (IC) é uma síndrome caracterizada por sintomas (dispneia, fadiga) e sinais típicos (pressão venosa jugular aumentada, sons pulmonares, edema), com impacto na qualidade de vida (McDonagh et al., 2021). Objetivo: capacitar a pessoa para a gestão da IC. Material e métodos: o Projeto, com parecer da Comissão de Ética, tem como critérios de inclusão: internamento por IC, idade superior a 21 anos, nacionalidade portuguesa e cognição mantida. Usada Metodologia de Planeamento em Saúde: Fase I (Diagnóstico de grupo); Fase II (plano educacional/reabilitação) e Fase III (avaliação). No diagnóstico de situação, aplicado o Kansas City Cardiomyopathy Questionnaire (KCCQ) – versão portuguesa e a Escala Europeia de Autocuidado (EEAc) na IC, na admissão e 1 mês pós-alta (Fernanda Ávila da Costa Pereira, 2013) (Nave-Leal et al., 2009). Aplicada a escala de Barthel e Medical Research Council e a prova marcha de 6 minutos (PM6M), na admissão e alta. Dados analisados no Excel Office® . Resultados: Procedeu-se à analise dos resultados, numa amostra constituída por 7 pessoas (n=7). Constatou-se pela escala de Barthel uma melhoria na realização das atividades de vida diária (AVD), bem como na força muscular. Na alta, a PM6M melhorou, mas a distância mantém-se inferior a 300metros. Da aplicação inicial da EEAc, concluiu-se que: 7 pessoas tomam a medicação (como prescrita), 7 referiram fazer uma pausa durante o dia, 7 referiram abrandar o ritmo na presença de dispneia, 6 referiram que fazem uma dieta hipossalina, 6 limitam a quantidade de ingestão hídrica, 6 sustentaram que sabem contactar um profissional se agudizarem, 5 tomam anualmente a vacina e 5 pesam-se diariamente. Após a alta, questões relacionadas com a dieta hipossalina, limitação da ingestão hídrica, peso diário e o contato com o profissional evidenciaram maior concordância. Ao KCCQ, 5 referiram que têm “mais ou menos certeza do que fazer”, se agudizarem, 4 referiram que a IC os tem limitado “moderadamente”, no que mais gostam de fazer e 3 referiram que “melhoraram muito”. Conclusões: Verificou-se uma melhoria na realização das AVD, ao longo do internamento. Destaca-se a necessidade de desenvolver o conhecimento e a capacidade da pessoa na gestão da IC.
- Endobronchial Amphotericin B to Treat Hemoptysis in an Inoperable Patient with AspergillosisPublication . Pinto, M; Rodrigues, J; Silva, M; Maia, D; Miguel, AA 37-year-old man presented with chronic cavitary pulmonary aspergillosis and hemoptysis refractory to systemic antifungal therapy with voriconazole and bronchial artery embolization. Surgical excision was unfeasible due to the patient's refusal of blood transfusions. Ten sessions of intracavitary instillation of amphotericin B via flexible bronchoscopy were then performed. Hemoptysis cessation and aspergilloma resolution were achieved, with no toxicity or side effects, and the clinical benefits were sustained at six months of follow-up.
- CIRSE Standards of Practice on Portal Vein Embolization and Double Vein Embolization/Liver Venous DeprivationPublication . Bilhim, T; Böning, G; Guiu, B; Luz, JH; Denys, AThis CIRSE Standards of Practice document is aimed at interventional radiologists and provides best practices for performing liver regeneration therapies prior to major hepatectomies, including portal vein embolization, double vein embolization and liver venous deprivation. It has been developed by an expert writing group under the guidance of the CIRSE Standards of Practice Committee. It encompasses all clinical and technical details required to perform liver regeneration therapies, revising the indications, contra-indications, outcome measures assessed, technique and expected outcomes.
- “O Meu Coração Bate Saudável” – Results From a Pilot Project for Health Education in Portuguese ChildrenPublication . Timóteo, AT; Cachulo, MC; Dinis, P; Negrão, L; Barreiros-Mota, I; Dores, H; Gonçalves, LIntroduction and objectives: Childhood offers an excellent window of opportunity to start interventions to promote behavioral changes before unhealthy lifestyles become established, leading to cardiovascular diseases. The goal of this pilot educational project for children is the promotion of healthy lifestyles and cardiovascular health. Methods: This project was implemented in 4th grade children and included teacher-led classroom activities, a lesson given by a cardiologist and a practical lesson with dietitians. The teacher received a manual containing information on the topics to be discussed in class with the pupils and the children received a book that addresses cardiovascular risk factors and prevention. The components included were diet (D), physical activity (PA) and human body and heart awareness (BH). At the beginning and at the end of the schoolyear, a questionnaire was applied to the children to assess knowledge (K), attitudes (A) and habits (H) on these topics. Results: A total of 73 children from two schools from an urban district public school in Lisbon, in a low to medium income area, participated in the project. Following the intervention, there was a 9.5% increase in the overall KAH score, mainly driven by the PA component (14.5%) followed by the BH component (12.3%). No improvement was observed for component D. The benefits were also more significant in children from a lower income area, suggesting that socioeconomic status is a determinant in the response obtained. Conclusions: An educational project for cardiovascular health can be implemented successfully in children aged 9 years, but longer and larger studies are necessary.
- Análise da Relação Entre Desempenho e Comprometimento em Profissionais de Saúde: Revisão SistemáticaPublication . Pimenta, CIntrodução – O desempenho dos profissionais de saúde refere-se às competências clínicas, conhecimentos e habilidades técnicas, enquanto o seu comprometimento está relacionado com o vínculo psicológico e emocional com o trabalho e a organização. A compreensão da interação entre estes conceitos é importante para otimizar os resultados em saúde. Objetivos – Explorar a extensão e a natureza da relação entre desempenho e comprometimento nos profissionais de saúde, identificando os fatores que influenciam esta relação e quais as metodologias utilizadas para o seu estudo. Métodos – Foi realizada uma revisão sistemática da literatura seguindo o protocolo Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Resultados – Foram identificados 847 artigos, dos quais 14 foram incluídos para análise. Destaca-se a atualidade e universalidade do tema devido à profunda interação entre os constructos estudados. Alguns estudos apontam para correlações positivas diretas, enquanto outros evidenciam relações de influência mútua ou identificam o comprometimento como mediador em várias interações. Além disso, fatores como a satisfação no trabalho, o burnout, a liderança e a motivação também impactam a relação entre desempenho e comprometimento nos profissionais de saúde. Discussão – A relação entre desempenho e comprometimento nos profissionais de saúde é complexa e suscetível a diferentes influências. Conclusão – É pertinente a continuação de investigações para aprofundar o conhecimento nesta área, já que as organizações de saúde enfrentam o desafio contínuo de proporcionar uma assistência de qualidade aos pacientes, ao mesmo tempo que tentam gerir de forma eficiente recursos limitados.