Browsing by Issue Date, starting with "2025"
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- The Efficacy of Dupilumab Largely Exceeds the 6-Month Treat-to-target Goals: An Analysis in an Atopic Dermatitis Referral CenterPublication . Valente C; Figueira Vilela B; Paiva-Lopes MJ; Duarte B
- Ortho-Monitorizer: A Portable Device for Quantitative Monitoring of Temperature and Pressure in a 3D-Printed Upper Limb Orthosis.Publication . Antão, Matilde; Rodrigues, Inês; Quintão, Carla; Quaresma, CláudiaBackground: Adherence to wrist-hand orthoses in patients with musculoskeletal conditions, such as Carpal Tunnel Syndrome, is crucial for effective rehabilitation. However, objective methods for monitoring wear time and pressure distribution remain limited. Purpose: This study presents the Ortho-Monitorizer, a portable 3D-printed sensor-integrated device designed to provide real-time, quantitative monitoring of temperature and pressure in upper limb orthoses. The objective is to evaluate the system's feasibility in detecting patient adherence and identifying critical pressure points. Study design: A descriptive and cross-sectional study was conducted to develop and validate the device, including sensor integration and data acquisition. Methods: Using a 3D scanner and Fusion 360 software, the orthoses were customized and printed in thermoplastic polyurethane. Data from healthy participants (n = 55) and patients with Carpal Tunnel Syndrome (n = 2) were collected through the Ortho-Monitorizer's application, using six sensors (three temperature and three pressure sensors) placed at clinically relevant anatomical points. Data were acquired over five hand positions, and normal reference values were established. Results: Mean temperature values ranged between 29.5∘C and 32.5∘C, while pressure values varied from 0.00 MPa to 0.08 MPa across different hand positions. One CTS patient exhibited pressure values above normal thresholds in specific positions, correlating with discomfort and numbness reports. The device achieved a System Usability Scale (SUS) score of 86.8% (healthy participants) and 92.5% (CTS patients), indicating high usability and acceptance. Conclusions: The Ortho-Monitorizer provides a non-invasive, objective method for monitoring patient adherence to orthotic treatments. By offering real-time tracking of critical parameters, it enhances clinical decision-making and patient outcomes. Future research should explore wireless integration and long-term clinical validation to further optimize its applicability.
- Reconciliação Medicamentosa num Serviço de Urgência: um Processo de Melhoria ContínuaPublication . de Almeida Marinho Diniz, Ana Cristina; Pereira Borges Sousa, Anabela; Tartaglia Reis, Cláudia; Sardinha Vieira Ramos, Susana Maria; Máximo Barreiros, Paulo Mnuel; dos Santos Sousa, Paulo JorgeObjetivos: estruturar o plano de melhoria para a reconciliação da medicação num serviço de urgência português. Método: elaborou-se o projeto de melhoria com a metodologia Plan, Do, Act, Plan (PDSA), em um estudo observacional, descritivo, quantitativo. Na etapa Plan, participaram 282 pacientes admitidos em serviço de urgência, cujo familiar teve teleconsulta de Enfermagem; e 447 na etapa Study. Realizada a estruturação da teleconsulta com a técnica Identify, Situation, Background, Assessment e Recommendation (ISBAR); formação da equipe. Resultados: na prática habitual dos enfermeiros, identificaram-se 4,6% (n=13) discrepâncias não intencionais entre a prescrição e a medicação em uso no domicílio. Observou-se o aumento para 9,4% (n=42) de discrepâncias após a estruturação da teleconsulta, que passou a incluir as questões sobre a medicação habitual. A interrupção, sobretudo de medicamentos que atuam no sistema nervoso central, dose/frequência incorreta, foi a discrepância mais frequente, posteriormente corrigida. Conclusão: o estudo contribuiu para identificar/corrigir as falhas na reconciliação de medicação, a fim de evidenciar a importância da participação da Enfermagem e da família
- Estudo da Prevalência da Hipertensão Arterial em Crianças e Adolescentes na Região de Lisboa e Vale do Tejo.Publication . Simão, Carla; Glória, Joana; Torres Oliveira, Sara; Deuchande, Sofia; Abranches, Margarida; Correia, Susana; Nunes, Paula; Teodoro, Filomena; Saraiva, Duarte; Ferreira, Carmen; Rocha, Liliana; Teixeira, Ana; Oliveira, Paula; Mendes, Patrícia; Santos, Raquel; Sociedade Portuguesa de HipertensãoIntrodução: A hipertensão arterial (HTA) é um fator de risco importante de doença cardiovascular (DCV) em qualquer idade. Estima-se uma prevalência na criança de 3-5%. O conhecimento da sua prevalência permite adequar medidas de controlo, tratamento e prevenção, procurando diminuir a morbilidade e mortalidade associadas à DCV. Objetivos: Avaliar a prevalência da HTA em crianças e adolescentes em idade escolar e o efeito de variáveis sociodemográficas e somatométricas no perfil tensional. Metodologia: Estudo multicêntrico, observacional, prospetivo e transversal que decorreu entre 2016 e 2019. Amostra com crianças entre os 6 e 18 anos, residentes na região de Lisboa e Vale do Tejo. Realizada medição da pressão arterial (PA) pelo método oscilométrico, em ambiente escolar. A classificação do perfil tensional em PA normal, PA elevada (PAE) e hipertensão arterial (HTA), baseou-se nos critérios da ESH-2016. Registados género, idade, raça, escolaridade, peso e estatura. Realizada análise estatística descritiva. Resultados: Participantes: 1245 crianças, 215 participantes entre os 6-10 anos (17%); 720 entre 11-15 anos (58%) e 310 com 16 -18 anos (25%). Caucasianos: 88%; género feminino: 635 (51%). Registaram-se 16% com excesso de peso e 7% de obesos. A prevalência de HTA é de 8,4% e de PAE 12,8%. Registaram-se entre os 6-10 anos 5,6% de casos de HTA; 11-15 anos: 8,6% e 16-18 anos: 10%. Nos rapazes 10,5% tinham HTA (vs F.6,5%-p<0,001). Na raça caucasiana 8,7% apresentavam HTA, 6% na raça negra e 5,9 % entre asiáticos. As crianças com excesso de peso ou obesidade apresentaram valores mais elevados de HTA, 17% e 26% respetivamente. Discussão/Conclusão: A prevalência de HTA é elevada (8,4%) e aumenta com a idade, género masculino e nível de escolaridade mais avançado. Excesso de peso e obesidade contribuem para o aumento dos casos de HTA.
- PRESERFLO Microshunt™ versus Non-Penetrating Deep Sclerectomy for Glaucoma Management, One-Year Results.Publication . Cunha, Bruna; Gil, Pedro; Lopes, Edgar; Elisa-Luís, Maria; Reina, Maria; Gomes, Teresa; Cardigos, JoanaPurpose: To compare the short-term efficacy and safety of the PRESERFLO™ MicroShunt (PF) versus Non-Penetrating Deep Sclerectomy (NPDS) with Esnoper®. Methods: Retrospective comparative cohort study at a tertiary hospital including 79 eyes from 79 patients submitted to surgery (32 PF implantation, Group 1 and 47 NPDS, Group 2) between January 2022 and August 2023, with one year follow-up. Outcome measures included intraocular pressure (IOP), complications, surgical duration, postoperative major and minor interventions. Surgical failure was defined as IOP>21 mmHg or <20% reduction from baseline, IOP<5 mmHg, major postoperative intervention, or loss of light perception. Conversely, success was defined as the absence of these failure criteria: complete success without glaucoma medications, and qualified success with. Results: Baseline characteristics, including age, sex, IOP, number of IOP-lowering medications, and visual field defects, were comparable between groups (p>0.05). After one year, IOP decreased significantly in both groups (PF: 20.13±6.20 to 15.00±3.15 mmHg; NPDS: 19.57±5.73 to 13.30±3.59 mmHg, both p<0.001). Complete success rates were 28.1% for PF and 40.4% for NPDS (p=0.189), while surgical failure was significantly higher in the PF group (65.6% vs 38.3%, p=0.015). Major reinterventions were more frequent with PF (10 vs 3, p=0.005), partly due to encapsulated blebs, while NPDS required more minor interventions (2 vs 17, p=0.002). Complication rates were similar (31.3% vs 14.9%, p=0.073), but surgical duration was shorter in the PF group (60.03±17.95 min vs 69.91±15.23 min, p=0.008). Conclusion: PF and NPDS share comparable safety profiles. Although PF surgery is faster, it is associated with a higher rate of major postoperative interventions and failure. NPDS, while requiring more minor interventions, such as goniopuncture and needling, rarely demands major re-interventions. NPDS is known for its meticulous and technically challenging technique, but once mastered, it can result in fewer invasive re-interventions and improved efficacy.
- Assessment of Competencies of Clinical Research Professionals and Proposals to Improve Clinical Research in Portugal.Publication . Bogas, Mónica; Antas, Joana; Magalhães, Cátia; Revige, Mafalda; Guerra, Liliana; Ribeiro, Cheila; Eça, Rita Cunha; Nunes, Filipa; Lopes, Ana; Costa, Luís; Gonçalves, Mónica; Pedrosa, Jorge; Capela, Andreia; Gregório, Tiago; Dias, Patrícia; Alfaro, Tiago; Pais, Ana; Soares, Rui; Queirós, Ana; Torres, Tiago; Assis, Joana; Maia, Joana; Ferreira, Margarida; Horta, Luís; Carreiro, Rita; Almeida, João; Meireles, Maria João; Loução, Carla; António, Sofia; Lopes, Catarina; Coelho, Pedro; Costa, Rita; Santana, Margarida; Sousa, NunoBackground: Clinical studies are coordinated by multidisciplinary teams, which often lack adequate training and competencies. In this study, ROCHE and AICIB (Agency for Clinical Research and Biomedical Innovation) conducted a self-assessment survey aiming to evaluate the competency of clinical research professionals to conduct clinical research in Portugal and promote the identification of key actions to address priority gaps. Methods: Clinical research professionals from 10 Portuguese centres answered an electronic survey, adapted and translated from the Joint Task Force for Clinical Trial Competency (JTFCTC) framework. Representatives of the centres, ROCHE and AICIB held a meeting to discuss the survey results, identify priority gaps and propose recommendations. Results: A total of 109 participants answered the questionnaire with the following national geographical distribution: North (n = 46), Centre Region (n = 16), and Lisbon metropolitan area (n = 47). A considerable proportion were Investigators (44.0%) and had more than 10 years of experience (34.9%). The eight JTFCTC Domains scored under 60% in the level of knowledge, with Investigators achieving overall higher scores. To address these gaps, key actions were proposed, such as enhancing training and educational opportunities, fostering collaboration and networking, and investing in infrastructure and resources. Conclusion: This study was the first to assess clinical trial competency in Portugal, registering a high participation rate. The study highlights the need to develop a national plan of action, in a collaborative effort, between clinical research centres, universities, industry, regulatory authorities, national agencies, and patient organizations. This will not only contribute to elevate the quality of studies but also improve compliance with international standards, ultimately benefiting both researchers and patients.
- First-Trimester Screening and Small for Gestational Age in Twin Pregnancies: a Single Center Cohort Study.Publication . Queirós, Alexandra; Bernardo, Ana; Rijo, Cláudia; Carocha, Ana; Ferreira, Leonor; Martins, Ana Teresa; Cohen, Álvaro; Alves, Marta; Papoila, Ana Luísa; Simões, TeresinhaObjective: This study aimed to investigate the association between maternal factors and first-trimester biophysical and biochemical markers with small for gestational age (SGA) neonates in twin pregnancies (TwPs). Methods: Single-center retrospective cohort study of TwPs followed from January 2010 to December 2022 at a tertiary perinatal center, Portugal. Maternal and pregnancy characteristics, mean arterial pressure, pregnancy-associated plasma protein-A (PAPP-A), β-human chorionic gonadotropin (β-HCG), and uterine artery pulsatility index (UtA-PI) were analyzed. Univariable, multivariable logistic regression (LR) and receiver-operating characteristic curve analyses were performed. The main outcome measures considered were: SGA < 3rd, < 5th and < 10th percentile, the composite outcome of SGA combined with preterm birth (PTB) (< 32, < 34, and < 36 weeks). Results: 572 TwPs were included, 450 (78.7%) DC and 122 (21.3%) MC. TwPs affected with SGA < 3rd, < 5th or < 10th percentiles were 120/572 (20.9%), 157/572 (27.4%) and 190/572 (33.2%), respectively. SGA < 3rd percentile was associated with a higher rate of PTB, 59.0% of cases < 32 weeks, OR 6.4 (95% CI: 3.2-12.7, p < 0.001). Shorter maternal height, UtA-PI ≥ 95th percentile, and low PAPP-A were identified as significant independent risk factors associated with SGA and SGA combined with PTB. The best LR model was obtained for the composite outcome SGA < 3rd percentile and PTB < 32 weeks, with an AUC of 0.834, a sensitivity rate of 77%, and a false positive rate of 17%. Conclusion: The majority of pregnancies at risk for SGA combined with prematurity can be detected in the first trimester. However, larger datasets are necessary to develop robust predictive models.
- Medication Reconciliation in Primary Care: Practices, Knowledge and Attitudes in the Lisbon and Tagus Valley Health RegionPublication . Ascenção, Raquel; Almeida, Mariana; Ribeiro, Cristina; Broeiro, Paula; Costa, João; Ordem dos MédicosDespite the importance of medication reconciliation for the continuity of care, there is currently no information on the practices, knowledge, and attitudes of Portuguese family doctors on this subject. This study aimed to characterize the formal medication reconciliation procedures in the Lisbon and Tagus Valley Health Region, as well as the perception of family doctors in this region about what they know, how they think and how they practice medication reconciliation.
- Subdural Hematoma as a Complication of Endoscopic Third Ventriculostomy in a Pediatric Patient: a Case Report and Literature Review.Publication . Fernandes, Rafael Tiza; Sobrinho, Rui; Azevedo, Miguel; Matos, Mário; Sagarribay, Amets; Forte, DalilaBackground: Subdural hematoma (SDH) typically occurs due to traumatic brain injury but can arise as a rare complication of procedures like endoscopic third ventriculostomy (ETV). Case presentation: We report an unusual case in a 9-year-old male with previous resection of a fourth-ventricle ependymoma at 2 years of age. Seven years post-surgery, he presented with worsening hydrocephalus and underwent ETV. One month later, he developed severe headaches and motor difficulties. Imaging revealed a significant right SDH, necessitating urgent drainage. Postoperative recovery was uneventful, and follow-up imaging showed resolution of the hematoma. Literature review and discussion: ETV is generally preferred for obstructive hydrocephalus due to lower complication rates compared to shunt procedures. However, cases of SDH post-ETV remain reported, albeit rarely. Potential mechanisms include altered cerebrospinal fluid dynamics and intraoperative vessel injury. This case aligns with literature findings and reinforces the importance of postoperative monitoring and prompt intervention in symptomatic cases to prevent complications. Conclusion: Clinicians should consider SDH in pediatric patients with new symptoms post-ETV. Further research should focus on understanding the risk factors and mechanisms for SDH development.
- Under-Five Mortality and Social Determinants in Africa: a Systematic ReviewPublication . Avelino, Israel C; Van-Dúnem, Joaquim; Varandas, LuísPurpose: Under-five mortality is a key public health indicator, highly responsive to preventive interventions. While global efforts have made strides in reducing mortality rates in this age group, significant disparities persist, particularly in Sub-Saharan Africa. This study aimed to systematically review the factors influencing under-five mortality in Africa, focusing on sociodemographic factors and health-related determinants. Methods: A systematic review was conducted adhering to PRISMA guidelines. Studies were identified from a range of well-established indexed academic databases. Keywords and Boolean operators facilitated relevant study retrieval. Only articles published in English, Portuguese, or Spanish between January 2013 and November 2024, in peer-reviewed journals, were included. Methodological quality assessment utilised the Joanna Briggs Institute tool. Results: Of the 602 studies identified, 39 met the inclusion criteria. Key determinants of under-five mortality included socioeconomic factors such as poverty and maternal education, along with maternal age extremes, multiparity, inadequate prenatal care, and low birth weight. Conclusion: Addressing social disparities, particularly through enhanced maternal education and improved access to primary healthcare, is critical in reducing under-five mortality in Africa. The findings underscore the importance of targeted interventions that address both social and healthcare-related factors to mitigate child mortality in the region. What is known: •Under-five mortality in Sub-Saharan Africa is primarily driven by preventable infectious diseases, such as diarrhoea, pneumonia, malaria, and HIV/AIDS, compounded by malnutrition and inadequate healthcare infrastructure. •Socio-economic factors, including poverty, maternal education, and limited access to quality healthcare, are consistently identified as key determinants of high child mortality rates in the region. What is new: •This review applies the Mosley and Chen framework to categorise the determinants of under-five mortality into distal, intermediate, and proximal factors, providing a structured understanding of their interconnections. •The findings underscore how socio-economic conditions, maternal education, and healthcare access interact to influence child survival outcomes in Sub-Saharan Africa, offering valuable insights for region-specific public health interventions.