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
- 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.
- Targeted Disease-Specific Therapy for Patients with Hereditary Transthyretin Amyloidosis and Cardiac Involvement After Orthotopic Liver Transplantation. Consensus from the Working Group on Myocardial and Pericardial Diseases of the Portuguese Society of Cardiology and National Reference Centers for Familial Amyloidosis.Publication . Aguiar Rosa, Sílvia; Ferreira, Catarina; Conceição, Isabel; Coelho, Teresa; Marques, Nuno; Azevedo, Olga; Elsevier España
- Abdominal Hypoperfusion and Acute Kidney Injury in the Critically Ill Patient with Liver Cirrhosis: A Prospective Cohort Study.Publication . Pereira, Rui; Lopes, Diogo; Brandão Machado, Sara; Val-Flores, Luís; Caeiro, Fernando; Perdigoto, Rui; Marcelino, Paulo; Saliba, FaouziReduced abdominal perfusion pressure (APP) is an underdiagnosed potential pathophysiological mechanism for acute kidney injury (AKI) in the patient with liver cirrhosis and ascites. This study aimed to analyze the prevalence of abdominal hypoperfusion (AhP) (APP <60 mm Hg) and the impact of APP on AKI in critically ill patients with liver cirrhosis. This was a post hoc analysis from a prospective cohort study set in a general ICU at a tertiary university hospital. Patients were recruited between October 2016 and December 2021. Acute renal failure (ARF) was defined by stage 3 AKI according to the International Club of Ascites. Fifty-eight patients where included, with a mean age of 57 (±8.4) years, 79% were male, and 93% had acute-on-chronic liver failure at admission. The prevalence of AhP reached 75%, and 29% of cases had persisting AhP during the first week of ICU stay. Patients with baseline AhP had a higher 28-day mortality compared to those without AhP (respectively, 76% vs. 49%, = 0.03). Acute renal failure developed in 48% of patients. Higher serum urea (aOR: 1.01, 95% CI: 1.00-1.02, = 0.04) and white blood cell count (aOR: 1.1, 95% CI: 1.01-1.2, = 0.02) at ICU admission, as well as low persisting APP (aOR: 0.9, 95% CI: 0.86-0.98, = 0.02) were independent risk factors for ARF. Critically ill patients with liver cirrhosis presented a high prevalence of ARF, independently associated with higher baseline serum urea and WBC, and lower persisting APP. A structured clinical approach to optimize APP may reduce renal dysfunction in high-risk patients with cirrhosis.
- The Role of Nurses Caring for Children Diagnosed with Sickle Cell Anemia and Their Families in a Hospital Setting: A Rapid Review of the Recent Literature.Publication . Freitas, Eduarda; Loura, David; Inês, Mariana; Martins, Carla; Duarte, Inês: Sickle cell anemia (SCA) affects a significant number of children worldwide, for whom the progression of the disease can lead to functional disability-impaired development. Nurses are pivotal in providing holistic care to these children and their families. This review aims to identify recent evidence on the role of nurses in intervening with children with SCA and their families in a hospital setting. : A rapid review reported under the PRISMA methodology was carried out in the CINAHL, MEDLINE, and Scopus databases with the expression (sickle cell anemia OR sickle cell disease) AND (child* OR family OR pediatric*) AND (nurs* OR "nursing interventions" OR "pediatric nursing") AND (hospital*), considering studies between 2019 and 2024, written in English, identifying articles with insights about the role of nurses in this context. Articles other than primary or secondary studies were excluded. Data were analyzed through a rapid qualitative approach. : Fifty-two studies were identified and seventeen articles were included. The nurse's role is key and multidisciplinary, focusing on the child and family (care management and therapeutic education), the team (training, and the promotion of safety and quality of care), and the health system (optimizing access to care and promoting adequate resources for its implementation). Such a role is important for short-term clinical problems and to prevent long-term complications. : Nurses play a central role in empowering families and coordinating multidisciplinary care. Greater investment is needed at a clinical level, through a more effective response to the needs of these patients, and in research, through experimental studies and other designs focused on multidisciplinary interventions.