Browsing by Author "Freitas, Ana Cristina"
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- Fatores de risco para cicatriz renal após a primeira infeção febril do trato urinárioPublication . Freitas, Ana Cristina; Leite, Joana; Matos, Paula; Rocha, Liliana; Costa, Teresa; Faria, Maria Sameiro; Mota, ConceiçãoIntroduction: The urinary tract infection (UTI) is one of the most common paediatric infectious diseases and it increases the risk for hypertension and end-stage renal disease. Authors’ aim was to identify risk factors for permanent renal injury after a first febrile urinary tract infection. Methods: Retrospective analysis of clinical, laboratorial and imaging data of children aged 1 to 36 months hospitalized between January 2010 and December 2012 with the first febrile UTI, comparing with late renal scintigraphy results. Results: Seventy seven children were included - 53% female, median age of 5 months, Escherichia coli identified in 95%. Renal scintigraphy, performed after the acute episode, revealed renal scars in 19.5%. Cystourethrography was done in 21 patients and vesicoureteral reflux identified in 3. There was no statistically difference between children with and without renal scarring regarding gender, age, body temperature, C-reactive protein, plasmatic creatinine level, bacteriuria or urine nitrite test, urine bacteria identified, presence of vesicoureteral reflux or recurrence rate of UTI. Conclusions: The authors did not detect any clinical, laboratory or imaging data that may predict progression to renal scarring following a first episode of febrile UTI in children between 1 and 36 months.
- Minimally invasive surfactant therapy in preterm infants: towards less invasive managementPublication . Meireles, Daniel; Neiva-Araújo, Luísa; Nascimento, Marta; Pinho, Liliana; Freitas, Ana Cristina; Almeida, Alexandra; Carvalho, Carmen; Proença, ElisaIntroduction: Minimally invasive surfactant therapy (MIST) is a surfactant administration procedure that intends to reduce intubations and associated risks. The aim of this study was to compare MIST with INtubation-SURfactant-Extubation (INSURE) technique. Material and methods: Retrospective analysis (from January 2015 to June 2019) of preterm infants on nasal continuous positive airway pressure (nCPAP) treated with surfactant. Results: Fifty-four preterm infants were included and divided in two groups: MIST (n=34) and INSURE (n=20). No significant differences were found between groups regarding gestational age (p=0.480), birth weight (p=0.299), fraction of inspired oxygen (FiO2) prior to surfactant (p=0.220), oxygen therapy duration (p=0.306), progression to intubation (p=0.712), or length of Neonatal Intensive Care Unit stay (p=0.778). FiO2 variation before and after surfactant administration was higher in MIST group (14% vs 9%, p=0.078). No significant complications were reported with either technique. Conclusions: MIST is a safe technique in preterm infants on nCPAP. This study shows similar outcomes with MIST and INSURE procedures, with a greater reduction in FiO2 requirements with MIST. Overall, MIST is less invasive and as effective as INSURE in preterm infants.
- Motivos de recurso ao Serviço de Urgência PediátricaPublication . Freitas, Ana Cristina; Moreira, Ana Raquel; Tomé, Soraia; Cardoso, RaquelIntrodução: O recurso ao serviço de urgência (SU) hospitalar motivado por situações não urgentes é frequente e conduz a pior prestação de cuidados, insatisfação dos utentes e profissionais e aumento dos custos. Objectivos: Determinar os motivos para recurso a SU pediátrica hospitalar. Material e métodos: Estudo descritivo, transversal, entre 10/10 e 31/12/2013 em SU pediátrico hospitalar, através de análises de inquéritos preenchidos de forma anónima pelos acompanhantes e complementados com informação clínica pelo médico. Resultados: Foram analisados 481 questionários. O recurso ao SU ocorreu nas primeiras 24 horas de doença em 48% dos casos. Os principais motivos foram: noção de doença grave e urgente (33%), local de atendimento mais próximo (17%), preferência por avaliação por pediatra (17%). A maioria teve alta sem realização de exames complementares de diagnóstico ou tratamento (89%) e os principais diagnósticos de alta foram nasofaringite e gastroenterite agudas. Apenas 19,7% das idas ao SU poderiam ser consideradas como “justificadas” pelo cumprimento dos critérios de OMS para urgência hospitalar ou por orientação prévia por outra entidade de saúde. Não existem diferenças estatisticamente significativas entre as características das crianças que recorreram ao SU de forma “justificada” e “não justificada”. Discussão e conclusão: O reconhecimento de situações clínicas que justifiquem o recurso ao SU hospitalar não parece relacionado com habilitações literárias parentais ou atribuição de médico de família. A percepção de doença grave em situação benigna com recurso precoce e injustificado ao atendimento em contexto de serviço de urgência denota falta de educação para a saúde na população geral.
- Shared decisions in neonatal intensive care − bioethical approachPublication . Carvalho, Carmen; Freitas, Ana Cristina; Pinho, Liliana; Novo, AnaTechnological and therapeutic advances in neonatal intensive care have led to a decrease in neonatal morbidity and mortality in recent decades. Along with technical and scientific expertise, it is important to provide a holistic and comprehensive approach to the care of the newborn and family. The purpose of this review is to describe and analyze strategies to improve decision-making within a shared process between health professionals and caregivers at neonatal intensive care setting. The decision-making process is not linear or immutable over time and there is no consensus on the definition of ‘shared decision’. More unanimous is the role of communication as a atherapeutic relationship pillar. Professional ethics, bioethics, and narrative medicine should be used as tools to address the vulnerabilities of families and professionals and as a way to consolidate and structure the human relational dimension intrinsic to medical practice.