Browsing by Author "Rodrigues, G."
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- Deliriumin the ICU setting ‐ a subjective and theoretical survey before the implementation of the Confusion Assessment Method for the ICU in an unitPublication . Bragança, J. P.; Rodrigues, G.; Aragão, I.; Teixeira, C.; Quintaneiro, C.Background and Goal of Study: The current definition of delirium comprises acute change or fluctuation in mental status and inattention, accompanied by either altered level of consciousness or disorganized thinking. It is a frequent condition in the ICU and it is associated with longer hospital stay, increase in mortality at 6 months and long-term cognitive impairment, but remains under diagnosed. The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) has been validated and implemented in many ICUs and its use is recommended by the Society of Critical Care Medicine. It is our purpose to evaluate the individual perspective and the objective knowledge of our staf f about delirium before the implementation of the CAM-ICU. Materials and Methods: Anonymous survey to our ICU clinical staf f which contained subjective and ‘true or false’ questions. Data was analised with the sof tware SPSS version 17.0. The Wilcoxon test was used to compare autoperception of knowledge about delirium and the content of answers regarding its definiton. Results: Forty two questionnaires were returned (participation rate of 73%), 11 from physicians and 31 from nurses. Overall, 61,9% of inquiries think they can give a definition for delirium in the ICU and 50% claim to be able to evaluate delirium. 28,6% of the respondents - 63,6% of the physicians and 16,1% of the nurses - know the CAM-ICU. From these only a quarter has received education on this method, 75% think it’s easy to apply and 66% don’t see its use as an increase in the daily workload. We found a high rate of wrong and ‘I don’t know’ answers to questions about operationalization, diagnosis and outcome. The subjects’ auto-perception on their knowledge about delirium [Likert scale] was compared to their ability to answer questions related to its definiton - ‘attention deficit is essencial for diagnosis’ [true], Wilcoxon test Z=-4,699 (p< 0,001); ‘disorganized thinking is essential for diagnosis’ [false], Wilcoxon test Z=-4,437 (p< 0,001). Conclusions: The respondents’ auto perception of knowledge about delirium doesn’t translate in the ability of giving an appropriate definition and making an adequate evaluation. Most of the inquiries don’t know the CAM-ICU, but those who do believe it’s easy to apply and its use won’t increase the workload. We performed educational sessions about delirium and the CAM-ICU in our unit to encourage our clinical staf f to deal properly with this hazardous condition.
- Estenose da artéria renal em Pediatria - a propósito de um caso clínicoPublication . Duarte, S.; Marçal, M.; Antunes, M.; Teixeira, A.; Anjos, R.; Rodrigues, G.A hipertensão renovascular representa 5 a 25% dos casos de hipertensão arterial (HTA) na criança e adolescente. Por ser uma causa tratável de HTA, é importante o diagnóstico atempado e a precocidade do tratamento, reduzindo as complicações decorrentes de uma HTA mantida. Apresenta-se o caso clínico de uma jovem de 16 anos com antecedentes de enxaqueca que recorreu a uma consulta de Pediatria por agravamento das cefaleias. No exame físico observou-se um valor muito elevado de pressão arterial (170/110 mmHg, superior ao percentil 95), que se manteve nos dias seguintes, em controlo ambulatório. O eco-Doppler abdominal e renal foi considerado normal e analiticamente destacava-se hipercolesterolemia e aumento da actividade da renina plasmática (20,2 ng/mL/h para valor referência de 0,2-0,3 ng/mL/h). Realizou angio-tomografia computorizada (angio-TC) abdominal que identificou estenose grave da artéria renal direita. Foi medicada com atenolol sem controlo da HTA. A arteriografia renal confirmou uma estenose grave da artéria renal direita (estenose de 70%). Foi realizada de imediato angioplastia desta artéria, com normalização do aspecto angiográfico. A medicação foi reduzida progressivamente e três semanas depois estava assintomática, com pressão arterial normal, suspendendo a terapêutica anti-hipertensiva. A avaliação seis meses após a dilatação mostrou pressão arterial normal. Neste caso clínico destaca-se a importância da suspeição clínica da estenose da artéria renal pelo quadro clínico e idade da doente, que fundamentou a realização de angio-TC apesar do eco-Doppler renal não ser conclusivo. O tempo decorrido do diagnóstico até ao tratamento cirúrgico foi curto, e em menos de dois meses a doente ficou assintomática e com pressão arterial normal, dispensando o uso de anti-hipertensores a longo prazo. ABSTRACT Renovascular hypertension accounts for 5 to 25% of all causes of child and adolescent arterial hypertension. Being a treatable cause of hypertension, early diagnosis and prompt treatment are important to reduce long term complications related to persistent high blood pressure. The authors report a case study of a 16 year-old girl with known migraine, who was referred to a paediatric consultation for worsening headache. Physical examination was normal except for a very high blood pressure (170/110 mmHg, above the 95th percentile), which persisted in the following days at ambulatory control. Abdominal and renal echo-Doppler were described as normal and laboratory studies revealed hypercholesterolemia and high plasmatic renin activity (20,2 ng/ mL/h for a reference of 0,2-0,3 ng/mL/h). Abdominal angio-CT showed severe narrowing of the right renal artery. She was prescribed atenolol without full control of blood pressure. A right renal arteriography confi rmed a 70% stenosis and immediate angioplasty was performed. The procedure was well succeeded and a final angiogram revealed resolution of the stenosis. She was kept on atenolol with progressive lower dosage. Three weeks later she had no complaints and blood pressure was normal. Six months after the intervention she remained asymptomatic and with normal blood pressure without any anti-hypertensive drug therapy. In this case report we highlight the importance of clinical suspicion of renal artery stenosis in our patient, based on age and clinical presentation. This suspicion justified the request of abdominal angio-CT even with an inconclusive echo-Doppler. We achieved a rapid diagnosis and treatment. Two months after first consultation the patient was asymptomatic and blood pressure was normal, avoiding lifelong medication.