Browsing by Author "Saraiva, J."
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- Bloqueio do nervo pudendo e simulação obstétricaPublication . Guedes-Martins, L.; Guedes, L.; Saraiva, J.; Reynolds, A.A primeira descrição do bloqueio do nervo pudendo foi em 1908. Esta é uma técnica indicada para analgesia nas fases mais adiantadas do trabalho de parto. O uso de técnicas analgésicas eficazes desde os estadios mais precoces do trabalho de parto, como as técnicas do neuro-eixo, deixaram o bloqueio do pudendo para segundo plano. No entanto, é de fácil execução, habitualmente pelo obstetra, e com baixo risco de hemorragia ou infeção. O bloqueio do pudendo é um procedimento com poucas oportunidades de treino na prática clínica, pelo que o retomar da prática na sua execução através do uso de simuladores obstétricos torna-se pertinente. Ainda, a sua utilização em cenários simulados permite a familiarização de equipas multidisciplinares na sua aplicação em diversos contextos, emergentes ou não emergentes. Os principais objetivos deste trabalho são (1) efetuar uma revisão sobre o bloqueio do nervo pudendo na analgesia de parto, focando as principais vantagens e limitações, (2) repensar a sua utilização na ausência ou contraindicação de outras técnicas analgésicas, (3) reavivar a técnica de execução através da simulação aplicada à Obstetrícia.
- Caso Neurológico: Síndrome de JoubertPublication . Oliveira, D.; Andrade, I.; Fineza, I.; Saraiva, J.; Andrade, N.; Moreira, N.
- Descodificação dos comportamentos autolesivos sem intenção suicida - estudo qualitativo das funções e significados na adolescênciaPublication . Calejo-Jorge, J.; Queirós, O.; Saraiva, J.Os comportamentos autolesivos sem intenção suicida devem ser vistos como um modo de expressão de um conflito ou dificuldade vivencial do adolescente e, por isso, carecem de uma “descodificação” atenta. O presente estudo qualitativo teve como principal objetivo conhecer os significados e funções subjacentes a estes comportamentos numa amostra clínica de adolescentes. A amostra foi constituída por 25 participantes, recrutados na consulta externa do Serviço de Adolescência do Departamento de Psiquiatria da infância e da adolescência do Centro Hospitalar do Porto. A análise de conteúdo revelou a existência de funções intrapsíquicas e interpessoais, estando os comportamentos ao serviço de mais do que uma função, na maioria dos casos. Estas enquadraram-se em diferentes modelos explicativos teóricos, sendo possível identificar o predomínio de funções de alívio da tensão emocional e tentativa de fuga/retirada, ambas pertencentes ao modelo de Regulação emocional, e de funções interpessoais, enquadradas no modelo Ambiental. Embora exploratórios, estes resultados tendem a apoiar a investigação existente, apontando, contudo, para algumas especificidades. Evidenciam, ainda, a importância da avaliação atenta e compreensiva destes comportamentos de forma a aprimorar o seu tratamento.
- Fetal-maternal interface impedance parallels local NADPH oxidase related superoxide productionPublication . Guedes-Martins, L.; Silva, E.; Gaio, R.; Saraiva, J.; Soares, A.; Afonso, J.; Macedo, F.; Almeida, H.Blood flow assessment employing Doppler techniques is a useful procedure in pregnancy evaluation, as it may predict pregnancy disorders coursing with increased uterine vascular impedance, as pre-eclampsia. While the local causes are unknown, emphasis has been put on reactive oxygen species (ROS) excessive production. As NADPH oxidase (NOX) is a ROS generator, it is hypothesized that combining Doppler assessment with NOX activity might provide useful knowledge on placental bed disorders underlying mechanisms. A prospective longitudinal study was performed in 19 normal course, singleton pregnancies. Fetal aortic isthmus (AoI) and maternal uterine arteries (UtA) pulsatility index (PI) were recorded at two time points: 20-22 and 40-41 weeks, just before elective Cesarean section. In addition, placenta and placental bed biopsies were performed immediately after fetal extraction. NOX activity was evaluated using a dihydroethidium-based fluorescence method and associations to PI values were studied with Spearman correlations. A clustering of pregnancies coursing with higher and lower PI values was shown, which correlated strongly with placental bed NOX activity, but less consistently with placental tissue. The study provides evidence favoring that placental bed NOX activity parallels UtA PI enhancement and suggests that an excess in oxidation underlies the development of pregnancy disorders coursing with enhanced UtA impedance.
- Hiperfenilalaninémia materna - causa de microcefalia e atraso do desenvolvimento de uma criançaPublication . Mesquita, S.; Crisóstomo, A.; Saraiva, J.RESUMO A hiperfenilalaninémia é consequência de defeitos no sistema de hidroxilação da fenilalanina com consequente aumento sérico deste aminoácido. Os níveis de fenilalanina plasmática maternos, quando aumentados durante a gravidez, são teratogénicos associandose a um maior risco de atraso do crescimento intra-uterino, malformações congénitas, microcefalia e atraso do desenvolvimento psicomotor. Os autores descrevem o caso clínico de um rapaz de quatro anos, ex-prematuro, com microcefalia e síndrome dismórfico. É filho de mãe epiléptica com défice cognitivo ligeiro e evoluiu com atraso global do desenvolvimento e epilepsia. Do estudo efectuado destacamos níveis maternos de fenilalanina plasmática aumentados (12,9 mg/dl). Atendendo a que a introdução do diagnóstico precoce para a fenilcetonúria em Portugal só foi feita em 1979, algumas mulheres em idade fértil com hiperfenilalaninémia desconhecem a sua condição com consequente risco para os filhos. Os autores concluem que na presença de uma microcefalia de início pré-natal, aliada a um atraso do desenvolvimento, o médico deve suspeitar de uma hiperfenilalaninémia/ fenilcetonúria materna e proceder ao doseamento da fenilalaninémia materna. ABSTRACT Hyperphenylalaninemia results from defects in the hydroxylation system of the phenylalanine with consequent increase of this amino acid. The levels of maternal plasmatic phenylalanine, when increased during pregnancy, are terateratogenic and associated to a higher risk of intrauterine growth retardation, congenital malformations, microcephaly and psychomotor delay. The authors describe the clinical case of a four years old boy, former-premature, with microcephaly dismorphic syndrome, epilepsy and global development delay. His mother had epilepsy. Maternal levels of plasmatic phenylalanine were increased (12,9 mg/dl). Since the introduction of the precocious diagnosis for phenylketonuria was only available in Portugal in 1979, some women in fertile age with hyperphelylalaninemia are unaware of its condition with consequent risk for their children. The authors conclude that in the presence of a microcephaly allied to a development delay the doctor must suspect of maternal hyperphenilalaninemia/phenylketonuria and measure maternal levels of phenylalanine.
- Internal iliac and uterine arteries Doppler ultrasound in the assessment of normotensive and chronic hypertensive pregnant womenPublication . Guedes-Martins, L.; Cunha, A.; Saraiva, J.; Gaio, R.; Macedo, F.; Almeida, H.The objective of this work was to compare Doppler flows pulsatility index (PI) and resistance indexes (RI) of uterine and internal iliac arteries during pregnancy in low risk women and in those with stage-1 essential hypertension. From January 2010 and December 2012, a longitudinal and prospective study was carried out in 103 singleton uneventful pregnancies (72 low-risk pregnancies and 31 with stage 1 essential hypertension)at the 1(st), 2(nd) and 3(rd) trimesters. Multiple linear regression models, fitted using generalized least squares and whose errors were allowed to be correlated and/or have unequal variances, were employed; a model for the relative differences of both arteries impedance was utilized. In both groups, uterine artery PI and RI exhibited a gestational age related decreasing trend whereas internal iliac artery PI and RI increased. The model testing the hemodynamic adaptation in women with and without hypertension showed similar trend. Irrespective of blood pressure conditions, the internal iliac artery resistance pattern contrasts with the capacitance pattern of its immediate pelvic division, suggesting a pregnancy-related regulatory mechanism in the pelvic circulation.
- Prediction of one year mortality in extremely premature newborns using classification treesPublication . Januário, A.; Gouveia, S.; Pinto da Costa, J.; Sá, M.; Almeida, A.; Carvalho, C.; Saraiva, J.; Fonte, M.; Soares, P.
- Prenatal Diagnosis of Infantile Neuroaxonal DystrophyPublication . Pinto, F.; Pina, C.; Rodrigues, M.; Carrilho, I.; Saraiva, J.; Mendes, M.; Santos, J.; Martins, M.Infantile Neuroaxonal Dystrophy (INAD1, MIM # 256600), is a rare autossomal recessive neurodegenerative disorder. The clinical picture is characterized by psychomotor regression and hypotonia, which progresses to spastic tetraplegia, visual impairment and dementia. Onset is within the first 2 years of life and death usually happens before the age of 10. In 2006, Morgan et al described that mutations in PLA2G6 gene localized in chromosome 22 (22q13), caused INAD1. Evidence showed that a large proportion of patients with infantile neuroaxonal dystrophy have a mutation in the PLA2G6 gene. A 36-years-old pregnant woman presented for obstetric follow up. It was the second pregnancy of this healthy, nonconsanguineous couple. Their 7 year-old daughter was affected with Infantile Neuroaxonal Dystrophy. Molecular testing was done in the child and, as a causal mutation was detected, it was possible to offer a specific prenatal diagnosis. The molecular study of PLA2G6 gene by amniocentesis showed the presence of a mutation in heterozygoty and the karyotype was normal for a female foetus. To our knowledge, this is the first molecular prenatal diagnosis of INAD1 in Portugal.
- Preterm infants under 27 weeks gestational age: outcomes in a tertiary hospitalPublication . Sá, M.; Fonte, M.; Carvalho, C.; Soares, P.; Almeida, A.; Januário, A.; Gouveia, S.; Saraiva, J.Introduction: Over the last decades, survival of extremely preterm infants improved but there´s still significant morbidity among this group. We pretend to evaluate if specific attitudes/characteristics are associated with higher survival or survival without severe disabilities and elaborate predicting outcome models. Material and Methods: Observational descriptive study, including the 205 liveborn/stillborn infants -gestational age 22w0d-26w6d- born at an Obstetrics Unit or transferred to a Neonatology Unit of a Level III Hospital, from January-2000 to December-2009. We collected variables related to management in the prenatal/neonatal period, neonate performances and psychomotor development (18-24 months). Significant associations between variables/outcomes were identified by chi-square test or t-test; multivariate logistic regression models were used to describe and predict mortality/morbidity. Results: Advanced Gestational Age (GA) (p=0.001), antenatal corticotherapy(p=0.001), cesarean section(p=0.001), inborn delivery(p=0.021) and increased weight(p=0.001) were associated with survival. Absence of Intraventricular Hemorrhage (IVH) grade 3-4(p=0.001) and absence of Periventricular Leukomalacia (PVL) (p=0.005) were associated with survival without severe neurossensorial deficit. According to multivariable models, advanced GA (OR=0.353,CI95% 0.208-0.599), increased weight (OR=0.996,CI95% 0.993-0.999) and antenatal corticotherapy (OR=0.150,CI95% 0.044-0.510) were associated with lower mortality risk. Rupture of membranes less than 12 h duration was associated with higher mortality risk (OR=3.88,CI95% 1.406-10.680). IVH grades 3-4 was associated with higher morbidity risk (OR=16.931,CI95% 2.744-104.452). Mortality and severe morbidity models predicted correctly the outcome in 78.1% and 85.7% of the cases, respectively. Conclusions: Mortality/morbidity models might be valuable tools providing insight in the prediction of the outcome of these neonates and helping parental counseling.
- [Readmission to an Adolescent Psychiatry Inpatient Unit: Readmission Rates and Risk Factors]Publication . Mendes, P.; Fonseca, M.; Aguiar, I.; Pangaio, N.; Confraria, L.; Queirós, O.; Saraiva, J.; Monteiro, P.; Guerra, J.INTRODUCTION: Most mental disorders have a chronic evolution and therefore a certain amount of psychiatric readmissions are inevitable. Several studies indicate that over 25% of child and adolescent inpatients were readmitted within one year of discharge. Several risk factors for psychiatric readmissions have been reported in the literature, but the history of repeated readmissions is the most consistent risk factor. Our aim is to calculate the readmission rates at 30 days and 12 months after discharge and to identify associated risk factors. MATERIAL AND METHODS: The authors consulted the clinical files of patients admitted to the Inpatient Unit between 2010 and 2013, in order to calculate the readmission rates at 30 days and at 12 months. The demographic and clinical characteristics of the readmitted patients were analyzed and compared with a second group of patients with no hospital readmissions, in order to investigate possible predictors of readmission. RESULTS: A total of 445 patients were admitted to our inpatient unit between 2010 and 2013. Six adolescents were readmitted in a 30 days period (1.3%) and 52 were readmitted in a 12 month period after discharge (11.5%). Duration of the hospitalization and the previous number of mental health admissions were significant predictors of future hospital readmissions (p = 0.04 and p = 0.014). DISCUSSION: The low readmission rates may reflect the positive clinical and sociofamilial support being provided after discharge. CONCLUSION: Rehospitalisation is considered a fundamental target for intervention concerning prevention and intervention in mental healthcare. Thus, knowledge regarding their minimisation is crucial.