Browsing by Issue Date, starting with "2021-09"
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- Association Between Preexisting Versus Newly Identified Atrial Fibrillation and Outcomes of Patients With Acute Pulmonary EmbolismPublication . Bikdeli, Behnood; Jiménez, David; del Toro, Jorge; Piazza, Gregory; Rivas, Agustina; Fernández‐Reyes, José Luis; Sampériz, Ángel; Otero, Remedios; Suriñach, José María; Siniscalchi, Carmine; Martín‐Guerra, Javier Miguel; Castro, Joaquín; Muriel, Alfonso; Lip, Gregory Y. H.; Goldhaber, Samuel Z.; Monreal, Manuel; Monreal, Manuel; Prandoni, Paolo; Brenner, Benjamin; Farge‐Bancel, Dominique; Barba, Raquel; Di Micco, Pierpaolo; Bertoletti, Laurent; Schellong, Sebastian; Tzoran, Inna; Reis, Abilio; Bosevski, Marijan; Bounameaux, Henri; Malý, Radovan; Verhamme, Peter; Caprini, Joseph A.; Bui, Hanh My; Adarraga, María Dolores; Agud, María; Aibar, Jesús; Aibar, Miguel Ángel; Amado, Cristina; Arcelus, Juan Ignacio; Baeza, Carlos; Ballaz, Aitor; Barba, Raquel; Barbagelata, Cristina; Barrón, Manuel; Barrón‐Andrés, Belén; Blanco‐Molina, Ángeles; Botella, Ernesto; Camon, Ana María; Cañas, Inmaculada; Casado, Ignacio; Castro, Joaquín; Chasco, Leyre; Criado, Juan; de Ancos, Cristina; de Miguel, Javier; del Toro, Jorge; Demelo‐Rodríguez, Pablo; Díaz‐Peromingo, José Antonio; Di Campli, Mario Virgilio; Díez‐Sierra, Javier; Domínguez, Irene Milagros; Escribano, José Carlos; Falgá, Conxita; Farfán‐Sedano, Ana Isabel; Fernández‐Capitán, Carmen; Fernández‐Reyes, Jose Luis; Fidalgo, María Ángeles; Flores, Katia; Font, Carme; Font, Llorenç; Francisco, Iria; Gabara, Cristina; Galeano‐Valle, Francisco; Galindo, David; García, María Angelina; García‐Bragado, Ferrán; García de Herreros, Marta; García‐Hernáez, Raquel; García‐Mullor, María Mar; García‐Raso, Arantxa; Gavín‐Sebastián, Olga; Gil‐Díaz, Aida; Gómez‐Cuervo, Covadonga; Grau, Enric; Guirado, Leticia; Gutiérrez, Javier; Hernández‐Blasco, Luis; Hernando, Elena; Herreros, Miguel; Jara‐Palomares, Luis; Jaras, María Jesús; Jiménez, David; Jiménez, Rafael; Joya, Maria Dolores; León, José Manuel; Lima, Jorge; Llamas, Pilar; Lobo, José Luis; López‐Jiménez, Luciano; López‐Miguel, Patricia; López‐Núñez, Juan José; López‐Reyes, Raquel; López‐Ruiz, Antonio; López‐Sáez, Juan Bosco; Lorenzo, Alicia; Madridano, Olga; Maestre, Ana; Marchena, Pablo Javier; Martín del Pozo, Mar; Martín‐Guerra, Javier Miguel; Martín‐Martos, Francisco; Mella, Carmen; Mellado, Meritxell; Mercado, Maria Isabel; Moisés, Jorge; Monreal, Manuel; del Valle Morales, María; Muñoz‐Blanco, Arturo; Muñoz‐Rivas, Nuria; Navas, María Sierra; Nieto, Jose Antonio; Núñez‐Fernández, Manuel Jesús; Obispo, Berta; Olid, Mónica; Olivares, María Carmen; Orcastegui, José Luis; Ortega‐Michel, Clara; Osorio, Jeisson; Otalora, Sonia; Otero, Remedios; Parra, Pedro; Parra, Virginia; Pedrajas, José María; Pellejero, Galadriel; Porras, José Antonio; Portillo, José; Riera‐Mestre, Antoni; Rivas, Agustina; Rivera‐Civico, Francisco; Rodríguez‐Chiaradía, Diego Agustín; Rodríguez‐Cobo, Ana; Rodríguez‐Matute, Consolación; Rogado, Jacobo; Roig, Sonia; Rosa, Vladimir; Ruiz‐Artacho, Pedro; Ruiz‐Giménez, Nuria; Ruiz‐Ruiz, Justo; Ruiz‐Sada, Pablo; Salgueiro, Giorgina; Sánchez‐Martínez, Rosario; Sánchez‐Muñoz‐Torrero, Juan Francisco; Sancho, Teresa; Sirisi, Merçe; Soler, Silvia; Suriñach, José María; Tirado, Raimundo; Torres, María Isabel; Tolosa, Carles; Trujillo‐Santos, Javier; Uresandi, Fernando; Valero, Beatriz; Valle, Reina; Vela, Jerónimo Ramón; Vidal, Gemma; Villares, Paula; Zamora, Carles; Gutiérrez, Paula; Vázquez, Fernando Javier; Engelen, Matthias; Vanassche, Thomas; Verhamme, Peter; Hirmerova, Jana; Malý, Radovan; Salgado, Estuardo; Ait Abdallah, Nassim; Bertoletti, Laurent; Bura‐Riviere, Alessandra; Crichi, Benjamin; Debourdeau, Philippe; Olivier, Espitia; Falvo, Nicolas; Farge‐Bancel, Dominique; Galliazzo, Silvia; Helfer, Hélène; Mahé, Isabelle; Moustafa, Farès; Poenou, Geraldine; Schellong, Sebastian; Braester, Andrei; Brenner, Benjamin; Tzoran, Inna; Bilora, Franca; Bucherini, Eugenio; Ciammaichella, Maurizio; Di Micco, Pierpaolo; Imbalzano, Egidio; Maida, Rosa; Mastroiacovo, Daniela; Pace, Federica; Pesavento, Raffaele; Pomero, Fulvio; Prandoni, Paolo; Quintavalla, Roberto; Rocci, Anna; Romualdi, Roberta; Siniscalchi, Carmine; Tufano, Antonella; Visonà, Adriana; Zalunardo, Beniamino; Gibietis, Valdis; Kigitovica, Dana; Skride, Andris; Fonseca, Samuel; Martins, Filipa; Meireles, Jose; Bosevski, Marijan; Bounameaux, Henri; Mazzolai, Lucia; Bikdeli, Behnood; Caprini, Joseph A.; Tafur, Alfonso J.; Ochoa‐Chaar, Cassius Iyad; Weinberg, Ido; Wilkins, Hannah; Bui, Hanh MyBackground Atrial fibrillation (AF) may exist before or occur early in the course of pulmonary embolism (PE). We determined the PE outcomes based on the presence and timing of AF. Methods and Results Using the data from a multicenter PE registry, we identified 3 groups: (1) those with preexisting AF, (2) patients with new AF within 2 days from acute PE (incident AF), and (3) patients without AF. We assessed the 90-day and 1-year risk of mortality and stroke in patients with AF, compared with those without AF (reference group). Among 16 497 patients with PE, 792 had preexisting AF. These patients had increased odds of 90-day all-cause (odds ratio [OR], 2.81; 95% CI, 2.33-3.38) and PE-related mortality (OR, 2.38; 95% CI, 1.37-4.14) and increased 1-year hazard for ischemic stroke (hazard ratio, 5.48; 95% CI, 3.10-9.69) compared with those without AF. After multivariable adjustment, preexisting AF was associated with significantly increased odds of all-cause mortality (OR, 1.91; 95% CI, 1.57-2.32) but not PE-related mortality (OR, 1.50; 95% CI, 0.85-2.66). Among 16 497 patients with PE, 445 developed new incident AF within 2 days of acute PE. Incident AF was associated with increased odds of 90-day all-cause (OR, 2.28; 95% CI, 1.75-2.97) and PE-related (OR, 3.64; 95% CI, 2.01-6.59) mortality but not stroke. Findings were similar in multivariable analyses. Conclusions In patients with acute symptomatic PE, both preexisting AF and incident AF predict adverse clinical outcomes. The type of adverse outcomes may differ depending on the timing of AF onset.
- Children and teens moving towards mental healthPublication . Pires, Sara; Vieira, Diana; Castello-Branco, MariaChildhood and adolescence are periods of rapid growth when several structural and behavioral transformations take place. It is important to identify positive environmental exposures during these years and establish behavioral patterns that may have a positive effect on the development of these populations. There is an increasing body of evidence showing that regular exercise has unquestionable physical, social, and psychological benefits, contributing to general health and wellbeing. The aim of this study was to review the available literature regarding the impact of regular physical activity on the mental health of children and adolescents and to highlight possible mechanisms involved in this association. Study findings suggest that there is a global positive impact of physical activity on mental health, with the strongest effect related to the decrease of depressive symptoms. Other benefits include improvement in self-esteem, cognitive function, and sleep quality and a reduction of externalizing behaviors and anxiety symptoms. Competitive and esthetical sports were an exception. Overall, the current evidence allows recommending regular physical activity in children and adolescents, not only for its organic but also mental health benefits.
- Chronic tenosynovitis of the hand – An unusual presentation of tuberculosis in children tenossinovitePublication . Vieira-Martins, Miguel; Santos, Constança; Teixeira, Ana Luísa; Costa, Ricardo; Pon, Jorge; Rodrigues, CarlosTuberculosis remains the most common cause of death from infectious diseases worldwide. Extrapulmonary tuberculosis with musculoskeletal involvement occurs in about 10-15% of cases, mainly affecting joints and bones. Of these, only 1-5% are reported as synovitis of the hand. However, prompt diagnosis and treatment are often delayed and, if left untreated, bone and tendon destruction soon ensue and may lead to chronic synovitis. A 15-year-old girl presented with recurrent pain of the hand following trauma. Imaging showed tenosynovitis and tendon rupture. Surgical treatment was performed. Pathological assessment revealed necrotic caseous granulomas. Chest radiography showed no abnormal findings, but both Tuberculin Skin Test and Interferon Gamma-Release Assay were positive. Tuberculous tenosynovitis was diagnosed, and 12-month anti-tuberculous chemotherapy was instated. Five years after surgery, the patient maintained chronic pain and functional hand limitation. Tuberculous tenosynovitis of the hand is a rare and insidious condition that should be considered in the differential diagnosis of chronic hand pain. Delayed diagnosis and treatment can lead to residual functional limitation, making disease recognition critical.
- Dermatology clinical casePublication . Costa Azevedo, André; Camilo Marinhas, Andreia; Costa e Silva, André; Costa, Mariana; Martinho, IsabelHerein are reported two cases of a previously healthy fourteen-year-old girl and a nine-year-old boy who presented to the Pediatric Emergency Department with a cutaneous reaction after applying a temporary black henna tattoo. Diagnosis of delayed hypersensitivity to black henna was established. Black henna tattoos are known for their temporary and harmless nature, but henna usually contains paraphenylendamine (PPD), originating black henna. PPD induces skin sensitization and causes allergic contact dermatitis.
- Weight loss as a cause of superior mesenteric artery syndromePublication . Leitão-Martins, Vânia; Cruz, AntónioIntroduction and objective: Superior mesenteric artery syndrome (SMAS) is a rare condition in pediatric age, often presenting with non-specific gastrointestinal symptoms. The aim of this report was to highlight the importance of considering/excluding this diagnosis. Case description: A 17-year-old female presented with slowly progressing epigastralgia, heartburn, early satiety, nausea and sporadic vomiting with one and a half years of evolution. She had lost 13% of her weight in the previous six months. On physical examination, the girl complained of pain on epigastrium palpation, with no further changes. Laboratory tests were normal. Esophageal, gastric and duodenal transit (EGDT) revealed a vertically elongated stomach, with the greater curvature projecting towards the pelvic cavity and a slight delay in gastric emptying. Abdominal computed tomography scan confirmed the diagnosis of SMAS and a conservative approach with a hypercaloric fractionated diet was initiated. The girl maintained multidisciplinary follow-up (Nutrition, Pediatrics and Pedopsychiatry), with marked improvement and without requiring surgical intervention. Comments: Although rare, SMAS should be considered after exclusion of the most frequent underlying causes of persistent non-specific gastrointestinal symptoms.
- Neonatal cranial bone depressionPublication . Tenente, Joana; Cardoso, Ivana; Vinhas da Silva, António; Torres, JacintoA female preterm was admitted to the Neonatal Intensive Care Unit for late prematurity and very low weight. The physical examination was normal. On the third day of life, a hard left, non-painful parietal depression was noted, with no evidence of neurological impairment. Head computed tomography (CT) showed focal sinking of the left parietal bone posteriorly to the coronal suture. A watchful attitude was adopted and the patient was discharged on day 28. The diagnosis was a “ping-pong fracture”, which can occur iatrogenically or spontaneously in uterus. This diagnosis can be confirmed by x-ray or CT scan and the prognosis is usually good, with complete deformity regression. At two months, the parietal fracture was barely perceptible, and neurological examination was normal.
- Digital Rehabilitation for Acute Ankle Sprains: Prospective Longitudinal Cohort StudyPublication . Dias Correia, Fernando; Molinos, Maria; Neves, Carlos; Janela, Dora; Carvalho, Diana; Luis, Sara; Francisco, Gerard E; Lains, Jorge; Bento, VirgilioBackground: Ankle sprains are one of the most prevalent soft-tissue injuries worldwide. Physical therapy, especially progressive exercise, has proven effective in improving function, while preventing recurrence. Objective: We aim to present the results of a fully remote and digitally guided rehabilitation program for acute ankle sprains. Methods: We performed a prospective longitudinal cohort study of individuals eligible for workers' compensation, who were referred for digital rehabilitation therapy for a sprained ankle. Therapeutic exercise sessions were to be performed independently by the patient at home using the biofeedback device provided by SWORD Health. Primary endpoints were the change in self-reported Numerical Pain Rating Scale (NPRS) and Foot and Ankle Ability Measure-activities of daily living (FAAM-ADL) and FAAM-Sports scores. Participants were assessed at baseline, end of the program, and 6 months after program completion. Secondary outcomes included digital therapy dosage, pain and fatigue during sessions, and satisfaction. Results: In total, 93 (89.4%) patients completed the program and 79 (76.0%) were available for follow-up. Changes in the primary outcomes between baseline and the 6-month follow-up were both significant (P<.001) and clinically meaningful: mean difference of -2.72 points (95% CI -3.31 to -2.13) on the NPRS (49.8% reduction), 21.7 points (95% CI 17.13-26.27) on the FAAM-ADL (41.1% increase), and 37.8 points (95% CI 30.45-45.15) on the FAAM-Sports (151.8% increase). Longer waiting periods between the accident date and treatment initiation were found to negatively impact functional status at baseline and at the end of the program, triggering an extension in the program duration. The total training volume (12.5 hours, SD 10.5 hours) was similar to that of other interventions for ankle sprains, but the dosage per week was much higher (2.4 hours per week, SD 0.87 hours per week). The mean patient satisfaction score was 8.8 (SD 1.57) out of 10. Among program completers, 83.9% attained full recovery and were discharged with no residual disability. Conclusions: Being far less demanding in terms of human resources, the digital program presented constituted a viable, clinically effective, and convenient solution for ankle sprain rehabilitation, particularly during the pandemic. This is the first study presenting a fully remote home-based rehabilitation program for acute ankle sprains, with patients achieving sustained long-term results. This was a prospective cohort study and, as such, did not include a control group, but the results appear comparable to those published for face-to-face interventions.
- Serotonin after β-Adrenoreceptors’ Exposition: New Approaches for Personalized Data in Breast Cancer CellsPublication . Correia, Ana Salomé; Duarte, Diana; Silva, Isabel; REGUENGO, HENRIQUE; Oliveira, José Carlos; Vale, NunoSerotonin is an important monoamine in the human body, playing crucial roles, such as a neurotransmitter in the central nervous system. Previously, our group reported that β-adrenergic drugs (ICI 118,551, isoprenaline, and propranolol) influence the proliferation of breast cancer cells (MCF-7 cells) and their inherent production of adrenaline. Thus, we aimed to investigate the production of serotonin in MCF-7 cells, clarifying if there is a relationship between this production and the viability of the cells. To address this question, briefly, we treated the MCF-7 cells with ICI 118,551, isoprenaline, and propranolol, and evaluated cellular viability and serotonin production by using MTT, Sulforhodamine B (SRB) and Neutral Red (NR) assays, and HPLC-ECD analysis, respectively. Our results demonstrate that isoprenaline promotes the most pronounced endogenous synthesis of serotonin, about 3.5-fold greater than control cells. Propranolol treatment also increased the synthesis of serotonin (when compared to control). On the other hand, treatment with the drug ICI 118,551 promoted a lower endogenous synthesis of serotonin, about 1.1-fold less than what was observed in the control. Together, these results reveal that MCF-7 cells can produce serotonin, and the drugs propranolol, isoprenaline and ICI 118,551 influence this endogenous production. For the first time, after modulation of the β-adrenergic system, a pronounced cellular growth can be related to higher consumption of serotonin by the cells, resulting in decreased levels of serotonin in cell media, indicative of the importance of serotonin in the growth of MCF-7 cells.
- Watchful waiting? Portuguese approach to otitis media with effusionPublication . Vera-Cruz, Paulo; Larroudé, António; Gouveia, Nélia; Mendes, Jorge; Simões-Coelho, PedroIntroduction and objective: Otitis media with effusion (OME) is an important public health problem. Several clinical practice guidelines for diagnosis and treatment of OME are in place, including from the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS). This study aimed to evaluate the clinical practice of OME diagnosis and treatment among the Otolaryngology medical community working in Portugal. Material and methods: A questionnaire was developed based on AAO-HNS guidelines regarding placement of tympanostomy tubes in children. Each directive was transformed into a question, and further questions were added to improve the characterization of the population and its practices. Results: Answers provided agreed with “recommendations” and “recommendations against” enunciated in the guidelines. The exceptions were recommendations regarding the adoption of measures to prevent water from entering the external ear canal of children with tympanostomy tubes and the use of drugs. Questions asked outside guidelines scope revealed that 96.7% of doctors consider children’s age and 49.1% wait for the end of summer when deciding about surgery for tube placement, 68% recommend bathing in beaches, and 21.9% recommend mineral water treatment. Conclusion: These results suggest that Portuguese otolaryngologists act according to the latest international guidelines and consider factors like season, bathing in beaches, and mineral water treatment in surgical or treatment decisions.
- After pediatric stroke, it’s time to enable!Publication . Jorge, Ines Santos; Vouga, Luis Afonso; Castro, João Paulo; Amorim, Rosa; Palhau, LurdesIntroduction: Although rare, pediatric stroke is more common than one may think. Deficits may not be evident in the short term but emerge months or years later, when psychomotor development, educational, and social requirements increase. Aims: To characterize the pediatric population with stroke followed at the Physical and Rehabilitation Medicine (PRM) consultation in a tertiary center and compare it with data in the literature and review the evidence on pediatric stroke rehabilitation care. Material and Methods: This was a retrospective study focusing on the first observation of stroke patients followed at a pediatric PRM consultation over 12 months. Gender, age, type of stroke, vascular territory, risk factors, functionality, event recurrence, and mortality were assessed. A bibliographic search was conducted on PubMed and Medline using the keywords ‘stroke’, ‘pediatric’, ‘perinatal’, ‘neuroplasticity’, ‘functionality’, and ‘rehabilitation’. Inclusion criteria comprised meta-analysis, systematic review, and review type of studies, written in Portuguese and English languages, and focusing human studies. Results: The study included 42 patients, 25 of whom were male (60%). Perinatal stroke was reported in 33 patients (13 in the prenatal period and 20 up to 28 days of life). Ischemic stroke was reported in 35 cases (83%), with the middle cerebral artery being the most affected vascular territory in 29 cases (69%). Fifty percent of patients had known risk factors, specifically prematurity in 21%. Fifty to 75% of patients had high functionality levels. No stroke recurrence or deaths were reported during the study period. Rehabilitation care should be implemented as soon as possible. Evidence-based guidance is still lacking for this population. Conclusions: Stroke, although uncommon in the pediatric population, is a major cause of morbidity and mortality. Diagnosis is challenging, as symptoms are often subtle and mimic other more frequent diseases in this age group. Timely referral to the physiatrist allows integration of the child into a rehabilitation program, optimizing neuroplasticity and improving participation in several activities.