Browsing by Issue Date, starting with "2022"
Now showing 1 - 10 of 22
Results Per Page
Sort Options
- Hemostatic spray as therapy for pancreatic stump bleeding after cephalic duodenopancreatectomyPublication . Falc�o, Daniela; Ferreira, Daniela; Maia, Luís; Sadio, Ana; Pedroto, IsabelA 70-year-old man with a cholangiocarcinoma underwent a cephalic duodenopancreatectomy. On the 2nd postoperative day, he had hematemesis without hemodynamic instability. Upper endoscopy (EGD) revealed a massive clot at the pancreatic stump, suspected as the source of hemorrhage. After partial clot removal, no active bleeding was found and no therapy was performed. Pancreaticogastric and gastrojejunal anastomoses, as well as the efferent-limb, showed no suspicious lesions. Octreotide was initiated and heparin prophylaxis was temporarily stopped. Bleeding from pancreatic stump following pancreatoduodenectomy is a rare but a life-threatening condition. Conventional endoscopic therapies, including clip placement and cautery, are mostly ineffective and with high risk of pancreatitis. We report the second case of hemostatic powder as a safe and successful therapy in this scenario.
- Geriatric otorhinolaryngology: reasons for outpatient referrals from generalists to ENT specialistsPublication . Alves, Clara Serdoura; Santos, Mariline; Castro, Afonso; Lino, João; Freitas, Susana Vaz; Almeida e Sousa, Cecília; da Silva, Álvaro MoreiraPurpose: To determine the main symptoms leading to referral of geriatric patients from primary care to otorhinolaryngology. Methods: Retrospective, observational study performed on patients aged 65 and older, referred from Primary Care to the Otorhinolaryngology and Head and Neck Surgery department of a tertiary centre during 2019 and 2020. Symptoms leading to otorhinolaryngological referral were categorized as "Oto-neurological symptoms", "Nasal symptoms", "Pharyngolaryngeal symptoms", "Other Head and Neck symptoms" and "Other Reasons". Data regarding age, gender and whether patients maintain follow-up or have been discharged was also collected. Results: The study population included a total of 1304 patients (697 female; 607 male). Oto-neurological symptoms were found to be the most prevalent symptoms, with 65% of patients reporting oto-neurological symptoms as at least one of the reasons for referral. Hearing loss was the most commonly reported symptom, with an association found between this symptom and age (p < 0.001). Results also showed an association between the female gender and vertigo/dizziness (p < 0.001) and tinnitus (p = 0.007). An association between the male gender and nasal symptoms was also found (p = 0.018), particularly nasal obstruction (p = 0.003) and epistaxis (p = 0.028). No statistically significant associations were found among the pharyngolaryngeal group. Conclusions: This retrospective observational study allowed for a better understanding of the type of otorhinolaryngological symptoms affecting elderly patients and driving otorhinolaryngology evaluation, cementing hearing loss as one of the major complaints among older adults and allowing for a better preparation by otorhinolaryngologists for the changing needs of this subset of the population.
- Efficacy and safety of vutrisiran for patients with hereditary transthyretin-mediated amyloidosis with polyneuropathy: a randomized clinical trialPublication . Adams, David; Tournev, Ivailo L.; Taylor, Mark S.; Coelho, Teresa; Planté-Bordeneuve, Violaine; Berk, John L.; González-Duarte, Alejandra; Gillmore, Julian D.; Low, Soon-Chai; Sekijima, Yoshiki; Obici, Laura; Chen, Chongshu; Badri, Prajakta; Arum, Seth M.; Vest, John; Polydefkis, MichaelBackground: The study objective was to assess the effect of vutrisiran, an RNA interference therapeutic that reduces transthyretin (TTR) production, in patients with hereditary transthyretin (ATTRv) amyloidosis with polyneuropathy. Methods: HELIOS-A was a phase 3, global, open-label study comparing the efficacy and safety of vutrisiran with an external placebo group (APOLLO study). Patients were randomized 3:1 to subcutaneous vutrisiran 25 mg every 3 months (Q3M) or intravenous patisiran 0.3 mg/kg every 3 weeks (Q3W) for 18 months. Results: HELIOS-A enrolled 164 patients (vutrisiran, n = 122; patisiran reference group, n = 42); external placebo, n = 77. Vutrisiran met the primary endpoint of change from baseline in modified Neuropathy Impairment Score +7 (mNIS+7) at 9 months (p = 3.54 × 10-12), and all secondary efficacy endpoints; significant improvements versus external placebo were observed in Norfolk Quality of Life-Diabetic Neuropathy, 10-meter walk test (both at 9 and 18 months), mNIS+7, modified body-mass index, and Rasch-built Overall Disability Scale (all at 18 months). TTR reduction with vutrisiran Q3M was non-inferior to within-study patisiran Q3W. Most adverse events were mild or moderate in severity, and consistent with ATTRv amyloidosis natural history. There were no drug-related discontinuations or deaths. Conclusions: Vutrisiran significantly improved multiple disease-relevant outcomes for ATTRv amyloidosis versus external placebo, with an acceptable safety profile.
- Anuário Científico do CHUP 2021Publication . DEFIO Anuário Científico de 2021 é um documento integrador da produção científica do Centro Hospitalar Universitário do Porto (CHUP). O Serviço de Investigação Clínica do Departamento de Ensino, Formação e Investigação (DEFI), com a edição deste anuário, pretende partilhar a atividade científica hospitalar com a comunidade e os seus profissionais
- Análise de repetição de exames em radiologia convencionalPublication . Freitas, Artur; Pereira, José ManuelIntrodução: A Radiologia Convencional é o método de primeira linha no diagnóstico de diversas patologias e avaliação da anatomia. A repetição de exames relaciona-se com o não cumprimento de critérios de boa realização que resultem em ausência/insuficiência de valor diagnóstico. A diminuição da taxa de repetição representa um fator importante na área da radiologia e da saúde comunitária, contribuindo para a diminuição da dose recebida pelos doentes e profissionais de saúde. O objetivo principal deste estudo foi determinar os exames de radiologia convencional mais suscetíveis de serem repetidos pelos técnicos de radiologia, e causas associadas. Métodos: Realizou-se um estudo analítico, observacional e transversal. Os dados foram colhidos através da aplicação online de um inquérito por questionário aos participantes no estudo. A população em estudo consistiu em técnicos de radiologia portugueses, licenciados em radiologia ou imagem médica e radioterapia, a exercer funções em Portugal ou no estrangeiro. Para o estudo de associações entre variáveis, utilizaram-se os testes estatísticos de Correlação de Pearson e Qui-quadrado da independência. Resultados: A amostra foi constituída por 228 participantes, dos quais 176 (77,2%) do sexo feminino, com média de idade de 33.93 (±10.37) anos e tempo médio de experiência profissional de10.58 (±10.34) anos. O exame ao joelho (61%) foi considerado pelos participantes como o mais provável de ser repetido, seguido do tórax (29.4%) e ombro (24.6%). Os participantes apontaram como erro técnico mais comum o posicionamento incorreto, sendo a não colaboração do doente, o principal fator preditor de erro técnico. Observou-se uma correlação negativa de fraca amplitude entre o tempo de experiência dos profissionais e a frequência com que repetem exames radiológicos. Conclusão: Os exames realizados ao joelho, ombro e tórax, são aqueles que apresentam maior taxa de repetição, sendo o erro mais comum o posicionamento incorreto do doente. O fator que mais contribui para o erro é a não colaboração do doente. Os participantes realçam a necessidade do desenvolvimento de programas de formação contínua e a introdução de pequenas pausas durante os turnos.
- Controlo radiográfico de dispositivos médicos em neonatologia: revisão narrativaPublication . Reis, Raquel; Rebelo, Sofia; Pereira, José ManuelIntrodução: A gestão clínica dos recém-nascidos nas unidades de cuidados intensivos neonatais implica a colocação de diversos dispositivos médicos invasivos que necessitam de controlo radiográfico. O principal objetivo deste trabalho consistiu em realizar uma revisão narrativa sobre as boas práticas a adotar na aquisição de imagens radiográficas, em unidades de cuidados intensivos neonatais, para o controlo de dispositivos médicos de acordo com a literatura publicada e a experiência dos autores. Material e Métodos: Realizou-se uma revisão narrativa da literatura. Recorreu-se às bases de dados científicas PubMed; Science Direct; Google Scholar e Portal RCAAP, para a recolha de documentos de análise. Foram, ainda, consultados livros das coleções particulares dos autores. Resultados: A revisão narrativa incidiu sobre 39 documentos, dos quais 26 artigos científicos, quatro guidelines/consensos/recomendações e nove livros/capítulos de livro. Desenvolvimento: A colocação de cateteres intravasculares, sondas nasogástricas e tubos endotraqueais são procedimentos interventivos habitualmente utilizados na prestação de cuidados a recém-nascidos prematuros internados nas unidades de cuidados intensivos neonatais. O posicionamento preciso destes dispositivos é essencial e a radiografia do tórax e abdómen desempenha um papel de extrema relevância no controlo e monitorização da colocação destes dispositivos. Os desafios técnicos inerentes à realização destes exames radiográficos assumem uma exigência suplementar atendendo aos ajustes ao posicionamento e parâmetros de exposição em relação à população adulta. Os parâmetros de aquisição, bem como o pós-processamento da imagem, deverão ser otimizados de forma a permitirem visualizar o trajeto dos dispositivos médicos em toda a sua extensão e demonstrarem inequivocamente a posição da sua extremidade distal. Ao mesmo tempo a imagem terá de apresentar leitura anatómica suficiente para a monitorização de eventuais lesões iatrogénicas. Conclusão: O célere reconhecimento radiográfico de dispositivos incorretamente colocados, assim como, as complicações que podem originar, é essencial para uma rápida intervenção que permita a prevenção do agravamento do estado clínico do recém-nascido.
- Dermatology clinical casePublication . Luís, Telma; Clemêncio, Tatiana; Santos, André L.; Loureiro, FernandaThe case of a teenager with guttate psoriasis secondary to trauma and upper airway infection is reported. Guttate psoriasis is the second most common psoriasis variant in pediatric age. Infection and trauma (leading to Koebner phenomenon) seem to be major triggers of the condition. The diagnosis is clinical. Most cases with no previous history of psoriasis spontaneously remit. Topical corticosteroids and vitamin D analogs, as well as phototherapy, are the first-line treatments.
- Measles, Mumps, and Rubella vaccination in children with egg allergyPublication . Cunha, Leonor; Almeida, Diana Oliveira; dos Santos, Filipa Rodrigues; Falcão, HelenaIntroduction: Egg allergy is one of the most common food allergies in childhood. Administration of the measles, mumps, and rubella (MMR) vaccine is recommended in pediatric age. Despite the presence of traces of egg protein in its composition, the literature recommends MMR vaccine administration regardless of the patient’s past egg allergy history, identifying cases in which the administration should occur in hospital setting. Purpose: To characterize the pediatric population referred to the Allergy and Clinical Immunology Department of Centro Hospitalar Universitário do Porto for MMR vaccine administration and investigate vaccination safety in children with egg allergy or sensitization. Methods: This was a retrospective observational study of clinical records of children with confirmed or suspected egg allergy referred to the Allergy and Clinical Immunology Department for administration of the MMR vaccine between January 1, 2013 and December 31, 2019. Results: Among 60 children studied, 90% presented symptoms upon egg intake, with cutaneous reactions being the most prevalent (67%) and four reported cases of anaphylaxis. Allergy to cow’s milk protein (55%), followed by allergy to other foods (45%) were the most frequent personal histories of allergic diseases. Asthma was identified in 10% of patients and was controlled in all cases. Among children referred for vaccination booster dose, one had had a reaction to the previous MMR vaccine dose. Three children developed late local skin reactions, and one had a late systemic reaction after vaccination. All children had negative oral food challenge. Conclusion: MMR vaccine administration is safe and recommended in pediatric age, regardless of egg allergy history. However, immunization should be performed in hospital setting in children with a history of anaphylaxis due to egg allergy, previous anaphylactic reaction to MMR vaccine or one of its constituents, uncontrolled asthma with documented egg allergy, and uncontrolled asthma with allergy to a previous MMR vaccine dose.
- Pulmonary clinical casePublication . Amaro, C.M.; Protasio, Pedro; Rodrigues, Carlos; Ferreira, AnaPost-extubation acute pulmonary edema (PEAPE) is an uncommon complication of tracheal extubation, occurring in 0.1% of patients undergoing general anesthesia. It has rarely been described in pediatric age, but its incidence is thought to be underestimated, as many cases of post-operative respiratory distress may be misdiagnosed or unrecognized. A formerly healthy 15-year-old male diagnosed with acute appendicitis was submitted to a laparoscopic appendectomy under general anesthesia. Immediately after extubation, he developed signs and symptoms of respiratory distress, and chest radiograph was compatible with acute pulmonary edema. Due to suspicion of PEAPE, supplementary oxygen and intravenous furosemide were administered, with favorable outcome. PEAPE is a major anesthesia-related emergency, which may worsen the prognosis of low-risk surgical procedures. A high degree of suspicion should be maintained in children and adolescents presenting with signs of respiratory distress and hypoxia after general anesthesia, as prompt diagnosis and treatment are crucial for a favorable outcome.
- Congenital disorders of glycosylationPublication . Mendes, Ana Raquel; Quelhas, D; Correia, Joana; Paiva Coelho, Margarida; Bandeira, Anabela; Martins, EsmeraldaCongenital disorders of glycosylation are a highly variable, rapidly expanding family of genetic diseases that result from defects in the synthesis of glycans. The vast majority of these monogenic diseases are inherited in an autosomal recessive way, but some types follow an autosomal dominant or X-linked inheritance. The present work aimed to review the state of the art of congenital disorders of glycosylation, including available therapeutic options, and present a simplified diagnostic approach to this group of diseases. Congenital disorders of glycosylation can be classified into four categories: N-linked glycosylation defects, O-linked glycosylation defects, combined glycosylation defects, and glycosphingolipid and glycosylphosphatidylinositol anchor synthesis defects. The phenotype may range from mild to severe, depending on disease severity. Clinical features include dysmorphic features, neurologic, dermatologic, cardiac, endocrine, immunologic, hematologic, gastrointestinal and liver involvement, and skeletal muscle abnormalities. As there is no universal or pathognomonic sign or symptom and no sensitive diagnostic test, it is of foremost importance to keep a high index of suspicion of these diseases. When a congenital disorder of glycosylation is suspected, the first step in screening is to perform serum transferrin isoelectric focusing. Molecular genetic testing is the most specific diagnostic test. Treatment is usually symptomatic, with specific treatment only available for some of these disorders. Since congenital defects of glycosylation may affect any organ at any age and have variable clinical presentation, they should be considered in the differential diagnosis of any patient with multiorgan involvement.
- «
- 1 (current)
- 2
- 3
- »