Browsing by Author "Fernandes, S"
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- Efeitos da estimulação diafragmática no volume corrente em doentes ventilados mecanicamentePublication . Alves Lopes, António; Clemente, J; Fernandes, S; Ferreira, M; Machado, AEnquanto área emergente da Fisioterapia, os cuidados intensivos, representam um dos novos desafios às competências e conhecimentos dos profissionais. Dentro deste âmbito propomos verificar se a utilização de Estimulação Manual Diafragmática(E.M.D.) induz a alterações no Volume Corrente(V.C.) em doentes ventilados mecanicamente. Utilizou-se um estudo quasi-experimental, com uma amostra de conveniência de 12 sujeitos internados nas Unidades de Cuidados Intensivos dos Hospitais Curry Cabral, São José, e Nossa senhora do Desterro, ventilados mecanicamente em Pressão Assistida (P.A.) com valores entre 10/20 cm H2O, não traumatizados torácicos, hemodinâmicamente estáveis, eupneicos, vigis e colaborantes. Excluímos desta amostra utentes com patologia neurológica e com lesões do nervo frénico. Estabeleceu-se um protocolo, em os utentes que constituíram a amostra foram avaliados em duas fazes distintas; na primeira fase enquanto grupo de controlo foram-lhe aplicadas técnicas de desobstrução, na fase subsequente enquanto grupo experimental foram aplicadas técnicas de desobstrução mais Estimulação Manual Diafragmática, sendo sempre realizado em 1º a situação de controlo e depois a experimental. O posicionamento dos utentes foi o mesmo tanto para o grupo de controle, como para o grupo experimental. Na primeira fase deu-se início ao protocolo com dois momentos avaliativos (O1 e O2), separados por um intervalo de 10 minutos para estabelecer valores de baseline, de seguida procedeu-se à aplicação das técnicas de desobstrução das vias respiratórias, ao que se seguiram quatro momentos avaliativos: O3 (minuto seguinte), O4 (após 10 minutos), O5 (após 30 minutos) e O6 (após 90 minutos). Na fase 2 estabeleceu-se igualmente a baseline(O`1 e O`2), realizando-se de seguida aplicação das técnicas de desobstrução das vias respiratórias mais a E.M.D (Ciesla, 1996), ao que se seguiram quatro momentos avaliativos: O`3 (minuto seguinte), O`4 (após 10 minutos), O`5 (após 30 minutos) e O`6 (após 90 minutos). Os valores médios do V.C. encontrados na situação experimental foram mais elevados que os da situação de controlo, sendo essa diferença mais marcada após a aplicação da E.M.D. Nas avaliações subsequentes não se verificam diferenças significativas relativamente aos valores iniciais. Da análise de resultados podemos inferir que a aplicação da E.M.D induz um aumento do volume corrente, durante a sua execução e no 1º momento avaliativo após a sua aplicação, esbatendo-se o seu efeito nos momentos avaliativos subsequentes. O uso desta técnica é valido para esta amostra, outros estudos com melhor controlo de variáveis parasitas poderão vir a reforçar estes resultados. Podemos identificar como limitações deste estudo; uma amostra não muito significativa e heterogénea, falta de consenso na fundamentação teórica das técnicas e inerentes á aplicação das técnicas, inexistência de fundamentação bibliográfica para elaboração do protocolo avaliação/medição.
- Epidemiological and Clinical Aspects of Cutaneous and Mucosal Leishmaniases in Portugal: Retrospective Analysis of Cases Diagnosed in Public Hospitals and Reported in the Literature between 2010 and 2020Publication . Rocha, R; Conceição, C; Gonçalves, L; Carvalho, AC; Maia, A; Martins, A; Carujo, A; Maio, A; Forra, C; Melita, C; Couto, D; Fernandes, D; Pereira, D; Leal, E; Sarmento, H; Sousa, I; Gonçalves, JP; Marinho, J; Vasconcelos, J; Cunha, J; Rodrigues, J; Silva, JM; Caley, L; Malheiro, L; Santos, L; Garcia, M; Cunha, M; Lima, M; Andrade, MM; Marques, M; Alpalhão, M; Silva, M; Ferraz, R; Soares, R; Fernandes, S; Llobet, S; Cruz, S; Guimarães, T; Branco, T; Robalo-Nunes, T; Almeida, V; Maia, CLeishmania infantum, a zoonotic vector-born parasite, is endemic in the Mediterranean region, presenting mostly as visceral (VL), but also as cutaneous (CL) and mucosal leishmaniasis (ML). This study aimed to describe the epidemiological and clinical aspects of the CL and ML cases diagnosed in mainland Portugal between 2010 and 2020. Collaboration was requested from every hospital of the Portuguese National Health System. Cases were screened through a search of diagnostic discharge codes or positive laboratory results for Leishmania infection. Simultaneously, a comprehensive literature search was performed. Descriptive statistics and hypothesis testing were performed using IBM® SPSS® Statistics. A total of 43 CL and 7 ML cases were identified, with a predominance of autochthonous cases (86%). In CL, immunosuppressed individuals constituted a significant proportion of patients (48%), and in this group, disseminated CL (22%) and simultaneous VL (54%) were common. In autochthonous cases, lesions, mostly papules/nodules (62%), were frequently observed on the head (48%). The approach to treatment was very heterogeneous. ML cases were all autochthonous, were diagnosed primarily in older immunosuppressed individuals, and were generally treated with liposomal amphotericin B. The findings suggest a need for enhanced surveillance and reporting, clinical awareness, and diagnostic capacity of these forms of leishmaniasis to mitigate underdiagnosis and improve patient outcomes. A holistic One Health approach is advocated to address the multifaceted challenges posed by leishmaniases in Portugal and beyond.
- Epidemiological and Clinical Aspects of Cutaneous and Mucosal Leishmaniases in Portugal: Retrospective Analysis of Cases Diagnosed in Public Hospitals and Reported in the Literature between 2010 and 2020Publication . Rocha, R; Conceição, C; Gonçalves, L; Carvalho, AC; Maia, A; Martins, A; Carujo, A; Maio, A; Forra, C; Melita, C; Couto, D; Fernandes, D; Pereira, D; Leal, E; Sarmento, H; Sousa, I; Gonçalves, JP; Marinho, J; Vasconcelos, J; Cunha, J; Rodrigues, J; Silva, JM; Caley, L; Malheiro, L; Santos, L; Garcia, M; Cunha, M; Lima, M; Andrade, MM; Marques, M; Alpalhão, M; Silva, M; Ferraz, R; Soares, R; Fernandes, S; Llobet, S; Cruz, S; Guimarães, T; Branco, T; Robalo-Nunes, T; Almeida, V; Maia, CLeishmania infantum, a zoonotic vector-born parasite, is endemic in the Mediterranean region, presenting mostly as visceral (VL), but also as cutaneous (CL) and mucosal leishmaniasis (ML). This study aimed to describe the epidemiological and clinical aspects of the CL and ML cases diagnosed in mainland Portugal between 2010 and 2020. Collaboration was requested from every hospital of the Portuguese National Health System. Cases were screened through a search of diagnostic discharge codes or positive laboratory results for Leishmania infection. Simultaneously, a comprehensive literature search was performed. Descriptive statistics and hypothesis testing were performed using IBM® SPSS® Statistics. A total of 43 CL and 7 ML cases were identified, with a predominance of autochthonous cases (86%). In CL, immunosuppressed individuals constituted a significant proportion of patients (48%), and in this group, disseminated CL (22%) and simultaneous VL (54%) were common. In autochthonous cases, lesions, mostly papules/nodules (62%), were frequently observed on the head (48%). The approach to treatment was very heterogeneous. ML cases were all autochthonous, were diagnosed primarily in older immunosuppressed individuals, and were generally treated with liposomal amphotericin B. The findings suggest a need for enhanced surveillance and reporting, clinical awareness, and diagnostic capacity of these forms of leishmaniasis to mitigate underdiagnosis and improve patient outcomes. A holistic One Health approach is advocated to address the multifaceted challenges posed by leishmaniases in Portugal and beyond.
- Infection on Frail Patients in the Intensive Care Unit: Insights From the PalMuSIC StudyPublication . Correia, I; Fernandes, S; Bernardino, M; Gonçalves Pereira, JBackground: Along with population aging, frailty is also increasingly common in the intensive care unit (ICU). However, the impact of frailty on the infection incidence, the risk of multidrug-resistant (MDR) microorganisms, and the potential benefits of broad-spectrum antibiotics are still poorly studied. Methods: This is a multicentric, prospective, observational study collecting data for 15 consecutive days of all consecutive adult patients admitted in each participating ICU. Exclusion criteria included admission for less than 24 hours or failure to obtain informed consent. The Clinical Frailty Score (CFS) was calculated both by the doctor and by the nurse in charge, and the patient's next of kin. Patients were considered frail if the mean of the three measured scores was ≥5. This is a post hoc analysis of the PALliative MUlticenter Study in Intensive Care (PalMuSIC) study. The Hospital de Vila Franca de Xira Ethics Committee approved the study (approval number: 63). Results: A total of 335 patients from 23 Portuguese ICUs were included. Frailty was diagnosed in 20.9%. More than 60% of the patients had a diagnosis of infection during their ICU stay, either present on admission or hospital-acquired. This included 25 (35.7%) frail and 75 (28.3%) non-frail (p=0.23) patients diagnosed with infection. In 34 patients, MDR microorganisms were isolated, which were more common in frail patients (odds ratio (OR): 2.65, 95% confidence interval (CI): 1.3-5.6, p=0.018). Carbapenems were started in 37 (18.1%) patients, but after adjusting for frailty and severity, no clear mortality benefit of this strategy was noted (odds ratio for ICU mortality: 1.61, 95% confidence interval: 0.49-5.31, p=0.43; odds ratio for hospital mortality: 1.61, 95% confidence interval: 0.61-4.21, p=0.33). Conclusion: Frail patients had similar rates of infection to non-frail patients but were more prone to have MDR microorganisms as causative pathogens. The use of empirical therapy with large-spectrum antibiotics should be based on microbiological risk factors and not simply on the host characteristics.
- Return to Play After the Diagnosis of Reactive Arthritis in a Professional Football PlayerPublication . Fernandes, A; Cunha, P; Pinto, J; Duarte, C; Estaca, A; Pereira, T; Bettencourt, M; e Silva, MR; Fernandes, SIn professional football, most of the injuries are traumatic; however, these athletes may suffer from rheumatologic diseases, that may present as sports-related injuries. Reactive arthritis (ReA) is classified as a sub-group of the spondyloarthritis family and is relatively rare. In this article, we highlight the successful return to play (RTP) process after the ReA diagnosis in an elite football player in the Portuguese first league. The athlete was able to RTP four months and one week after the diagnosis, had no ReA recurrence nor re-injury >8 months after RTP, and is playing at an elite level.