Browsing by Author "Santos, I"
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- Enhancing precision in hysteroscopic surgery: The role of intraoperative ultrasoundPublication . Ferreira de Castro, L; Santos, I; Laganà, AS; de Vree, B; van Herendael, BJ; Djokovic, DHysteroscopy stands as the gold-standard approach for managing intrauterine pathology. However, in complex clinical cases, hysteroscopic evaluation alone may prove insufficient for the safest and successful patient management. Intraoperative ultrasound (IOUS) has emerged as a valuable adjunct to hysteroscopic surgery, offering real-time visualization of endometrial cavity, uterine walls and instruments within the uterine cavity, enabling precise delineation of anatomical structures, and helping to assess the extent of pathology during intricate interventions. This review aims to comprehensively assess the applications, efficacy and utility of IOUS in hysteroscopic surgery. Available evidence indicates that in hysteroscopic myomectomy, IOUS significantly reduces the risk of uterine perforation, particularly in submucosal FIGO 2 myomas, and enhances the likelihood of a single-step procedure. During hysteroscopic metroplasty, ultrasound guidance decreases the chance of incomplete uterine septum resection. In the hysteroscopic management of severe Asherman syndrome, IOUS reduces the risk of uterine perforation or false passage. For cesarean scar pregnancy (CSP), ultrasound is crucial in defining the most appropriate surgical approach and is effective in guiding the hysteroscopic treatment of endogenic CSP. The use of IOUS in hysteroscopy proves valuable in complex cases where the risk of uterine perforation or incomplete procedure is increased.
- Eutectic mixture of local anesthetics’ dosage in newborns: a scoping review.Publication . Prior, F; Querido, D; Santos, IIntrodução: A Mistura Eutética de Anestésico Local (EMLA) está facilmente disponível, não sendo amplamente utilizado na população neonatal por falta de evidência quanto a uma dose adequada para administração. Objetivos: Identificar como o creme EMLA é utilizado para reduzir a dor, sem reação adversa, nos recém-nascidos sujeitos a procedimentos dolorosos. Métodos: Revisão scoping para mapear a literatura respeitante à população, conceito e contexto (PCC) em estudo, considerando literatura obtida de bases de dados científicas e literatura cinzenta publicada entre 2002 e 2021, com texto completo disponível e sem restrições de linguagem. Resultados: Doze documentos respeitantes a 2661 recém-nascidos – desde as 28 semanas de idade gestacional até recémnascidos de termo – considerando a eficácia e descrevendo a quantidade e tempo de contacto com a pele do EMLA creme. Oito protocolos recomendam o uso de penso oclusivo. Um documento descreveu reações de palidez e eritema na pele Conclusão: O EMLA é eficaz quando utilizado em recém-nascidos sujeitos a procedimentos dolorosos. A quantidade mais utilizada é de 0,5g em recém-nascidos pré-termo e 1g nos recém-nascidos de termo. O tempo mais frequente de contato com a pele é de 60 minutos. Sendo estas as dosagens mais frequentes, o intervalo identificado é de 0,5 a 2g na quantidade utilizada, e o tempo de contato com a pele de 3 a 180 minutos. A utilização de penso oclusivo é descrita na maioria dos protocolos.
- Home Ultrasound: A Contemporary and Valuable Tool for Palliative MedicinePublication . Monteiro, AC; França de Santana, T; Morais, M; Santos, C; Aurélio, J; Santos, I; Cruz, S; Vázquez, D; Ferreira Arroja, S; Mariz, JThis narrative review explores the application of point-of-care ultrasound (POCUS) in palliative care and its feasibility in home care settings. POCUS has the potential to streamline diagnostic strategies without patient transfer to the hospital, expedite timely symptomatic relief, and reduce complications from specific palliative interventions. The advent of handheld ultrasound devices has made it an attractive diagnostic and interventional adjunct in acute palliative care. POCUS has gained widespread acceptance as part of routine care in emergency medicine and intensive care, guiding certain procedures and increasing their safety. The modernization and miniaturization of ultrasound equipment have made ultra-portable devices available, allowing for better-quality images at affordable prices. Handheld devices have the potential to revolutionize everyday clinical practice in home-based palliative care, contributing to important bedside clinical decisions. Palliative care patients often require diagnostic examinations in the last months of their lives, with CT being the most frequently performed imaging procedure. However, CT imaging is associated with high costs and burdens, leading to increased suffering and impaired quality of life. Clinical ultrasound, a dialogic imaging modality, offers a safer and more efficient approach to palliative care. POCUS applications, which are cost-effective, non-invasive, and well-tolerated, can be used to improve patient satisfaction and diagnostic understanding. POCUS is a valuable tool in palliative care, improving diagnostic accuracy and reducing the time to diagnosis for various pathologies. It is a standard of care for many procedures and improves patient safety. However, there are limitations to POCUS in palliative care, such as operator-dependent examination variability and limited availability of trained professionals. To overcome these limitations, palliative care physicians should receive mandatory training in POCUS, which can be incorporated into the core curriculum. Additionally, ultrasound teleconsulting can assist less experienced examiners in real-time examinations. The literature on POCUS in palliative care is limited, but research on patient-oriented outcomes is crucial. POCUS should be considered a supplement to good clinical reasoning and regulated radiological evaluations.
- Immunomodulatory Effects and Protection in Sepsis by the Antibiotic MoxifloxacinPublication . Velho, TR; Raquel, H; Figueiredo, N; Neves-Costa, A; Pedroso, D; Santos, I; Willmann, K; Moita, LFSepsis is a leading cause of death in Intensive Care Units. Despite its prevalence, sepsis remains insufficiently understood, with no substantial qualitative improvements in its treatment in the past decades. Immunomodulatory agents may hold promise, given the significance of TNF-α and IL-1β as sepsis mediators. This study examines the immunomodulatory effects of moxifloxacin, a fluoroquinolone utilized in clinical practice. THP1 cells were treated in vitro with either PBS or moxifloxacin and subsequently challenged with lipopolysaccharide (LPS) or E. coli. C57BL/6 mice received intraperitoneal injections of LPS or underwent cecal ligation and puncture (CLP), followed by treatment with PBS, moxifloxacin, meropenem or epirubicin. Atm-/- mice underwent CLP and were treated with either PBS or moxifloxacin. Cytokine and organ lesion markers were quantified via ELISA, colony-forming units were assessed from mouse blood samples, and DNA damage was evaluated using a comet assay. Moxifloxacin inhibits the secretion of TNF-α and IL-1β in THP1 cells stimulated with LPS or E. coli. Intraperitoneal administration of moxifloxacin significantly increased the survival rate of mice with severe sepsis by 80% (p < 0.001), significantly reducing the plasma levels of cytokines and organ lesion markers. Notably, moxifloxacin exhibited no DNA damage in the comet assay, and Atm-/- mice were similarly protected following CLP, boasting an overall survival rate of 60% compared to their PBS-treated counterparts (p = 0.003). Moxifloxacin is an immunomodulatory agent, reducing TNF-α and IL-1β levels in immune cells stimulated with LPS and E. coli. Furthermore, moxifloxacin is also protective in an animal model of sepsis, leading to a significant reduction in cytokines and organ lesion markers. These effects appear unrelated to its antimicrobial activity or induction of DNA damage.